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Cardiopulmonary exercise test methodology for assessing exertion intolerance in myalgic encephalomyelitis/chronic fatigue syndrome

LongCOVID Syndrome (LCS) affects millions of patients worldwide and manifests as a constellation of multisystem symptoms persisting months after viral clearance, with mechanisms that remain elusive ( Recent studies have highlighted the ability of SARS-CoV-2 proteins to interfere with key intracellular pathways, including autophagy, mitochondrial dynamics, oxidative and nitrosative stress responses, calcium signaling, and the regulation of transcription factors such as HIF-1 and Nrf2 ( This review aims to fill this gap by providing an integrative analysis of how viral proteins reprogram intracellular signaling, with particular focus on autophagy, Nrf2-mediated antioxidant defenses, calcium signaling, and mitochondrial function

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