Understanding Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Physical Fatigue Through the Perspective of Immunosenescence.

Luo, Yingzhe, Xu, Huimin, Xiong, Shaoquan et al. · Comprehensive Physiology · 2025 · DOI

Quick Summary

This review examines how our immune system's aging process may explain the severe fatigue in ME/CFS. As immune cells age, they cause chronic inflammation that damages the energy-producing parts of our cells (mitochondria), while stress hormones and nerve signals become imbalanced. These problems across different body systems work together to create and maintain the exhaustion that defines ME/CFS.

Why It Matters

This work offers a coherent biological explanation for ME/CFS fatigue by connecting immune aging to energy metabolism and hormone dysfunction—potentially identifying new therapeutic targets and biomarkers (cytokines, immune exhaustion markers). Understanding these cross-system interactions may shift clinical approaches from single-system treatments to integrated strategies addressing immune and metabolic dysfunction simultaneously.

Observed Findings

Aging immune cells drive chronic inflammatory states that impair mitochondrial ATP production and promote muscle protein breakdown.
HPA-axis suppression and β2-adrenergic dysfunction amplify immune dysregulation and exacerbate energy imbalance.
Senescent immune phenotypes are associated with persistent fatigue states.
Maladaptive signaling occurs between immune, muscular, neuroendocrine, and vascular systems in ME/CFS.
Cytokines and immune exhaustion markers emerge as potential biomarkers for disease severity.

Inferred Conclusions

Immunosenescence provides a unifying biological framework that explains how immune aging, mitochondrial dysfunction, and neuroendocrine imbalance converge to produce systemic fatigue in ME/CFS.
Cross-organ communication and maladaptive crosstalk are central to ME/CFS pathology and should guide therapeutic development.
Integrated treatment strategies targeting both immune dysregulation and metabolic dysfunction may be more effective than single-pathway interventions.

Remaining Questions

Does immunosenescence precede ME/CFS onset or develop secondarily; is it a primary driver or consequence of disease?
Which specific cytokines and exhaustion markers best predict disease severity and treatment response?
What are the effective therapeutic targets within immune, metabolic, and neuroendocrine networks, and which interventions provide clinical benefit?
How do genetic, environmental, and infectious factors interact with immunosenescence to initiate and maintain ME/CFS?

What This Study Does Not Prove

This review does not prove that immunosenescence causes ME/CFS; it presents evidence for association and biological plausibility. The study cannot establish whether immunosenescence is primary or secondary to other disease processes. It also does not validate specific biomarkers or demonstrate efficacy of proposed therapeutic interventions in clinical trials.

Metadata

DOI: 10.1002/cph4.70056
PMID: 41017304
Review status: Editor reviewed
Evidence level: Established evidence from major reviews, guidelines, or evidence maps
Last updated: 7 April 2026