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Hong SS, Lee JY, Lee JS, Lee HW, Kim HG, Lee SK, Park BK, Son CG. The traditional drug Gongjin-Dan ameliorates chronic fatigue in a forced-stress mouse exercise model. JOURNAL OF ETHNOPHARMACOLOGY 2015; 168:268-278. [PMID: 25865680 DOI: 10.1016/j.jep.2015.04.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Revised: 03/31/2015] [Accepted: 04/01/2015] [Indexed: 06/04/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Gongjin-Dan is a representative traditional Oriental medicine herbal drug that has been used to treat chronic fatigue symptoms for several hundred years. We evaluated the anti-fatigue effects of Gongjin-Dan and the underlying mechanisms in a chronic forced exercise mouse model. METHODS AND MATERIALS Balb/C male mice underwent an extreme treadmill-based running stress (1-h, 5 days/week), and daily oral administration of distilled water, Gongjin-Dan (100, 200, or 400 mg/kg), or ascorbic acid (100 mg/kg) for 28 days. The anti-fatigue effects of Gongjin-Dan were evaluated with behavioral tests (exercise tolerance and swimming tests), and the corresponding mechanisms were investigated based on oxidative stress and inflammatory cytokine and stress hormone levels in skeletal muscle, sera, and brain tissue. RESULTS Gongjin-Dan significantly increased exercise tolerance and latency times but reduced the number of electric shocks and immobilization time on the treadmill running and swimming tests, compared with the control group. Gongjin-Dan also significantly ameliorated alterations in oxidative stress-related biomarkers (reactive oxygen species and malondialdehyde), inflammatory cytokines (tumor necrosis factor-α, interleukin-1 beta, interleukin-6, and interferon-γ) and glycogen and L-lactate levels in skeletal muscle, compared with those in the control group. Moreover, Gongjin-Dan considerably normalized the forced running stress-induced changes in serum corticosterone and adrenaline levels, as well as brain serotonin level. These antioxidant and anti-stress effects of Gongjin-Dan were supported by the results of Western blotting (4-hydroxynonenal and heme oxygenase-1) and the gene expression levels (serotonin receptor and serotonin transporter). CONCLUSION These results support the clinical relevance of Gongjin-Dan regarding anti-chronic fatigue properties. The underlying mechanisms involve attenuation of oxidative and inflammatory reactions in muscle and regulation of the stress response through the hypothalmo-pituitary-adrenal axis.
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Affiliation(s)
- Sung-Shin Hong
- Korean Medical College of Daejeon University, 22-5 Yongwoon-dong, Dong-gu, Daejeon 301-724, Republic of Korea
| | - Ji-Young Lee
- Korean Medical College of Daejeon University, 22-5 Yongwoon-dong, Dong-gu, Daejeon 301-724, Republic of Korea
| | - Jin-Seok Lee
- Liver and Immunology Research Center, Daejeon Oriental Hospital of Daejeon University, 22-5 Daeheung-dong, Jung-gu, Daejeon 301-704, Republic of Korea
| | - Hye-Won Lee
- TKM-based Herbal Drug Research Group, Korea Institute of Oriental Medicine, Daejeon 305-811, Republic of Korea
| | - Hyeong-Geug Kim
- Liver and Immunology Research Center, Daejeon Oriental Hospital of Daejeon University, 22-5 Daeheung-dong, Jung-gu, Daejeon 301-704, Republic of Korea
| | - Sam-Keun Lee
- Department of Applied Chemistry, Oriental Medicine College of Daejeon University, 62, Daehak-ro, Dong-gu, Daejeon 300-716, Republic of Korea
| | - Bong-Ki Park
- Medical research division, Korea Institute of Oriental Medicine, Daejeon 305-811, Republic of Korea
| | - Chang-Gue Son
- Korean Medical College of Daejeon University, 22-5 Yongwoon-dong, Dong-gu, Daejeon 301-724, Republic of Korea.
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Brinth L. Is Chronic Fatigue Syndrome/Myalgic Encephalomyelitis a Relevant Diagnosis in Patients with Suspected Side Effects to Human Papilloma Virus Vaccine? ACTA ACUST UNITED AC 2015. [DOI: 10.15406/ijvv.2015.01.00003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Kempke S, Luyten P, De Coninck S, Van Houdenhove B, Mayes LC, Claes S. Effects of early childhood trauma on hypothalamic-pituitary-adrenal (HPA) axis function in patients with Chronic Fatigue Syndrome. Psychoneuroendocrinology 2015; 52:14-21. [PMID: 25459889 DOI: 10.1016/j.psyneuen.2014.10.027] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 10/30/2014] [Accepted: 10/31/2014] [Indexed: 01/08/2023]
Abstract
BACKGROUND There is a paucity of studies that have investigated the assumption that early childhood trauma is associated with hypothalamic-pituitary-adrenal (HPA) axis dysfunction in Chronic Fatigue Syndrome (CFS). The current study is the first to simultaneously investigate relationships among early childhood trauma, cortisol activity, and cortisol stress reactivity to psychosocial stress in a sample of well-screened CFS patients. We also examined whether self-critical perfectionism (SCP) plays a mediating role in the potential relationship between early trauma and neurobiological stress responses. METHODS A total of 40 female patients diagnosed with CFS were asked to provide morning saliva cortisol samples (after awakening, 30min later, and 1h later) for seven consecutive days as a measure of cortisol activity. In addition, patients were exposed to the Trier Social Stress Test, a well-validated stress test, to investigate the relationship between early childhood trauma and cortisol stress reactivity. Before the start of the study, patients completed the Childhood Trauma Questionnaire-Short form (CTQ-SF) as a measure of early childhood trauma (i.e. sexual, physical and emotional traumatic experiences). SCP was measured with the Depressive Experiences Questionnaire (DEQ). Data were analyzed by calculating several indices of cortisol secretion (i.e. Cortisol Awakening Response and Area Under the Curve). RESULTS There was no association between early childhood trauma and cortisol as measured over the 7-day period. However, emotional neglect was significantly negatively related to cortisol reactivity in the TSST. SCP did not significantly mediate this association. CONCLUSION Findings of this study suggest that emotional neglect is associated with blunted HPA axis reactivity, congruent with the assumption that CFS may reflect loss of adaptability of the neuroendocrine stress response system in at least a subgroup of patients.
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Affiliation(s)
- Stefan Kempke
- Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium.
| | - Patrick Luyten
- Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium; Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Sarah De Coninck
- Biological Psychology, Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Brussels, Belgium
| | | | - Linda C Mayes
- Yale Child Study Center, Yale Medical School, Yale University, New Haven, USA
| | - Stephan Claes
- Department of Psychiatry, University Hospitals Leuven, University of Leuven, Leuven, Belgium
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Lazzeri L, Orlandini C, Vannuccini S, Pinzauti S, Tosti C, Zupi E, Nappi RE, Petraglia F. Endometriosis and perceived stress: impact of surgical and medical treatment. Gynecol Obstet Invest 2015; 79:229-33. [PMID: 25591624 DOI: 10.1159/000368776] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 10/01/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND The aim of the study was to investigate the levels of perceived stress in a group of women with a long-term history of endometriosis in conjunction with surgical and/or medical treatments. METHODS A clinical trial was conducted at the Department of Molecular and Developmental Medicine, University of Siena, in collaboration with a non-profit association of women with endometriosis, A.P.E. Onlus. Patients (n = 204) with a previous diagnosis of endometriosis (for at least 3 years) were included in this study. Each patient completed a semi-structured questionnaire and a validated scale to assess perceived stress, the Perceived Stress Scale (PSS) by e-mail. RESULTS The study showed that in women with a long-term history of endometriosis, the level of perceived stress was increased by repeated surgical treatments and reduced by some medical treatments. The median PSS value was 23 (range 9-36) and 30.6% of the study population were included in the highest stress category (>26). The highest levels were found in patients who had undergone the most surgery. The use of progestins was associated with a lower perceived stress (p = 0.004) than in the patients treated with gonadotropin-releasing hormones. CONCLUSIONS Long-term endometriosis has a relevant impact on perceived stress, in particular in those undergoing repeated surgery.
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Affiliation(s)
- Lucia Lazzeri
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
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Abstract
Chronic fatigue syndrome (CFS) is a poorly understood condition that presents as long-term physical and mental fatigue with associated symptoms of pain and sensitivity across a broad range of systems in the body. The poor understanding of the disorder comes from the varying clinical diagnostic definitions as well as the broad array of body systems from which its symptoms present. Studies on metabolism and CFS suggest irregularities in energy metabolism, amino acid metabolism, nucleotide metabolism, nitrogen metabolism, hormone metabolism, and oxidative stress metabolism. The overwhelming body of evidence suggests an oxidative environment with the minimal utilization of mitochondria for efficient energy production. This is coupled with a reduced excretion of amino acids and nitrogen in general. Metabolomics is a developing field that studies metabolism within a living system under varying conditions of stimuli. Through its development, there has been the optimisation of techniques to do large-scale hypothesis-generating untargeted studies as well as hypothesis-testing targeted studies. These techniques are introduced and show an important future direction for research into complex illnesses such as CFS.
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de Vega WC, Vernon SD, McGowan PO. DNA methylation modifications associated with chronic fatigue syndrome. PLoS One 2014; 9:e104757. [PMID: 25111603 PMCID: PMC4128721 DOI: 10.1371/journal.pone.0104757] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 07/14/2014] [Indexed: 01/30/2023] Open
Abstract
Chronic Fatigue Syndrome (CFS), also known as myalgic encephalomyelitis, is a complex multifactorial disease that is characterized by the persistent presence of fatigue and other particular symptoms for a minimum of 6 months. Symptoms fail to dissipate after sufficient rest and have major effects on the daily functioning of CFS sufferers. CFS is a multi-system disease with a heterogeneous patient population showing a wide variety of functional disabilities and its biological basis remains poorly understood. Stable alterations in gene function in the immune system have been reported in several studies of CFS. Epigenetic modifications have been implicated in long-term effects on gene function, however, to our knowledge, genome-wide epigenetic modifications associated with CFS have not been explored. We examined the DNA methylome in peripheral blood mononuclear cells isolated from CFS patients and healthy controls using the Illumina HumanMethylation450 BeadChip array, controlling for invariant probes and probes overlapping polymorphic sequences. Gene ontology (GO) and network analysis of differentially methylated genes was performed to determine potential biological pathways showing changes in DNA methylation in CFS. We found an increased abundance of differentially methylated genes related to the immune response, cellular metabolism, and kinase activity. Genes associated with immune cell regulation, the largest coordinated enrichment of differentially methylated pathways, showed hypomethylation within promoters and other gene regulatory elements in CFS. These data are consistent with evidence of multisystem dysregulation in CFS and implicate the involvement of DNA modifications in CFS pathology.
