Using MRI to assess brain neuroinflammation and the lymphatic system in ME/CFS

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Dr Zack Shan


University of the Sunshine Coast, Australia

Start date

June 2023


ME Research UK with the financial support of the Fred and Joan Davies Bequest


Neuroinflammation occurs when the brain’s immune system is activated, and this is believed to play an important role in ME/CFS, causing a variety of symptoms including  fatigue, pain sensitivity, cognitive problems and sleep disturbances.

The immune system of the brain was once thought to be entirely separate from the immune system in the rest of the body, but recent discoveries show that there is actually a pathway linking them: the brain lymphatic system.

The lymphatic system is a network of organs and vessels that has an important role in protecting us from infection. It moves fluid between different tissues, removes waste products of cells, and contains white blood cells which are involved in immunity.

The brain lymphatic system provides a two-way connection between the brain and the central immune system, transmitting immune messages in both directions, and clearing waste. It is potentially important in neuroinflammation, but has not been assessed before in ME/CFS.

Dr Zack Shan

Dr Shan and his colleagues are conducting the world’s first controlled study directly assessing neuroinflammation in the brains of people with ME/CFS. While a number of techniques are available to investigate these aspects, they are either indirect or highly invasive.

The team therefore plans to use newly available, advanced imaging techniques based on magnetic resonance imaging to conduct a thorough investigation of neuroinflammation and the brain lymphatic network in ME/CFS.

In addition to Dr Shan, the team includes Prof. Jim Lagopoulos also from the University of the Sunshine Coast, together with general practitioner Dr Peter Del Fante and rheumatologist Dr Richard Kwiatek, both of whom have an interest in ME/CFS.

Prof. Jim Lagopoulos, Dr Peter Del Fante & Dr Richard Kwiatek


The main aims of the study are to:

  • Compare the characteristics of microglia and astrocytes (the immune cells of the brain) between 72 people with ME/CFS (diagnosed using the Canadian Consensus Criteria) and 72 healthy control subjects.
  • Investigate the characteristics of the brain lymphatic network in ME/CFS.
  • Assess various measures of brain inflammation, including neurometabolites (the products of metabolism) and brain temperature.
  • Test whether these inflammatory markers are associated with ME/CFS symptoms.

Potential benefits

The researchers anticipate that the findings from this study will expand our understanding of the disease process in ME/CFS, including the role of neuroinflammation. This may give insights into new directions for research, and help in the development of evidence-based treatments to control chronic neuroinflammation.

Dr Shan explains more about his research in this video.

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