{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T04:31:56Z","timestamp":1791433916891,"version":"4.3.3"},"reference-count":200,"publisher":"MDPI AG","issue":"23","license":[{"start":{"date-parts":[[2025,11,27]],"date-time":"2025-11-27T00:00:00Z","timestamp":1764201600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Khosla Family Gift Fund"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJMS"],"abstract":"<jats:p>Defined by the World Health Organization as a neurological disorder, Myalgic Encephalomyelitis\/Chronic Fatigue Syndrome (ME\/CFS) is a disabling illness, affecting millions of people worldwide. First reported in the early nineteenth century, ME\/CFS is uniquely characterized by a wide array of symptoms, including fatigue, brain fog, post-exertional malaise (PEM), sleep dysfunction, and orthostatic intolerance (OI). Despite decades of extensive research, there are no effective medical treatments or simple diagnostics for ME\/CFS, with an estimated 90% of patients remaining undiagnosed. The recently discovered glymphatic system, a lymphatic analog of the brain, is believed to be responsible for the removal of toxic metabolic wastes accumulated in the course of daily activities, primarily during sleep. A link between glymphatic dysfunction and some neurological disorders such as Alzheimer\u2019s disease has already been established, raising the possibility of its involvement in ME\/CFS. Accordingly, we believe the ME\/CFS medical\/scientific community will be interested in seriously considering GD an important contributor to its pathophysiology. If so, therapeutics that modulate glymphatic function may also benefit patients with ME\/CFS.<\/jats:p>","DOI":"10.3390\/ijms262311524","type":"journal-article","created":{"date-parts":[[2025,11,27]],"date-time":"2025-11-27T16:31:52Z","timestamp":1764261112000},"page":"11524","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Glymphatic System Dysregulation as a Key Contributor to Myalgic Encephalomyelitis\/Chronic Fatigue Syndrome"],"prefix":"10.3390","volume":"26","author":[{"given":"Mohsen","family":"Nemat-Gorgani","sequence":"first","affiliation":[{"name":"Stanford Genome Technology Center, Department of Biochemistry, Stanford University, Palo Alto, CA 94304, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9230-1027","authenticated-orcid":false,"given":"Michael Anthony","family":"Jensen","sequence":"additional","affiliation":[{"name":"Stanford Genome Technology Center, Department of Biochemistry, Stanford University, Palo Alto, CA 94304, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronald Wayne","family":"Davis","sequence":"additional","affiliation":[{"name":"Stanford Genome Technology Center, Department of Biochemistry, Stanford University, Palo Alto, CA 94304, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1101","DOI":"10.1001\/jama.2015.1346","article-title":"Beyond myalgic encephalomyelitis\/chronic fatigue syndrome: An IOM report on redefining an illness","volume":"313","author":"Clayton","year":"2015","journal-title":"JAMA"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1111\/j.1365-2796.2011.02428.x","article-title":"Myalgic encephalomyelitis: International Consensus Criteria","volume":"270","author":"Carruthers","year":"2011","journal-title":"J. Intern. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"907","DOI":"10.1038\/s41467-024-45107-3","article-title":"Deep phenotyping of post-infectious myalgic encephalomyelitis\/chronic fatigue syndrome","volume":"15","author":"Walitt","year":"2024","journal-title":"Nat. Commun."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1021\/acs.biochem.3c00433","article-title":"Catalytic Antibodies May Contribute to Demyelination in Myalgic Encephalomyelitis\/Chronic Fatigue Syndrome","volume":"63","author":"Jensen","year":"2024","journal-title":"Biochemistry"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"63","DOI":"10.3389\/fphys.2013.00063","article-title":"Caught in the thickness of brain fog: Exploring the cognitive symptoms of Chronic Fatigue Syndrome","volume":"4","author":"Ocon","year":"2013","journal-title":"Front. Physiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1186\/s12967-022-03764-2","article-title":"Brain fog of post-COVID-19 condition and Chronic Fatigue Syndrome, same medical disorder?","volume":"20","author":"Azcue","year":"2022","journal-title":"J. Transl. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2208372","DOI":"10.1080\/07853890.2023.2208372","article-title":"Myalgic encephalomyelitis\/chronic fatigue syndrome and fibromyalgia are indistinguishable by their cerebrospinal fluid proteomes","volume":"55","author":"Schutzer","year":"2023","journal-title":"Ann. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1187163","DOI":"10.3389\/fmed.2023.1187163","article-title":"ME\/CFS and Long COVID share similar symptoms and biological abnormalities: Road map to the literature","volume":"10","author":"Komaroff","year":"2023","journal-title":"Front. Med."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Jason, L.A., and Dorri, J.A. (2022). ME\/CFS and Post-Exertional Malaise among Patients with Long COVID. Neurol. Int., 15.","DOI":"10.3390\/neurolint15010001"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Dafoe, W. (2021). Extremely Severe ME\/CFS-A Personal Account. Healthcare, 9.","DOI":"10.3390\/healthcare9050504"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Cortes Rivera, M., Mastronardi, C., Silva-Aldana, C.T., Arcos-Burgos, M., and Lidbury, B.A. (2019). Myalgic Encephalomyelitis\/Chronic Fatigue Syndrome: A Comprehensive Review. Diagnostics, 9.","DOI":"10.3390\/diagnostics9030091"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1038\/s44324-025-00079-w","article-title":"Heightened innate immunity may trigger chronic inflammation, fatigue and post-exertional malaise in ME\/CFS","volume":"3","author":"Che","year":"2025","journal-title":"npj Metab. Health Dis."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1257557","DOI":"10.3389\/fphys.2023.1257557","article-title":"Post-exertional malaise in daily life and experimental exercise models in patients with myalgic encephalomyelitis\/chronic fatigue syndrome","volume":"14","author":"Mengshoel","year":"2023","journal-title":"Front. Physiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1038\/s41467-023-44432-3","article-title":"Muscle abnormalities worsen after post-exertional malaise in long COVID","volume":"15","author":"Appelman","year":"2024","journal-title":"Nat. Commun."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1186\/s12916-023-02893-9","article-title":"Biomarkers for myalgic encephalomyelitis\/chronic fatigue syndrome (ME\/CFS): A systematic review","volume":"21","author":"Maksoud","year":"2023","journal-title":"BMC Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1048","DOI":"10.1186\/s12967-025-07203-w","article-title":"Development and validation of blood-based diagnostic biomarkers for Myalgic Encephalomyelitis\/Chronic Fatigue Syndrome (ME\/CFS) using EpiSwitch","volume":"23","author":"Hunter","year":"2025","journal-title":"J. Transl. Med."