Myalgic encephalomyelitis/chronic fatigue Syndrome (Me/cfS) is a debilitating multisystemic disease of unknown etiology, affecting thousands of individuals worldwide. Its diagnosis still relies on ruling out medical problems leading to unexplained fatigue due to a complete lack of disease-specific biomarkers. Our group and others have explored the potential value of microRNA profiles (miRNomes) as diagnostic tools for this disease. However, heterogeneity of participants, low numbers, the variety of samples assayed, and other pre-analytical variables, have hampered the identification of diseaseassociated miRNomes. In this study, our team has evaluated, for the first time, ME/CFS miRNomes in peripheral blood mononuclear cells (pBMcs) and extracellular vesicles (eVs) from severely ill patients recruited at the monographic UK Me biobank to assess, using standard operating procedures (Sops), blood fractions with optimal diagnostic power for a rapid translation of a miR-based diagnostic method into the clinic. Our results show that routine creatine kinase (CK) blood values, plasma EVs physical characteristics (including counts, size and zeta-potential), and a limited number of differentially expressed PBMC and EV miRNAs appear significantly associated with severe ME/CFS (p < 0.05). Gene enrichment analysis points to epigenetic and neuroimmune dysregulated pathways, in agreement with previous reports. Population validation by a cost-effective approach limited to these few potentially discriminating variables is granted.Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a disease characterized by long-lasting (over 6 months) persistent debilitating widespread fatigue, which is exacerbated by exercise (post-exertional malaise or PEM), and not alleviated by rest 1-5 . It has been classified by the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) with code R53.82 or G93.3 if post-viral 6 . It affects at least 0.23 to 0.41% of the population worldwide 7,8 , although numbers can reach up to 5% depending on the diagnostic criteria and geographic locations, according to a recent revision by the EUROpean Myalgic Encephalomyelitis Network (EUROMENE) epidemiology working group 9 . The disease strikes people of all ages and within all socio-economic levels, being more common in women (female:male ratios between 2:1 and 6:1) 7-10 . ME/CFS is considered a life-long disabling disease, since only about 5% of patients return to their previous state of health 11 .The confusion among General Health Practitioners (GPs) due to multiple clinical definitions 12 and the large number of comorbidities, such as fibromyalgia, IBS (irritable bowel syndrome), POTS (postural orthostatic tachycardia syndrome), depression, etc, stigmatized the disease, delaying diagnosis and treatment of patients. This highlights the urgent need of unbiased, specific methods to diagnose ME/CFS in a clinical setting.