Complement C4a

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Complement C4a is a protein that is expressed, primarily in the liver and in macrophage, in response to acute inflammation or tissue injury. Increased C4a levels have been found after exercise in ME/CFS patients and not in healthy controls. Others found a strong relation between the change in complement C4a level and an increase in post-exertional pain and fatigue in ME/CFS patients. For these reasons, it has been suggested C4a could be used as a marker of post-exertional malaise in ME/CFS.