Post-Viral Trials (@postviraltrials.bsky.social)

ME/CFS and PASC Patient-Derived Immunoglobulin Complexes Disrupt Mitochondrial Function and Alter Inflammatory Marker Secretion Autoimmunity is a key clinical feature in both post-infectious Myalgic encephalomyelitis / chronic fatigue syndrome (ME/CFS) and Post-Acute Sequelae of COVID (PASC). Passive transfer of immunoglobulins from patients’ sera into mice induces some clinical features of PASC. IgG-induced transfer of disease phenotypes has long been appreciated, yet the exact mechanism of disease development remains largely elusive. Here, we demonstrate that IgG isolated from post-infectious ME/CFS patients selectively induces mitochondrial fragmentation in human endothelial cells, thereby altering mitochondrial energetics. This effect is lost upon cleavage of IgG into its Fab and Fc fragments. The digested Fab fragment from ME/CFS alone was able to alter the mitochondrial energetics, resembling the effect of intact IgG. In contrast, the Fc fragment alone induced a hypometabolic phenotype characterized by a trend towards reduced overall ATP content. IgG from ME/CFS and PASC patients induced distinct but separate cytokine secretion profiles in healthy PBMCs. Proteomics analysis of IgG-bound immune complexes revealed significant changes within the immune complexes of ME/CFS patients, affecting extracellular matrix organization, while the same from PASC patients pointed towards alterations in hemostasis and blood clot regulation. We demonstrate that IgGs from ME/CFS patients carry a chronic protective stress response that promotes mitochondrial adaptation via fragmentation, without altering mitochondrial ATP generation capacity in endothelial cells. Together, these results highlight a potential pathogenic role of IgG in post-infectious ME/CFS and point to novel therapeutic strategies targeting antibody-mediated metabolic dysregulation. One Sentence Summary IgG immune complexes from ME/CFS and PASC patients differ from those of healthy individuals and affect mitochondrial structure and function. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This work was supported by grants from ME Research UK, with the financial support of the Gordon Parish Charitable Trust (to BKP), the Amar Foundation, USA (to BKP), and the Bundesministerium fuer Bildung und Forschung (BMBF) (grant number 01EJ2204E) (to BKP). ZL was supported by a fellowship from Bundesverband fuer ME/CFS - Fatigatio e.V. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethics Committee of Charite Universitaetsmedizin Berlin (EA2/067/20; EA2\_066\_22; EA4\_174\_22) and Medizinische Ethikkommission of JMU, Wuerzburg (83/23) I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes The mass spectrometry proteomics data for the serum immunoglobulin proteome study have been deposited in the ProteomeXchange Consortium via the PRIDE partner repository with the dataset identifier PXD065439. Any additional information required to reanalyze the data reported in this paper is available from the lead contact upon request. https://www.medrxiv.org/content/10.1101/2025.08.06.25332978v1