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{{Cleanup/Citations needed | date = Mar 2021}} The '''microbiome''' is the community of microorganisms (such as [[bacteria]], [[fungus|fungi]], and [[virus]]es) that inhabit a particular environment, especially the human body. <ref>{{Cite web|website=Merrian-Webster Medical Dictionary|access-date=2021-02-20 | title = Definition of MICROBIOME|url=https://www.merriam-webster.com/dictionary/microbiome}}</ref> ==Anatomical areas== The microorganisms live on the skin and genitals and in the [[nose microbiome|nose]], ears, [[oral microbiome|mouth]] and [[gut microbiome|gut]]. [[Dysbiosis]] or an imbalance in this community may play a role in the pathophysiology of [[chronic fatigue syndrome]].{{Citation needed | date = Mar 2021}} ===Gut flora=== The [[gut microbiome]] is a complex community of trillions of microorganisms residing in the intestines. 99% of bacteria in the gut are [[Anaerobic bacteria|anaerobes]]. ===Skin flora=== ===Nose flora=== ===Oral flora=== ==ME/CFS== A growing body of evidence suggests that an [[dysbiosis|altered microbiome]]; [[intestinal permeability|mucosal barrier]] dysfunction;<ref name="Lakhan2010">{{Citation| doi = 10.1186/1743-7075-7-79| issn = 1743-7075| volume = 7|issue = | pages = 79| last1 = Lakhan | first1 = Shaheen E| last2 = Kirchgessner | first2 = Annette| title = Gut inflammation in chronic fatigue syndrome| journal = Nutrition & Metabolism| access-date = 2016-12-13 | date = 2010-10-12| url = http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2964729/| pmid = 20939923}}</ref> the translocation or crossing of bacteria from the gut into the [[blood|bloodstream]]; and subsequent immune response may pay a role in the pathophysiology of [[myalgic encephalomyelitis]]\[[chronic fatigue syndrome]]. A 2021 study by Damiano and colleagues observed significant differences in several types of bacteria in the saliva and gut in CFS/ME patients compared to controls, but was unable to determine if the alteration of the microbiome is a cause or a consequence of the onset of CFS/ME and if the changes in the microbial composition are related to any of the several secondary symptoms.<ref name="Damiano2021" /> The study showed that the intestinal microbial profile recorded in a group of ME/CFS patients was consistent with the reported for other autoimmune conditions, such as Crohn’s disease, [[ulcerative colitis]] and [[systemic lupus erythematous]].{{citation needed | date = 2021}} ===Immune response=== A study of 128 [[ME/CFS]] patients found significantly increased [[IgA]] response to [[lipopolysaccharide]]s from the cell walls of commensal bacteria. Increased IgA response was associated with increased serum [[interleukin 1|IL-1]], [[TNFα]], [[neopterin]] and [[elastase]]. The study concluded that increased translocation of commensal bacteria may be responsible for the disease activity in some ME/CFS patients.