Preprint iPSC-Derived Myogenic Progenitor Cells from People with ME/CFS Reveal Altered Genes and Pathways with Drug Repurposing Potential, 2026, Nguyen

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iPSC-Derived Myogenic Progenitor Cells from People with ME/CFS Reveal Altered Genes and Pathways with Drug Repurposing Potential

Nguyen, Dao

Background
Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a debilitating multisystem disorder characterised by profound fatigue, post-exertional malaise, muscle pain and weakness. Although skeletal muscle abnormalities and mitochondrial alterations have been reported in people with ME/CFS, the underlying biological processes remain poorly understood, and no validated disease models, biomarkers or effective treatments are currently available.

This study used patient-derived induced pluripotent stem cell (iPSC) myogenic progenitor (MP) cells to investigate intrinsic transcriptomic abnormalities in ME/CFS and identify potential drug repurposing candidates.

Methods
MP cells were generated from iPSCs derived from people with ME/CFS and healthy controls, and successfully characterised. Global mRNA sequencing was performed to compare transcriptomic profiles between ME/CFS and control MP cells (n = 6 ME/CFS; n = 7 controls).

Differentially expressed genes and pathways were identified, followed by drug repurposing analysis using the Library of Integrated Network-based Cellular Signatures drug database (LINCS2) and supporting literature review.

Results
RNA sequencing identified seven differentially expressed genes at adjusted p < 0.05, including MIR205HG , FEZF1 , HLA-DMB , SLC1A2 , SYT13 , GALNT4 , and SLC2A14 . Pathway analysis identified 73 differentially expressed pathways, of which 96% were downregulated in ME/CFS MP cells.

Downregulated pathways included those involved in cell cycle regulation, DNA replication, mismatch repair, immune response and muscle cytoskeleton regulation-related pathways. In contrast, upregulated pathways were associated with metabolic reprogramming, including increased reliance on branched-chain amino acids for energy production.

These findings suggest intrinsic abnormalities in ME/CFS-derived MP cells, particularly involving metabolic regulation, mitochondrial function and muscle-related cellular processes.

Based on the differentially expressed genes, LINCS2-based drug repurposing analysis and literature review identified 22 candidate drugs with potential relevance to ME/CFS. These included safe and widely available agents such as leflunomide, melatonin and midodrine, which target pathways related to antiviral defence, immunomodulation, neurotransmitter modulation, autonomic regulation and vascular function.

Conclusions
Patient-derived iPSC-MP cells provide a useful model for investigating intrinsic skeletal muscle-related abnormalities in ME/CFS.

Transcriptomic profiling revealed altered pathways related to cell cycle regulation, immune function, cytoskeletal organisation and energy metabolism, supporting the involvement of mitochondrial and metabolic dysfunction in ME/CFS pathobiology.

Drug repurposing analysis identified several clinically relevant candidates that may warrant further functional validation as potential therapeutic options for ME/CFS.

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Discussion about buspirone/prolactin response:
MIR205HG is a non-long coding gene that regulates the prolactin expression, primarily through its modulatory effects on transcriptional and post-transcriptional signalling pathways [30]. [...]

Previous studies have reported heightened prolactin responses to serotonergic and dopaminergic challenge tests in ME/CFS patients, despite baseline prolactin levels being typically normal. [...]

It is possible that reduced MIR205HG expression diminishes its regulatory control over prolactin synthesis or release, contributing to the heightened sensitivity of the prolactin axis seen in ME/CFS.
 
Dang no males in the ME/CFS cohort, with only 7 patients.

Unveiling the ups and downs of miR-205 in physiology and cancer: transcriptional and post-transcriptional mechanisms
Finally,miR-205 is highly expressed in thymic epithelial cells,
where it helps to preserve T-cell maturation in response
to strong inflammatory insults, such as infections, radia-
tion exposure, and steroids.
 
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