Oxidative Stress

Oxidative Stress

Inflammation,
Elevated Cytokines
IL-1β, IL-6, IL-10, TNF-a

Inflammation,…

Hepcidin
Increased

Hepcidin…

Low Iron

Low Iron

ssDNA Breakage, PARP ->
AP1, MAPK,
NF-kB 

ssDNA Breakage, PARP…

L-DOPA Decreased

L-DOPA Decreased

Neurotransmitters, Blood Volume Impaired

Neurotransmitters, B…

Norepinephine, Epinephine Dysregulation

Norepinephine, Epine…

Fatty Acid Oxidation, Cori Cycle
Impaired

Fatty Acid Oxidation…

Postural Orthostatic Tachycardia Syndrome

Postural Orthostatic…

Histamine Increased

Histamine Increased

Backup Pathways to Succinyl-CoA, Succinate, Fumarate
Overused

Backup Pathways to S…

Mast Cell Activation Syndrome

Mast Cell Activation…

Hypovolemia,
Electrolyte Losses

Hypovolemia,…

Post-Exertion
(Lactic) Acidemia,
pH Shift Down

Post-Exertion…

Oxidized
Riboflavin Metabolite
Insufficiency

Oxidized…

Folate Metabolism, BH4 Impaired
Nitric Oxide 

Folate Metabolism, B…

Cholesterol Elevation,
BCAA Overuse,
Nitrogen Elevation

Cholesterol Elevatio…

Unproductive
Sleep

Unproductive…

Complex II /
Succinate Dehydrogenase Impaired

Complex II /…

TCA Cycle Impairments

TCA Cycle Impairments

Acetyl-CoA
Decreased

Acetyl-CoA…

Itaconate Pathway Activation

Itaconate Pathway Ac…

Pyruvate Dehydrogenase
Decreased

Pyruvate Dehydrogena…

Hypoxia Inducible Factors (HIF) Promoted

Hypoxia Inducible Fa…

Renal Function
Dysregulated

Renal Function…

LDH Increased, Lactic Acid
Increased

LDH Increased, Lacti…

Prolyl Hydroxylases
Decreased

Prolyl Hydroxylases…

Collagen Synthesis
Impaired

Collagen Synthesis…

Energy Deficiency

Energy Deficiency

Intracellular
Pyridoxal-5′-Phosphate
Impaired

Intracellular…

Cell Membranes / Transporters Impaired, PEM,
Insulin Resistance

Cell Membranes / Tra…

Rouleaux, Thrombi,
Hypoxia, Metabolite Transport Impairment

Rouleaux, Thrombi,…

Low
Copper

Low…

Thyroid Function
Decreased

Thyroid Function…

Low
Manganese

Low…

Low
Rubidium

Low…

Excess Lead, Mercury, Uranium, Cadmium, Bismuth

Excess Lead, Mercury…

Glucose Metabolism
Impaired

Glucose Metabolism…

Low
Selenium

Low…

Low
Lithium

Low…

Muscle Weakness,
Gastroparesis

Muscle Weakness,…

Low
Chromium

Low…

Low
Vanadium

Low…

Low
Phosphorus

Low…

Low
Iodine

Low…

Low
Boron

Low…

Low
Cobalt

Low…

Small Intestinal
Bowel Overgrowth, LPS

Small Intestinal…

Low
Zinc

Low…

Low
Germanium

Low…

Low
Zirconium

Low…

Urea Cycle Dysregulated

Urea Cycle Dysregula…

Choline Increased, Acetylcholine Decreased

Choline Increased, A…

Cognitive
 Impairment

Cognitive…

Complex V Impaired,
ATP Decreased

Complex V Impaired,…

Low
Bismuth

Low…

Figure 2.

Figure 2.

Pathway Diagram: (High-Level) Hypothetical Disease Model for ME/CFS, Long COVID / Long Vaccine.

Pathway Diagram: (High-Level) Hypothetical Disease Model for ME/CFS, Long COVID / Long Vaccine.

Authors: Joshua Leisk, Aline Noçon ©2022, [DRAFT / INCOMPLETE – may contain errors]

Authors: Joshua Leisk, Aline Noçon ©2022, [DRAFT / INCOMPLETE – may contain errors]

