Mitochondria and Immunity in Chronic Fatigue Syndrome, by G Anderson, Michael Maes in Prog Neuropsychopharmacol Biol Psychiatry 2020 May 26 [DOI:10.1016/j.pnpbp.2020.109976]
Review abstract:
It is widely accepted that the pathophysiology and treatment of myalgic encephalomyelitis/ chronic fatigue syndrome (ME/CFS) could be considerably improved. The heterogeneity of ME/CFS and the confusion over its classification have undoubtedly contributed to this, although this would seem a consequence of the complexity of the array of ME/CFS presentations and high levels of diverse comorbidities.
This article reviews the biological underpinnings of ME/CFS presentations, including the interacting roles of the gut microbiome/permeability, endogenous opioidergic system, immune cell mitochondria, autonomic nervous system, microRNA-155, viral infection/re-awakening and leptin as well as melatonin and the circadian rhythm. This details not only relevant pathophysiological processes and treatment options, but also highlights future research directions.
Due to the complexity of interacting systems in ME/CFS pathophysiology, clarification as to its biological underpinnings is likely to considerably contribute to the understanding and treatment of other complex and poorly managed conditions, including fibromyalgia, depression, migraine, and dementia. The gut and immune cell mitochondria are proposed to be two important hubs that interact with the circadian rhythm in driving ME/CFS pathophysiology.
Creatine supplementation may recharge creatine stores (at least in the skeletal muscles) but this does not inevitably lead to better clinical features in all PFS (postviral fatigue syndrome) patients. It might help some patients to perform more physical work without negative consequences yet creatine is probably less effective to tackle general fatigue and/or nervous system-specific signs and symptoms of PFS. We are still short of information. Does supplemental creatine even reach the brain in PFS, a major stumbling block for creatine delivery in clinical neurology.
Information on human papillomavirus vaccinations and selected syndromes with autonomic dysfunction (chronic fatigue syndrome, complex regional pain syndrome, and postural orthostatic tachycardia syndrome) identified using ICD-10 (international classification of diseases, revision 10) diagnostic codes from Danish nationwide registers.
Since the 1990s, 
We assessed cognitive differences in 80 subjects with GWI and 38 with CFS by comparing corresponding 
This study included patients diagnosed for the first time with CFS in one of 1238 general practices in Germany between 2010 and 2017 (index date). Controls without CFS were matched (1:1) to cases with CFS by sex, age, index year, and practice. Physical and psychiatric conditions diagnosed in the year prior to the index date were included if they were present in at least 3% of patients with CFS. Associations between physical and psychiatric conditions (33 potential independent variables) and CFS (dependent variable) were analyzed in an adjusted conditional logistic regression model, and physical and psychiatric disorders were included in the model using forward stepwise selection.