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Affiliation(s)
- Wilfred C. de Vega
- Centre for Environmental Epigenetics and Development, University of Toronto, Scarborough, ON, Canada
- Department of Biological Sciences, University of Toronto, Scarborough, ON, Canada
- Department of Cell and Systems Biology, University of Toronto, Toronto, ON, Canada
| | - Suzanne D. Vernon
- CFIDS Association of America, Charlotte, North Carolina, United States of America
| | - Patrick O. McGowan
- Centre for Environmental Epigenetics and Development, University of Toronto, Scarborough, ON, Canada
- Department of Biological Sciences, University of Toronto, Scarborough, ON, Canada
- Department of Cell and Systems Biology, University of Toronto, Toronto, ON, Canada
- * E-mail:
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Jacobsen HB, Bjørngaard JH, Hara KW, Borchgrevink PC, Woodhouse A, Landrø NI, Harris A, Stiles TC. The role of stress in absenteeism: cortisol responsiveness among patients on long-term sick leave. PLoS One 2014; 9:e96048. [PMID: 24788346 PMCID: PMC4008526 DOI: 10.1371/journal.pone.0096048] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 04/03/2014] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE This study aimed to (1) See whether increased or decreased variation relate to subjective reports of common somatic and psychological symptoms for a population on long-term sick leave; and (2) See if this pattern in variation is correlated with autonomic activation and psychological appraisal. METHODS Our participants (n = 87) were referred to a 3.5-week return-to-work rehabilitation program, and had been on paid sick leave >8 weeks due to musculoskeletal pain, fatigue and/or common mental disorders. An extensive survey was completed, addressing socio-demographics, somatic and psychological complaints. In addition, a physician and a psychologist examined the participants, determining baseline heart rate, medication use and SCID-I diagnoses. During the 3.5-week program, the participants completed the Trier Social Stress Test for Groups. Participants wore heart rate monitors and filled out Visual Analogue Scales during the TSST-G. RESULTS Our participants presented a low cortisol variation, with mixed model analyses showing a maximal increase in free saliva cortisol of 26% (95% CI, 0.21-0.32). Simultaneously, the increase in heart rate and Visual Analogue Scales was substantial, indicating autonomic and psychological activation consistent with intense stress from the Trier Social Stress Test for Groups. CONCLUSIONS The current findings are the first description of a blunted cortisol response in a heterogeneous group of patients on long-term sick leave. The results suggest lack of cortisol reactivity as a possible biological link involved in the pathway between stress, sustained activation and long-term sick leave.
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Affiliation(s)
- Henrik B. Jacobsen
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
- Hysnes Rehabilitation Center, St. Olav's University Hospital, Trondheim, Norway
- National Centre for Complex Disorders, St. Olav's University Hospital, Trondheim, Norway
- * E-mail:
| | - Johan Håkon Bjørngaard
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway
- Forensic Department and Research Centre Brøset, St. Olav's University Hospital, Trondheim, Norway
| | - Karen W. Hara
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
- Hysnes Rehabilitation Center, St. Olav's University Hospital, Trondheim, Norway
- National Centre for Complex Disorders, St. Olav's University Hospital, Trondheim, Norway
| | - Petter C. Borchgrevink
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
- Hysnes Rehabilitation Center, St. Olav's University Hospital, Trondheim, Norway
- National Centre for Complex Disorders, St. Olav's University Hospital, Trondheim, Norway
| | - Astrid Woodhouse
- Hysnes Rehabilitation Center, St. Olav's University Hospital, Trondheim, Norway
- National Centre for Complex Disorders, St. Olav's University Hospital, Trondheim, Norway
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway
| | - Nils Inge Landrø
- National Centre for Complex Disorders, St. Olav's University Hospital, Trondheim, Norway
- Clinical Neuroscience Research Group, Department of Psychology, University of Oslo, Oslo, Norway
| | - Anette Harris
- Department of Health Promotion and Development, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Tore C. Stiles
- Hysnes Rehabilitation Center, St. Olav's University Hospital, Trondheim, Norway
- National Centre for Complex Disorders, St. Olav's University Hospital, Trondheim, Norway
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
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Lee JC, Kao JY, Kuo DH, Liao CF, Huang CH, Fan LL, Way TD. Antifatigue and Antioxidant Activity of Alcoholic Extract from Saussurea involucrata. J Tradit Complement Med 2014; 1:64-8. [PMID: 24716107 PMCID: PMC3943003 DOI: 10.1016/s2225-4110(16)30058-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Fatigue is a noticeable and highly prevalent symptom in tense, industriously, and economically affluent modern society. Therefore, new antifatigue agents to smooth the fatigue feature are an energetic topic. The total ethanol extract (ESI) of Saussurea involucrata Kar et Kir., known as Tian-Shan snow lotus, was evaluated for antifatigue activity in ICR mice with mice forced swimming test and the determination of the contents of blood lactic acid and serum urea nitrogen. ESI (0.05, 0.15, 0.25 g/kg) was administered orally to mice for 4 weeks. The average swimming times to exhaustion of the ESI-treated ICR mice (0.15, 0.25 g/kg) were prolonged by 132% and 180% (p<0.001) with a lessening of fatigue compared with that of the control group. Analysis of biochemical parameters showed that levels of serum urea nitrogen and blood lactic acid of experimental groups were also decreased significantly (p<0.001) compared with that of the control group. The antioxidant activity of ESI was investigated by the 2,2-diphenyl-1-picrylhydrazyl (DPPH) free radical-scavenging assay and the hydrogen peroxide-induced luminol chemiluminescence assay and the results indicated that ESI exerts DPPH scavenging ability and reducing power. These results provide scientific evidence that S. involucrata may have been potential as an antifatigue agent.
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Affiliation(s)
- Jang-Chang Lee
- School of Pharmacy, College of Pharmacy, China Medical University, Taichung, Taiwan
| | - Jung-Yie Kao
- Institute of Biochemistry, College of Life Science, National Chung Hsing University, Taichung, Taiwan
| | - Daih-Huang Kuo
- Department of Pharmacy and Graduate Institute of Pharmaceutical Technology, College of Pharmacy and Health Care, Tajen University, Pingtung, Taiwan
| | - Chien-Fu Liao
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Chi-Hung Huang
- Taiwan Advance Biopharm, Inc., Xizhi City, Taipei, Taiwan
| | - Ling-Ling Fan
- Department of Biological Science and Technology, College of Life Sciences, China Medical University, Taichung, Taiwan
| | - Tzong-Der Way
- Institute of Biochemistry, College of Life Science, National Chung Hsing University, Taichung, Taiwan
- Department of Biological Science and Technology, College of Life Sciences, China Medical University, Taichung, Taiwan
- Correspondence to: Dr. Tzong-Der Way, Department of Biological Science and Technology, College of Life Sciences, China Medical University, No.91 Hsueh-Shih Road, Taichung, 40402, Taiwan. Tel: +886-4-2205-3366 ext: 2509, Fax: +886-4-2207-0465, E-mail:
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Nijhof SL, Rutten JMTM, Uiterwaal CSPM, Bleijenberg G, Kimpen JLL, Putte EMVD. The role of hypocortisolism in chronic fatigue syndrome. Psychoneuroendocrinology 2014; 42:199-206. [PMID: 24636516 DOI: 10.1016/j.psyneuen.2014.01.017] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Revised: 12/22/2013] [Accepted: 01/22/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND There is accumulating evidence of hypothalamic-pituitary-adrenal (HPA) axis hypofunction in chronic fatigue syndrome (CFS). However, knowledge of this hypofunction has so far come exclusively from research in adulthood, and its clinical significance remains unclear. The objective of the current study was to assess the role of the HPA-axis in adolescent CFS and recovery from adolescent CFS. METHOD Before treatment, we compared the salivary cortisol awakening response of 108 diagnosed adolescent CFS patients with that of a reference group of 38 healthy peers. Salivary cortisol awakening response was measured again after 6 months of treatment in CFS patients. RESULTS Pre-treatment salivary cortisol levels were significantly lower in CFS-patients than in healthy controls. After treatment recovered patients had a significant rise in salivary cortisol output attaining normalization, whereas non-recovered patients improved slightly, but not significantly. The hypocortisolism found in CFS-patients was significantly correlated to the amount of sleep. Logistic regression analysis showed that an increase of one standard deviation in the difference between pre- and post-treatment salivary cortisol awakening response was associated with a 93% higher odds of recovery (adjusted OR 1.93 (1.18 to 3.17), p=0.009). Pre-treatment salivary cortisol did not predict recovery. CONCLUSIONS Hypocortisolism is associated with adolescent CFS. It is not pre-treatment cortisol but its change to normalization that is associated with treatment success. We suggest that this finding may have clinical implications regarding the adaptation of future treatment strategies.
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Affiliation(s)
- Sanne L Nijhof
- Department of Paediatrics, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands.
| | - Juliette M T M Rutten
- Department of Paediatrics, Emma Children's Hospital, Academic Medical Centre, Amsterdam, The Netherlands.
| | - Cuno S P M Uiterwaal
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands.
| | - Gijs Bleijenberg
- Expert Centre for Chronic Fatigue, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
| | - Jan L L Kimpen
- Department of Paediatrics, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands.
| | - Elise M van de Putte
- Department of Paediatrics, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands.
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Craddock TJA, Fritsch P, Rice MA, del Rosario RM, Miller DB, Fletcher MA, Klimas NG, Broderick G. A role for homeostatic drive in the perpetuation of complex chronic illness: Gulf War Illness and chronic fatigue syndrome. PLoS One 2014; 9:e84839. [PMID: 24416298 PMCID: PMC3885655 DOI: 10.1371/journal.pone.0084839] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 11/19/2013] [Indexed: 12/15/2022] Open
Abstract
A key component in the body's stress response, the hypothalamic-pituitary-adrenal (HPA) axis orchestrates changes across a broad range of major biological systems. Its dysfunction has been associated with numerous chronic diseases including Gulf War Illness (GWI) and chronic fatigue syndrome (CFS). Though tightly coupled with other components of endocrine and immune function, few models of HPA function account for these interactions. Here we extend conventional models of HPA function by including feed-forward and feedback interaction with sex hormone regulation and immune response. We use this multi-axis model to explore the role of homeostatic regulation in perpetuating chronic conditions, specifically GWI and CFS. An important obstacle in building these models across regulatory systems remains the scarcity of detailed human in vivo kinetic data as its collection can present significant health risks to subjects. We circumvented this using a discrete logic representation based solely on literature of physiological and biochemical connectivity to provide a qualitative description of system behavior. This connectivity model linked molecular variables across the HPA axis, hypothalamic-pituitary-gonadal (HPG) axis in men and women, as well as a simple immune network. Inclusion of these interactions produced multiple alternate homeostatic states and sexually dimorphic responses. Experimental data for endocrine-immune markers measured in male GWI subjects showed the greatest alignment with predictions of a naturally occurring alternate steady state presenting with hypercortisolism, low testosterone and a shift towards a Th1 immune response. In female CFS subjects, expression of these markers aligned with an alternate homeostatic state displaying hypocortisolism, high estradiol, and a shift towards an anti-inflammatory Th2 activation. These results support a role for homeostatic drive in perpetuating dysfunctional cortisol levels through persistent interaction with the immune system and HPG axis. Though coarse, these models may nonetheless support the design of robust treatments that might exploit these regulatory regimes.
