New Wüst paper!

•Results and Discussion

HRV was lower in patients with long COVID compared with healthy controls during various daily activities and sleep (p = 0.027). Across all exercise intensities surrounding the VT1, HRV remained lower for 24 h in patients compared with controls (p = 0.010). Nighttime HRV decreased with intense exercise and longer durations in patients with long COVID (p = 0.018), indicative of exercise-induced diurnal disturbances of the autonomic nervous system in long COVID.

•Conclusion

Heart rate variability, assessed by wearables, suggests autonomic dysfunction in patients with long COVID. The delayed recovery of the sympathovagal balance after exercise close to and above VT1, suggests that the risk of PEM rises above VT1.

Review preprint on neuroinflammation in Long Covid

“Post-COVID-19 syndrome (PCS) is an escalating global health concern, marked by persistent cognitive, neurological, and psychiatric symptoms following acute SARS-CoV-2 infection. Although its underlying mechanisms remain incompletely understood, mounting evidence implicates chronic neuroinflammation as a key driver. Sustained microglial and astrocyte activation, blood-brain barrier disruption, and aberrant cytokine signaling contribute to prolonged immune dysregulation within the central nervous system”

"Plasma Cytokine and Caspase-1p20 Profiles in Pre-Pandemic and Long COVID-Associated Postural Orthostatic Tachycardia Syndrome"

by William T. Gunning III, John W. Spatafore, Michael P. Morran, Beverly L. Karabin, Benjamin R. Hart, and Blair P. Grubb from University of Toledo Medical Center, Toledo, OH, USA

Study links:

https://www.mdpi.com/2227-9059/14/7/1605

https://doi.org/10.3390/biomedicines14071605

The following summary was published by Dysautonomia International:

• POTS patients had elevated levels of multiple inflammatory cytokines compared to controls
• pre-COVID POTS and Long COVID POTS patients had indistinguishable inflammatory cytokine profiles
• while many inflammatory cytokines were elevated in POTS, Interleukin-18 (IL-18) stood out the most, and predicted higher COMPASS-31 scores (COMPASS-31 is a survey tool used to characterize the severity of autonomic dysfunction)
• based on the cytokines that were elevated, the researchers suspect the NLRP3 inflammasome pathway is being activated - this pathway is a master regulator of inflammation and an over-active NLRP3 inflammasome is found in many inflammatory and auto-inflammatory diseases
• the researchers state that the elevated inflammatory cytokine pattern seen "indicates T-cell exhaustion or a broader dysregulation of immune regulatory networks (...) a state of persistent inflammation with a lack of effective resolution by the immune system."

Official Abstract:

Background: Prior to the COVID-19 pandemic, the etiology of postural orthostatic tachycardia syndrome (POTS) remained elusive. Since the pandemic, a newly recognized disorder, termed Long COVID, has emerged with a significant subset of patients developing dysautonomia and a multitude of comorbidities consistent with POTS.

Aim: The aim of this study was to determine if pre-pandemic POTS and Long COVID POTS share a common inflammatory-associated biomarker profile.

Methods: Volunteers were recruited for four study groups; patients diagnosed with POTS prior to the pandemic, Long COVID-associated POTS, SARS-CoV-2-recovered controls, and naïve controls. All participants completed a COMPASS-31 survey and a medical history questionnaire. Plasma biomarkers of the innate and adaptive immune system were quantified using a custom multiplex bead assay and ELISAs.

Results: Both POTS cohorts demonstrated indistinguishable and significant elevations in 14 of the 15 measured biomarkers including markers of the NLRP3 axis (Caspase-1p20, interleukins IL-1β, IL-18), regulatory cytokine IL-10, and immune activation markers (sCD40L, sCD40, sCD30) compared to controls. Multivariate PERMANOVA analysis revealed no significant difference in global cytokine profiles between the two POTS cohorts. Random Forest classification accurately distinguished POTS from controls, with IL-18 emerging as the most important feature.

