{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T12:48:40Z","timestamp":1792759720143,"version":"4.5.0"},"reference-count":69,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T00:00:00Z","timestamp":1771977600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100017001","name":"Li Ka Shing Institute of Virology, University of Alberta","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100017001","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>The cellular mechanisms underlying Long COVID (LC) associated with myalgic encephalomyelitis\/chronic fatigue syndrome (ME\/CFS) remain poorly understood.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed single-cell RNA sequencing (scRNA-seq) on peripheral blood mononuclear cells collected 12 months after acute COVID-19 infection from female individuals with LC-ME\/CFS and recovered (R) individuals. Comparative analysis was also performed using publicly available scRNA-seq datasets from idiopathic ME\/CFS patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Based on transcriptional signatures, LC-ME\/CFS patients exhibited a marked reduction in na\u00efve CD4\n                      <jats:sup>+<\/jats:sup>\n                      and CD8\n                      <jats:sup>+<\/jats:sup>\n                      T cells, regulatory T cells, MAIT cells, and \u03b3\u03b4 T cells, accompanied by an expansion of effector T cells. NK cells displayed reduced frequency and altered activation-associated transcriptional factors, consistent with impaired cytotoxic potentials. B cells in LC patients exhibited gene expression profiles indicative of heightened activation, while plasma cells revealed a distinct transcriptional subset expressing NK-associated genes. Platelets and low-density neutrophils were expanded and exhibited enrichment of activated-related transcripts. Monocyte subsets demonstrated transcriptional skewing characterized by reduced expression of phagocytosis-associated genes and increased expression of pro-inflammatory cytokine-related genes\/pathways. In contrast, idiopathic ME\/CFS patients exhibited less pronounced immune alterations at the transcriptional level: while T cell activation was evident, there was no reduction in MAIT or NK cells, nor signs of T cell exhaustion. Notably, FOXP3 expression was upregulated, and B cells and platelets demonstrated dysregulated signatures in idiopathic ME\/CFS. Mechanistically, we identify Galectin-9\u2013TIM-3 interaction as a potential pathway driving \u03b3\u03b4 and MAIT cell depletion in LC.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our results reveal extensive peripheral immune remodeling in LC-ME\/CFS, distinct from idiopathic ME\/CFS, and support a model of chronic immune activation and dysregulation. Our findings offer a cellular framework for understanding LC pathogenesis and point to potential biomarkers and therapeutic targets for intervention.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fimmu.2026.1745933","type":"journal-article","created":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T07:03:12Z","timestamp":1772002992000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":7,"title":["Single-cell analysis reveals immune remodeling of monocytes, NK cells, T cell exhaustion, and Galectin-9\u2013associated depletion of gamma delta and mucosal-associated invariant T cells in Long COVID with ME\/CFS"],"prefix":"10.3389","volume":"17","author":[{"given":"Shima","family":"Shahbaz","sequence":"first","affiliation":[{"name":"Mike Petryk School of Dentistry, Division of Foundational Sciences, University of Alberta","place":["Edmonton, AB, Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Najmeh","family":"Bozorgmehr","sequence":"additional","affiliation":[{"name":"Mike Petryk School of Dentistry, Division of Foundational Sciences, University of Alberta","place":["Edmonton, AB, Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amirhossein","family":"Rahmati","sequence":"additional","affiliation":[{"name":"Mike Petryk School of Dentistry, Division of Foundational Sciences, University of Alberta","place":["Edmonton, AB, Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amal","family":"Abouda","sequence":"additional","affiliation":[{"name":"Mike Petryk School of Dentistry, Division of Foundational Sciences, University of