{
  "slug": "me-cfs",
  "id": "me-cfs-biomarkers",
  "condition": {
    "name": "Myalgic Encephalomyelitis / Chronic Fatigue Syndrome",
    "shortName": "ME/CFS",
    "alternateNames": [
      "ME/CFS",
      "CFS",
      "ME"
    ]
  },
  "page": {
    "title": "ME/CFS Biomarker Atlas | Myalgic Encephalomyelitis / Chronic Fatigue Syndrome",
    "breadcrumbName": "ME/CFS Biomarkers",
    "description": "Searchable atlas of biomarker, metabolite, cytokine, mitochondrial, and autonomic alterations in ME/CFS vs healthy controls — synthesized from peer-reviewed systematic reviews and meta-analyses.",
    "keywords": [
      "ME/CFS biomarkers",
      "myalgic encephalomyelitis biomarkers",
      "chronic fatigue syndrome blood tests",
      "PEM biomarkers",
      "acylcarnitines ME/CFS",
      "CFS lab markers",
      "post exertional malaise blood test",
      "cytokines ME/CFS",
      "mitochondrial dysfunction CFS",
      "HRV ME/CFS",
      "RNase L chronic fatigue",
      "NK cell function ME/CFS",
      "CPET ME/CFS biomarkers",
      "GPCR autoantibodies ME/CFS",
      "biomarker atlas",
      "biomarker database",
      "peer-reviewed biomarkers",
      "chronic illness biomarkers"
    ],
    "canonical": "https://research.opensourcemed.info/me-cfs-biomarkers.html",
    "hero": "Molecular, metabolic, immunological, and autonomic alterations in myalgic encephalomyelitis / chronic fatigue syndrome (ME/CFS) compared to healthy sedentary and active controls — including post-exertional malaise (PEM) phenotypes.",
    "dateModified": "2026-06-29"
  },
  "categories": {
    "inflammatory": "Inflammatory",
    "metabolic": "Metabolic",
    "mitochondrial": "Mitochondrial",
    "immune": "Immune",
    "autoimmune": "Autoimmune",
    "autonomic": "Autonomic",
    "neurological": "Neurological",
    "urinary": "Urinary",
    "functional": "Functional"
  },
  "filters": [
    "inflammatory",
    "metabolic",
    "mitochondrial",
    "immune",
    "autoimmune",
    "autonomic",
    "neurological",
    "urinary",
    "functional"
  ],
  "faq": [
    {
      "question": "Is there a single diagnostic biomarker for ME/CFS?",
      "answer": "No. ME/CFS remains a clinical diagnosis. Multiple biomarker domains show group-level differences vs healthy controls but none are FDA-validated as standalone diagnostic tests."
    },
    {
      "question": "What biomarkers are most replicated in ME/CFS research?",
      "answer": "Meta-analyses report altered cytokines (IL-1, TGF-β), elevated acylcarnitines, reduced heart rate variability, mitochondrial abnormalities, and urinary metabolite signatures."
    }
  ],
  "markers": [
    {
      "name": "Interleukin-1 (IL-1α/β)",
      "alternateName": "Pro-inflammatory cytokine",
      "direction": "up",
      "category": "inflammatory",
      "comparison": "HC",
      "symptoms": "Immune activation, fatigue",
      "reference": {
        "citation": "Corbitt et al. 2019",
        "doi": "10.1016/j.psyneuen.2019.05.008"
      },
      "testType": "BloodTest",
      "loinc": "26864-3"
    },
    {
      "name": "Transforming Growth Factor-β (TGF-β)",
      "alternateName": "Immunomodulatory cytokine",
      "direction": "up",
      "category": "inflammatory",
      "comparison": "HC",
      "symptoms": "Immune regulation, fibrosis signaling",
      "reference": {
        "citation": "Corbitt et al. 2019",
        "doi": "10.1016/j.psyneuen.2019.05.008"
      },
      "testType": "BloodTest",
      "loinc": "27999-4"
    },
    {
      "name": "Tumor Necrosis Factor-α (TNF-α)",
      "alternateName": "Pro-inflammatory cytokine",
      "direction": "mixed",
      "category": "inflammatory",
      "comparison": "HC",
      "symptoms": "Fatigue, heterogeneous across studies",
      "reference": {
        "citation": "Corbitt et al. 2019",
        "doi": "10.1016/j.psyneuen.2019.05.008"
      },
      "testType": "BloodTest",
      "loinc": "3074-8"
    },
    {
      "name": "Interleukin-6 (IL-6)",
      "alternateName": "Pro-inflammatory cytokine",
      "direction": "mixed",
      "category": "inflammatory",