<ref name="Maes2012" /> ===Dysbiosis=== :''{{main|page_name =Dysbiosis}}'' There is strong evidence that [[dysbiosis]] or an imbalance in the microbial ecology of the gut plays a role in the symptoms of [[ME/CFS]]. ME/CFS patients have higher levels of [[D-lactic acid]] bacteria,<ref>{{Cite journal | last = Sheedy | first = John R. | authorlink = | last2 = Wettenhall | first2 = Richard E. H. | authorlink2 = | last3 = Scanlon | first3 = Denis | authorlink3 = | last4 = Gooley | first4 = Paul R. | authorlink4 = Paul Gooley | last5 = Lewis | first5 = Donald P. | authorlink5 = Donald Lewis | last6 = McGregor | first6 = Neil | authorlink6 = Neil McGregor | last7 = Stapleton | first7 = David I. | last8 = Butt | first8 = Henry L. | authorlink8 = Henry Butt | last9 = De Meirleir | first9 = Kenny L. | authorlink9 = Kenny De Meirleir | date = Jul 2009 | title = Increased d-lactic Acid intestinal bacteria in patients with chronic fatigue syndrome|url=https://pubmed.ncbi.nlm.nih.gov/19567398|journal=In Vivo (Athens, Greece)|volume=23|issue=4 | pages = 621–628|doi=|issn=0258-851X|pmc=|pmid=19567398|access-date=|quote=|via=}}</ref> decreased levels of [[bifidobacteria]],<ref>{{Cite journal | last = Logan | first = Alan C | authorlink = | last2 = Venket Rao | first2 = A | authorlink2 = | last3 = Irani | first3 = Dinaz | authorlink3 = | date = Jun 2003 | title = Chronic fatigue syndrome: lactic acid bacteria may be of therapeutic value|url=https://linkinghub.elsevier.com/retrieve/pii/S0306987703000963|journal=Medical Hypotheses|language=en|volume=60|issue=6 | pages = 915–923|doi=10.1016/S0306-9877(03)00096-3|pmc=|pmid=|access-date=|quote=|via=}}</ref> and may suffer from [[small intestinal bacterial overgrowth]] (SIBO) at higher rates.{{citation needed}} ===Exercise=== A small study of ten CFS patients found significant changes in the composition of the microbiome and increased bacterial translocation (movement from the [[gastrointestinal system|intestine]] into the [[blood|bloodstream]] following [[exercise]]). In the blood, the study found increased [[Clostridium]] fifteen minutes after exercise and increased [[bacilli]] 48 hours later.<ref name="Shukla2015" /><ref>{{citation | last = Johnson | first = Cort | date = December 21, 2015 | title = Exercise Triggers Gut Changes in Chronic Fatigue Syndrome (ME/CFS)|url= http://www.cortjohnson.org/blog/2015/12/21/exercise-gut-chronic-fatigue-syndrome-me-cfs/|newspaper= HealthRising|location= Houston|access-date= 2016-12-12}}</ref>{{citation needed | date = 2021 | reason=Add original research}} ===Sleep=== In a very small study, CFS patients treated with [[erythromycin]] who had clinical response (i.e., reduced [[streptococcus]]) had improved sleep. Higher [[lactobacillus]] was associated with poorer mood.<ref name="Jackson2015" /> ===Gender=== A study of 274 [[ME/CFS]] patients found sex-specific interactions between [[Firmicute]]s ([[Clostridium]], [[Streptococcus]], [[Lactobacillus]] and [[Enterococcus]]) and ME/CFS symptoms (including neurological, immune and mood symptoms) and symptoms in spite of similar overall composition across sexes.<ref name="Wallis2016" /> ==Factors affecting microbiome== === Diet === The food we eat has a considerable effect on the composition of the intestinal microbiota.<ref name="Maslowski2011" /> === Viral infection === Viruses can cause shifts in the gut microbiome. In mice, the influenza virus leads to injury of both the lungs (the primary site of infection) and the intestinal tract, even when there is no evidence of viral replication in the gut, and causes decreases [[Lactobacillus]] and [[Lactococcus]] species and increases in [[Enterobacteriaceae]].