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Affiliation(s)
- Travis J. A. Craddock
- Center for Psychological Studies, Nova Southeastern University, Fort Lauderdale, Florida, United States of America
- Graduate School for Computer and Information Sciences, Nova Southeastern University, Fort Lauderdale, Florida, United States of America
- Institute for Neuro-Immune Medicine, Nova Southeastern University, Fort Lauderdale, Florida, United States of America
- * E-mail:
| | - Paul Fritsch
- Department of Medicine, Faculty of Dentistry and Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Mark A. Rice
- Institute for Neuro-Immune Medicine, Nova Southeastern University, Fort Lauderdale, Florida, United States of America
| | - Ryan M. del Rosario
- Institute for Neuro-Immune Medicine, Nova Southeastern University, Fort Lauderdale, Florida, United States of America
| | - Diane B. Miller
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Morgantown, West Virginia, United States of America
| | - Mary Ann Fletcher
- Department of Medicine, Miller School of Medicine, University of Miami, Miami, Florida, United States of America
| | - Nancy G. Klimas
- Institute for Neuro-Immune Medicine, Nova Southeastern University, Fort Lauderdale, Florida, United States of America
- College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, Florida, United States of America
| | - Gordon Broderick
- Center for Psychological Studies, Nova Southeastern University, Fort Lauderdale, Florida, United States of America
- Institute for Neuro-Immune Medicine, Nova Southeastern University, Fort Lauderdale, Florida, United States of America
- Department of Medicine, Faculty of Dentistry and Medicine, University of Alberta, Edmonton, Alberta, Canada
- College of Pharmacy, Nova Southeastern University, Fort Lauderdale, Florida, United States of America
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Masuko K, Nakamura H. Functional somatic syndrome: how it could be relevant to rheumatologists. Mod Rheumatol 2014. [DOI: 10.3109/s10165-007-0563-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Common biological pathways underlying the psychoneurological symptom cluster in cancer patients. Cancer Nurs 2013; 35:E1-E20. [PMID: 22228391 DOI: 10.1097/ncc.0b013e318233a811] [Citation(s) in RCA: 129] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND A symptom cluster is a group of symptoms that occur together and are interrelated. The clinical implication of symptom cluster research is to use the clustering patterns of symptoms to understand the mechanisms for these symptoms and develop management strategies targeted at multiple symptoms. OBJECTIVE The purposes of this review were to summarize the evidence for a psychoneurological symptom cluster in cancer patients, to provide information regarding the underlying biological mechanisms for each of the psychoneurological symptoms within the cluster, and to propose possible common biological pathways that may underlie this cluster. METHODS A systematic review of the literature was conducted. RESULTS Empirical evidence exists to support a cluster of psychoneurological symptoms (ie, depressive symptoms, cognitive disturbance, fatigue, sleep disturbance, pain). At a molecular level, common biological pathways (ie, proinflammatory cytokines, hypothalamic-pituitary-adrenal axis, and monoamine neurotransmission system) may underlie the development of symptoms within this cluster. Activation of proinflammatory cytokines is proposed as a first stage of mechanistic pathway. However, other biological factors, such as lowered estrogen or hemoglobin levels, may influence psychoneurological cluster. CONCLUSION Additional studies are needed to confirm the roles of cytokines as well as other biological factors in the development of the psychoneurological cluster and to determine the biomarkers to identify the subgroups of cancer patients who are at greatest risk for this cluster. IMPLICATIONS FOR PRACTICE This information can be used by researchers and clinicians to guide the selection of symptom management strategies that are ideally targeted to the biological mechanisms that underlie this symptom cluster.
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Powell DJH, Liossi C, Moss-Morris R, Schlotz W. Unstimulated cortisol secretory activity in everyday life and its relationship with fatigue and chronic fatigue syndrome: a systematic review and subset meta-analysis. Psychoneuroendocrinology 2013; 38:2405-22. [PMID: 23916911 DOI: 10.1016/j.psyneuen.2013.07.004] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Revised: 07/04/2013] [Accepted: 07/10/2013] [Indexed: 10/26/2022]
Abstract
The hypothalamic-pituitary-adrenal (HPA) axis is a psychoneuroendocrine regulator of the stress response and immune system, and dysfunctions have been associated with outcomes in several physical health conditions. Its end product, cortisol, is relevant to fatigue due to its role in energy metabolism. The systematic review examined the relationship between different markers of unstimulated salivary cortisol activity in everyday life in chronic fatigue syndrome (CFS) and fatigue assessed in other clinical and general populations. Search terms for the review related to salivary cortisol assessments, everyday life contexts, and fatigue. All eligible studies (n=19) were reviewed narratively in terms of associations between fatigue and assessed cortisol markers, including the cortisol awakening response (CAR), circadian profile (CP) output, and diurnal cortisol slope (DCS). Subset meta-analyses were conducted of case-control CFS studies examining group differences in three cortisol outcomes: CAR output; CAR increase; and CP output. Meta-analyses revealed an attenuation of the CAR increase within CFS compared to controls (d=-.34) but no statistically significant differences between groups for other markers. In the narrative review, total cortisol output (CAR or CP) was rarely associated with fatigue in any population; CAR increase and DCS were most relevant. Outcomes reflecting within-day change in cortisol levels (CAR increase; DCS) may be the most relevant to fatigue experience, and future research in this area should report at least one such marker. Results should be considered with caution due to heterogeneity in one meta-analysis and the small number of studies.
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Affiliation(s)
- Daniel J H Powell
- Faculty of Social and Human Sciences, University of Southampton, Southampton, UK.
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A review of hypothalamic-pituitary-adrenal axis function in chronic fatigue syndrome. ISRN NEUROSCIENCE 2013; 2013:784520. [PMID: 24959566 PMCID: PMC4045534 DOI: 10.1155/2013/784520] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 08/29/2013] [Indexed: 02/06/2023]
Abstract
Hypothalamic-pituitary-adrenal (HPA) axis dysfunction has been found in a high proportion of chronic fatigue syndrome (CFS) patients and includes enhanced corticosteroid-induced negative feedback, basal hypocortisolism, attenuated diurnal variation, and a reduced responsivity to challenge. A putative causal role for genetic profile, childhood trauma, and oxidative stress has been considered. In addition, the impact of gender is demonstrated by the increased frequency of HPA axis dysregulation in females. Despite the temporal relationship, it is not yet established whether the endocrine dysregulation is causal, consequent, or an epiphenomenon of the disorder. Nonetheless, given the interindividual variation in the effectiveness of existing biological and psychological treatments, the need for novel treatment strategies such as those which target the HPA axis is clear.
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65
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Cancer-related fatigue in the elderly. Support Care Cancer 2013; 21:2899-911. [PMID: 23852408 DOI: 10.1007/s00520-013-1897-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Accepted: 06/26/2013] [Indexed: 12/29/2022]
Abstract
PURPOSE Cancer is a disease of the elderly: 60 % of tumours occur in patients aged 65 years or older. Cancer-related fatigue is a common symptom experienced by cancer patients and cancer survivors that profoundly affects all aspects of the quality of life. Although it has been estimated that up to 70 % of elderly with cancer experience fatigue, this symptom is still largely ignored in ageing population. METHODS We performed a systematic review of the literature identified by MEDLINE. RESULTS The relationship between ageing process and pathogenesis of cancer-related fatigue is still not fully understood. CONCLUSIONS Ageing is associated with an increased prevalence of chronic diseases, decreased functional reserve in multiple organ systems and enhanced susceptibility to stress. Ageing and the concomitant presence of a condition of frailty may predispose to the presence of fatigue. Nevertheless, only few studies have to date specifically assessed the impact of fatigue in the geriatric population. Since cancer-related fatigue is a peculiarly debilitating condition characteristic of elderly cancer patient population, we suggest the early recognition and thorough evaluation of the symptom fatigue, its co-existing causes (i.e. anaemia, mood disorders and sleep disturbances) and co-morbidities (i.e., endocrine disorders, metabolic, cardiovascular and liver diseases).
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A comparison of sex-specific immune signatures in Gulf War illness and chronic fatigue syndrome. BMC Immunol 2013; 14:29. [PMID: 23800166 PMCID: PMC3698072 DOI: 10.1186/1471-2172-14-29] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Accepted: 06/11/2013] [Indexed: 11/19/2022] Open
Abstract
Background Though potentially linked to the basic physiology of stress response we still have no clear understanding of Gulf War Illness (GWI), a debilitating condition presenting complex immune, endocrine and neurological symptoms. Here we compared male (n = 20) and female (n = 10) veterans with GWI separately against their healthy counterparts (n = 21 male, n = 9 female) as well as subjects with chronic fatigue syndrome/ myalgic encephalomyelitis (CFS/ME) (n = 12 male, n = 10 female). Methods Subjects were assessed using a Graded eXercise Test (GXT) with blood drawn prior to exercise, at peak effort (VO2 max) and 4-hours post exercise. Using chemiluminescent imaging we measured the concentrations of IL-1a, 1b, 2, 4, 5, 6, 8, 10, 12 (p70), 13, 15, 17 and 23, IFNγ, TNFα and TNFβ in plasma samples from each phase of exercise. Linear classification models were constructed using stepwise variable selection to identify cytokine co-expression patterns characteristic of each subject group. Results Classification accuracies in excess of 80% were obtained using between 2 and 5 cytokine markers. Common to both GWI and CFS, IL-10 and IL-23 expression contributed in an illness and time-dependent manner, accompanied in male subjects by NK and Th1 markers IL-12, IL-15, IL-2 and IFNγ. In female GWI and CFS subjects IL-10 was again identified as a delineator but this time in the context of IL-17 and Th2 markers IL-4 and IL-5. Exercise response also differed between sexes: male GWI subjects presented characteristic cytokine signatures at rest but not at peak effort whereas the opposite was true for female subjects. Conclusions Though individual markers varied, results collectively supported involvement of the IL-23/Th17/IL-17 axis in the delineation of GWI and CFS in a sex-specific way.
