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Blood-based pathological changes are well documented in ME/CFS, including blood and plasma abnormalities [1], immunological dysfunction (including lymphocytes [35,36,37], natural killer cells [38,39,40,41,42], the complement system [4], auto-antibodies [43,44,45], cytokine dysfunction[2, 46,47,48,49]), gene expression [50,51,52,53], metabolic dysfunction [54,55,56,57], and circulating microRNAs in plasma [58,59,60]