<ref>{{citation | last = Racaniello | first = Vincent | date = 10 December 2014 | title = How influenza virus infection might lead to gastrointestinal symptoms|url= http://www.virology.ws/2014/12/10/how-influenza-virus-infection-might-lead-to-gastrointestinal-symptoms/|newspaper= Virology Blog|location= New York|access-date= 2016-12-12}}</ref> === Pregnancy === Gut microbiota change dramatically from the first trimester to the third trimester of [[pregnancy]]. During the first trimester, there is an overrepresentation of 18 bacterial groups, mainly [[Faecalibacterium]], a [[butyrate]] producer that has been shown to improve symptoms of [[inflammatory bowel disease]].<ref name="koren2012" /> During the third trimester, populations of pro-inflammatory [[bacteria]] species such as [[proteobacteria]] and [[actinobacteria]] increase and there is a reduction in diversity. Populations of [[Faecalibacterium]] decrease.<ref name="koren2012" /> Overall bacterial load increases over the course of pregnancy.<ref>http://www.scopus.com/record/display.uri?eid=2-s2.0-53849104768&origin=inward&txGid=B73C4858FB9D5F216C9F222F22386A44.iqs8TDG0Wy6BURhzD3nFA%3a2</ref> ===Nervous system=== The intestinal microbiota play a major role in the [[gut-brain axis]] with consequences for both neurological development and host behavior. === Stress === There is growing evidence that the microbiome plays an important role in the [[stress]] response. Animals raised in a germ-free environment show an exaggerated [[HPA]] response to psychological stress which normalizes when [[Bifidobacterium infantis|''Bifidobacterium infantis'']] is introduced. [[Escherichia coli|''Escherichia coli'']] can activate the HPA.<ref name="Dinan2012" /> Stress also increases [[intestinal permeability]]. ==Planned studies== British patient charity [[Invest in ME]] is raising funds for a gut microbiome study at the University of East Anglia in the United Kingdom led by professor [[Simon Carding]].<ref>[http://www.investinme.org/LDR%20UK%20Gut%20Microbiota.htm Invest in ME – UK gut microbiota research]</ref> Funds are being raised by patients (originally led by the late [[Vanessa Li]]) for [[Ian Lipkin]] and [[Mady Hornig]] of Columbia University in the United States to perform a study, called the [[ME/CFS Monster Study]], looking at many areas including the gut microbiome in [[ME/CFS]] patients. Fundraising efforts are led by the [[Microbe Discovery Project]]. ==Notable studies== *2009, Increased d-lactic Acid intestinal bacteria in patients with chronic fatigue syndrome<ref>{{Cite journal | last = Sheedy | first = John R. | authorlink = | last2 = Wettenhall | first2 = Richard E. H. | authorlink2 = | last3 = Scanlon | first3 = Denis | authorlink3 = | last4 = Gooley | first4 = Paul R. | authorlink4 = Paul Gooley | last5 = Lewis | first5 = Donald P. | authorlink5 = Donald Lewis | last6 = McGregor | first6 = Neil | authorlink6 = Neil McGregor | last7 = Stapleton | first7 = David I. | last8 = Butt | first8 = Henry L. | authorlink8 = Henry Butt | last9 = De Meirleir | first9 = Kenny L. | authorlink9 = Kenny De Meirleir | date = Jul 2009 | title = Increased d-lactic Acid intestinal bacteria in patients with chronic fatigue syndrome|url=https://pubmed.ncbi.nlm.nih.gov/19567398|journal=In Vivo (Athens, Greece)|volume=23|issue=4 | pages = 621–628|doi=|issn=0258-851X|pmc=|pmid=19567398|access-date=|quote=|via=}}</ref> - [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5843715/ (Full Text)] *2010, [https://www.ncbi.nlm.nih.gov/pubmed/20939923 Gut inflammation in chronic fatigue syndrome]<ref name="Lakhan2010" /> *2012, [https://www.ncbi.nlm.nih.gov/pubmed/21967891 Increased IgA responses to the LPS of commensal bacteria is