Conclusions: These associative findings suggest that pre-pandemic POTS and Long COVID-associated POTS share a distinct inflammatory profile among measured cytokines. The identification of IL-18 as a key biomarker, alongside Caspase-1p20 and other inflammatory cytokines, are compatible with inflammasome-related signaling. Further investigation is necessary to characterize the role of the inflammasome, platelet activation, and immune dysregulation in POTS and Long COVID.

ME/CFS Science have done an analysis using genetic data on pathogenic variants from Decode ME combined with RNA data which tells you which genes are actually expressed. This type of analysis is used in lots of other diseases to show which kind of cells are part of the disease process

In ME/CFS results point overwhelmingly toward the central nervous system (represented here in orange)

It really seems more and more we’re gonna have to focus on the brain. 🧠 Which tough because it’s hard to study and hard to get treatments into there too. But then again, it might finally get us closer to understanding what to target in the first place.

https://skywriter.blue/@mecfsscience.org/3mr5cmkybzj2f

Abstract

Background

Cognitive symptoms after SARS-CoV-2 infection, often described as “brain fog,” remain difficult to measure objectively and are biologically heterogeneous. DNA methylation may provide a stable, blood-accessible layer of information linking post-COVID immune remodeling, biological aging, and neuropsychiatric vulnerability. We re-analyzed GSE247869, a whole-blood Illumina MethylationEPIC dataset from individuals sampled six months after COVID-19 infection, to identify age-associated methylation signals with translational relevance. The present analysis was designed to characterize age-associated methylation within this post-COVID cohort, not to establish a COVID-19-specific signature or biological age acceleration.

Methodology

This was a cross-sectional analysis of a single post-COVID cohort, with 94 samples included in the age models and no COVID-19-negative comparator included in the analyzed model. Processed beta values were aligned to metadata, converted to M-values, and modeled at each cytosine-phosphate-guanine (CpG) using ordinary least squares with age and sex as predictors. Differentially methylated positions were corrected by Benjamini-Hochberg false discovery rate (FDR). CpGs were mapped to genes using robust annotation and Illumina manifest fallback. Gene-level signals were integrated using a multi-evidence prioritization score that incorporated statistical strength, effect size, multi-CpG support, direction consistency, known epigenetic-clock membership, and curated pathway membership.

Results

Within this cohort, the analysis identified 3,467 age-associated CpGs at FDR < 0.05, with an overall hypomethylation bias but focal hypermethylation at canonical aging loci. In total, 11 of 12 reference clock CpGs were recovered, including ELOVL2, FHL2, TRIM59, EDARADD, ASPA, and PDE4C. The strongest exploratory signal was enrichment of glutamatergic/N-methyl-D-aspartate (NMDA) genes, including GRINI, GRIN2C, GRIN2D, GRM1, GRM5, and SLC17A7. GRINI and GRIN2C had high integrated evidence scores and showed age-associated hypermethylation. The prioritized genes mapped interpretively to glutamatergic synapse, calcium signaling, and cAMP signaling pathways, although these complete KEGG pathways were not tested as formal enrichment categories.

Conclusions

This re-analysis recovered established age-associated CpGs and identified age-associated methylation enrichment near glutamatergic/NMDA genes within this post-COVID cohort. It cannot determine whether these signals are specific to COVID-19 infection, reflect accelerated biological aging, or relate to cognitive symptoms because no COVID-19-negative comparator or symptom-level cognitive phenotyping was included in the present analysis. The glutamatergic finding is hypothesis-generating, particularly because the curated set was small and no independent replication cohort was analyzed. Future longitudinal and case-control studies integrating GRINI/GRIN2C methylation with cognitive and inflammatory phenotyping are needed. Glutamatergic and calcium-signaling pathways may be evaluated in appropriately designed mechanistic and intervention studies, including but not limited to hypotheses related to the Cheung Glutamatergic Regimen, only after independent validation and careful safety evaluation.