},{"key":"ref_17","doi-asserted-by":"crossref","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":"ref_18","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1146\/annurev-pathol-051217-111018","article-title":"The Glymphatic System in Central Nervous System Health and Disease: Past, Present, and Future","volume":"13","author":"Plog","year":"2018","journal-title":"Annu. Rev. Pathol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1016","DOI":"10.1016\/S1474-4422(18)30318-1","article-title":"The glymphatic pathway in neurological disorders","volume":"17","author":"Rasmussen","year":"2018","journal-title":"Lancet Neurol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1016\/j.mehy.2018.07.007","article-title":"The putative glymphatic signature of chronic fatigue syndrome: A new view on the disease pathogenesis and therapy","volume":"118","author":"Wostyn","year":"2018","journal-title":"Med. Hypotheses"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"108647","DOI":"10.1016\/j.isci.2023.108647","article-title":"Glymphatic system dysfunction in recovered patients with mild COVID-19: A DTI-ALPS study","volume":"27","author":"Wu","year":"2024","journal-title":"iScience"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1038\/s42003-024-05911-5","article-title":"Glymphatic and lymphatic communication with systemic responses during physiological and pathological conditions in the central nervous system","volume":"7","author":"Licastro","year":"2024","journal-title":"Commun. Biol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"7698","DOI":"10.1523\/JNEUROSCI.0619-21.2021","article-title":"The Glymphatic System: A Novel Component of Fundamental Neurobiology","volume":"41","author":"Hablitz","year":"2021","journal-title":"J. Neurosci."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1584767","DOI":"10.3389\/fncel.2025.1584767","article-title":"Targeting autophagy in astrocytes: A potential for neurodegenerative disease intervention","volume":"19","author":"Potokar","year":"2025","journal-title":"Front. Cell Neurosci."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"103731","DOI":"10.1016\/j.mcn.2022.103731","article-title":"Elevated ATG13 in serum of patients with ME\/CFS stimulates oxidative stress response in microglial cells via activation of receptor for advanced glycation end products (RAGE)","volume":"120","author":"Gottschalk","year":"2022","journal-title":"Mol. Cell. Neurosci."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1007\/978-1-4939-7180-0_9","article-title":"Hydrolysis and Dissolution of Amyloids by Catabodies","volume":"1643","author":"Meretoja","year":"2017","journal-title":"Methods Mol. Biol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1186\/s12987-024-00557-1","article-title":"Cellular and molecular mechanisms of the blood-brain barrier dysfunction in neurodegenerative diseases","volume":"21","author":"Chen","year":"2024","journal-title":"Fluids Barriers CNS"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Lyck, R., and Enzmann, G. (2017). Blood-Brain Barrier Dysfunction during Central Nervous System Autoimmune Diseases. The Blood Brain Barrier and Inflammation, Springer International Publishing.","DOI":"10.1007\/978-3-319-45514-3"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1042\/BST20220830","article-title":"The role of the blood-brain barrier during neurological disease and infection","volume":"51","author":"Patabendige","year":"2023","journal-title":"Biochem. Soc. Trans."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1177\/1753425920954281","article-title":"Immune response and blood-brain barrier dysfunction during viral neuroinvasion","volume":"27","author":"Chen","year":"2021","journal-title":"Innate Immun."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2489","DOI":"10.1038\/s41423-021-00757-x","article-title":"The blood-brain barrier in systemic infection and inflammation","volume":"18","author":"Galea","year":"2021","journal-title":"Cell. Mol. Immunol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1138769","DOI":"10.3389\/fnmol.2023.1138769","article-title":"Glymphatic system: An emerging therapeutic approach for neurological disorders","volume":"16","author":"Gao","year":"2023","journal-title":"Front. Mol. Neurosci."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1016\/j.neubiorev.2018.03.028","article-title":"Interaction between blood-brain barrier and glymphatic system in solute clearance","volume":"90","author":"Verheggen","year":"2018","journal-title":"Neurosci. Biobehav. Rev."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"871","DOI":"10.2147\/CIA.S204269","article-title":"The relationship between blood-brain barrier permeability and enlarged perivascular spaces: A cross-sectional study","volume":"14","author":"Li","year":"2019","journal-title":"Clin. Interv. Aging"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"877772","DOI":"10.3389\/fneur.2022.877772","article-title":"Molecular Mechanisms of Neuroinflammation in ME\/CFS and Long COVID to Sustain Disease and Promote Relapses","volume":"13","author":"Tate","year":"2022","journal-title":"Front. Neurol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"5124","DOI":"10.3390\/ijms24065124","article-title":"Towards a Better Understanding of the Complexities of Myalgic Encephalomyelitis\/Chronic Fatigue Syndrome and Long COVID","volume":"24","author":"Tate","year":"2023","journal-title":"Int. J. Mol. Sci."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"102259","DOI":"10.1016\/j.xcrm.2025.102259","article-title":"Causes of symptoms and symptom persistence in long COVID and myalgic encephalomyelitis\/chronic fatigue syndrome","volume":"6","author":"Komaroff","year":"2025","journal-title":"Cell Rep. Med."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1186\/s12979-015-0029-9","article-title":"Blood-brain barrier dysfunction developed during normal aging is associated with inflammation and loss of tight junctions but not with leukocyte recruitment","volume":"12","author":"Elahy","year":"2015","journal-title":"Immun. Ageing"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1625","DOI":"10.1038\/jcbfm.2010.29","article-title":"Oxidative stress increases blood-brain barrier permeability and induces alterations in occludin during hypoxia-reoxygenation","volume":"30","author":"Lochhead","year":"2010","journal-title":"J. Cereb. Blood Flow Metab."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"3666","DOI":"10.1096\/fj.07-8329com","article-title":"Reactive oxygen species alter brain endothelial tight junction dynamics via RhoA, PI3 kinase, and PKB signaling","volume":"21","author":"Schreibelt","year":"2007","journal-title":"FASEB J."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1528995","DOI":"10.3389\/fncel.2025.1528995","article-title":"Glymphatic system: A self-purification circulation in brain","volume":"19","author":"Chen","year":"2025","journal-title":"Front. Cell Neurosci."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"2661","DOI":"10.4103\/1673-5374.391312","article-title":"Glymphatic system: A gateway for neuroinflammation","volume":"19","author":"Zou","year":"2024","journal-title":"Neural Regen. Res."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"106426","DOI":"10.1016\/j.nbd.2024.106426","article-title":"The relationship between inflammation, impaired glymphatic system, and neurodegenerative disorders: A vicious cycle","volume":"192","author":"Cai","year":"2024","journal-title":"Neurobiol. Dis."},{"key":"ref_44","first-page":"100025","article-title":"Aberrant waste disposal in neurodegeneration: Why improved sleep could be the solution","volume":"2","author":"Wafford","year":"2021","journal-title":"Cereb. Circ. Cogn. Behav."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"155147","DOI":"10.1016\/j.phymed.2023.155147","article-title":"Promotion of neuroinflammation by the glymphatic system: A new insight into ethanol extracts from Alisma orientale in alleviating obesity-associated cognitive impairment","volume":"122","author":"Zhan","year":"2024","journal-title":"Phytomedicine"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"2016","DOI":"10.2174\/1570159X22666240130091235","article-title":"Glymphatic System and Psychiatric Disorders: A Rapid Comprehensive Scoping Review","volume":"22","author":"Barlattani","year":"2024","journal-title":"Curr. Neuropharmacol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"10366","DOI":"10.3390\/ijms241210366","article-title":"Glymphatic System and Mitochondrial Dysfunction as Two Crucial Players in Pathophysiology of Neurodegenerative Disorders","volume":"24","author":"Szleszkowski","year":"2023","journal-title":"Int. J. Mol. Sci."