Sato, Wakiro, Ono, Hirohiko, Matsutani, Takaji et al. · Brain, behavior, and immunity · 2021 · DOI
This study looked at immune cells called B cells in people with ME/CFS and compared them to healthy people. The researchers found that ME/CFS patients have an unusual pattern of B cells—certain types are overrepresented while others are underrepresented. These abnormal B cell patterns were especially strong in patients whose ME/CFS started after an infection, suggesting the immune system may be stuck responding to something from that earlier infection.
This study provides objective, molecular evidence of immune dysfunction in ME/CFS that could support development of diagnostic biomarkers and shed light on disease mechanisms. Understanding the skewed B cell response may help explain why ME/CFS often follows infections and could inform future therapeutic approaches targeting aberrant B cell responses.
This study does not prove that the abnormal B cells cause ME/CFS symptoms—it only shows an association. It does not identify what specific infectious agent or antigen the B cells are responding to, nor does it demonstrate whether these B cell abnormalities persist, resolve, or change over the course of illness. The cross-sectional design cannot determine if the skewed repertoire is a cause, consequence, or marker of 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
Sato, Wakiro, Ono, Hirohiko, Matsutani, Takaji, Nakamura, Masakazu, Shin, Isu, Amano, Keiko, et al. (2021). Skewing of the B cell receptor repertoire in myalgic encephalomyelitis/chronic fatigue syndrome.. Brain, behavior, and immunity. https://doi.org/10.1016/j.bbi.2021.03.023
BibTeX
@article{mecfsatlas-sato-2021-skewing-cell,
author = {Sato, Wakiro and Ono, Hirohiko and Matsutani, Takaji and Nakamura, Masakazu and Shin, Isu and Amano, Keiko and Suzuki, Ryuji and Yamamura, Takashi},
title = {Skewing of the B cell receptor repertoire in myalgic encephalomyelitis/chronic fatigue syndrome.},
journal = {Brain, behavior, and immunity},
year = {2021},
doi = {10.1016/j.bbi.2021.03.023},
note = {PubMed: 33794313},
url = {https://www.mecfsatlas.com/evidence/sato-2021-skewing-cell},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/sato-2021-skewing-cell
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