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Hamilton OS, Steptoe A. Stress and Sleep Duration in Immune and Neuroendocrine Patterning. An Analytical Triangulation in ELSA. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.07.23.24310898. [PMID: 39108528 PMCID: PMC11302604 DOI: 10.1101/2024.07.23.24310898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/12/2024]
Abstract
Background Proinflammatory and neuroendocrine mediators are implicated in disease aetiopathogenesis. Stress increases concentrations of immune-neuroendocrine biomarkers through a complex network of brain-body signalling pathways. Suboptimal sleep further modulates these processes by altering major effector systems that sensitise the brain to stress. Given the ubiquitous, impactful nature of material deprivation, we tested for a synergistic association of financial stress and suboptimal sleep with these molecular processes. Methods With data drawn from the English Longitudinal Study of Ageing (ELSA), associations were tested on 4,940 participants (~66±9.4 years) across four-years (2008-2012). Through analytical triangulation, we tested whether financial stress (>60% insufficient resources) and suboptimal sleep (≤5/≥9 hours) were independently and interactively associated with immune-neuroendocrine profiles, derived from a latent profile analysis (LPA) of C-reactive protein, fibrinogen, white blood cell counts, hair cortisol, and insulin-like growth factor-1. Results A three-class LPA model offered the greatest parsimony. After adjustment for genetic predisposition, sociodemographics, lifestyle, and health, financial stress was associated with short-sleep cross-sectionally (RRR=1.45; 95%CI=1.18-1.79; p<0.001) and longitudinally (RRR=1.31; 95%CI=1.02-1.68; p=0.035), and it increased risk of belonging to the high-risk biomarker profile by 42% (95%CI=1.12-1.80; p=0.004). Suboptimal sleep was not related to future risk of high-risk profile membership, nor did it moderate financial stress-biomarker profile associations. Discussion Results advance psychoneuroimmunological knowledge by revealing how immune-neuroendocrine markers cluster in older cohorts and respond to financial stress over time. Financial stress associations with short-sleep are supported. The null role of suboptimal sleep, as exposure and mediator, in profile membership, provides valuable insight into the dynamic role of sleep in immune-neuroendocrine processes.
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Affiliation(s)
- Odessa S. Hamilton
- Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, 1-19 Torrington Place, London WC1E 7HB, UK
| | - Andrew Steptoe
- Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, 1-19 Torrington Place, London WC1E 7HB, UK
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Bondar G, Mahapatra AD, Bao TM, Silacheva I, Hairapetian A, Vu T, Su S, Katappagari A, Galan L, Chandran J, Adamov R, Mancusi L, Lai I, Rahman A, Grogan T, Hsu JJ, Cappelletti M, Ping P, Elashoff D, Reed EF, Deng MC. An Exercise Immune Fitness Test to Unravel Disease Mechanisms-A Proof-of-Concept Heart Failure Study. J Clin Med 2024; 13:3200. [PMID: 38892912 PMCID: PMC11172881 DOI: 10.3390/jcm13113200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 05/22/2024] [Accepted: 05/23/2024] [Indexed: 06/21/2024] Open
Abstract
Background: Cardiorespiratory fitness positively correlates with longevity and immune health. Regular exercise may provide health benefits by reducing systemic inflammation. In chronic disease conditions, such as chronic heart failure and chronic fatigue syndrome, mechanistic links have been postulated between inflammation, muscle weakness, frailty, catabolic/anabolic imbalance, and aberrant chronic activation of immunity with monocyte upregulation. We hypothesize that (1) temporal changes in transcriptome profiles of peripheral blood mononuclear cells during strenuous acute bouts of exercise using cardiopulmonary exercise testing are present in adult subjects, (2) these temporal dynamic changes are different between healthy persons and heart failure patients and correlate with clinical exercise-parameters and (3) they portend prognostic information. Methods: In total, 16 Heart Failure (HF) patients and 4 healthy volunteers (HV) were included in our proof-of-concept study. All participants underwent upright bicycle cardiopulmonary exercise testing. Blood samples were collected at three time points (TP) (TP1: 30 min before, TP2: peak exercise, TP3: 1 h after peak exercise). We divided 20 participants into 3 clinically relevant groups of cardiorespiratory fitness, defined by peak VO2: HV (n = 4, VO2 ≥ 22 mL/kg/min), mild HF (HF1) (n = 7, 14 < VO2 < 22 mL/kg/min), and severe HF (HF2) (n = 9, VO2 ≤ 14 mL/kg/min). Results: Based on the statistical analysis with 20-100% restriction, FDR correction (p-value 0.05) and 2.0-fold change across the three time points (TP1, TP2, TP3) criteria, we obtained 11 differentially expressed genes (DEG). Out of these 11 genes, the median Gene Expression Profile value decreased from TP1 to TP2 in 10 genes. The only gene that did not follow this pattern was CCDC181. By performing 1-way ANOVA, we identified 8/11 genes in each of the two groups (HV versus HF) while 5 of the genes (TTC34, TMEM119, C19orf33, ID1, TKTL2) overlapped between the two groups. We found 265 genes which are differentially expressed between those who survived and those who died. Conclusions: From our proof-of-concept heart failure study, we conclude that gene expression correlates with VO2 peak in both healthy individuals and HF patients, potentially by regulating various physiological processes involved in oxygen uptake and utilization during exercise. Multi-omics profiling may help identify novel biomarkers for assessing exercise capacity and prognosis in HF patients, as well as potential targets for therapeutic intervention to improve VO2 peak and quality of life. We anticipate that our results will provide a novel metric for classifying immune health.
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Affiliation(s)
- Galyna Bondar
- David Geffen School of Medicine, University of California Los Angeles Medical Center, Los Angeles, CA 90095, USA; (G.B.); (T.-M.B.); (I.S.); (A.H.); (T.V.); (S.S.); (A.K.); (L.G.); (J.C.); (R.A.); (L.M.); (I.L.); (A.R.); (T.G.); (J.J.H.); (M.C.); (P.P.); (D.E.); (E.F.R.)
| | | | - Tra-Mi Bao
- David Geffen School of Medicine, University of California Los Angeles Medical Center, Los Angeles, CA 90095, USA; (G.B.); (T.-M.B.); (I.S.); (A.H.); (T.V.); (S.S.); (A.K.); (L.G.); (J.C.); (R.A.); (L.M.); (I.L.); (A.R.); (T.G.); (J.J.H.); (M.C.); (P.P.); (D.E.); (E.F.R.)
| | - Irina Silacheva
- David Geffen School of Medicine, University of California Los Angeles Medical Center, Los Angeles, CA 90095, USA; (G.B.); (T.-M.B.); (I.S.); (A.H.); (T.V.); (S.S.); (A.K.); (L.G.); (J.C.); (R.A.); (L.M.); (I.L.); (A.R.); (T.G.); (J.J.H.); (M.C.); (P.P.); (D.E.); (E.F.R.)
| | - Adrian Hairapetian
- David Geffen School of Medicine, University of California Los Angeles Medical Center, Los Angeles, CA 90095, USA; (G.B.); (T.-M.B.); (I.S.); (A.H.); (T.V.); (S.S.); (A.K.); (L.G.); (J.C.); (R.A.); (L.M.); (I.L.); (A.R.); (T.G.); (J.J.H.); (M.C.); (P.P.); (D.E.); (E.F.R.)
