Blitshteyn et al. (2026)
- Authors: Svetlana Blitshteyn, Taylor A. Doherty, Lawrence Steinman
- Institutes: Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA, University of California San Diego, La Jolla, CA, USA, Stanford University, Stanford, CA, USA
- Publisher: ImmunoTargets and Therapy
- Link: DOI
Summary
This review provides a critical theoretical foundation for treating post-viral syndromes as biological, neuroimmune diseases rather than psychological ones. By validating shared mechanisms like autoimmunity and neuroinflammation, it paves the way for wider research into and use of immunomodulating treatments such as intravenous immunoglobulin (IVIG) 💊. The paper argues that reclassifying these conditions will modernize clinical training and improve patient access to specialized neurological care.
What was researched?
This narrative review examines the overlapping pathophysiological mechanisms of POTS, ME/CFS, and Long COVID. It explores how autonomic dysfunction, immune dysregulation, and neuroinflammation collectively characterize these conditions as a unified category of illness.
Why was it researched?
These disorders are frequently misdiagnosed as psychiatric conditions, leading to significant disability and delays in effective care. The authors seek to establish a formal neuroimmune framework to improve medical education and clinical care pathways.
How was it researched?
The researchers synthesized evidence from neuroimaging, immunological studies, and clinical observations across the three syndromes. They analyzed shared biomarkers, such as G-protein coupled receptor autoantibodies and cytokines, to identify common disease pathways involving the brain-immune axis.
What has been found?
The study identified common mechanisms including autoimmunity, mitochondrial dysfunction, and cerebral hypoperfusion across all three conditions. Advanced 7T MRI imaging reveals localized neuroinflammation in the brainstem’s dorsolateral medulla, which may serve as a central driver for autonomic and cognitive symptoms.
Discussion
The authors compare the current clinical landscape of these disorders to the historical trajectory of Multiple Sclerosis, which was once dismissed as psychological. They emphasize that recognizing the role of microglial activation and the vagus nerve is essential for moving beyond outdated psychiatric models.
Conclusion & Future Work
POTS, ME/CFS, and Long COVID should be formally categorized as neuroimmune disorders and integrated into the field of neuroimmunology. This shift is expected to facilitate the development and repurposing of effective immunotherapies 💊.