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1251755","DOI":"10.3389\/fnagi.2023.1251755","article-title":"Altered sleep and neurovascular dysfunction in alpha-synucleinopathies: The perfect storm for glymphatic failure","volume":"15","author":"Buongiorno","year":"2023","journal-title":"Front. Aging Neurosci."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"27982","DOI":"10.1038\/s41598-024-79147-y","article-title":"Loss of aquaporin-4 impairs cerebrospinal fluid solute clearance through cerebrospinal fluid drainage pathways","volume":"14","author":"Kato","year":"2024","journal-title":"Sci. Rep."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1739","DOI":"10.3892\/mmr.2017.6786","article-title":"Alterations in AQP4 expression and polarization in the course of motor neuron degeneration in SOD1G93A mice","volume":"16","author":"Dai","year":"2017","journal-title":"Mol. Med. Rep."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"61","DOI":"10.14336\/AD.2021.0731","article-title":"Aquaporin-4 and Cognitive Disorders","volume":"13","author":"Wang","year":"2022","journal-title":"Aging Dis."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1038\/s41572-020-0214-9","article-title":"Neuromyelitis optica","volume":"6","author":"Jarius","year":"2020","journal-title":"Nat. Rev. Dis. Primers"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"2296","DOI":"10.3390\/antiox11112296","article-title":"Glymphatic Dysfunction Induced Oxidative Stress and Neuro-Inflammation in Major Depression Disorders","volume":"11","author":"Gu","year":"2022","journal-title":"Antioxidants"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"771","DOI":"10.1038\/nrn3820","article-title":"Polyunsaturated fatty acids and their metabolites in brain function and disease","volume":"15","author":"Bazinet","year":"2014","journal-title":"Nat. Rev. Neurosci."},{"key":"ref_55","doi-asserted-by":"crossref","unstructured":"Carnac, T. (2025). A Systems-Based Hypothesis for Myalgic Encephalomyelitis\/Chronic Fatigue Syndrome (ME\/CFS): Phosphatidylcholine Deficiency, Insulin Signaling and Noradrenergic Neuron Dysregulation. Preprints.","DOI":"10.20944\/preprints202409.1467.v2"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"1161","DOI":"10.1080\/14728222.2017.1398236","article-title":"The aquaporin-4 water channel as a potential drug target in neurological disorders","volume":"21","author":"Verkman","year":"2017","journal-title":"Expert Opin. Ther. Targets"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"106035","DOI":"10.1016\/j.nbd.2023.106035","article-title":"Aquaporin-4 in glymphatic system, and its implication for central nervous system disorders","volume":"179","author":"Peng","year":"2023","journal-title":"Neurobiol. Dis."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"523","DOI":"10.1080\/14728222.2023.2240017","article-title":"The aquaporin-4 water channel and updates on its potential as a drug target for Alzheimer\u2019s disease","volume":"27","author":"Silverglate","year":"2023","journal-title":"Expert Opin. Ther. Targets"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1186\/s12967-024-05349-7","article-title":"Systematic review of fatigue severity in ME\/CFS patients: Insights from randomized controlled trials","volume":"22","author":"Park","year":"2024","journal-title":"J. Transl. Med."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"1544","DOI":"10.1016\/j.mayocp.2023.07.032","article-title":"Diagnosis and Management of Myalgic Encephalomyelitis\/Chronic Fatigue Syndrome","volume":"98","author":"Grach","year":"2023","journal-title":"Mayo Clin. Proc."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1186\/s12967-021-03143-3","article-title":"An attempt to explain the neurological symptoms of Myalgic Encephalomyelitis\/Chronic Fatigue Syndrome","volume":"19","author":"Wirth","year":"2021","journal-title":"J. Transl. Med."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1186\/s12967-018-1644-y","article-title":"Chronic viral infections in myalgic encephalomyelitis\/chronic fatigue syndrome (ME\/CFS)","volume":"16","author":"Rasa","year":"2018","journal-title":"J. Transl. Med."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1016\/j.jns.2010.11.018","article-title":"Cerebral blood flow is reduced in chronic fatigue syndrome as assessed by arterial spin labeling","volume":"301","author":"Biswal","year":"2011","journal-title":"J. Neurol. Sci."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1111\/j.1475-097X.2006.00649.x","article-title":"Patients with chronic fatigue syndrome have reduced absolute cortical blood flow","volume":"26","author":"Yoshiuchi","year":"2006","journal-title":"Clin. Physiol. Funct. Imaging"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"658340","DOI":"10.3389\/fpsyt.2021.658340","article-title":"Glymphatic Dysfunction: A Bridge Between Sleep Disturbance and Mood Disorders","volume":"12","author":"Yan","year":"2021","journal-title":"Front. Psychiatry"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1186\/s10194-024-01741-2","article-title":"The glymphatic system in migraine and other headaches","volume":"25","author":"Vittorini","year":"2024","journal-title":"J. Headache Pain."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"885020","DOI":"10.3389\/fneur.2022.885020","article-title":"Glymphatic System Dysfunction: A Novel Mediator of Sleep Disorders and Headaches","volume":"13","author":"Yi","year":"2022","journal-title":"Front. Neurol."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1126\/science.1241224","article-title":"Sleep drives metabolite clearance from the adult brain","volume":"342","author":"Xie","year":"2013","journal-title":"Science"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1038\/s41526-024-00365-9","article-title":"A perspective on the evidence for glymphatic obstruction in spaceflight associated neuro-ocular syndrome and fatigue","volume":"10","author":"Bateman","year":"2024","journal-title":"npj Microgravity"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"106297","DOI":"10.1016\/j.jinf.2024.106297","article-title":"The persistence of myalgic encephalomyelitis\/chronic fatigue syndrome (ME\/CFS) after SARS-CoV-2 infection: A systematic review and meta-analysis","volume":"89","author":"Dehlia","year":"2024","journal-title":"J. Infect."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"e1011523","DOI":"10.1371\/journal.ppat.1011523","article-title":"The viral origin of myalgic encephalomyelitis\/chronic fatigue syndrome","volume":"19","author":"Hanson","year":"2023","journal-title":"PLoS Pathog."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1186\/s12883-025-04133-4","article-title":"Asymmetrical glymphatic dysfunction in patients with long Covid associated neurocognitive impairment- correlation with BBB disruption","volume":"25","author":"Chaganti","year":"2025","journal-title":"BMC Neurol."},{"key":"ref_73","first-page":"20499361211009385","article-title":"COVID-19 and post-infectious myalgic encephalomyelitis\/chronic fatigue syndrome: A narrative review","volume":"8","author":"Poenaru","year":"2021","journal-title":"Ther. Adv. Infect. Dis."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"523379","DOI":"10.3389\/fcimb.2020.523379","article-title":"Astrocytes, HIV and the Glymphatic System: A Disease of Disrupted Waste Management?","volume":"10","author":"Tice","year":"2020","journal-title":"Front. Cell. Infect. Microbiol."