| | - Thomas Vu
- David Geffen School of Medicine, University of California Los Angeles Medical Center, Los Angeles, CA 90095, USA; (G.B.); (T.-M.B.); (I.S.); (A.H.); (T.V.); (S.S.); (A.K.); (L.G.); (J.C.); (R.A.); (L.M.); (I.L.); (A.R.); (T.G.); (J.J.H.); (M.C.); (P.P.); (D.E.); (E.F.R.)
| | - Stephanie Su
- David Geffen School of Medicine, University of California Los Angeles Medical Center, Los Angeles, CA 90095, USA; (G.B.); (T.-M.B.); (I.S.); (A.H.); (T.V.); (S.S.); (A.K.); (L.G.); (J.C.); (R.A.); (L.M.); (I.L.); (A.R.); (T.G.); (J.J.H.); (M.C.); (P.P.); (D.E.); (E.F.R.)
| | - Ananya Katappagari
- David Geffen School of Medicine, University of California Los Angeles Medical Center, Los Angeles, CA 90095, USA; (G.B.); (T.-M.B.); (I.S.); (A.H.); (T.V.); (S.S.); (A.K.); (L.G.); (J.C.); (R.A.); (L.M.); (I.L.); (A.R.); (T.G.); (J.J.H.); (M.C.); (P.P.); (D.E.); (E.F.R.)
| | - Liana Galan
- David Geffen School of Medicine, University of California Los Angeles Medical Center, Los Angeles, CA 90095, USA; (G.B.); (T.-M.B.); (I.S.); (A.H.); (T.V.); (S.S.); (A.K.); (L.G.); (J.C.); (R.A.); (L.M.); (I.L.); (A.R.); (T.G.); (J.J.H.); (M.C.); (P.P.); (D.E.); (E.F.R.)
| | - Joshua Chandran
- David Geffen School of Medicine, University of California Los Angeles Medical Center, Los Angeles, CA 90095, USA; (G.B.); (T.-M.B.); (I.S.); (A.H.); (T.V.); (S.S.); (A.K.); (L.G.); (J.C.); (R.A.); (L.M.); (I.L.); (A.R.); (T.G.); (J.J.H.); (M.C.); (P.P.); (D.E.); (E.F.R.)
| | - Ruben Adamov
- David Geffen School of Medicine, University of California Los Angeles Medical Center, Los Angeles, CA 90095, USA; (G.B.); (T.-M.B.); (I.S.); (A.H.); (T.V.); (S.S.); (A.K.); (L.G.); (J.C.); (R.A.); (L.M.); (I.L.); (A.R.); (T.G.); (J.J.H.); (M.C.); (P.P.); (D.E.); (E.F.R.)
| | - Lorenzo Mancusi
- David Geffen School of Medicine, University of California Los Angeles Medical Center, Los Angeles, CA 90095, USA; (G.B.); (T.-M.B.); (I.S.); (A.H.); (T.V.); (S.S.); (A.K.); (L.G.); (J.C.); (R.A.); (L.M.); (I.L.); (A.R.); (T.G.); (J.J.H.); (M.C.); (P.P.); (D.E.); (E.F.R.)
| | - Isabel Lai
- David Geffen School of Medicine, University of California Los Angeles Medical Center, Los Angeles, CA 90095, USA; (G.B.); (T.-M.B.); (I.S.); (A.H.); (T.V.); (S.S.); (A.K.); (L.G.); (J.C.); (R.A.); (L.M.); (I.L.); (A.R.); (T.G.); (J.J.H.); (M.C.); (P.P.); (D.E.); (E.F.R.)
| | - Anca Rahman
- David Geffen School of Medicine, University of California Los Angeles Medical Center, Los Angeles, CA 90095, USA; (G.B.); (T.-M.B.); (I.S.); (A.H.); (T.V.); (S.S.); (A.K.); (L.G.); (J.C.); (R.A.); (L.M.); (I.L.); (A.R.); (T.G.); (J.J.H.); (M.C.); (P.P.); (D.E.); (E.F.R.)
| | - Tristan Grogan
- David Geffen School of Medicine, University of California Los Angeles Medical Center, Los Angeles, CA 90095, USA; (G.B.); (T.-M.B.); (I.S.); (A.H.); (T.V.); (S.S.); (A.K.); (L.G.); (J.C.); (R.A.); (L.M.); (I.L.); (A.R.); (T.G.); (J.J.H.); (M.C.); (P.P.); (D.E.); (E.F.R.)
| | - Jeffrey J. Hsu
- David Geffen School of Medicine, University of California Los Angeles Medical Center, Los Angeles, CA 90095, USA; (G.B.); (T.-M.B.); (I.S.); (A.H.); (T.V.); (S.S.); (A.K.); (L.G.); (J.C.); (R.A.); (L.M.); (I.L.); (A.R.); (T.G.); (J.J.H.); (M.C.); (P.P.); (D.E.); (E.F.R.)
| | - Monica Cappelletti
- David Geffen School of Medicine, University of California Los Angeles Medical Center, Los Angeles, CA 90095, USA; (G.B.); (T.-M.B.); (I.S.); (A.H.); (T.V.); (S.S.); (A.K.); (L.G.); (J.C.); (R.A.); (L.M.); (I.L.); (A.R.); (T.G.); (J.J.H.); (M.C.); (P.P.); (D.E.); (E.F.R.)
| | - Peipei Ping
- David Geffen School of Medicine, University of California Los Angeles Medical Center, Los Angeles, CA 90095, USA; (G.B.); (T.-M.B.); (I.S.); (A.H.); (T.V.); (S.S.); (A.K.); (L.G.); (J.C.); (R.A.); (L.M.); (I.L.); (A.R.); (T.G.); (J.J.H.); (M.C.); (P.P.); (D.E.); (E.F.R.)
| | - David Elashoff
- David Geffen School of Medicine, University of California Los Angeles Medical Center, Los Angeles, CA 90095, USA; (G.B.); (T.-M.B.); (I.S.); (A.H.); (T.V.); (S.S.); (A.K.); (L.G.); (J.C.); (R.A.); (L.M.); (I.L.); (A.R.); (T.G.); (J.J.H.); (M.C.); (P.P.); (D.E.); (E.F.R.)
| | - Elaine F. Reed
- David Geffen School of Medicine, University of California Los Angeles Medical Center, Los Angeles, CA 90095, USA; (G.B.); (T.-M.B.); (I.S.); (A.H.); (T.V.); (S.S.); (A.K.); (L.G.); (J.C.); (R.A.); (L.M.); (I.L.); (A.R.); (T.G.); (J.J.H.); (M.C.); (P.P.); (D.E.); (E.F.R.)
| | - Mario C. Deng
- David Geffen School of Medicine, University of California Los Angeles Medical Center, Los Angeles, CA 90095, USA; (G.B.); (T.-M.B.); (I.S.); (A.H.); (T.V.); (S.S.); (A.K.); (L.G.); (J.C.); (R.A.); (L.M.); (I.L.); (A.R.); (T.G.); (J.J.H.); (M.C.); (P.P.); (D.E.); (E.F.R.)
