Sign in

Manuel Ruiz-Pablos

@manruipa.bsky.social
192 followers 6 following 102 posts

🔬Diving deep into #MECFS, #LongCOVID, #LongEBV & post-vaccine syndrome research. 🦠Dual role:Researcher and EBV ME/CFS patient. Seeking answers. #Antivirals #HLA

PostsRepliesMedia
Reposted by Manuel Ruiz-Pablos
Manuel Ruiz-Pablos @manruipa.bsky.social · 04/10/2026
Could altered cortisol signalling contribute to fatigue in ME/CFS and Long COVID? A 2026 meta-analysis found lower cortisol availability and altered HPA-axis regulation in ME/CFS. After SARS, hypocortisolism affected 24/61 survivors. I explore this and ginseng manruipa.substack.com/p/ginseng-co...
manruipa.substack.com
Ginseng, cortisol and the HPA axis: an overlooked connection in ME/CFS and Long COVID
What SARS, autoimmune disease and decades of neuroendocrine research can teach us about hypocortisolism — and why ginsenosides deserve a closer look
132
Manuel Ruiz-Pablos @manruipa.bsky.social · 04/10/2026
Could altered cortisol signalling contribute to fatigue in ME/CFS and Long COVID? A 2026 meta-analysis found lower cortisol availability and altered HPA-axis regulation in ME/CFS. After SARS, hypocortisolism affected 24/61 survivors. I explore this and ginseng manruipa.substack.com/p/ginseng-co...
manruipa.substack.com
Ginseng, cortisol and the HPA axis: an overlooked connection in ME/CFS and Long COVID
What SARS, autoimmune disease and decades of neuroendocrine research can teach us about hypocortisolism — and why ginsenosides deserve a closer look
132
Manuel Ruiz-Pablos @manruipa.bsky.social · 29/09/2026
If you have Long COVID or ME/CFS and struggle with unrefreshing sleep, insomnia or disrupted circadian rhythms, melatonin may be more interesting than it seems. I reviewed what we know about dose, timing, mitochondria, inflammation and safety. manruipa.substack.com/p/melatonin-... #LongCOVID #MECFS
manruipa.substack.com
Melatonin Is More Than a Sleep Hormone — What the Evidence Actually Says
Sleep, circadian timing, mitochondria, red light, Long COVID, ME/CFS and the recent cardiovascular controversy
012
Manuel Ruiz-Pablos @manruipa.bsky.social · 26/09/2026
Can an infection change how our immune system responds years later? In my new article, I explore trained immunity, future vaccines and potential links to Long COVID and ME/CFS. Subscribe for free! 🩵 manruipa.substack.com/p/can-the-in...
manruipa.substack.com
Can the Innate Immune System Remember? How Trained Immunity Could Change Vaccination, Genetics and Our Understanding of Chronic Disease
Can infections leave a lasting imprint on our immune system? Exploring trained immunity and its potential implications for Long COVID, ME/CFS and future vaccines.
011
Reposted by Manuel Ruiz-Pablos
Manuel Ruiz-Pablos @manruipa.bsky.social · 24/09/2026
Could congenital infections influence autism? A new study of 3.6 million people raises questions about genetics, immunity and brain development. My latest article explores the evidence and possible links with ME/CFS and Long COVID. 🩵 manruipa.substack.com/p/autism-con...
manruipa.substack.com
Autism, congenital infections and autoimmunity: what does the science actually tell us?
From genetics and TORCH infections to maternal autoantibodies, cerebral folate deficiency and the possible lessons from ME/CFS and Long COVID
032
Manuel Ruiz-Pablos @manruipa.bsky.social · 24/09/2026
Could congenital infections influence autism? A new study of 3.6 million people raises questions about genetics, immunity and brain development. My latest article explores the evidence and possible links with ME/CFS and Long COVID. 🩵 manruipa.substack.com/p/autism-con...
manruipa.substack.com
Autism, congenital infections and autoimmunity: what does the science actually tell us?
