Stressors, stress, and neuroendocrine integration of the adaptive response. The 1997 Hans Selye Memorial Lecture

Comparative Evaluation of the Autonomic Response to Cognitive and Sensory Stimulations through Wearable Sensors

Psychological stress is known to activate the autonomic nervous system (ANS), thus representing a useful target to be monitored to understand the physiological, unconscious effect of stress on the human body. However, little is known about how differently the ANS responds to cognitive and sensory stimulations in healthy subjects. To this extent, we enrolled 23 subjects and administered a stress protocol consisting of the administration of sensory (olfactory) and cognitive (mathematical) stressors. Autonomic parameters were unobtrusively monitored through wearable sensors for capturing electrocardiogram and skin conductance signals. The results obtained demonstrated an increase of the heart rate during both stress protocols, with a similar decrease of the heart rate variability. Cognitive stress test appears to affect the autonomic parameters to a greater extent, confirming its effects on the human body. However, olfactory stimulation could be useful to study stress in specific experimental settings when the administration of complex cognitive testing is not feasible.

Stress responses in fish: From molecular to evolutionary processes

In the context of global changes, fish are increasingly exposed to multiple stressors that have cascading effects from molecules to the whole individual, thereby affecting wild fish populations through selective processes. In this review, we synthetize recent advances in molecular biology and evolutionary biology to outline some potentially important effects of stressors on fish across biological levels. Given the burgeoning literature, we highlight four promising avenues of research. First, (1) the exposure to multiple stressors can lead to unexpected synergistic or antagonistic effects, which should be better taken into account to improve our predictions of the effects of actual and future human activities on aquatic organisms. Second, (2) we argue that such interactive effects might be due to switches in energy metabolism leading to threshold effects. Under multiple stress exposure, fish could switch from a "compensation" strategy, i.e. a reallocation of energy to defenses and repair to a "conservation" strategy, i.e. blocking of stress responses leading to strong deleterious effects and high mortality. Third, (3) this could have cascading effects on fish survival and population persistence but multiscale studies are still rare. We propose emerging tools merging different levels of biological organization to better predict population resilience under multiple stressors. Fourth (4), there are strong variations in sensitivity among populations, which might arise from transgenerational effects of stressors through plastic, genetic, and epigenetic mechanisms. This can lead to local adaptation or maladaptation, with strong impacts on the evolutionary trajectories of wild fish populations. With this review, we hope to encourage future research to bridge the gap between molecular ecology, ecotoxicology and evolutionary biology to better understand the evolution of responses of fishes to current and future multiple stressors in the context of global changes.

Effect of dietary synbiotic supplementation on growth, immune and physiological status of Labeo rohita juveniles exposed to low pH stress

In this study, we investigated the effect of dietary Bacillus circulans PB7 (BCPB7) and fructoligosaccharide (FOS), used singly or in combination for evaluation of growth, immune and physiological status of Labeo rohita (rohu) juveniles reared under low pH and normal pH for 60 days. Experimental fishes were distributed in two sets such as one set continuously exposed to low pH (5.5) and other reared under normal pH (7.0), and fed with four iso-nitrogenous diets viz. basal (control), Bacillus circulans PB7 (BCPB7, 10⁶ cfug^-1), 1% fructooligosaccharide (FOS) and their combination. The effect of such pre, pro and synbiotics dietary treatments on growth performance (weight gain, specific growth rate, feed conversion ratio and protein efficiency ratio), immune response (hematological indices, serum biochemistry, lysozyme, NBT activity), antioxidative status in the form of antioxidant enzyme (catalase, superoxide dismutase, glutathione-S-transferase), acetylcholine esterase (AChE), Na⁺ K⁺ ATPase and stress bio-markers (cortisol, glucose and HSP-70) were examined. The group treated with low pH and fed with control diet (without supplementation) was found to be inhibited (p  <  0.05) in growth and immuno-physiological function. However, supplementation of BCPB7 and FOS was non-significant (p < 0.05) on growth performance and physiological process but their concurrent feeding remarkably improved (p < 0.05) growth and immune-physiological function when exposed to low pH. Overall results indicate that dietary combination of BCPB7 and FOS can be considered an effective synbiotic formula against low pH stress in culture practices of L. rohita juveniles.

The Use of Biochemical Measurements to Identify Pre-Slaughter Stress in Pasture Finished Beef Cattle

This study considered the relationship between pre-slaughter stressors and plasma biomarkers in 488 pasture-raised cattle across two experiments. The design aimed to test groups consisting of steer only, heifer only, and mixed sex cattle under direct kill versus rested (14 days in abattoir holding paddocks) protocols. In Experiment One, cattle were sourced from four farms, and transported by trucks and ships on the same day. In Experiment Two, cattle were sourced from four farms where a comparison was made between marketing via two commercial saleyards or direct farm gate consignment to abattoir. Blood samples were collected at exsanguination for subsequent analyses and relation to meat quality attributes. Muscle damage, as indicated by creatine kinase, is the biomarker most correlated to ultimate pH and muscle glycogen concentrations. A two-week rest period is effective for lowering this enzyme and improving muscle glycogen concentration. Although the cattle was subjected to a range of stress inducing treatments, we found that plasma biomarkers alone appeared insufficient for use as diagnostic stress indicators.

Stress, psychiatric disorders, molecular targets, and more

Mental health is central to normal health outcomes. A widely accepted theory is that chronic persistent stress during adulthood as well as during early life triggers onset of neuropsychiatric ailments. However, questions related to how that occurs, and why are some individuals resistant to stress while others are not, remain unanswered. An integrated, multisystemic stress response involving neuroinflammatory, neuroendocrine, epigenetic and metabolic cascades have been suggested to have causative links. Several theories have been proposed over the years to conceptualize this link including the cytokine hypothesis, the endocrine hypothesis, the oxidative stress hypothesis and the oxido-neuroinflammation hypothesis. The data discussed in this review describes potential biochemical basis of the link between stress, and stress-induced neuronal, behavioral and emotional deficits, providing insights into potentially novel drug targets.

Prenatal stress and elevated seizure susceptibility: Molecular inheritable changes

Stressful episodes are common during early-life and may have a wide range of negative effects on both physical and mental status of the offspring. In addition to various neurobehavioral complications induced by prenatal stress (PS), seizure is a common complication with no fully explained cause. In this study, the association between PS and seizure susceptibility was reviewed focusing on sex differences and various underlying mechanisms. The role of drugs in the initiation of seizure and the effects of PS on the nervous system that prone the brain for seizure, especially the hypothalamic-pituitary-adrenal (HPA) axis, are also discussed in detail by reviewing the papers studying the effect of PS on glutamatergic, gamma-aminobutyric acid (GABA)ergic, and adrenergic systems in the context of seizure and epilepsy. Finally, epigenetic changes in epilepsy are described, and the underlying mechanisms of this change are expanded. As the effects of PS may be life-lasting, it is possible to prevent future psychiatric and behavioral disorders including epilepsy by preventing avoidable PS risk factors.