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Martínez M, Postolache TT, García-Bueno B, Leza JC, Figuero E, Lowry CA, Malan-Müller S. The Role of the Oral Microbiota Related to Periodontal Diseases in Anxiety, Mood and Trauma- and Stress-Related Disorders. Front Psychiatry 2021; 12:814177. [PMID: 35153869 PMCID: PMC8833739 DOI: 10.3389/fpsyt.2021.814177] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 12/30/2021] [Indexed: 12/12/2022] Open
Abstract
The prevalence of anxiety, mood and trauma- and stress-related disorders are on the rise; however, efforts to develop new and effective treatment strategies have had limited success. To identify novel therapeutic targets, a comprehensive understanding of the disease etiology is needed, especially in the context of the holobiont, i.e., the superorganism consisting of a human and its microbiotas. Much emphasis has been placed on the role of the gut microbiota in the development, exacerbation, and persistence of psychiatric disorders; however, data for the oral microbiota are limited. The oral cavity houses the second most diverse microbial community in the body, with over 700 bacterial species that colonize the soft and hard tissues. Periodontal diseases encompass a group of infectious and inflammatory diseases that affect the periodontium. Among them, periodontitis is defined as a chronic, multi-bacterial infection that elicits low-grade systemic inflammation via the release of pro-inflammatory cytokines, as well as local invasion and long-distance translocation of periodontal pathogens. Periodontitis can also induce or exacerbate other chronic systemic inflammatory diseases such as atherosclerosis and diabetes and can lead to adverse pregnancy outcomes. Recently, periodontal pathogens have been implicated in the etiology and pathophysiology of neuropsychiatric disorders (such as depression and schizophrenia), especially as dysregulation of the immune system also plays an integral role in the etiology and pathophysiology of these disorders. This review will discuss the role of the oral microbiota associated with periodontal diseases in anxiety, mood and trauma- and stress-related disorders. Epidemiological data of periodontal diseases in individuals with these disorders will be presented, followed by a discussion of the microbiological and immunological links between the oral microbiota and the central nervous system. Pre-clinical and clinical findings on the oral microbiota related to periodontal diseases in anxiety, mood and trauma- and stress-related phenotypes will be reviewed, followed by a discussion on the bi-directionality of the oral-brain axis. Lastly, we will focus on the oral microbiota associated with periodontal diseases as a target for future therapeutic interventions to alleviate symptoms of these debilitating psychiatric disorders.
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Affiliation(s)
- María Martínez
- Etiology and Therapy of Periodontal and Peri-Implant Diseases Research Group, University Complutense Madrid, Madrid, Spain.,Department of Dental Clinical Specialties, Faculty of Dentistry, Universidad Complutense de Madrid, Madrid, Spain
| | - Teodor T Postolache
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, United States.,Military and Veteran Microbiome: Consortium for Research and Education, Aurora, CO, United States.,Rocky Mountain Mental Illness Research Education and Clinical Center, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, United States
| | - Borja García-Bueno
- Department of Pharmacology and Toxicology, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain.,Hospital 12 de Octubre Research Institute (Imas12), Neurochemistry Research Institute, Universidad Complutense de Madrid, Madrid, Spain.,Biomedical Network Research Center of Mental Health (CIBERSAM), Institute of Health Carlos III, Madrid, Spain
| | - Juan C Leza
- Department of Pharmacology and Toxicology, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain.,Hospital 12 de Octubre Research Institute (Imas12), Neurochemistry Research Institute, Universidad Complutense de Madrid, Madrid, Spain.,Biomedical Network Research Center of Mental Health (CIBERSAM), Institute of Health Carlos III, Madrid, Spain
| | - Elena Figuero
- Etiology and Therapy of Periodontal and Peri-Implant Diseases Research Group, University Complutense Madrid, Madrid, Spain.,Department of Dental Clinical Specialties, Faculty of Dentistry, Universidad Complutense de Madrid, Madrid, Spain
| | - Christopher A Lowry
- Military and Veteran Microbiome: Consortium for Research and Education, Aurora, CO, United States.,Rocky Mountain Mental Illness Research Education and Clinical Center, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, United States.,Department of Integrative Physiology, Center for Neuroscience, Center for Microbial Exploration, University of Colorado Boulder, Boulder, CO, United States.,Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.,inVIVO Planetary Health of the Worldwide Universities Network, New York, NY, United States
| | - Stefanie Malan-Müller
- Department of Pharmacology and Toxicology, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain.,Biomedical Network Research Center of Mental Health (CIBERSAM), Institute of Health Carlos III, Madrid, Spain
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Pagliaccio D, Herbstman JB, Perera F, Tang D, Goldsmith J, Peterson BS, Rauh V, Margolis AE. Prenatal exposure to polycyclic aromatic hydrocarbons modifies the effects of early life stress on attention and Thought Problems in late childhood. J Child Psychol Psychiatry 2020; 61:1253-1265. [PMID: 31907931 PMCID: PMC7338249 DOI: 10.1111/jcpp.13189] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 11/15/2019] [Accepted: 12/04/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Risk for childhood psychopathology is complex and multifactorial, implicating direct and interacting effects of familial and environmental factors. The role of environmental neurotoxicants in psychiatric risk is of growing concern, including polycyclic aromatic hydrocarbons (PAH), common in air pollution. Prenatal PAH exposure is linked to adverse physical, behavioral, and cognitive outcomes as well as increasing psychiatric risk. It is unclear whether environmental exposures, like PAH, magnify the effects of exposure to early life stress (ELS), a critical risk factor for psychopathology. The current work aimed to test potential interactions between prenatal PAH exposure and psychosocial/socioeconomic stress on psychiatric symptoms in school-age children. METHODS Data were from the Columbia Center for Children's Environmental Health Mothers and Newborns longitudinal birth cohort study. Prenatal PAH exposure was ascertained though air monitoring during pregnancy and maternal PAH-DNA adducts at delivery. Mothers reported on ELS (child age 5) and on child psychiatric symptoms across childhood (child age 5, 7, 9, and 11) using the Child Behavior Checklist (CBCL). RESULTS Significant prenatal airborne PAH × ELS interactions (FDR-corrected) predicted CBCL Attention (β = 0.22, t(307) = 3.47, p < .001, pfdr = .003) and Thought Problems T-scores (β = 0.21, t(307) = 3.29, p = .001, pfdr = .004) at age 11 (n = 319). Relative to those with lower exposure, children with higher prenatal PAH exposure exhibited stronger positive associations between ELS and CBCL Attention and Thought Problem T-scores. This interaction was also significant examining convergent ADHD measures (Conners, DuPaul) and examining maternal PAH-DNA adducts (β = 0.29, t(261) = 2.48, p = .01; n = 273). A three-way interaction with assessment wave indicated that the PAH × ELS interaction on Attention Problems was stronger later in development (β = 0.03, t(1,601) = 2.19, p = .03; n = 477). CONCLUSIONS Prenatal exposure to PAH, a common neurotoxicant in air pollution, may magnify or sustain the effects of early life psychosocial/socioeconomic stress on psychiatric outcomes later in child development. This work highlights the critical role of air pollution exposure on child mental health.
