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ME/CFS Atlas — A public knowledge atlas for ME/CFS

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ME/CFS Atlas is an evidence reference platform, not a medical provider. Content is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.

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ME/CFS Evidence Browser — Classified Studies on Myalgic Encephalomyelitis

Evidence browser

Search and filter 6,119 studies by evidence level, diagnostic criteria, PEM status, and research domain. Each entry links to the original source.

Studies sorted by evidence level, then year. Browse by topic instead →

Evidence level (E0–E3) reflects study type and replication, not methodological quality. A weak systematic review still sits at E0. How evidence levels work →

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1185 studies

E0 — Consensus628E1 — Replicated319E2 — Moderate2,756E3 — Preliminary2,416

ME/CFS4,009Long COVID207Post-infectious188Overlapping1,031

Required for diagnosis409Not specified / unclear2,190Not required3,520

Post-Exertional Malaise1,039Cognitive Dysfunction1,711Pain1,606Unrefreshing Sleep786Orthostatic Intolerance470

Cytokines812Gene Expression564Metabolomics469Neuroimaging464Autoantibodies454

Infection-Triggered1,157Long COVID Overlap563Pediatric494Severe227

Strong Phenotyping427Sex-Stratified325Severe ME Included115

Systematic Review256Meta-Analysis59RCT299

Peer-reviewed6,062Preprint3Unclear54

81–100 of 1,185 studies

E0 ConsensusReviewPEM not requiredReview-Narrative

Antibodies Against GPCR.

Meyer, Carlotto, Heidecke, Harald·Frontiers in bioscience (Landmark edition)·2018

This review examines how the body's own antibodies (immune proteins) can mistakenly attack receptors on cell surfaces called GPCRs, which are involved in many bodily functions. The authors summarize evidence that these misdirected antibodies may play a role in several diseases, including chronic fatigue syndrome (ME/CFS), heart disease, and autoimmune conditions. Understanding these antibodies could help doctors develop better diagnostic tests and treatments.

E0 ConsensusReviewPEM unclearReview-Narrative

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome - Evidence for an autoimmune disease.

Sotzny, Franziska, Blanco, Julià, Capelli, Enrica et al.·Autoimmunity reviews·2018

This review examines evidence that ME/CFS may be caused by the immune system attacking the body (autoimmune disease). Researchers found that people with ME/CFS have unusual immune patterns, including abnormal antibodies and changes in immune cells. Importantly, a treatment that removes certain immune cells (rituximab) helped about half of ME/CFS patients in clinical trials, suggesting an autoimmune mechanism in at least some people.

Energy MetabolismImmune System

E0 ConsensusReviewPEM unclearReview-Narrative

Metabolic abnormalities in chronic fatigue syndrome/myalgic encephalomyelitis: a mini-review.

Tomas, Cara, Newton, Julia·Biochemical Society transactions·2018

This review examines research showing that people with ME/CFS have problems with how their bodies use energy at a cellular level. Scientists have found several different metabolic abnormalities—issues with immune function, mitochondria (the cell's power plants), muscle acid buildup, and other energy-related problems—that could potentially be used as biomarkers (measurable signs) to diagnose the disease. However, no single test can yet reliably identify ME/CFS.

BiomarkersImmune System

E0 ConsensusReviewPEM unclearSystematic-Review

A systematic review of the association between fatigue and genetic polymorphisms.

Wang, Tengteng, Yin, Jie, Miller, Andrew H et al.·Brain, behavior, and immunity·2017

Researchers reviewed 50 studies to understand whether differences in our genes (called genetic polymorphisms) might make some people more likely to experience severe fatigue. They found that certain genetic variations in immune system and brain chemistry genes were linked to fatigue across different diseases, including ME/CFS. This suggests that our genes may play a role in determining how tired we become.

E0 ConsensusReviewPEM unclearReview-Narrative

Gut Microbiota, Bacterial Translocation, and Interactions with Diet: Pathophysiological Links between Major Depressive Disorder and Non-Communicable Medical Comorbidities.

Slyepchenko, Anastasiya, Maes, Michael, Jacka, Felice N et al.·Psychotherapy and psychosomatics·2017

This review examines how changes in gut bacteria and a 'leaky gut' (where bacteria can cross the intestinal barrier) may contribute to depression and related conditions like ME/CFS. The authors found evidence that diet, gut bacteria composition, and immune system activation are interconnected, and that these connections may explain why depression often occurs alongside conditions like irritable bowel syndrome, ME/CFS, obesity, and diabetes.

E0 ConsensusReviewPEM not requiredEditorial

Evidence Refuting the Existence of Autoimmune/Autoinflammatory Syndrome Induced by Adjuvants (ASIA).