Alberta","place":["Edmonton, AB, Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hussain","family":"Syed","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Gastroenterology, University of Alberta","place":["Edmonton, AB, Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed","family":"Osman","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Rheumatology, University of Alberta","place":["Edmonton, AB, Canada"]},{"name":"Li Ka Shing Institute of Virology, University of Alberta","place":["Edmonton, AB, Canada"]},{"name":"Women and Children Health Research Institute, University of Alberta","place":["Edmonton, AB, Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shokrollah","family":"Elahi","sequence":"additional","affiliation":[{"name":"Mike Petryk School of Dentistry, Division of Foundational Sciences, University of Alberta","place":["Edmonton, AB, Canada"]},{"name":"Department of Medicine, Division of Rheumatology, University of Alberta","place":["Edmonton, AB, Canada"]},{"name":"Women and Children Health Research Institute, University of Alberta","place":["Edmonton, AB, Canada"]},{"name":"Cancer Research Institute of Northern Alberta, University of Alberta","place":["Edmonton, AB, Canada"]},{"name":"Glycomics Institute of Alberta, University of Alberta","place":["Edmonton, AB, Canada"]},{"name":"Alberta Transplant Institute, Faculty of Medicine and Dentistry, University of Alberta","place":["Edmonton, AB, Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,2,25]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1136\/jim-2021-002051","article-title":"Long COVID following mild SARS-CoV-2 infection: characteristic T cell alterations and response to antihistamines","volume":"70","author":"Glynne","year":"2022","journal-title":"J Investig Med"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2024.1443363","article-title":"Exploring the role of galectin-9 and artemin as biomarkers in long COVID with chronic fatigue syndrome: links to inflammation and cognitive function","volume":"15","author":"Elahi","year":"2024","journal-title":"Front Immunol"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaut.2024.103267","article-title":"Diverse immunological dysregulation, chronic inflammation, and impaired erythropoiesis in long COVID patients with chronic fatigue syndrome","volume":"147","author":"Saito","year":"2024","journal-title":"J Autoimmun"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2024.1341843","article-title":"Metabolomic and immune alterations in long COVID patients with chronic fatigue syndrome","volume":"15","author":"Saito","year":"2024","journal-title":"Front Immunol"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1038\/s41579-022-00846-2","article-title":"Long COVID: major findings, mechanisms and recommendations","volume":"21","author":"Davis","year":"2023","journal-title":"Nat Rev Microbiol"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1002\/rmv.1832","article-title":"The bitter side of sweet: the role of Galectin-9 in immunopathogenesis of viral infections","volume":"25","author":"Merani","year":"2015","journal-title":"Rev Med Virol"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1038\/nm.2422","article-title":"Protective HIV-specific CD8+ T cells evade Treg cell suppression","volume":"17","author":"Elahi","year":"2011","journal-title":"Nat Med"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.4049\/jimmunol.1901481","article-title":"Galectin-9 and VISTA expression define terminally exhausted T cells in HIV-1 infection","volume":"204","author":"Shahbaz","year":"2020","journal-title":"J Immunol"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.4049\/immunohorizons.1900087","article-title":"Galectin-9 expression defines a subpopulation of NK cells with impaired cytotoxic effector molecules but enhanced IFN-gamma production, dichotomous to TIGIT, in HIV-1 infection","volume":"3","author":"Motamedi","year":"2019","journal-title":"Immunohorizons"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1038\/s41590-023-01724-6","article-title":"Long COVID manifests with T cell dysregulation, inflammation and an uncoordinated adaptive immune response to SARS-CoV-2","volume":"25","author":"Yin","year":"2024","journal-title":"Nat Immunol"},{"key":"B11","doi-asserted-by":"publisher","first-page":"0","DOI":"10.1016\/j.bbi.2024.11.032","article-title":"Upregulation of olfactory receptors and neuronal-associated genes highlights complex immune and neuronal