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Affiliation(s)
- David Pagliaccio
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, NY, USA;,Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Julie B. Herbstman
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA;,Columbia Center for Children’s Environmental Health, Department of Environmental Health Sciences, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Frederica Perera
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA;,Columbia Center for Children’s Environmental Health, Department of Environmental Health Sciences, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Deliang Tang
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA;,Columbia Center for Children’s Environmental Health, Department of Environmental Health Sciences, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Jeff Goldsmith
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Bradley S. Peterson
- Department of Psychiatry, Keck School of Medicine University of Southern California, Los Angeles, CA, USA
| | - Virginia Rauh
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA;,Columbia Center for Children’s Environmental Health, Department of Environmental Health Sciences, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Amy E. Margolis
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, NY, USA;,Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
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Ndongson-Dongmo B, Lang GP, Mece O, Hechaichi N, Lajqi T, Hoyer D, Brodhun M, Heller R, Wetzker R, Franz M, Levy FO, Bauer R. Reduced ambient temperature exacerbates SIRS-induced cardiac autonomic dysregulation and myocardial dysfunction in mice. Basic Res Cardiol 2019; 114:26. [DOI: 10.1007/s00395-019-0734-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 04/12/2019] [Indexed: 12/13/2022]
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Abstract
PURPOSE OF THE REVIEW Proinflammatory cytokines are consistently elevated in congestive heart failure. In the current review, we provide an overview on the current understanding of how tumor necrosis factor-α (TNFα), a key proinflammatory cytokine, potentiates heart failure by overwhelming the anti-inflammatory responses disrupting the homeostasis. RECENT FINDINGS Studies have shown co-relationship between severity of heart failure and levels of the proinflammatory cytokine TNFα and one of its secondary mediators interleukin-6 (IL-6), suggesting their potential as biomarkers. Recent efforts have focused on understanding the mechanisms of how proinflammatory cytokines contribute towards cardiac dysfunction and failure. In addition, how unchecked proinflammatory cytokines and their cross-talk with sympathetic system overrides the anti-inflammatory response underlying failure. The review offers insights on how TNFα and IL-6 contribute to cardiac dysfunction and failure. Furthermore, this provides a forum to begin the discussion on the cross-talk between sympathetic drive and proinflammatory cytokines and its determinant role in deleterious outcomes.
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Affiliation(s)
- Sarah M Schumacher
- NB50, Department of Molecular Cardiology, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Sathyamangla V Naga Prasad
- NB50, Department of Molecular Cardiology, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
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Perera FP, Wheelock K, Wang Y, Tang D, Margolis AE, Badia G, Cowell W, Miller RL, Rauh V, Wang S, Herbstman JB. Combined effects of prenatal exposure to polycyclic aromatic hydrocarbons and material hardship on child ADHD behavior problems. ENVIRONMENTAL RESEARCH 2018; 160:506-513. [PMID: 28987706 PMCID: PMC5724364 DOI: 10.1016/j.envres.2017.09.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 08/28/2017] [Accepted: 09/07/2017] [Indexed: 05/22/2023]
Abstract
IMPORTANCE Polycyclic aromatic hydrocarbons (PAH) are carcinogenic and neurotoxic combustion by-products commonly found in urban air. Exposure to PAH is disproportionately high in low income communities of color who also experience chronic economic stress. OBJECTIVE In a prospective cohort study in New York City (NYC) we previously found a significant association between prenatal PAH exposure and Attention Deficit Hyperactivity Disorder (ADHD) behavior problems at age 9. Here, we have evaluated the joint effects of prenatal exposure to PAH and prenatal/childhood material hardship on ADHD behavior problems. MATERIALS AND METHODS We enrolled nonsmoking African-American and Dominican pregnant women in New York City between 1998 and 2006 and followed their children through 9 years of age. As a biomarker of prenatal PAH exposure, PAH-DNA adducts were measured in maternal blood at delivery and were dichotomized at the limit of detection (to indicate high vs. low exposure). Maternal material hardship (lack of adequate food, housing, utilities, and clothing) was self-reported prenatally and at multiple time points through child age 9. Latent variable analysis identified four distinct patterns of hardship. ADHD behavior problems were assessed using the Conners Parent Rating Scale- Revised. Analyses adjusted for relevant covariates. RESULTS Among 351 children in our sample, across all hardship groups, children with high prenatal PAH exposure (high adducts) generally had more symptoms of ADHD (higher scores) compared to those with low PAH exposure. The greatest difference was seen among the children with hardship persisting from pregnancy through childhood. Although the interactions between high PAH exposure and hardship experienced at either period ("persistent" hardship or "any" hardship) were not significant, we observed significant differences in the number of ADHD symptoms between children with high prenatal PAH exposure and either persistent hardship or any hardship compared to the others. These differences were most significant for combined high PAH and persistent hardship: ADHD Index (p < 0.008), DSM-IV Inattentive (p = 0.006), DSM-IV Hyperactive Impulsive problems (p = 0.033), and DSM-IV Index Total (p = 0.009). CONCLUSION The present findings add to existing evidence that co-exposure to socioeconomic disadvantage and air pollution in early life significantly increases the risk of adverse neurodevelopmental outcomes. They suggest the need for multifaceted interventions to protect pregnant mothers and their children.
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Affiliation(s)
- Frederica P Perera
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, 722W. 168th Street, New York, NY 10032, USA; Columbia Center for Children's Environmental Health, Mailman School of Public Health, Columbia University, 722W. 168th Street, New York, NY 10032, USA.
| | - Kylie Wheelock
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, 722W. 168th Street, New York, NY 10032, USA; Columbia Center for Children's Environmental Health, Mailman School of Public Health, Columbia University, 722W. 168th Street, New York, NY 10032, USA.
| | - Ya Wang
- Columbia Center for Children's Environmental Health, Mailman School of Public Health, Columbia University, 722W. 168th Street, New York, NY 10032, USA; Department of Biostatistics, Mailman School of Public Health, Columbia University, 722W. 168th Street, New York, NY 10032, USA.
| | - Deliang Tang
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, 722W. 168th Street, New York, NY 10032, USA; Columbia Center for Children's Environmental Health, Mailman School of Public Health, Columbia University, 722W. 168th Street, New York, NY 10032, USA.
| | - Amy E Margolis
- Columbia Center for Children's Environmental Health, Mailman School of Public Health, Columbia University, 722W. 168th Street, New York, NY 10032, USA; The Heilbrunn Center for Population and Family Health, Mailman School of Public Health, Columbia University, 60 Haven Avenue, New York, NY 10032, USA.
| | - Gladys Badia
- Columbia Center for Children's Environmental Health, Mailman School of Public Health, Columbia University, 722W. 168th Street, New York, NY 10032, USA.
| | - Whitney Cowell
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, 722W. 168th Street, New York, NY 10032, USA.
| | - Rachel L Miller
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, 722W. 168th Street, New York, NY 10032, USA; Columbia Center for Children's Environmental Health, Mailman School of Public Health, Columbia University, 722W. 168th Street, New York, NY 10032, USA; Division of Child & Adolescent Psychiatry and the Center for Developmental Neuropsychiatry, Department of Psychiatry, the New York State Psychiatric Institute and the College of Physicians and Surgeons, Columbia University, New York, NY, USA; Division of Pulmonary, Allergy and Critical Care of Medicine, Department of Medicine, College of Physicians and Surgeons, Columbia University, 630 West 168th Street, New York, NY 10032, USA.
| | - Virginia Rauh
- Columbia Center for Children's Environmental Health, Mailman School of Public Health, Columbia University, 722W. 168th Street, New York, NY 10032, USA; Division of Pediatric Allergy, Immunology and Rheumatology, Department of Pediatrics, College of Physicians and Surgeons, Columbia University, 630 West 168th Street, New York, New York 10032, USA.
| | - Shuang Wang
- Columbia Center for Children's Environmental Health, Mailman School of Public Health, Columbia University, 722W. 168th Street, New York, NY 10032, USA; Department of Biostatistics, Mailman School of Public Health, Columbia University, 722W. 168th Street, New York, NY 10032, USA.
| | - Julie B Herbstman
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, 722W. 168th Street, New York, NY 10032, USA; Columbia Center for Children's Environmental Health, Mailman School of Public Health, Columbia University, 722W. 168th Street, New York, NY 10032, USA.