associated with inflammation and activation of cell-mediated immunity in chronic fatigue syndrome]<ref name="Maes2012" /> *2012, [http://www.cdd.com.au/pdf/publications/All%20Publications/2013%20-%20The%20GI%20microbiome%20and%20its%20role%20in%20CFS%20-%20ACNEM%20paper.pdf/ The GI Microbiome and its Role in Chronic Fatigue Syndrome: A Summary of Bacteriotherapy]<ref name="Borody2012" /> *2013, [https://www.ncbi.nlm.nih.gov/pubmed/23791918 High-throughput 16S rRNA gene sequencing reveals alterations of intestinal microbiota in myalgic encephalomyelitis/chronic fatigue syndrome patients]<ref name="Fremont2013" /> *2015, [https://www.ncbi.nlm.nih.gov/pubmed/26779319 Sleep quality and the treatment of intestinal microbiota imbalance in Chronic Fatigue Syndrome: A pilot study]<ref name="Jackson2015" /> *2015, [https://www.ncbi.nlm.nih.gov/pubmed/26683192 Changes in Gut and Plasma Microbiome following Exercise Challenge in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)]<ref name="Shukla2015" /> *2016, [https://www.ncbi.nlm.nih.gov/pubmed/27634186 The role of microbiota and intestinal permeability in the pathophysiology of autoimmune and neuroimmune processes with an emphasis on Inflammatory Bowel Disease Type 1 Diabetes and Chronic Fatigue Syndrome]<ref name="Morris, 2016" /> *2016, [https://microbiomejournal.biomedcentral.com/articles/10.1186/s40168-016-0171-4 Reduced diversity and altered composition of the gut microbiome in individuals with myalgic encephalomyelitis/chronic fatigue syndrome]<ref>{{Cite journal | last = Giloteaux | first = Ludovic | authorlink = Ludovic Giloteaux | last2 = Goodrich | first2 = Julia K. | authorlink2 = | last3 = Walters | first3 = William A. | authorlink3 = | last4 = Levine | first4 = Susan M. | authorlink4 = Susan Levine | last5 = Ley | first5 = Ruth E. | authorlink5 = | last6 = Hanson | first6 = Maureen R. | authorlink6 = Maureen Hanson | date = Dec 2016 | title = Reduced diversity and altered composition of the gut microbiome in individuals with myalgic encephalomyelitis/chronic fatigue syndrome|url=http://microbiomejournal.biomedcentral.com/articles/10.1186/s40168-016-0171-4|journal=Microbiome|language=en|volume=4|issue=1|pages=|doi=10.1186/s40168-016-0171-4|issn=2049-2618|pmc=4918027|pmid=27338587|quote=|via=}}</ref> *2016, [http://www.nature.com/articles/srep19171 Support for the Microgenderome: Associations in a Human Clinical Population]<ref name="Wallis2016" /> *2017, Fecal metagenomic profiles in subgroups of patients with [[ME/CFS|myalgic encephalomyelitis/chronic fatigue syndrome]]<ref name="Nagy-Szakal, 2017" /> [https://microbiomejournal.biomedcentral.com/articles/10.1186/s40168-017-0261-y (Full Text)] *2018, Does the microbiome and virome contribute to myalgic encephalomyelitis/chronic fatigue syndrome?<ref name="Newberry, 2018" /> *2018, [[Chronic fatigue syndrome]] patients have alterations in their oral microbiome composition and function<ref>{{Cite journal | last = Wang | first = Taiwu | last2 = Yu | first2 = Lei | last3 = Xu | first3 = Cong | last4 = Pan | first4 = Keli | last5 = Mo | first5 = Minglu | last6 = Duan | first6 = Mingxiang | last7 = Zhang | first7 = Yao | last8 = Xiong | first8 = Hongyan | date = 2018-09-11 | title = Chronic fatigue syndrome patients have alterations in their oral microbiome composition and function | url =https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0203503|journal=PLOS