dysregulation in Long COVID patients","author":"Shahbaz","year":"2024","journal-title":"Brain Behavious Immun"},{"key":"B12","doi-asserted-by":"publisher","first-page":"e0173022","DOI":"10.1128\/spectrum.01730-22","article-title":"Differential impact of SARS-coV-2 isolates, namely, the wuhan strain, delta, and omicron variants on erythropoiesis","volume":"10","author":"Saito","year":"2022","journal-title":"Microbiol Spectr"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1016\/j.stemcr.2021.04.001","article-title":"Erythroid precursors and progenitors suppress adaptive immunity and get invaded by SARS-CoV-2","volume":"16","author":"Shahbaz","year":"2021","journal-title":"Stem Cell Rep"},{"key":"B14","doi-asserted-by":"publisher","first-page":"100849","DOI":"10.1016\/S2666-5247(24)00055-7","article-title":"Blood transcriptomic analyses reveal persistent SARS-CoV-2 RNA and candidate biomarkers in post-COVID-19 condition","volume":"5","author":"Menezes","year":"2024","journal-title":"Lancet Microbe"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(24)00171-3","article-title":"The persistence of SARS-CoV-2 in tissues and its association with long COVID symptoms: a cross-sectional cohort study in China","volume":"24","author":"Zuo","year":"2024","journal-title":"Lancet Infect Dis"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1016\/j.lanmic.2024.101012","article-title":"Blood transcriptomic analyses do not support SARS-CoV-2 persistence in patients with post-COVID-19 condition with chronic fatigue syndrome","volume":"6","author":"Rahmati","year":"2025","journal-title":"Lancet Microbe"},{"key":"B17","doi-asserted-by":"publisher","first-page":"13046","DOI":"10.1038\/s41598-018-31390-w","article-title":"Genetic and animal model analyses reveal the pathogenic role of a novel deletion of RELN in schizophrenia","volume":"8","author":"Sobue","year":"2018","journal-title":"Sci Rep"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1016\/j.celrep.2023.112669","article-title":"Reelin through the years: From brain development to inflammation","volume":"42","author":"Alexander","year":"2023","journal-title":"Cell Rep"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1016\/j.xcrm.2023.101373","article-title":"Single-cell transcriptomics of the immune system in ME\/CFS at baseline and following symptom provocation","volume":"5","author":"Vu","year":"2024","journal-title":"Cell Rep Med"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1016\/j.xcrm.2025.102449","article-title":"Integrated immune, hormonal, and transcriptomic profiling reveals sex-specific dysregulation in long COVID patients with ME\/CFS","volume":"6","author":"Shahbaz","year":"2025","journal-title":"Cell Rep Med"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1128\/mBio.02767-19","article-title":"CD71(+) erythroid cells exacerbate HIV-1 susceptibility, mediate trans-infection, and harbor infective viral particles","volume":"10","author":"Namdar","year":"2019","journal-title":"mBio"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2023.1131379","article-title":"Galectin-9 promotes natural killer cells activity via interaction with CD44","volume":"14","author":"Rahmati","year":"2023","journal-title":"Front Immunol"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1136\/jitc-2020-002189","article-title":"Expanded antigen-experienced CD160(+)CD8(+)effector T cells exhibit impaired effector functions in chronic lymphocytic leukemia","volume":"9","author":"Bozorgmehr","year":"2021","journal-title":"J Immunother Cancer"},{"key":"B24","doi-asserted-by":"publisher","first-page":"e1289","DOI":"10.1002\/cti2.1289","article-title":"Differential transcriptional and functional properties of regulatory T cells in HIV-infected individuals on antiretroviral therapy and long-term non-progressors","volume":"10","author":"Shahbaz","year":"2021","journal-title":"Clin Transl Immunol"},{"key":"B25","doi-asserted-by":"publisher","first-page":"e1010378","DOI":"10.1371\/journal.ppat.1010378","article-title":"Elevated ATP via enhanced miRNA-30b, 30c, and 30e downregulates the expression of CD73 in CD8+ T cells of HIV-infected individuals","volume":"18","author":"Shahbaz","year":"2022","journal-title":"PloS Pathog"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1038\/s41592-019-0619-0","article-title":"Fast, sensitive and accurate integration of single-cell data with