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8
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Janam P, Saneesh Babu PS, Prasad M, Vinod D, Anil Kumar PR, Kumary TV, Asha Nair S, Radhakrishna Pillai M. An ex vivo evaluation of the efficacy of andrographolide in modulating differential expression of transcription factors and target genes in periodontal cells and its potential role in treating periodontal diseases. JOURNAL OF ETHNOPHARMACOLOGY 2017; 196:160-167. [PMID: 27993634 DOI: 10.1016/j.jep.2016.12.029] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 12/14/2016] [Accepted: 12/15/2016] [Indexed: 06/06/2023]
Abstract
ETHANOPHARMACOLOGICAL RELEVANCE Andrographolide is a herbal extract traditionally used in South Asian countries for treating inflammatory diseases. AIM OF THE STUDY To evaluate the efficacy of andrographolide in management of periodontal disease which is a highly prevalent oral disease. MATERIALS AND METHODS Periodontal ligament fibroblasts (PDLF) were cultured from healthy and diseased periodontium using explant culture methods. The safe dose of AG was determined using MTT assay. LPS (lipopolysaccharide) of the most important periodontopathogen, P gingivalis was used to activate NF-κB and STAT3 in PDLF. The efficacy of AG in inhibiting NF-κB and STAT3 was analyzed using immunofluorescence. Down regulation of expression of target genes of these transcription factors related to inflammation and bone resorption were analyzed using real time PCR. RESULTS AG up to the concentration of 25μM was found to be safe as determined by MTT assay. Statistically significant activation of NF-κB and STAT3 in cultured PDLF was observed in diseased group compared to healthy controls before and after LPS challenge. 5μM AG pretreatment significantly inhibited activation of NF-κB and STAT3 and down regulated expression of inflammatory and bone resorptive genes in cultured PDLF. CONCLUSIONS The findings of the present study propose the adjunctive use of a novel herbal drug andrographolide as a promising host modulation agent for periodontal therapy by inhibiting NF-κB and STAT3 activation and inhibition of inflammation and bone resorption related genes.
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Affiliation(s)
| | - P S Saneesh Babu
- Rajiv Gandhi Centre for Biotechnology (RGCB), Poojappura, Thiruvananthapuram 695014, Kerala, India
| | - Manu Prasad
- Rajiv Gandhi Centre for Biotechnology (RGCB), Poojappura, Thiruvananthapuram 695014, Kerala, India
| | - D Vinod
- Tissue Culture Laboratory, Sree Chitra Thirunal Institute for Medical Sciences and Technology (SCTIMST), Biomedical Technology Wing, Poojapura 695012, Thiruvananthapuram, India
| | - P R Anil Kumar
- Tissue Culture Laboratory, Sree Chitra Thirunal Institute for Medical Sciences and Technology (SCTIMST), Biomedical Technology Wing, Poojapura 695012, Thiruvananthapuram, India
| | - T V Kumary
- Tissue Culture Laboratory, Sree Chitra Thirunal Institute for Medical Sciences and Technology (SCTIMST), Biomedical Technology Wing, Poojapura 695012, Thiruvananthapuram, India
| | - S Asha Nair
- Rajiv Gandhi Centre for Biotechnology (RGCB), Poojappura, Thiruvananthapuram 695014, Kerala, India
| | - M Radhakrishna Pillai
- Rajiv Gandhi Centre for Biotechnology (RGCB), Poojappura, Thiruvananthapuram 695014, Kerala, India
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9
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Warren KR, Postolache TT, Groer ME, Pinjari O, Kelly DL, Reynolds MA. Role of chronic stress and depression in periodontal diseases. Periodontol 2000 2015; 64:127-38. [PMID: 24320960 PMCID: PMC7167640 DOI: 10.1111/prd.12036] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2013] [Indexed: 12/15/2022]
Abstract
An extensive body of experimental and clinical evidence documents the negative impact of chronic psychological stress and depression on the immune system and health. Chronic stress and depression can result in general dysregulation of the immune system, of both cellular and humoral pathways, which may contribute to pathogenic infection and concomitant periodontal tissue destruction. In general, the evidence is consistent with the hypothesis that stress can modify the host defense and progression of periodontal infections in patients susceptible to periodontitis. However, substantial evidence also indicates that these conditions can mediate risk for disease, including periodontitis, through changes in health-related behaviors, such as oral hygiene, smoking and diet. The unequivocal interpretation of studies has also been hampered, in part, by issues related to conceptualization of stress and depression, as well as commonly associated comorbidities, such as diabetes, that can modify the onset and progression of periodontal disease. In addition, stress and depression appear to fall into a spectrum, ranging from mild to severe, involving a complex interaction of genetic background, coping strategies and environment. Differences in the conceptualization of stress and depression are probably important in assessing associations with other biologic and clinical measures. Future studies are necessary to clarify the complex interactions of chronic stress and depression in periodontal diseases.
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10
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Vishnevetsky J, Tang D, Chang HW, Roen EL, Wang Y, Rauh V, Wang S, Miller RL, Herbstman J, Perera FP. Combined effects of prenatal polycyclic aromatic hydrocarbons and material hardship on child IQ. Neurotoxicol Teratol 2015; 49:74-80. [PMID: 25912623 DOI: 10.1016/j.ntt.2015.04.002] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 02/20/2015] [Accepted: 04/15/2015] [Indexed: 01/09/2023]
Abstract
IMPORTANCE Polycyclic aromatic hydrocarbons are common carcinogenic and neurotoxic urban air pollutants. Toxic exposures, including air pollution, are disproportionately high in communities of color and frequently co-occur with chronic economic deprivation. OBJECTIVES We examined whether the association between child IQ and prenatal exposure to polycyclic aromatic hydrocarbons differed between groups of children whose mothers reported high vs. low material hardship during their pregnancy and through child age 5. We tested statistical interactions between hardships and polycyclic aromatic hydrocarbons, as measured by DNA adducts in cord blood, to determine whether material hardship exacerbated the association between adducts and IQ scores. DESIGN Prospective cohort. Participants were recruited from 1998 to 2006 and followed from gestation through age 7 years. SETTING Urban community (New York City) PARTICIPANTS A community-based sample of 276 minority urban youth EXPOSURE MEASURE: Polycyclic aromatic hydrocarbon-DNA adducts in cord blood as an individual biomarker of prenatal polycyclic aromatic hydrocarbon exposure. Maternal material hardship self-reported prenatally and at multiple timepoints through early childhood. MAIN OUTCOME MEASURE Child IQ at 7 years assessed using the Wechsler Intelligence Scale for Children. RESULTS Significant inverse effects of high cord PAH-DNA adducts on full scale IQ, perceptual reasoning and working memory scores were observed in the groups whose mothers reported a high level of material hardship during pregnancy or recurring high hardship into the child's early years, and not in those without reported high hardship. Significant interactions were observed between high cord adducts and prenatal hardship on working memory scores (β = -8.07, 95% CI (-14.48, -1.66)) and between high cord adducts and recurrent material hardship (β = -9.82, 95% CI (-16.22, -3.42)). CONCLUSION The findings add to other evidence that socioeconomic disadvantage can increase the adverse effects of toxic physical "stressors" like air pollutants. Observed associations between high cord adducts and reduced IQ were significant only among the group of children whose mothers reported high material hardship. These results indicate the need for a multifaceted approach to prevention.