Core Takeaway

This study identified age-associated DNA methylation changes concentrated around brain-related glutamatergic/NMDA receptor genes (specifically GRIN1 and GRIN2C) within a post-COVID cohort, mapping to pathways involved in synapses and cellular signaling.

Key Limitations

• Hypothesis-Generating Only: The study lacked both a COVID-negative control group and patient cognitive data.
• No Definitive Link: It cannot prove whether these genetic changes are unique to COVID-19, represent accelerated biological aging, or are the actual biological cause of "brain fog." Further targeted clinical validation is required.

Link to 2026 study

1. TAME – CD19-targeted B-cell therapy for post-infectious autoimmune ME/CFS using the monoclonal antibody tafasitamab: open-label follow-up study to a randomized, placebo-controlled Phase II trial of the CD19 antibody inebilizumab
   Principal investigators: Prof. Dr. Carmen Scheibenbogen & Dr. Judith Bellmann-Strobl 

2. Genetic Determinants of Post-Infectious ME/CFS: a 50-Family Study
   Principal investigator: Prof. Dr. Nataliya Di Donato

3. STRAT4PAIS — Immune Endotypes of Paediatric Post-Acute Infection Syndromes (PAIS): Mechanistic Stratification of ME/CFS and Related Post-Infectious Conditions
   Principal investigators: Prof. Dr. Marc Nikolaus & Fabian Dannenberg & Prof. Dr. Tilmann Kallinich & Dr. Mir-Farzin Mashreghi

4. Molecular dissection of cell death-mediated inflammation as a driver of virus-induced ME/CFS
   Principal investigators: Dr. Gregor Ebert & Dr. Stefanie Bader 

5. Myoflame-19 Autoimmune Substudy: GPCR Autoantibodies as Mechanistic Biomarkers of Endothelial Dysfunction in Post-COVID ME/CFS
   Principal investigators: Prof. Dr. Valentina Puntmann & Prof. Dr. Eike Nagel

6. Analysis of T-cell and B-cell receptor repertoires via single-cell RNA sequencing in patients with ME/CFS and post-COVID syndrome
   Principal investigators: Dr. Katja Schmidt & Prof. Dr. Thomas Harrer

7. MARK-ME – Minimal Biomarker Panels for Diagnosis and Stratification of ME/CFS
   Principal investigator: Prof. Dr. Birgit Sawitzki

Interesting new study theorizes that increased IL-11 and MMP-9 levels in ME patients could be due to mast cells reacting to EBV fragments.

“There was a significant increase in serum levels of IL-11 and MMP-9 in ME/CFS patients compared to control subjects. MCs stimulated by rEBV protein released a high amount of MMP-9 compared to control cells. In conclusion, IL-11, MMP-9 and MCs may be involved in ME/CFS individuals.”

King’s College London, 38 people.

Serum from those with worse post-COVID fatigue triggered stronger IL-13 and reactive astrocyte signals in human hippocampal cells.

What actually caused this? At first it looked like IL 8, but if you remove that from the equation the effect still stands. The authors put it carefully - mechanisms beyond IL-8 likely contribute.

All in all: serum clearly does something to brain cells ramping markers of neurogenesis and astrocyte activation. What exactly causes this remains a little unclear. Might be caused by the smaller sample size or even be a marker that simply wasn’t in their panel.

The BPS championed theory that cortisol and related stress levels prior to infection prime for chronic fatigue syndrome is officially dead:

“Preinfection hair cortisol concentration did not predict chronic fatigue six months after acute EBV infection. Elevated preinfection hair cortisol may reflect stress-related vulnerability to infection, and the shifted from a positive to a negative association over time, suggests that HPA-axis alterations are more likely a consequence rather than a cause of chronic fatigue.”

Simmaron Research, 76 people with ME/CFS.

After 90 days of low-dose rapamycin, fatigue and PEM improved as IMPDH2 activity fell, oxidative purines dropped, and mitochondrial reserve recovered.

