Sung, Alexander P, Tang, Jennifer J-J, Guglielmo, Michael J et al. · Fatigue : biomedicine, health & behavior · 2020 · DOI
This study looked at immune cells called NK cells in families where multiple members have ME/CFS. The researchers found that ME/CFS patients and their healthy family members both had fewer of a specific type of NK cell and weaker immune responses compared to unrelated healthy people. This suggests that a genetic weakness in immune cell function might run in families and could increase the risk of developing ME/CFS.
Understanding genetic immune factors in familial ME/CFS could help identify people at risk before illness develops and guide development of targeted treatments. This study suggests that inherited immune weaknesses—particularly in the NK cell system—may be fundamental to ME/CFS pathogenesis, opening new avenues for research and potential early intervention strategies.
This study does not prove that low ADCC causes ME/CFS, only that it is associated with familial cases. It cannot explain why some family members with the same immune weakness develop ME/CFS while others remain well, nor does it address other potential triggers (viral infections, environmental factors) that may be necessary. The small sample size (five families) limits generalizability to the broader ME/CFS population.
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
Sung, Alexander P, Tang, Jennifer J-J, Guglielmo, Michael J, Smith-Gagen, Julie, Bateman, Lucinda, Navarrete-Galvan, Lydia, et al. (2020). Antibody-Dependent Cell-mediated Cytotoxicity (ADCC) in Familial Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS).. Fatigue : biomedicine, health & behavior. https://doi.org/10.1080/21641846.2021.1876613
BibTeX
@article{mecfsatlas-sung-2020-antibody-dependent,
author = {Sung, Alexander P and Tang, Jennifer J-J and Guglielmo, Michael J and Smith-Gagen, Julie and Bateman, Lucinda and Navarrete-Galvan, Lydia and Redelman, Doug D and Hudig, Dorothy},
title = {Antibody-Dependent Cell-mediated Cytotoxicity (ADCC) in Familial Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS).},
journal = {Fatigue : biomedicine, health & behavior},
year = {2020},
doi = {10.1080/21641846.2021.1876613},
note = {PubMed: 33777500},
url = {https://www.mecfsatlas.com/evidence/sung-2020-antibody-dependent},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/sung-2020-antibody-dependent
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