      "comparison": "HC",
      "symptoms": "Systemic inflammation, variable",
      "reference": {
        "citation": "Corbitt et al. 2019",
        "doi": "10.1016/j.psyneuen.2019.05.008"
      },
      "testType": "BloodTest",
      "loinc": "26881-5"
    },
    {
      "name": "Interleukin-8 (IL-8 / CXCL8)",
      "alternateName": "Chemokine",
      "direction": "mixed",
      "category": "inflammatory",
      "comparison": "HC",
      "symptoms": "Neutrophil recruitment",
      "reference": {
        "citation": "Corbitt et al. 2019",
        "doi": "10.1016/j.psyneuen.2019.05.008"
      },
      "testType": "BloodTest",
      "loinc": "26998-9"
    },
    {
      "name": "Interleukin-10 (IL-10)",
      "alternateName": "Anti-inflammatory cytokine",
      "direction": "mixed",
      "category": "inflammatory",
      "comparison": "HC",
      "symptoms": "Immune regulation",
      "reference": {
        "citation": "Corbitt et al. 2019",
        "doi": "10.1016/j.psyneuen.2019.05.008"
      },
      "testType": "BloodTest",
      "loinc": "26862-5"
    },
    {
      "name": "C-Reactive Protein (CRP)",
      "alternateName": "Acute phase protein",
      "direction": "mixed",
      "category": "inflammatory",
      "comparison": "HC",
      "symptoms": "Low-grade inflammation",
      "reference": {
        "citation": "Strawbridge et al. 2019",
        "doi": "10.1016/j.psyneuen.2019.06.019"
      },
      "testType": "BloodTest",
      "loinc": "1988-5"
    },
    {
      "name": "Leptin",
      "alternateName": "Adipokine",
      "direction": "up",
      "category": "inflammatory",
      "comparison": "HC",
      "symptoms": "Inflammatory signaling",
      "reference": {
        "citation": "Strawbridge et al. 2019",
        "doi": "10.1016/j.psyneuen.2019.06.019"
      },
      "testType": "BloodTest",
      "loinc": "21365-2"
    },
    {
      "name": "Resistin",
      "alternateName": "Adipokine",
      "direction": "mixed",
      "category": "inflammatory",
      "comparison": "HC",
      "symptoms": "Metabolic inflammation",
      "reference": {
        "citation": "Strawbridge et al. 2019",
        "doi": "10.1016/j.psyneuen.2019.06.019"
      },
      "testType": "BloodTest",
      "loinc": "42702-4"
    },
    {
      "name": "Acylcarnitines (composite)",
      "alternateName": "Fatty acid oxidation intermediates",
      "direction": "up",
      "category": "metabolic",
      "comparison": "HC",
      "symptoms": "Mitochondrial dysfunction, PEM",
      "reference": {
        "citation": "Jinushi et al. 2023",
        "doi": "10.1186/s12967-023-04347-4"
      },
      "testType": "BloodTest"
    },
    {
      "name": "C16 Acylcarnitine (palmitoylcarnitine)",
      "alternateName": "Long-chain acylcarnitine",
      "direction": "up",
      "category": "metabolic",
      "comparison": "HC",
      "symptoms": "Impaired β-oxidation",
      "reference": {
        "citation": "Jinushi et al. 2023",
        "doi": "10.1186/s12967-023-04347-4"
      },
      "testType": "BloodTest"
    },
    {
      "name": "C18 Acylcarnitine (stearoylcarnitine)",
      "alternateName": "Long-chain acylcarnitine",
      "direction": "up",
      "category": "metabolic",
      "comparison": "HC",
      "symptoms": "Fatty acid metabolism block",
      "reference": {
        "citation": "Jinushi et al. 2023",
        "doi": "10.1186/s12967-023-04347-4"
      },
      "testType": "BloodTest"
    },
    {
      "name": "Free carnitine",
      "alternateName": "C0",
      "direction": "mixed",
      "category": "metabolic",
      "comparison": "HC",
      "symptoms": "Carnitine shuttle dysfunction",
      "reference": {
        "citation": "Jinushi et al. 2023",
        "doi": "10.1186/s12967-023-04347-4"
      },
      "testType": "BloodTest"
    },
    {
      "name": "Lactate (blood)",
      "alternateName": "Anaerobic metabolite",
      "direction": "up",
      "category": "metabolic",
      "comparison": "HC",
      "symptoms": "Exercise intolerance, PEM",
      "reference": {
        "citation": "Holden et al. 2020",
        "doi": "10.1186/s12967-020-02477-4"