ONE|language=en|volume=13|issue=9| pages = e0203503|doi=10.1371/journal.pone.0203503|issn=1932-6203}}</ref> [https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0203503 (Full Text)] *2018, Myalgic Encephalomyelitis/Chronic Fatigue Syndrome in the era of the human microbiome: persistent pathogens drive chronic symptoms by interfering with host [[metabolism]], [[gene expression]] and [[Immune system|immunity]]<ref>{{Cite journal | last = Proal | first = Amy | authorlink = Amy Proal | last2 = Marshall | first2 = Trevor | authorlink2 = Trevor Marshall | date = Nov 2018 | title = Myalgic Encephalomyelitis/Chronic Fatigue Syndrome in the era of the human microbiome: persistent pathogens drive chronic symptoms by interfering with host metabolism, gene expression and immunity|url=https://www.frontiersin.org/articles/10.3389/fped.2018.00373/full|journal=Frontiers in Pediatrics|volume=|issue=|pages=|quote=|via=|doi=10.3389/fped.2018.00373}}</ref> [https://www.frontiersin.org/articles/10.3389/fped.2018.00373/full (Full text)] * 2021, Potential role of microbiome in Chronic Fatigue Syndrome/Myalgic Encephalomyelits (CFS/ME)<ref name="Damiano2021">{{Cite journal | last = Lupo | first = Giuseppe Francesco Damiano | author-link = | last2 = Rocchetti | first2 = Gabriele | authorlink2 = | last3 = Lucini | first3 = Luigi | authorlink3 = | last4 = Lorusso | first4 = Lorenzo | authorlink4 = Lorenzo Lorusso | last5 = Manara | first5 = Elena | authorlink5 = | last6 = Bertelli | first6 = Matteo | authorlink6 = | last7 = Puglisi | first7 = Edoardo | last8 = Capelli | first8 = Enrica | authorlink8 = Enrica Capelli | date = March 2021 | title = Potential role of microbiome in Chronic Fatigue Syndrome/Myalgic Encephalomyelits (CFS/ME)|url=http://www.nature.com/articles/s41598-021-86425-6|journal=Scientific Reports|language=en|volume=11|issue=1 | pages = 7043|doi=10.1038/s41598-021-86425-6|issn=2045-2322|pmc=|pmid=33782445|access-date=|quote=|via=}}</ref> - [https://www.nature.com/articles/s41598-021-86425-6 (Full text)] ==Commercial testers== *[[uBiome]] ==Academic projects== *[[American Gut]] *[[British Gut Project]] ==Learn more== *[https://en.wikipedia.org/wiki/Microbiota Wikipedia - Microbiota] *[[CFS Remission]] ([[Ken Lassesen]]'s blogs about experimental ME/CFS microbiome and probiotic treatments) *2016, [https://cfsremission.wordpress.com/2016/08/09/what-should-be-in-the-ideal-microbiome-test-for-cfs/ What should be in the ideal microbiome test for CFS] ''[[CFS Remission]]'' *2016, [https://cfstreatment.blogspot.co.uk/2016/07/all-in-your-gut.html It's All in Your Gut] ''[[Onward Through the Fog]]'' *2016, [http://well.blogs.nytimes.com/2016/07/07/gut-bacteria-are-different-in-people-with-chronic-fatigue-syndrome/ Gut Bacteria Are Different in People With Chronic Fatigue Syndrome] ''The New York Times''<ref>{{citation | last = Bakalar | first = Nicholas | date = 7 July 2016 | title = Gut Bacteria Are Different in People With Chronic Fatigue Syndrome|url= http://well.blogs.nytimes.com/2016/07/07/gut-bacteria-are-different-in-people-with-chronic-fatigue-syndrome/|newspaper= The New York Times|location= |access-date= 2016-12-13}}</ref> *2016, [https://www.washingtonpost.com/news/to-your-health/wp/2016/06/30/new-study-shows-chronic-fatigue-isnt-just-in-your-head-it-may-have-to-do-with-your-gut/ New study shows chronic fatigue syndrome may have to do with gut microbes] ''The Washington Post''<ref>{{citation | last = Cha | first = Ariana Eunjung | date = Jun 30, 2016 | title = New study shows chronic fatigue syndrome may have to do with gut microbes|url= https://www.washingtonpost.com/news/to-your-health/wp/2016/06/30/new-study-shows-chronic-fatigue-isnt-just-in-your-head-it-may-have-to-do-with-your-gut/|newspaper= The Washington Post|location= |access-date= 2016-12-13}}</ref> *2016, [http://news.cornell.edu/stories/2016/06/indicator-chronic-fatigue-syndrome-found-gut-bacteria Indicator of chronic fatigue syndrome found in gut bacteria] ''Cornell Chronicle''<ref>{{citation | last = Ramanujan | first = Krishna | date = 24 June 2016 | title = Indicator of chronic fatigue syndrome found in gut bacteria|url= http://news.cornell.edu/stories/2016/06/indicator-chronic-fatigue-syndrome-found-gut-bacteria|newspaper= Cornell Chronicle|location= New York|access-date= 2016-12-13}}</ref> *2016, [http://www.cortjohnson.org/blog/2016/02/21/gut-chronic-fatigue-syndrome-gender-differences/ Gender Gut Wars: Australian ME/CFS Study Suggests Different Gut Treatment Protocols Needed For Men and Women] ''[[Health Rising]]''<ref>{{citation | last = Johnson | first = Cort | date = 21 February 2016 | title = Gender Gut Wars: Australian ME/CFS Study Suggests Different Gut Treatment Protocols Needed For Men and Women | url = http://www.cortjohnson.org/blog/2016/02/21/gut-chronic-fatigue-syndrome-gender-differences/|newspaper= HealthRising|location= Houston|access-date= 2016-12-13}}</ref> *[https://cfsremission.wordpress.com/2016/04/02/vitamin-d-and-the-microbiome/ Vitamin D and the Microbiome] ''[[CFS Remission]]'' ==See also== *[[Probiotics]] *[[Gastrointestinal system]] *[[Helminthic therapy]] *[[Ken Lassesen's model]] *[[Nasal microbiome]] *[[Oral microbiome]] *[[Indoor microbiome]] *[[Dr Markov's chronic bacterial intoxication syndrome (CBIS) theory of ME/CFS]] (Dr Markov has evidence that ME/CFS is caused by a dysbiosis in the kidneys) ==References== <references> <ref name="Lakhan2010">{{Citation| doi = 10.1186/1743-7075-7-79| issn = 1743-7075| volume = 7|issue = | pages = 79| last1 = Lakhan | first1 = Shaheen E| last2 = Kirchgessner | first2 = Annette| title = Gut inflammation in chronic fatigue syndrome| journal = Nutrition & Metabolism| access-date = 2016-12-13 | date = 2010-10-12| url = http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2964729/| pmid = 20939923}}</ref> <ref name="Maes2012">{{Citation| doi = 10.1016/j.jad.2011.09.010| issn = 1573-2517| volume = 136 | issue = 3| pages = 909–917| last1 = Maes | first1 = Michael | last2 = Twisk | first2 = Frank N.M. | last3 = Kubera | first3 = Marta | last4 = Ringel | first4 = Karl | last5 = Leunis | first5 = Jean-Claude | last6 = Geffard | first6 = Michel| title = Increased IgA responses to the LPS of commensal bacteria is associated with inflammation and activation of cell-mediated immunity in chronic fatigue syndrome| journal = Journal of Affective Disorders| date = February 2012 | pmid = 21967891}}</ref> <ref name="Shukla2015">{{Citation| doi = 10.1371/journal.pone.0145453| issn = 1932-6203| volume = 10 | issue = 12| pages = 0145453| last1 = Shukla | first1 = Sanjay K. | last2 = Cook | first2 = Dane | last3 = Meyer | first3 = Jacob| last4 = Vernon | first4 = Suzanne D. | last5 = Le | first5 = Thao | last6 = Clevidence | first6 = Derek | last7 = Robertson | first7 = Charles E. | last8 = Schrodi | first8 = Steven J. | last9 = Yale | first9 = Steven | last10 = Frank | first10 = Daniel N.