Genetic Factors Mediate the Impact of Chronic Stress and Subsequent Response to Novel Acute Stress

Individual differences in physiological and biobehavioral adaptation to chronic stress are important predictors of health and fitness; genetic differences play an important role in this adaptation. To identify these differences we measured the biometric, neuroendocrine, and transcriptional response to stress among inbred mouse strains with varying degrees of genetic similarity, C57BL/6J (B), C57BL/6NJ (N), and DBA/2J (D). The B and D strains are highly genetically diverse whereas the B and N substrains are highly similar. Strain differences in hypothalamic-pituitary-adrenal (HPA) axis cross-sensitization were determined by plasma corticosterone (CORT) levels and hippocampal gene expression following 7-weeks of chronic mild stress (CMS) or normal housing (NH) and subsequent exposure to novel acute restraint. Fecal CORT metabolites and body and organ weights were also measured. All strains exposed to CMS had reduced heart weights, whereas body weight gain was attenuated only in B and N strains. Acute stress alone produced larger plasma CORT responses in the D and N strains compared to the B strain. CMS paired with acute stress produced cross-sensitization of the CORT response in the N strain. The N strain also had the largest number of hippocampal transcripts with up-regulated expression in response to stress. In contrast, the D strain had the largest number of transcripts with down-regulated expression following CMS and acute stress. In summary, we observed differential responses to CMS at both the physiological and molecular level among genetically diverse strains, indicating that genetic factors drive individual differences in experience-dependent regulation of the stress response.

Nitrergic neurotransmission in the paraventricular nucleus of the hypothalamus modulates autonomic, neuroendocrine and behavioral responses to acute restraint stress in rats

We investigated the involvement of nitrergic neurotransmission within the paraventricular nucleus of the hypothalamus (PVN) in modulation of local neuronal activation, autonomic and neuroendocrine responses and behavioral consequences of acute restraint stress in rats. Bilateral microinjections of the selective neuronal nitric oxide (NO) synthase (nNOS) inhibitor Nw-Propyl-L-arginine (NPLA) or the NO scavenger carboxy-PTIO into the PVN reduced arterial pressure and heart rate increases, as well as the fall in cutaneous tail temperature induced by restraint stress. PVN injection of either NPLA or carboxy-PTIO also inhibited restraint-induced increases in anxiety-related behaviors in the elevated plus-maze 24 h later. Local microinjection of NPLA or carboxy-PTIO into the PVN reduced the number of c-fos-immunoreactive neurons in the dorsal parvocellular, ventromedial, medial parvocellular and lateral magnocelllular portions of the PVN in animals subjected to restraint stress. However, neither NPLA nor carboxy-PTIO into the PVN affected restraint-induced increases in plasma corticosterone concentration. The present results indicate that PVN nitrergic neurotransmission acting via nNOS activation has a facilitatory influence on autonomic responses to acute restraint and the delayed emotional consequences of restraint stress. Our results also provide evidence of a prominent role of local nitrergic neurotransmission in PVN neuronal activation during stress.

Sex differences in interleukin-6 stress responses in people with Type 2 diabetes

People with Type 2 diabetes (T2D) show dysregulated inflammatory responses to acute stress, but the effect of sex on inflammatory responses in T2D remains unclear. The purpose of this study was to investigate differences in interleukin (IL)-6 stress responses between older men and women with T2D. One hundred and twenty-one people (76 men; mean age = 64.09, SD = 7.35, 45 women; mean age = 63.20, SD = 6.70) with doctor-verified T2D took part in this laboratory-based stress testing study. Participants carried out acute mental stress tasks, and blood was sampled at baseline, immediately poststress, 45 min poststress, and 75 min poststress to detect plasma IL-6 concentrations. IL-6 change scores were computed as the difference between the baseline measurement and the three time points poststress. Main effects and interactions were tested using mixed model analysis of covariance. We found a significant main effect of time on IL-6 levels, and a significant Sex × Time interaction. In adjusted analyses including the three change scores and all the covariates, the significant Sex × Time interaction was maintained; IL-6 responses were greater in women at 45 and 75 min poststress compared with men, adjusting for age, body mass index, smoking, household income, glycated hemoglobin, oral antidiabetic medication, insulin/other injectable antidiabetic medication, depressive symptoms, and time of day of testing. Different inflammatory stress response pathways are present in men and women with T2D, with women producing larger IL-6 increases. The long-term implications of these differences need to be elucidated in future studies.

Gender-based violence and trauma in marginalized populations of women: Role of biological embedding and toxic stress

Gender-based violence (GBV) and trauma can dysregulate and recalibrate environmentally sensitive physiological (i.e. central nervous, endocrine, and immune) systems placing survivors at risk for multiple health problems. The researchers build the case that the effects of GBV are likely to be particularly high impact and contribute to health disparities for marginalized survivors of GBV. Further, the researchers underscore a need for a multi-level bio-socio-ecological model that deciphers, characterizes, and explains individual differences in these effects and the need to establish an evidence base from which to derive interventions that address biological effects of toxic stress among marginalized survivors of GBV.

Psychosocial stress reactivity is associated with decreased whole-brain network efficiency and increased amygdala centrality

Cognitive and emotional functions are supported by the coordinated activity of a distributed network of brain regions. This coordinated activity may be disrupted by psychosocial stress, resulting in the dysfunction of cognitive and emotional processes. Graph theory is a mathematical approach to assess coordinated brain activity that can estimate the efficiency of information flow and determine the centrality of brain regions within a larger distributed neural network. However, limited research has applied graph-theory techniques to the study of stress. Advancing our understanding of the impact stress has on global brain networks may provide new insight into factors that influence individual differences in stress susceptibility. Therefore, the present study examined the brain connectivity of participants that completed the Montreal Imaging Stress Task (Goodman et al., 2016; Wheelock et al., 2016). Salivary cortisol, heart rate, skin conductance response, and self-reported stress served as indices of stress, and trait anxiety served as an index of participant's disposition toward negative affectivity. Psychosocial stress was associated with a decrease in the efficiency of the flow of information within the brain. Further, the centrality of brain regions that mediate emotion regulation processes (i.e., hippocampus, ventral prefrontal cortex, and cingulate cortex) decreased during stress exposure. Interestingly, individual differences in cortisol reactivity were negatively correlated with the efficiency of information flow within this network, whereas cortisol reactivity was positively correlated with the centrality of the amygdala within the network. These findings suggest that stress reduces the efficiency of information transfer and leaves the function of brain regions that regulate the stress response vulnerable to disruption. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Somatostatin receptor subtype 5 modifies hypothalamic-pituitary-adrenal axis stress function

