Pituitary-adrenal-immune system in normal subjects and in patients with anorexia nervosa: the number of circulating helper T lymphocytes (CD4) expressing the homing receptor Leu8 is regulated in part by pituitary-adrenal products

Effect of type II collagen extract on immunosuppression induced by methotrexate in rats

This study investigated the effect of type II collagen extract on SD rats with deteriorated immunity caused by methotrexate. The test samples were dosed once a day for 28 days by gastric gavage at dosage 250 mg/kg and 500 mg/kg after methotrexate treatment, and the changes on body weight, total blood leukocyte numbers, the percentages of B-cells, CD4+ T-cells and CD8+ T-cells in the blood and spleen were observed. The changes on body weight, the total blood leukocyte numbers, the total lymphocyte numbers in the spleen, the ratio of CD4+ and CD8+ T-cells in the blood and spleen were increased significantly in type II collagen extract groups as compared with the control group. According to the above results, type II collagen extract has an effect of increasing immune responses on rats with deteriorated immunity caused by methotrexate.

Increased naive CD4+ and B lymphocyte subsets are associated with body mass loss and drive relative lymphocytosis in anorexia nervosa patients

Anorexia nervosa (AN) is an atypical form of malnutrition with peculiar changes in the immune system. We hypothesized that different lymphocyte subsets are differentially affected by malnutrition in AN, and thus, our aim was to investigate the influence of body mass loss on the variability of lymphocyte subsets in AN patients. A group of 66 adolescent female patients, aged 12-17 years, referred for their first episode of either AN or feeding or eating disorders not elsewhere classified were studied upon admission (46 AN-restricting subtype, 11 AN-binge/purging subtype, and 9 feeding or eating disorders not elsewhere classified). Ninety healthy adolescents served as controls. White blood cells and lymphocyte subsets were analyzed by flow cytometry. Relationships with the body mass index (BMI) z score were assessed in linear models adjusted by diagnostic subtype and age. Leukocyte numbers were lower in AN patients than in controls, and relative lymphocytosis was observed in AN-restricting subtype. Lower CD8⁺, NK, and memory CD8⁺ counts were found in eating disorder patients compared with controls. No differences were found for CD4⁺ counts or naive and memory CD4⁺ subsets between the groups. Negative associations between lymphocyte percentage and the BMI z score, as well as between the B cell counts, naive CD4⁺ percentage and counts, and the BMI z score, were found. In conclusion, increased naive CD4⁺ and B lymphocyte subsets associated with body mass loss drive the relative lymphocytosis observed in AN patients, which reflects an adaptive mechanism to preserve the adaptive immune response.

Cortisol increases CXCR4 expression but does not affect CD62L and CCR7 levels on specific T cell subsets in humans

Glucocorticoids are well known to affect T cell migration, leading to a redistribution of the cells from blood to the bone marrow, accompanied by a concurrent suppression of lymph node homing. Despite numerous studies in this context, with most of them employing synthetic glucocorticoids in nonphysiological doses, the mechanisms of this redistribution are not well understood. Here, we investigated in healthy men the impact of cortisol at physiological concentrations on the expression of different migration molecules on eight T cell subpopulations in vivo and in vitro. Hydrocortisone (cortisol, 22 mg) infused during nocturnal rest when endogenous cortisol levels are low, compared with placebo, differentially reduced numbers of T cell subsets, with naive CD4(+) and CD8(+) subsets exhibiting the strongest reduction. Hydrocortisone in vivo and in vitro increased CXCR4 expression, which presumably mediates the recruitment of T cells to the bone marrow. Expression of the lymph node homing receptor CD62L on total CD3(+) and CD8(+) T cells appeared reduced following hydrocortisone infusion. However, this was due to a selective extravasation of CD62L(+) T cell subsets, as hydrocortisone affected neither CD62L expression on a subpopulation level nor CD62L expression in vitro. Corresponding results in the opposite direction were observed after blocking of endogenous cortisol synthesis by metyrapone. CCR7, another lymph node homing receptor, was also unaffected by hydrocortisone in vitro. Thus, cortisol seems to redirect T cells to the bone marrow by upregulating their CXCR4 expression, whereas its inhibiting effect on T cell homing to lymph nodes is apparently regulated independently of the expression of classical homing receptors.