ME/CFS: Correcting Chronic Mitochondrial Dysfunction

ME/CFS: Correcting Chronic Mitochondrial Dysfunction

cAMP,
Protein Kinase A
Impaired

cAMP,…

Borrelia, Bartonella
Infection, Opioids

Borrelia, Bartonella…

Vitamin D,
Vitamin A
Sufficiency

Vitamin D,…

(Pathogenic) GDH Elevation, as Direct Competition Against a-KGDH

(Pathogenic) GDH Ele…

v0.92

v0.92

5-AR Inhibitors,
AR Antagonists

5-AR Inhibitors,…

Vitamin C
Insufficiency

Vitamin C…

Hyperoxaluria

Hyperoxaluria

Isocitrate Lyase Expressing Bacteria, 
Glyoxylate Shunt

Isocitrate Lyase Exp…

D-Lactate Producing Bacteria

D-Lactate Producing…

Tyrosinase
Decreased, Tyramine Increased

Tyrosinase…

Dopamine Beta Hydroxylase
 Insufficiency

Dopamine Beta Hydrox…

Clostridia1

Clostridia1

Immune Deficiency,
T cell Exhaustion

Immune Deficiency,…

GABA
Decreased

GABA…

Free Testosterone
Decreased

Free Testosterone…

Cortisol
Dysregulated

Cortisol…

Peripheral Neuropathy

Peripheral Neuropathy

Estrogen
Decreased

Estrogen…

Pathogenic & Deficiency Based Pathway Promoters

Pathway Inhibitor

Pathogenic & Deficiency Base…

Lines intersecting at right
angles do not connect.

Lines intersecting at right…

Key:
ADP – Adenosine Diphosphate
AP-1 – Activator Protein-1
a-KGDH – alpha-Ketoglutarate Dehydrogenase
ATP – Adenosine Triphosphate
BH4 – Tetrahydrobiopterin
cAMP- Cyclic Adenosine Monophosphate
GABA – Gamma-Aminobutyric Acid
GDH – Glutamate Dehydrogenase
GI – Gastro-Intestinal
IDH – Isocitrate Dehydrogenase
HHV – Human Herpesviruses
HIV – Human Immunodeficiency virus
HYPDH – Hydroxyproline Dehydrogenase
LDH – Lactate Dehydrogenase
LPS – Lipopolysaccharides
MAPK – Mitogen Activated Protein Kinases
MDH – Malate Dehydrogenase
NF-kB – Nuclear Factor Kappa Beta
NO – Nitric Oxide
PARP – Poly (ADP-ribose) Polymerase
PEM – Post Exertion Malaise
PRODH – Proline Dehydrogenase
RR-MADD – Riboflavin-Responding Multiple Acyl-CoA                        Dehydrogenase Deficiency
ssDNA – Single Stranded DNA
TCA – TriCitric Acid
Th[#] – T Helper

Key:…

Intracellular Mineral Decrease, GI Absorption Blocked

Intracellular Minera…

Ferroportin, DMT-1 Decreased

Ferroportin, DMT-1 D…

Clostria Species – C. sporogenes, C.botulinum, C. caloritolerans, C. mangenoti, C. ghoni, C.bifermentans, C. difficile, C. sordellii

1 Clostria Species – C. sporogenes, C.botulinum, C. caloritolerans, C. mangenoti, C. ghoni, C.bifermentans, C. difficile,…

M.tuberculosis, C.albicans, P. indigofera, P. aeruginosa, A.calcoaceticus, S. Typhimurium, B. suis, Y. enterocolitica,

Y. pseudotuberculosis, Y. pestis, R. equi, E. coli., H. pylori strains P12, G27, 26, 695, Tx30a

2 M.tuberculosis, C.albicans, P. indigofera, P. aeruginosa, A.calcoaceticus, S. Typhimurium, B. suis, Y. enterocoli…

Complex III
Impaired

Complex III…

Complex I
Impaired

Complex I…

Complex IV
Impaired

Complex IV…

ETF-QO
Impaired

ETF-QO…

NAD+ Redox
Impaired

NAD+ Redox…

FAD Redox
Impaired

FAD Redox…

 Peroxynitrites 
BH4 Oxidation

Peroxynitrites ↑↑…

Low
Molybdenum

Low…

Acyl-CoA Dehydrogenases
Decreased, Mito Lipid Accumulation

Acyl-CoA Dehydrogena…

PRODH, HYPDH
Excess Activity

PRODH, HYPDH…

Innate Immune Response

Innate Immune Respon…

Numerous
Pathogens –
eg. SARS-CoV-2,
Herpesviridae

Numerous…

Chronic Cranial Instability

Chronic Cranial Inst…

Lytic Reactivation
of Latent
HHV, HIV

Lytic Reactivation…

Riboflavin Kinase Decreased

Riboflavin Kinase De…

FAD Synthase Decreased

FAD Synthase Decreas…

Tinnitus, Myoclonus

Tinnitus, Myoclonus

Silicon
Sufficiency

Silicon…

SARS-CoV-2 Spike Protein, Fibrinogen

SARS-CoV-2 Spike Pro…

Necrosis

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