Jose Montoya

From MEpedia, a crowd-sourced encyclopedia of ME and CFS science and history
Source: Stanford HealthCare

Jose Gilberto Montoya is an infectious disease doctor. Until 2019,[1] he was Professor of Medicine (Infectious Diseases and Geographic Medicine) at Stanford University Medical Center and head of the Stanford ME/CFS Initiative. His special areas of clinical focus include: chronic fatigue syndrome, infectious disease, Toxoplasmosis, infection in the setting of solid organ transplantation, and infection as a trigger of chronic diseases.[2] Considered one of the foremost experts of ME/CFS, Dr. Montoya has served on numerous government and institutional committees on ME/CFS. He is also an ME/CFS researcher and frequent conference speaker.

Education[edit | edit source]

  • 1985, Medical Education: Universidad Del Valle, Colombia[2]
  • 1988, Internship: Tulane University School of Medicine, Louisiana, US[2]
  • 1990, Residency: Tulane University School of Medicine, Louisiana, US[2]
  • 1994, Fellowship: Stanford University School of Medicine, California, US[2]

Research[edit | edit source]

Dr. Montoya published a number of seminal studies on ME/CFS. In one study he was able to show elevated, pro-inflammatory cytokines in ME/CFS patients, indicating a likely connection between inflammation, potentially due to immune-system dysfunction, causing some of the symptoms experienced by ME/CFS patients.[3][4]

Stanford ME/CFS Initiative[edit | edit source]

Dr. Montoya and his team at the Stanford ME/CFS Initiative had short-term goals of patient care; research and discovery; and education. They also had a long-term goal of establishing an inpatient center, apart from a hospital where patients with chronic conditions could receive long-term treatment.

On May 30, 2019, Stanford University terminated Dr. Montoya from his university positions, after it received "complaints relating to his conduct" and conducted "an investigation led by an outside attorney and Stanford faculty member that found multiple violations of the University’s conduct policies."[1] The university campus newspaper, The Stanford Daily, reported that allegations of sexual harassment, misconduct and assault, brought forward in March by women who had worked for Dr. Montoya, prompted the investigation.[5][6]

Dr. Montoya responded to the allegations with a statement from his lawyer, saying, “I sincerely apologize to anyone who, in any way, I offended. What has unfolded since March has been a huge surprise[...] It was even more shattering to learn [...] it was members of my Stanford ME/CFS team who experienced some of my behaviors as attempts at unsolicited sexual acts, harassment, and misconduct. It is extremely important that you know I have not been involved in any sexual or romantic relationships with employees, trainees, colleagues, or CFS team members”.[1]

Committees/Working Groups[edit | edit source]

IOM Committee on Diagnostic Criteria for ME/CFS[edit | edit source]

Dr Montoya was a reviewer for the 2015 report produced by the Institute of Medicine's Committee on Diagnostic Criteria for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome.[7]

ME/CFS Collaborative Research Center at Stanford University[edit | edit source]

Dr. Montoya was a member of the Working Group which offered their expertise and resources to the ME/CFS Collaborative Research Center at Stanford University.[8]

ME/CFS Common Data Elements (CDE) Project[edit | edit source]

Dr. Montoya was co-chair with Dr. Anthony Komaroff for the Baseline/Covariate Working Group and co-chair with Kimberly Sullivan, PhD of the Neurologic/Cognitive/CNS Imaging Working Group for the Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Common Data Elements (CDE) Project sponsored by the National Institute of Neurological Disorders and Stroke and the Centers for Disease Control and Prevention.[9]

Awards[edit | edit source]