Adhesion molecules and cytokine expression in fibromyalgia patients: increased L-selectin on monocytes and neutrophils

Several lines of evidence implicate the immune system in the pathophysiology of fibromyalgia (FM). We investigated the role of cytokines and adhesion molecules involved in immune cell trafficking and the influence of 1.5 mg of dexamethasone (DEX) per os on their expression. L-selectin was elevated on monocytes and neutrophils of FM patients. Differences in group response to DEX were observed for CD11b on NK cells, sICAM-1 and IL-2. This study shows a slight disturbance in the innate immune system of FM patients, and suggests an enhanced adhesion and recruitment of leukocytes to inflammatory sites.

Hostility and helper T-cells in patients with bulimia nervosa

OBJECTIVE

The study aimed to analyze the correlation between lymphocyte counts and several psychopathological variables associated with psychological instability (depression, hostility, impulsivity, self-defeating personality traits, and borderline personality symptoms) in patients with bulimia nervosa (BN).

METHOD

Sixty BN patients were assessed, using specific scales for eating pathology, general psychopathology, impulsivity, depression, and borderline personality features. Lymphocyte and lymphocyte subset counts were performed. Plasma cortisol at 8:00, before and after administration of 1 mg of dexamethasone at 23:00, was determined. The influence of body weight, and the use of tobacco, alcohol, and caffeine was controlled. The relationship between each isolated variable and the number of immune cells was analyzed. In a second step, supplementary post-hoc analysis of the variables was introduced to confirm the accuracy of the psychopathological assessment.

RESULTS

Hostility was negatively correlated with the number of helper T-cells (CD4+). Patients with high hostility had lower CD4+ cell counts and lower CD4+/CD8+ ratios. In the post-hoc control study, hostility was significantly related with other "interpersonal" items.

CONCLUSIONS

These results support the idea that hostility, as an expression of disturbed interpersonal relationships, could play a role as a modulator of immune activity in patients with BN.

Psychomotor performance and sequence planning in anorexia nervosa before and after weight restoration

BACKGROUND

In the study of psychomotor performance in anorexia nervosa (AN), motor control has not been studied extensively. The present study explores sequence planning in a sample of AN patients.

METHOD

A group of 26 female restricting AN inpatients, aged 14 to 25, was compared with 24 healthy women matched for age and educational level. During the performance of a simple copying task, in which movement planning, but not working capacity, was challenged, the ease with which generally favored graphic production rules could be applied was manipulated. Computerized recordings of the drawing movements allowed detailed analyses of reaction and movement times and of drawing sequences. Fifteen patients were retested after weight restoration, as were 15 controls.

RESULTS

Copying patterns that normally elicit a conflict between preferred graphic production rules induced significantly less slowing in the reaction times of the anorexia nervosa patients than in the controls, both before and after weight restoration. There were no group differences as regards the consistency with which the implicit production rules were applied.

DISCUSSION

AN patients seem to show a fast response style combined with good sequence planning capacity.

