There is something coming up in the near future that may well help. The DEcode ME study. A genetic analysis of about 20,000 me/cfs patients which is looking to find what makes a person susceptible to me/cfs. Should be published in a couple of months. So maybe putting research like this together with that will lead to treatments.
That sounds very promising. I suspect that DecodeME will help reveal an underlying genetic vulnerability in connective tissues, particularly affecting the intestinal and capillary linings. Such a predisposition could compromise both the endothelial layer and the glycocalyx, leading to chronic barrier dysfunction and immune dysregulation. For this reason, I believe that restoring endothelial and epithelial environments should be considered as crucial as addressing the anaerobic pathogens that often colonize these compromised interfaces in ME/CFS.
In this context, a drug like sulodexide —a purified glycosaminoglycan compound used clinically to repair endothelial damage, treat chronic venous disease, and improve microcirculation— could represent a real breakthrough in the management of this condition. Sulodexide has demonstrated the ability to reconstruct the endothelial glycocalyx, enhance endothelial function, and modulate vascular inflammation.
Ferro et al., Sulodexide for the treatment of vascular diseases: a review, Vascular Health and Risk Management, 2017.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5710929/
In long COVID patients, sulodexide significantly improved the Endothelial Quality Index (EQI) and reduced symptoms such as chest pain, palpitations, and fatigue after just 21 days of treatment.
Vlachopoulos et al., Sulodexide improves endothelial glycocalyx and reduces symptoms in post-COVID-19 patients, Clinical Research in Cardiology, 2022.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8710949/
In vitro studies also showed that sulodexide reduced IL-6 and von Willebrand factor when coronary endothelial cells were exposed to post-COVID serum, indicating protective effects on the endothelium under inflammatory stress.
Barale et al., Human plasma from post-COVID-19 patients induces endothelial dysfunction in vitro: protective effect of sulodexide, Frontiers in Cellular and Infection Microbiology, 2023.
https://www.frontiersin.org/articles/10.3389/fcimb.2023.1268016/full
The integration of large-scale genetic research like DecodeME with biomarker discovery and pharmacological approaches —including glycocalyx and endothelial restoration using sulodexide— may finally pave the way for mechanism-based therapies in ME/CFS.
I've written about this in more detail in a recent blog post (in Spanish):
https://fatigacronica.es/disfuncion-endotelial-sfc-em-long-covid/
Hopefully your browser can translate it if needed.