      },
      "testType": "BloodTest",
      "loinc": "2524-7"
    },
    {
      "name": "ATP production capacity",
      "alternateName": "Bioenergetic reserve",
      "direction": "down",
      "category": "mitochondrial",
      "comparison": "HC, post-exercise",
      "symptoms": "PEM, cellular energy deficit",
      "reference": {
        "citation": "Holden et al. 2020",
        "doi": "10.1186/s12967-020-02477-4"
      },
      "testType": "BloodTest"
    },
    {
      "name": "Mitochondrial membrane potential",
      "alternateName": "ΔΨm",
      "direction": "down",
      "category": "mitochondrial",
      "comparison": "HC",
      "symptoms": "Mitochondrial dysfunction",
      "reference": {
        "citation": "Holden et al. 2020",
        "doi": "10.1186/s12967-020-02477-4"
      },
      "testType": "BloodTest"
    },
    {
      "name": "Pyruvate dehydrogenase activity",
      "alternateName": "PDH complex",
      "direction": "down",
      "category": "mitochondrial",
      "comparison": "HC",
      "symptoms": "Aerobic metabolism impairment",
      "reference": {
        "citation": "Holden et al. 2020",
        "doi": "10.1186/s12967-020-02477-4"
      },
      "testType": "BloodTest"
    },
    {
      "name": "Oxidative phosphorylation efficiency",
      "alternateName": "OXPHOS",
      "direction": "down",
      "category": "mitochondrial",
      "comparison": "HC",
      "symptoms": "Fatigue, reduced exercise capacity",
      "reference": {
        "citation": "Holden et al. 2020",
        "doi": "10.1186/s12967-020-02477-4"
      },
      "testType": "BloodTest"
    },
    {
      "name": "Serine",
      "alternateName": "Amino acid",
      "direction": "down",
      "category": "metabolic",
      "comparison": "HC — LC overlap",
      "symptoms": "Cognitive dysfunction, fatigue",
      "reference": {
        "citation": "Saito et al. 2024",
        "doi": "10.3389/fimmu.2024.1341843"
      },
      "testType": "BloodTest"
    },
    {
      "name": "Sarcosine",
      "alternateName": "Methylglycine",
      "direction": "down",
      "category": "metabolic",
      "comparison": "HC — LC overlap",
      "symptoms": "Brain fog, depression",
      "reference": {
        "citation": "Saito et al. 2024",
        "doi": "10.3389/fimmu.2024.1341843"
      },
      "testType": "BloodTest"
    },
    {
      "name": "Kynurenine",
      "alternateName": "Tryptophan metabolite",
      "direction": "up",
      "category": "metabolic",
      "comparison": "HC",
      "symptoms": "Neuroinflammation, fatigue",
      "reference": {
        "citation": "Saito et al. 2024",
        "doi": "10.3389/fimmu.2024.1341843"
      },
      "testType": "BloodTest"
    },
    {
      "name": "NK cell cytotoxicity",
      "alternateName": "Natural killer cell function",
      "direction": "down",
      "category": "immune",
      "comparison": "HC",
      "symptoms": "Impaired antiviral immunity",
      "reference": {
        "citation": "Maksoud et al. 2023",
        "doi": "10.1186/s12916-023-02893-9"
      },
      "testType": "BloodTest"
    },
    {
      "name": "CD8+ T cell perforin",
      "alternateName": "Cytotoxic effector molecule",
      "direction": "down",
      "category": "immune",
      "comparison": "HC",
      "symptoms": "T cell dysfunction",
      "reference": {
        "citation": "Maksoud et al. 2023",
        "doi": "10.1186/s12916-023-02893-9"
      },
      "testType": "BloodTest"
    },
    {
      "name": "RNase L (37-kDa fragment)",
      "alternateName": "Antiviral pathway enzyme",
      "direction": "up",
      "category": "immune",
      "comparison": "HC",
      "symptoms": "Chronic immune activation",
      "reference": {
        "citation": "Maksoud et al. 2023",
        "doi": "10.1186/s12916-023-02893-9"
      },
      "testType": "BloodTest"
    },
    {
      "name": "Neutrophil elastase",
      "alternateName": "Protease",
      "direction": "up",
      "category": "immune",
      "comparison": "HC",
      "symptoms": "Tissue damage, inflammation",
      "reference": {