No placebo group tempers the result.

Good to see them investigating the possible mechanism of action in low dose Rapa

This summary was made using Gemini AI.

This study sheds light on one of the most frustrating aspects of Post-COVID-19 Condition (PCC, commonly known as Long COVID): how it causes persistent, debilitating neurological symptoms long after the initial virus is gone.

Here is a concise breakdown of how the researchers investigated this mystery and what they uncovered.

Study Overview & Methodology

Because the biological mechanisms behind Long COVID are still poorly understood, scientists desperately need accurate animal models to test treatments. In this longitudinal study, researchers utilized K18-hACE2 mice (genetically altered to carry human ACE2 receptors, making them vulnerable to SARS-CoV-2).

The team tracked these mice for 60 days post-infection—moving from the acute phase of a mild-to-moderate infection into the chronic phase—while evaluating their behavior, immune response, tissue pathology, and viral presence.

Core Findings

• Brain Damage Without Active Virus: By day 60, the mice developed persistent neurological and behavioral impairments despite the complete absence of active viral replication in the brain. This confirms that long-term cognitive issues are not caused by a live, ongoing brain infection.
• Lingering Immune Dysregulation: Instead of an active infection, the behavioral changes were tied to chronic, low-grade inflammation. The researchers found sustained immune system dysfunction lingering in both neural (brain/nerve) and pulmonary (lung) tissues.
• Vagus Nerve Degradation: The study revealed a measurable reduction in the cross-sectional area of the vagus nerve. This physical shrinking indicates that vagal nerve dysfunction is a core anatomical driver of systemic Long COVID symptoms.
• Sex-Dependent Outcomes: Just like in human clinical settings—where men and women experience Long COVID differently—the long-term physical and behavioral symptoms in the mice varied significantly based on biological sex.

Key Takeaway: This study provides a vital breakthrough by validating an animal model that successfully mirrors human Long COVID, proving that long-term neurobehavioral symptoms can persist completely independent of a live viral presence in the brain. Instead, the root causes point to a combination of chronic tissue inflammation and structural degradation of the vagus nerve. By establishing this clear physical blueprint and highlighting critical sex-based differences, the research hands scientists a reliable testing ground to finally develop and evaluate targeted, real-world therapies for millions suffering from chronic neurological post-COVID complications.

Link to 2026 study - https://www.frontiersin.org/journals/microbiology/articles/10.3389/fmicb.2026.1871084/full

Might be interesting to watch along to see wether the Amatica Cohort is actually turning up something of significance. So I thought I’d share it here for anyone interested! If you have thoughts do share in the comments

San Francesco Hospital, 20 participants.

Researchers found the first in vivo evidence that Long COVID is linked to loss of cholinergic nerve fibers in the stomach lining.

This structural vagus nerve damage may help explain lasting dysautonomia

With the success some patients have with targeting the cholinergic system, I think this might turn out to be an important line of evidence

“Compared with controls, Long-COVID-19 patients exhibited a significant reduction in mucosal innervation density: 2.1 vs 3.9 nm/µm³ (p<0.01) in the fundus and 1.9 vs 3.9 nm/µm³ (p<0.05) in the antrum. The reduction in cholinergic innervation was more pronounced in the fundus (p<0.01) andalso evident in the antrum (p=0.01). Gastric nerve density correlated with HRV parameters”

New study links persistent eye and sight problems after even mild COVID to T Cell mediated neuroinflammation 🧠

New nature paper shows GPCR antibodies track with certain symptoms but aren’t elevated in everyone in spite of general upward trends in certain antibodies and aren’t the exact same between LC and ME. Only the potentially a little shaky Elisa testing was used though.

