Psychoneuroimmunology: stress effects on pathogenesis and immunity during infection

Neuroendocrine and immune system interactions in stress and depression

Based on the extensive characterization of communication pathways between the nervous system and the immune system, there has been increasing interest in the impact of the nervous system on the development and expression of disorders involving the immune system and the contribution of the immune system to psychiatric disease. A vast literature has documented the impact of various stressors on a wide array of immune partners, and the specific neuroendocrine pathways involved have been elucidated. The impact of cytokines on neuroendocrine function and behavior has also been determined, and the relevance of cytokines to the pathophysiology of depression has become an exciting new research frontier. This article provides a foundation for integrating neuroendocrine-immune interactions into the formulation of neuropsychiatric and immunologic disease.

Host resistance to mycobacteria is compromised by activation of the hypothalamic-pituitary-adrenal axis

Host resistance to the growth of Mycobacterium avium and Mycobacterium tuberculosis is controlled by a gene, termed Nramp1, that maps to chromosome 1 in mice. Activation of the HPA axis or treatment of macrophages from susceptible mice with corticosterone suppresses the expression of Nramp1 mRNA and results in an increased susceptibility to mycobacterial growth. In contrast, neither activation of the HPA axis nor treatment of macrophages from resistant mice with corticosterone results in an alteration in their resistance or suppression of Nramp1 expression. Investigation into the mechanism of the differential response of the macrophages to corticosterone indicated that differences were associated with the stability of the mRNA in macrophages from BCG-resistant mice. Thus, corticosterone induced the accelerated degradation of Nramp1 mRNA as well as mRNA of several other macrophage activation genes in macrophages from BCG-susceptible mice. Treatment of macrophages with corticosterone before the induction of Nramp1 resulted in the accelerated degradation of mRNA in macrophages from both resistant and susceptible mice. The Nramp1 gene product appears to protect the mRNA of macrophage activation genes from degradation induced by corticosterone by an iron-dependent mechanism.

The effect of depression in an animal model on 5'-ectonucleotidase, antibody production, and tissue ascorbate stores

The learned helplessness model of depression in rats was tested. It was hypothesized that 5'-ectonucleotidase (NT), ascorbate, and antibody to sheeps' red blood cells (SRBC) are significantly reduced in rats who experienced uncontrollable shock, compared with rats who did not receive shock or could control it. During a learned-helplessness manipulation, antibody response to SRBC and NT values were unaffected. However, tissue ascorbate stores fell significantly, by 20-30%. The lack of effects on antibody responses and NT are discussed n terms of the acute nature of the stressor used in this model, as opposed to the more chronic stressors that have occurred in the human model.

Endocrine regulation of murine macrophage function: effects of dehydroepiandrosterone, androstenediol, and androstenetriol

In these studies, the in vitro influences of dehydroepiandrosterone (DHEA), androstenediol (AED), and androstenetriol (AET) on proinflammatory cytokine production from macrophages was examined. From physiologic to pharmacologic doses, DHEA suppressed secretion of each pro-inflammatory cytokine while AED had little influence on the responses. In sharp contrast, AET augmented TNF-alpha and IL-1 secretion while not influencing IL-6 production. Furthermore, the antiglucocorticoid activity of DHEA, AED, and AET was also investigated. Co-culture with AET counteracted the down-regulatory effect of hydrocortisone on LPS-induced TNF-alpha and IL-1 secretion. These data imply that AET is capable of regulating cytokine secretion from macrophages and may function to counterbalance glucocorticoid function.

Newcastle disease vaccines

Newcastle disease (ND) is a worldwide problem with severe economic implications, affecting chickens, turkeys and other birds. Newcastle disease virus (NDV), a member of the Paramyxoviridae group can cause disease of diverse severity in accordance with environmental factors. NDV strains are classified according to their virulence into three categories. The lentogenic strains are very mild and naturally inhabit healthy flocks. They can be used as live vaccines even for young chicks. Killed vaccines can be produced from the same viruses following inactivation. Mesogenic ND viruses, which cause mild or inapparent respiratory infections, have recently been banned in many countries even for killed vaccine production due to fears of disease emergence. Velogenic strains are the causative agents of the disease and can be used for the purpose of vaccine challenge test. Production and use of Newcastle disease vaccines are discussed in this review.