        "citation": "Maksoud et al. 2023",
        "doi": "10.1186/s12916-023-02893-9"
      },
      "testType": "BloodTest"
    },
    {
      "name": "CD26 / sCD26 (DPPIV)",
      "alternateName": "T cell activation marker",
      "direction": "mixed",
      "category": "immune",
      "comparison": "HC",
      "symptoms": "Immune dysregulation",
      "reference": {
        "citation": "Maksoud et al. 2023",
        "doi": "10.1186/s12916-023-02893-9"
      },
      "testType": "BloodTest"
    },
    {
      "name": "β2-adrenergic receptor autoantibodies",
      "alternateName": "Anti-β2AR",
      "direction": "up",
      "category": "autoimmune",
      "comparison": "HC",
      "symptoms": "Dysautonomia, POTS",
      "reference": {
        "citation": "Maksoud et al. 2023",
        "doi": "10.1186/s12916-023-02893-9"
      },
      "testType": "BloodTest"
    },
    {
      "name": "Muscarinic cholinergic autoantibodies",
      "alternateName": "Anti-M3/M4",
      "direction": "up",
      "category": "autoimmune",
      "comparison": "HC",
      "symptoms": "Autonomic, GI symptoms",
      "reference": {
        "citation": "Maksoud et al. 2023",
        "doi": "10.1186/s12916-023-02893-9"
      },
      "testType": "BloodTest"
    },
    {
      "name": "Heart rate variability (RMSSD)",
      "alternateName": "Parasympathetic tone",
      "direction": "down",
      "category": "autonomic",
      "comparison": "HC",
      "symptoms": "Dysautonomia, orthostatic intolerance",
      "reference": {
        "citation": "Nelson et al. 2019",
        "doi": "10.1186/s12967-019-02100-4"
      },
      "testType": "MedicalTest"
    },
    {
      "name": "Heart rate variability (SDNN)",
      "alternateName": "Overall HRV",
      "direction": "down",
      "category": "autonomic",
      "comparison": "HC",
      "symptoms": "Reduced autonomic flexibility",
      "reference": {
        "citation": "Nelson et al. 2019",
        "doi": "10.1186/s12967-019-02100-4"
      },
      "testType": "MedicalTest"
    },
    {
      "name": "LF/HF ratio",
      "alternateName": "Sympathovagal balance",
      "direction": "mixed",
      "category": "autonomic",
      "comparison": "HC",
      "symptoms": "Autonomic imbalance",
      "reference": {
        "citation": "Nelson et al. 2019",
        "doi": "10.1186/s12967-019-02100-4"
      },
      "testType": "MedicalTest"
    },
    {
      "name": "Orthostatic heart rate increment",
      "alternateName": "Tilt/stand test",
      "direction": "up",
      "category": "autonomic",
      "comparison": "HC",
      "symptoms": "POTS, orthostatic intolerance",
      "reference": {
        "citation": "Nelson et al. 2019",
        "doi": "10.1186/s12967-019-02100-4"
      },
      "testType": "MedicalTest"
    },
    {
      "name": "Blood pressure variability",
      "alternateName": "Beat-to-beat BP",
      "direction": "up",
      "category": "autonomic",
      "comparison": "HC",
      "symptoms": "Autonomic dysregulation",
      "reference": {
        "citation": "Nelson et al. 2019",
        "doi": "10.1186/s12967-019-02100-4"
      },
      "testType": "MedicalTest"
    },
    {
      "name": "Baroreflex sensitivity",
      "alternateName": "Cardiovascular reflex",
      "direction": "down",
      "category": "autonomic",
      "comparison": "HC",
      "symptoms": "Orthostatic symptoms",
      "reference": {
        "citation": "Nelson et al. 2019",
        "doi": "10.1186/s12967-019-02100-4"
      },
      "testType": "MedicalTest"
    },
    {
      "name": "Cortisol (diurnal rhythm)",
      "alternateName": "HPA axis hormone",
      "direction": "mixed",
      "category": "neurological",
      "comparison": "HC",
      "symptoms": "Flattened rhythm, fatigue",
      "reference": {
        "citation": "Maksoud et al. 2023",
        "doi": "10.1186/s12916-023-02893-9"
      },
      "testType": "BloodTest",
      "loinc": "2143-6"
    },
    {
      "name": "Neurofilament light chain (NfL)",
      "alternateName": "Axonal damage marker",
      "direction": "mixed",
      "category": "neurological",
      "comparison": "HC",
