Nilsson, Isabell, Palmer, Jeremy, Apostolou, Eirini et al. · Frontiers in medicine · 2020 · DOI
Researchers tested whether ME/CFS patients have immune system antibodies that attack their mitochondria (the energy-producing parts of cells), similar to what happens in a different disease called primary biliary cholangitis. They found that ME/CFS patients almost never have these specific antibodies, while patients with the other disease have them consistently. This suggests that the energy problems seen in ME/CFS are caused by something other than the immune system attacking mitochondria.
Previous research suggested ME/CFS involves energy metabolism problems similar to those in autoimmune diseases. This study clarifies that autoimmune antibodies are not the primary mechanism, redirecting research toward other explanations for the observed metabolic dysfunction. This helps researchers focus on non-antibody biological mechanisms that may underlie ME/CFS pathophysiology.
This study does not prove that mitochondrial dysfunction doesn't occur in ME/CFS—only that antibodies are not responsible for it. It also does not identify what actually causes the metabolic problems observed in ME/CFS patients. The cross-sectional design cannot establish causation or temporal relationships, and unmeasured serum factors or non-immune mechanisms could still drive disease.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
Nilsson, Isabell, Palmer, Jeremy, Apostolou, Eirini, Gottfries, Carl-Gerhard, Rizwan, Muhammad, Dahle, Charlotte, et al. (2020). Metabolic Dysfunction in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Not Due to Anti-mitochondrial Antibodies.. Frontiers in medicine. https://doi.org/10.3389/fmed.2020.00108
BibTeX
@article{mecfsatlas-nilsson-2020-metabolic-dysfunction,
author = {Nilsson, Isabell and Palmer, Jeremy and Apostolou, Eirini and Gottfries, Carl-Gerhard and Rizwan, Muhammad and Dahle, Charlotte and Rosén, Anders},
title = {Metabolic Dysfunction in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Not Due to Anti-mitochondrial Antibodies.},
journal = {Frontiers in medicine},
year = {2020},
doi = {10.3389/fmed.2020.00108},
note = {PubMed: 32296708},
url = {https://www.mecfsatlas.com/evidence/nilsson-2020-metabolic-dysfunction},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-29. https://www.mecfsatlas.com/evidence/nilsson-2020-metabolic-dysfunction
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