  • 1988, Outstanding Intern Award, Department of Medicine, Tulane University School of Medicine[2]
  • 1990, The Owl Club Award for Outstanding Clinical Teaching, Tulane University School of Medicine[2]
  • 1990, The Department of Medicine Outstanding Teaching Award, Tulane University School of Medicine[2]
  • 1990, Outstanding Senior Resident Awar, Department of Medicine, Tulane University School of Medicine[2]
  • 1995, The Franklin G. Ebaugh, Jr. Award for Advising Medical Students, Stanford University School of Medicine[2]
  • 1995, The Henry J. Kaiser Award for Excellence in Clinical Teaching, Stanford University School of Medicine[2]
  • 1997, The Arthur L. Bloomfield Award for Excellence in the Teaching of Clinical Medicine, Stanford University School of Medicine[2]
  • 1998, The David A. Rytand Teaching Award for Excellence in Clinical Teaching, Department of Medicine, Stanford University School of Medicine[2]
  • 2000, The Kenneth Vosti Teaching Award for Excellence in Teaching, Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine[2]
  • 2001, The David A. Rytand Teaching Award for Excellence in Clinical Teaching., Department of Medicine, Stanford University School of Medicine[2]
  • 2002, The Kenneth Vosti Teaching Award for Excellence in Teaching, Division of Infectious Diseases, Department of Medicine, Stanford University School of Medicine[2]
  • 2003, Chief Residents Teaching Award for exemplary teaching at Stanford Resident's report, Department of Medicine, Stanford University School of Medicine[2]
  • 2011, The Arthur L. Bloomfield Award for Excellence in the Teaching of Clinical Medicine, Stanford University School of Medicine[2]
  • 2011, Fellow of the Infectious Diseases Society of America (FIDSA), Infectious Diseases Society of America[2]
  • 2011, Fellow of the American College of Physicians (FACP), American College of Physicians[2]
  • 2013, Selected as one of the 100 Colombians who have excelled abroad, 2013 Edition., 100 Colombianos en el exterior[2]

Notable studies[edit | edit source]

  • 2006, Use of valganciclovir in patients with elevated antibody titers against Human Herpesvirus-6 (HHV-6) and Epstein-Barr Virus (EBV) who were experiencing central nervous system dysfunction including long-standing fatigue[10] - (Abstract)
  • 2012, Response to valganciclovir in chronic fatigue syndrome patients with human herpesvirus 6 and Epstein-Barr virus IgG antibody titers[11]
  • 2012, A Multicenter Blinded Analysis Indicates No Association between Chronic Fatigue Syndrome/Myalgic Encephalomyelitis and either Xenotropic Murine Leukemia Virus-Related Virus or Polytropic Murine Leukemia Virus[12] - (Full Text)
  • 2013, Daily cytokine fluctuations, driven by leptin, are associated with fatigue severity in chronic fatigue syndrome: evidence of inflammatory pathology[13]
  • 2013, Randomized Clinical Trial to Evaluate the Efficacy and Safety of Valganciclovir in a Subset of Patients With Chronic Fatigue Syndrome[14]
  • Mar 2014, Cortical hypoactivation during resting eLORETA suggests central nervous system pathology in patients with chronic fatigue syndrome (Conference paper, 2014 Stanford Myalgic Encephalomyelitis/ Chronic Fatigue Syndrome Symposium: Advances in Clinical Care and Translational Research for health care providers, At Stanford School of Medicine, Palo Alto, CA[15] - (Abstract - full text on request)
  • 2015, Distinct plasma immune signatures in ME/CFS are present early in the course of illness[16] - (Full text)
  • 2015, Right Arcuate Fasciculus Abnormality in Chronic Fatigue Syndrome[17] - (Full Text)
  • 2017, Cytokine signature associated with disease severity in chronic fatigue syndrome patients[18] - (Full Text)
  • 2017, Patients diagnosed with Myalgic encephalomyelitis/chronic fatigue syndrome also fit systemic exertion intolerance disease criteria[19]
  • 2017, Fecal metagenomic profiles in subgroups of patients with myalgic encephalomyelitis/chronic fatigue syndrome[20] - (Full Text)
  • 2018 - Cortical hypoactivation during resting EEG suggests central nervous system pathology in patients with chronic fatigue syndrome[21] - (Abstract)
  • 2018, Deconstructing post-exertional malaise in myalgic encephalomyelitis/ chronic fatigue syndrome: A patient-centered, cross-sectional survey[22] - (Full Text)
  • 2018, Value of Circulating Cytokine Profiling During Submaximal Exercise Testing in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome[23]
  • 2018, KPAX002 as a treatment for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS): A prospective, randomized trial[24] - (Full Text)
  • 2018, Insights into myalgic encephalomyelitis/chronic fatigue syndrome phenotypes through comprehensive metabolomics[25] - (Full Text)
  • 2019, Onset patterns and course of myalgic encephalomyelitis/ chronic fatigue syndrome[26]
  • 2021, Caring for the Patient with Severe or Very Severe Myalgic Encephalomyelitis/Chronic Fatigue Syndrome[27] - (Full text)

