Understanding, diagnosing, and treating Myalgic encephalomyelitis/chronic fatigue syndrome - State of the art: Report of the 2nd international meeting at the Charité Fatigue Center.

Observed Findings

• Increased ME/CFS prevalence is occurring following the COVID-19 pandemic and Long COVID emergence, expanding the affected population.
• Immune system dysfunction, endothelial dysfunction, and autonomic nervous system dysfunction were identified as key pathomechanisms across multiple research groups.
• Viral reactivation was discussed as a potential contributing factor in disease etiology and pathophysiology.
• Current diagnostic approaches lack standardization and validated biomarkers, complicating disease recognition and research.
• Over 700 researchers and clinicians worldwide are actively engaged in ME/CFS research, indicating growing scientific momentum.

Inferred Conclusions

• ME/CFS involves dysregulation of multiple interconnected systems (immune, vascular, neurological) rather than a single pathogenic mechanism.
• Despite increased public attention and funding opportunities, ME/CFS remains significantly under-resourced relative to disease burden and complexity.
• Systematic identification of diagnostic biomarkers and mechanistic understanding of patient heterogeneity are essential prerequisites for developing targeted therapies.
• Collaborative, multidisciplinary international research efforts are necessary to advance the field toward precision medicine approaches.

Remaining Questions