| title = Changes in Gut and Plasma Microbiome following Exercise Challenge in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)| journal = PLOS ONE| access-date = 2016-12-13 | date = 2015-12-18| url = http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0145453}}</ref> <ref name="Jackson2015">{{citation | last1 = Jackson | first1 = Melinda L | authorlink1 = Melinda Jackson | last2 = Butt | first2 = Henry L | authorlink2 = Henry Butt | last3 = Ball | first3 = Michelle | authorlink3 = Michelle Ball | last4 = Lewis | first4 = Donald P | authorlink4 = Donald Lewis | last5 = Bruck | first5 = Dorothy | authorlink5 = Dorothy Bruck | title = Sleep quality and the treatment of intestinal microbiota imbalance in Chronic Fatigue Syndrome: A pilot study | journal = Sleep Science | volume = 8 | issue = 3 | pages = 124-133 | date = 23 Oct 2015 | pmid = 26779319 | doi = 10.1016/j.slsci.2015.10.001 | url = http://www.sciencedirect.com/science/article/pii/S1984006315000632 }}</ref> <ref name="Wallis2016">{{citation | last1 = Wallis | first1 = Amy| authorlink1 = Amy Wallis | last2 = Butt | first2 = Henry L | authorlink2 = Henry Butt | last3 = Ball | first3 = Michelle | authorlink3 = Michelle Ball | last4 = Lewis | first4 = Donald P | authorlink4 = Donald Lewis | last5 = Bruck | first5 = Dorothy | authorlink5 = Dorothy Bruck | title = Support for the Microgenderome: Associations in a Human Clinical Population | journal = Scientific Reports | volume = | pages = | date = 13 Jan 2016 |issue = | pmid = 26757840 | doi = 10.1038/srep19171 | url = http://www.nature.com/articles/srep19171 }}</ref> <ref name="Maslowski2011">{{Citation| doi = 10.1038/ni0111-5| issn = 1529-2916| volume = 12 | issue = 1| pages = 5–9| last1 = Maslowski | first1 = Kendle M. | last2 = Mackay | first2 = Charles R.| title = Diet, gut microbiota and immune responses| journal = Nature Immunology | date = January 2011 | pmid = 21169997}}</ref> <ref name="koren2012">{{Citation| doi = 10.1016/j.cell.2012.07.008| issn = 1097-4172| volume = 150 | issue = 3| pages = 470–480| last1 = Koren | first1 = Omry | last2 = Goodrich | first2 = Julia K. | last3 = Cullender | first3 = Tyler C. | last4 = Spor | first4 = Aymé| last5 = Laitinen | first5 = Kirsi | last6 = Bäckhed | first6 = Helene Kling | last7 = Gonzalez | first7 = Antonio | last8 = Werner | first8 = Jeffrey J. | last9 = Angenent | first9 = Largus T. | last10 = Knight | first10 = Rob| last11 = Bäckhed | first11 = Fredrik | last12 = Isolauri | first12 = Erika | last13 = Salminen | first13 = Seppo | last14 = Ley | first14 = Ruth E.| title = Host remodeling of the gut microbiome and metabolic changes during pregnancy| journal = Cell| date = 2012-08-03 | pmid = 22863002}}</ref> <ref name="Dinan2012">{{Citation| doi = 10.1016/j.psyneuen.2012.03.007| issn = 0306-4530| volume = 37 | issue = 9| pages = 1369–1378| last1 = Dinan | first1 = Timothy G. | last2 = Cryan | first2 = John F.