Ameratunga, Rohan, Gillis, David, Gold, Michael et al.·The journal of allergy and clinical immunology. In practice·2017

This study examined whether a theory called ASIA (a proposed condition blamed on vaccine adjuvants like aluminum) is supported by scientific evidence. Researchers looked at data from people who received allergen immunotherapy, which contains much more aluminum than vaccines, and found they actually had fewer autoimmune diseases, not more. The study concludes that current evidence does not support the idea that aluminum in vaccines causes autoimmune problems.

E0 ConsensusReviewPEM unclearSystematic-Review

Serious adverse events after HPV vaccination: a critical review of randomized trials and post-marketing case series.

Martínez-Lavín, Manuel, Amezcua-Guerra, Luis·Clinical rheumatology·2017

This review examined safety reports from HPV vaccine studies and medical databases. The authors found that some large vaccine trials reported more serious side effects in vaccinated groups than in control groups, though researchers did not conclude these were caused by the vaccine. The study raises questions about how thoroughly vaccine safety is monitored and reported.

E0 ConsensusReviewPEM unclearReview-Narrative

Hypothalamic-Pituitary-Adrenal Hypofunction in Myalgic Encephalomyelitis (ME)/Chronic Fatigue Syndrome (CFS) as a Consequence of Activated Immune-Inflammatory and Oxidative and Nitrosative Pathways.

Morris, Gerwyn, Anderson, George, Maes, Michael·Molecular neurobiology·2017

This review examines why people with ME/CFS often have low cortisol levels (a stress hormone). The researchers found that the problem likely starts with an overactive immune system producing excessive inflammatory markers, which then damages the body's stress-hormone system. This is important because it suggests the low cortisol is a consequence of the disease, not its cause.

E0 ConsensusReviewPEM unclearReview-Narrative

Chronic fatigue syndrome and the immune system: Where are we now?

Mensah, Fane Kojo Fosu, Bansal, Amolak Singh, Ford, Brian et al.·Neurophysiologie clinique = Clinical neurophysiology·2017

This review examines research on how the immune system may be involved in ME/CFS. Studies have reported associations between ME/CFS and changes in certain immune cells (particularly natural killer cells) and chemical messengers called cytokines, though findings across different studies have been inconsistent. While some early reports suggest that B-cell-depleting therapies may be associated with symptom improvement in some patients, the authors note that more research in different patient groups is needed to understand how the immune system contributes to this condition.

E0 ConsensusReviewPEM unclearReview-Narrative

A Role for the Intestinal Microbiota and Virome in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)?

Navaneetharaja, Navena, Griffiths, Verity, Wileman, Tom et al.·Journal of clinical medicine·2016

This review examines whether infections—particularly viruses in the gut—might trigger ME/CFS. The authors suggest that an imbalance in the gut's microbial and viral communities could be a key factor in developing the disease. They propose that understanding these gut infections could help identify better treatments and ways to prevent ME/CFS.

E0 ConsensusReviewPEM not requiredReview-Narrative

Fecal microbiota transplantation broadening its application beyond intestinal disorders.

Xu, Meng-Que, Cao, Hai-Long, Wang, Wei-Qiang et al.·World journal of gastroenterology·2015

This review explores how fecal microbiota transplantation (FMT)—transferring healthy gut bacteria from donors to patients—might help treat conditions beyond intestinal diseases, including chronic fatigue syndrome. The authors found that FMT has shown promise in improving insulin sensitivity in metabolic disease and has produced favorable results in case reports of patients with Parkinson's disease, multiple sclerosis, and chronic fatigue syndrome, suggesting that gut bacteria imbalance may contribute to these conditions.

E0 ConsensusReviewPEM not requiredSystematic-Review

Chronic fatigue syndrome and circulating cytokines: A systematic review.

Blundell, S, Ray, K K, Buckland, M et al.·Brain, behavior, and immunity·2015

Researchers reviewed 38 studies looking at whether immune proteins called cytokines are elevated in people with ME/CFS. They found that one specific cytokine, TGF-β, was consistently higher in people with ME/CFS compared to healthy people in about 63% of studies. However, most other immune proteins measured were normal, and exercise did not change cytokine levels differently between people with ME/CFS and healthy controls.

Immune SystemPost-Exertional Malaise

E0 ConsensusReviewPEM not requiredReview-Narrative

Algo-dysfunctional syndromes: a critical digest of the recent literature.

Talotta, Rossella, Atzeni, Fabiola, Bazzichi, Laura et al.·Clinical and experimental rheumatology·2015

This review summarizes recent research on three related conditions—chronic fatigue syndrome (ME/CFS), fibromyalgia, and irritable bowel syndrome—that share overlapping symptoms and may involve similar underlying mechanisms. Researchers observed associations between these syndromes and multiple factors including genetic predisposition, infections, inflammation, stress hormone abnormalities, and nerve damage, suggesting that treatment may need to address multiple systems. The authors propose that managing these conditions effectively likely requires a combination of medications and non-medication approaches, though the review does not establish which specific treatments work best.

E0 ConsensusReviewPEM not requiredReview-Narrative

The inflammatory hypothesis of mood spectrum broadened to fibromyalgia and chronic fatigue syndrome.

