In addition, we also discovered that ME/CFS is characterized by increased immunoglobulin A/immunoglobulin M (IgA/IgM) responses to Gram-negative bacteria indicating increased bacterial or lipopolysaccharide (LPS) translocation and IgM-mediated autoimmune responses to a number of neoantigens including malondialdehyde (MDA), azelaic acid, and nitrosylated proteins, indicating increased nitrosylation (18, 19). Here, CD40LG is linked to myalgic encephalomeyelitis/chronic fatigue syndrome.