Pituitary corticotroph somatostatin receptor subtype 5 (SSTR5) signals to inhibit adrenocorticotrophin (ACTH) secretion. As ACTH deficiency results in attenuated adrenal cortisol production and an impaired stress response, we sought to clarify the role of SSTR5 in modifying the hypothalamic/pituitary/adrenal (HPA) axis. We generated Tg HP5 mice overexpressing SSTR5 in pituitary corticotrophs that produce the ACTH precursor proopiomelanocortin (POMC). Basal ACTH and corticosterone were similar in HP5 and WT mice, while HP5 mice showed attenuated ACTH and corticosterone responses to corticotrophin releasing hormone (CRH). HP5 mice exhibited attenuated corticosterone responses upon a restraint stress test and inflammatory stress following LPS injection, as well as increased anxiety-like and depressive-like behavior on open field and forced swim tests. Pituitary corticotroph CRH receptor subtype 1 (CRHR1) mRNA expression and ACTH responses to CRH were also attenuated in HP5 mice. In AtT20 cells stably overexpressing SSTR5, CRHR1 expression and cAMP response to CRH were reduced, whereas both were increased after SSTR5 KO. In elucidating mechanisms for these observations, we show that SSTR5-induced miR-449c suppresses both CRHR1 expression and function. We conclude that corticotroph SSTR5 attenuates HPA axis responses via CRHR1 downregulation, suggesting a role for SSTR5 in the pathogenesis of secondary adrenal insufficiency.

The effectiveness of a health promotion and stress-management intervention program in a sample of obese children and adolescents

OBJECTIVE

Our study aimed to evaluate the effectiveness of an 8-week stress management intervention program that included progressive muscle relaxation, diaphragmatic breathing, guided imagery, and cognitive restructuring in obese Greek children and adolescents.

DESIGN

Thirty-six patients were prospectively recruited to participate in this randomized controlled study. Of these, 16 participants formed the intervention group and 20 participants the control group. Anthropometric measurements and salivary cortisol, determined serially 3 times a day, were assessed at the beginning and at the end of the study. Participants also completed the state-trait anxiety in children questionnaire (STAIC), the stress in children questionnaire (SiC), and the child behavior checklist (CBCL).

RESULTS

The intervention resulted in a significant reduction of waist-hip ratio (p = 0.008) in the intervention group compared with the control group. Moreover, school performance was improved in the intervention group (p = 0.025), while both the intervention and the control group adopted healthier daily habits (p = 0.020 and 0.011, respectively). However, there was no statistically significant difference between body mass index (BMI) z-score, stress, anxiety, and diurnal patterns in salivary cortisol.

CONCLUSIONS

The present study supports the effectiveness of stress management intervention programs on waist-hip ratio reduction. Further research is required to investigate biomarkers able to predict and evaluate the effectiveness of stress management intervention programs.

Anatomy, development, and plasticity of the neurosecretory hypothalamus in zebrafish

The paraventricular nucleus (PVN) of the hypothalamus harbors diverse neurosecretory cells with critical physiological roles for the homeostasis. Decades of research in rodents have provided a large amount of information on the anatomy, development, and function of this important hypothalamic nucleus. However, since the hypothalamus lies deep within the brain in mammals and is difficult to access, many questions regarding development and plasticity of this nucleus still remain. In particular, how different environmental conditions, including stress exposure, shape the development of this important nucleus has been difficult to address in animals that develop in utero. To address these open questions, the transparent larval zebrafish with its rapid external development and excellent genetic toolbox offers exciting opportunities. In this review, we summarize recent information on the anatomy and development of the neurosecretory preoptic area (NPO), which represents a similar structure to the mammalian PVN in zebrafish. We will then review recent studies on the development of different cell types in the neurosecretory hypothalamus both in mouse and in fish. Lastly, we discuss stress-induced plasticity of the PVN mainly discussing the data obtained in rodents, but pointing out tools and approaches available in zebrafish for future studies. This review serves as a primer for the currently available information relevant for studying the development and plasticity of this important brain region using zebrafish.

Association between Loin Ultimate pH and Plasma Indicators of Pre-Slaughter Stressors in Australian Lamb

The purpose of this study was to test if associations exist between plasma indicators of acute and chronic stress and lamb ultimate pH. Blood was collected at exsanguination from 2,877 lambs from the Meat and Livestock Australia Genetic Research flock with a suite of indicators analyzed. Ultimate pH was measured in the loin (M. longissimus lumborum) at 24 h post-slaughter. There was a positive association (P < 0.05) between ultimate pH and plasma glucose and lactate concentrations, which indicates that opportunities exist to reduce variation in ultimate pH by reducing stress in the pre-slaughter period. These effects were small by comparison to production factors, however further understanding of how to best manage lambs in the pre-slaughter period is required to minimize stress and maximize lamb wellbeing and meat quality.

Acute stress enhances pupillary responses to erotic nudes: Evidence for differential effects of sympathetic activation and cortisol

Chronic stress attenuates reproductive behavior in many species, but evidence regarding the impact of acute stress on human sexual arousability is insufficient. Stressor-specific effects might result from divergent roles of both stress response systems. Social self-threat, linked to affiliation-oriented coping, might also influence sexual responsivity. To investigate stress-induced modulation of the processing of sexual cues and its relationship with cortisol, 58 participants underwent either a predominantly sympathetic stressor (3 min sustained handgrip) or similar control procedure. In both conditions, half of the sample was monitored by an opposite-sex person (social evaluation). Pupillary responses to erotic nudes were recorded and dissociated into fast and slow PCA components. Physically stressed participants showed enhanced (slow) dilation to explicit pictures. Cortisol levels after stress negatively predicted rapid responses to opposite-sex and (marginally) explicit stimuli. Our results suggest that acute sympathetic stress exposure facilitates cognitive sexual processing, whereas subsequent HPA-axis activation may induce counteracting effects.

Maternal Predator Odor Exposure in Mice Programs Adult Offspring Social Behavior and Increases Stress-Induced Behaviors in Semi-Naturalistic and Commonly-Used Laboratory Tasks

Maternal stress has a profound impact on the long-term behavioral phenotype of offspring, including behavioral responses to stressful and social situations. In this study, we examined the effects of maternal exposure to predator odor, an ethologically relevant psychogenic stressor, on stress-induced behaviors in both semi-naturalistic and laboratory-based situations. Adult C57BL/6 mice offspring of dams exposed to predator odor during the last half of pregnancy showed increased anti-predatory behavior, more cautious foraging behavior and, in the elevated plus maze, avoidance of elevated open areas and elevated open areas following restraint stress challenge. These offspring also exhibited alterations in social behavior including reduced free interaction and increased initial investigation despite normal social recognition. These changes in behavior were associated with increased transcript abundance of corticotropin-releasing factor, mineralocorticoid receptor and oxytocin (Oxt) in the periventricular nucleus of the hypothalamus. Taken together, the findings are consistent with a long-term increase in ethologically-relevant behavioral and neural responses to stress in male and female offspring as a function of maternal predator odor exposure.