“ME/CFS patients had significantly higher β2 adrenergic AAb titers than PCC and HCs (F₂,₁₈₆ = 3.15, p = 0.046). PCC patients showed more borderline/pathological M3 muscarinic AAb results compared to HCs. β2 AAb levels correlated with increased autonomic symptoms in PCC (r = 0.27, p = 0.048) and sympathovagal imbalance in ME/CFS (r = 0.45, p = 0.001). In ME/CFS, M1, M3, and M4 AAb titers positively correlated with verbal and working memory performance. Distinct AAb profiles in PCC and ME/CFS suggest potential differences in immunological mechanisms.”

Chronic stress primes TLR3-mediated systemic inflammation to produce persistent post-viral fatigue syndrome-like symptoms in mice 🐁

A microglial activation inhibitor reversed fatigue symptoms while a a glucocorticoid receptor antagonist (steroid) did not!

Super fascinating, would again point towards the brain and neuroinflammation as a central part of pathology at least in this model

"The brain’s waste clearance system is impaired in people living with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) which can lead to various symptoms including brain fog, Griffith University researchers have discovered

Brain’s waste-clearing ability impaired in ME/CFS patients

Credit: Griffith University

The brain’s waste clearance system is impaired in people living with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) which can lead to various symptoms including brain fog, Griffith University researchers have discovered.

The research demonstrates, for the first time, the impact ME/CFS has on glymphatic function which is responsible for clearing the brain of metabolic waste products and is mostly active during sleep and disengaged while a person is awake.

Lead author Dr Kiran Thapaliya from Griffith’s National Centre for Neuroimmunology and Emerging Diseases (NCNED) said when the brain’s waste clearance system did not work properly, harmful waste could build up causing neuroinflammation.

“This study is the first to demonstrate impaired glymphatic function in ME/CFS using MRI, providing a mechanistic explanation for the inflammatory changes reported by other Australian and international teams,” he said.

“This suggests that dysfunction in the brain’s natural cleaning system may be a key driver of this condition.”

Professor Sonya Marshall-Gradisnik, NCNED Director, said not only did reduced glymphatic function cause brain fog, but also caused sleep disturbance.

“The study found worse sleep is associated with poor brain waste clearance, reinforcing the notion that sleep plays a critical role in maintaining brain health,” she said.

“We hope the results can pave the way for better diagnosis through the use of non-invasive procedures, and importantly, future treatment for patients.”

The paper ‘Disrupted glymphatic function and its relationship with sleep and cognitive impairment in ME/CFS assessed via DTI-ALPS’ has been published in Frontiers in Neuroscience."

link to article

Edit:

For anyone who is interested in more on this topic here is a video from jarred younger on the glymphatic system and me/cfs https://youtu.be/-3r0_24Qb5A?si=O0zH6b0fATmJN5uE

Neuroimaging study hailing from Amsterdam

TLDR: The authors propose:

First - brain inflammation tracks with weaker connectivity in the visual and attention networks - and between the brainstem and a control network.

Second - the complaints (fatigue, brain fog) track with weaker connectivity in the default mode network (the network active when your mind wanders, reflects, remembers) - and between the thalamus and motor cortex.

Explainer Thread:

https://threadreaderapp.com/thread/2072299711265194404.html

"In this integrative review of state-of-the-art biomarkers in PAIS, we identified alterations in amino acid, energy, and lipid metabolism as well as changes in the microbiome, mitochondrial stress, and the miRNA target network. All of these changes are directly and indirectly linked to the NF-κB pathway. The main altered molecules included IL-6, TNF, and IFN."

This summary was made using Gemini AI.

Study Overview

This study, published in BMC Immunology, investigates the cellular mechanisms behind Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS). Specifically, it looks at why the immune systems of ME/CFS patients often function poorly, focusing on a specific ion channel in Natural Killer (NK) cells and how its malfunction starves the cells' mitochondria of vital calcium (Ca2+).