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"979","DOI":"10.3390\/cells12070979","article-title":"The Glymphatic System May Play a Vital Role in the Pathogenesis of Hepatic Encephalopathy: A Narrative Review","volume":"12","author":"Sepehrinezhad","year":"2023","journal-title":"Cells"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"e0188622","DOI":"10.1128\/mbio.01886-22","article-title":"Dysfunctional Glymphatic System with Disrupted Aquaporin 4 Expression Pattern on Astrocytes Causes Bacterial Product Accumulation in the CSF during Pneumococcal Meningitis","volume":"13","author":"Generoso","year":"2022","journal-title":"mBio"},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"3682","DOI":"10.1002\/jmv.25744","article-title":"Cytomegalovirus, Epstein-Barr virus, and human herpesvirus-6 infections in patients with myalgic encephalomyelitis\/chronic fatigue syndrome","volume":"92","author":"Shikova","year":"2020","journal-title":"J. Med. Virol."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1038\/s41579-020-0382-3","article-title":"Epigenetic and epitranscriptomic regulation of viral replication","volume":"18","author":"Tsai","year":"2020","journal-title":"Nat. Rev. Microbiol."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"e29634","DOI":"10.1002\/jmv.29634","article-title":"Epstein-Barr virus-driven metabolic alterations contribute to the viral lytic reactivation and tumor progression in nasopharyngeal carcinoma","volume":"96","author":"Shi","year":"2024","journal-title":"J. Med. Virol."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"1380","DOI":"10.3390\/biom11091380","article-title":"Stress-Induced Epstein-Barr Virus Reactivation","volume":"11","author":"Sausen","year":"2021","journal-title":"Biomolecules"},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"ftae002","DOI":"10.1093\/femspd\/ftae002","article-title":"Awakening the sleeping giant: Epstein-Barr virus reactivation by biological agents","volume":"82","author":"Indari","year":"2024","journal-title":"Pathog. Dis."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"931","DOI":"10.3390\/ph15080931","article-title":"The Occurrence of Hyperactivated Platelets and Fibrinaloid Microclots in Myalgic Encephalomyelitis\/Chronic Fatigue Syndrome (ME\/CFS)","volume":"15","author":"Nunes","year":"2022","journal-title":"Pharmaceuticals"},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"2153","DOI":"10.3390\/medicina59122153","article-title":"Worsening Symptoms Is Associated with Larger Cerebral Blood Flow Abnormalities during Tilt-Testing in Myalgic Encephalomyelitis\/Chronic Fatigue Syndrome (ME\/CFS)","volume":"59","author":"Rowe","year":"2023","journal-title":"Medicina"},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"107557","DOI":"10.1016\/j.jstrokecerebrovasdis.2024.107557","article-title":"The glymphatic system and cerebral small vessel disease","volume":"33","author":"Ang","year":"2024","journal-title":"J. Stroke Cerebrovasc. Dis."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"316","DOI":"10.3389\/fneur.2019.00316","article-title":"Corrigendum: Neuroinflammation and Cytokines in Myalgic Encephalomyelitis\/Chronic Fatigue Syndrome (ME\/CFS): A Critical Review of Research Methods","volume":"10","author":"VanElzakker","year":"2019","journal-title":"Front. Neurol."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"286","DOI":"10.3390\/cells13030286","article-title":"Glymphatic System Pathology and Neuroinflammation as Two Risk Factors of Neurodegeneration","volume":"13","author":"Szlufik","year":"2024","journal-title":"Cells"},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1016\/j.phrs.2014.06.002","article-title":"Oxygen glucose deprivation-induced astrocyte dysfunction provokes neuronal death through oxidative stress","volume":"87","author":"Gouix","year":"2014","journal-title":"Pharmacol. Res."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"105493","DOI":"10.1016\/j.nbd.2021.105493","article-title":"Amyloid beta acts synergistically as a pro-inflammatory cytokine","volume":"159","author":"LaRocca","year":"2021","journal-title":"Neurobiol. Dis."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1016\/j.pnpbp.2015.06.008","article-title":"The role of pro-inflammatory cytokines in neuroinflammation, neurogenesis and the neuroendocrine system in major depression","volume":"64","author":"Kim","year":"2016","journal-title":"Prog. Neuropsychopharmacol. Biol. Psychiatry"},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1016\/j.psyneuen.2018.11.032","article-title":"Persistent fatigue induced by interferon-alpha: A novel, inflammation-based, proxy model of chronic fatigue syndrome","volume":"100","author":"Russell","year":"2019","journal-title":"Psychoneuroendocrinology"},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"147234","DOI":"10.1016\/j.brainres.2020.147234","article-title":"Astrocytes in heavy metal neurotoxicity and neurodegeneration","volume":"1752","author":"Li","year":"2021","journal-title":"Brain Res."},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"1386607","DOI":"10.3389\/fimmu.2024.1386607","article-title":"Myalgic Encephalomyelitis\/Chronic Fatigue Syndrome: The biology of a neglected disease","volume":"15","author":"Arron","year":"2024","journal-title":"Front. Immunol."},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"4","DOI":"10.3390\/neuroglia6010004","article-title":"Glial Perturbation in Metal Neurotoxicity: Implications for Brain Disorders","volume":"6","author":"Ijomone","year":"2025","journal-title":"Neuroglia"},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"12890","DOI":"10.1038\/s41598-018-31270-3","article-title":"Oxidative Stress is a Convincing Contributor to Idiopathic Chronic Fatigue","volume":"8","author":"Lee","year":"2018","journal-title":"Sci. Rep."},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"e2426564122","DOI":"10.1073\/pnas.2426564122","article-title":"Oxidative stress is a shared characteristic of ME\/CFS and Long COVID","volume":"122","author":"Shankar","year":"2025","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"7152","DOI":"10.3390\/ijms21197152","article-title":"Neuroprotective Effect of Antioxidants in the Brain","volume":"21","author":"Lee","year":"2020","journal-title":"Int. J. Mol. Sci."},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"116186","DOI":"10.1016\/j.bcp.2024.116186","article-title":"The role of oxidative stress in blood-brain barrier disruption during ischemic stroke: Antioxidants in clinical trials","volume":"228","author":"Lochhead","year":"2024","journal-title":"Biochem. Pharmacol."},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"2112","DOI":"10.1177\/0271678X16661202","article-title":"Glymphatic clearance controls state-dependent changes in brain lactate concentration","volume":"37","author":"Lundgaard","year":"2017","journal-title":"J. Cereb. Blood Flow Metab."},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1186\/s12987-024-00527-7","article-title":"Role of aquaporin-4 polarization in extracellular solute clearance","volume":"21","author":"Bojarskaite","year":"2024","journal-title":"Fluids Barriers CNS"},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"13532","DOI":"10.1073\/pnas.0605796103","article-title":"Temporary loss of perivascular aquaporin-4 in neocortex after transient middle cerebral artery occlusion in mice","volume":"103","author":"Frydenlund","year":"2006","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"84","DOI":"10.3389\/fphys.2017.00084","article-title":"Hypoxia-Induced Oxidative Stress Modulation with Physical Activity","volume":"8","author":"Debevec","year":"2017","journal-title":"Front. Physiol."