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Affiliation(s)
- Julia Vishnevetsky
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, 722 W. 168th Street, New York, NY 10032, USA; Columbia Center for Children's Environmental Health, Mailman School of Public Health, Columbia University, 722 W. 168th Street, New York, NY 10032, USA
| | - Deliang Tang
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, 722 W. 168th Street, New York, NY 10032, USA; Columbia Center for Children's Environmental Health, Mailman School of Public Health, Columbia University, 722 W. 168th Street, New York, NY 10032, USA
| | - Hsin-Wen Chang
- Columbia Center for Children's Environmental Health, Mailman School of Public Health, Columbia University, 722 W. 168th Street, New York, NY 10032, USA; Department of Biostatistics, Mailman School of Public Health, Columbia University, 722 W. 168th Street, New York, NY 10032, USA
| | - Emily L Roen
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, 722 W. 168th Street, New York, NY 10032, USA; Columbia Center for Children's Environmental Health, Mailman School of Public Health, Columbia University, 722 W. 168th Street, New York, NY 10032, USA
| | - Ya Wang
- Columbia Center for Children's Environmental Health, Mailman School of Public Health, Columbia University, 722 W. 168th Street, New York, NY 10032, USA; Department of Biostatistics, Mailman School of Public Health, Columbia University, 722 W. 168th Street, New York, NY 10032, USA
| | - Virginia Rauh
- Columbia Center for Children's Environmental Health, Mailman School of Public Health, Columbia University, 722 W. 168th Street, New York, NY 10032, USA; The Heilbrunn Center for Population and Family Health, Mailman School of Public Health, Columbia University, 60 Haven Avenue, New York, NY 10032, USA
| | - Shuang Wang
- Columbia Center for Children's Environmental Health, Mailman School of Public Health, Columbia University, 722 W. 168th Street, New York, NY 10032, USA; Department of Biostatistics, Mailman School of Public Health, Columbia University, 722 W. 168th Street, New York, NY 10032, USA
| | - Rachel L Miller
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, 722 W. 168th Street, New York, NY 10032, USA; Columbia Center for Children's Environmental Health, Mailman School of Public Health, Columbia University, 722 W. 168th Street, New York, NY 10032, USA; Division of Pulmonary, Allergy and Critical Care of Medicine, Department of Medicine, College of Physicians and Surgeons, Columbia University, 630 West 168th Street, New York, NY 10032, USA; Division of Pediatric Allergy, Immunology and Rheumatology, Department of Pediatrics, College of Physicians and Surgeons, Columbia University, 630 West 168th Street, New York, NY 10032, USA
| | - Julie Herbstman
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, 722 W. 168th Street, New York, NY 10032, USA; Columbia Center for Children's Environmental Health, Mailman School of Public Health, Columbia University, 722 W. 168th Street, New York, NY 10032, USA
| | - Frederica P Perera
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, 722 W. 168th Street, New York, NY 10032, USA; Columbia Center for Children's Environmental Health, Mailman School of Public Health, Columbia University, 722 W. 168th Street, New York, NY 10032, USA.
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11
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Pereira-Figueiredo I, Carro J, Muñoz LJ, Sancho C, Castellano O, Gómez-Nieto R, López DE. Sex Differences in the Effects of Sertraline and Stressors in Rats Previously Exposed to Restraint Stress. ACTA ACUST UNITED AC 2015. [DOI: 10.4236/jbise.2015.87038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
Regional anesthesia plays a key role in the treatment of patients with orthopedic trauma. Trauma-induced pain can be in multiple locations, severe, and can predispose the patient to other morbidities. Additional complications as a result of the overdependence on opioids as a primary pain therapy that can be minimized or avoided with the use of regional anesthesia. Both neuraxial and peripheral regional techniques in patients with orthopedic trauma should be incorporated into the patient care plan and recognized as an essential therapeutic intervention in the overall treatment of this unique patient population.
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Affiliation(s)
- Laura Clark
- Department of Anesthesiology and Perioperative Medicine, University of Louisville School of Medicine, 530 S Jackson Street, C2A01, Louisville, KY 40202, USA.
| | - Marjorie Robinson
- Department of Anesthesiology and Perioperative Medicine, University of Louisville School of Medicine, 530 S Jackson Street, C2A01, Louisville, KY 40202, USA
| | - Marina Varbanova
- Department of Anesthesiology and Perioperative Medicine, University of Louisville School of Medicine, 530 S Jackson Street, C2A01, Louisville, KY 40202, USA
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13
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Silverman MN, Deuster PA. Biological mechanisms underlying the role of physical fitness in health and resilience. Interface Focus 2014; 4:20140040. [PMID: 25285199 PMCID: PMC4142018 DOI: 10.1098/rsfs.2014.0040] [Citation(s) in RCA: 201] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Physical fitness, achieved through regular exercise and/or spontaneous physical activity, confers resilience by inducing positive psychological and physiological benefits, blunting stress reactivity, protecting against potentially adverse behavioural and metabolic consequences of stressful events and preventing many chronic diseases. In this review, we discuss the biological mechanisms underlying the beneficial effects of physical fitness on mental and physical health. Physical fitness appears to buffer against stress-related disease owing to its blunting/optimizing effects on hormonal stress responsive systems, such as the hypothalamic-pituitary-adrenal axis and the sympathetic nervous system. This blunting appears to contribute to reduced emotional, physiological and metabolic reactivity as well as increased positive mood and well-being. Another mechanism whereby regular exercise and/or physical fitness may confer resilience is through minimizing excessive inflammation. Chronic psychological stress, physical inactivity and abdominal adiposity have been associated with persistent, systemic, low-grade inflammation and exert adverse effects on mental and physical health. The anti-inflammatory effects of regular exercise/activity can promote behavioural and metabolic resilience, and protect against various chronic diseases associated with systemic inflammation. Moreover, exercise may benefit the brain by enhancing growth factor expression and neural plasticity, thereby contributing to improved mood and cognition. In summary, the mechanisms whereby physical fitness promotes increased resilience and well-being and positive psychological and physical health are diverse and complex.
