Development and validation of blood-based diagnostic biomarkers for [ME/CFS] using EpiSwitch®… 2025, Hunter et al. (Oxford Biodynamics)

Why ME/CFS Biomarker Headlines Keep Failing to Deliver​


Every few years, headlines appear claiming that scientists have finally found a biomarker for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Each time, the community feels a surge of hope: maybe this is it—the long-awaited diagnostic test that will legitimize the disease and speed up treatment research.

And yet, decades later, we still don’t have a clinically validated biomarker. The latest announcement about the EpiSwitch blood test is just the newest chapter in this long story of excitement and disappointment.

Why a Biomarker for ME/CFS Matters​

A biomarker—a measurable biological signal that identifies a disease—could change everything for ME/CFS. It could shorten the years-long diagnostic delays, help distinguish ME/CFS from overlapping illnesses, and guide treatment development (Jason et al., 2023).

But identifying one has proven incredibly difficult. ME/CFS is a heterogeneous condition. No two patients are the same, and the biological pathways involved—immune, metabolic, vascular, and neurological—are deeply interconnected (Proal & VanElzakker, 2025).

The Pattern: Discovery, Hype, and Disappointment​

The ME/CFS field has followed a predictable pattern for years:

  1. A small study identifies a biological difference between patients and healthy controls.
  2. The media declares it a “breakthrough blood test.”
  3. The findings fail to replicate in larger, more diverse groups.
  4. The discovery fades—until the next big claim.
This cycle has played out with cytokine panels (Montoya et al., 2017), mitochondrial enzyme assays (Armstrong et al., 2015), metabolomic signatures (Naviaux et al., 2016), and red blood cell deformability (Saha et al., 2019). Each produced intriguing findings, but none proved specific or stable enough to serve as a diagnostic test.

Nature News actually reported on this development. I don't think I am allowed to share the article because it requires a subscription (which I have). I can share this one quote that might be the most important takeaway.

“I think it’s really cool they brought this method to the field,” says Katie Glass, a molecular biologist who studies ME/CFS at Cornell University in Ithaca, New York. “As far as it being a biomarker, my enthusiasm would be pretty tempered because the cohort is very small and they looked at only very severe patients.”

The tools available to researchers keep improving.

 
Nature News actually reported on this development. I don't think I am allowed to share the article because it requires a subscription (which I have). I can share this one quote that might be the most important takeaway.

“I think it’s really cool they brought this method to the field,” says Katie Glass, a molecular biologist who studies ME/CFS at Cornell University in Ithaca, New York. “As far as it being a biomarker, my enthusiasm would be pretty tempered because the cohort is very small and they looked at only very severe patients.”

The tools available to researchers keep improving.

Don’t take this a legal advice because I don’t have a legal background, but I think fair use generally allows for sharing a fairly large chunk of the article for non-commercial comment or criticism.

So your quote is probably well within what’s allowed.
 
Article in Womens health magazine:

Scientists just developed a blood test that can diagnose chronic fatigue and long Covid​


Turns out, Chronic Fatigue Syndrome (CFS) and long Covid have a few things in common. For one, they're notoriously tricky to diagnose. So when researchers said they developed a blood test that may be able to detect both of these conditions, our curiosity was piqued.



In case you're not familiar with the diseases, CFS is a disease that causes extreme, life-altering fatigue, per the Centers for Disease Control and Prevention (CDC). It's estimated that it impacts 3.3 million people in the US. In the UK, recent research suggests that approximately 403,000 people are living with ME/CFS – roughly 0.6% of the population – though older estimates put the figure closer to 250,000.


Long Covid is a chronic condition that happens after someone has a Covid-19 infection, with symptoms like fatigue, trouble breathing, and brain fog lasting for at least three months, per the CDC. It's affected roughly two million people in the UK.
While the study focused on CFS, there is some biological overlap with long Covid, says Dmitry Pshezhetskiy, PhD, lead study author and research fellow at the University of East Anglia.


Basically, because the two conditions may create similar changes (called biological "signatures") in DNA and biology that are detectable on a blood test, this CFS test could eventually be adapted and tweaked in order to detect long Covid. Still, more and larger studies will need to confirm all of this.

What does this mean for patients?