From genetics and TORCH infections to maternal autoantibodies, cerebral folate deficiency and the possible lessons from ME/CFS and Long COVID
032
Reposted by Manuel Ruiz-Pablos
Manuel Ruiz-Pablos @manruipa.bsky.social · 21/09/2026
Why is NAC attracting interest in MS, autoimmunity, ME/CFS and Long COVID? My Substack explores how glutamate, glutathione, mitochondria, astrocytes and immune metabolism may connect. 🔗 manruipa.substack.com/p/nac-glutam... #MECFS #LongCOVID
manruipa.substack.com
NAC, glutamate and the brain: why is such an old mucolytic drug attracting interest in depression, multiple sclerosis, autoimmune disease, ME/CFS and Long COVID?
N-acetylcysteine (NAC) is an old mucolytic with a surprisingly modern story: it sits at the crossroads of glutamate, glutathione, mitochondria, oxidative stress and immune regulation.
034
Manuel Ruiz-Pablos @manruipa.bsky.social · 21/09/2026
Why is NAC attracting interest in MS, autoimmunity, ME/CFS and Long COVID? My Substack explores how glutamate, glutathione, mitochondria, astrocytes and immune metabolism may connect. 🔗 manruipa.substack.com/p/nac-glutam... #MECFS #LongCOVID
manruipa.substack.com
NAC, glutamate and the brain: why is such an old mucolytic drug attracting interest in depression, multiple sclerosis, autoimmune disease, ME/CFS and Long COVID?
N-acetylcysteine (NAC) is an old mucolytic with a surprisingly modern story: it sits at the crossroads of glutamate, glutathione, mitochondria, oxidative stress and immune regulation.
034
Reposted by Manuel Ruiz-Pablos
Manuel Ruiz-Pablos @manruipa.bsky.social · 18/09/2026
New evidence suggests EBV reactivation may precede MS relapses, linking viral persistence, B cells, HLA and autoimmunity. This may also matter for subsets of ME/CFS and Long COVID with impaired EBV control. Full article: manruipa.substack.com/p/what-if-eb... #EBV #MECFS #LongCOVID
manruipa.substack.com
What if EBV reactivation helps trigger autoimmune relapses?
New evidence from multiple sclerosis is connecting viral reactivation, HLA genetics, B-cell biology and loss of immune tolerance
096
Manuel Ruiz-Pablos @manruipa.bsky.social · 18/09/2026
New evidence suggests EBV reactivation may precede MS relapses, linking viral persistence, B cells, HLA and autoimmunity. This may also matter for subsets of ME/CFS and Long COVID with impaired EBV control. Full article: manruipa.substack.com/p/what-if-eb... #EBV #MECFS #LongCOVID
manruipa.substack.com
What if EBV reactivation helps trigger autoimmune relapses?
New evidence from multiple sclerosis is connecting viral reactivation, HLA genetics, B-cell biology and loss of immune tolerance
096
Manuel Ruiz-Pablos @manruipa.bsky.social · 15/09/2026
🔴 Fatigue, brain fog & PEM in Long COVID: a new Phase 2 trial with bezisterim points again to neuroinflammation and the ERK–NF-κB–TNF-α axis. I review the results, limitations and how it compares with LDN/metformin: manruipa.substack.com/p/bezisterim... #LongCOVID #MECFS
manruipa.substack.com
Bezisterim in Long COVID: a new approach to fatigue, brain fog and PEM
A new Phase 2 trial suggests that targeting inflammatory signalling in the brain may help fatigue, cognitive dysfunction and post-exertional malaise in some people with Long COVID
1175
Reposted by Manuel Ruiz-Pablos
Manuel Ruiz-Pablos @manruipa.bsky.social · 12/09/2026
🔴 What if histamine is not the disease itself, but one layer of a larger immune process? Mast cells, Long COVID, ME/CFS, autoimmunity and viral persistence — and why treatment may need to target different physiological layers. manruipa.substack.com/p/antihistam... #LongCOVID #MECFS
manruipa.substack.com
Antihistamines Beyond Allergy: Mast Cells, Long COVID, ME/CFS, Autoimmunity and Viral Persistence
What if histamine is not the disease itself, but one layer of a much larger immune process?