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Affiliation(s)
| | - Patricia A. Deuster
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
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14
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Protein glycation during aging and in cardiovascular disease. J Proteomics 2013; 92:248-59. [DOI: 10.1016/j.jprot.2013.05.012] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 05/08/2013] [Accepted: 05/12/2013] [Indexed: 01/11/2023]
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15
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Seaman DR. Body mass index and musculoskeletal pain: is there a connection? Chiropr Man Therap 2013; 21:15. [PMID: 23687943 PMCID: PMC3665675 DOI: 10.1186/2045-709x-21-15] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 05/17/2013] [Indexed: 02/07/2023] Open
Abstract
Background Back pain is one of the most common complaints that patients report to physicians and two-thirds of the population has an elevated body mass index (BMI), indicating they are either overweight or obese. It was once assumed that extra body weight would stress the low back and lead to pain, however, researchers have reported inconsistencies association between body weight and back pain. In contrast, more recent studies do indicate that an elevated BMI is associated with back pain and other musculoskeletal pain syndromes due to the presence of a chronic systemic inflammatory state, suggesting that the relationship between BMI and musculoskeletal pains be considered in more detail. Objective To describe how an elevated BMI can be associated with chronic systemic inflammation and pain expression. To outline measurable risk factors for chronic inflammation that can be used in clinical practice and discuss basic treatment considerations. Discussion Adiposopathy, or “sick fat” syndrome, is a term that refers to an elevated BMI that is associated with a chronic systemic inflammatory state most commonly referred to as the metabolic syndrome. The best available evidence suggests that the presence of adiposopathy determines if an elevated BMI will contribute to musculoskeletal pain expression. It is not uncommon for physicians to fail to identify the presence of adiposopathy/metabolic syndrome. Conclusion Patients with an elevated BMI should be further examined to identify inflammatory factors associated with adiposopathy, such as the metabolic syndrome, which may be promoting back pain and other musculoskeletal pain syndromes.
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Affiliation(s)
- David R Seaman
- National University of Health Sciences, SPC-Health Education Center, 7200 66th St, Pinellas Park, FL 33781, USA.
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16
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Djuric Z, Kashif M, Fleming T, Muhammad S, Piel D, von Bauer R, Bea F, Herzig S, Zeier M, Pizzi M, Isermann B, Hecker M, Schwaninger M, Bierhaus A, Nawroth PP. Targeting activation of specific NF-κB subunits prevents stress-dependent atherothrombotic gene expression. Mol Med 2012; 18:1375-86. [PMID: 23114885 DOI: 10.2119/molmed.2012.00282] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Accepted: 10/23/2012] [Indexed: 11/06/2022] Open
Abstract
Psychosocial stress has been shown to be a contributing factor in the development of atherosclerosis. Although the underlying mechanisms have not been elucidated entirely, it has been shown previously that the transcription factor nuclear factor-κB (NF-κB) is an important component of stress-activated signaling pathway. In this study, we aimed to decipher the mechanisms of stress-induced NF-κB-mediated gene expression, using an in vitro and in vivo model of psychosocial stress. Induction of stress led to NF-κB-dependent expression of proinflammatory (tissue factor, intracellular adhesive molecule 1 [ICAM-1]) and protective genes (manganese superoxide dismutase [MnSOD]) via p50, p65 or cRel. Selective inhibition of the different subunits and the respective kinases showed that inhibition of cRel leads to the reduction of atherosclerotic lesions in apolipoprotein(-/-) (ApoE(-/-)) mice via suppression of proinflammatory gene expression. This observation may therefore provide a possible explanation for ineffectiveness of antioxidant therapies and suggests that selective targeting of cRel activation may provide a novel approach for the treatment of stress-related inflammatory vascular disease.
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Affiliation(s)
- Zdenka Djuric
- Department of Medicine I and Clinical Chemistry, University of Heidelberg, Heidelberg, Germany
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17
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Simm A, Navarrete-Santos A, Hofmann B, Bushnaq H, Nass N. [Protein glycation as a pathological mechanism in diabetes]. Z Gerontol Geriatr 2012; 45:95-9. [PMID: 22350390 DOI: 10.1007/s00391-011-0282-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The incidence of diabetes has increased in the recent years. Diabetes is characterized by increased sugar concentrations in the blood. Due to this dysregulation, more carbohydrate-induced modification of proteins - so-called advanced glycation end products (AGEs) - are formed endogenously by non-enzymatic reactions. These are discussed to be at least in part responsible for diabetes-associated diseases. The accumulation of AGEs in the tissue can be used as a biomarker for patient outcome. In contrast, the effects of the uptake of AGEs from nutrition are still unclear.
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Affiliation(s)
- A Simm
- Klinik und Poliklinik für Herz und Thoraxchirurgie, Universitätsklinikum Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle, Deutschland.
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18
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Xu W, Hang J, Guo L, Zhao Y, Li Z, Gao W. Plasma fibrinogen: a possible link between job stress and cardiovascular disease among Chinese workers. Am J Ind Med 2012; 55:167-75. [PMID: 22025037 DOI: 10.1002/ajim.21017] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2011] [Indexed: 11/09/2022]
Abstract
BACKGROUND Little is known about the effect of effort-reward imbalance (ERI) on fibrinogen. We aimed to examine the association between ERI and fibrinogen among Chinese workers. METHODS A total of 732 subjects without vascular diseases were analyzed. Associations between job stress evaluated by ERI model and plasma fibrinogen were explored by multiple regression. RESULTS Effort, overcommitment, and ERI were significantly positively associated with fibrinogen, while reward was negatively related with fibrinogen both for men and for women. Compared with low level group, high level of effort, overcommitment, and ERI significantly increased risk of elevated fibrinogen (more than mean concentration) with adjusted OR of 3.3, 12.5, and 7.7 for men; 2.9, 7.2, and 7.2 for women, respectively; however, high reward reduced 80% risk for elevated fibrinogen. CONCLUSIONS Effort, overcommitment, and ERI are significantly associated with fibrinogen among Chinese workers. High fibrinogen may be a possible link between job stress and cardiovascular disease.
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Affiliation(s)
- Weixian Xu
- Department of Cardiology, Peking University Third Hospital and Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, No 49 North Garden Road, Haidian District, Beijing, China
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19
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McEwen BS, Tucker P. Critical biological pathways for chronic psychosocial stress and research opportunities to advance the consideration of stress in chemical risk assessment. Am J Public Health 2011; 101 Suppl 1:S131-9. [PMID: 22021312 DOI: 10.2105/ajph.2011.300270] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Emerging evidence suggests that psychosocial stress and toxicants may interact to modify health risks. Stress-toxicant interactions could be important in chemical risk assessment, but these interactions are poorly understood and additional research is necessary to advance their application. Environmental health research can increase knowledge of these interactions by exploring hypotheses on allostatic load, which measures the cumulative impacts of stress across multiple physiological pathways, using knowledge about physiological pathways for stress-related health effects, and evidence of common target pathways for both stress and toxicants. In this article, critical physiological pathways for stress-related health effects are discussed, with specific attention to allostatic load and stress-toxicant interactions, concluding with research suggestions for potential applications of such research in chemical risk assessment.