Harmony","volume":"16","author":"Korsunsky","year":"2019","journal-title":"Nat Methods"},{"key":"B27","doi-asserted-by":"publisher","first-page":"82","DOI":"10.1186\/s13024-022-00584-2","article-title":"Single-cell microglial transcriptomics during demyelination defines a microglial state required for lytic carcass clearance","volume":"17","author":"Zia","year":"2022","journal-title":"Mol Neurodegener"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1182\/blood.2024025655","article-title":"Hallmarks of T-cell exhaustion and antigen experience are absent in multiple myeloma from diagnosis to maintenance therapy","volume":"145","author":"Shasha","year":"2025","journal-title":"Blood"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2017.01215","article-title":"Coinhibitory receptor expression and immune checkpoint blockade: maintaining a balance in CD8(+) T cell responses to chronic viral infections and cancer","volume":"8","author":"Okoye","year":"2017","journal-title":"Front Immunol"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1038\/s41590-023-01575-1","article-title":"Single-cell analysis of human MAIT cell transcriptional, functional and clonal diversity","volume":"24","author":"Garner","year":"2023","journal-title":"Nat Immunol"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1182\/bloodadvances.2019000699","article-title":"Diversity of peripheral blood human NK cells identified by single-cell RNA sequencing","volume":"4","author":"Smith","year":"2020","journal-title":"Blood Adv"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1038\/s41590-024-01883-0","article-title":"High-dimensional single-cell analysis of human natural killer cell heterogeneity","volume":"25","author":"Rebuffet","year":"2024","journal-title":"Nat Immunol"},{"key":"B33","doi-asserted-by":"publisher","first-page":"e0159924","DOI":"10.1128\/mbio.01599-24","article-title":"Bipotential B-neutrophil progenitors are present in human and mouse bone marrow and emerge in the periphery upon stress hematopoiesis","volume":"15","author":"Shahbaz","year":"2024","journal-title":"mBio"},{"key":"B34","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1080\/21641846.2013.862993","article-title":"Examining case definition criteria for chronic fatigue syndrome and myalgic encephalomyelitis","volume":"2","author":"Jason","year":"2014","journal-title":"Fatigue"},{"key":"B35","doi-asserted-by":"publisher","first-page":"100","DOI":"10.1186\/s12967-020-02269-0","article-title":"Systematic review and meta-analysis of the prevalence of chronic fatigue syndrome\/myalgic encephalomyelitis (CFS\/ME)","volume":"18","author":"Lim","year":"2020","journal-title":"J Trans Med"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.1093\/pnasnexus\/pgaf406","article-title":"Soluble CD14 promotes Th17 expansion and differentiation through gamma-aminobutyric acid and expands infidel innate lymphoid cells","volume":"5","author":"Shahbaz","year":"2026","journal-title":"PNAS Nexus"},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.1002\/1878-0261.13519","article-title":"Transcriptomic profiling of peripheral blood cells in HPV-associated carcinoma patients receiving combined valproic acid and avelumab","volume":"18","author":"Bozorgmehr","year":"2024","journal-title":"Mol Oncol"},{"key":"B38","doi-asserted-by":"publisher","first-page":"e1008696","DOI":"10.1371\/journal.ppat.1008696","article-title":"Selective Upregulation of CTLA-4 on CD8+ T Cells Restricted by HLA-B*35Px Renders them to an Exhausted Phenotype in HIV-1 infection","volume":"16","author":"Elahi","year":"2020","journal-title":"PloS Pathog"},{"key":"B39","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.1012356108","article-title":"Revisiting human natural killer cell subset function revealed cytolytic CD56 CD16 NK cells as rapid producers of abundant IFN-\u03b3 on activation","volume":"108","author":"De Maria","year":"2011","journal-title":"Proc Natl Acad Sci United States America"},{"key":"B40","doi-asserted-by":"publisher","DOI":"10.1111\/all.14633","article-title":"Single-cell molecular profiling provides a high-resolution map of basophil and mast cell development","volume":"76","author":"Hamey","year":"2021","journal-title":"Allergy"},{"key":"B41","doi-asserted-by":"publisher","DOI":"10.1111\/all.70209","article-title":"Single-cell omics analysis of human basophils reveals two transcriptionally distinct