Evidence browser

Recent insights into innate and adaptive immune responses to Giardia.

Singer, Steven M, Fink, Marc Y, Angelova, Vanessa V·Advances in parasitology·2019

This review examines how the body's immune system responds to infection with Giardia, a parasite that causes diarrhea and other gastrointestinal symptoms. Researchers have discovered that Giardia infection can lead to long-term complications including chronic fatigue syndrome and irritable bowel syndrome in some people. Understanding how the immune system fights Giardia may help explain why some infections lead to these persistent conditions and could guide development of better treatments or vaccines.

E3 PreliminaryMechanismPEM unclearMechanistic

Naltrexone Restores Impaired Transient Receptor Potential Melastatin 3 Ion Channel Function in Natural Killer Cells From Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Patients.

Cabanas, Helene, Muraki, Katsuhiko, Staines, Donald et al.·Frontiers in immunology·2019

This study looked at a protein channel called TRPM3 in immune cells from ME/CFS patients and found it wasn't working properly. The researchers discovered that a drug called naltrexone (an opioid blocker used off-label for ME/CFS) could restore the function of this damaged channel in laboratory tests. This finding suggests naltrexone may help ME/CFS symptoms by fixing this broken immune mechanism.

NeuroinflammationImmune System

Neuroimmunology: What Role for Autoimmunity, Neuroinflammation, and Small Fiber Neuropathy in Fibromyalgia, Chronic Fatigue Syndrome, and Adverse Events after Human Papillomavirus Vaccination?

Ryabkova, Varvara A, Churilov, Leonid P, Shoenfeld, Yehuda·International journal of molecular sciences·2019

This review explores three interconnected biological processes that may cause fibromyalgia and chronic fatigue syndrome (ME/CFS): the immune system attacking the body's own tissues, inflammation in the nervous system, and damage to small nerve fibers. The authors propose that these three mechanisms work together and may explain why patients experience widespread pain, extreme fatigue, and other symptoms like brain fog and sleep problems. They also examine whether similar mechanisms might explain some adverse reactions to HPV vaccination.

E3 PreliminaryBehavioralPEM not requiredCross-Sectional

Relationship Between Different Experimental Measures of Distorted Symptom Perception in Functional Syndrome Patients.

Van Den Houte, Maaike, Van Oudenhove, Lukas, Bogaerts, Katleen et al.·Psychosomatic medicine·2019

This study tested whether people with ME/CFS and fibromyalgia show a consistent pattern of reporting symptoms that don't match what's actually happening in their bodies. Researchers used two different experiments—one involving controlled breathing challenges and another using emotional pictures—to see if the same people would show symptom distortion in both tests. They found that symptom distortion in one test did not predict symptom distortion in the other, suggesting that how symptoms are perceived depends heavily on the specific situation rather than being a stable trait.

Advances in Understanding the Pathophysiology of Chronic Fatigue Syndrome.

Komaroff, Anthony L·JAMA·2019

This review article examines what scientists currently understand about how ME/CFS develops and affects the body at a cellular level. Researcher Anthony Komaroff synthesizes evidence suggesting that ME/CFS involves problems with energy production in cells, immune system dysfunction, and nervous system abnormalities. The article helps explain why ME/CFS causes such severe fatigue and why patients often feel worse after physical activity.

E3 PreliminaryDiagnosticPEM requiredMethods-Paper

Assessment of Post-Exertional Malaise (PEM) in Patients with Myalgic Encephalomyelitis (ME) and Chronic Fatigue Syndrome (CFS): A Patient-Driven Survey.

Holtzman, Carly S, Bhatia, Shaun, Cotler, Joseph et al.·Diagnostics (Basel, Switzerland)·2019

This study worked directly with ME/CFS patients to create a better way to measure post-exertional malaise (PEM)—the symptom where activity makes you feel significantly worse. Over 1,500 patients completed a survey to help researchers understand what aspects of PEM are most important to measure, including what triggers it, how quickly symptoms start, and how long they last. The study shows that involving patients in designing assessment tools leads to more thorough and meaningful measurements.

Post-Exertional Malaise

E3 PreliminaryReviewPEM not requiredReview-Narrative

Chronic fatigue syndrome (CFS): Suggestions for a nutritional treatment in the therapeutic approach.

Bjørklund, Geir, Dadar, Maryam, Pen, Joeri J et al.·Biomedicine & pharmacotherapy = Biomedecine & pharmacotherapie·2019

This review article examines how nutrition might play a role in chronic fatigue syndrome (CFS). The authors found that people with CFS often have low levels of certain vitamins and minerals—like vitamin C, B vitamins, magnesium, zinc, and others—and that these deficiencies may make CFS symptoms worse. The review suggests that nutritional support could be an important part of treating CFS alongside other medical approaches.

E3 PreliminaryMechanismPEM not requiredObservational

Network structure underpinning (dys)homeostasis in chronic fatigue syndrome; Preliminary findings.

Clark, James E, Ng, Wan-Fai, Rushton, Stephen et al.·PloS one·2019

This study looked at how three key body systems (nervous system, stress hormone system, and immune system) work together in ME/CFS patients compared to healthy people. Researchers measured blood pressure, heart rate, and stress hormones at rest, then used a special mathematical approach to map how these measurements connect to each other. They found that in ME/CFS patients, these connections form a different pattern than in healthy controls, with a few key measurements being especially influential.

