Myalgic encephalomyelitis/chronic fatigue syndrome—metabolic disease or disturbed homeostasis due to focal inflammation in the hypothalamus?
Abstract
Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a complex disease characterized by debilitating fatigue, lasting for at least 6 months, with associated malaise, headaches, sleep disturbance, and cognitive impairment, which severely impacts quality of life. A significant percentage of ME/CFS patients remain undiagnosed, mainly due to the complexity of the disease and the lack of reliable objective biomarkers. ME/CFS patients display decreased metabolism and the severity of symptoms appears to be directly correlated to the degree of metabolic reduction that may be unique to each individual patient. However, the precise pathogenesis is still unknown, preventing the development of effective treatments. The ME/CFS phenotype has been associated with abnormalities in energy metabolism, which are apparently due to mitochondrial dysfunction in the absence of mitochondrial diseases, resulting in reduced oxidative metabolism. Such mitochondria may be further contributing to the ME/CFS symptomatology by extracellular secretion of mitochondrial DNA, which could act as an innate pathogen and create an autoinflammatory state in the hypothalamus. We propose that stimulation of hypothalamic mast cells by environmental, neuroimmune, pathogenic and stress triggers activates microglia, leading to focal inflammation in the brain and disturbed homeostasis. This process could be targeted for the development of novel effective treatments.
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Epstein-Barr and hepatitis viral infections have been implicated as potential causes of ME/CFS, with evidence that these viruses can persistently inhibit innate and adaptive immunity.
“Epstein-Barr and hepatitis viral infections have been implicated as potential causes14,67, with evidence that these viruses can persistently inhibit innate and adaptive immunity.”
From Leveraging Prior Knowledge of Endocrine Immune Regulation in the Therapeutically-relevant Phenotyping of Women with Chronic Fatigue Syndrome (2019) · cites this paper as [67]
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Flagged first, then by citations
9 of the 278 references couldn’t be matched to a known paper.
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Long‐COVID syndrome‐associated brain fog and chemofog: Luteolin to the rescue
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The relevance of pacing strategies in managing symptoms of post-COVID-19 syndrome
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Theoharides, T. C. (2021) · Journal of Personalized Medicine · doi:10.3390/jpm11090860 · Cited by 29 · see citing works
Differential diagnosis between “chronic fatigue” and “chronic fatigue syndrome”
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Genetics of COVID‐19 and myalgic encephalomyelitis/chronic fatigue syndrome: a systematic review
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Morris, M. C., Cooney, K. E., Sedghamiz, H., Abreu, M., Collado, F., Balbin, E. G., Craddock, T. J. A., Klimas, N. G., Broderick, G., & Fletcher, M. A. (2019) · Clinical Therapeutics · doi:10.1016/j.clinthera.2019.03.002 · Cited by 14 · see citing works
Chronic Fatigue Exhibits Heterogeneous Autoimmunity Characteristics Which Reflect Etiology
Даниленко, О. И., Gavrilova, N., & Churilov, L. P. (2022) · Pathophysiology · doi:10.3390/pathophysiology29020016 · Cited by 15 · see citing works
Lessons From Heat Stroke for Understanding Myalgic Encephalomyelitis/Chronic Fatigue Syndrome
Stanculescu, D., Sepúlveda, N., Lim, C. L., & Bergquist, J. (2021) · Frontiers in Neurology · doi:10.3389/fneur.2021.789784 · Cited by 12 · see citing works
Mast Cells in Autism Spectrum Disorder—The Enigma to Be Solved?
Kovacheva, E., Gevezova, M., Maes, M. H. J., & Sarafian, V. S. (2024) · International Journal of Molecular Sciences · doi:10.3390/ijms25052651 · Cited by 12 · see citing works
Oxytocin, the panacea for long-COVID? a review
Diep, P.-T., Chaudry, M., Dixon, A., Chaudry, F., & Kasabri, V. N. (2022) · Hormone Molecular Biology and Clinical Investigation · doi:10.1515/hmbci-2021-0034 · Cited by 10 · see citing works
[Asthenia, mental fatigue and cognitive dysfunction].
Titova, N., Bezdolny, Y. N., & Katunina, E. (2023) · Zhurnal Nevrologii i Psikhiatrii imeni S.S. Korsakova · doi:10.17116/jnevro202312305138 · Cited by 9 · see citing works
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Hypothalamus Connectivity in Adolescent Myalgic Encephalomyelitis/Chronic Fatigue Syndrome
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NANOENCAPSULATION OF LUTEOLIN: ENHANCING BIOAVAILABILITY AND MEDICINAL BENEFITS
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The duality of asthenia and cognitive impairments in cerebral diseases
Борисовна, Л. А., & Zakharov, V. V. (2023) · Meditsinskiy sovet = Medical Council · doi:10.21518/ms2023-401 · Cited by 4 · see citing works
Chronic fatigue syndrome against the background of the COVID-19 pandemic
Nikitina, A. Y., & Levin, O. S. (2021) · S S Korsakov Journal of Neurology and Psychiatry · doi:10.17116/jnevro202112110292 · Cited by 3 · see citing works
A Timely Multidisciplinary Update on Myalgic Encephalomyelitis/Chronic Fatigue Syndrome
Theoharides, T. C. (2019) · Clinical Therapeutics · doi:10.1016/j.clinthera.2019.03.004 · Cited by 3 · see citing works
Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)
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Myalgic encephalomyelitis / chronic fatigue syndrome as a breakdown of homeostasisPreprint
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Myalgic encephalomyelitis - enigma at the medicine’s crossroads
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Myalgic encephalomyelitis /chronic fatigue syndrome as a breakdown of homeostasisPreprint
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Myalgic encephalomyelitis / chronic fatigue syndrome as a breakdown of homeostasisPreprint
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The preclinical studies of the stress-protective activity of “Tonus-aktiv” homeopathic granules
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Mast Cells and their Role in Health and Disease
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- Authors
- Hatziagelaki, E., Adamaki, M., Tsilioni, I., Dimitriadis, G., & Theoharides, T. C.
- Affiliations
- Tufts University (US)
- Venue
- The Journal of Pharmacology and Experimental Therapeutics
- Publisher
- Elsevier BV
- Published
- 2018-10
- Volume
- 367
- Issue
- 1
- Pages
- 155-167
- ISSN
- 0022-3565 (ISSN-L)
- OpenAlex
- W2885130212
- Cited by
- 62
- References
- 278
- Citations by year
- 2026: 5 · 2025: 3 · 2024: 8 · 2023: 10 · 2022: 15 · 2021: 9 · 2020: 5 · 2019: 6 · 2018: 1
- FWCI
- 0.81
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Pharmacology and Experimental Therapeutics (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Fibromyalgia and Chronic Fatigue Syndrome Research
- Health Sciences › Medicine › Neurology › Long-Term Effects of COVID-19
- Health Sciences › Medicine › Infectious Diseases › Infectious Encephalopathies and Encephalitis
- Keywords
- chronic fatigue syndrome, hypothalamic inflammation, mitochondrial dysfunction, energy metabolism, mitochondrial DNA release, mast cells, microglial activation, neuroinflammation, autoinflammation, homeostasis disruption, biomarkers, pathogenesis
- MeSH terms
- Animals, Energy Metabolism, Homeostasis, Humans, Hypothalamus, Inflammation, Metabolic Diseases, Mitochondria, Biomarkers, Fatigue Syndrome, Chronic
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