populations","author":"Papavasileiou","year":"2026","journal-title":"Allergy"},{"key":"B42","doi-asserted-by":"publisher","first-page":"e3001387","DOI":"10.1371\/journal.pbio.3001387","article-title":"Neutrophils promote T-cell activation through the regulated release of CD44-bound Galectin-9 from the cell surface during HIV infection","volume":"19","author":"Dunsmore","year":"2021","journal-title":"PloS Biol"},{"key":"B43","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2021.780910","article-title":"Differential signature of the microbiome and neutrophils in the oral cavity of HIV-infected individuals","volume":"12","author":"Perez Rosero","year":"2021","journal-title":"Front Immunol"},{"key":"B44","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1186\/s40164-023-00375-5","article-title":"Depletion of polyfunctional CD26(high)CD8(+) T cells repertoire in chronic lymphocytic leukemia","volume":"12","author":"Bozorgmehr","year":"2023","journal-title":"Exp Hematol Oncol"},{"key":"B45","doi-asserted-by":"publisher","DOI":"10.1038\/ni1271","article-title":"The Tim-3 ligand galectin-9 negatively regulates T helper type 1 immunity","volume":"6","author":"Zhu","year":"2005","journal-title":"Nat Immunol"},{"key":"B46","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2011-11-389585","article-title":"Galectin-9 binding to Tim-3 renders activated human CD4+ T cells less susceptible to HIV-1 infection","volume":"119","author":"Elahi","year":"2012","journal-title":"Blood"},{"key":"B47","doi-asserted-by":"publisher","DOI":"10.1128\/mBio.00384-21","article-title":"Galectin-9, a player in cytokine release syndrome and a surrogate diagnostic biomarker in SARS-coV-2 infection","volume":"12","author":"Bozorgmehr","year":"2021","journal-title":"mBio"},{"key":"B48","doi-asserted-by":"publisher","DOI":"10.4049\/jimmunol.1901114","article-title":"Intracellular galectin-9 enhances proximal TCR signaling and potentiates autoimmune diseases","volume":"204","author":"Chen","year":"2020","journal-title":"J Immunol"},{"key":"B49","doi-asserted-by":"publisher","DOI":"10.1016\/j.biocel.2012.05.003","article-title":"Association of HLA-alleles with the immune regulation of chronic viral infections","volume":"44","author":"Elahi","year":"2012","journal-title":"Int J Biochem Cell Biol"},{"key":"B50","doi-asserted-by":"publisher","first-page":"e001849","DOI":"10.1136\/jitc-2020-001849","article-title":"Galectin-9 expression defines exhausted T cells and impaired cytotoxic NK cells in patients with virus-associated solid tumors","volume":"8","author":"Okoye","year":"2020","journal-title":"J immunotherapy Cancer"},{"key":"B51","doi-asserted-by":"publisher","first-page":"e2415119121","DOI":"10.1073\/pnas.2415119121","article-title":"Transcriptional reprogramming primes CD8+ T cells toward exhaustion in Myalgic encephalomyelitis\/chronic fatigue syndrome","volume":"121","author":"Iu","year":"2024","journal-title":"Proc Natl Acad Sci United States America"},{"key":"B52","doi-asserted-by":"publisher","first-page":"2991","DOI":"10.1038\/s41591-025-03788-3","article-title":"AI-driven multi-omics modeling of myalgic encephalomyelitis\/chronic fatigue syndrome","volume":"31","author":"Xiong","year":"2025","journal-title":"Nat Med"},{"key":"B53","doi-asserted-by":"publisher","DOI":"10.1038\/s41577-020-0345-y","article-title":"Thymic development of unconventional T cells: how NKT cells, MAIT cells and \u03b3\u03b4 T cells emerge","volume":"20","author":"Pellicci","year":"2020","journal-title":"Nat Rev Immunol"},{"key":"B54","doi-asserted-by":"publisher","DOI":"10.1016\/j.smim.2022.101661","article-title":"Emerging features of MAIT cells and other unconventional T cell populations in human viral disease and vaccination","author":"Hackstein","year":"2022","journal-title":"Semin Immunol"},{"key":"B55","doi-asserted-by":"publisher","first-page":"44","DOI":"10.1111\/sji.12388","article-title":"Pilot study of natural killer cells in chronic fatigue syndrome\/myalgic encephalomyelitis and multiple sclerosis","volume":"83","author":"Huth","year":"2016","journal-title":"Scand J Immunol"},{"key":"B56","doi-asserted-by":"publisher","first-page":"e10817","DOI":"10.1371\/journal.pone.0010817","article-title":"Biomarkers in chronic fatigue syndrome: evaluation of natural killer cell function and dipeptidyl peptidase IV\/CD26","volume":"5","author":"Fletcher","year":"2010","journal-title":"PloS