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Minton O, Berger A, Barsevick A, Cramp F, Goedendorp M, Mitchell SA, Stone PC. Cancer-related fatigue and its impact on functioning. Cancer 2013; 119 Suppl 11:2124-30. [DOI: 10.1002/cncr.28058] [Citation(s) in RCA: 111] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Revised: 12/19/2012] [Accepted: 12/20/2012] [Indexed: 11/12/2022]
Affiliation(s)
- Ollie Minton
- Division of Population Health Sciences and Education; St. George's University of London; London United Kingdom
| | - Ann Berger
- University of Nebraska College of Nursing; Omaha Nebraska
| | - Andrea Barsevick
- Fox Chase Cancer Center; Thomas Jefferson University; Philadelphia Pennsylvania
| | - Fiona Cramp
- Musculoskeletal Health, Faculty of Health and Life Sciences; University of the West of England; Bristol United Kingdom
| | - Martine Goedendorp
- Expert Centre for Chronic Fatigue; Radboud University Nijmegen Medical Centre; Nijmegen the Netherlands
| | - Sandra A. Mitchell
- Outcomes Research Branch; Applied Research Program; Division of Cancer Control and Population Sciences; National Cancer Institute; Bethesda Maryland
| | - Patrick C. Stone
- Palliative Medicine, Division of Population Health Sciences and Education; St. George's University of London; London United Kingdom
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Borges S, Gayer-Anderson C, Mondelli V. A systematic review of the activity of the hypothalamic-pituitary-adrenal axis in first episode psychosis. Psychoneuroendocrinology 2013; 38:603-11. [PMID: 23369532 DOI: 10.1016/j.psyneuen.2012.12.025] [Citation(s) in RCA: 115] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Revised: 12/19/2012] [Accepted: 12/31/2012] [Indexed: 10/27/2022]
Abstract
Up to now studies on hypothalamic-pituitary-adrenal (HPA) axis activity in psychosis have shown inconsistent findings. These inconsistencies have been often ascribed to confounding effects of long duration of illness and chronic treatment with psychotropic medications of the subjects studied (chronic psychosis). In the last years, several studies have focused on the study of subjects at their first episode of psychosis to overcome these possible confounders. The aim of this paper was to review the literature investigating HPA axis activity in first episode psychosis. Findings from these studies support the presence of HPA axis hyperactivity and a blunted HPA axis response to stress at the onset of psychosis. Possible biological pathways linking these HPA axis abnormalities to the development of psychosis are discussed.
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Affiliation(s)
- Susana Borges
- Institute of Psychiatry, King's College London, Department of Psychological Medicine, London, UK
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69
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Brenu EW, Hardcastle SL, Atkinson GM, van Driel ML, Kreijkamp-Kaspers S, Ashton KJ, Staines DR, Marshall-Gradisnik SM. Natural killer cells in patients with severe chronic fatigue syndrome. AUTOIMMUNITY HIGHLIGHTS 2013; 4:69-80. [PMID: 26000145 PMCID: PMC4389023 DOI: 10.1007/s13317-013-0051-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Accepted: 03/06/2013] [Indexed: 02/06/2023]
Abstract
Maintenance of health and physiological homeostasis is a synergistic process involving tight regulation of proteins, transcription factors and other molecular processes. The immune system consists of innate and adaptive immune cells that are required to sustain immunity. The presence of pathogens and tumour cells activates innate immune cells, in particular Natural Killer (NK) cells. Stochastic expression of NK receptors activates either inhibitory or activating signals and results in cytokine production and activation of pathways that result in apoptosis of target cells. Thus, NK cells are a necessary component of the immunological process and aberrations in their functional processes, including equivocal levels of NK cells and cytotoxic activity pre-empts recurrent viral infections, autoimmune diseases and altered inflammatory responses. NK cells are implicated in a number of diseases including chronic fatigue syndrome (CFS). The purpose of this review is to highlight the different profiles of NK cells reported in CFS patients and to determine the extent of NK immune dysfunction in subtypes of CFS patients based on severity in symptoms.
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Affiliation(s)
- E. W. Brenu
- Griffith Health Institute, School of Medical Science, Griffith University, Gold Coast, QLD Australia
- The National Centre for Neuroimmunology and Emerging Diseases, Griffith University, Gold Coast, QLD Australia
- Immunology Research Group, Centre for Medicine and Oral Health, Griffith University, GH1, Room 7.59, Southport, QLD 4215 Australia
| | - S. L. Hardcastle
- Griffith Health Institute, School of Medical Science, Griffith University, Gold Coast, QLD Australia
- The National Centre for Neuroimmunology and Emerging Diseases, Griffith University, Gold Coast, QLD Australia
| | - G. M. Atkinson
- Griffith Health Institute, School of Medical Science, Griffith University, Gold Coast, QLD Australia
- The National Centre for Neuroimmunology and Emerging Diseases, Griffith University, Gold Coast, QLD Australia
| | - M. L. van Driel
- Queensland Health, Gold Coast Public Health Unit, Robina, Gold Coast, QLD Australia
| | | | - K. J. Ashton
- Faculty of Health Sciences and Medicine, Bond University, Robina, QLD Australia
| | - D. R. Staines
- The National Centre for Neuroimmunology and Emerging Diseases, Griffith University, Gold Coast, QLD Australia
- Queensland Health, Gold Coast Public Health Unit, Robina, Gold Coast, QLD Australia
| | - S. M. Marshall-Gradisnik
- Griffith Health Institute, School of Medical Science, Griffith University, Gold Coast, QLD Australia
- The National Centre for Neuroimmunology and Emerging Diseases, Griffith University, Gold Coast, QLD Australia
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The neuropsychiatric and neuropsychological features of chronic fatigue syndrome: revisiting the enigma. Curr Psychiatry Rep 2013; 15:353. [PMID: 23440559 DOI: 10.1007/s11920-013-0353-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The aim of this article is to provide a comprehensive and updated review of the key neuropsychiatric and neuropsychological complaints associated with chronic fatigue syndrome (CFS). Neuropsychiatric and neuropsychological difficulties are common in CFS and are linked primarily to disorders of mood, affect and behaviour. The neuropsychiatric complaint most frequently encountered amongst CFS patients is depression and in particular major depressive disorder (MDD). Despite decades of research, the precise aetiological relationship between CFS and MDD remains poorly understood. This has resulted in the development of a number of interesting and polarised hypotheses regarding the aetiological nature of CFS. Recent scientific advances have however begun to unravel a number of interesting inflammatory and immunological explanations that suggest CFS and MDD are distinct yet interrelated conditions. The possibility that the overlap between CFS and MDD might be explained in terms of shared oxidative and nitrosative (IO&NS) pathways is an area of intense research interest and is reviewed in detail in this article. The overlap between CFS and MDD is further differentiated by variations in HPA axis activity between the two disorders. Important immunological differences between MDD and CFS are also reviewed with particular emphasis on antiviral RNase L pathways in CFS. In addition to the presence of neuropsychiatric complaints, CFS is also associated with neuropsychological symptoms such as impaired attention, memory and reaction time. The key neuropsychological problems reported by CFS patients are also included in the review in an effort to understand the significance of cognitive impairment in CFS.
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Bower JE, Lamkin DM. Inflammation and cancer-related fatigue: mechanisms, contributing factors, and treatment implications. Brain Behav Immun 2013; 30 Suppl:S48-57. [PMID: 22776268 PMCID: PMC3978020 DOI: 10.1016/j.bbi.2012.06.011] [Citation(s) in RCA: 218] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Revised: 06/16/2012] [Accepted: 06/19/2012] [Indexed: 01/18/2023] Open
Abstract
Fatigue is one of the most common and distressing side effects of cancer and its treatment, and may persist for years after treatment completion in otherwise healthy survivors. Guided by basic research on neuro-immune interactions, a growing body of research has examined the hypothesis that cancer-related fatigue is driven by activation of the pro-inflammatory cytokine network. In this review, we examine the current state of the evidence linking inflammation and cancer-related fatigue, drawing from recent human research and from experimental animal models probing effects of cancer and cancer treatment on inflammation and fatigue. In addition, we consider two key questions that are currently driving research in this area: what are the neural mechanisms of fatigue, and what are the biological and psychological factors that influence the onset and/or persistence of inflammation and fatigue in cancer patients and survivors? Identification of the mechanisms driving cancer-related fatigue and associated risk factors will facilitate the development of targeted interventions for vulnerable patients.
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Affiliation(s)
- Julienne E. Bower
- UCLA Department of Psychology at UCLA,Cousins Center for Psychoneuroimmunology, Semel Institute at UCLA,UCLA Department of Psychiatry and Biobehavioral Sciences at UCLA,Division of Cancer Prevention and Control Research, Jonsson Comprehensive Cancer Center at UCLA
| | - Donald M. Lamkin
- Cousins Center for Psychoneuroimmunology, Semel Institute at UCLA
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Konishi M, Takahashi M, Endo N, Numao S, Takagi S, Miyashita M, Midorikawa T, Suzuki K, Sakamoto S. Effects of sleep deprivation on autonomic and endocrine functions throughout the day and on exercise tolerance in the evening. J Sports Sci 2013; 31:248-55. [DOI: 10.1080/02640414.2012.733824] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Tomic S, Brkic S, Maric D, Mikic AN. Lipid and protein oxidation in female patients with chronic fatigue syndrome. Arch Med Sci 2012; 8:886-91. [PMID: 23185200 PMCID: PMC3506242 DOI: 10.5114/aoms.2012.31620] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2010] [Revised: 03/24/2011] [Accepted: 04/04/2011] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION Chronic fatigue syndrome (CFS) is a widely recognized problem, characterized by prolonged, debilitating fatigue and a characteristic group of accompanying symptoms, that occurs four times more frequently in women than in men. The aim of the study was to determine the existence of oxidative stress and its possible consequences in female patients with CFS. MATERIAL AND METHODS Twenty-four women aged 15-45 who fulfilled the diagnostic criteria for CFS with no comorbidities were recruited and were age matched to a control group of 19 healthy women. After conducting the routine laboratory tests, levels of the lipid oxidation product malondialdehyde (MDA) and protein oxidation protein carbonyl (CO) were determined. RESULTS The CFS group had higher levels of triglycerides (p = 0.03), MDA (p = 0.03) and CO (p = 0.002) and lower levels of HDL cholesterol (p = 0.001) than the control group. There were no significant differences in the levels of total protein, total cholesterol or LDL cholesterol. CONCLUSIONS The CFS group had an unfavorable lipid profile and signs of oxidative stress induced damage to lipids and proteins. These results might be indicative of early proatherogenic processes in this group of patients who are otherwise at low risk for atherosclerosis. Antioxidant treatment and life style changes are indicated for women with CFS, as well as closer observation in order to assess the degree of atherosclerosis.
