Image description. Two people dressed in white coats examine research with a clipboard and microscope. Inset pictures feature red blood cells and the other data analysis results. ME Association logo (bottom right) The title reads: Research: Biomarkers for ME/CFS: A Systemic Review.

Research: Biomarkers for ME/CFS: A Systemic Review. 

BMC Medicine

by Rebekah Maksoud, Chandi Magawa, Natalie Eaton-Fitch, Kiran Thapaliya, Sonya Marshall- Gradisnik

This is a comprehensive review of all the potential biomarkers for ME/CFS that have been assessed in the past, or are currently being assessed.

For a blood test, or any other investigation, to achieve the status of being an objective biomarker for a disease it has be positive in all, or a very high percentage of people with the condition and it should not be positive in any other condition that has similar symptoms.

As the review points out there are a considerable number of blood and other abnormalities that have the potential to become biomarkers for ME/CFS.
However, in our current state of knowledge, none of them can be regarded as being reliable when it comes to differentiating people with ME/CFS from people who have other health conditions, or are perfectly healthy.

Dr Charles Shepherd,
Trustee and
Hon. Medical Adviser
to the ME Association.

Dr Charles Shepherd

Extracts

Background

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a multifaceted condition that affects most body systems.

There is currently no known diagnostic biomarker; instead, diagnosis is dependent on application of symptom-based case criteria following exclusion of any other potential medical conditions. While there are some studies that report potential biomarkers for ME/CFS, their efficacy has not been validated.

The aim of this systematic review is to collate and appraise literature pertaining to a potential biomarker(s) which may effectively differentiate ME/CFS patients from healthy controls.

Results

A total of 101 publications were included in this systematic review.

Potential biomarkers ranged from genetic/epigenetic (19.8%), immunological (29.7%), metabolomics/mitochondrial/microbiome (14.85%), endovascular/circulatory (17.82%), neurological (7.92%), ion channel (8.91%) and physical dysfunction biomarkers (8.91%).

Most of the potential biomarkers reported were blood-based (79.2%). Use of lymphocytes as a model to investigate ME/CFS pathology was prominent among immune-based biomarkers.

Most biomarkers had secondary (43.56%) or tertiary (54.47%) selectivity, which is the ability for the biomarker to identify a disease-causing agent, and a moderate (59.40%) to complex (39.60%) ease-of-detection, including the requirement of specialised equipment.

Conclusion

All potential ME/CFS biomarkers differed in efficiency, quality, and translatability as a diagnostic marker.

Reproducibility of findings between the included publications were limited, however, several studies validated the involvement of immune dysfunction in the pathology of ME/CFS and the use of lymphocytes as a model to investigate the pathomechanism of illness.

The heterogeneity shown across many of the included studies highlights the need for multidisciplinary research and uniform protocols in ME/CFS biomarker research.

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