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Microbes & Immunity Microbial involvement in ME/CFS

cytokines, which may interfere with gut-brain interaction Diet, similar to prebiotics, has been linked to some disease
and contribute to the symptoms of ME/CFS. 44,58 An pathophysiology, and is able to alter the balance of microbiota
alternative hypothesis suggests that bacterial metabolites composition and attenuate inflammation. Patients
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could influence ME/CFS by interfering with the pathways of with IBS, obesity, and Crohn’s disease have seen positive
estrogen and Vitamin D receptors. The Vitamin D receptor outcomes with diet therapy, and dietary interventions have
has been linked to the onset of autoimmune disorders also been investigated within the neuropsychiatric field.
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that commonly present alongside ME/CFS. However, this Intake of omega-3 polyunsaturated fatty acids enhances
potential connection remains insufficiently explored. 55,59 microbiota diversity and reduces metabolic endotoxemia,
Several investigations have identified possible variations while consumption of polyphenols and fibers is also
in metabolite levels between individuals with ME/CFS and advantageous, due to their protective effects of polyphenols
controls. In particular, SCFAs (such as butyrate, acetate, or in obesity, neurodegenerative diseases, Type 2 diabetes,
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isobutyrate) were significantly reduced in feces, blood, and and cardiovascular diseases. 65-68 Eicosapentaenoic acid,
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urine of patients with ME/CFS. A substantial decrease in prevalent in omega-3-rich oil, may mitigate symptoms
serum a-tocopherol (vitamin E), an antioxidant that may in patients with ME/CFS. Combining a diet aimed at
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be metabolized by specific gut microorganisms, was also reducing intestinal permeability with anti-inflammatory
noted in patients with ME/CFS. 10 and antioxidant agents led to marked improvements in
leaky gut, indicating a novel therapeutic strategy for ME/
4. Modulation of gut microbiome as a CFS. Similar findings have been observed in individuals
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potential therapy for ME/CFS with depression, suggesting that gut permeability and the
Based on its lower biodiversity compared to healthy associated heightened immune response might elucidate
subjects, it is believed that the gut microbiome may be a connection between major depressive disorder and the
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a novel therapeutic target for patients with ME/CFS, cognitive symptoms of ME/CFS.
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leading to several potential therapies, including probiotics, Recently, FMT has gained attention as a potential
diet, and fecal microbiota transplantation (FMT). 6,55 treatment for ME/CFS. This approach aims to reestablish
Probiotics are live bacteria that are thought to foster health. a balanced gut microbiota by transferring fecal matter
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A pilot study showed that the consumption of five different from a healthy donor into the recipient’s gastrointestinal
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mixtures of probiotics (Enterelle: Enterococcus faecium tract. About 70% response rate was achieved when
and Saccharomyces boulardii; Bifiselle: Bifidobacterium 13 non-pathogenic bacteria were delivered through
longum, Bifidobacterium breve, Bifidobacterium bifidum, colonoscopy to 60 patients with ME/CFS. After 15 –
and Bifidobacterium infantis; Rotanelle: Bifidobacterium 20 years of follow-up, 58% of cases were documented
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longum strain AR81; Citogenex: Lactobacillus casei and to have maintained response without relapse. Kenyon
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Bifidobacterium lactis; and Ramnoselle: Lactobacillus et al. conducted an FMT trial in which each patient
rhamnosus strain GG and Lactobacillus acidophilus) over an received 10 FMTs delivered via a rectal catheter into the
8-week period led to changes in overall welfare, along with lower part of the sigmoid colon. Of the 21 patients treated
alterations in inflammatory and oxidative indices in subjects with FMT, 17 reported 65 – 95% improvement, with seven
with ME/CFS, culminating in a decrease of inflammatory patients describing a normalization of their quality of life.
indicators. In another study, Sullivan et al. investigated the However, a recent study showed that FMT was safe, but did
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impact of Lacticaseibacillus (formerly Lactobacillus) paracasei not enhance the health-related quality of life for subjects
subsp. paracasei strain F19, Lactobacillus acidophilus strain suffering from CFS. 75
NCFB 1748, and Bifidobacterium animalis subsp. lactis strain 5. Discussion
Bb12 on fatigue and physical activity in 15 patients with ME/
CFS. After 4-week period, neurocognitive functions showed While gut microbiome homeostasis has been associated
a significant improvement, while fatigue and physical with diverse diseases, its role in the pathogenesis and
activity scores did not change. Finally, the administration of progression of ME/CFS is still not fully defined. However,
B. longum subsp. infantis strain 35624 to 48 ME/CFS cases several factors implicating the gut-brain axis may explain
demonstrated the capability of probiotics to downregulate the connection between gut dysbiosis and ME/CFS.
levels of systemic proinflammatory markers, such as As changes in the gut microbiome have also been
C-reactive protein (CRP), tumor necrosis factor-alpha (TNF- reported in postulated autoimmune diseases such as
a), and interleukin 6 (IL-6). 63 Crohn’s disease, systemic lupus erythematosus 2, and
Dietary modification is a quick, consistent, and Type 2 diabetes, it would be valuable to explore whether
straightforward approach to modify the gut microbiota. the microbiome could be associated with autoimmune
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Volume 2 Issue 1 (2025) 21 doi: 10.36922/mi.4783