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Affiliation(s)
- Slavica Tomic
- Clinic for Infectious Diseases, Clinical Center Vojvodina, Novi Sad, Serbia
| | - Snezana Brkic
- Clinic for Infectious Diseases, Clinical Center Vojvodina, Novi Sad, Serbia
| | - Daniela Maric
- Clinic for Infectious Diseases, Clinical Center Vojvodina, Novi Sad, Serbia
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Abstract
OBJECTIVE In people with coronary artery disease, the association between endocrine measures and fatigue is not well understood. We evaluated possible associations of fatigue and exercise capacity with function of adrenal axis and thyroid axis. METHODS Sixty-five men and 18 women (mean age 55 years) attending a rehabilitation program were examined using the Multidimensional Fatigue Inventory, Dutch Exertion Fatigue Scale, and the Hospital Anxiety and Depression Scale. Exercise capacity was measured using a bicycle ergometer procedure. Serum concentrations of free triiodothyronine (T₃), free thyroxine (T₄), morning cortisol, afternoon cortisol, and change in cortisol concentrations (ΔCortisol) were measured. RESULTS In univariate regression analysis, lower free T₄ concentrations were associated with general and exertion fatigue, lower free T₃ concentrations were associated with general and physical fatigue, and lower ΔCortisol was associated with mental fatigue. After adjusting for age, sex, body mass index, hypertension, previous myocardial infarction, heart failure, diabetes, New York Heart Association functional class, depressive symptoms, and anxiety symptoms, lower free T3 concentrations remained associated with physical fatigue (β = -.224, p = .03); lower free T₄ concentrations, with exertion fatigue (β = -.219, p = .03); and lower morning cortisol and lower ΔCortisol concentrations, with mental fatigue (β = -.193 [p = .03] and β = -.180 [p =.04], respectively). Exercise capacity was not associated with endocrine factors. CONCLUSIONS In coronary artery disease patients, increased thyroid hormone concentrations are associated with decreased physical fatigue and decreased exertion fatigue, and increased cortisol concentrations with decreased mental fatigue. Exercise capacity is not associated with endocrine factors.
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Ogawa T, Sei H, Konishi H, Shishioh-Ikejima N, Kiyama H. The absence of somatotroph proliferation during continuous stress is a result of the lack of extracellular signal-regulated kinase 1/2 activation. J Neuroendocrinol 2012; 24:1335-45. [PMID: 22612533 DOI: 10.1111/j.1365-2826.2012.02338.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The integrity of homeostasis can be affected by chronic stress, and hyposomatotropism is evident in chronic stress-associated illnesses. In the present study, we demonstrated that a continuous stress (CS) severely affected somatotrophs among hormone-secreting cells in the anterior lobe (AL) of the pituitary by using a rat CS model. Among AL cells, the proliferation of somatotrophs was almost entirely suppressed in rats that had 3-5 days of CS (5dCS), although other hormone-secreting cells continued to proliferate. The cell size of somatotrophs was reduced at 5dCS (P<0.01), the number of secretory granules was increased at 3dCS (P<0.01) and serum growth hormone (GH) was on declining trend during 1 to 5dCS, suggesting that GH release was inhibited. GH-releasing hormone (GHRH) mRNA level in the arcuate nucleus was transiently decreased, whereas its receptor expression in the AL was significantly increased in CS rats. When 5dCS rats were injected with GHRH, transient GH secretion was observed, whereas proliferation of somatotrophs did not occur. The GHRH administration failed to stimulate extracellular signal-regulated kinase (ERK) 1/2 phosphorylation and the nuclear translocation of ERK in somatotrophs. These results suggest that somatotrophs of 5dCS rats expressed sufficient GHRH receptor, which could transfer a signal for GH release. However, the GHRH-induced proliferation signal was blocked somewhere between the receptor and ERK1/2. Because significant increase of corticosterone in the initial stage (the 1-3dCS) was observed in this model, the corticosterone may affect the signalling. Although the mechanism underlying the blockage of the proliferation signal in somatotrophs under CS remains unclear, these somatotrophic disorder, suggesting that the present animal model may be useful for understanding the molecular mechanisms of chronic stress-associated illnesses.
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Affiliation(s)
- T Ogawa
- Department of Anatomy & Neurobiology, Graduate School of Medicine, Osaka City University, Abeno-ku, Osaka, Japan
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76
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Fatigue in multiple sclerosis - a brief review. J Neurol Sci 2012; 323:9-15. [PMID: 22935407 DOI: 10.1016/j.jns.2012.08.007] [Citation(s) in RCA: 146] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Revised: 06/26/2012] [Accepted: 08/08/2012] [Indexed: 11/22/2022]
Abstract
Fatigue is the most common and debilitating symptom in multiple sclerosis (MS) and is believed to be distinctly different from fatigue seen in other chronic conditions. It can affect a patient's mood, sleep and have a detrimental effect on their quality of life. In the recent years much literature has emerged in an attempt to elucidate the potential causes and treatment of this common symptom. This review article aims to examine the most recent theories on the pathophysiology of fatigue in MS as well as its association with sleep and depression. We describe the pharmacological and non-pharmacological approaches to its treatment and propose a multidisciplinary, patient enabled and individualised manner to the management of fatigue in MS.
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78
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Singh PK, Chopra K, Kuhad A, Kaur IP. Role of Lactobacillus acidophilus loaded floating beads in chronic fatigue syndrome: behavioral and biochemical evidences. Neurogastroenterol Motil 2012; 24:366-e170. [PMID: 22296294 DOI: 10.1111/j.1365-2982.2011.01861.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND In recent years the interface between neuropsychiatry and gastroenterology has converged in to a new discipline referred to as enteric neuroscience. Implications of brain-gut communication in the pathogenesis of psychiatric disorders indicate a possible role of suitably packaged/delivered probiotics as newer therapeutic options. In the present study probable role of per-oral administration of free Lactobacillus acidophilus (LAB) and LAB loaded alginate beads in attenuation of the symptoms associated with chronic fatigue syndrome (CFS) were evaluated. METHODS Chronic fatigue syndrome following physical fatigue was induced in rats by forcing them to swim (forced swim test; FST) in water till exhaustion, after weighing them down with 10% their body weight, daily for 28 days. Immobility (I) and postswim fatigue time (PSF) were taken as suitable markers. Free LAB and LAB loaded floating beads (FBs) were administered, from 21 to 28 days. KEY RESULTS Immobility and PSF were found to increase considerably in FST rats (665 ± 22 s and 196 ± 6 s) as compared with the naïve (32 ± 7 s and 22 ± 2 s) at 20 days, establishing severe fatigue like behavior. FST control group exhibited significant (P < 0.05) hypertrophy of spleen, hypotrophy of thymus, and increased oxido-nitrosative stress in brain and tumor necrosis factor-α (TNF-α) levels in serum. Treatment with LAB and LAB FBs significantly decreased I and PSF and attenuated (P < 0.05) oxido-nitrosative stress and TNF-α levels. Spleen and thymus were also restored to their original size in this group. CONCLUSIONS & INFERENCES The findings suggest a valuable therapeutic role of LAB especially when incorporated into alginate beads for the treatment of CFS.
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Affiliation(s)
- P K Singh
- University Institute of Pharmaceutical Sciences, UGC Centre of Advanced Study, Panjab University, Chandigarh 160014, India
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Simoens VL, Hébert S. Cortisol suppression and hearing thresholds in tinnitus after low-dose dexamethasone challenge. BMC EAR, NOSE, AND THROAT DISORDERS 2012; 12:4. [PMID: 22449242 PMCID: PMC3328238 DOI: 10.1186/1472-6815-12-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2011] [Accepted: 03/26/2012] [Indexed: 02/03/2023]
Abstract
BACKGROUND Tinnitus is a frequent, debilitating hearing disorder associated with severe emotional and psychological suffering. Although a link between stress and tinnitus has been widely recognized, the empirical evidence is scant. Our aims were to test for dysregulation of the stress-related hypothalamus-pituitary adrenal (HPA) axis in tinnitus and to examine ear sensitivity variations with cortisol manipulation. METHODS Twenty-one tinnitus participants and 21 controls comparable in age, education, and overall health status but without tinnitus underwent basal cortisol assessments on three non-consecutive days and took 0.5 mg of dexamethasone (DEX) at 23:00 on the first day. Cortisol levels were measured hourly the next morning. Detection and discomfort hearing thresholds were measured before and after dexamethasone suppression test. RESULTS Both groups displayed similar basal cortisol levels, but tinnitus participants showed stronger and longer-lasting cortisol suppression after DEX administration. Suppression was unrelated to hearing loss. Discomfort threshold was lower after cortisol suppression in tinnitus ears. CONCLUSIONS Our findings suggest heightened glucocorticoid sensitivity in tinnitus in terms of an abnormally strong glucocorticoid receptor (GR)-mediated HPA-axis feedback (despite a normal mineralocorticoid receptor (MR)-mediated tone) and lower tolerance for sound loudness with suppressed cortisol levels. Long-term stress exposure and its deleterious effects therefore constitute an important predisposing factor for, or a significant pathological consequence of, this debilitating hearing disorder.