Gene expression profile in peripheral blood mononuclear cells of postpartum depression patients

Postpartum depression (PPD) is a common mental health problem that causes maternal suffering and various negative consequences for offspring. The pathogenesis of PPD and the causes of consequences for offspring remain largely unknown. Here, we applied RNA sequencing to sequence the whole transcriptomes of peripheral blood mononuclear cells (PBMCs) from PPD patients (Edinburgh Postnatal Depression Scale [EPDS] score ≥13) and control subjects (EPDS = 0). We found that PPD was positively correlated with multiple genes involved in energy metabolism, neurodegenerative diseases and immune response, while negatively correlated with multiple genes in mismatch repair and cancer-related pathways. Remarkably, genes associated with appetite regulation and nutrient response were differentially expressed between PPD and control subjects. Then, we employed a postnatal growth retardation model by repeated immobilization stress (IS) stimulation to maternal mice. The expression of appetite regulation and nutrient response-related genes in the PBMCs of IS mice and in the hypothalamus of their offspring were also affected. In conclusion, this study provides a comprehensive characterization of the PBMCs transcriptome in PPD and suggests that maternal stress may affect appetite regulation and nutrient response in the hypothalamus of offspring mice.

Association between Oklahoma earthquakes and anxiety-related Google search episodes

BACKGROUND

Oklahoma has experienced a rise in seismicity since 2010, with many earthquakes induced by wastewater injection. While large single earthquakes have documented mental health repercussions, health implications of these new, frequent earthquakes remain unknown. We aimed to examine associations between Oklahoma earthquakes and statewide anxiety measured by Google queries.

METHODS

The U.S. Geologic Survey's Advanced National Seismic System Comprehensive Catalog supplied earthquake dates and magnitudes. We used the Google Health application programming interface to compile the proportion of weekly Oklahoma-based health-related search episodes for anxiety. A quasi-experimental time-series analysis from January 2010 to May 2017 evaluated monthly counts of earthquakes ≥ magnitude 4 (a level felt by most people) in relation to anxiety, controlling for US-wide anxiety search episodes and Oklahoma-specific health-related queries.

RESULTS

Oklahoma experienced an average of two (SD = 2) earthquakes ≥ magnitude 4 per month during the study period. For each additional earthquake ≥ magnitude 4, the proportion of Google search episodes for anxiety increased by 1.3% (95% confidence interval = 0.1%, 2.4%); 60% of this increase persisted for the following month. In months with 2 or more ≥ magnitude 4 earthquakes, the proportion of Google search episodes focused on anxiety increased by 5.8% (95% confidence interval = 2.3%, 9.3%). In a sub-analysis, Google search episodes for anxiety peaked about 3 weeks after ≥ magnitude 4 quakes.

CONCLUSIONS

These findings suggest that the recent increase in Oklahoma earthquakes has elicited a psychological response that may have implications for public health and regulatory policy.

Maternal predator odour exposure programs metabolic responses in adult offspring

A cardinal feature of the reaction to stress is the promotion of energy mobilization, enabling appropriate behavioural responses. Predator odours are naturalistic and ecologically relevant stressors present over evolutionary timescales. In this study, we asked whether maternal predator odour exposure could program long-term energy mobilization in C57BL/6 mice offspring. To test this hypothesis, we measured rates of oxygen consumption in prenatally predator odour exposed mice in adulthood while controlling for levels of locomotor activity at baseline and under stress. Circulating thyroid hormone levels and the transcript abundance of key regulators of the hypothalamic-pituitary-thyroid axis within the periventricular nucleus (PVN) of the hypothalamus and in the liver, including carriers and receptors and thyrotropin-releasing hormone, were measured as endocrine mediators facilitating energy availability. Prenatally predator odour exposed mice of both sexes mobilized more energy during lower energy demand periods of the day and under stressful conditions. Further, prenatally predator odour exposed mice displayed modifications of their hypothalamic-pituitary-thyroid axis through increased circulating thyroxine and thyroid hormone receptor α within the PVN and decreased transthyretin in the liver. Overall, these results suggest that maternal exposure to predator odour is sufficient to increase long-term energy mobilization in adult offspring.

Parental Advisory: Maternal and Paternal Stress Can Impact Offspring Neurodevelopment

Parental stress exposures are implicated in the risk for offspring neurodevelopmental and neuropsychiatric disorders, prompting critical examination of preconception and prenatal periods as vulnerable to environmental insults such as stress. Evidence from human studies and animal models demonstrates the influence that both maternal and paternal stress exposures have in changing the course of offspring brain development. Mechanistic examination of modes of intergenerational transmission of exposure during pregnancy has pointed to alterations in placental signaling, including changes in inflammatory, nutrient-sensing, and epigenetic pathways. Transmission of preconception paternal stress exposure is associated with changes in epigenetic marks in sperm, with a primary focus on the reprogramming of DNA methylation, histone posttranslational modifications, and small noncoding RNAs. In this review, we discuss evidence supporting the important contribution of intergenerational parental stress in offspring neurodevelopment and disease risk, and the currently known epigenetic mechanisms underlying this transmission.

The role of neuroinflammation and neurovascular dysfunction in major depressive disorder

Although depression has generally been explained with monoamine theory, it is far more multifactorial, and therapies that address the disease’s pathway have not been developed. In this context, an understanding of neuroinflammation and neurovascular dysfunction would enable a more comprehensive approach to depression. Inflammation is in a sense a type of allostatic load involving the immune, endocrine, and nervous systems. Neuroinflammation is involved in the pathophysiology of depression by increasing proinflammatory cytokines, activating the hypothalamus–pituitary–adrenal axis, increasing glucocorticoid resistance, and affecting serotonin synthesis and metabolism, neuronal apoptosis and neurogenesis, and neuroplasticity. In future, identifying the subtypes of depression with increased vulnerability to inflammation and testing the effects of inflammatory modulating agents in these patient groups through clinical trials will lead to more concrete conclusions on the matter. The vascular depression hypothesis is supported by evidence for the association between vascular disease and late-onset depression and between ischemic brain lesions and distinctive depressive symptoms. Vascular depression may be the entity most suitable for studies of the mechanisms of depression. Pharmacotherapies used in the prevention and treatment of cerebrovascular disease may help prevent vascular depression. In future, developments in structural and functional imaging, electrophysiology, chronobiology, and genetics will reveal the association between depression and brain lesions. This article aims to give a general review of the existing issues examined in the literature pertaining to depression-related neuroinflammatory and vascular functions, related pathophysiology, applicability to depression treatment, and directions for future research.

Glucometabolic effects of single and repeated exposure to forced-swimming stressor in Sprague-Dawley rats

Objectives. We aimed to evaluate the effects of a single (acute) and repeated (chronic) exposure to forced-swimming stressor on glucose tolerance, insulin sensitivity, lipid profile and glycogen content in male rats.

Methods. Thirty adult male Sprague-Dawley rats (12 weeks old) were divided randomly into five groups: control group, single exposure (SE) to forced-swim stressor, repeated exposure to forced-swim stressor for 7 days (RE7), 14 days (RE14) and 28 days (RE28). Glucose tolerance test and Homeostatic Model Assessment-Insulin Resistance (HOMA-IR) were undertaken on fasting rats to obtain glucose and insulin profiles. ELISA was performed to assess plasma insulin and corticosterone levels. Total cholesterol, triglyceride, high- and low-density lipoproteins, hepatic and skeletal glycogen content were also determined.