095
Manuel Ruiz-Pablos @manruipa.bsky.social · 14/09/2026
Nicotine patches in Long COVID/ME/CFS: what does the evidence actually show? I review nAChRs, PET findings, dysautonomia, Mestinon and autoimmunity. manruipa.substack.com/p/nicotine-p... #LongCOVID #MECFS
manruipa.substack.com
Nicotine patches beyond smoking cessation: what could they actually be doing in Long COVID and ME/CFS?
The cholinergic hypothesis is biologically interesting, but the evidence is far more complex than the idea that nicotine simply “displaces Spike” from a receptor
052
Manuel Ruiz-Pablos @manruipa.bsky.social · 12/09/2026
🔴 What if histamine is not the disease itself, but one layer of a larger immune process? Mast cells, Long COVID, ME/CFS, autoimmunity and viral persistence — and why treatment may need to target different physiological layers. manruipa.substack.com/p/antihistam... #LongCOVID #MECFS
manruipa.substack.com
Antihistamines Beyond Allergy: Mast Cells, Long COVID, ME/CFS, Autoimmunity and Viral Persistence
What if histamine is not the disease itself, but one layer of a much larger immune process?
095
Manuel Ruiz-Pablos @manruipa.bsky.social · 11/09/2026
Why can Long COVID, ME/CFS, lupus, MS, fibromyalgia, IBD or Lyme disease cause similar fatigue? My article explores immune, autonomic, neuroimmune & metabolic pathways — and why we may need biomarkers of mechanism, not just fatigue scores. manruipa.substack.com/p/where-does... #LongCOVID #MECFS
manruipa.substack.com
Where Does Fatigue Really Come From?
What Long COVID, ME/CFS, autoimmune diseases, fibromyalgia, cancer and post-infectious syndromes may teach us about the shared biology of fatigue
0152
Manuel Ruiz-Pablos @manruipa.bsky.social · 09/09/2026
🔴New article on Mestinon in Long COVID and ME/CFS. Why might it help some patients with dysautonomia, low preload or impaired autonomic compensation, while doing little for others? I also look at GPCR autoantibodies, POTS and alternative treatments. substack.com/@manruipa/no... #LongCOVID #MECFS
substack.com
Manuel Ruiz-Pablos (@manruipa)
New article about Mestinon (pyridostigmine) in Long COVID and ME/CFS. I look at why it may make physiological sense in some patients with dysautonomia, low preload or impaired autonomic compensation,...
1104
Manuel Ruiz-Pablos @manruipa.bsky.social · 09/09/2026
🔴 Long COVID didn’t come out of nowhere. From the Russian flu and 1918 influenza to EBV, Q fever, SARS and Ebola, post-infectious illness has a much longer history. What can that history teach us about Long COVID & ME/CFS? substack.com/@manruipa/no... #LongCOVID #MECFS
substack.com
Long COVID Did Not Come Out of Nowhere: A Century of Post-Infectious Illness
From the Russian flu and the 1918 influenza pandemic to EBV, Q fever, SARS, Ebola and ME/CFS — what history can teach us about why some people never fully recover after infection
0208
Manuel Ruiz-Pablos @manruipa.bsky.social · 08/09/2026
🔴New on Substack: a deeper look at low-dose naltrexone in Long COVID and ME/CFS — from neuroinflammation and TLR4 to TRPM3, Ca²⁺ signaling, clinical evidence, metformin and why patient subgroups may matter. manruipa.substack.com/p/low-dose-n...
manruipa.substack.com
Low-Dose Naltrexone in Long COVID and ME/CFS: Neuroinflammation, TRPM3 and the Search for the Right Patient
Why LDN may make biological sense in some patients — and why comparing it with metformin reveals a bigger problem in how we study post-infectious disease
1143
Manuel Ruiz-Pablos @manruipa.bsky.social · 06/09/2026
🔴A few of you suggested I start posting my long threads as articles too, so I finally opened a Substack 😅 I’m completely new there, but I’ll be uploading article versions of my threads for those who prefer that format or don’t use X. substack.com/@manruipa/no...
substack.com
Are persistent pathogens an overlooked part of healthy aging?