      "symptoms": "Cognitive dysfunction subset",
      "reference": {
        "citation": "Maksoud et al. 2023",
        "doi": "10.1186/s12916-023-02893-9"
      },
      "testType": "BloodTest",
      "loinc": "94635-5"
    },
    {
      "name": "Urinary metabolite panel",
      "alternateName": "Metabolomic signature",
      "direction": "mixed",
      "category": "urinary",
      "comparison": "HC",
      "symptoms": "Non-invasive disease signature",
      "reference": {
        "citation": "Taccori et al. 2023",
        "doi": "10.1186/s12967-023-04398-7"
      },
      "testType": "PathologyTest"
    },
    {
      "name": "Urinary creatinine-normalized metabolites",
      "alternateName": "Metabolomic ratios",
      "direction": "mixed",
      "category": "urinary",
      "comparison": "HC",
      "symptoms": "Metabolic pathway alterations",
      "reference": {
        "citation": "Taccori et al. 2023",
        "doi": "10.1186/s12967-023-04398-7"
      },
      "testType": "PathologyTest"
    },
    {
      "name": "2-day CPET VO₂ peak (day 2)",
      "alternateName": "Cardiopulmonary exercise test",
      "direction": "down",
      "category": "functional",
      "comparison": "Day 1 vs Day 2",
      "symptoms": "PEM, exercise intolerance",
      "reference": {
        "citation": "Holden et al. 2020",
        "doi": "10.1186/s12967-020-02477-4"
      },
      "testType": "MedicalTest"
    },
    {
      "name": "Workload at anaerobic threshold",
      "alternateName": "CPET parameter",
      "direction": "down",
      "category": "functional",
      "comparison": "HC",
      "symptoms": "Reduced exercise capacity",
      "reference": {
        "citation": "Holden et al. 2020",
        "doi": "10.1186/s12967-020-02477-4"
      },
      "testType": "MedicalTest"
    },
    {
      "name": "6-minute walk distance",
      "alternateName": "Functional capacity",
      "direction": "down",
      "category": "functional",
      "comparison": "HC",
      "symptoms": "Activity limitation",
      "reference": {
        "citation": "Maksoud et al. 2023",
        "doi": "10.1186/s12916-023-02893-9"
      },
      "testType": "MedicalTest"
    },
    {
      "name": "SF-36 physical function score",
      "alternateName": "Quality of life",
      "direction": "down",
      "category": "functional",
      "comparison": "HC",
      "symptoms": "Disability, activity limitation",
      "reference": {
        "citation": "Maksoud et al. 2023",
        "doi": "10.1186/s12916-023-02893-9"
      },
      "testType": "MedicalTest"
    },
    {
      "name": "Anti-GPCR autoantibodies (panel)",
      "alternateName": "GPCR autoAbs",
      "direction": "up",
      "category": "autoimmune",
      "comparison": "HC — LC/PACVS overlap",
      "symptoms": "Dysautonomia",
      "reference": {
        "citation": "Maksoud et al. 2023",
        "doi": "10.1186/s12916-023-02893-9"
      },
      "testType": "BloodTest"
    },
    {
      "name": "Ceramides (plasma)",
      "alternateName": "Sphingolipids — LC overlap",
      "direction": "down",
      "category": "metabolic",
      "comparison": "HC",
      "symptoms": "Mitochondrial dysfunction",
      "reference": {
        "citation": "Saito et al. 2024",
        "doi": "10.3389/fimmu.2024.1341843"
      },
      "testType": "BloodTest"
    },
    {
      "name": "ATP (plasma)",
      "alternateName": "Adenosine triphosphate — LC overlap",
      "direction": "down",
      "category": "metabolic",
      "comparison": "HC",
      "symptoms": "Energy deficit",
      "reference": {
        "citation": "Saito et al. 2024",
        "doi": "10.3389/fimmu.2024.1341843"
      },
      "testType": "BloodTest"
    },
    {
      "name": "sCD14",
      "alternateName": "Monocyte activation — LC overlap",
      "direction": "up",
      "category": "inflammatory",
      "comparison": "HC",
      "symptoms": "Innate immune activation",
      "reference": {
        "citation": "Saito et al. 2024",
        "doi": "10.3389/fimmu.2024.1341843"
      },
      "testType": "BloodTest",
      "loinc": "30180-5"
    }
  ]
}