Abstract
The illness ME/CFS has been repeatedly tied to infectious agents such as Epstein Barr Virus. Expanding research on the human microbiome now allows ME/CFS-associated pathogens to be studied as interacting members of human microbiome communities. Humans harbor these vast ecosystems of bacteria, viruses and fungi in nearly all tissue and blood. Most well-studied inflammatory conditions are tied to dysbiosis or imbalance of the human microbiome. While gut microbiome dysbiosis has been identified in ME/CFS, microbes and viruses outside the gut can also contribute to the illness. Pathobionts, and their associated proteins/metabolites, often control human metabolism and gene expression in a manner that pushes the body toward a state of illness. Intracellular pathogens, including many associated with ME/CFS, drive microbiome dysbiosis by directly interfering with human transcription, translation, and DNA repair processes. Molecular mimicry between host and pathogen proteins/metabolites further complicates this interference. Other human pathogens disable mitochondria or dysregulate host nervous system signaling. Antibodies and/or clonal T cells identified in patients with ME/CFS are likely activated in response to these persistent microbiome pathogens. Different human pathogens have evolved similar survival mechanisms to disable the host immune response and host metabolic pathways. The metabolic dysfunction driven by these organisms can result in similar clusters of inflammatory symptoms. ME/CFS may be driven by this pathogen-induced dysfunction, with the nature of dysbiosis and symptom presentation varying based on a patient's unique infectious and environmental history. Under such conditions, patients would benefit from treatments that support the human immune system in an effort to reverse the infectious disease process.
Highlights
ME/CFS ENTERS THE ERA OF THE HUMAN MICROBIOMEToward the end of a career spent studying persistent bacteria in chronic disease, microbiologist Gerald Domingue wrote, “It is unwise to dismiss the pathogenic capacities of any microbe in a patient with a mysterious disease” [1]
The history of ME/CFS strongly suggests that infectious agents play a central role in driving the disease process
Humans are best described as holobionts, in which the microbial genomes and the human genome continually interact to regulate metabolism and immunity [15, 16]
Summary
Toward the end of a career spent studying persistent bacteria in chronic disease, microbiologist Gerald Domingue wrote, “It is unwise to dismiss the pathogenic capacities of any microbe in a patient with a mysterious disease” [1]. This thinking greatly applies to the illness ME/CFS. ME/CFS may be driven by pathogeninduced dysfunction, with resulting microbiome dysbiosis varying based on a patient’s unique infectious and environmental history Under such conditions, patients would benefit from treatments that, like those being developed for cancer, support the human immune system in an effort to reverse the inflammatory disease process
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