Understanding, diagnosing, and treating Myalgic encephalomyelitis/chronic fatigue syndrome - State of the art: Report of the 2nd international meeting at the Charité Fatigue Center.
Steiner, Sophie, Fehrer, Annick, Hoheisel, Friederike et al. · Autoimmunity reviews · 2023 · DOI
Quick Summary
Over 100 international researchers gathered in Berlin in May 2023 to discuss what we currently know about ME/CFS, how to diagnose it, and how to treat it. The conference highlighted that ME/CFS involves problems with the immune system, blood vessel function, and nervous system control, and that some cases may be triggered by viruses reactivating in the body. Despite growing interest due to Long COVID, ME/CFS remains under-researched and needs significantly more funding to find better diagnostic tests and targeted treatments.
Why It Matters
This conference report captures the current scientific consensus on ME/CFS from leading international experts and identifies critical research gaps during a pivotal moment when Long COVID has increased disease visibility and research funding. It provides patients and clinicians with an authoritative overview of emerging diagnostic and treatment approaches, while emphasizing that substantial additional research is needed to move from general pathomechanism understanding to specific, actionable interventions.
Observed Findings
- Increased ME/CFS prevalence is occurring following the COVID-19 pandemic and Long COVID emergence, expanding the affected population.
- Immune system dysfunction, endothelial dysfunction, and autonomic nervous system dysfunction were identified as key pathomechanisms across multiple research groups.
- Viral reactivation was discussed as a potential contributing factor in disease etiology and pathophysiology.
- Current diagnostic approaches lack standardization and validated biomarkers, complicating disease recognition and research.
- Over 700 researchers and clinicians worldwide are actively engaged in ME/CFS research, indicating growing scientific momentum.
Inferred Conclusions
- ME/CFS involves dysregulation of multiple interconnected systems (immune, vascular, neurological) rather than a single pathogenic mechanism.
- Despite increased public attention and funding opportunities, ME/CFS remains significantly under-resourced relative to disease burden and complexity.
- Systematic identification of diagnostic biomarkers and mechanistic understanding of patient heterogeneity are essential prerequisites for developing targeted therapies.
- Collaborative, multidisciplinary international research efforts are necessary to advance the field toward precision medicine approaches.
Remaining Questions
- Which specific immune abnormalities, viral reactivation patterns, or autonomic/endothelial dysfunctions are pathogenic versus secondary to disease, and which are present across all patients versus patient subgroups?
- What validated diagnostic biomarkers or clinical assessments can reliably identify ME/CFS, stratify patient subtypes, and monitor disease progression?
- Which emerging treatment approaches show promise in rigorous clinical trials, and what mechanistic targets should be prioritized for drug development?
- How does Long COVID relate to ME/CFS mechanistically, and do post-viral ME/CFS cases share identical pathophysiology with non-viral onset cases?
What This Study Does Not Prove
This is a conference summary and evidence map, not a primary research study; it does not prove any novel hypotheses but rather synthesizes existing knowledge and expert opinion. The document does not establish definitive causative mechanisms, validated diagnostic criteria, or efficacy of any specific treatment—it identifies these as future research priorities. The findings represent areas of scientific consensus but do not constitute proof at the level of controlled trials or robust mechanistic studies.
Topics
Tags
Metadata
- DOI
- 10.1016/j.autrev.2023.103452
- PMID
- 37742748
- Review status
- Editor reviewed
- Evidence level
- Established evidence from major reviews, guidelines, or evidence maps
- Last updated
- 7 April 2026