Why immunosenescence, viral reactivation and chronic immune stimulation may deserve a place in the longevity conversation
011
Manuel Ruiz-Pablos @manruipa.bsky.social · 05/09/2026
For those of you asking where you can read my posts if you don’t have X, I’m going to start publishing article versions of my threads on Substack as well 😊 That way, you’ll be able to read them in full without needing an X account: substack.com/@manruipa/no...
substack.com
Metformin Beyond Diabetes: Why It May Matter in Long COVID and ME/CFS
From immunometabolism and viral persistence to oxidative stress, endothelial dysfunction and patient selection
032
Manuel Ruiz-Pablos @manruipa.bsky.social · 24/02/2026
🔁 If you know patients with Long COVID or ME/CFS — or clinicians treating them — please share this. Early endocrine evaluation could prevent years of avoidable deterioration in a subset of patients. Screening is simple. Permanent damage is not. Let’s stop missing what is testable.
010
Manuel Ruiz-Pablos @manruipa.bsky.social · 24/02/2026
⏳ When will early endocrine intervention become standard of care? Because delayed recognition may turn reversible dysfunction into permanent damage. And that is avoidable.
110
Manuel Ruiz-Pablos @manruipa.bsky.social · 24/02/2026
The literature is there. The precedent is there. The replication is there. Yet it remains under-recognized. Final thought We are not proposing something new. We are pointing out something that already happened once — and is happening again.
100
Manuel Ruiz-Pablos @manruipa.bsky.social · 24/02/2026
How many patients are told “your labs are normal” while sitting at the lower edge of cortisol reserve? 7️⃣The bigger picture This is not about one virus It is a recurring pattern: Viral infection → inflammatory/autoimmune pituitary involvement → secondary hypocortisolism → chronic symptom persistence
100
Manuel Ruiz-Pablos @manruipa.bsky.social · 24/02/2026
6️⃣ The uncomfortable question If we already knew this from SARS-1… And similar findings are now documented in SARS-CoV-2… Why is early endocrine screening not standard in Long COVID? Morning cortisol alone is not enough. Dynamic testing (ACTH stimulation, ITT) is often required.
100
Manuel Ruiz-Pablos @manruipa.bsky.social · 24/02/2026
If secondary adrenal insufficiency is not recognized early: • Chronic hypocortisolism persists • Inflammation worsens • Autonomic instability increases • Recovery becomes harder Early detection could prevent long-term endocrine damage.
100
Manuel Ruiz-Pablos @manruipa.bsky.social · 24/02/2026
5️⃣ Why does this matter? HPA-axis damage is not trivial. The adrenal glands and pituitary have: ⚠️ Very low regenerative capacity ⚠️ Slow cellular turnover ⚠️ Limited repair once chronic fibrosis sets in
100
Manuel Ruiz-Pablos @manruipa.bsky.social · 24/02/2026
In other words: SARS-1 mechanism documented (2005) ↓ Mechanistic extrapolation to SARS-CoV-2 (our review, July 2024) ↓ Clinical confirmation in SARS-CoV-2 (August 2024) History repeating itself.
100
Manuel Ruiz-Pablos @manruipa.bsky.social · 24/02/2026
4️⃣ And then what happened? One month after our review was published… A new SARS-CoV-2 paper reported pituitary involvement and secondary adrenal insufficiency in COVID-19. ec.bioscientifica.com/view/journal...
ec.bioscientifica.com
100
Manuel Ruiz-Pablos @manruipa.bsky.social · 24/02/2026
– inflammatory hypophysitis – or autoimmune processes targeting hypothalamus/pituitary Again, review here: www.frontiersin.org/journals/imm... Because this pattern had already happened.
frontiersin.org
Frontiers | Hypocortisolemic ASIA: a vaccine- and chronic infection-induced syndrome behind the origin of long COVID and myalgic encephalomyelitis
Myalgic encephalomyelitis or chronic fatigue syndrome (ME/CFS), long COVID (LC) and post-COVID-19 vaccine syndrome show similarities in their pathophysiology...
