Table 1.

Activation of Na⁺/K⁺-ATPase by physiological transmitters and ATP in skeletal muscle: possible dysfunction and modulation in ME/CFS

Mechanism	Importance	Na+/K+−ATPase function in ME/CFS
Acetylcholine	At rest	Enhanced by physostigmine (Mestinon™)
Insulin	At rest	Decreased by potential insulin resistance
ß2AdR-agonist	Exercise	Decreased by ß2AdR-dysfunction/downregulation
ccGRP	Exercise	Decreased by small fiber degeneration Diminished due to low expression of TRPM3?
ATP	Exercise mainly	Decreased due to ATP depletion
ROS	Exercise mainly	Inhibition