Talks and interviews[edit | edit source]

Notable quotes[edit | edit source]

Back in 2005, while attending a conference on toxoplasmosis in Paris, Montoya told his mentor that he wanted to research ME/CFS. His mentor scoffed at the idea, pointing to a homeless person lying in a Parisian gutter. 'That’s going to be you if you go into chronic fatigue research,' the mentor told him.[34]

Online presence[edit | edit source]

Learn more[edit | edit source]

See also[edit | edit source]

References[edit | edit source]

  1. ↑ 1.0 1.1 1.2 Wadman, Meredith (June 4, 2019). "Chronic fatigue scientist fired after conduct complaints, Stanford says". Science | AAAS. Retrieved June 6, 2019.
  2. ↑ 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 2.11 2.12 2.13 2.14 2.15 2.16 2.17 2.18 2.19 2.20 Montoya, Jose G. "Stanford Medicine Bio".
  3. ↑ Montoya, Jose G.; Holmes, Tyson H.; Anderson, Jill N.; Maecker, Holden T.; Rosenberg-Hasson, Yael; Valencia, Ian J.; Chu, Lily; Younger, Jarred W.; Tato, Cristina M.; Davis, Mark M. (August 22, 2017). "Cytokine signature associated with disease severity in chronic fatigue syndrome patients". Proceedings of the National Academy of Sciences of the United States of America. 114 (34): E7150–E7158. doi:10.1073/pnas.1710519114. ISSN 1091-6490. PMC 5576836. PMID 28760971.
  4. ↑ goldmanb@stanford.edu, <img src='https://med stanford edu/news/media-contacts/bruce_goldman/_jcr_content/image img 620 high jpg/goldman-bruce-90 jpg' alt='Bruce Goldman'> Bruce Goldman Bruce Goldman is a senior science writer in the Office of Communications Email him at. "Researchers identify biomarkers associated with chronic fatigue syndrome severity". News Center (in Gagana Samoa). Retrieved March 11, 2023.
  5. ↑ Ingram, Julia; Wang, Claire (June 5, 2019). "Sexual harassment, misconduct behind medicine professor's dismissal". The Stanford Daily. Retrieved June 6, 2019.
  6. ↑ Johnson, Cort (June 5, 2019). "Sexual Assault Investigation Results in Dr. Jose Montoya's Termination From Stanford University". Health Rising. Retrieved June 6, 2019.
  7. ↑ "Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome - Redefining an Illness" (PDF of Powerpoint). nap.edu. Pg. 3.
  8. ↑ "OMF grants $1.2M to Ramp Up Collaborative Research Center at Stanford University". bos.etapestry.com. Retrieved August 15, 2018.
  9. ↑ "Complete Myalgic Encephalomyelitis/Chronic Fatigue Syndrome CDE Roster". NIH. Retrieved October 11, 2019.
  10. ↑ Kogelnik, AM; Loomis, K; Hoegh-Petersen, M; Rosso, F; Hischier, C; Montoya, JG. "Use of valganciclovir in patients with elevated antibody titers against Human Herpesvirus-6 (HHV-6) and Epstein-Barr Virus (EBV) who were experiencing central nervous system dysfunction including long-standing fatigue". Journal of Clinical Virology. 37: Suppl 1:S33-8. doi:10.1016/S1386-6532(06)70009-9. PMID 17276366.
  11. ↑ Watt, Tessa; Oberfoell, Stephanie; Balise, Raymond; Lunn, Mitchell R; Kar, Aroop K; Merrihew, Lindsey E; Bhangoo, Munveer S; Montoya, JG (2012). "Response to valganciclovir in chronic fatigue syndrome patients with human herpesvirus 6 and Epstein-Barr virus IgG antibody titers". Journal of Medical Virology. 84 (12): 1967-1974. doi:10.1002/jmv.23411. PMID 23080504.