100
Manuel Ruiz-Pablos @manruipa.bsky.social · 24/02/2026
3️⃣ What did we write in 2024? In our review, we argued that: • SARS-CoV-2 shares high genetic similarity with SARS-CoV • Therefore, similar HPA-axis vulnerability is biologically plausible • Hypocortisolism in Long COVID may reflect: – direct viral injury
100
Manuel Ruiz-Pablos @manruipa.bsky.social · 24/02/2026
Post-mortem data (Wei et al.) also showed reduced corticotroph staining. This was not psychosomatic. It was endocrine.
100
Manuel Ruiz-Pablos @manruipa.bsky.social · 24/02/2026
Importantly: • It was often reversible • Early recognition mattered • It strongly suggested inflammatory pituitary damage Original study: onlinelibrary.wiley.com/doi/10.1111/...
onlinelibrary.wiley.com
Hypocortisolism in survivors of severe acute respiratory syndrome (SARS)
Objective Following the severe acute respiratory syndrome (SARS) outbreak, many survivors were observed to suffer from psychosomatic symptoms reminiscent of various endocrine disorders. Hence, we so...
100
Manuel Ruiz-Pablos @manruipa.bsky.social · 24/02/2026
2️⃣What happened with the first SARS (2003)? After the original SARS-CoV outbreak, Leow et al. (2005) showed that ~40% of SARS survivors developed secondary adrenal insufficiency, likely due to pituitary involvement.
100
Manuel Ruiz-Pablos @manruipa.bsky.social · 24/02/2026
👉 Hypocortisolism in ME/CFS and Long COVID may result from direct infection or immune-mediated damage of the HPA axis (hypothalamus–pituitary–adrenal). Our review: www.frontiersin.org/journals/imm...
frontiersin.org
Frontiers | Hypocortisolemic ASIA: a vaccine- and chronic infection-induced syndrome behind the origin of long COVID and myalgic encephalomyelitis
Myalgic encephalomyelitis or chronic fatigue syndrome (ME/CFS), long COVID (LC) and post-COVID-19 vaccine syndrome show similarities in their pathophysiology...
120
Manuel Ruiz-Pablos @manruipa.bsky.social · 24/02/2026
Read this thread — and consider discussing testing with your doctor. 👇 1️⃣ HPA axis damage in Long COVID and ME/CFS is not new. We’ve seen this before. In July 2024, in our review, we discussed something many still overlook:
100
Manuel Ruiz-Pablos @manruipa.bsky.social · 24/02/2026
🔴🚩🧵 What if part of severe Long COVID and ME/CFS is not “mysterious” — but untreated, potentially reversible HPA-axis damage? We already saw this after SARS-1. It happened again with SARS-CoV-2. And almost no one is screening for it. Some of the worst symptoms may be preventable.
150
Reposted by Manuel Ruiz-Pablos
Manuel Ruiz-Pablos @manruipa.bsky.social · 07/02/2026
🔴🧬 1) New study on EBV confirms an immunogenetic model we had already proposed A new immunology study provides solid evidence that the persistence of Epstein–Barr virus (EBV) is modulated by how HLA class II molecules present viral antigens to CD4⁺ T cells. 🧵 👉🏼 www.nature.com/articles/s41...