Results. Repeated exposure to stressor induced glucose intolerance and insulin resistance in the experimental rats. Results showed that all RE groups exhibited a significantly higher area under the curve compared with others (p=0.0001); similarly, HOMA-IR increased (p=0.0001) in all RE groups compared with control. Prolonged exposure to stressor significantly increased the plasma insulin and corticosterone levels but decreased the glycogen content in the liver and skeletal muscle when compared with the control group. Additionally, chronic stressor significantly increased the total cholesterol and triglyceride levels, however, acute stressor produced significantly elevated high-density lipoproteins level.

Conclusions. In conclusion, repeated exposure to forced-swimming stressor induced glucose intolerance and insulin resistance in rats by disrupting the insulin sensitivity as well as heightening the glycogenolysis in the liver and skeletal muscle. Acute stressor was unable to cause glucose intolerance and insulin resistance but it appears that may have a positive effect on the lipid metabolism.

Prospective association between major depressive disorder and leukocyte telomere length over two years

BACKGROUND

Reduced leukocyte telomere length (LTL) has been found to be associated with multiple common age-related diseases, including heart disease, diabetes, and cancer. A link has also been suggested between shortened LTL and major depressive disorder (MDD), suggesting that MDD may be a disease of accelerated aging. This prospective, longitudinal study examined the association between depression diagnosis at baseline and change in LTL over two years in a well-characterized sample of N = 117 adults with or without MDD at baseline, using rigorous entry criteria.

METHODS

Participants aged 18-70 were assessed with validated instruments by trained, doctoral-level clinician raters at baseline and at two-year follow-up, and blood samples were obtained at both visits. LTL was assayed under identical methods using quantitative polymerase chain reaction (qPCR). The effect of an MDD diagnosis at baseline on change in LTL over two years was examined via hierarchical mixed models, which included potential confounders.

RESULTS

Individuals with MDD at baseline had greater LTL shortening over two years than individuals without MDD (p = 0.03), even after controlling for differences in age, sex, and body mass index (BMI). In the sub-sample of individuals with MDD diagnoses at baseline, no significant associations between LTL change and symptom severity or duration were found.

CONCLUSION

A baseline diagnosis of MDD prospectively predicted LTL shortening over two years. Our results provide further support for MDD as a disease associated with accelerated aging in a well-characterized sample using validated, clinician-rated measures.

Mechanisms of Mitochondrial Redox Signaling in Psychosocial Stress-Responsive Systems: New Insights into an Old Story

SIGNIFICANCE

Psychosocial stress is associated with alterations in serum glucocorticoids and cytokines, such as interleukin-6 (IL-6) and IL-1β, which functionally interact. However, the molecular mechanisms and physiological relationship between the two systems within the context of stress exposure are not well characterized. Recent Advances: Extracellular IL-6, which stimulates the release of cortisol from the zona fasciculata of the adrenal cortex, mediates its intracellular effects by tyrosine phosphorylation of the transcription factor signal transducer and activator of transcription 3 (STAT3). Mitochondrial electron transfer reactions are involved in both STAT3-driven ATP production in oxidative respiration and adrenocortical steroid biosynthesis.

CRITICAL ISSUES

The role of STAT3 in oxidative respiration and steroidogenesis suggests that it integrates both nuclear and mitochondrial actions, thereby preserving main steps of glucocorticoid biosynthesis in the adrenal gland under psychosocial stress. This review discusses the notion that these two pathways are together simultaneously involved in protection against chronic stressors.

FUTURE DIRECTIONS

Linking the function of cytokines and main components of the hypothalamic-pituitary-adrenal (HPA) axis to molecular mechanisms of mitochondrial redox signaling will be essential for a better understanding of the relevant stress-responsive systems engaged in stress vulnerability. Antioxid. Redox Signal. 28, 760-772.

Autonomic Nervous System and Stress to Predict Secondary Ischemic Events after Transient Ischemic Attack or Minor Stroke: Possible Implications of Heart Rate Variability

Transient ischemic attack (TIA) and minor stroke have high risks of recurrence and deterioration into severe ischemic strokes. Risk stratification of TIA and minor stroke is essential for early effective treatment. Traditional tools have only moderate predictive value, likely due to their inclusion of the limited number of stroke risk factors. Our review follows Hans Selye’s fundamental work on stress theory and the progressive shift of the autonomic nervous system (ANS) from adaptation to disease when stress becomes chronic. We will first show that traditional risk factors and acute triggers of ischemic stroke are chronic and acute stress factors or “stressors,” respectively. Our first review shows solid evidence of the relationship between chronic stress and stroke occurrence. The stress response is tightly regulated by the ANS whose function can be assessed with heart rate variability (HRV). Our second review demonstrates that stress-related risk factors of ischemic stroke are correlated with ANS dysfunction and impaired HRV. Our conclusions support the idea that HRV parameters may represent the combined effects of all body stressors that are risk factors for ischemic stroke and, thus, may be of important predictive value for the risk of subsequent ischemic events after TIA or minor stroke.

NGF-dependent neurons and neurobiology of emotions and feelings: Lessons from congenital insensitivity to pain with anhidrosis

NGF is a well-studied neurotrophic factor, and TrkA is a receptor tyrosine kinase for NGF. The NGF-TrkA system supports the survival and maintenance of NGF-dependent neurons during development. Congenital insensitivity to pain with anhidrosis (CIPA) is an autosomal recessive genetic disorder due to loss-of-function mutations in the NTRK1 gene encoding TrkA. Individuals with CIPA lack NGF-dependent neurons, including NGF-dependent primary afferents and sympathetic postganglionic neurons, in otherwise intact systems. Thus, the pathophysiology of CIPA can provide intriguing findings to elucidate the unique functions that NGF-dependent neurons serve in humans, which might be difficult to evaluate in animal studies. Preceding studies have shown that the NGF-TrkA system plays critical roles in pain, itching and inflammation. This review focuses on the clinical and neurobiological aspects of CIPA and explains that NGF-dependent neurons in the peripheral nervous system play pivotal roles in interoception and homeostasis of our body, as well as in the stress response. Furthermore, these NGF-dependent neurons are likely requisite for neurobiological processes of 'emotions and feelings' in our species.

