ter Wolbeek, Maike, van Doornen, Lorenz J P, Kavelaars, Annemieke et al. · Brain, behavior, and immunity · 2007 · DOI
This study compared immune system markers in severely fatigued teenagers, healthy teenagers, and a small group of ME/CFS patients over one year. While fatigued teenagers reported more depression, anxiety, and sleep problems similar to ME/CFS patients, their immune systems looked normal. Only the ME/CFS patients showed a distinct immune pattern with unusually high anti-inflammatory and low pro-inflammatory markers.
This study provides evidence that symptom overlap between severe fatigue in healthy populations and ME/CFS does not reflect identical immunological mechanisms, establishing that ME/CFS involves a distinct immune dysregulation pattern. Understanding this biological distinction is crucial for developing ME/CFS-specific treatments and for differential diagnosis in adolescent populations presenting with fatigue and somatic symptoms.
This study does not establish whether the altered cytokine profile in CFS patients causes the illness, results from it, or is a marker of another underlying process. The small CFS sample (N=11) limits generalizability, and the study does not address whether severely fatigued adolescents might later develop CFS or whether the immune differences emerge at disease onset. Correlation between immune markers and symptoms is not established.
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
ter Wolbeek, Maike, van Doornen, Lorenz J P, Kavelaars, Annemieke, van de Putte, Elise M, Schedlowski, Manfred, & Heijnen, Cobi J (2007). Longitudinal analysis of pro- and anti-inflammatory cytokine production in severely fatigued adolescents.. Brain, behavior, and immunity. https://doi.org/10.1016/j.bbi.2007.04.007
BibTeX
@article{mecfsatlas-ter-wolbeek-2007-longitudinal-analysis,
author = {ter Wolbeek, Maike and van Doornen, Lorenz J P and Kavelaars, Annemieke and van de Putte, Elise M and Schedlowski, Manfred and Heijnen, Cobi J},
title = {Longitudinal analysis of pro- and anti-inflammatory cytokine production in severely fatigued adolescents.},
journal = {Brain, behavior, and immunity},
year = {2007},
doi = {10.1016/j.bbi.2007.04.007},
note = {PubMed: 17544255},
url = {https://www.mecfsatlas.com/evidence/ter-wolbeek-2007-longitudinal-analysis},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/ter-wolbeek-2007-longitudinal-analysis
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