ME/CFS Explainer

1. 1

   Maria Tsamou

   Paper, not X

   Where: microRNA

   Maria Tsamou, Fabiënne A. C. Kremers, Keano A. Samaritakis, Erwin L. Roggen.

   A 2024 review of ME/CFS and fibromyalgia, not only Long COVID. MicroRNAs named more than once sit on the immune response, mitochondria and oxidative stress, including miR-146a, miR-21, miR-150 and miR-29. Not a test.

   Tsamou et al., Int. J. Mol. Sci. 2024

2. 2

   Mateusz Piotr Kaczmarek

   Paper, not X

   Where: microRNA · EBV

   Mateusz Piotr Kaczmarek.

   A 2023 computation: circulating microRNAs in ME/CFS differ from person to person, but hit the same gene cluster. Eight of the ten most central ones are raised by herpesviruses, including Epstein-Barr, also in latency. Not proof of an active infection. No X post with this file.

   Kaczmarek, PLOS One 2023

3. 3

   Carmen Scheibenbogen

   @C_Scheibenbogen · post

   Where: Reading

   Nature news desk. Shared by Carmen Scheibenbogen.

   Post of 8 September 2026. A survey of the research on Long COVID and ME/CFS. A citation. No treatment from this app.

   Nature, News Feature 2026

4. 4

   Carmen Scheibenbogen

   @C_Scheibenbogen · post

   Where: Reading

   Carmen Scheibenbogen, Jonas Bergquist and others.

   Post of 17 October 2025. ME/CFS is not a result of avoiding activity. PEM remains the leading symptom. A citation.

   Nature Communications 2025

5. 5

   Solve ME/CFS Initiative

   @PlzSolveCFS · post

   Where: Reading

   Carmen Scheibenbogen, Jonas Bergquist and others.

   Post of 23 October 2025. The same paper, shared by Solve. A citation, not our voice.

   Nature Communications 2025

6. 6

   Carmen Scheibenbogen

   @C_Scheibenbogen · post

   Where: Pacing

   Charité, CFS_CARE. Shared by Carmen Scheibenbogen.

   Post of 27 June 2026. Preprint: no improvement after twelve months. In 45 percent, a worsening afterwards. A citation, not a recommendation.

7. 7

   Jon Douglas

   @atranscendedman · post

   Where: Triangle

   Braeden T. Charlton, Anouk Slaghekke, Brent Appelman, Moritz Eggelbusch, Rob C. I. Wüst and others. Vrije Universiteit Amsterdam.

   Post of 28 July 2026. Muscle and mitochondria in Long COVID and ME/CFS differ from 60 days of bed rest. Inactivity does not explain it. A citation.

   Charlton et al., Nature Communications 2026

8. 8

   Thailand Medical News

   @ThailandMedicaX · post

   Where: Triangle

   The same muscle paper: Charlton, Wüst and others.

   Post of 29 July 2026. A news piece on the same finding. A citation, not our voice.

   Charlton et al., Nature Communications 2026

9. 9

   AMMES

   @AmmesAdmin · post

   Where: Triangle

   Sergio Abanades, Irene Fernández, Nuria Capdevila, Francisco Cardona.

   Post of 28 August 2026. A review of micronutrients and mitochondria in ME/CFS, including B-complex, Q10, GlyNAC and L-carnitine. No dose from this app.

   Abanades et al., Nutrients 2026

10. 10

    Tom Kindlon

    @TomKindlon · post

    Where: Reading

    Named in the post as a US paper, without an author line.

    Post of 10 June 2026. Vesicles and mitochondrial membrane potential in Long COVID and ME/CFS. A citation.

    Open Forum Infectious Diseases 2026

11. 11

    Carmen Scheibenbogen

    @C_Scheibenbogen · post

    Where: Reading

    Sonya Marshall-Gradisnik and others. Shared by Carmen Scheibenbogen.

    Post of 21 May 2025. LDN and the ion channel TRPM3, with a link to mitochondria. A citation. This app sets no drug dose.

    Frontiers in Molecular Biosciences 2025

12. 12

    Carmen Scheibenbogen

    @C_Scheibenbogen

    Where: Triangle · reading

    Claudia Kedor, Carmen Scheibenbogen and others.

    Nature Communications 2022: SARS-CoV-2 can trigger ME/CFS. Patient sheet of February 2020 with Grabowski: four weeks of B-complex, Q10 at most 100 mg, D-ribose 3×5 g, NAC 2–3×600 mg. No single X post carries this file. A citation. Not a treatment.

    Kedor et al., Nature Communications 2022

13. 13

    Jesús Castro-Marrero

    @JCastro_Marrero

    Where: Q10

    Jesús Castro-Marrero, Maria José Segundo, Marcos Lacasa, Alba Martinez-Martinez, Ramon Sanmartin Sentañes, José Alegre-Martin.