  12. ↑ Alter, Harvey J.; Mikovits, Judy A.; Switzer, William M.; Ruscetti, Francis W.; Lo, Shyh-Ching; Klimas, Nancy; Komaroff, Anthony L.; Montoya, Jose G.; Bateman, Lucinda; Levine, Susan; Peterson, Daniel; Levin, Bruce; Hanson, Maureen R.; Genfi, Afia; Bhat, Meera; Zheng, HaoQiang; Wang, Richard; Li, Bingjie; Hung, Guo-Chiuan; Lee, Li Ling; Sameroff, Stephen; Heneine, Walid; Coffin, John; Hornig, Mady; Lipkin, W. Ian (2012). "A Multicenter Blinded Analysis Indicates No Association between Chronic Fatigue Syndrome/Myalgic Encephalomyelitis and either Xenotropic Murine Leukemia Virus-Related Virus or Polytropic Murine Leukemia Virus". mBio. 3 (5): e00266–12. doi:10.1128/mBio.00266-12.
  13. ↑ Stringer, Elizabeth Ann; Baker, Katharine Susanne; Carroll, Ian R; Montoya, Jose G; Chu, Lily; Maecker, Holden T; Younger, Jarred W (April 9, 2013). "Daily cytokine fluctuations, driven by leptin, are associated with fatigue severity in chronic fatigue syndrome: evidence of inflammatory pathology". Journal of Translational Medicine. 2013 (11): 93. doi:10.1186/1479-5876-11-93.
  14. ↑ Montoya, JG; Kogelnik, AM; Bhangoo, M; Lunn, MR; Flamand, L; Merrihew, LE; Watt, T; Kubo, JT; Paik, J; Desai, M (2013). "Randomized clinical trial to evaluate the efficacy and safety of valganciclovir in a subset of patients with chronic fatigue syndrome". Journal of Medical Virology. 85 (12): 2101-9. doi:10.1002/jmv.23713. PMID 23959519.
  15. ↑ Zinn, Mark A; May, Marcie L; Norris, Jane; Valencia, Ian; Montoya, Jose G; Maldonado, Jose R (2014), "Cortical hypoactivation during resting eLORETA suggests central nervous system pathology in patients with chronic fatigue syndrome", Conference: 2014 Stanford Myalgic Encephalomyelitis/ Chronic Fatigue Syndrome Symposium
  16. ↑ Hornig, M; Montoya, JG; Klimas, NG; Levine, SM; Felsenstein, D; Bateman, L; Peterson, DL; Gottschalk, CG; Schultz, AF; Che, X; Eddy, ML; Komaroff, AL; Lipkin, WI (2015). "Distinct plasma immune signatures in ME/CFS are present early in the course of illness". Science Advances. 1 (1). doi:10.1126/sciadv.1400121.
  17. ↑ Zeineh, Michael M.; Kang, James; Atlas, Scott W.; Raman, Mira M.; Reiss, Allan L.; Norris, Jane L.; Valencia, Ian; Montoya, Jose G. (2015). "Right Arcuate Fasciculus Abnormality in Chronic Fatigue Syndrome". Radiology. 274 (2): 517–526. doi:10.1148/radiol.14141079. ISSN 0033-8419.
  18. ↑ Montoya, Jose G.; Holmes, Tyson H.; Anderson, Jill N.; Maecker, Holden T.; Rosenberg-Hasson, Yael; Valencia, Ian J.; Chu, Lily; Younger, Jarred W.; Tato, Cristina M.; Davis, Mark M. (2017). "Cytokine signature associated with disease severity in chronic fatigue syndrome patients". Proceedings of the National Academy of Sciences of the United States of America. 114 (34): E7150-E7158. doi:10.1073/pnas.1710519114.
  19. ↑ Chu, Lily; Norris, Jane; Valencia, Ian J.; Montoya, Jose G. (2017). "Patients diagnosed with Myalgic encephalomyelitis/chronic fatigue syndrome also fit systemic exertion intolerance disease criteria". Fatigue: Biomedicine, Health & Behavior. 5. doi:10.1080/21641846.2017.1299079.
  20. ↑ Nagy-Szakal, Dorottya; Williams, Brent L.; Mishra, Nischay; Che, Xiaoyu; Lee, Bohyun; Bateman, Lucinda; Klimas, Nancy G.; Komaroff, Anthony L.; Levine, Susan; Montoya, Jose G.; Peterson, Daniel L.; Ramanan, Devi; Jain, Komal; Eddy, Meredith L.; Hornig, Mady; Lipkin, W. Ian (2017). "Fecal metagenomic profiles in subgroups of patients with myalgic encephalomyelitis/chronic fatigue syndrome". Microbiome. 5 (44). doi:10.1186/s40168-017-0261-y.
  21. ↑ Zinn, Mark A.; Zinn, Marcie L.; Valencia, Ian; Jason, Leonard A.; Montoya, Jose G. (2018). "Cortical hypoactivation during resting EEG suggests central nervous system pathology in patients with chronic fatigue syndrome". Biological Psychology. 136 (1): 87-99. doi:10.1016/j.biopsycho.2018.05.016.
