Elsevier

Autoimmunity Reviews

Volume 17, Issue 6, June 2018, Pages 601-609
Autoimmunity Reviews

Review
Myalgic Encephalomyelitis/Chronic Fatigue Syndrome – Evidence for an autoimmune disease

https://doi.org/10.1016/j.autrev.2018.01.009Get rights and content
Under a Creative Commons license
open access

Highlights

  • The pathogenesis of ME/CFS is multifactorial, and immunological and environmental factors play a role.

  • Autoimmune mechanisms can be linked with ME/CFS at least in a subset of patients.

  • Autoantibodies mostly against nuclear and neurotransmitter receptors are found in a subset of ME/CFS patients.

  • Immunomodulatory therapeutic strategies targeting autoantibodies may be beneficial and should be pursued.

Abstract

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a frequent and severe chronic disease drastically impairing life quality. The underlying pathomechanism is incompletely understood yet but there is convincing evidence that in at least a subset of patients ME/CFS has an autoimmune etiology. In this review, we will discuss current autoimmune aspects for ME/CFS. Immune dysregulation in ME/CFS has been frequently described including changes in cytokine profiles and immunoglobulin levels, T- and B-cell phenotype and a decrease of natural killer cell cytotoxicity. Moreover, autoantibodies against various antigens including neurotransmitter receptors have been recently identified in ME/CFS individuals by several groups. Consistently, clinical trials from Norway have shown that B-cell depletion with rituximab results in clinical benefits in about half of ME/CFS patients. Furthermore, recent studies have provided evidence for severe metabolic disturbances presumably mediated by serum autoantibodies in ME/CFS. Therefore, further efforts are required to delineate the role of autoantibodies in the onset and pathomechanisms of ME/CFS in order to better understand and properly treat this disease.

Abbreviations

AdR
adrenergic receptor
BAFF
B-lymphocyte activating factor
dUTPase
deoxyuridine 5′-triphosphate nucleotidohydrolase
EBV
Epstein-Barr virus
FM
fibromyalgia
5-HT
5-hydroxytryptanime
HHV
human herpes virus
IFNγ
interferon gamma
KIR
killer cell immunoglobulin-like receptor
M AChR
muscarinic acetylcholine receptor
ME/CFS
Myalgic Encephalomyelitis/Chronic Fatigue Syndrome
MS
multiple sclerosis
NK
natural killer cells
PBMC
peripheral blood mononuclear cells
POTS
postural orthostatic tachycardia syndrome
pSS
primary Sjögren's syndrome
RA
rheumatoid arthritis
SLE
systemic lupus erythematosus
SNP
single nucleotide polymorphisms
TCA
tricarboxylic acid
Tfh
T follicular helper cells
Th
T helper cells
TNFα
tumor necrosis factor alpha
Treg
regulatory T cells

Keywords

Autoimmune
Biomarker
Myalgic Encephalomyelitis
Chronic Fatigue Syndrome
Autoantibodies

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