Paul, Bindu D, Lemle, Marian D, Komaroff, Anthony L et al. · Proceedings of the National Academy of Sciences of the United States of America · 2021 · DOI
This review examines how COVID-19 and ME/CFS may share similar biological problems, particularly an imbalance in how the body handles harmful molecules called free radicals. Both conditions appear to involve problems with inflammation, energy production in cells, and a slowed metabolism. While this research shows these biological abnormalities exist in both illnesses, more studies are needed to understand exactly how they work together and how to treat them.
This review provides scientific validation that ME/CFS and long COVID-19 involve measurable biological abnormalities rather than being purely psychological conditions. Understanding these shared mechanisms could accelerate development of treatments applicable to both illnesses and help clinicians recognize long COVID-19 as potentially part of the ME/CFS disease spectrum.
This review does not prove that redox imbalance directly causes ME/CFS or long COVID-19—it documents associations that may be correlational. It also does not establish that all ME/CFS cases involve identical biological mechanisms, nor does it provide evidence that current treatments targeting these pathways will be effective in patients.
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
Paul, Bindu D, Lemle, Marian D, Komaroff, Anthony L, & Snyder, Solomon H (2021). Redox imbalance links COVID-19 and myalgic encephalomyelitis/chronic fatigue syndrome.. Proceedings of the National Academy of Sciences of the United States of America. https://doi.org/10.1073/pnas.2024358118
BibTeX
@article{mecfsatlas-paul-2021-redox-imbalance,
author = {Paul, Bindu D and Lemle, Marian D and Komaroff, Anthony L and Snyder, Solomon H},
title = {Redox imbalance links COVID-19 and myalgic encephalomyelitis/chronic fatigue syndrome.},
journal = {Proceedings of the National Academy of Sciences of the United States of America},
year = {2021},
doi = {10.1073/pnas.2024358118},
note = {PubMed: 34400495},
url = {https://www.mecfsatlas.com/evidence/paul-2021-redox-imbalance},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-27. https://www.mecfsatlas.com/evidence/paul-2021-redox-imbalance
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