    Nutrients 2021: 200 mg Q10 plus 20 mg NADH. A small effect on cognitive fatigue. The app stays at most 100 mg Q10. The post for this exact file was not at hand.

    Castro-Marrero et al., Nutrients 2021

14. 14

    Jacob Teitelbaum

    Paper, not X

    Where: Ribose

    Jacob Teitelbaum, C. Johnson, J. St. Cyr.

    Open pilot study 2006, no placebo: D-ribose 3×5 g. Weak evidence. No X post with this file.

    Teitelbaum, Johnson, St. Cyr, 2006

15. 15

    Dikoma C. Shungu

    Paper, not X

    Where: NAC

    Dikoma C. Shungu and others.

    IACFS/ME 2016 and an MRS abstract 2020: four weeks of NAC, glutathione in the brain. No proof that fatigue falls in a clinically relevant way. No X post with this file.

    Shungu et al., ISMRM 2020

DecodeME: 29 genes in the first tier and three in the second. The study set histone genes aside. Under that, the readout of mitochondrial genes, which is not an inherited change. Not a test, not a diagnosis, not a treatment.

• RABGAP1L

  Tier 1

  Defence against viruses and bacteria. The risk allele goes with less of this protein.

• DARS2

  Tier 1 · mitochondria

  Builds protein inside mitochondria. Mitochondrial aspartyl-tRNA synthetase.

• RC3H1

  Tier 1

  Regulates immune RNA. A candidate at the same place as RABGAP1L.

• GPR52

  Tier 1

  A receptor in the nervous system. A candidate, not a single cause.

• ZBTB37

  Tier 1

  A switch for reading genes. A candidate.

• TNFSF4

  Tier 1

  A signal to T cells, also called OX40L.

• ANKRD45

  Tier 1

  A candidate at the same DNA place. Not shown to be the cause.

• KLHL20

  Tier 1

  Helps break down proteins. A candidate.

• PRDX6

  Tier 1

  Protects against oxidative stress.

• SERPINC1

  Tier 1

  Antithrombin. Clotting. Not meant as an ME/CFS test.

• SLC9C2

  Tier 1

  Exchanges sodium and protons. A candidate.

• BTN2A2

  Tier 1

  T cells and innate immunity.

• TRIM38

  Tier 1

  Immune signalling. A candidate at the butyrophilin place.

• ZNF322

  Tier 1

  A zinc finger, reading of genes. A candidate.

• ABT1

  Tier 1

  Helps start the reading of genes. A candidate.

• HFE

  Tier 1

  Iron handling. A candidate, not iron advice.

• BTN3A3

  Tier 1

  A butyrophilin, immunity. A candidate.

• HMGN4

  Tier 1

  Sits on chromatin. A candidate.

• SUDS3

  Tier 1

  Dampens microglial inflammation.

• PEBP1

  Tier 1

  Binds signalling kinases. A candidate at the same place as SUDS3.

• VSIG10

  Tier 1

  Immune-like. A candidate, function open.

• CA10

  Tier 1

  Pain pathways. Overlaps a known pain signal. Not depression.

• CSE1L

  Tier 1

  Transport into the nucleus. A candidate.

• ARFGEF2

  Tier 1

  Vesicle traffic in the cell. A candidate.

• DDX27

  Tier 1

  An RNA helicase. A candidate.

• STAU1

  Tier 1

  Moves RNA. A candidate.

• ZNFX1

  Tier 1

  Recognises RNA viruses.

• B4GALT5

  Tier 1

  Adds sugars to proteins. A candidate.

• PTGIS

  Tier 1

  Makes prostacyclin. Blood vessels. A candidate, no dose.

• FBXL4

  Tier 2 · mitochondria

  Maintains mitochondria and clears broken ones.

• OLFM4

  Tier 2

  Neutrophils, immunity. Also faintly seen with PEM in other biobanks.

• CCPG1

  Tier 2

  Autophagy and stress of the endoplasmic reticulum.

• MT-RNR1 · MT-RNR2

  Readout

  Two genes of the mitochondrial genome. Read less in immune cells. Not an inherited change.

• MT-ATP6 · MT-CO1 · MT-CO2 · MT-CO3

  Readout

  Respiratory chain, read more in platelets. The direction depends on the tissue.

• MT-CYB · MT-ND3 · MT-ND5

  Readout

  Further mitochondrial genes, the same platelet paper. Not a panel for every tissue.

DecodeME, medRxiv 2025 · Mitochondrial genes, Int. J. Mol. Sci. 2026

• WASF3

  Protein

  Higher in muscle in some people with ME/CFS. Can disturb mitochondrial supercomplexes. Endoplasmic stress can raise it.

• PDH

  Enzyme complex

  Pyruvate dehydrogenase. This is where carbohydrate enters the mitochondria. Fluge describes a brake here.