Cortisol mediates redistribution of CD8+ but not of CD56+ cells after the psychological stress of public speaking

The present study investigated the question if a pharmacological blockade of cortisol release with stress affects lymphocyte redistribution in healthy volunteers. It was expected that the well known increases in the number of CD8+ (T-suppressor/cytotoxic cells) and CD56+ (natural killer cells) after stress would not be downregulated in the absence of an appropriate cortisol response, since redistribution is markedly influenced by glucocorticoids. In a double blind design, forty healthy male volunteers were exposed to a brief psychological stressor (public speaking) and received a single oral dose of dexamethasone [DEX] (N=20) or placebo (N=20) the evening before the main experiment. Ratings on emotional states and blood samples for determination of hormones, CD8+, and CD56+ cell counts were obtained at different time points during the experiment. Stress of public speaking led to highly significant increases in catecholamine and cortisol concentrations, to subjective discomfort and, most pronounced, to high increases in the number of CD8+ and CD56+ cells. DEX neither influenced baseline levels of mood, catecholamines and cell numbers nor stress induced responses of mood and catecholamines. However, during the whole experiment cortisol concentrations were suppressed in the DEX-condition and the number of CD8+, but not CD56+, cells remained elevated at the end of the session, while in the placebo condition the numbers of these cells were decreased to baseline levels. The data demonstrate that cortisol seems to play an important role in stress induced redistribution patterns of CD8+ but not CD56+ cells. This, however, can be explained by different migration processes between those cells (e.g. different targets of migration) and, therefore, different glucocorticoid influences on target tissues.

Cytokines in de obsessief compulsieve stoornis en in anorexia nervosa: een overzicht

The alterations in the inflammatory response system (IRS) appear to be quite different between OCD and anorexia nervosa and are also different from the changes observed in major depression. In anorexia nervosa, there is some evidence for increased production of monocytic cytokines, i.e. tumor necrosis factor-α (TNFα) and interleukin-6 (IL-6), and decreased production of Th-1 like cytokines, i.e. IL-2 and IFNγ. In the same patients there are also signs of immunosuppression, e.g. lowered numbers of CD4 and CD8 T cells and increased production of transforming growth factor-beta (TGFβ). The increased production of monocytic cytokines may be the consequence of the hyponutritional status of those patients. The diminished production of the Th-1 like cytokines may be the consequence of at least four different factors: 1) the deficiency in nutritional factors; 2) neuroendocrine disorders, such as increased Cortisol production; 3) the increased TGFβ production; and 4) lower serum dipeptidyl peptidase activity. In OCD no consistent or specific alterations in the IRS are observed. There is no evidence that IRS activation may play a role in the pathophysiology of OCD and anorexia nervosa.

Hypothalamic-pituitary-adrenal axis function, psychopathological traits, and natural killer (NK) cell activity in anorexia nervosa

To evaluate the role of Hypothalamic-Pituitary-Adrenal (HPA) hormones and psychoneuroendocrine modulation on NK cell activity in Anorexia Nervosa (AN) we studied in 24 patients and 20 sex- and age-matched healthy controls, the spontaneous NK activity of peripheral blood mononuclear (PBM) cells and the susceptibility in vitro to cortisol or immune interferon or interleukin-2. NK cytotoxicity of PBM cells was measured in a direct non-radiometric 4h cytolytic assay using K562 cells as targets. HPA axis function was evaluated by IV ovine Corticotropin Releasing Hormone (o-CRH) administration. We did not find clear-cut abnormalities of NK cytotoxicities either in basal conditions or after exposure to challengers. The extent of cortisol-dependent inhibition was comparable in patients and controls. Significant inverse and direct correlations were found respectively between the spontaneous NK cell activity and baseline serum cortisol at 0800 h (r = -0.5; p < .02), and between IL-2 dependent boosting of NK cell cytotoxicity and ACTH, beta-endorphin or cortisol responses after o-CRH, expressed as areas under the curve (AUC) (r = 0.46, p < .05; r = 0.46, p < .05; and r = -0.48, p < .05, respectively). Correlations observed with AUC ratios yielded more significant results (r = 0.62; p < .01 and r = 0.51; p < .05 respectively). These data suggest a role for Proopiomelanocortin (POMC) derived peptides in the regulation of NK cell activity in AN, and multifaceted relationships between this particular immune function, on the one hand, and certain patterns of HPA axis function on the other.

