Pietrangelo, T, Toniolo, L, Paoli, A et al. · International journal of immunopathology and pharmacology · 2009 · DOI
This study looked at muscle tissue from ME/CFS patients and compared it to healthy controls. Researchers found that ME/CFS patients had a shift in their muscle fiber types—more of the fast-twitch fibers (which tire easily) and fewer slow-twitch fibers (which are better for endurance). However, the individual muscle fibers themselves worked normally; the problem was the wrong mix of fiber types, which could explain why ME/CFS patients get tired so quickly.
This study provides direct molecular and contractile evidence that muscle tissue pathology is a primary feature of ME/CFS rather than a secondary psychological effect. Understanding that patients have an energetically inefficient muscle fiber composition could explain characteristic symptoms like disproportionate fatigue and may guide future therapeutic strategies targeting muscle metabolism.
This study does not establish the cause of the fiber-type shift—whether it results from neurological signaling changes, metabolic dysfunction, viral persistence, or deconditioning. It also cannot determine whether the altered fiber composition causes other ME/CFS symptoms (immune dysfunction, post-exertional malaise) or whether these represent independent disease mechanisms. The cross-sectional design prevents assessment of whether fiber-type changes precede symptom onset.
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
Pietrangelo, T, Toniolo, L, Paoli, A, Fulle, S, Puglielli, C, Fanò, G, et al. (2009). Functional characterization of muscle fibres from patients with chronic fatigue syndrome: case-control study.. International journal of immunopathology and pharmacology. https://doi.org/10.1177/039463200902200219
BibTeX
@article{mecfsatlas-pietrangelo-2009-functional-characterization,
author = {Pietrangelo, T and Toniolo, L and Paoli, A and Fulle, S and Puglielli, C and Fanò, G and Reggiani, C},
title = {Functional characterization of muscle fibres from patients with chronic fatigue syndrome: case-control study.},
journal = {International journal of immunopathology and pharmacology},
year = {2009},
doi = {10.1177/039463200902200219},
note = {PubMed: 19505395},
url = {https://www.mecfsatlas.com/evidence/pietrangelo-2009-functional-characterization},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/pietrangelo-2009-functional-characterization
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