Targeting self-regulation to promote health behaviors in children

Poor self-regulation (i.e., inability to harness cognitive, emotional, motivational resources to achieve goals) is hypothesized to contribute to unhealthy behaviors across the lifespan. Enhancing early self-regulation may increase positive health outcomes. Obesity is a major public health concern with early-emerging precursors related to self-regulation; it is therefore a good model for understanding self-regulation and health behavior. Preadolescence is a transition when children increase autonomy in health behaviors (e.g., eating, exercise habits), many of which involve self-regulation. This paper presents the scientific rationale for examining self-regulation mechanisms that are hypothesized to relate to health behaviors, specifically obesogenic eating, that have not been examined in children. We describe novel intervention protocols designed to enhance self-regulation skills, specifically executive functioning, emotion regulation, future-oriented thinking, and approach bias. Interventions are delivered via home visits. Assays of self-regulation and obesogenic eating behaviors using behavioral tasks and self-reports are implemented and evaluated to determine feasibility and psychometrics and to test intervention effects. Participants are low-income 9-12 year-old children who have been phenotyped for self-regulation, stress, eating behavior and adiposity through early childhood. Study goals are to examine intervention effects on self-regulation and whether change in self-regulation improves obesogenic eating.

Patterns of change in anxiety and depression during pregnancy predict preterm birth

BACKGROUND

To determine whether changes in anxiety and depression during pregnancy influence the risk of having a preterm birth (PTB), and whether chronic stress modifies this relationship.

METHODS

The data source for the current study is the All Our Babies prospective cohort (AOB). Anxiety and depression were measured at 17-24 weeks and again at 32-36 weeks' gestation using the Spielberg State Anxiety Scale and the Edinburgh Postnatal Depression Scale, respectively. Chronic stress was assessed at 17-24 weeks' gestation as a potential covariate, and was measured using the Perceived Stress Scale. Multivariable logistic regression modeling was used to assess each relationship RESULTS: Women who experienced an increase in anxiety scores, (time point 32-36 weeks, compared to the earlier time point 17-24 weeks), had 2.70 times higher odds of preterm delivery, compared to those with a reduction in anxiety scores (95% CI 1.28, 5.69). Consistent low or high depression scores did not significantly influence the odds of PTB compared to a decrease in depression scores. A co-occurring increase in anxiety and depression scores was not found to increase the risk of PTB, and chronic stress did not modify any of these relationships.

LIMITATIONS

This study was limited by a relatively small sample of women who delivered preterm, and therefore it was not possible to conduct additional analyses. Further, the analyses were limited to mostly late preterm infants (32-36 weeks' gestation).

CONCLUSIONS

These findings should be validated with additional cohorts and a larger sample size. Ultimately, primary prevention could address anxiety during pregnancy.

Increased Postprandial Colonic Motility and Autonomic Nervous System Activity in Patients With Irritable Bowel Syndrome: A Prospective Study

Background/Aims

The prevalence and severity of irritable bowel syndrome (IBS) declines with age, but the cause of this is unknown. This study tested 2 hypotheses: (1) autonomic nervous system responses to eating and bowel distention, measured by heart rate variability (HRV), differs by age in IBS patients and (2) HRV is correlated with colonic motility and IBS symptoms.

Methods

One hundred and fifty-six Rome III positive IBS patients and 31 healthy controls underwent colonic manometry with bag distention in the descending colon, followed by ingestion of an 810-kcal meal. HRV, evaluated by low frequency (%LF; 0.04–0.15 Hz) component, high frequency (%HF; 0.15–0.40 Hz) component, and the LF/HF ratio, was measured during colonic distention and after the meal. Motility index and subjective symptom scores were simultaneously quantified.

Results

Both colonic distention and eating decreased %HF and increased the LF/HF ratio, and both indices of autonomic nervous system correlated with age. In IBS patients, %HF negatively correlated with the postprandial motility index after adjusting for age. The %HF and LF/HF ratios also correlated with psychological symptoms but not bowel symptoms in IBS patients.

Conclusion

Decreased vagal activity is associated with increase in age and greater postprandial colonic motility in patients with IBS, which may contribute to postprandial symptoms.

Shifting priorities: highly conserved behavioral and brain network adaptations to chronic stress across species

Parallel clinical and preclinical research have begun to illuminate the biological basis of stress-related disorders, including major depression, but translational bridges informing discrete mechanistic targets for intervention are missing. To address this critical need, we used structural MRI in a mouse model and in a large human sample to examine stress effects on brain structure that may be conserved across species. Specifically, we focused on a previously unexplored approach, whole-brain structural covariance, as it reflects synchronized changes in neuroanatomy, potentially due to mutual trophic influences or shared plasticity across regions. Using the unpredictable chronic mild stress (UCMS) paradigm in mouse we first demonstrate that UCMS-induced elevated behavioral emotionality correlates with increased size of the amygdala and other corticolimbic regions. We further identify focal increases in the amygdala's 'hubness' (degree and strength) set against the background of a global stress-related loss of network clustering and modularity. These macroscopic changes are supported on the molecular level by increased postsynaptic density-95 protein in the amygdala, consistent with stress-induced plastic changes and synaptic strengthening. Finally, we provide clinical evidence that strikingly similar structural network reorganization patterns exist in young adults reporting high childhood trauma and increased mood symptoms. Collectively, we provide initial translational evidence for a conserved stress-related increase in amygdala-centered structural synchrony, as measured by enhanced structural covariance, which is paralleled by a decrease in global structural synchrony. This putative trade-off reflected in increased amygdala-centered plastic changes at the expense of global structural dedifferentiation may represent a mechanistic pathway for depression and related psychopathology.

Psychosocial Stress, Cortisol Levels, and Maintenance of Vaginal Health

Stress stimuli are ubiquitous and women do not enjoy any exemptions. The physiologic "fight-or-flight" response may be deleterious to the female lower genital tract microbiome if the stress stimuli persist for longer than necessary. Persistent exposure to psychosocial stress and stimulation of the hypothalamic-pituitary-adrenal (HPA) and sympathetic-adrenal-medullary (SAM) axes, and associated hormones are risk factors for several infections including genitourinary tract infections. Though this could be due to a dysregulated immune response, a cortisol-induced inhibition of vaginal glycogen deposition may be involved especially in the instance of vaginal infection. The estrogen-related increased vaginal glycogen and epithelial maturation are required for the maintenance of a healthy vaginal ecosystem (eubiosis). The ability of cortisol to disrupt this process as indicated in animal models is important in the pathogenesis of vaginal dysbiosis and the subsequent development of infection and inflammation. This phenomenon may be more crucial in pregnancy where a healthy Lactobacillus-dominated vaginal microbiota is sacrosanct, and there is local production of more corticotropin-releasing hormone (CRH) from the decidua, fetal membranes and placenta. To highlight the relationship between the stress hormone cortisol and the vaginal microbiomial architecture and function, the potential role of cortisol in the maintenance of vaginal health is examined.

Brain Under Stress and Alzheimer's Disease

Modern society is characterized by the ubiquity of stressors that affect every individual to different extents. Furthermore, experimental, clinical, and epidemiological data have shown that chronic activation of the stress response may participate in the development of various somatic as well as neuropsychiatric diseases. Surprisingly, the role that stress plays in the etiopathogenesis of Alzheimer's disease (AD) has not yet been studied in detail and is therefore not well understood. However, accumulated data have shown that neuroendocrine and behavioral changes accompanying the stress response affect neuronal homeostasis and compromise several key neuronal processes. Mediators of the neuroendocrine stress response, if elevated repeatedly or chronically, exert direct detrimental effects on the brain by impairing neuronal metabolism, plasticity, and survival. Stress-induced hormonal and behavioral reactions may also participate in the development of hypertension, atherosclerosis, insulin resistance, and other peripheral disturbances that may indirectly induce neuropathological processes participating in the development and progression of AD. Importantly, stress-induced detrimental effects as etiological factors of AD are attractive because they can be reduced by several approaches including behavioral and pharmacological interventions. These interventions may therefore represent an important strategy for prevention or attenuation of the progression of AD.