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Affiliation(s)
- Veerle L Simoens
- Cognitive Brain Research Unit, Cognitive Science, Department of Behavioural Sciences, University of Helsinki, Helsinki, P.O. Box 9 00014, Finland
- Finnish Centre of Excellence in Interdisciplinary Music Research, Department of Music, University of Jyväskylä, Jyväskylä, Finland
- BRAMS, International Laboratory for Brain, Music, and Sound research, Montreal, Canada
| | - Sylvie Hébert
- BRAMS, International Laboratory for Brain, Music, and Sound research, Montreal, Canada
- École d'orthophonie et d'audiologie, Faculté de médecine, Université de Montréal, Canada, and Centre de recherche de l'Institut universitaire de gériatrie de Montréal, Montréal, Canada
- Université de Montréal BRAMS, Pavillon 1420, Mont-Royal C.P. 6128, succ. Centre-ville, Montréal, QC H3C 3J7, Canada
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Wikgren M, Maripuu M, Karlsson T, Nordfjäll K, Bergdahl J, Hultdin J, Del-Favero J, Roos G, Nilsson LG, Adolfsson R, Norrback KF. Short telomeres in depression and the general population are associated with a hypocortisolemic state. Biol Psychiatry 2012; 71:294-300. [PMID: 22055018 DOI: 10.1016/j.biopsych.2011.09.015] [Citation(s) in RCA: 133] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2011] [Revised: 09/02/2011] [Accepted: 09/20/2011] [Indexed: 01/22/2023]
Abstract
BACKGROUND The hypothalamic-pituitary-adrenal (HPA) axis plays a central role in stress regulation, and leukocyte telomere length (TL) has been suggested to represent a cumulative measure of stress. Depression is intimately related with stress and frequently exhibits a dysregulated HPA axis. We aimed to study the relationships between TL and biological and psychological facets of stress in recurrent major depressive disorder and controls. METHODS Leukocyte TL was measured in 91 subjects with recurrent major depressive disorder and 451 control subjects. Stress was assessed from both a biological perspective, by assessing HPA axis function with a weight-adjusted very-low-dose dexamethasone suppression test (DST), and a psychological perspective, with self-report questionnaires. RESULTS TL was shorter among patients compared with control subjects (277 base pairs, p = .001). Overall, short TL was associated with a hypocortisolemic state (low post-DST cortisol and high percentage of cortisol reduction after the DST) among both patients and control subjects but more pronounced among patients. This state, which was overrepresented among patients, was characterized by high familial loading of affective disorders among patients (p = .001) and high C-reactive protein levels among control subjects (p = .040). TL was also inversely associated with stress measured with the Perceived Stress Questionnaire (r(s) = -.258, p = .003). CONCLUSIONS Short TL is associated with depression and hypocortisolism. Because hypocortisolism has been shown to develop from chronic stress exposure, our findings corroborate the concept of TL as a cumulative measure of stress and provide novel insights into the detrimental role of stress in depressive illness and the general population.
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Affiliation(s)
- Mikael Wikgren
- Division of Psychiatry, Department of Clinical Sciences, Umeå University, Umeå, Sweden.
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81
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Fairchild G. Hypothalamic-pituitary-adrenocortical axis function in attention-deficit hyperactivity disorder. Curr Top Behav Neurosci 2012; 9:93-111. [PMID: 22231898 DOI: 10.1007/7854_2010_101] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The hypothalamic-pituitary-adrenocortical axis plays a critical role in mediating the physiological response to the imposition of stress. There are theoretical reasons to expect reduced basal cortisol secretion and cortisol hyporeactivity in hyperactive/impulsive or combined type attention-deficit hyperactivity disorder (ADHD). Early studies reported profound abnormalities in the diurnal rhythm of cortisol secretion or the cortisol response to stress in children with severe or persistent ADHD. However, subsequent work using larger samples or improved methods has not provided convincing evidence for changes in basal cortisol secretion in non-comorbid forms of ADHD. In contrast, children with ADHD and comorbid oppositional defiant disorder show lower basal cortisol concentrations and a blunted cortisol awakening response. With respect to cortisol reactivity to stress in ADHD, recent evidence has been mixed, with some studies reporting normal cortisol responses and others showing blunted cortisol responses in non-comorbid ADHD. Again, it appears important to consider whether comorbid disorders are present, because children with ADHD and comorbid disruptive behavior disorders exhibit blunted cortisol responses, whereas those with comorbid anxiety disorders show enhanced cortisol responses to stress. Longitudinal studies are required to investigate whether abnormalities in cortisol secretion play a causal role in the etiology of ADHD and related disruptive behavior disorders.
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Affiliation(s)
- G Fairchild
- Developmental Psychiatry Section, Department of Psychiatry, Cambridge University, Cambridge, UK,
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82
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Seltzer MM, Barker ET, Greenberg JS, Hong J, Coe C, Almeida D. Differential sensitivity to life stress in FMR1 premutation carrier mothers of children with fragile X syndrome. Health Psychol 2011; 31:612-22. [PMID: 22149120 DOI: 10.1037/a0026528] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The premutation of the FMR1 gene (defined as between 55 and 200 CGG repeats) is estimated to affect 1 in 149 females and 1 in 643 males, and some people who carry the FMR1 premutation display signs of impairment. METHOD This study focuses on 82 premutation carrier mothers (M age = 51.4 years; SD = 7.7) of adolescent and adult children with fragile X syndrome (FXS). A Gene × Environment interaction approach examined the ways in which the experience of negative life events interacts with genetic vulnerability to predict depressive symptoms, anxiety, and daily cortisol levels. RESULTS The associations of life events with all 3 dependent measures were associated with CGG repeat length but in a curvilinear manner. Mothers with midsize CGG repeats who experienced above-average numbers of negative life events in the previous year had more depressive symptoms and anxiety and had a blunted cortisol awakening response, as compared with those with higher or lower repeat lengths. However, mothers with midsize CGG repeats who experienced below-average numbers of negative life events in the previous year had the lowest levels of depressive symptoms and anxiety, and they exhibited the typical cortisol response to awakening, meeting the criteria for differential susceptibility. CONCLUSIONS This research extends our understanding of the phenotypic effects of the expansion of the FMR1 gene, and it adds to the growing literature on the curvilinear relationship between CGG repeat length and mental and physical health.
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83
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Joosen MCW, Frings-Dresen MHW, Sluiter JK. Long-term outcomes following vocational rehabilitation treatments in patients with prolonged fatigue. Int J Behav Med 2011; 20:42-51. [PMID: 22135188 PMCID: PMC3576556 DOI: 10.1007/s12529-011-9208-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background Multi-component vocational rehabilitation (VR) provides positive short-term outcomes in patients with prolonged fatigue. Purpose The purpose of this study is to evaluate the long-term outcomes of Dutch multi-component VR up to 18 months after treatment. Method In a pre–post-study, measurements were taken before treatment (t0), after treatment (t1) and in long-term follow-ups at 6 (t2), 12 (t3) and 18 months (t4) after treatment. Primary outcomes (fatigue, work participation and workability) and secondary outcomes [physical and social functioning, mental health and heart rate variability (HRV)] were assessed over time using linear mixed models analyses. Post hoc long-term outcomes were compared with t0 and t1. Results Sixty patients with severe fatigue complaints participated. The primary outcomes significantly (p < 0.001) improved at follow-ups compared with t0 and showed no relapse compared with t1. Moreover, fatigue decreased (p < 0.002) whereas workability (p < 0.001) and work participation (p < 0.001) increased further after treatment (t1). The secondary outcomes, physical functioning, mental health, social functioning and HRV, improved significantly (p < 0.001, p < 0.001, p < 0.001 and p = 0.049, respectively) over the long term compared with t0. At 6-month follow-up (t2), mental health (p < 0.003) and social functioning (p = 0.003) further increased after the treatment was stopped. Conclusion Multi-component VR treatments seem to significantly and in a clinically relevant way decrease fatigue symptoms and improve individual functioning and work participation in patients with severe prolonged fatigue over the long term and without showing relapse.
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Affiliation(s)
- Margot C. W. Joosen
- Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands
- Present Address: School of Social and Behavioral Sciences, Tilburg University, Tranzo, Tilburg The Netherlands
| | - Monique H. W. Frings-Dresen
- Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands
| | - Judith K. Sluiter
- Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands
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84
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Fischer A, Heesen C, Gold SM. Biological outcome measurements for behavioral interventions in multiple sclerosis. Ther Adv Neurol Disord 2011; 4:217-29. [PMID: 21765872 DOI: 10.1177/1756285611405252] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Behavioral interventions including exercise, stress management, patient education, psychotherapy and multidisciplinary neurorehabilitation in general are receiving increasing recognition in multiple sclerosis (MS) clinical practice and research. Most scientific evaluations of these approaches have focused on psychosocial outcome measures such as quality of life, fatigue or depression. However, it is becoming increasingly clear that neuropsychiatric symptoms of MS are at least partially mediated by biological processes such as inflammation, neuroendocrine dysfunction or regional brain damage. Thus, successful treatment of these symptoms with behavioral approaches could potentially also affect the underlying biology. Rigidly designed scientific studies are needed to explore the potential of such interventions to affect MS pathology and biological pathways linked to psychological and neuropsychiatric symptoms of MS. Such studies need to carefully select outcome measures on the behavioral level that are likely to be influenced by the specific intervention strategy and should include biomarkers with evidence for an association with the outcome parameter in question. In this overview, we illustrate how biological and psychological outcome parameters can be combined to evaluate behavioral interventions. We focus on two areas of interest as potential targets for behavioral interventions: depression and fatigue.
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Affiliation(s)
- Anja Fischer
- Institute for Neuroimmunology and Clinical Multiple Sclerosis Research (inims), University Hospital Hamburg, Eppendorf, Germany
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85
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Morelli V. Fatigue and Chronic Fatigue in the Elderly: Definitions, Diagnoses, and Treatments. Clin Geriatr Med 2011; 27:673-86. [DOI: 10.1016/j.cger.2011.07.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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86
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Jason L, Sorenson M, Sebally K, Alkazemi D, Lerch A, Porter N, Kubow S. Increased HDAC in association with decreased plasma cortisol in older adults with chronic fatigue syndrome. Brain Behav Immun 2011; 25:1544-7. [PMID: 21549189 DOI: 10.1016/j.bbi.2011.04.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2010] [Revised: 03/24/2011] [Accepted: 04/04/2011] [Indexed: 01/05/2023] Open
Abstract
Hypocortisolism is a frequent finding in individuals with chronic fatigue syndrome (CFS) with other research findings implying potential dysregulation of glucocorticoid signaling. Glucocorticoid signaling is under the influence of several pathways, several of which are of interest in the study of CFS. Oxidative stress and decreased antioxidant capacity are known to disrupt the hypothalamic-pituitary-adrenal (HPA) axis (Epel et al., 2004) and the presence of histone deacetylases (HDAC) could also impact glucocorticoid signaling. The intent of this pilot study was to investigate the relationship among oxidative stress elements, select HDAC's (2/3) and glucocorticoid receptor signaling in an elderly sample with CFS. Findings suggest increased histone deacetylase activity, lower total antioxidant power, in the context of decreased plasma cortisol and increased plasma dehydroepiandrosterone concomitant with decreased expression of the encoding gene for the glucocorticoid receptor. These findings support the presence of HPA axis dysregulation in elderly individuals with CFS.
