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In ME/CFS elevated plasma tryptophan levels may enhance the conversion of tryptophan to 5-hydroxytryptophan in the brain, potentially leading to central fatigue, a core symptom of ME/CFS (Castell et al., 2015)

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on the other hand, increased levels of VEGF-A in the brain may lead to the production of pro-inflammatory cytokines, neuroinflammation and BBB stratification