DHEAS patterning across childhood in three sub-Saharan populations: Associations with age, sex, ethnicity, and cortisol

OBJECTIVES

Hormones have many roles in human ontogeny, including the timing of life history 'switch points' across development. Limited hormonal data exist from non-Western children, leaving a significant gap in our understanding of the diversity of life history patterning. This cross-sectional study examines dehydroepiandrosterone sulfate (DHEAS) production in relation to age, sex, ethnicity, and cortisol concentrations, as well as average age of adrenarche, among Aka and Ngandu children of the Central African Republic and Sidama children of Ethiopia.

METHODS

Hair was collected from 480 children (160 per population) aged 3-18 years old. These samples were analyzed for DHEAS and cortisol concentrations using ELISAs. A generalized additive model was used to examine DHEAS patterning in relation to age, sex, cortisol, and ethnicity. The derivative of DHEAS as a function of age was used to identify average age of adrenarche in each population.

RESULTS

DHEAS patterning in these three populations is distinct from Euro-American patterns of production. In all three groups, the population-level age at adrenarche onset occurs slightly later than Euro-American averages, with both Central African populations experiencing a later onset than the Ethiopian population.

CONCLUSIONS

DHEAS patterns and age at adrenarche vary across cultures, perhaps indicating adaptive life history responses in diverse eco-cultural environments. Delayed involution of the fetal zone and DHEAS patterning may offer both cognitive protection and immune defense in high-risk, nutritionally-poor environments. Additional research in the majority world is essential to improving our understanding of the diversity of hormonal development and timing of 'switch points' in life history trajectories.

Association between Stress and the HPA Axis in the Atopic Dermatitis

The hypothalamic–pituitary–adrenal (HPA) axis is one of the body’s neuroendocrine networks that responds to psychological stress (PS). In the skin, there exists a peripheral HPA axis similar to the central axis. Glucocorticoids (GCs) are key effector molecules of the HPA axis and are essential for cutaneous homeostasis. Atopic dermatitis (AD) is a condition typically characterized by a chronic relapsing course that often results in PS. HPA dysfunction is present in AD patients by the decreased response of GCs elevation to stress as compared to those unaffected by AD. Nevertheless, in skin, acute PS activates several metabolic responses that are of immediate benefit to the host. During the acute phase of PS, increased endogenous GCs have been shown to provide benefit rather than by aggravating cutaneous inflammatory dermatoses. However, a chronic T helper cell type 2 (Th2) predominant cytokine profile acts as a negative feedback loop to blunt the HPA axis response in AD. In this article, we reviewed the role of CRF, pro-opiomelanocortin (POMC)-derived peptides, GCs of the HPA, and 11β-hydroxysteroid dehydrogenase 1 (11β-HSD1) in AD, with a discussion of the pathogenetic mechanisms of inflammation and skin barrier functions, including antimicrobial defense, and their association with PS.

Endocannabinoids: Effectors of glucocorticoid signaling

For decades, there has been speculation regarding the interaction of cannabinoids with glucocorticoid systems. Given the functional redundancy between many of the physiological effects of glucocorticoids and cannabinoids, it was originally speculated that the biological mechanisms of cannabinoids were mediated by direct interactions with glucocorticoid systems. With the discovery of the endocannabinoid system, additional research demonstrated that it was actually the opposite; glucocorticoids recruit endocannabinoid signaling, and that the engagement of endocannabinoid signaling mediated many of the neurobiological and physiological effects of glucocorticoids. With the development of advances in pharmacology and genetics, significant advances in this area have been made, and it is now clear that functional interactions between these systems are critical for a wide array of physiological processes. The current review acts a comprehensive summary of the contemporary state of knowledge regarding the biological interactions between glucocorticoids and endocannabinoids, and their potential role in health and disease.

Evaluation of efforts in untrained Wistar rats following exercise on forced running wheel at maximal lactate steady state

[Purpose]

We aimed to examine the effect of running speed on metabolic responses associated with maximal lactate steady state (MLSS) in rats during forced running wheel (FRW) exercise.

[Methods]

Forty male adult Wistar rats were divided into seven groups. The blood lactate threshold and peak running speed were determined for an incremental power test group. Five groups participated in constant power tests at intensities 10, 13, 14.5, 16, and 17.5 m/min to determine MLSS and a non-exercise group was chosen as the control. Animals were euthanized immediately after constant power tests and their corticosterone, non-esterified fatty acid (NEFA), blood glucose, and creatine kinase (CK) levels analyzed. The differences among groups were identified by one-way analysis of variance (p < 0.05).

[Results]

Blood lactate threshold corresponded a running intensity of 15 m/min, while MLSS was determined to be 16 m/min. Serum corticosterone concentrations were significantly higher in 14.5, 16, and 17.5 m/min groups (298.8±62, 338.3±65, and 354±26 nM, respectively) as compared to that in the control group (210.6±16 nM). Concentrations of NEFA observed in groups 13, 14.5, 16, and 17.5 m/min (662.8±24, 702.35±69, 718.4±34, and 752.8±77 μM, respectively) were significantly higher than those in 10 m/min and control groups (511.1±53 and 412.1±56 μM, respectively). The serum CK concentration recorded for group 17.5 m/min (372.4±56 U/L) was higher than those recorded for other groups.

[Conclusion]

The speed above 16 m/min on FRW resulted in increased physiological demands and muscle damage in untrained healthy Wistar rats.

Interoceptive modulation of neuroendocrine, emotional, and hypophagic responses to stress

Periods of caloric deficit substantially attenuate many centrally mediated responses to acute stress, including neural drive to the hypothalamic-pituitary-adrenal (HPA) axis, anxiety-like behavior, and stress-induced suppression of food intake (i.e., stress hypophagia). It is posited that this stress response plasticity supports food foraging and promotes intake during periods of negative energy balance, even in the face of other internal or external threats, thereby increasing the likelihood that energy stores are repleted. The mechanisms by which caloric deficit alters central stress responses, however, remain unclear. The caudal brainstem contains two distinct populations of stress-recruited neurons [i.e., noradrenergic neurons of the A2 cell group that co-express prolactin-releasing peptide (PrRP+ A2 neurons), and glucagon-like peptide 1 (GLP-1) neurons] that also are responsive to interoceptive feedback about feeding and metabolic status. A2/PrRP and GLP-1 neurons have been implicated anatomically and functionally in the central control of the HPA axis, anxiety-like behavior, and stress hypophagia. The current review summarizes a growing body of evidence that caloric deficits attenuate physiological and behavioral responses to acute stress as a consequence of reduced recruitment of PrRP+ A2 and hindbrain GLP-1 neurons, accompanied by reduced signaling to their brainstem, hypothalamic, and limbic forebrain targets.