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Affiliation(s)
- Leonard Jason
- Department of Psychology, DePaul University, Chicago, IL 60614, United States
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87
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Son GH, Chung S, Kim K. The adrenal peripheral clock: glucocorticoid and the circadian timing system. Front Neuroendocrinol 2011; 32:451-65. [PMID: 21802440 DOI: 10.1016/j.yfrne.2011.07.003] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Revised: 04/25/2011] [Accepted: 07/06/2011] [Indexed: 12/27/2022]
Abstract
The mammalian circadian timing system is organized in a hierarchy, with the master clock residing in the suprachiasmatic nucleus (SCN) of the hypothalamus and subsidiary peripheral clocks in other brain regions as well as peripheral tissues. Since the local oscillators in most cells contain a similar molecular makeup to that in the central pacemaker, determining the role of the peripheral clocks in the regulation of rhythmic physiology and behavior is an important issue. Glucocorticoids (GCs) are a class of multi-functional adrenal steroid hormones, which exhibit a robust circadian rhythm, with a peak linked with the onset of the daily activity phase. It has long been believed that the production and secretion of GC is primarily governed through the hypothalamus-pituitary-adrenal (HPA) neuroendocrine axis in mammals. Growing evidence, however, strongly supports the notion that the periodicity of GC involves the integrated activity of multiple regulatory mechanisms related to circadian timing system along with the classical HPA neuroendocrine regulation. The adrenal-intrinsic oscillator as well as the central pacemaker plays a pivotal role in its rhythmicity. GC influences numerous biological processes, such as metabolic, cardiovascular, immune and even higher brain functions, and also acts as a resetting signal for the ubiquitous peripheral clocks, suggesting its importance in harmonizing circadian physiology and behavior. In this review, we will therefore focus on the recent advances in our understanding of the circadian regulation of adrenal GC and its functional relevance.
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Affiliation(s)
- Gi Hoon Son
- Department of Biological Sciences, Seoul National University, Brain Research Center for the 21st Century Frontier Program in Neuroscience, Seoul 151-742, Republic of Korea
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88
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Abstract
The weight of current evidence supports the presence of the following factors related to hypothalamic-pituitary-adrenal (HPA) axis dysfunction in patients with chronic fatigue syndrome (CFS): mild hypocortisolism; attenuated diurnal variation of cortisol; enhanced negative feedback to the HPA axis; and blunted HPA axis responsiveness. Furthermore, HPA axis changes seem clinically relevant, as they are associated with worse symptoms and/or disability and with poorer outcomes to standard treatments for CFS. Regarding etiology, women with CFS are more likely to have reduced cortisol levels. Studies published in the past 8 years provide further support for a multifactorial model in which several factors interact to moderate HPA axis changes. In particular, low activity levels, depression and early-life stress appear to reduce cortisol levels, whereas the use of psychotropic medication can increase cortisol. Addressing these factors-for example, with cognitive behavioral therapy-can increase cortisol levels and is probably the first-line approach for correcting HPA axis dysfunction at present, as steroid replacement is not recommended. Given what is now a fairly consistent pattern of findings for the type of HPA axis changes found in CFS, we recommend that future work focuses on improving our understanding of the cause and relevance of these observed changes.
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Affiliation(s)
- Andrew S Papadopoulos
- Department of Psychological Medicine, Institute of Psychiatry, Box P074, 103 Denmark Hill, London SE5 8AZ, UK
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89
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Hartley SL, Seltzer MM, Hong J, Greenberg JS, Smith L, Almeida D, Coe C, Abbeduto L. Cortisol response to behavior problems in FMR1 premutation mothers of adolescents and adults with fragile X syndrome: A diathesis-stress model. INTERNATIONAL JOURNAL OF BEHAVIORAL DEVELOPMENT 2011; 36:53-61. [PMID: 22798702 DOI: 10.1177/0165025411406857] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Mothers of adolescents and adults with fragile X syndrome (FXS) are faced with high levels of parenting stress. The extent to which mothers are negatively impacted by this stress, however, may be influenced by their own genetic status. The present study uses a diathesis-stress model to examine the ways in which a genetic vulnerability in mothers with the premutation of the FMR1 gene interacts with child-related environmental stress to predict their morning cortisol levels. Seventy-six mothers of an adolescent or adult with FXS participated in an 8-day telephone diary study in which they reported on the behavior problems of their son or daughter with FXS each day. We analyzed salivary cortisol collected from mothers at awakening and 30 minutes after awakening on 4 of these days. The results indicated that mothers with greater genetic vulnerability had a lower level of cortisol on mornings following days when their son or daughter with FXS manifested more episodes of behavior problems, whereas mothers with less genetic risk evinced the opposite pattern of higher morning cortisol in response to their child's behavior problems. This finding contributes to our understanding of gene-by-environment interactions and highlights the importance of interventions to alleviate parenting stress in mothers raising children with FXS.
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90
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Rahman K, Burton A, Galbraith S, Lloyd A, Vollmer-Conna U. Sleep-wake behavior in chronic fatigue syndrome. Sleep 2011; 34:671-8. [PMID: 21532961 DOI: 10.1093/sleep/34.5.671] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
STUDY OBJECTIVES Disturbances of the internal biological clock manifest as fatigue, poor concentration, and sleep disturbances-symptoms reminiscent of chronic fatigue syndrome (CFS) and suggestive of a role for circadian rhythm disturbance in CFS. We examined circadian patterns of activity, sleep, and cortisol secretion in patients with CFS. DESIGN Case-control study, 5-day behavioral observation. SETTING Natural setting/home environment PARTICIPANTS 15 patients with CFS and 15 healthy subjects of similar age, sex, body mass index (BMI), and activity levels. INTERVENTIONS N/A. MEASUREMENTS Self-report questionnaires were used to obtain medical history and demographic information and to assess health behaviors, somatic and psychological symptoms, and sleep quality. An actiwatch accelerometer recorded activity and sleep patterns over 5 days with concurrent activity and symptom logs. Diurnal salivary cortisol secretion was measured. Additionally, overnight heart rate monitoring and pain sensitivity assessment was undertaken. RESULTS Ratings of symptoms, disability, sleep disturbance, and pain sensitivity were greater in patients with CFS. No between-group differences were found in the pattern or amount of sleep, activity, or cortisol secretion. Afternoon activity levels significantly increased evening fatigue in patients but not control subjects. Low nocturnal heart rate variability was identified as a biological correlate of unrefreshing sleep. CONCLUSIONS We found no evidence of circadian rhythm disturbance in CFS. However, the role of autonomic activity in the experience of unrefreshing sleep warrants further assessment. The activity symptom-relationship modelled here is of clinical significance in the approach to activity and symptom management in the treatment of CFS.
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91
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Chung S, Son GH, Kim K. Circadian rhythm of adrenal glucocorticoid: Its regulation and clinical implications. Biochim Biophys Acta Mol Basis Dis 2011; 1812:581-91. [DOI: 10.1016/j.bbadis.2011.02.003] [Citation(s) in RCA: 154] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Revised: 01/31/2011] [Accepted: 02/07/2011] [Indexed: 10/18/2022]
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92
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Anty R, Marjoux S, Bekri S, DeGalleani L, Dainese R, Gelsi E, Cherikh F, Tran A, Piche T. Plasma carnitine is associated with fatigue in chronic hepatitis C but not in the irritable bowel syndrome. Aliment Pharmacol Ther 2011; 33:961-8. [PMID: 21366633 DOI: 10.1111/j.1365-2036.2011.04608.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Fatigue is an important determinant of altered quality of life in patients affected by chronic hepatitis C or the irritable bowel syndrome (IBS). AIM In this study, we aimed at determining the contributory role of plasma levels of leptin and carnitine on fatigue in chronic hepatitis C and IBS. METHODS We enrolled 81 patients with chronic hepatitis C, 42 with IBS and 44 healthy subjects. Fatigue was evaluated using the Fatigue Impact Scale questionnaire. Body composition was assessed through impedance analysis. Plasma carnitine and leptin were measured. RESULTS Fatigue scores were significantly more elevated in patients with chronic hepatitis C and IBS than in healthy subjects. Patients with chronic hepatitis C but not IBS, had significant lower plasma levels of total and free carnitine adjusted for fat mass compared with healthy subjects. In patients with chronic hepatitis C and not with IBS, fatigue scores were negatively correlated with plasma levels of carnitine. Levels of free carnitine were significantly and independently associated with the severity of fatigue in patients with chronic hepatitis C [OR=2.019, P=0.02, CI 95% (1.01-1.23)]. CONCLUSIONS In patients with chronic hepatitis C, the severity of fatigue is associated with a low level of carnitine, suggesting that an oral supplementation may be effective to relieve fatigue in chronic hepatitis C. The underlying mechanism of fatigue in IBS does not seem to involve carnitine.
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Affiliation(s)
- R Anty
- INSERM U895, Centre Hospitalier Universitaire of Nice-Digestive Center, Nice Cedex 3, France
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93
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Jason LA, Sorenson M, Porter N, Belkairous N. An Etiological Model for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. NEUROSCIENCE AND MEDICINE 2011; 2:14-27. [PMID: 21892413 PMCID: PMC3166239 DOI: 10.4236/nm.2011.21003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Kindling might represent a heuristic model for understanding the etiology of Myalgic Encephalomyelitis/chronic fatigue syndrome (ME/CFS). Kindling occurs when an organism is exposed repeatedly to an initially sub-threshold stimulus resulting in hypersensitivity and spontaneous seizure-like activity. Among patients with ME/CFS, chronically repeated low-intensity stimulation due to an infectious illness might cause kindling of the limbic-hypothalamic-pituitary axis. Kindling might also occur by high-intensity stimulation (e.g., brain trauma) of the limbic-hypothalamic-pituitary axis. Once this system is charged or kindled, it can sustain a high level of arousal with little or no external stimulus and eventually this could lead to hypocortisolism. Seizure activity may spread to adjacent structures of the limbic-hypothalamic-pituitary axis in the brain, which might be responsible for the varied symptoms that occur among patients with ME/CFS. In addition, kindling may also be responsible for high levels of oxidative stress, which has been found in patients with ME/CFS.
