Review POTS, ME/CFS and Long COVID as Neuroimmune Disorders, 2026, Blitshteyn et al

[John Mac]

Full title: Postural Orthostatic Tachycardia Syndrome, Myalgic Encephalomyelitis/Chronic Fatigue Syndrome and Long COVID as Neuroimmune Disorders

Abstract:
Postural orthostatic tachycardia syndrome (POTS), myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and Long COVID are heterogeneous disorders with overlapping complex, multi-factorial and multi-systemic pathophysiology.

POTS and ME/CFS are the most common phenotypes of Long COVID that can lead to significant disability and functional impairment. The exact pathophysiologic mechanisms of these disorders alone or in combination are still being investigated, but important mechanistic factors have been identified, such as autonomic dysfunction, immune dysregulation, autoimmunity, mitochondrial dysfunction, cerebral hypoperfusion, and neuroinflammation.

To this end, we believe that these conditions should be viewed as neuroimmune disorders and should be included in the field of neuroimmunology, with its educational curriculum, training, and clinical care pathways. Including these disorders as part of neuroimmunology subspecialty is the key to advancing the science and clinical care of this underserved patient population with these complex and disabling conditions.

POTS, ME/CFS and Long COVID as neuroimmune disorders | ITT

Postural orthostatic tachycardia syndrome, myalgic encephalomyelitis/chronic fatigue syndrome and Long COVID are heterogeneous disorders with overlapping terms.

www.dovepress.com

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[Jonathan Edwards]

Just plain wrong again, unsurprisingly.

 

[Jaybee00]

Just plain wrong again, unsurprisingly

Svetlana disagrees.



Hot off the press: my new paper that moves this field forward and changes the narrative on what #POTS, #MECFS and #LongCOVID are... Neuroimmune Disorders!

The brain and the autonomic nervous system are involved in the immune system regulation.
There is evidence of autoimmunity, immune dysregulation, cerebral hypoperfusion, neuroinflammation and other mechanisms in all three disorders.
#Neuroimmunology is a field that should embrace these disorders: #MultipleSclerosis, the staple of neuroimmunology, used to be called hysterical paralysis before CT and MRI were invented. We're at the same crossroads with these disorders.
These disorders are not "mysterious", "anxiety", "deconditioning," "functional neurologic" etc. etc.
Classifying these disorders as neuroimmune and including them as part of neuroimmunology training is critical.
#PatientCare and lives of millions of people living with these disabling conditions are at stake!

Thanks to my esteemed colleagues and co-authors, Dr. @TaylorDoherty8, immunologist from UC San Diego and Dr. Lawrence Steinman, neuroimmunologist from @StanfordMed, for their support!

 

[DHagen]

Just plain wrong again, unsurprisingly.

Would you be willing to comment on what, specifically, is obviously wrong here? I know there are lots of problems with Dr. Blitshteyn's work and comments elsewhere, and there is much here that is clearly speculative, but are there claims that are demonstrably false?

 

[DMissa]

Would you be willing to comment on what, specifically, is obviously wrong here? I know there are lots of problems with Dr. Blitshteyn's work and comments elsewhere, and there is much here that is clearly speculative, but are there claims that are demonstrably false?

Possibly claims of mechanism in the abstract, when there are currently none that can be made in specific terms with reliable evidence behind them.

 

[Jonathan Edwards]

Would you be willing to comment on what, specifically, is obviously wrong here?

Yup.

important mechanistic factors have been identified, such as autonomic dysfunction, immune dysregulation, autoimmunity, mitochondrial dysfunction, cerebral hypoperfusion, and neuroinflammation.

None of these have been identified convincingly to my knowledge. Certainly nothing has been shown to be an 'important mechanistic factor' even if there are a few data showing differences from normals. The mechanisms are completely unknown.

 

[Jonathan Edwards]

Also:

POTS and ME/CFS are the most common phenotypes of Long COVID that can lead to significant disability and functional impairment.

Is wrong. Most Long Covid gets better before it qualifies as ME/CFS. 'POTS' is so vaguely defined, beyond orthosttic tachycardia, which may be normal, that it is absurd even to make this statement.

This is make believe quack medicine pure and simple.

 

[hotblack]

Hot off the press: my new paper that moves this field forward and changes the narrative on what #POTS, #MECFS and #LongCOVID are... Neuroimmune Disorders!

How can this move the field forward when there is (1) no new evidence, it’s a review and (2) no new ideas, just claims of things like neuroinflammation and t-cell exhaustion we’ve heard before.. Repeating something does not move a field forward. New evidence and new ideas do.

 

[DHagen]

None of these have been identified convincingly to my knowledge. Certainly nothing has been shown to be an 'important mechanistic factor' even if there are a few data showing differences from normals. The mechanisms are completely unknown.

Also:


Is wrong. Most Long Covid gets better before it qualifies as ME/CFS. 'POTS' is so vaguely defined, beyond orthosttic tachycardia, which may be normal, that it is absurd even to make this statement.

This is make believe quack medicine pure and simple.

Thank you for responding. I suppose I was just surprised at the casual and complete dismissal and was not reading "identified" to mean "proven," but that's on me. I was more focused on the neuroimmune claim, which I thought many here supported, at least as a likelihood.

Despite participating in some of the recent discussions on the topic, I also keep forgetting that everyone working on ME/CFS (save, what? Maybe 4 researchers?) practices "quack medicine."

Regardless, I recognize that, even if this paper's claims were 100% supported, it wouldn't get us anywhere and doesn't have anything new to offer - so I'll stop wasting time on the matter.

Thanks again for the clarification. I can imagine it must be exhausting to have so many people clamoring for comment and explanation (particularly when new people keep dropping in and out of the on-going conversation and you no doubt feel - quite rightly - your position has been made abundantly clear elsewhere). I appreciate your taking the time.