Stringer, Elizabeth Ann, Baker, Katharine Susanne, Carroll, Ian R et al. · Journal of translational medicine · 2013 · DOI
This study tracked blood samples and fatigue reports from 10 people with ME/CFS and 10 healthy people over 25 days. Researchers found that a hormone called leptin—which controls hunger and immune function—was linked to daily changes in fatigue severity in people with ME/CFS. A computer program analyzing all measured immune markers could correctly identify high fatigue days versus low fatigue days about 78% of the time, suggesting the immune system plays a real role in ME/CFS symptoms.
Most prior ME/CFS research relied on single blood draws, potentially missing the fluctuating nature of the illness. This study's finding that immune markers—particularly leptin—correlate with daily fatigue changes suggests inflammatory mechanisms may directly drive symptom variability, opening new avenues for tracking disease severity and developing treatments targeted at immune dysregulation.
This study does not prove that leptin or cytokines *cause* fatigue—only that they are associated with it; causation requires additional evidence. The small sample size (10 participants per group) means findings may not generalize to all ME/CFS patients or to males. The 78% machine learning accuracy, while promising, does not establish a clinical biomarker suitable for diagnosis without validation in independent cohorts.
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
Stringer, Elizabeth Ann, Baker, Katharine Susanne, Carroll, Ian R, Montoya, Jose G, Chu, Lily, Maecker, Holden T, et al. (2013). Daily cytokine fluctuations, driven by leptin, are associated with fatigue severity in chronic fatigue syndrome: evidence of inflammatory pathology.. Journal of translational medicine. https://doi.org/10.1186/1479-5876-11-93
BibTeX
@article{mecfsatlas-stringer-2013-daily-cytokine,
author = {Stringer, Elizabeth Ann and Baker, Katharine Susanne and Carroll, Ian R and Montoya, Jose G and Chu, Lily and Maecker, Holden T and Younger, Jarred W},
title = {Daily cytokine fluctuations, driven by leptin, are associated with fatigue severity in chronic fatigue syndrome: evidence of inflammatory pathology.},
journal = {Journal of translational medicine},
year = {2013},
doi = {10.1186/1479-5876-11-93},
note = {PubMed: 23570606},
url = {https://www.mecfsatlas.com/evidence/stringer-2013-daily-cytokine},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/stringer-2013-daily-cytokine
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