Theorell, Jakob, Bileviciute-Ljungar, Indre, Tesi, Bianca et al. · Frontiers in immunology · 2017 · DOI
Researchers tested whether immune cells called cytotoxic lymphocytes—which normally fight infections and respond to stress—work differently in ME/CFS patients compared to healthy people. They studied 48 ME/CFS patients and found that these immune cells looked and functioned normally, suggesting they are not responsible for ME/CFS symptoms. This means cytotoxic lymphocytes alone cannot be used as a simple blood test to diagnose the condition.
This study provides important negative evidence suggesting that cytotoxic lymphocyte dysfunction is not a primary feature of ME/CFS, redirecting research toward other immune mechanisms or biomarkers. For patients, it clarifies that a major subset of immune cells likely functions normally, which may inform understanding of disease mechanisms and future therapeutic strategies.
This study does not prove that cytotoxic lymphocytes play no role in ME/CFS under all conditions—it only shows they appear structurally and functionally normal at baseline. It does not establish the primary cause(s) of ME/CFS or rule out dysfunction in other immune cell types. Negative findings in one study cannot exclude subtle or context-dependent abnormalities detectable only under specific physiological stressors.
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
Theorell, Jakob, Bileviciute-Ljungar, Indre, Tesi, Bianca, Schlums, Heinrich, Johnsgaard, Mette Sophie, Asadi-Azarbaijani, Babak, et al. (2017). Unperturbed Cytotoxic Lymphocyte Phenotype and Function in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Patients.. Frontiers in immunology. https://doi.org/10.3389/fimmu.2017.00723
BibTeX
@article{mecfsatlas-theorell-2017-unperturbed-cytotoxic,
author = {Theorell, Jakob and Bileviciute-Ljungar, Indre and Tesi, Bianca and Schlums, Heinrich and Johnsgaard, Mette Sophie and Asadi-Azarbaijani, Babak and Bolle Strand, Elin and Bryceson, Yenan T},
title = {Unperturbed Cytotoxic Lymphocyte Phenotype and Function in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Patients.},
journal = {Frontiers in immunology},
year = {2017},
doi = {10.3389/fimmu.2017.00723},
note = {PubMed: 28694809},
url = {https://www.mecfsatlas.com/evidence/theorell-2017-unperturbed-cytotoxic},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-26. https://www.mecfsatlas.com/evidence/theorell-2017-unperturbed-cytotoxic
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