Wendt, Katharina, Schieck, Maximilian, Gille, Christian et al. · Frontiers in immunology · 2026 · DOI
This systematic review examined laboratory findings and molecular markers across 142 studies of post-acute infection syndromes, including post-COVID and ME/CFS. Researchers observed that energy metabolism, immune signalling, and gut bacteria appear to be altered in these conditions, with a central control pathway called NF-κB potentially linking many of these changes. However, the studies reviewed used very different methods and tested different molecules, so no single marker has yet been confirmed as reliable for diagnosis or treatment.
This review identifies molecular patterns potentially relevant to ME/CFS by synthesising evidence across overlapping post-acute infection syndromes. By analogy, the proposed framework connecting metabolic, immune, and microbiome alterations via NF-κB may help researchers and clinicians move from symptom-based to mechanism-informed approaches in ME/CFS. However, because the review pools findings from multiple heterogeneous studies without a dedicated ME/CFS cohort analysis, direct application to ME/CFS diagnosis or treatment requires further validation.
This systematic review does not establish causation or confirm that any single biomarker is diagnostic or predictive in ME/CFS; it summarises associations reported across disparate studies. The review does not validate NF-κB as the causal hub of PAIS—this is an interpretive synthesis, not an empirical finding. The heterogeneity of included studies means no individual biomarker or pathway has yet been prospectively validated or shown to distinguish ME/CFS from other conditions.
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
Wendt, Katharina, Schieck, Maximilian, Gille, Christian, Marschollek, Michael, Illig, Thomas, Wolff, Dominik, et al. (2026). Biomarkers of post-acute infection syndrome: a systematic literature review.. Frontiers in immunology. https://doi.org/10.3389/fimmu.2026.1741761
BibTeX
@article{mecfsatlas-wendt-2026-biomarkers-post,
author = {Wendt, Katharina and Schieck, Maximilian and Gille, Christian and Marschollek, Michael and Illig, Thomas and Wolff, Dominik and Nee, Sarah},
title = {Biomarkers of post-acute infection syndrome: a systematic literature review.},
journal = {Frontiers in immunology},
year = {2026},
doi = {10.3389/fimmu.2026.1741761},
note = {PubMed: 42454043},
url = {https://www.mecfsatlas.com/evidence/wendt-2026-biomarkers-post},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-07-16. https://www.mecfsatlas.com/evidence/wendt-2026-biomarkers-post
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