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Affiliation(s)
- Leonard A. Jason
- DePaul University, Center for Community Research. Fullerton Ave., Chicago, USA
| | - Matthew Sorenson
- DePaul University, Center for Community Research. Fullerton Ave., Chicago, USA
| | - Nicole Porter
- DePaul University, Center for Community Research. Fullerton Ave., Chicago, USA
| | - Natalie Belkairous
- DePaul University, Center for Community Research. Fullerton Ave., Chicago, USA
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94
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Meta-analysis and meta-regression of hypothalamic-pituitary-adrenal axis activity in functional somatic disorders. Biol Psychol 2011; 87:183-94. [PMID: 21315796 DOI: 10.1016/j.biopsycho.2011.02.002] [Citation(s) in RCA: 151] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2010] [Revised: 12/08/2010] [Accepted: 02/03/2011] [Indexed: 01/14/2023]
Abstract
Dysfunction of the hypothalamic-pituitary-adrenal (HPA) axis is the most investigated biological risk marker in functional somatic disorders (FSDs), such as chronic fatigue syndrome (CFS), fibromyalgia (FM), and irritable bowel syndrome (IBS). Our aim was to assess whether there is an association between basal hypocortisolism and FSD and to identify potential moderators of this association. Meta-analysis on 85 studies revealed that although basal cortisol levels were generally lower in FSD subjects compared to controls, this association did not reach statistical significance (SMD -0.07, 95% CI -0.17 to 0.04, p=0.241). However, when the three FSD were assessed separately, statistically significant basal hypocortisolism was observed in CFS subjects compared to controls (SMD -0.14, 95% CI -0.28 to 0.00, p=0.047), but not in FM or IBS. When all potential moderators were entered into a meta-regression analysis, only type of FSD and female gender were significant independent predictors of basal hypocortisolism. In conclusion, we did not find evidence to consider all three main FSD as hypocortisolemic disorders, as significant reduction in basal cortisol compared to healthy controls was only found in CFS and in females with FM, but not in IBS.
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95
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Norheim KB, Jonsson G, Omdal R. Biological mechanisms of chronic fatigue. Rheumatology (Oxford) 2011; 50:1009-18. [DOI: 10.1093/rheumatology/keq454] [Citation(s) in RCA: 145] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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96
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Cho SY, Lee JH, Song MJ, Park PJ, Shin ES, Sohn JH, Seo DB, Lim KM, Kim WG, Lee SJ. Effects of chitooligosaccharide lactate salt on sleep deprivation-induced fatigue in mice. Biol Pharm Bull 2010; 33:1128-32. [PMID: 20606301 DOI: 10.1248/bpb.33.1128] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Chitooligosaccharides (COS), oligosaccharides composed of two to seven glucosamine residues, are known to exhibit various biological activities. In this study, we investigated the effects of COS in an in vivo mouse sleep deprivation-induced fatigue model in an effort to develop a functional food with anti-fatigue efficacy. Male Balb/c mice were orally administered 500 mg (kg d)(-1) of COS lactate or COS HCl for 2 weeks, and severe fatigue was induced by sleep deprivation. To evaluate the extent of fatigue, the swimming time, representing the immobility time, was measured in a forced swim test. As a result, oral intake of COS lactate-manifested anti-fatigue effects could be observed by the attenuation of fatigue-induced body weight loss and shorter immobility period. In addition, COS lactate was shown to alleviate the fatigue-induced increase in cortisol and lipid peroxidation and a decrease in superoxide dismutase (SOD) activity. Of particular note, the oral administration of COS lactate increased the mitochondrial membrane potential and the mitochondrial number significantly, indicating that COS lactate may enhance mitochondrial function. In support of this, COS lactate increased the expression of peroxisome proliferator-activated receptor gamma coactivator-1alpha (PGC-1alpha) and cytochrome c (Cyt C) mRNA, indicating that it may increase mitochondrial biogenesis. These results suggest that COS lactate can be an effective anti-fatigue functional food, and this anti-fatigue effect may result from, at least in part, the enhancement of mitochondrial biogenesis and the inhibition of free radical generation.
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Affiliation(s)
- Si Young Cho
- Food Research Institute, R&D Center, AmorePacific Corporation, Yongin-si, Gyeonggi-do 446-729, Korea
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97
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High cocoa polyphenol rich chocolate may reduce the burden of the symptoms in chronic fatigue syndrome. Nutr J 2010; 9:55. [PMID: 21092175 PMCID: PMC3001690 DOI: 10.1186/1475-2891-9-55] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2010] [Accepted: 11/22/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chocolate is rich in flavonoids that have been shown to be of benefit in disparate conditions including cardiovascular disease and cancer. The effect of polyphenol rich chocolate in subjects with chronic fatigue syndrome (CFS) has not been studied previously. METHODS We conducted a double blinded, randomised, clinical pilot crossover study comparing high cocoa liquor/polyphenol rich chocolate (HCL/PR) in comparison to simulated iso-calorific chocolate (cocoa liquor free/low polyphenols(CLF/LP)) on fatigue and residual function in subjects with chronic fatigue syndrome. Subjects with CFS having severe fatigue of at least 10 out of 11 on the Chalder Fatigue Scale were enrolled. Subjects had either 8 weeks of intervention in the form of HCL/PR or CLF/LP, with a 2 week wash out period followed by 8 weeks of intervention with the other chocolate. RESULTS Ten subjects were enrolled in the study. The Chalder Fatigue Scale score improved significantly after 8 weeks of the HCL/PR chocolate arm [median (range) Exact Sig. (2-tailed)] [33 (25 - 38) vs. 21.5 (6 - 35) 0.01], but that deteriorated significantly when subjects were given simulated iso-calorific chocolate (CLF/CP) [ 28.5 (17 - 20) vs. 34.5 (13-26) 0.03]. The residual function, as assessed by the London Handicap scale, also improved significantly after the HCL/PR arm [0.49 (0.33 - 0.62) vs. 0.64 (0.44 - 0.83) 0.01] and deteriorated after iso-calorific chocolate [00.44 (0.43 - 0.68) vs. 0.36 (0.33 - 0.62)0.03]. Likewise the Hospital Anxiety and Depression score also improved after the HCL/PR arm, but deteriorated after CLF/CP. Mean weight remained unchanged throughout the trial. CONCLUSION This study suggests that HCL/PR chocolate may improve symptoms in subjects with chronic fatigue syndrome.
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98
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Functional genomics of serotonin receptor 2A (HTR2A): interaction of polymorphism, methylation, expression and disease association. Neuromolecular Med 2010; 13:66-76. [PMID: 20941551 PMCID: PMC3044825 DOI: 10.1007/s12017-010-8138-2] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2010] [Accepted: 09/25/2010] [Indexed: 10/24/2022]
Abstract
Serotonergic neurotransmission plays a key role in the pathophysiology of neuropsychiatric illnesses. The functional significance of a promoter polymorphism, -1438G/A (rs6311), in one of the major genes of this system (serotonin receptor 2A, HTR2A) remains poorly understood in the context of epigenetic factors, transcription factors and endocrine influences. We used functional and structural equation modeling (SEM) approaches to assess the contributions of the polymorphism (rs6311), DNA methylation and clinical variables to HTR2A expression in chronic fatigue syndrome (CFS) subjects from a population-based study. HTR2A was up-regulated in CFS through allele-specific expression modulated by transcription factors at critical sites in its promoter: an E47 binding site at position -1,438, (created by the A-allele of rs6311 polymorphism), a glucocorticoid receptor (GR) binding site encompassing a CpG at position -1,420, and Sp1 binding at CpG methylation site -1,224. Methylation at -1,420 was strongly correlated with methylation at -1,439, a CpG site that is dependent upon the G-allele of rs6311 at position -1,438. SEM revealed a strong negative interaction between E47 and GR binding (in conjunction with cortisol level) on HTR2A expression. This study suggests that the promoter polymorphism (rs6311) can affect both transcription factor binding and promoter methylation, and this along with an individual's stress response can impact the rate of HTR2A transcription in a genotype and methylation-dependent manner. This study can serve as an example for deciphering the molecular determinants of transcriptional regulation of major genes of medical importance by integrating functional genomics and SEM approaches. Confirmation in an independent study population is required.
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Abstract
The relationship between corticosteroids (endogenous and exogenous) and stress is well known, as is the use of steroids as concomitant treatment in pain management during acute inflammation. In the past, steroids have not been considered the first line of treatment in pain management. In this review, we examine new scientific and clinical evidence that demonstrates the direct role that steroids play in the generation and clinical management of chronic pain. We will discuss the new findings demonstrating the fact that steroids and related mediators produce paradoxical effects on pain such as analgesia, hyperalgesia, and even placebo analgesia. In addition, we will examine the physiologic effect of stress, high allostatic load, and idiopathic disease states such as chronic fatigue syndrome, fibromyalgia, irritable bowel syndrome, and burnout. The recently observed positive relationship between glutaminergic activity in the insula and clinical pain will be examined in the context of understanding the central role of steroids in chronic pain. The complex role of the hypothalamic-pituitary-adrenal axis in pain will be discussed as well as other heterogeneous forms of chronic pain that involve many components of the central nervous system. Components of the hypothalamic-pituitary-adrenal axis have paradoxical effects on certain types of pain that are dependent on dose and on site (whether peripheral or central) and mode of application. Recent studies on glia have shown that they prolong a state of neuronal hypersensitization in the dorsal root ganglia by releasing growth factors and other substances that act on the immune system. We will discuss the implication of these new findings directly linking pain to steroids, stress, and key higher brain regions in the context of future therapeutic targets.
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Affiliation(s)
- Bruce S McEwen
- Laboratory of Neuroendocrinology, The Rockefeller University, New York, NY 10065, USA.
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100
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Braley TJ, Chervin RD. Fatigue in multiple sclerosis: mechanisms, evaluation, and treatment. Sleep 2010; 33:1061-7. [PMID: 20815187 DOI: 10.1093/sleep/33.8.1061] [Citation(s) in RCA: 241] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Among patients with multiple sclerosis (MS), fatigue is the most commonly reported symptom, and one of the most debilitating. Despite its high prevalence and significant impact, fatigue is still poorly understood and often under-emphasized because of its complexity and subjective nature. In recent years, an abundance of literature from specialists in sleep medicine, neurology, psychiatry, psychology, physical medicine and rehabilitation, and radiology have shed light on the potential causes, impact, and treatment of MS-related fatigue. Though such a diversity of contributions clearly has advantages, few recent articles have attempted to synthesize this literature, and existing overviews have focused primarily on potential causes of fatigue rather than clinical evaluation or treatment. The aims of this review are to examine, in particular for sleep specialists, the most commonly proposed primary and secondary mechanisms of fatigue in MS, tools for assessment of fatigue in this setting, and available treatment approaches to a most common and challenging problem.
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Affiliation(s)
- Tiffany J Braley
- Multiple Sclerosis Center, Department of Neurology, University ofMichigan, Ann Arbor MI, USA.
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