Depression, Inflammation, and Physiological Risk in Late Life: A National Longitudinal Study

This nationally representative study queried effects of community dwelling older adults' depression and inflammation at baseline on over-time changes in surrogate markers of their cardiometabolic risk. Data were from the 2005-2006 and 2010-2011 waves of the U.S. National Social Life, Health, and Aging Project. Inflammation was indicated by C-reactive protein and depression by the CES-D scale. Cardiometabolic markers included hemoglobin A1c and systolic BP. Lagged dependent variable models were used to examine effects. In none of the models did Wave 1 depression predict residual change in cardiometabolic states (i.e., Wave 2 values net of Wave 1). In contrast, men's baseline C-reactive protein predicted their Wave 2 hemoglobin A1c (Coeff. = 0.02, p < .05) as well as their systolic BP (Coeff. = 3.22, p < .05). No such effects were found among women. Contrary to a growing clinical literature, depression may not increase cardiometabolic risk among older adults on average. Moderators that may interact with depression to yield such effects in delimited samples remain to be identified. Inflammation, in contrast, does seem linked to increase in physiological risk-but only among men, not women. Clinical research is needed to identify biological factors responsible for this sex difference.

Investigating Vulnerability for Developing Eating Disorders in a Multi-confessional Population

The present study aimed to examine the vulnerability to eating disorders (ED) among 949 Lebanese female young adults as well as its association with stress, anxiety, depression, body image dissatisfaction (BID), dysfunctional eating, body mass index, religious affiliation (Christian, Muslim, Druze or Other), religiosity and activity level. Results showed that anxiety had the greatest effect on increasing the predisposition to ED, followed by stress level, BID, depression and restrained eating. Affiliating as Christian was found to significantly decrease the vulnerability to developing an ED. Furthermore, the interaction of anxiety with intrinsic religiosity was found to have a protective role on reducing ED. The current study emphasized a buffering role of intrinsic religiosity against anxiety and ED vulnerability.

Stress and Alterations in Bones: An Interdisciplinary Perspective

Decades of research have demonstrated that physical stress (PS) stimulates bone remodeling and affects bone structure and function through complex mechanotransduction mechanisms. Recent research has laid ground to the hypothesis that mental stress (MS) also influences bone biology, eventually leading to osteoporosis and increased bone fracture risk. These effects are likely exerted by modulation of hypothalamic-pituitary-adrenal axis activity, resulting in an altered release of growth hormones, glucocorticoids and cytokines, as demonstrated in human and animal studies. Furthermore, molecular cross talk between mental and PS is thought to exist, with either synergistic or preventative effects on bone disease progression depending on the characteristics of the applied stressor. This mini review will explain the emerging concept of MS as an important player in bone adaptation and its potential cross talk with PS by summarizing the current state of knowledge, highlighting newly evolving notions (such as intergenerational transmission of stress and its epigenetic modifications affecting bone) and proposing new research directions.

Chronic distress and the vulnerable host: a new target for HIV treatment and prevention?

Pathologic stress (distress) disturbs immune, cardiovascular, metabolic, and behavioral homeostasis. Individuals living with HIV and those at risk are vulnerable to stress disorders. Corticotropin-releasing hormone (CRH) is critical in neuroendocrine immune regulation. CRH, a neuropeptide, is distributed in the central and peripheral nervous systems and acts principally on CRH receptor type 1 (CRHR1). CRH in the brain modulates neuropsychiatric disorders. CRH and stress modulation of immunity is two-pronged; there is a direct action on hypothalamic-pituitary-adrenal secretion of glucocorticoids and through immune organ sympathetic innervation. CRH is a central and systemic proinflammatory cytokine. Glucocorticoids and their receptors have gene regulatory actions on viral replication and cause central and systemic immune suppression. CRH and stress activation contributes to central nervous system (CNS) viral entry important in HIV-associated neurocognitive disorders and HIV-associated dementia. CNS CRH overproduction short-circuits reward, executive, and emotional control, leading to addiction, cognitive impairment, and psychiatric comorbidity. CRHR1 is an important therapeutic target for medication development. CRHR1 antagonist clinical trials have focused on psychiatric disorders with little attention paid to neuroendocrine immune disorders. Studies of those with HIV and those at risk show that concurrent stress-related disorders contribute to higher morbidity and mortality; stress-related conditions, addiction, immune dysfunction, and comorbid psychiatric illness all increase HIV transmission. Neuropsychiatric disease, chronic inflammation, and substance abuse are endemic, and chronic distress is a pathologic factor. It is being understood that stress and CRH are fundamental to neuroendocrine immunity; therapeutic interventions with existing and novel agents hold promise for restoring homeostasis, reducing morbidity and mortality for those with HIV and possibly reducing future disease transmission.

Exaggerated plasma interleukin 6, interleukin 10, and subsequent development of health care-associated infections in patients with sepsis

BACKGROUND

Health care-associated infections (HAIs) are the target of many well-known preventive measures in the intensive care unit (ICU); however, little is known about post-sepsis-induced immunosuppression.

OBJECTIVES

This study explores the relationship between baseline plasma levels of inflammatory cytokines interleukin 6 (IL-6), IL-10, and IL-6:IL-10 and subsequent development of HAIs in patients with admitted with sepsis.

METHODS

Prospective observational study was conducted among veterans admitted to the ICU with sepsis and monitored daily through ICU discharge (up to 28 days) to investigate HAI development. Baseline plasma IL-6 and IL-10 levels were measured with a multiplex bead based assay. Exaggerated systemic inflammation was defined as the fourth quartile (IL-6 and IL-10) compared with other quartiles.

RESULTS

We recruited 78 patients over 18 months, primarily older (65.5 ± 12.6 years) men (94.9%) with underlying comorbidities (93.9%) and a high severity of illness (Acute Physiologic and Chronic Health Evaluation II score 20.6 ± 6.4). Seventeen patients (21.7%) developed at least 1 HAI, and candidemia was the leading infection. Patients with exaggerated baseline systemic inflammation developed a nonsignificantly higher proportion of HAI as compared with those not developing HAI (IL-6: 31.6% vs 18.6%, P = .55; IL-10: 26.3% vs 20.3%, P = .43).

DISCUSSION

Patients with exaggerated systemic inflammation had a higher severity of illness, but not a statistically significant higher incidence of HAI. A larger, more adequately powered sample with serial cytokine measures is needed. Routine surveillance cultures are needed. Health care-associated infection may occur in the absence of fever, and the emerging incidence of Candida is a concern. Immune suppression after sepsis should be recognized as a risk for HAI development. Antibiotic therapy should be targeted with prompt de-escalation of empiric therapy per established guidelines to preserve normal flora.