In recent times, docs and scientists are more and more learning long-lasting diseases that start after somebody recovers from an an infection. Two of probably the most well-known examples are lengthy COVID and myalgic encephalomyelitis/continual fatigue syndrome (ME/CFS).
It has been estimated that 400 million individuals, globally, could have lengthy COVID, and practically half of them meet standards for ME/CFS.
These situations had been typically misunderstood or missed previously, however that’s beginning to change. Researchers at the moment are learning them as half of a bigger group of diseases referred to as post-acute an infection syndromes, or PAISs.
A brand new evaluate by Mass Common Brigham investigator Anthony L Komaroff, MD, and Robert Dantzer, MD, of the MD Anderson Most cancers Heart in Houston, printed in Cell Experiences Medication, and a brand new evaluate by Dr. Komaroff within the Proceedings of the Nationwide Academy of Sciences (PNAS), brings collectively many years of analysis and new discoveries to assist clarify what causes these diseases and the way they is perhaps handled. Dr. Dantzer is among the world’s specialists on how animals reply to an infection.
Their evaluate highlights that lengthy COVID and ME/CFS share most of the identical organic issues similar to irritation within the mind, points with how cells produce power, and issues with the immune system.
Additionally they introduce the concept sure mind circuits that developed to assist the physique reply to critical sickness, could also be caught within the “on” place after the physique has cleared the an infection and could possibly be inflicting most of the ongoing signs individuals expertise.
On this Q&A, Dr. Komaroff shares what motivated this analysis and what it might imply for the way we perceive, diagnose, and deal with these advanced situations.
Q: What impressed you to review the sphere of lengthy COVID and different post-acute an infection syndromes?
My curiosity in ME/CFS started greater than 40 years in the past, after I met sufferers who by no means absolutely recovered from what appeared like a routine viral sickness.
On the time, their signs could not be defined by commonplace medical exams, which all got here again regular. That led some to conclude the signs had been psychologically primarily based.
A small group of us around the globe started to review if there have been, in truth, underlying goal organic abnormalities that is perhaps inflicting the long-lasting signs, maybe in individuals with a genetic vulnerability.
Over the previous 40 years, it grew to become clear that that is the case. The signs are related to a number of underlying abnormalities, involving a number of physique programs.
In each critiques, we postulate that lengthy COVID and ME/CFS fall beneath a broader class referred to as post-acute an infection syndromes.
This helps spotlight the organic similarities between them and opens the door to extra focused remedies.
Q: What did you discover on this evaluate?
Within the evaluate we requested two questions: what causes the signs, and why do the signs persist for years?
What causes the signs?
We recognized a variety of organic abnormalities widespread to each ME/CFS and lengthy COVID that may instantly trigger signs.
These embrace:
- Neuroinflammation: Activation of the mind’s immune system
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Mitochondrial dysfunction: A decreased capability to generate adenosine triphosphate (ATP), the first power supply for cells, resulting in a lower in body- and brain-based metabolism.
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Immune dysregulation: This may embrace persistent irritation, reactivation of latent viruses (like Epstein-Barr virus), and the presence of autoantibodies focusing on neural tissues.
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Endothelial dysfunction: Disruption of blood circulation and the blood-brain barrier, contributing to cognitive and cardiovascular signs.
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Intestine dysbiosis: An imbalance within the intestine microbiome that will perpetuate system irritation
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Oxidative stress: An imbalance between the manufacturing of free radicals and the physique’s potential to neutralize them, resulting in mobile harm and illness
Might “illness habits” be underlying these signs?
Our evaluate focuses on one other attainable explanation for the signs that has not beforehand been thought-about.
We predict it’s probably that these signs could also be pushed by evolutionarily-conserved responses to important threats which can be seen in all animals which were studied.
An infection results in signs, and the signs result in habits adjustments referred to as illness habits. An infection additionally results in adjustments in metabolism. Collectively, the behavioral and metabolic adjustments assist protect the physique’s power provide, its ATP, for the combat towards the an infection.
