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Haunhorst, S.* ; Dudziak, D.* ; Scheibenbogen, C.* ; Seifert, M.* ; Sotzny, F.* ; Finke, C.* ; Behrends, U. ; Aden, K.* ; Schreiber, S.* ; Brockmann, D.* ; Burggraf, P.* ; Bloch, W.* ; Ellert, C.* ; Ramoji, A.* ; Popp, J.* ; Reuken, P.* ; Walter, M.* ; Stallmach, A.* ; Puta, C.*

Towards an understanding of physical activity-induced post-exertional malaise: Insights into microvascular alterations and immunometabolic interactions in post-COVID condition and myalgic encephalomyelitis/chronic fatigue syndrome.

Infection, DOI: 10.1007/s15010-024-02386-8 (2024)
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BACKGROUND: A considerable number of patients who contracted SARS-CoV-2 are affected by persistent multi-systemic symptoms, referred to as Post-COVID Condition (PCC). Post-exertional malaise (PEM) has been recognized as one of the most frequent manifestations of PCC and is a diagnostic criterion of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Yet, its underlying pathomechanisms remain poorly elucidated. PURPOSE AND METHODS: In this review, we describe current evidence indicating that key pathophysiological features of PCC and ME/CFS are involved in physical activity-induced PEM. RESULTS: Upon physical activity, affected patients exhibit a reduced systemic oxygen extraction and oxidative phosphorylation capacity. Accumulating evidence suggests that these are mediated by dysfunctions in mitochondrial capacities and microcirculation that are maintained by latent immune activation, conjointly impairing peripheral bioenergetics. Aggravating deficits in tissue perfusion and oxygen utilization during activities cause exertional intolerance that are frequently accompanied by tachycardia, dyspnea, early cessation of activity and elicit downstream metabolic effects. The accumulation of molecules such as lactate, reactive oxygen species or prostaglandins might trigger local and systemic immune activation. Subsequent intensification of bioenergetic inflexibilities, muscular ionic disturbances and modulation of central nervous system functions can lead to an exacerbation of existing pathologies and symptoms.
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Publication type Article: Journal article
Document type Review
Keywords Me/cfs ; Physical Activity ; Post Covid Condition ; Post-exertional Malaise ; Sars-cov-2; Fatty-acid Oxidation; Acute Sequelae; Post-covid-19 Syndrome; Endothelial Function; Postacute Sequelae; Long; Sars-cov-2; Exercise; Muscle; Pathophysiology
Language english
Publication Year 2024
HGF-reported in Year 2024
ISSN (print) / ISBN 0300-8126
e-ISSN 1439-0973
Journal Infection - A Journal of Infectious Disease
Publisher Urban & Vogel
Publishing Place Tiergartenstrasse 17, D-69121 Heidelberg, Germany
Reviewing status Peer reviewed
Institute(s) Research Unit Gene Vector (AGV)
POF-Topic(s) 30203 - Molecular Targets and Therapies
Research field(s) Immune Response and Infection
PSP Element(s) G-501500-001
Grants Friedrich-Schiller-Universitt Jena (1010)
DOI 10.1007/s15010-024-02386-8
WOS ID 001308065700001
Scopus ID 85203282365
PubMed ID 39240417
Erfassungsdatum 2024-10-15
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