Differential effects of stress-induced adrenal function on components of the herpes simplex virus-specific memory cytotoxic T-lymphocyte response

We have previously demonstrated in a murine model system that psychological stress, applied in the form of physical restraint, suppresses both the activation of splenic-derived, herpes simplex virus (HSV)-specific memory cytotoxic T-lymphocytes (CTLm) to the lytic phenotype and the production of cytokines associated with CTL activation and function. In the studies described herein, we investigated the hypothesis that an adrenal-dependent event is responsible, either in whole or in part, for these observations. While adrenalectomy was shown to abrogate stress-induced suppression of both HSV-specific CTLm activation and the production of IL-6 and IFN-gamma, the reduction in splenic cellularity associated with restraint stress remained, In addition, a role for adrenal function in the regulation of splenic cellularity and IFN-gamma production in non-stressed mice was observed. Together, these results indicate that both adrenal-dependent and adrenal-independent events, operative under both baseline and stress conditions, mediate control of the memory component of the cellular immune response to HSV infection. Overall, these studies provide insight into the mechanisms by which psychological stress modulates immune responsiveness to viral pathogens.

Time-course of the murine lymphoid tissue involution during and following stressor exposure

Groups of 35-day-old male C57BL/6 mice were stressed 1 hour per day by immobilization for 1, 2, 3, 5, 8, 11 or 14 consecutive days. Control groups were left undisturbed. The animals were then killed and body weight and the weights of the thymus, spleen and axillary lymph nodes determined. Chronic immobilization stress caused involution of the thymus, spleen and lymph nodes to an extent depending on the number of days of stress. The thymus showed the fastest response: thymus weight was significantly lower in stressed animals than in controls by the third day of stress while significant effects on spleen and lymph node weight were not observed until day 5. Fast recovery of lymphoid organ weight was observed after the stress period. The thymus recovered most quickly: control values were re-attained approximately 8 days after cessation of stress, and indeed by day 20 thymus weight was about 12% higher than in normal animals. The spleen and lymph nodes recuperated weight more slowly, re-attaining control values after about 20 days.

Endocrine regulation of the immune response to influenza virus infection with a metabolite of DHEA-androstenediol

In these studies the influence of androstenediol on the course of an experimental virus infection was examined. Pretreatment with 320 mg/kg AED protected male mice from lethal influenza virus infection. In addition, AED enhanced antigen-induced trafficking of mononuclear cells into the draining lymph node and augmented antigen-specific activation of helper-T cells, which are important for control of viral pathogenesis. Furthermore, AED prevented the characteristic increase in serum corticosterone noted during influenza A virus infection. Although steroid hormones, at least corticosteroids, typically suppress host immune and inflammatory responses in vivo, these data suggest that AED may function to augment host immune and inflammatory responses in contrast to corticosteroids.

Restraint stress-induced elevation of endogenous glucocorticoid suppresses migration of granulocytes and macrophages to an inflammatory locus

It has been reported that restraint stress gives rise to various immunosuppressive events. In the present study, we focused our interest on an early stage of the host-defense system in which granulocytes, macrophages and natural killer (NK) cells are involved. We observed that an elevation of endogenous glucocorticoid levels in mice induced by 24 h-restraint stress (acute stress) did not significantly reduce the NK activity of the spleen cells but profoundly suppressed the migration of macrophages and granulocytes into peritoneal cavities of the mice at 24 h after an intraperitoneal injection of proteose peptone. The reduced number of the migrated granulocytes and macrophages corresponded to a down-regulated gene expression of such chemotactic factors as MCP-1/JE in the peritoneal exudate cells of the stress-loaded mice. The stress-loaded mice recovered from such a suppressive state upon treatment with the glucocorticoid antagonist, RU-486, or upon adrenalectomy, suggesting that the elevated level of endogenous glucocorticoid is responsible for these suppressive effects of acute stress.

Binding of alpha-adrenergic receptors stimulates the anti-mycobacterial activity of murine peritoneal macrophages

The effects of adrenergic stimulation of the anti-mycobacterial activity of peritoneal macrophages was investigated. We found that epinephrine and norepinephrine stimulated macrophages to suppress the growth of Mycobacterium avium. Stimulation was mediated by binding to the alpha 2 adrenergic receptor. The addition of the alpha 2 agonist clonidine to cultures resulted in an inhibition of mycobacterial growth and the effect of epinephrine was blocked by the alpha-antagonist phentolamine. Treatment of the macrophages with propranolol, a beta-antagonist, potentiated the effect of epinephrine. Epinephrine mediates its effect by stimulating the expression of macrophage activation genes.

Psychoneuroimmunology: animal models of disease

OBJECTIVE

Psychoneuroimmunology, which investigates the bidirectional communication between the central nervous system and the immune system, has been greatly advanced by the use of animal models. The objective of this paper is to describe animal models of disease that can or might be utilized to elucidate neural-immune interactions that alter pathogenesis.