  22. ↑ Chu, Lily; Valencia, Ian J.; Garvert, Donn W.; Montoya, Jose G. (June 1, 2018). "Deconstructing post-exertional malaise in myalgic encephalomyelitis/ chronic fatigue syndrome: A patient-centered, cross-sectional survey". PLOS One. doi:10.1371/journal.pone.0197811.
  23. ↑ Moneghetti, Kegan J.; Skhiri, Mehdi; Contrepois, Kévin; Kobayashi, Yukari; Maecker, Holden T.; Davis, Mark M.; Snyder, Michael; Haddad, Francois; Montoya, Jose G. (2018). "Value of Circulating Cytokine Profiling During Submaximal Exercise Testing in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome". Scientific Reports. 8. doi:10.1038/s41598-018-20941-w.
  24. ↑ Montoya, Jose G; Anderson, Jill N; Adolphs, Danya L; Bateman, Lucinda; Klimas, Nancy; Levine, Susan M; Garvert, Donn W; Kaiser, Jon D (2018). "KPAX002 as a treatment for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS): A prospective, randomized trial" (PDF). International Journal of Clinical and Experimental Medicine. 11 (3): 2890-2900.
  25. ↑ Nagy-Szakal, Dorottya; Barupal, Dinesh K.; Lee, Bohyun; Che, Xiaoyu; Williams, Brent L.; Kahn, Ellie J. R.; Ukaigwe, Joy E.; Bateman, Lucinda; Klimas, Nancy G.; Komaroff, Anthony L.; Levine, Susan; Montoya, Jose G.; Peterson, Daniel L.; Levin, Bruce; Hornig, Mady; Fiehn, Oliver; Lipkin, W. Ian (2018). "Insights into myalgic encephalomyelitis/chronic fatigue syndrome phenotypes through comprehensive metabolomics". Scientific Reports. 8 (1): 10056. doi:10.1038/s41598-018-28477-9.
  26. ↑ Chu, Lily; Valencia, Ian J.; Garvert, Donn W.; Montoya, Jose G. (January 14, 2019). "Onset patterns and course of myalgic encephalomyelitis/ chronic fatigue syndrome". Frontiers in Pediatrics. doi:10.3389/fped.2019.00012.
  27. ↑ Montoya, Jose; Dowell, Theresa; Mooney, Amy; Dimmock, Mary; Chu, Lily (October 6, 2021). "Caring for the Patient with Severe or Very Severe Myalgic Encephalomyelitis/Chronic Fatigue Syndrome". Healthcare. 9 (10): 1331. doi:10.3390/healthcare9101331. ISSN 2227-9032. PMC 8544443. PMID 34683011.
  28. ↑ Montoya, Jose (March 11, 2011). "Stanford's Dr. Jose Montoya on Chronic Fatigue Syndrome". YouTube. Stanford Health Care.
  29. ↑ Waroff, Deborah (August 10, 2014). "Episode 65: Dr. Jose Montoya Interviewed by Deborah Waroff". YouTube. ME/CFS Alert.
  30. ↑ "Stanford leads fight against chronic fatigue". ABC7 San Francisco. July 26, 2016. Retrieved August 15, 2018.
  31. ↑ Montoya, Jose. "IACFS/ME Biennial Conference". IACFSME. Session 1: The Latest Research in Immunology and the Microbiome.
  32. ↑ Ortleb, Charles (September 14, 2017). "The author of The Chronic Fatigue Syndrome Epidemic Cover-up interviews the leading Chronic Fatigue Syndrome researcher". charlesortleb.podbean.com. PodBean.
  33. ↑ "Science for ME Q&A with Dr José G. Montoya, 16th January 2018". YouTube. Science for ME. January 26, 2018.
  34. ↑ Newby, Kris (Fall 2014). "Immune system disruption". Stanford Medicine. Retrieved August 15, 2018.
  35. ↑ "Jose G. Montoya - CAP Profiles". med.stanford.edu.
  36. ↑ "Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Initiative". med.stanford.edu.
  37. ↑ "Stanford leads fight against chronic fatigue". ABC7 San Francisco. July 26, 2016. Retrieved August 15, 2018.
  38. ↑ Johnson, Cort (July 14, 2016). "Will 2016 Finally be Montoya's Year? Taking Stock of the Stanford ME/CFS Initiative". Health Rising's Chronic Fatigue Syndrome (ME/CFS) and Fibromyalgia Forums. Retrieved August 15, 2018.