},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"151228","DOI":"10.1016\/j.scitotenv.2021.151228","article-title":"Hypoxia causes mitochondrial dysfunction and brain memory disorder in a manner mediated by the reduction of Cirbp","volume":"806","author":"Liu","year":"2022","journal-title":"Sci. Total Environ."},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"982","DOI":"10.3390\/biom11070982","article-title":"Endothelial Dysfunction Driven by Hypoxia-The Influence of Oxygen Deficiency on NO Bioavailability","volume":"11","author":"Siekierzycka","year":"2021","journal-title":"Biomolecules"},{"key":"ref_104","doi-asserted-by":"crossref","first-page":"1026","DOI":"10.1113\/EP091276","article-title":"Hypoxia-induced endothelial dysfunction: Could targeting oxidative stress provide protection?","volume":"108","author":"Rossetti","year":"2023","journal-title":"Exp. Physiol."},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"2204","DOI":"10.1007\/s00415-022-11530-z","article-title":"Impaired glymphatic drainage underlying obstructive sleep apnea is associated with cognitive dysfunction","volume":"270","author":"Wang","year":"2023","journal-title":"J. Neurol."},{"key":"ref_106","doi-asserted-by":"crossref","first-page":"712317","DOI":"10.3389\/fphys.2021.712317","article-title":"Hypoxia-Induced Neuroinflammation in Alzheimer\u2019s Disease: Potential Neuroprotective Effects of","volume":"12","author":"Hambali","year":"2021","journal-title":"Front. Physiol."},{"key":"ref_107","doi-asserted-by":"crossref","first-page":"101928","DOI":"10.1016\/j.smrv.2024.101928","article-title":"Effects of acute exposure to hypoxia on sleep structure in healthy adults: A systematic review","volume":"75","author":"Guo","year":"2024","journal-title":"Sleep. Med. Rev."},{"key":"ref_108","doi-asserted-by":"crossref","first-page":"798","DOI":"10.3390\/cells12050798","article-title":"Transcriptional Response to Hypoxia: The Role of HIF-1-Associated Co-Regulators","volume":"12","author":"Yfantis","year":"2023","journal-title":"Cells"},{"key":"ref_109","doi-asserted-by":"crossref","first-page":"994","DOI":"10.1080\/02713680802447113","article-title":"Mechanical stretching elevates peptidyl arginine deiminase 2 expression in astrocytes","volume":"33","author":"Algeciras","year":"2008","journal-title":"Curr. Eye Res."},{"key":"ref_110","doi-asserted-by":"crossref","first-page":"1324","DOI":"10.1016\/j.bbrc.2004.10.173","article-title":"Increased peptidylarginine deiminase type II in hypoxic astrocytes","volume":"325","author":"Sambandam","year":"2004","journal-title":"Biochem. Biophys. Res. Commun."},{"key":"ref_111","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1152\/physiol.00056.2024","article-title":"Mitochondrial Dysfunction in Myalgic Encephalomyelitis\/Chronic Fatigue Syndrome","volume":"40","author":"Syed","year":"2025","journal-title":"Physiology"},{"key":"ref_112","doi-asserted-by":"crossref","first-page":"826","DOI":"10.1016\/j.jmb.2011.04.045","article-title":"Membrane integrity and amyloid cytotoxicity: A model study involving mitochondria and lysozyme fibrillation products","volume":"409","author":"Meratan","year":"2011","journal-title":"J. Mol. Biol."},{"key":"ref_113","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1002\/bip.22572","article-title":"Interaction of A\u03b2(25-35) fibrillation products with mitochondria: Effect of small-molecule natural products","volume":"102","author":"Ghobeh","year":"2014","journal-title":"Biopolymers"},{"key":"ref_114","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1016\/j.ijbiomac.2013.07.007","article-title":"Disruption of mitochondrial membrane integrity induced by amyloid aggregates arising from variants of SOD1","volume":"61","author":"Javanian","year":"2013","journal-title":"Int. J. Biol. Macromol."},{"key":"ref_115","doi-asserted-by":"crossref","first-page":"183251","DOI":"10.1016\/j.bbamem.2020.183251","article-title":"\u03b1-Synuclein fibrillation products trigger the release of hexokinase I from mitochondria: Protection by curcumin, and possible role in pathogenesis of Parkinson\u2019s disease","volume":"1862","author":"Dehghani","year":"2020","journal-title":"Biochim. Biophys. Acta Biomembr."},{"key":"ref_116","doi-asserted-by":"crossref","first-page":"2149","DOI":"10.1016\/j.bbamem.2012.04.020","article-title":"Mitochondrial membrane permeabilization upon interaction with lysozyme fibrillation products: Role of mitochondrial heterogeneity","volume":"1818","author":"Meratan","year":"2012","journal-title":"Biochim. Biophys. Acta"},{"key":"ref_117","doi-asserted-by":"crossref","first-page":"114","DOI":"10.3389\/fncel.2018.00114","article-title":"Effect of Chronic Oxidative Stress on Neuroinflammatory Response Mediated by CD4","volume":"12","year":"2018","journal-title":"Front. Cell Neurosci."},{"key":"ref_118","doi-asserted-by":"crossref","first-page":"103484","DOI":"10.1016\/j.autrev.2023.103484","article-title":"Brain-regional characteristics and neuroinflammation in ME\/CFS patients from neuroimaging: A systematic review and meta-analysis","volume":"23","author":"Lee","year":"2024","journal-title":"Autoimmun. Rev."},{"key":"ref_119","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1196\/annals.1427.030","article-title":"Impairing the mitochondrial fission and fusion balance: A new mechanism of neurodegeneration","volume":"1147","author":"Knott","year":"2008","journal-title":"Ann. N. Y. Acad. Sci."},{"key":"ref_120","doi-asserted-by":"crossref","first-page":"941","DOI":"10.1111\/j.1742-4658.2011.08010.x","article-title":"Mitochondrial oxidative stress causes mitochondrial fragmentation via differential modulation of mitochondrial fission-fusion proteins","volume":"278","author":"Wu","year":"2011","journal-title":"FEBS J."},{"key":"ref_121","doi-asserted-by":"crossref","first-page":"201","DOI":"10.4049\/immunohorizons.2000006","article-title":"Human Herpesvirus-6 Reactivation, Mitochondrial Fragmentation, and the Coordination of Antiviral and Metabolic Phenotypes in Myalgic Encephalomyelitis\/Chronic Fatigue Syndrome","volume":"4","author":"Schreiner","year":"2020","journal-title":"Immunohorizons"},{"key":"ref_122","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1186\/s12967-022-03244-7","article-title":"Letter: Could endothelial dysfunction and vascular damage contribute to pain, inflammation and post-exertional malaise in individuals with myalgic encephalomyelitis\/chronic fatigue syndrome (ME\/CFS)?","volume":"20","author":"Lubell","year":"2022","journal-title":"J. Transl. Med."},{"key":"ref_123","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1042\/cs0970603","article-title":"Impaired oxygen delivery to muscle in chronic fatigue syndrome","volume":"97","author":"McCully","year":"1999","journal-title":"Clin. Sci."},{"key":"ref_124","doi-asserted-by":"crossref","first-page":"18817","DOI":"10.1038\/s41598-019-55473-4","article-title":"Elevated blood lactate in resting conditions correlate with post-exertional malaise severity in patients with Myalgic encephalomyelitis\/Chronic fatigue syndrome","volume":"9","author":"Ghali","year":"2019","journal-title":"Sci. Rep."},{"key":"ref_125","doi-asserted-by":"crossref","first-page":"4874","DOI":"10.1182\/blood-2018-99-117260","article-title":"Erythrocyte Deformability as a Potential Biomarker for Chronic Fatigue Syndrome","volume":"132","author":"Saha","year":"2018","journal-title":"Blood"},{"key":"ref_126","doi-asserted-by":"crossref","first-page":"113","DOI":"10.3233\/CH-180469","article-title":"Red blood cell deformability is diminished in patients with Chronic Fatigue Syndrome","volume":"71","author":"Saha","year":"2019","journal-title":"Clin. Hemorheol. Microcirc."