174
Manuel Ruiz-Pablos @manruipa.bsky.social · 07/02/2026
17) 📣 If you find this information relevant, sharing it or following the page helps it reach those who may need it. #EBV #HLA #Autoimmunity #MECFS #LongCOVID
020
Manuel Ruiz-Pablos @manruipa.bsky.social · 07/02/2026
16) Because it allows us to:
📌 identify susceptibility to viral persistence 📌 anticipate the risk of chronic immune dysfunction 📌 stratify patients for early follow-up 📌 move toward preventive immunogenetic medicine
110
Manuel Ruiz-Pablos @manruipa.bsky.social · 07/02/2026
15) -patients with persistent viral infections -ME/CFS -long COVID -post-infectious inflammatory syndromes -individuals at risk of autoimmunity after infections
110
Manuel Ruiz-Pablos @manruipa.bsky.social · 07/02/2026
14) 📣 Clinical implication: HLA-II typing as a preventive tool
Taken together, these studies point in a clear direction: 🧬 HLA-II haplotype typing should be incorporated into:
110
Manuel Ruiz-Pablos @manruipa.bsky.social · 07/02/2026
13) share features of emerging autoimmune diseases, in which: -there is an infectious trigger (often EBV, SARS-CoV-2, or intracellular pathogens with immune evasion mechanisms) -antigen persistence occurs -ancestral host HLA-II shapes the immune response -loss of tolerance and autoreactivity develop
110
Manuel Ruiz-Pablos @manruipa.bsky.social · 07/02/2026
12) -ME/CFS -long COVID -post-viral syndromes -autoimmune diseases 🧬 A shared framework: emerging autoimmune diseases driven by antigen persistence
The convergence of evidence supports that:
➡️ ME/CFS ➡️ long COVID ➡️ post-vaccinal syndromes in predisposed individuals ➡️ post-infectious syndromes
120
Manuel Ruiz-Pablos @manruipa.bsky.social · 07/02/2026
11) 🎯 This new work on EBV confirms—through a different approach—exactly the same model: Viral persistence + specific HLA-II antigen presentation → chronic immune activation → loss of tolerance → autoimmune phenomena This is the same pathogenic sequence we had previously proposed for:
120
Manuel Ruiz-Pablos @manruipa.bsky.social · 07/02/2026
10) 👉 We proposed that these same haplotypes also shape the immune response to EBV, favoring viral persistence and prolonged inflammation. 👉🏼 www.frontiersin.org/journals/imm... 🔗 The new study provides important validation
frontiersin.org
Frontiers | The origin of autoimmune diseases: is there a role for ancestral HLA-II haplotypes in immune hyperactivity
The prevalence of autoimmune diseases in contemporary human populations poses a challenge for both medicine and evolutionary biology. This review explores ho...
110
Manuel Ruiz-Pablos @manruipa.bsky.social · 07/02/2026
9) -increased risk of persistent immune responses and autoreactivity -implicated in MS, lupus, RA, T1D, and most autoimmune diseases, including ME/CFS, long COVID, and post-vaccinal syndromes
110
Manuel Ruiz-Pablos @manruipa.bsky.social · 07/02/2026
8) 👉🏼 link.springer.com/article/10.1... 📌 Ancestral HLA-II haplotypes and autoimmune diseases
(Frontiers in Immunology, 2025)
Here we linked the genetic component to other autoimmune diseases: -DR2-DQ6, DR3-DQ2, DR4-DQ8 -haplotypes with broad and potent antigen presentation
link.springer.com
Epstein–Barr virus-acquired immunodeficiency in myalgic encephalomyelitis—Is it present in long COVID? - Journal of Translational Medicine
Both myalgic encephalomyelitis or chronic fatigue syndrome (ME/CFS) and long COVID (LC) are characterized by similar immunological alterations, persistence of chronic viral infection, autoimmunity, ch...
110
Manuel Ruiz-Pablos @manruipa.bsky.social · 07/02/2026
7) We showed that: -ME/CFS and long COVID share an EBV reactivation/persistence axis -leading to a state of chronic immune dysfunction -with sustained inflammation, impaired antiviral surveillance, and multisystem symptoms, particularly in patients with ancestral HLA-II haplotypes.
120
Manuel Ruiz-Pablos @manruipa.bsky.social · 07/02/2026
6) We proposed that the inability to control EBV-infected cells is a key driver of pathophysiology in patients with HLA-II genetic susceptibility. 👉🏼 www.frontiersin.org/journals/imm... 📌 EBV-induced acquired immunodeficiency in ME/CFS and long COVID
(Journal of Translational Medicine, 2023)
frontiersin.org
Frontiers | Epstein-Barr Virus and the Origin of Myalgic Encephalomyelitis or Chronic Fatigue Syndrome
Myalgic encephalomyelitis or chronic fatigue syndrome (ME/CFS) affects approximately 1% of the general population. It is a chronic, disabling, multi-system d...
110