METHODS

This paper reviews animal studies that have demonstrated a link among the brain, behavior, immunity, and disease, highlighting models in which the potential contribution of CNS-immune interactions has not yet been explored.

RESULTS

Animal studies allow for careful control of environmental stimuli, genetic background, and immunological challenge. As such, they are an important component of psychoneuroimmunology research. Models in which one might study the role of psychosocial factors in immunologically mediated disease processes, as in the case of other pathophysiologic processes, profit from an ability to manipulate both stressful events and the magnitude of the challenge to the immune system.

CONCLUSIONS

Animal studies in psychoneuroimmunology highlight the complexity of the interactions among behavior, the brain, the immune system, and pathogen. The genetic background of the animal (both in terms of central nervous and immune system responses), its previous history, the nature of the stressor, the nature of the pathogen and the type of immune response generated are some of the interacting factors that determine the magnitude and direction of stress-induced changes in disease outcome.

Exploratory case-control analysis of psychosocial factors and adult periodontitis

We explored the association between social factors and adult periodontitis by comparing self-reported information for daily strains and symptoms of depression in 71 cases and 77 controls. Cases and controls were selected from among 1,426 participants in the Erie County Risk Factor Study. We found differences among those who scored higher than their peers on measures of social strain. The odds ratio (OR) and 95% confidence interval (95% CI) for the association between case status and Role Strain score of 2.27 or more was 2.84, 95% CI = 1.08 to 7.46. We also examined serum antibody, dichotomized at the median, for three periodontal pathogens (Bacteroides forsythus [IgG Bf], Porphyromonas gingivalis [IgG Pg], Actinobacillus actinomycetemcomitans [IgG Aa]), and assessed interaction between antibody levels and a Depression score derived from the Brief Symptom Inventory. IgG Pg and IgG Aa were both strongly associated with case status (OR = 4.52, 95% CI = 1.99 to 10.3 and OR = 5.29, 95% CI = 2.34 to 12.0, respectively). IgG Bf was associated with periodontal disease but only among individuals who had higher scores for Depression (OR = 6.75, 95% CI = 1.25 to 36.5). Smoking status was associated with case status (OR = 4.95, 95% CI = 1.86 to 13.2). We assessed these findings prospectively by examining factors associated with more extensive disease among the 71 case subjects after 1 year of follow-up. We found baseline smoking status and IgG Bf among individuals scoring high on Depression at baseline to be associated with more extensive disease (8.1% or more of the sites showing further breakdown). In this population an elevated Depression score may be a marker for social isolation, which could play a role in immune function during periods of social strain. This exploratory analysis has served to identify specific lines of inquiry concerning psychosocial measures as important environmental factors in adult periodontitis.

Lymphocyte protein synthesis: evidence that murine T cells are more affected by stress than B cells

B and T cells present in the spleen and other sites of the immune system play a crucial role in the protection of individuals by mounting a specific primary and secondary immune response. Disturbances in their signaling and functioning could lead to a deterioration of the defense mechanisms and thereby lead to infections, pathologies or diseases. In this work, we studied the effects of stress on the protein synthesis and metabolism of mouse splenocytes. The study was done by radiolabeling the entire mouse with 35S-methionine (in vivo procedure) or by culturing spleen cells under various conditions of stimulation in the presence of 35S-methionine (in vitro labeling). The stimulus was lipopolysaccharide (LPS), LPS + interleukin-4 (IL-4) and concanavalin A (on A). Samples from immobilization stressed and control animals were studied in parallel. The results showed minimum alterations due to stress on B cells, though a small decrease in proliferative capacity was observed. In contrast, T cells are profoundly affected by stress. More than 100 new proteins are expressed on 2D-gel patterns of T cells from stressed animals as compared with controls, some of which could be implicated in different signaling, or could have appeared because of an alteration in a pathway of synthesis, or even as a consequence of a change in the composition of T cell populations induced by stress.

Emotional stress effects on immunity, gingivitis and periodontitis

Gingivitis and periodontitis are thought to result from an imbalance between those oral microorganisms which normally colonize tooth surfaces in close contact with the gingival margin, and the nature and efficiency of the host response. The bacteria are the triggering agents, but host defence mechanisms within the gingival/periodontal tissues seem to be responsible for most of the tissue damage and for the outcome and progression of the diseases. It has recently been shown that emotional or psychological load (stress) may influence immune activities directly via nerve messenger substances (neurotransmitters and neuropeptides) and/or indirectly via neuroendocrine (hormone) substances. This review discusses how emotional stressors and nervous and neuroendocrine responses to psychological stressors may modulate the immune response to bacteria, and thus be expected to influence the progression and course of gingivitis and periodontitis.

