Ruan, Brian T, Bulbule, Sarojini, Gile, Brooke et al. · Journal of translational medicine · 2025 · DOI
Researchers tested a low-dose drug called rapamycin in 86 ME/CFS patients to see if it could reduce fatigue and post-exertional malaise (PEM). About 74% of patients who completed the first month showed improvements in fatigue, PEM, and other symptoms, and the drug appeared safe with no serious side effects. The study suggests that rapamycin may work by fixing a cellular process called autophagy, which appears to be broken in ME/CFS patients.
This study provides evidence that a targetable biological mechanism—mTOR-mediated autophagy disruption—may drive ME/CFS symptoms, opening a potential therapeutic pathway. The safety profile and symptom improvements suggest rapamycin warrants further investigation in controlled trials, potentially offering the first disease-modifying treatment for ME/CFS.
This study does not prove rapamycin is effective, as it lacks a control group and placebo comparison; observed improvements could reflect natural variation, placebo effect, or regression to the mean. It does not establish that autophagy dysfunction is the primary cause of ME/CFS, only that it may be associated with symptoms in some patients. The study cannot identify which patients will respond, as no baseline predictive markers were validated.
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
Ruan, Brian T, Bulbule, Sarojini, Gile, Brooke, Reyes, Amy, Chheda, Bela, Bateman, Lucinda, et al. (2025). Low-dose rapamycin alleviates clinical symptoms of fatigue and PEM in ME/CFS patients via improvement of autophagy: a pilot study.. Journal of translational medicine. https://doi.org/10.1186/s12967-025-07213-8
BibTeX
@article{mecfsatlas-ruan-2025-low-dose-2,
author = {Ruan, Brian T and Bulbule, Sarojini and Gile, Brooke and Reyes, Amy and Chheda, Bela and Bateman, Lucinda and Bell, Jennifer and Yellman, Brayden and Grach, Stephanie L and Berner, Jon and Peterson, Daniel L and Kaufman, David and Roy, Avik and Gottschalk, C Gunnar},
title = {Low-dose rapamycin alleviates clinical symptoms of fatigue and PEM in ME/CFS patients via improvement of autophagy: a pilot study.},
journal = {Journal of translational medicine},
year = {2025},
doi = {10.1186/s12967-025-07213-8},
note = {PubMed: 41121328},
url = {https://www.mecfsatlas.com/evidence/ruan-2025-low-dose-2},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-26. https://www.mecfsatlas.com/evidence/ruan-2025-low-dose-2
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