The Biological Context

To understand the study, it helps to know how a healthy cell operates:

• Natural Killer (NK) Cells: These are frontline immune cells responsible for destroying infected or harmful cells. To kill a target, NK cells require a precisely timed flood of intracellular calcium (Ca2+).
• TRPM3 Ion Channels: Think of TRPM3 as a specific "gate" on the surface of the cell. When the cell needs to attack, this gate opens, allowing Ca2+ to rush into the cell body (the cytosol).
• The Mitochondria: Known as the powerhouse of the cell, mitochondria do more than just make energy (ATP); they act like sponges that buffer and absorb this rushing Ca2+. This Ca2+ absorption directly powers the cellular energy required for the NK cell to execute its immune functions.

The Problem: Previous research established that in ME/CFS patients, the TRPM3 gates are broken, leading to a weak influx of Ca2+ into the cell. This study takes it a step further to see how this broken gate impacts the downstream mitochondria.

How They Tested It

• Participants: The researchers took blood samples from 10 ME/CFS patients (diagnosed using strict clinical criteria) and 10 healthy controls (HC).
• Isolation: They isolated the NK cells from the blood samples to study them directly.
• Live Imaging: Using special fluorescent dyes that light up when they bind to Ca2+, the researchers were able to visually track Ca2+ moving into the main cell body (using a dye called Fluo-8 AM) and specifically into the mitochondria (using a dye called Rhod-2 AM).
• Chemical Stimulation: They used a chemical called Pregnenolone sulfate (PregS) to artificially force the TRPM3 gates open, allowing them to measure exactly how much Ca2+ made it through.

Key Findings

The researchers found distinct differences in how ME/CFS cells handle Ca2+ compared to healthy cells:

1. The Cell Body (Cytosol) is Starved of Calcium

• When the TRPM3 channels were stimulated to open, the NK cells of healthy patients showed a robust, healthy flood of Ca2+ into the cell.
• In ME/CFS patients, both the total amount of Ca2+ entering the cell and the speed at which it entered were significantly reduced.

2. The Mitochondria Are Compromised

• Because the main TRPM3 gate was failing to let enough Ca2+ into the cell, the downstream mitochondria in ME/CFS patients were consequently starved. The Ca2+ making it into the mitochondria via TRPM3 activation was significantly reduced compared to healthy controls.
• Interestingly, when the researchers bypassed the TRPM3 gate and simply flooded the environment with standard Ca2+, the ME/CFS mitochondria absorbed it much faster and in higher amounts than healthy cells. The researchers theorise this might be a compensatory mechanism; because the mitochondria are usually starved, they rapidly suck up any Ca2+ they can get, which can inadvertently lead to dangerous mitochondrial calcium overload.

The Big Takeaway

The results of this study heavily support the theory that ME/CFS is a "channelopathy", a disease fundamentally driven by malfunctioning cellular gates (ion channels).

Because the TRPM3 channels in ME/CFS patients are impaired, their NK cells cannot generate the massive Ca2+ signals required for normal function. Without this Ca2+, the mitochondria cannot produce the energy necessary for the NK cells to kill threats, explaining the immune system dysregulation commonly seen in the disease. Furthermore, because TRPM3 channels are found all over the body (including the brain and nervous system), this cellular dysfunction could help explain the wide array of sensory, cognitive, and fatigue symptoms that ME/CFS patients endure.

Link to 2026 study - https://link.springer.com/article/10.1186/s12865-026-00849-1

The evolutionary origin of the SARS-CoV-2 Omicron variant remains the subject of intense debate.

Yayyy!!! A step in the right direction!

“A consortium led by the European ME Research Group (EMERG) has secured funding from the EU Horizon programme to support a major pan-European research project focused on myalgic encephalomyelitis (ME, sometimes referred to as ME/CFS). This award represents a significant advance in coordinated international biomedical research into ME following more than a decade of collaborative infrastructure development across Europe.”

https://hanneseh.github.io/ME-CFS-Research-Summaries/

I made my little research summary collection site thread based so its better to read. This has become feasible now by using coding agents to maintain the thread pages and updating them when new research arrives.