},{"key":"ref_127","doi-asserted-by":"crossref","first-page":"122a","DOI":"10.1016\/j.bpj.2018.11.681","article-title":"Altered Erythrocyte Biophysical Properties in Chronic Fatigue Syndrome","volume":"116","author":"Saha","year":"2019","journal-title":"Biophys. J."},{"key":"ref_128","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1186\/s13195-024-01529-1","article-title":"Assessing blood-brain barrier dysfunction and its association with Alzheimer\u2019s pathology, cognitive impairment and neuroinflammation","volume":"16","author":"Preis","year":"2024","journal-title":"Alzheimers Res. Ther."},{"key":"ref_129","doi-asserted-by":"crossref","first-page":"695479","DOI":"10.3389\/fncel.2021.695479","article-title":"Relationship Between Amyloid-\u03b2 Deposition and Blood-Brain Barrier Dysfunction in Alzheimer\u2019s Disease","volume":"15","author":"Wang","year":"2021","journal-title":"Front. Cell Neurosci."},{"key":"ref_130","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1002\/nbm.1512","article-title":"Increased ventricular lactate in chronic fatigue syndrome measured by 1H MRS imaging at 3.0 T. II: Comparison with major depressive disorder","volume":"23","author":"Murrough","year":"2010","journal-title":"NMR Biomed."},{"key":"ref_131","doi-asserted-by":"crossref","first-page":"e89376","DOI":"10.1172\/jci.insight.89376","article-title":"Metabolic profiling indicates impaired pyruvate dehydrogenase function in myalgic encephalopathy\/chronic fatigue syndrome","volume":"1","author":"Fluge","year":"2016","journal-title":"JCI Insight"},{"key":"ref_132","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1042\/EBC20170111","article-title":"Biomarkers for mitochondrial energy metabolism diseases","volume":"62","author":"Boenzi","year":"2018","journal-title":"Essays Biochem."},{"key":"ref_133","doi-asserted-by":"crossref","first-page":"863","DOI":"10.1113\/JP278930","article-title":"Mitochondrial lactate metabolism: History and implications for exercise and disease","volume":"599","author":"Glancy","year":"2021","journal-title":"J. Physiol."},{"key":"ref_134","doi-asserted-by":"crossref","first-page":"1626","DOI":"10.1007\/s11306-015-0816-5","article-title":"Metabolic profiling reveals anomalous energy metabolism and oxidative stress pathways in chronic fatigue syndrome patients","volume":"11","author":"Armstrong","year":"2015","journal-title":"Metabolomics"},{"key":"ref_135","doi-asserted-by":"crossref","first-page":"5215","DOI":"10.1038\/s41380-025-03108-8","article-title":"Brain and muscle chemistry in myalgic encephalitis\/chronic fatigue syndrome (ME\/CFS) and long COVID: A 7T magnetic resonance spectroscopy study","volume":"30","author":"Godlewska","year":"2025","journal-title":"Mol. Psychiatry"},{"key":"ref_136","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1016\/j.tins.2025.01.003","article-title":"Defining brain fog across medical conditions","volume":"48","author":"Denno","year":"2025","journal-title":"Trends Neurosci."},{"key":"ref_137","doi-asserted-by":"crossref","first-page":"fcaf337","DOI":"10.1093\/braincomms\/fcaf337","article-title":"Systemic increase of AMPA receptors associated with cognitive impairment of long COVID","volume":"7","author":"Fujimoto","year":"2025","journal-title":"Brain Commun."},{"key":"ref_138","doi-asserted-by":"crossref","first-page":"989","DOI":"10.1016\/j.bbi.2025.07.024","article-title":"Blood-Brain barrier disruption in long COVID and cognitive correlates: A cross-sectional MRI study","volume":"129","author":"Rubin","year":"2025","journal-title":"Brain Behav. Immun."},{"key":"ref_139","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1038\/s41593-024-01576-9","article-title":"Blood-brain barrier disruption and sustained systemic inflammation in individuals with long COVID-associated cognitive impairment","volume":"27","author":"Greene","year":"2024","journal-title":"Nat. Neurosci."},{"key":"ref_140","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1186\/s12883-025-04198-1","article-title":"Neurologic symptoms as a hallmark of glymphatic alteration in recovered patients with COVID-19","volume":"25","author":"Kim","year":"2025","journal-title":"BMC Neurol."},{"key":"ref_141","doi-asserted-by":"crossref","first-page":"4146","DOI":"10.1016\/j.acra.2025.02.022","article-title":"Alterations in the Glymphatic System and Presence of Small Vessel Disease in Hospitalized and Non-hospitalized COVID Patients: A Study of PSMD Index and DTI-ALPS","volume":"32","author":"Buruk","year":"2025","journal-title":"Acad. Radiol."},{"key":"ref_142","doi-asserted-by":"crossref","first-page":"1","DOI":"10.18103\/mra.v10i9.3050","article-title":"The significance of oxidative stress in the pathophysiology of Long COVID and Myalgic Encephalomyelitis\/Chronic Fatigue Syndrome (ME\/CFS)","volume":"10","author":"Walker","year":"2022","journal-title":"Med. Res. Arch."},{"key":"ref_143","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1038\/s41424-018-0030-7","article-title":"Brain fogginess, gas and bloating: A link between SIBO, probiotics and metabolic acidosis","volume":"9","author":"Rao","year":"2018","journal-title":"Clin. Transl. Gastroenterol."},{"key":"ref_144","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1007\/s10286-019-00615-x","article-title":"Autonomic dysfunction in myalgic encephalomyelitis and chronic fatigue syndrome: Comparing self-report and objective measures","volume":"29","author":"Kemp","year":"2019","journal-title":"Clin. Auton. Res."},{"key":"ref_145","doi-asserted-by":"crossref","first-page":"814","DOI":"10.1186\/s12967-023-04678-3","article-title":"Dysautonomia and small fiber neuropathy in post-COVID condition and Chronic Fatigue Syndrome","volume":"21","author":"Azcue","year":"2023","journal-title":"J. Transl. Med."},{"key":"ref_146","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1016\/S0002-9629(15)40480-X","article-title":"The epidemic of orthostatic tachycardia and orthostatic intolerance","volume":"317","author":"Robertson","year":"1999","journal-title":"Am. J. Med. Sci."},{"key":"ref_147","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1186\/s12967-021-02819-0","article-title":"Deconditioning does not explain orthostatic intolerance in ME\/CFS (myalgic encephalomyelitis\/chronic fatigue syndrome)","volume":"19","author":"Rowe","year":"2021","journal-title":"J. Transl. Med."},{"key":"ref_148","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1016\/j.trf.2024.04.015","article-title":"Heart rate variability as an indicator of fatigue: A structural equation model approach","volume":"103","author":"Srinivasan","year":"2024","journal-title":"Transp. Res. Part F Traffic Psychol. Behav."},{"key":"ref_149","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1186\/s12967-019-02184-z","article-title":"Reduced heart rate variability predicts fatigue severity in individuals with chronic fatigue syndrome\/myalgic encephalomyelitis","volume":"18","author":"Escorihuela","year":"2020","journal-title":"J. Transl. Med."},{"key":"ref_150","doi-asserted-by":"crossref","first-page":"102774","DOI":"10.1016\/j.autneu.2021.102774","article-title":"The features of the glymphatic system","volume":"232","author":"Nycz","year":"2021","journal-title":"Auton. Neurosci."},{"key":"ref_151","doi-asserted-by":"crossref","first-page":"1258","DOI":"10.1002\/mds.29867","article-title":"Abnormal Cerebrovascular Activity, Perfusion, and Glymphatic Clearance in Lewy Body Diseases","volume":"39","author":"Ryman","year":"2024","journal-title":"Mov. Disord."