E3 PreliminaryCohortPEM not requiredCase-Control

[Use of Modafinil in Co-existing Major Depression and ErectileDysfunction: A Case Report].

Karaş, Hakan, Kaşer, Muzaffer·Turk psikiyatri dergisi = Turkish journal of psychiatry·2019

This case report describes one patient with depression who also had erectile dysfunction and fatigue. When the antidepressant fluoxetine alone did not fully help his symptoms, doctors added a stimulant medication called modafinil. After adding modafinil, the patient reported improvements in both his fatigue and erectile dysfunction alongside his mood symptoms.

E3 PreliminaryMechanismPEM unclearMechanistic

Changes in circulating microRNA after recumbent isometric yoga practice by patients with myalgic encephalomyelitis/chronic fatigue syndrome: an explorative pilot study.

Takakura, Shu, Oka, Takakazu, Sudo, Nobuyuki·BioPsychoSocial medicine·2019

This small study tested whether a gentle form of yoga (practiced lying down with adjustable resistance) could help ME/CFS patients feel less tired. Nine patients with ME/CFS who hadn't improved with standard treatment practiced this yoga for 3 months. Their fatigue scores improved significantly, and their blood showed changes in tiny molecules called microRNAs that may be related to how the yoga helped reduce their tiredness.

Biomarkers

E3 PreliminaryMechanismPEM unclearObservational

Epstein-Barr Virus Induced Gene-2 Upregulation Identifies a Particular Subtype of Chronic Fatigue Syndrome/Myalgic Encephalomyelitis.

Kerr, Jonathan R·Frontiers in pediatrics·2019

This study found that about 38-55% of ME/CFS patients have higher levels of a specific gene called EBI2 turned on in their immune cells. Patients with this EBI2 pattern appear to have more severe symptoms and different antibody levels compared to other ME/CFS patients. Because EBI2 is known to affect both immune function and brain function, finding this subtype could help explain why ME/CFS patients experience such different symptoms and may lead to new treatments.

BiomarkersImmune System

Impact of Polypharmacy on Candidate Biomarker miRNomes for the Diagnosis of Fibromyalgia and Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Striking Back on Treatments.

Almenar-Pérez, Eloy, Sánchez-Fito, Teresa, Ovejero, Tamara et al.·Pharmaceutics·2019

This study looked at how medicines commonly taken by fibromyalgia and ME/CFS patients might interfere with blood tests that could help diagnose these conditions. The researchers found that many prescription drugs can affect small molecules in the body called microRNAs, which are being studied as potential diagnostic markers. This means that when researchers try to identify disease-specific biomarkers, they may be picking up drug effects instead of actual disease signatures.

E3 PreliminaryCohortPEM unclearCross-Sectional

Paediatric chronic fatigue syndrome patients' and parents' perceptions of recovery.

Harland, Matthew Robert, Parslow, Roxanne Morin, Anderson, Nina et al.·BMJ paediatrics open·2019

This study asked children with ME/CFS and their parents what 'recovery' would look like for them. Researchers found that recovery means different things to different people—some wanted to return to their old activity levels, others focused on having more flexibility in daily routines and not experiencing crashes after activities. Importantly, recovery was about much more than just feeling less tired; it was about rebuilding their lives and returning to normal activities like school and socializing.

Differential diagnosis between "chronic fatigue" and "chronic fatigue syndrome".

Son, Chang-Gue·Integrative medicine research·2019

This article discusses the important difference between regular chronic fatigue (long-lasting tiredness) and Chronic Fatigue Syndrome (ME/CFS), a serious medical condition. The author explains why it's crucial to distinguish between these two conditions, since ME/CFS involves specific symptoms and has different causes than simple persistent tiredness.

E3 PreliminaryCommentaryPEM unclearEditorial

Differentiating Psychosomatic, Somatopsychic, Multisystem Illnesses, and Medical Uncertainty.

Bransfield, Robert C, Friedman, Kenneth J·Healthcare (Basel, Switzerland)·2019

Doctors often struggle to distinguish between illnesses caused by psychological factors, illnesses where physical symptoms cause psychological effects, true multisystem diseases (affecting many body systems), and situations where medical causes haven't been found yet. This article discusses how using outdated or inaccurate diagnostic labels—like 'all in your head'—can harm patients and delay proper diagnosis. The authors argue that many conditions previously thought to be purely psychological may actually involve the immune system and microbiome, and that doctors need better training to avoid misdiagnosing complex diseases like ME/CFS.

E3 PreliminaryPEM not required

[Clinical efficacy of neurometabolic therapy of dissomical disorders in asthenic syndrome].

Esipov, A V, Ivolgin, A F, Khritinin, D F et al.·Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova·2019

This study tested whether a medication called cytoflavin, which helps cells produce energy, could help 100 patients with fatigue and sleep problems. Patients received cytoflavin as an infusion, either alone or combined with melatonin or another sleep medication. By day 14, 97% of patients reported significant improvement in fatigue and sleep quality.

Sleep

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Comprehensive Review.

Cortes Rivera, Mateo, Mastronardi, Claudio, Silva-Aldana, Claudia T et al.·Diagnostics (Basel, Switzerland)·2019

ME/CFS is a serious, long-lasting illness that affects the brain and causes extreme fatigue and other symptoms, but doctors don't yet know what causes it. The condition is three times more common in women than men, usually starts between ages 20 and 45, and currently has no specific cure. This review summarizes what scientists know about ME/CFS by looking at how it affects the nervous system, immune system, and hormones.