chronic disease a disease or condition that usually lasts for 3 months or longer and may get worse over time. Chronic diseases are long-term (typically incurable and requiring long-term management) but are not necessarily severe.

cytokine any class of immunoregulatory proteins secreted by cells, especially immune cells. Cytokines are small proteins important in cell signaling that modulate the immune system. (Learn more: me-pedia.org)

National Academy of Medicine (NAM) - An American non-profit, non-governmental organization which provides expert advice to governmental agencies on issues relating to biomedical science, medicine and health. Formerly known as the Institute of Medicine (IOM).

See National Academy of Medicine.

myalgic encephalomyelitis (M.E.) - A disease often marked by neurological symptoms, but fatigue is sometimes a symptom as well. Some diagnostic criteria distinguish it from chronic fatigue syndrome, while other diagnostic criteria consider it to be a synonym for chronic fatigue syndrome. A defining characteristic of ME is post-exertional malaise (PEM), or post-exertional neuroimmune exhaustion (PENE), which is a notable exacerbation of symptoms brought on by small exertions. PEM can last for days or weeks. Symptoms can include cognitive impairments, muscle pain (myalgia), trouble remaining upright (orthostatic intolerance), sleep abnormalities, and gastro-intestinal impairments, among others. An estimated 25% of those suffering from ME are housebound or bedbound. The World Health Organization (WHO) classifies ME as a neurological disease.

antibodies Antibody/immunoglobulin refers to any of a large number of specific proteins produced by B cells that act against an antigen in an immune response.

cytokine any class of immunoregulatory proteins secreted by cells, especially immune cells. Cytokines are small proteins important in cell signaling that modulate the immune system. (Learn more: me-pedia.org)

myalgic encephalomyelitis (M.E.) - A disease often marked by neurological symptoms, but fatigue is sometimes a symptom as well. Some diagnostic criteria distinguish it from chronic fatigue syndrome, while other diagnostic criteria consider it to be a synonym for chronic fatigue syndrome. A defining characteristic of ME is post-exertional malaise (PEM), or post-exertional neuroimmune exhaustion (PENE), which is a notable exacerbation of symptoms brought on by small exertions. PEM can last for days or weeks. Symptoms can include cognitive impairments, muscle pain (myalgia), trouble remaining upright (orthostatic intolerance), sleep abnormalities, and gastro-intestinal impairments, among others. An estimated 25% of those suffering from ME are housebound or bedbound. The World Health Organization (WHO) classifies ME as a neurological disease.

central nervous system (CNS) - One of the two parts of the human nervous system, the other part being the peripheral nervous system. The central nervous system consists of the brain and spinal cord, while the peripheral nervous system consists of nerves that travel from the central nervous system into the various organs and tissues of the body.

post-exertional malaise (PEM) - A notable exacerbation of symptoms brought on by small physical or cognitive exertions. PEM may be referred to as a "crash" or "collapse" and can last for days or weeks. Symptoms can include cognitive impairments, muscle pain, trouble remaining upright (orthostatic intolerance), sleep abnormalities, and gastro-intestinal impairments, and others.

See National Institutes of Health.

National Institutes of Health (NIH) - A set of biomedical research institutes operated by the U.S. government, under the auspices of the Department of Health and Human Services.

cytokine any class of immunoregulatory proteins secreted by cells, especially immune cells. Cytokines are small proteins important in cell signaling that modulate the immune system. (Learn more: me-pedia.org)

microbiome The full collection of microscopic organisms (especially bacteria and fungi) which are present in a particular environment, particularly inside the human body.

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