• Komplex I

  Respiratory chain

  Protein machines in the mitochondrial membrane. Muscle biopsies show less oxidative output. Inactivity alone does not explain it.

• Komplex IV

  Respiratory chain

  Cytochrome c oxidase. Lower in muscle together with higher WASF3. Hwang 2023.

• GDF15

  Protein in blood

  A stress signal from mitochondria. Rises after exertion with fatigue and PEM. A marker, not a treatment.

• Komplement

  Immune proteins

  Proteins of innate immunity. More active after exertion in ME/CFS.

• ADRB2 · CHRM

  Receptors

  The β2-adrenergic receptor and muscarinic receptors. Autoantibodies in some people. One ELISA separates poorly.

• ATP1A

  Ion pump

  Na+/K+-ATPase in the muscle membrane. Wirth: a hypothesis, no proven mutation. No drug from this app.

• IDO1

  Enzyme

  First step from tryptophan to kynurenine. DecodeME does not name it. Newer measures see an active IDO, not a simple block.

• IDO2

  Enzyme

  Sister of IDO1. Phair and Davis 2019: the hypothetical trap sits here. Not a DecodeME signal.

• MAPK9 · NLGN1 · PTPRD

  Overlap

  Three genes that appear together in one ME analysis and in fatigue-dominant Long COVID. Candidates.

• LAG3

  Gene, candidate

  A 2026 network paper. Sits on T-cell exhaustion. Not confirmed as a cause.

WASF3, PNAS 2023 · Muscle, Scheibenbogen and Wirth 2025 · IDO trap, Phair and Davis 2019

MicroRNAs are short pieces of RNA. They do not build a protein. They turn other genes down. In ME/CFS they are not a Long COVID finding alone. A 2024 review of ME/CFS and fibromyalgia names microRNAs on the immune response, the mitochondria and oxidative stress, including miR-146a, miR-21, miR-150 and miR-29. A 2023 computation finds that the circulating microRNAs differ from person to person, yet point at the same gene cluster. Eight of the ten most central ones are raised by herpesviruses, including Epstein-Barr, even while the virus is latent. Epstein-Barr also makes its own microRNAs, from the BART and BHRF1 clusters, that help it evade immune defense. That is shown for the virus in general, not yet as a blood test in ME/CFS. A 2026 vesicle paper measures less let-7b in ME/CFS after COVID, together with fatigue and immune activation. The group measured is post-COVID. The same paper names Epstein-Barr as another trigger, and did not measure that group. Not a test, not a treatment.

Professor of immunology and deputy head of the Institute of Medical Immunology at Charité, head of the Charité Fatigue Center. Her work covers the EBV response, autoantibodies against β2-adrenergic and muscarinic receptors, reduced blood flow, and, with Klaus Wirth, a hypothesis that ties these findings to a mitochondrial energy shortfall. For her, ME/CFS (Myalgic Encephalomyelitis / Chronic Fatigue Syndrome) is a physical illness, not a psychosomatic label.

Described in public, including the February 2020 patient sheet with PD Dr Grabowski and lecture slides on mitochondria: B vitamins for four weeks, coenzyme Q10 at most 100 mg, D-ribose 3 × 5 g, NAC 2–3 × 600 mg. Also named, with no invented dose: B12, NADH, carnitine, arginine. A bridge toward symptom relief, explicitly not a causal treatment.

Scheibenbogen talks about medical off-label bridges until causal approaches are further along — autoimmunity, inflammation, low blood flow. Which substance that might be is a doctor's decision after findings. This app sets no drug dose.

The slide groups metabolism like this: the citric acid cycle with the B vitamins, the respiratory chain with Q10, ATP replenishment with ribose, and oxidative stress in between, where NAC sits. The classic vitamin triangle of D3, K2 and magnesium is a different model. It runs here only as an optional side module, because vitamin D in deficiency and magnesium as a cofactor of D activation are discussed apart from the mitochondrial core. K2 is the calcium partner of D3, not an established ME/CFS treatment, and it drops out under coumarins.

Metabolic papers (including Naviaux 2016, Fluge 2016 on PDH, Yamano 2016) describe disturbed energy pathways. They do not prove that capsules repair those pathways. Ribose rests on an open pilot study. Q10 plus NADH on small randomised trials, often with a small effect and sometimes a higher Q10 dose than Scheibenbogen names as a ceiling. NAC is mechanistically plausible and clinically thin. Pacing remains the step with the clearest practical priority, because post-exertional malaise can make the state worse.

• Charité Fatigue Centrum
• Fatigatio e.V.
• German Association for ME/CFS

From notes that have been published. Not a diagnosis, not a treatment, not a substitute for the doctor who treats you. If you get suddenly worse, use emergency medical care, not this app.