PCR activity of CMV in healthy CMV-seropositive individuals: does latency need redefinition?

To demonstrate a possible association between stress factors and the presence of human cytomegalovirus (HCMV) DNA in leukocytes and in cell-free body fluids, at 2-week intervals over a 6-month period, specimens were taken for HCMV DNA testing from 11 healthy CMV-seropositive individuals who were also surveyed for stress-producing events occurring during the previous week. A positive polymerase chain reaction (PCR) signal was given in 104/127 (81.9%) urines, 73/127 (57.3%) throat washings and 68/127 (53.6%) leukocyte samples. An association was found between HCMV DNA in urine and a stress-producing event at work (p < 0.04). An association was also found between detection of HCMV DNA in throat washings and alcohol ingestion (P < 0.006) and between the presence of oral herpes lesions and the detection of HCMV DNA in leukocytes (p < 0.0019). The results suggest that viral reactivation is more common than previously thought and that stress may be a triggering event.

Impairment of immunological functions in genetically epilepsy-prone rats

1. In genetically epilepsy-prone rats (GEPR-9s), which represent a natural genetic model of epilepsy, we observed that the number of peritoneal macrophages was significantly lower with respect to normal rats, and that some functional parameters (i.e. phagocytosis and intracellular killing) of these macrophages were impaired. 2. The count of lymphocyte populations showed a predominance of T-helper over T-cytotoxic/suppressor both in the spleen and lymph nodes. Moreover, an increased T-cell/B-cell ratio was observed in GEPR-9s. Flow cytometry revealed that GEPR-9s spleens possessed a large percentage of T-helper cells in comparison to normal rats. 3. By using concanavalin A-induced proliferation of GEPR-9s cultured lymphocytes, we have shown increased functional activation. 4. We suggest that the alterations in T-cell functions in GEPR-9s could be due to the involvement of the neuroendocrine system in the modulation of immunity, in the shift between Th1 and Th2, and in the activation of stress response.

Infectious gastroenterocolitides in children: an update on emerging pathogens

The recognition that bacterial infections induce signal transduction responses in infected epithelial cells also provides new avenues to consider as novel forms of therapy. For example, the chemokine interleukin-8, which attracts neutrophils to sites of mucosal infection, is produced by epithelial cells of gastric and intestinal origin in response to bacterial infection. Inhibitors of chemokine production or inhibition of the biologic effects of neutrophil chemoattractants have the potential to reduce both mucosal inflammatory responses and the attendant clinical sequelae. Eukaryotic cells also respond to infection with elevations in cytosolic second messengers, including inositol triphosphate (IP3) and calcium ([Ca2+]i). In intestinal epithelium, these second messengers can mediate the diarrheal response to infection. Calcium/calmodulin inhibitors may have a beneficial effect in treating those gastrointestinal infections mediated through changes in the level of cytosolic free calcium. DuPont and colleagues showed, for example, that oral therapy with zaldaride maleate relieves symptoms of disease and shortens the duration of diarrhea in travelers with ETEC-induced diarrhea. Evaluation of additional signal transduction responses to microbial infections should provide both new insights into the pathogenesis of gastrointestinal infectious diseases and novel approaches to consider for the prevention and therapy for these human illnesses.

The influence of stress intrusion on immunodepression in generalized anxiety disorder patients and controls

Previous work from our group has examined the relationship between stress and immunodepression in medical students taking National Boards, Part I, and has described a relationship between stress intrusion scores (SIS) and immunodepression. We have also shown that a high proportion of individuals with generalized anxiety disorders (GAD) and panic disorders (PD) exhibit enhanced stress intrusion (SI) and are more prone to upper respiratory infections (URI). In the present preliminary study, we sought to establish a model to evaluate further the role of SI level on the extent of immunodepression. This would serve to assess in further studies the mechanism(s) of stress-induced immunodepression, its relationship to morbidity, and the role of therapeutic interventions. In 14 GAD patients and 14 controls, we correlated the expression of interleukin-2 receptors (CD25) on T lymphocytes stimulated with anti-CD3 in short term cultures and the frequency of URI and the SIS to assess the relationships among these parameters. A decreased expression of CD25 correlates linearly with increasing SIS and with a higher number of sick days with URI. These results support our previous observations that GAD patients are more susceptible to URI. Moreover, they suggest that there may be a direct relationship between immunodepression and morbidity and between SIS and immunodepression.