Cellular immune correlates of clinical severity in oral lichen planus: preliminary association with mood states

OBJECTIVES

We investigated cellular immune and psycho-immune dysfunctions in patients with erosive and non-erosive oral lichen planus (OLP) lesions.

METHODS

Patients with erosive or non-erosive OLP were screened at the UCLA Dental Clinic. The profile of mood states (POMS) was administered. T lymphocyte subpopulations were monitored by dual fluorescence. T lymphocytes were stimulated with phytohemagglutinin (PHA) for assessment of markers of activation by flow cytometry and of interleukin (IL)-2 production by ELISA. Plasma cortisol and neopterin levels were assessed by radioimmunoassay.

RESULTS

Circulating T cells that express the cluster of differentiation no. 4 (CD4+) but devoid of the CD45RA marker, and POMS score were significantly associated (r = 0.83, P < 0.05) in the patients we studied. We found a significantly higher (P < 0.05) per cent and absolute lymphocyte numbers of circulating CD4+CD45RA- cells in the OLP patients with erosive lesions, compared to OLP patients with non-erosive lesions. The ratio of CD4+ CD45RA+ over CD4+CD45RA- cells was significantly (P < 0.05) biased toward the CD4+CD45RA- subpopulation in OLP patients with erosive lesions (ratio = 0.19 +/- 0.09) compared to patients with non-erosive OLP lesions (ratio = 0.47 +/- 0.15). The expression of CD54, but not that of CD69, was significantly blunted (P < 0.05) in OLP patients following CD3+ cell stimulation. IL-2 production and plasma neopterin were normal in these patients. There was no correlation between plasma cortisol and T cell populations.

CONCLUSIONS

We find fine differences in psycho-immune interactions between patients afflicted with non-erosive OLP lesions compared to those with erosive OLP lesions.

T lymphocyte subpopulations in anorexia nervosa and refeeding

Several studies have addressed the question of the effects of starvation on immune function and changes in lymphocyte subsets. Patients with anorexia nervosa are severely malnourished, but there have been few studies of immune parameters in this group. For this reason, phenotypic markers of T cell function and activation were studied in 20 severely underweight patients with anorexia nervosa and again after a period of refeeding. The most significant finding was a reduction in the percentage and absolute number of CD8+ T cells in patients with anorexia, the result of a marked reduction in memory (CD45RO+RA-) CD8 cells. A tendency for recovery in numbers of this subset was seen after refeeding. A decreased memory:maive cell ratio was also seen among CD4 cells, but was less marked. Subtle abnormalities in activated CD4 and CD8 cells were also found in the patient group at the initial sampling, but did not follow any clear pattern. These findings indicate that starvation in anorexic patients is accompanied by a large change in memory CD8 T cells. It may be speculated that this relates to the perceived lack of symptomatic common viral infections in underweight anorexic patients and their return with the recovery of weight.

Low lymphocyte interferon-gamma production and variable proliferative response in anorexia nervosa patients

Interferon-gamma (IFN-gamma) production by peripheral blood mononuclear cells (PBMC) in 14 patients with anorexia nervosa (AN) was significantly lower than in 14 age-matched healthy controls. Follow-up samples in four patients displayed low levels, except in two when they recovered the IFN-gamma production as the hormonal cycles were restored. A large interindividual variation for the lymphocyte proliferative response was observed in 30 AN patients. DNA synthesis of PBMC was normal in 8 patients (27%), significantly increased in 6 (20%) (P < 0.001), and significantly decreased in 16 (53%) (P < 0.001). IFN-gamma inhibition was reversed by culturing a control lymphocyte population with monocytes from patients with AN. This was not observed in cultures of control monocytes and AN lymphocytes. IL-2 receptor (TAC subunit) was assessed and no difference was found in the number of TAC-positive cells between patients and controls. These results point out impaired production of the immunomodulator cytokine IFN-gamma as a major functional defect of AN peripheral lymphocytes.