| title = Regulation of the stress response by the gut microbiota: Implications for psychoneuroendocrinology| journal = Psychoneuroendocrinology| access-date = 2016-12-13 | date = September 2012| url = http://www.sciencedirect.com/science/article/pii/S0306453012000935}}</ref> <ref name="Fremont2013">{{Citation| doi = 10.1016/j.anaerobe.2013.06.002| issn = 1095-8274| volume = 22 | issue = | pages = 50–56| last1 = Frémont | first1 = Marc| last2 = Coomans | first2 = Danny | last3 = Massart | first3 = Sebastien | last4 = De Meirleir | first4 = Kenny| title = High-throughput 16S rRNA gene sequencing reveals alterations of intestinal microbiota in myalgic encephalomyelitis/chronic fatigue syndrome patients| journal = Anaerobe | date = August 2013 | pmid = 23791918}}</ref> <ref name="Borody2012">{{Citation| issn = 1328-8040| volume = 31 | issue = 3| pages = 3| last1 = Borody | first1 = Thomas J. | last2 = Nowak | first2 = Anna | last3 = Finlayson | first3 = Sarah| title = The GI microbiome and its role in Chronic Fatigue Syndrome: A summary of bacteriotherapy| journal = Journal of the Australasian College of Nutritional and Environmental Medicine| access-date = 2016-12-13 | date = December 2012| url = http://www.cdd.com.au/pdf/publications/All%20Publications/2013%20-%20The%20GI%20microbiome%20and%20its%20role%20in%20CFS%20-%20ACNEM%20paper.pdf/}}</ref> <ref name="Morris, 2016">{{Citation | last1 = Morris | first1 = Gerwyn | authorlink1 = Gerwyn Morris | last2 = Berk | first2 = Michael | authorlink2 = Michael Berk | last3 = Carvalho | first3 = A.F. | authorlink3 = | last4 = Caso | first4 = J.R. | authorlink4 = | last5 = Sanz | first5 = Y. | authorlink5 = | last6 = Maes | first6 = Michael | authorlink6 = Michael Maes | title = The role of microbiota and intestinal permeability in the pathophysiology of autoimmune and neuroimmune processes with an emphasis on Inflammatory Bowel Disease Type 1 Diabetes and Chronic Fatigue Syndrome. | journal = Current Pharmaceutical Design | volume = | issue = | pages = | date = 2016 | pmid = 27634186 }}</ref> <ref name="Nagy-Szakal, 2017">{{Citation | last1 = Nagy-Szakal | first1 = Dorottya | authorlink1 = Dorottya Nagy-Szakal | last2 = Williams | first2 = Brent L. | authorlink2 = | last3 = Mishra | first3 = Nischay | authorlink3 = | last4 = Che | first4 = Xiaoyu | authorlink4 = | last5 = Lee | first5 = Bohyun | authorlink5 = | last6 = Bateman | first6 = Lucinda | authorlink6 = Lucinda Bateman | last7 = Klimas | first7 = Nancy G. | authorlink7 = Nancy Klimas | last8 = Komaroff | first8 = Anthony L. | authorlink8 = Anthony Komaroff | last9 = Levine | first9 = Susan | authorlink9 = Susan Levine | last10 = Montoya | first10 = Jose G. | authorlink10 = Jose Montoya | last11 = Peterson | first11 = Daniel L. | authorlink11 = Daniel Peterson | last12 = Ramanan | first12 = Devi | authorlink12 = | last13 = Jain | first13 = Komal | authorlink13 = | last14 = Eddy | first14 = Meredith L. | authorlink14 = | last15 = Hornig | first15 = Mady | authorlink15 = Mady Hornig | last16 = Lipkin | first16 = W. Ian | authorlink16 = Ian Lipkin | title = Fecal metagenomic profiles in subgroups of patients with myalgic encephalomyelitis/chronic fatigue syndrome | journal = Microbiome | volume = 5 | issue = 44 | pages = | date = 2017 | pmid = | doi = 10.1186/s40168-017-0261-y }}</ref> <ref name="Newberry, 2018">{{Citation | last1 = Newberry | first1 = F. | authorlink1 = | last2 = Hsieh | first2 = S.-Y. | authorlink2 = | last3 = Wileman | first3 = T. | authorlink3 = | last4 = Carding | first4 = S.R. | authorlink4 = Simon Carding | title = Does the microbiome and virome contribute to myalgic encephalomyelitis/chronic fatigue syndrome? | journal = Clinical Science | volume = 132 | issue = 5 | pages = 523–542 | date = 2018 | pmid = | doi = 10.1042/CS20171330 }}</ref> </references> [[Category:Body systems]] [[Category:Microbiome]]
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