One"},{"key":"B57","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1186\/s12865-015-0101-4","article-title":"Characterisation of cell functions and receptors in Chronic Fatigue Syndrome\/Myalgic Encephalomyelitis (CFS\/ME)","volume":"16","author":"Hardcastle","year":"2015","journal-title":"BMC Immunol"},{"key":"B58","doi-asserted-by":"publisher","first-page":"126.139","DOI":"10.4049\/jimmunol.202.Supp.126.39","article-title":"Mitochondrial alterations in NK lymphocytes from ME\/CFS patients","volume":"202","author":"Silvestre","year":"2019","journal-title":"J Immunol"},{"key":"B59","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbi.2025.106098","article-title":"Killer cell immunoglobulin-like receptor (KIR) alleles suggested to be associated with myalgic encephalomyelitis\/chronic fatigue syndrome (ME\/CFS)","volume":"130","author":"Ramadan","year":"2025","journal-title":"Brain Behav Immun"},{"key":"B60","doi-asserted-by":"publisher","DOI":"10.4049\/jimmunol.2300783","article-title":"The role of coinhibitory receptors in B cell dysregulation in SARS-coV-2-infected individuals with severe disease","volume":"212","author":"Saito","year":"2024","journal-title":"J Immunol"},{"key":"B61","doi-asserted-by":"publisher","DOI":"10.1016\/j.lanepe.2021.100242","article-title":"Long COVID risk - a signal to address sex hormones and women\u2019s health","volume":"11","author":"Stewart","year":"2021","journal-title":"Lancet Reg Health Eur"},{"key":"B62","doi-asserted-by":"publisher","DOI":"10.1007\/s40618-024-02334-1","article-title":"Sex and disease severity-based analysis of steroid hormones in ME\/CFS","volume":"47","author":"Pipper","year":"2024","journal-title":"J Endocrinol Invest"},{"key":"B63","doi-asserted-by":"publisher","first-page":"e29887","DOI":"10.1002\/jmv.29887","article-title":"Inflammation-, immunothrombosis,- and autoimmune-feedback loops may lead to persistent neutrophil self-stimulation in long COVID","volume":"96","author":"Thierry","year":"2024","journal-title":"J Med Virol"},{"key":"B64","doi-asserted-by":"publisher","first-page":"e0125623","DOI":"10.1128\/spectrum.01256-23","article-title":"Analysis of SARS-CoV-2 isolates, namely the Wuhan strain, Delta variant, and Omicron variant, identifies differential immune profiles","volume":"11","author":"Shahbaz","year":"2023","journal-title":"Microbiol Spectr"},{"key":"B65","doi-asserted-by":"publisher","DOI":"10.1038\/s41590-025-02135-5","article-title":"Identification of soluble biomarkers that associate with distinct manifestations of long COVID","volume":"26","author":"Gao","year":"2025","journal-title":"Nat Immunol"},{"key":"B66","doi-asserted-by":"publisher","DOI":"10.1101\/2023.05.22.23289895","article-title":"A novel neurodevelopmental syndrome caused by loss-of-function of the Zinc Finger Homeobox 3 (ZFHX3) gene","volume":"24","author":"Del Rocio Perez Baca","year":"2023","journal-title":"medRxiv"},{"key":"B67","doi-asserted-by":"publisher","first-page":"82","DOI":"10.1016\/j.ajhg.2023.11.008","article-title":"Exonic trinucleotide repeat expansions in ZFHX3 cause spinocerebellar ataxia type 4: A poly-glycine disease","volume":"111","author":"Wallenius","year":"2024","journal-title":"Am J Hum Genet"},{"key":"B68","doi-asserted-by":"publisher","DOI":"10.1161\/01.ATV.0000165656.65359.23","article-title":"Vascular implications of the Kruppel-like family of transcription factors","volume":"25","author":"Suzuki","year":"2005","journal-title":"Arterioscler Thromb Vasc Biol"},{"key":"B69","doi-asserted-by":"publisher","DOI":"10.1523\/JNEUROSCI.5284-09.2010","article-title":"Reelin regulates postnatal neurogenesis and enhances spine hypertrophy and long-term potentiation","volume":"30","author":"Pujadas","year":"2010","journal-title":"J Neurosci"}],"container-title":["Frontiers in Immunology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2026.1745933\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T07:03:13Z","timestamp":1772002993000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2026.1745933\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,25]]},"references-count":69,"alternative-id":["10.3389\/fimmu.2026.1745933"],"URL":"https:\/\/doi.org\/10.3389\/fimmu.2026.1745933","relation":{},"ISSN":["1664-3224"],"issn-type":[{"value":"1664-3224","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,25]]},"article-number":"1745933"}}