Ceramides, which are elevated in both GWS and ME/CFS, are implicated in the activation of pro-inflammatory cytokines, including interleukin-6 (IL-6) and tumor necrosis factor α (TNF-α) within immune cells such as macrophages, as well as in serum (Germain et al., 2020; Hoel et al., 2021; Oberlin et al., 2022). The gene discussed is TNF; the disease is myalgic encephalomeyelitis/chronic fatigue syndrome.