The Gut Microbiome in Myalgic Encephalomyelitis (ME)/Chronic Fatigue Syndrome (CFS).
König, Rahel S, Albrich, Werner C, Kahlert, Christian R et al. · Frontiers in immunology · 2021 · DOI
Quick Summary
This review examines whether changes in gut bacteria might contribute to ME/CFS. The authors suggest that lifetime antibiotic use could alter the balance of gut microbes, which might then affect the gut barrier, brain function, and energy production in cells. They propose several potential treatment approaches like probiotics and dietary changes, but emphasize that much more research is needed to understand if gut bacteria actually cause ME/CFS or simply change as a result of the disease.
Why It Matters
ME/CFS lacks validated diagnostic markers and proven therapies, making investigation of the microbiome-disease axis potentially valuable for identifying new diagnostic and treatment targets. Understanding whether early-life antibiotic exposure and dysbiosis contribute to ME/CFS pathogenesis could inform preventive strategies and personalized interventions for patients.
Observed Findings
Dysbiosis is associated with ME/CFS in multiple studies reviewed
Altered levels of short-chain fatty acids have been reported in ME/CFS patients
Abnormalities in tryptophan metabolism and reduced kynurenine pathway activity are documented in ME/CFS
Lifetime antibiotic exposure patterns differ in ME/CFS populations compared to controls
Increased gut permeability markers are reported in some ME/CFS cohorts
Inferred Conclusions
Antibiotic use throughout life may be a risk factor for dysbiosis that predisposes to ME/CFS
Multiple mechanistic pathways—including altered gut-brain axis signaling, bacterial translocation, and mitochondrial dysfunction—may link dysbiosis to ME/CFS symptoms
Microbiome-targeted interventions warrant systematic investigation in ME/CFS populations
Causality between microbiome composition and ME/CFS pathogenesis remains unclear and requires longitudinal studies
Remaining Questions
Does dysbiosis cause ME/CFS, or does ME/CFS cause dysbiosis through immune and metabolic changes?
What is the specific role of D-lactic acidosis and early-life antibiotic exposure in ME/CFS etiology?
What This Study Does Not Prove
This systematic review establishes plausibility and correlation between microbiome alterations and ME/CFS, but does not prove causation. The study cannot establish whether dysbiosis causes ME/CFS, results from ME/CFS, or represents an independent consequence of shared etiologic factors. No clinical efficacy data are presented for proposed interventions.
Which microbiota-targeted interventions (probiotics, dietary changes, fecal microbiota transplantation) are clinically efficacious and for which ME/CFS patient subgroups?
How do microbiome alterations mechanistically contribute to neurocognitive impairment in ME/CFS?