},{"key":"ref_152","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1038\/s41531-025-00942-z","article-title":"Clinical and brain volumetric correlates of decreased DTI-ALPS, suggestive of local glymphatic dysfunction, in iRBD","volume":"11","author":"Roura","year":"2025","journal-title":"npj Parkinsons Dis."},{"key":"ref_153","doi-asserted-by":"crossref","first-page":"105990","DOI":"10.1016\/j.neubiorev.2024.105990","article-title":"Vagus nerve stimulation and gut microbiota interactions: A novel therapeutic avenue for neuropsychiatric disorders","volume":"169","author":"Faraji","year":"2025","journal-title":"Neurosci. Biobehav. Rev."},{"key":"ref_154","doi-asserted-by":"crossref","first-page":"49","DOI":"10.3389\/fnins.2018.00049","article-title":"The Vagus Nerve at the Interface of the Microbiota-Gut-Brain Axis","volume":"12","author":"Bonaz","year":"2018","journal-title":"Front. Neurosci."},{"key":"ref_155","doi-asserted-by":"crossref","first-page":"101771","DOI":"10.1016\/j.smrv.2023.101771","article-title":"Objective sleep measures in chronic fatigue syndrome patients: A systematic review and meta-analysis","volume":"69","author":"Mohamed","year":"2023","journal-title":"Sleep Med. Rev."},{"key":"ref_156","doi-asserted-by":"crossref","first-page":"868","DOI":"10.3390\/brainsci10110868","article-title":"The Sleeping Brain: Harnessing the Power of the Glymphatic System through Lifestyle Choices","volume":"10","author":"Reddy","year":"2020","journal-title":"Brain Sci."},{"key":"ref_157","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1016\/j.conb.2017.02.008","article-title":"Astrocytes and the modulation of sleep","volume":"44","author":"Haydon","year":"2017","journal-title":"Curr. Opin. Neurobiol."},{"key":"ref_158","doi-asserted-by":"crossref","first-page":"1543725","DOI":"10.3389\/fneur.2025.1543725","article-title":"Glymphatic system in neurological disorders and implications for brain health","volume":"16","author":"Corbali","year":"2025","journal-title":"Front. Neurol."},{"key":"ref_159","doi-asserted-by":"crossref","first-page":"719","DOI":"10.5664\/jcsm.2276","article-title":"Sleep abnormalities in chronic fatigue syndrome\/myalgic encephalomyelitis: A review","volume":"8","author":"Jackson","year":"2012","journal-title":"J. Clin. Sleep Med."},{"key":"ref_160","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1016\/j.neuroscience.2025.03.066","article-title":"Exploring the nexus: Sleep disorders, circadian dysregulation, and Alzheimer\u2019s disease","volume":"574","author":"Khandayataray","year":"2025","journal-title":"Neuroscience"},{"key":"ref_161","doi-asserted-by":"crossref","first-page":"101572","DOI":"10.1016\/j.smrv.2021.101572","article-title":"Sleep, cerebrospinal fluid, and the glymphatic system: A systematic review","volume":"61","author":"Chong","year":"2022","journal-title":"Sleep Med. Rev."},{"key":"ref_162","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1007\/s10571-024-01487-0","article-title":"Sleep and Oxidative Stress: Current Perspectives on the Role of NRF2","volume":"44","author":"Davinelli","year":"2024","journal-title":"Cell. Mol. Neurobiol."},{"key":"ref_163","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1016\/j.jad.2023.07.040","article-title":"Association of oxidative balance score with sleep quality: NHANES 2007-2014","volume":"339","author":"Lei","year":"2023","journal-title":"J. Affect. Disord."},{"key":"ref_164","doi-asserted-by":"crossref","first-page":"459","DOI":"10.3390\/healthcare9040459","article-title":"Life-Threatening Malnutrition in Very Severe ME\/CFS","volume":"9","author":"Baxter","year":"2021","journal-title":"Healthcare"},{"key":"ref_165","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1016\/j.bpobgyn.2019.05.012","article-title":"Assessing and managing hypovolemic shock in puerperal women","volume":"61","author":"Pacagnella","year":"2019","journal-title":"Best Pract. Res. Clin. Obstet. Gynaecol."},{"key":"ref_166","doi-asserted-by":"crossref","first-page":"101075","DOI":"10.1016\/j.blre.2023.101075","article-title":"Cardiovascular and haematological pathology in myalgic encephalomyelitis\/chronic fatigue syndrome (ME\/CFS): A role for viruses","volume":"60","author":"Nunes","year":"2023","journal-title":"Blood Rev."},{"key":"ref_167","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1016\/j.molmed.2019.11.008","article-title":"Glymphatic System Impairment in Alzheimer\u2019s Disease and Idiopathic Normal Pressure Hydrocephalus","volume":"26","author":"Reeves","year":"2020","journal-title":"Trends Mol. Med."},{"key":"ref_168","doi-asserted-by":"crossref","first-page":"3","DOI":"10.3390\/life15010003","article-title":"The Microbiota-Gut-Brain Axis: Key Mechanisms Driving Glymphopathy and Cerebral Small Vessel Disease","volume":"15","author":"Jaffer","year":"2024","journal-title":"Life"},{"key":"ref_169","first-page":"628741","article-title":"The Gut Microbiome in Myalgic Encephalomyelitis (ME)\/Chronic Fatigue Syndrome (CFS)","volume":"12","author":"Albrich","year":"2021","journal-title":"Front. Immunol."},{"key":"ref_170","doi-asserted-by":"crossref","first-page":"1352744","DOI":"10.3389\/fimmu.2024.1352744","article-title":"The gastrointestinal microbiota in the development of ME\/CFS: A critical view and potential perspectives","volume":"15","author":"Stallmach","year":"2024","journal-title":"Front. Immunol."},{"key":"ref_171","doi-asserted-by":"crossref","first-page":"254","DOI":"10.3390\/neuroglia5030018","article-title":"The Gut Microbiome-Neuroglia Axis: Implications for Brain Health, Inflammation, and Disease","volume":"5","year":"2024","journal-title":"Neuroglia"},{"key":"ref_172","doi-asserted-by":"crossref","first-page":"7551","DOI":"10.3390\/ijms21207551","article-title":"Gut-Brain Axis: Role of Gut Microbiota on Neurological Disorders and How Probiotics\/Prebiotics Beneficially Modulate Microbial and Immune Pathways to Improve Brain Functions","volume":"21","author":"Suganya","year":"2020","journal-title":"Int. J. Mol. Sci."},{"key":"ref_173","doi-asserted-by":"crossref","first-page":"828","DOI":"10.3389\/fneur.2020.00828","article-title":"Signs of Intracranial Hypertension, Hypermobility, and Craniocervical Obstructions in Patients with Myalgic Encephalomyelitis\/Chronic Fatigue Syndrome","volume":"11","author":"Michos","year":"2020","journal-title":"Front. Neurol."},{"key":"ref_174","doi-asserted-by":"crossref","first-page":"205","DOI":"10.2147\/JPR.S394321","article-title":"The Link Between Empty Sella Syndrome, Fibromyalgia, and Chronic Fatigue Syndrome: The Role of Increased Cerebrospinal Fluid Pressure","volume":"16","author":"Hulens","year":"2023","journal-title":"J. Pain Res."},{"key":"ref_175","doi-asserted-by":"crossref","first-page":"1127702","DOI":"10.3389\/fneur.2023.1127702","article-title":"Life changing response to successive surgical interventions on cranial venous outflow: A case report on chronic fatigue syndrome","volume":"14","author":"Higgins","year":"2023","journal-title":"Front. Neurol."},{"key":"ref_176","doi-asserted-by":"crossref","first-page":"1324879","DOI":"10.3389\/fneur.2024.1324879","article-title":"Do people with ME\/CFS and joint hypermobility represent a disease subgroup? An analysis using registry data","volume":"15","author":"Mudie","year":"2024","journal-title":"Front. Neurol."},{"key":"ref_177","doi-asserted-by":"crossref","first-page":"1305972","DOI":"10.3389\/fneur.2023.1305972","article-title":"Characterizing a new clinical phenotype: The co-existence of cerebral venous outflow and connective tissue disorders","volume":"14","author":"Midtlien","year":"2023","journal-title":"Front. Neurol."},{"key":"ref_178","doi-asserted-by":"crossref","first-page":"fcab043","DOI":"10.1093\/braincomms\/fcab043","article-title":"Impaired glymphatic function in idiopathic intracranial hypertension","volume":"3","author":"Eide","year":"2021","journal-title":"Brain Commun."