We suspect these behavioral and metabolic adjustments could also be brought on by just lately found teams of devoted mind cells (neurons) when they’re stimulated by an an infection or different explanation for mind irritation.
We current proof that most of the underlying abnormalities that produce signs persist in some individuals, together with the infectious agent or items of the infectious agent.
As well as, we level out that most of the totally different underlying abnormalities can reinforce one another, resulting in ongoing vicious cycles that keep the signs.
Q: How has the COVID-19 pandemic and lengthy COVID modified the scientific and public notion of ME/CFS?
The pandemic has been a turning level. In 2020, we printed a paper predicting that COVID-19 would result in a surge in ME/CFS-like situations, and that has occurred.
Lengthy COVID has introduced visibility to post-infectious syndromes, as a result of its trigger is a particular infectious agent.
This has given credibility to the declare of many ME/CFS sufferers that their sickness started following an acute an infection—one through which no infectious agent was examined for.
It additionally offers credibility to related syndromes following well-documented acute infections like Lyme illness and West Nile virus.
The size of lengthy COVID’s affect—each when it comes to affected people and societal prices—has accelerated analysis and shifted the general public discourse.
Q: What are probably the most fascinating organic similarities between ME/CFS and lengthy COVID?
The symptom overlap between ME/CFS and lengthy COVID is nicely acknowledged. What our publications have cataloged is the numerous placing parallels within the underlying abnormalities.
These organic parallels embrace:
- Mind abnormalities, as seen by numerous kinds of mind imaging.
- Autonomic nervous system dysfunction affecting coronary heart price, respiration, and digestion.
- Immune system dysregulation and autoantibodies
- Impaired power metabolism resulting in fatigue and train intolerance.
- Cardiovascular points, particularly involving the liner of blood vessels (the endothelium).
These similarities recommend a shared pathophysiological basis, reinforcing the case for unified analysis and therapy methods.
Q: What are the present remedies for post-acute an infection syndrome, and why have some didn’t be efficient?
At the moment, there aren’t any FDA-approved remedies for ME/CFS or lengthy COVID. Nonetheless, proof exhibits that early antiviral therapy and vaccination towards SARS-CoV-2 can cut back the danger of creating lengthy COVID.
Our evaluate proposes that neuroinflammation—immune activation inside the mind—is one key driver of signs. It stimulates the precise neural circuits that produce illness habits and metabolic adjustments.
Subsequently, focusing on neuroinflammation and the molecules by which it stimulates the neural circuits might result in more practical therapies. A number of novel therapies that focus on neuroinflammation are beneath investigation.
Whereas promising, these remedies are nonetheless in experimental phases and never but accessible to clinicians
Q: What are a very powerful analysis questions that must be addressed to raised perceive and deal with ME/CFS and lengthy COVID?
Two main questions stand out:
- Cross-condition organic parallels: Do different post-infection syndromes—like post-Lyme illness, post-Ebola, and post-West Nile virus—share the identical organic abnormalities as ME/CFS and lengthy COVID? Systematic research are wanted to substantiate this.
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Therapeutic focusing on of neuroinflammation: There are 10–20 experimental approaches presently being examined in lab fashions to cut back neuroinflammation. Figuring out which, if any, are efficient in people is a crucial subsequent step.
These questions are central to advancing therapy and understanding the broader class of post-acute an infection syndromes
Lastly, it is essential to lift consciousness.
The thought of post-acute an infection syndromes continues to be comparatively new and never but well known in medical apply. Selling this framework may help enhance how we diagnose, examine, and deal with these long-lasting diseases.
Extra info:
Anthony L. Komaroff et al, Causes of signs and symptom persistence in lengthy COVID and myalgic encephalomyelitis/continual fatigue syndrome, Cell Experiences Medication (2025). DOI: 10.1016/j.xcrm.2025.102259
Quotation:
Scientists establish shared organic roots of lengthy COVID and continual fatigue syndrome (2025, August 1)
retrieved 2 August 2025
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