Dell'Osso, Liliana, Bazzichi, Laura, Baroni, Stefano et al.·Clinical and experimental rheumatology·2015

This review examined whether ME/CFS, fibromyalgia, and mood disorders like depression might share similar root causes involving inflammation and immune system dysfunction. Researchers looked at scientific papers from 2000-2014 and found striking similarities in how these conditions affect the brain, nervous system, and immune system. The findings suggest these seemingly different conditions may be connected through common biological mechanisms rather than being completely separate diseases.

Immune SystemNeuroinflammation

E0 ConsensusReviewPEM unclearSystematic-Review

Altered immune response to exercise in patients with chronic fatigue syndrome/myalgic encephalomyelitis: a systematic literature review.

Nijs, Jo, Nees, Andrea, Paul, Lorna et al.·Exercise immunology review·2014

When people with ME/CFS exercise, their immune system reacts differently than healthy people's immune systems do. This review looked at 23 studies comparing immune responses to exercise in ME/CFS patients versus healthy people. The key finding is that ME/CFS patients show stronger reactions in certain immune markers and more oxidative stress (damage from chemical imbalances), which may be connected to post-exertional malaise—the worsening of symptoms that happens after activity.

Immune SystemPost-Exertional Malaise

E0 ConsensusReviewPEM unclearReview-Narrative

Biological phenotypes underpin the physio-somatic symptoms of somatization, depression, and chronic fatigue syndrome.

Anderson, G, Berk, M, Maes, M·Acta psychiatrica Scandinavica·2014

This review examined research showing that the physical symptoms experienced in ME/CFS, depression, and somatization (medically unexplained symptoms) have real biological causes, not just psychological ones. The authors found that inflammation, immune system activation, and changes in how the body breaks down certain nutrients are linked to symptoms like fatigue, pain, and autonomic problems. Understanding these biological pathways may help explain why these conditions overlap and why symptoms feel so physically real.

E0 ConsensusReviewPEM not requiredReview-Narrative

A narrative review on the similarities and dissimilarities between myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and sickness behavior.

Morris, Gerwyn, Anderson, George, Galecki, Piotr et al.·BMC medicine·2013

This narrative review compared ME/CFS to 'sickness behavior'—the temporary fatigue and malaise that normally follows infection or injury. While the two conditions share some symptoms like fatigue and body pain, the authors observed key differences: sickness behavior is short-term and helps the body recover, whereas ME/CFS is a prolonged, disabling illness. The review concludes these are distinct conditions, though definitive evidence about ME/CFS triggers remains incomplete.

E0 ConsensusReviewPEM not requiredReview-Narrative

The neuropsychiatric and neuropsychological features of chronic fatigue syndrome: revisiting the enigma.

Christley, Yvonne, Duffy, Tim, Everall, Ian Paul et al.·Current psychiatry reports·2013

This review examined how mental health symptoms like depression and cognitive problems (such as memory and concentration difficulties) commonly occur in ME/CFS patients. Researchers found that depression and ME/CFS often happen together but may involve different biological mechanisms in the body, particularly involving inflammation, immune system dysfunction, and stress hormone imbalances. Understanding these connections helps explain why ME/CFS patients struggle with both physical fatigue and mental health challenges.

E0 ConsensusReviewPEM not requiredReview-Narrative

Chronic fatigue syndrome following infections in adolescents.

Katz, Ben Z, Jason, Leonard A·Current opinion in pediatrics·2013

This review examined teenagers who developed chronic fatigue syndrome (ME/CFS) after infections like mononucleosis. About 13% of teens had ME/CFS six months after infection, dropping to 7% at one year and 4% at two years. The good news is that teenagers generally recover better from post-infectious ME/CFS than adults do.

E0 ConsensusReviewPEM not requiredReview-Narrative

Fecal microbiota transplantation: past, present and future.

Aroniadis, Olga C, Brandt, Lawrence J·Current opinion in gastroenterology·2013

This review examines fecal microbiota transplantation (FMT), a treatment that restores healthy gut bacteria by transferring stool from a healthy donor to a patient. While FMT works very well for a specific bacterial infection, researchers are exploring whether it might help with other conditions including gut disorders and diseases affecting other parts of the body, such as chronic fatigue syndrome. The authors emphasize that more research is needed before FMT can be widely used for conditions beyond its proven application.

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PEM Immune Neuro Metabolic Biomarkers Severe ME Long COVID Cognitive

Curated Collections

Thematic groupings by clinical question or research area.

Neuroinflammation Evidence

PET imaging and other studies providing evidence for brain inflammation in ME/CFS.

Metabolism & Mitochondria

Metabolomics and mitochondrial function studies revealing energy metabolism disruption.

Biomarkers

Studies identifying potential biological markers for ME/CFS diagnosis and stratification.

PEM-Specific Research

Studies specifically examining post-exertional malaise, the hallmark symptom of ME/CFS.