“It would be hugely helpful—incredibly valuable—to have a test for long Covid,” says James C. Jackson, PsyD, research professor of Medicine at Vanderbilt Medical Center and author of Clearing the Fog: From Surviving to Thriving with Long Covid—A Practical Guide. “In the absence of an objective test, diagnosing long Covid is challenging and, often, it is a diagnosis of exclusion—meaning that if clinicians can't come up with other explanations, it is only then that they land on a diagnosis of long Covid.” This process takes a lot of time and resources and can be “incredibly frustrating” for patients, Jackson says.


Similarly, for CFS, diagnosis is often based on symptoms and ruling out other causes, which can take months or even years. A reliable blood test would give patients faster answers.


Ultimately, figuring out where these two illnesses overlap can help guide researchers into developing targeted treatments to help get to the root of what is causing these conditions, Pshezhetskiy says.
:thumbsdown:
 
Response to the study

Wheat and chaff in Myalgic Encephalomyelitis/Chronic fatigue syndrome (ME/CFS) in clinics and laboratory​


First, the article repeatedly asserts that “immune dysregulation” is a hallmark of ME/CFS, citing elevated pro-inflammatory cytokines and natural killer (NK) cell dysfunction. However, whereas the authors cite updated papers with a presumptive relationship with the issue, a critical omission here is the lack of citation of early foundational immunological studies in ME/CFS [2]. Notably absent is the 1994 work by Tirelli et al. in the Scandinavian Journal of Immunology, which documented, for the first time, immunological abnormalities in CFS patients and could serve as an important historical anchor for claims of immune dysregulation [2]. This omission raises concerns about reporting bias and selective citation to frame the narrative around newer, possibly more aligned findings with the current study methodology [2, 3].

 
This letter to the editor promotes oxygen-ozone therapy for ME/CFS in the absence of reliable evidence. The authors of the letter appear to have a strong commitment to this therapy, yet they declare they have no conflict of interest.

The paragraph of interest:
Most notably, the paper omits discussion of alternative or adjunctive therapies for ME/CFS that have shown promise, such as oxygen-ozone therapy (OOT) [5,6,7]. Despite growing peer-reviewed literature on the potential of oxygen-ozone autohemotherapy to alleviate fatigue symptoms in ME/CFS, the authors do not cite recent studies regarding the ability of oxygen-ozone to address fatigue and other disabilities in ME/CFS (5–7). The omission of this therapy, which directly targets oxidative stress and immune modulation, both relevant to ME/CFS pathophysiology, suggests selective reporting and a possible conflict of interest given the study commercial backing by Oxford BioDynamics plc [1].

Affiliation of one of the authors:
Italian Scientific Society of Oxygen-Ozone Therapy (SIOOT), Bergamo, Italy
Marianno Franzini

It looks like this organization has paid courses about oxygen-ozone therapy (auto-translated link). The program (archived link) says "SIOOT/ASOO member fee: €180,00 - Non-members: €230,00" (translated from Italian).

The above author appears to be a speaker at both of the courses listed on the website, while the author Salvatore Chirumbolo appears to be listed for one.
 
From the letter to the editor, with bolding added:
Most notably, the paper omits discussion of alternative or adjunctive therapies for ME/CFS that have shown promise, such as oxygen-ozone therapy (OOT) [5,6,7].
It's interesting that the authors think the most notable issue in a paper about developing a diagnostic test is that they didn't discuss alternative treatments.

And for the only example of such a treatment that they give, the only references they used to support the treatment are from the same three authors as this letter.
5. Chirumbolo S, Franzini M, Tirelli U. Post-infective myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and post-COVID as two puzzling faces of the same medal. Recent insights. Int Immunopharmacol. 2025;152:114365. https://doi.org/10.1016/j.intimp.2025.114365

6. Tirelli U, Franzini M, Valdenassi L, Pandolfi S, Berretta M, Ricevuti G, Chirumbolo S. Patients with myalgic Encephalomyelitis/Chronic fatigue syndrome (ME/CFS) greatly improved fatigue symptoms when treated with Oxygen-Ozone autohemotherapy. J Clin Med. 2021;11(1):29. https://doi.org/10.3390/jcm11010029

7. Chirumbolo S, Valdenassi L, Franzini M, Pandolfi S, Ricevuti G, Tirelli U. Male vs. Female differences in responding to Oxygen-Ozone autohemotherapy (O2-O3-AHT) in patients with myalgic Encephalomyelitis/Chronic fatigue syndrome (ME/CFS). J Clin Med. 2021;11(1):173. https://doi.org/10.3390/jcm11010173
 
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