},{"key":"ref_179","doi-asserted-by":"crossref","first-page":"2160","DOI":"10.3174\/ajnr.A7326","article-title":"Idiopathic Intracranial Hypertension is Associated with a Higher Burden of Visible Cerebral Perivascular Spaces: The Glymphatic Connection","volume":"42","author":"Jones","year":"2021","journal-title":"AJNR Am. J. Neuroradiol."},{"key":"ref_180","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1080\/23328940.2019.1691896","article-title":"Brain temperature and its role in physiology and pathophysiology: Lessons from 20 years of thermorecording","volume":"6","author":"Kiyatkin","year":"2019","journal-title":"Temperature"},{"key":"ref_181","doi-asserted-by":"crossref","first-page":"1481","DOI":"10.1152\/japplphysiol.00319.2006","article-title":"How the body controls brain temperature: The temperature shielding effect of cerebral blood flow","volume":"101","author":"Zhu","year":"2006","journal-title":"J. Appl. Physiol."},{"key":"ref_182","doi-asserted-by":"crossref","first-page":"562","DOI":"10.1007\/s11682-018-0029-4","article-title":"Evidence of widespread metabolite abnormalities in Myalgic encephalomyelitis\/chronic fatigue syndrome: Assessment with whole-brain magnetic resonance spectroscopy","volume":"14","author":"Mueller","year":"2020","journal-title":"Brain Imaging Behav."},{"key":"ref_183","doi-asserted-by":"crossref","first-page":"957055","DOI":"10.3389\/fneur.2022.957055","article-title":"Hypothermia reduces glymphatic transportation in traumatic edematous brain assessed by intrathecal dynamic contrast-enhanced MRI","volume":"13","author":"Bai","year":"2022","journal-title":"Front. Neurol."},{"key":"ref_184","doi-asserted-by":"crossref","first-page":"5073","DOI":"10.1038\/s41467-020-18756-3","article-title":"Astrocytes regulate brain extracellular pH via a neuronal activity-dependent bicarbonate shuttle","volume":"11","author":"Theparambil","year":"2020","journal-title":"Nat. Commun."},{"key":"ref_185","doi-asserted-by":"crossref","first-page":"763","DOI":"10.1038\/s41573-022-00500-9","article-title":"The glymphatic system: Implications for drugs for central nervous system diseases","volume":"21","author":"Lohela","year":"2022","journal-title":"Nat. Rev. Drug Discov."},{"key":"ref_186","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1111\/bph.13702","article-title":"Treatment and management of chronic fatigue syndrome\/myalgic encephalomyelitis: All roads lead to Rome","volume":"174","author":"Santillo","year":"2017","journal-title":"Br. J. Pharmacol."},{"key":"ref_187","doi-asserted-by":"crossref","first-page":"110","DOI":"10.37349\/ent.2022.00022","article-title":"Can meditation-based approaches improve the cleansing power of the glymphatic system?","volume":"2","author":"Wostyn","year":"2022","journal-title":"Explor. Neuroprotective Ther."},{"key":"ref_188","doi-asserted-by":"crossref","first-page":"9960304","DOI":"10.1155\/2021\/9960304","article-title":"Electroacupuncture Improves Clearance of Amyloid-\u03b2 through the Glymphatic System in the SAMP8 Mouse Model of Alzheimer\u2019s Disease","volume":"2021","author":"Liang","year":"2021","journal-title":"Neural Plast."},{"key":"ref_189","doi-asserted-by":"crossref","first-page":"3073","DOI":"10.1002\/ar.24953","article-title":"Electroacupuncture at BL15 attenuates chronic fatigue syndrome by downregulating iNOS\/NO signaling in C57BL\/6 mice","volume":"306","author":"Zhu","year":"2023","journal-title":"Anat. Rec."},{"key":"ref_190","doi-asserted-by":"crossref","first-page":"e3062","DOI":"10.1002\/brb3.3062","article-title":"rTMS treatment for abrogating intracerebral hemorrhage-induced brain parenchymal metabolite clearance dysfunction in male mice by regulating intracranial lymphatic drainage","volume":"13","author":"Liu","year":"2023","journal-title":"Brain Behav."},{"key":"ref_191","doi-asserted-by":"crossref","first-page":"1597311","DOI":"10.3389\/fnagi.2025.1597311","article-title":"The glymphatic system as a therapeutic target: TMS-induced modulation in older adults","volume":"17","author":"Sundman","year":"2025","journal-title":"Front. Aging Neurosci."},{"key":"ref_192","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1016\/j.ibneur.2023.10.008","article-title":"Repetitive transcranial magnetic stimulation ameliorates symptoms in patients with myalgic encephalomyelitis (chronic fatigue syndrome)","volume":"15","author":"Miwa","year":"2023","journal-title":"IBRO Neurosci. Rep."},{"key":"ref_193","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1016\/j.jad.2016.01.009","article-title":"An assessment of the anti-fatigue effects of ketamine from a double-blind, placebo-controlled, crossover study in bipolar disorder","volume":"194","author":"Saligan","year":"2016","journal-title":"J. Affect. Disord."},{"key":"ref_194","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1038\/s41467-024-55678-w","article-title":"Modulation of glymphatic system by visual circuit activation alleviates memory impairment and apathy in a mouse model of Alzheimer\u2019s disease","volume":"16","author":"Wu","year":"2025","journal-title":"Nat. Commun."},{"key":"ref_195","doi-asserted-by":"crossref","unstructured":"Liu, J., He, J., Chen, X., and Wu, D. (2025). Manipulation of glymphatic system by focused ultrasound: A promising treatment of neurological diseases. J. Cereb. Blood Flow Metab., 271678X251383857.","DOI":"10.1177\/0271678X251383857"},{"key":"ref_196","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1038\/s41586-024-07132-6","article-title":"Multisensory gamma stimulation promotes glymphatic clearance of amyloid","volume":"627","author":"Murdock","year":"2024","journal-title":"Nature"},{"key":"ref_197","doi-asserted-by":"crossref","unstructured":"Lahmar, T., Thuau, F., Pinard, G., Boutoleau-Bretonniere, C., Perrot, P., and Lancien, U. (2025). Brain lymphatic drainage pathways, deep cervical lymphatic surgery, and current insights: A systematic review. J. Prev. Alzheimers Dis., 100335.","DOI":"10.1016\/j.tjpad.2025.100335"},{"key":"ref_198","doi-asserted-by":"crossref","first-page":"976","DOI":"10.1097\/ALN.0000000000001888","article-title":"Anesthesia with Dexmedetomidine and Low-dose Isoflurane Increases Solute Transport via the Glymphatic Pathway in Rat Brain When Compared with High-dose Isoflurane","volume":"127","author":"Benveniste","year":"2017","journal-title":"Anesthesiology"},{"key":"ref_199","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1186\/1741-7015-11-205","article-title":"Myalgic encephalomyelitis\/chronic fatigue syndrome and encephalomyelitis disseminata\/multiple sclerosis show remarkable levels of similarity in phenomenology and neuroimmune characteristics","volume":"11","author":"Morris","year":"2013","journal-title":"BMC Med."},{"key":"ref_200","doi-asserted-by":"crossref","first-page":"e183810","DOI":"10.1172\/jci.insight.183810","article-title":"Immune exhaustion in ME\/CFS and long COVID","volume":"9","author":"Rudd","year":"2024","journal-title":"JCI Insight"}],"container-title":["International Journal of Molecular Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1422-0067\/26\/23\/11524\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T08:28:41Z","timestamp":1764318521000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1422-0067\/26\/23\/11524"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,27]]},"references-count":200,"journal-issue":{"issue":"23","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["ijms262311524"],"URL":"https:\/\/doi.org\/10.3390\/ijms262311524","relation":{},"ISSN":["1422-0067"],"issn-type":[{"value":"1422-0067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,27]]}}}