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Affiliation(s)
- Bruce S McEwen
- Harold and Margaret Milliken Hatch Laboratory of Neuroendrocrinology, Rockefeller University, New York, NY, USA
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20
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Novío S, Núñez MJ, Amigo G, Freire-Garabal M. Effects of fluoxetine on the oxidative status of peripheral blood leucocytes of restraint-stressed mice. Basic Clin Pharmacol Toxicol 2011; 109:365-71. [PMID: 21624059 DOI: 10.1111/j.1742-7843.2011.00736.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Emotional stress can be viewed as a cause of adverse circumstances that induces a wide range of biochemical and behavioural changes. Oxidative stress is a critical route of damage in various psychological stress-induced disorders such as depression. Antidepressants are widely prescribed to treat these conditions; however, no animal study has investigated the effect of selective serotonin reuptake inhibitors (SSRIs) on the levels of intracellular reactive oxygen species in peripheral blood leucocytes of stressed mice. In this study, mice were immobilized for a period of 6 hr. Fluoxetine (5 mg/kg of body-weight) was administered 30 min. before subjecting the animals to acute stress. The level of intracellular reactive oxygen species in leucocytes of the peripheral blood of stressed mice was investigated using a 2',7'-dichlorofluorescein diacetate probe, and the antioxidant response of fluoxetine was evaluated by superoxide dismutase, diaphorase, catalase and reduced glutathione. Our results show that restraint stress significantly increases the generation of reactive oxygen species in the peripheral defence cells. Treatment with fluoxetine partially reverses the adverse effects of stress. The improvement in cellular oxidative status may be an important mechanism underlying the protective pharmacological effects of fluoxetine, which are clinically observed in the treatment of depressive disorders.
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Affiliation(s)
- Silvia Novío
- Department of Pharmacology, School of Medicine and Dentistry, University of Santiago de Compostela, C/San Francisco, Spain
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21
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Shivpuri S, Gallo LC, Crouse JR, Allison MA. The association between chronic stress type and C-reactive protein in the multi-ethnic study of atherosclerosis: does gender make a difference? J Behav Med 2011; 35:74-85. [PMID: 21503709 DOI: 10.1007/s10865-011-9345-5] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2010] [Accepted: 04/05/2011] [Indexed: 01/24/2023]
Abstract
The objective of this study is to examine how chronic stress in major life domains [relationship, work, sympathetic-caregiving, financial] relates to CVD risk, operationalized using the inflammatory marker C-Reactive Protein (CRP), and whether gender differences exist. Participants were 6,583 individuals aged 45-84 years, recruited as part of the Multi-Ethnic Study of Atherosclerosis. Demographic and behavioral factors, health history, and chronic stress were self-reported. CRP was obtained through venous blood draw. In aggregate, gender by chronic stress interaction effects accounted for a significant, albeit small, amount of variance in CRP (P < .01). The sympathetic-caregiving stress by gender interaction was significant (P < .01); the work stress by gender effect approached significance (P = .05). Women with sympathetic-caregiving stress had higher CRP than those without, whereas no difference in CRP by stress group was observed for men. Findings underscore the importance of considering gender as an effect modifier in analyses of stress-CVD risk relationships.
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Affiliation(s)
- Smriti Shivpuri
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California-San Diego, 9245 Sky Park Ct., San Diego, CA 92123, USA.
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Identifying blood biomarkers and physiological processes that distinguish humans with superior performance under psychological stress. PLoS One 2009; 4:e8371. [PMID: 20020041 PMCID: PMC2791215 DOI: 10.1371/journal.pone.0008371] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2009] [Accepted: 11/19/2009] [Indexed: 11/22/2022] Open
Abstract
Background Attrition of students from aviation training is a serious financial and operational concern for the U.S. Navy. Each late stage navy aviator training failure costs the taxpayer over $1,000,000 and ultimately results in decreased operational readiness of the fleet. Currently, potential aviators are selected based on the Aviation Selection Test Battery (ASTB), which is a series of multiple-choice tests that evaluate basic and aviation-related knowledge and ability. However, the ASTB does not evaluate a person's response to stress. This is important because operating sophisticated aircraft demands exceptional performance and causes high psychological stress. Some people are more resistant to this type of stress, and consequently better able to cope with the demands of naval aviation, than others. Methodology/Principal Findings Although many psychological studies have examined psychological stress resistance none have taken advantage of the human genome sequence. Here we use high-throughput -omic biology methods and a novel statistical data normalization method to identify plasma proteins associated with human performance under psychological stress. We identified proteins involved in four basic physiological processes: innate immunity, cardiac function, coagulation and plasma lipid physiology. Conclusions/Significance The proteins identified here further elucidate the physiological response to psychological stress and suggest a hypothesis that stress-susceptible pilots may be more prone to shock. This work also provides potential biomarkers for screening humans for capability of superior performance under stress.
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Schmittinger CA, Wurzinger B, Deutinger M, Wohlmuth C, Knotzer H, Torgersen C, Dünser MW, Hasibeder WR. How to protect the heart in septic shock: a hypothesis on the pathophysiology and treatment of septic heart failure. Med Hypotheses 2009; 74:460-5. [PMID: 19889504 DOI: 10.1016/j.mehy.2009.10.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2009] [Accepted: 10/04/2009] [Indexed: 01/29/2023]
Abstract
Heart failure is a well-recognized manifestation of organ failure in sepsis and septic shock. The pathophysiology of septic heart failure is complex and currently believed to involve several mechanisms. So far, the contributory role of high plasma catecholamine levels has not been investigated. In this manuscript, we present a hypothesis suggesting that excessive catecholamine production and exogenous administration of catecholamines may relevantly contribute to the development of heart failure and cardiovascular collapse in patients suffering from septic shock. Substantially elevated plasma catecholamine levels were measured during critical illness and sepsis or septic shock. There is a growing body of clinical and experimental evidence demonstrating that high catecholamine plasma levels exert direct toxic effects on the heart. The pathophysiologic mechanisms involved in catecholamine-induced cardiomyocyte toxicity may involve a combination of inflammation, oxidative stress, and abnormal calcium handling resulting in myocardial stunning, apoptosis and necrosis. Clinical signs of catecholamine-induced heart failure can present with a wide range of symptoms reaching from subtle histological changes with preserved myocardial pump function to severe heart failure exhibiting a distinctive echocardiographic pattern which became known as "Takotsubo"-like cardiomyopathy or the left ventricular apical ballooning syndrome. In a medical intensive care unit patient population, presence of sepsis was the only variable associated with the development of left ventricular apical ballooning. Since several therapeutic interventions influence catecholamine plasma levels in septic shock patients, treatment strategies aiming at the reduction of endogenous or exogenous catecholamine exposure may protect the heart during septic shock and could facilitate patient survival.
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Affiliation(s)
- Christian A Schmittinger
- Department of Anaesthesiology and Critical Care Medicine, Innsbruck Medical University, Innsbruck, Austria
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Mazurek B, Haupt H, Joachim R, Klapp BF, Stöver T, Szczepek AJ. Stress induces transient auditory hypersensitivity in rats. Hear Res 2009; 259:55-63. [PMID: 19840840 DOI: 10.1016/j.heares.2009.10.006] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2009] [Revised: 07/09/2009] [Accepted: 10/13/2009] [Indexed: 12/31/2022]
Abstract
Exposure to harsh environment induces stress reactions that increase probability of survival. Stress influences the endocrine, nervous and immune systems and affects the functioning of a variety of organs. Numerous researchers demonstrated that a 24-h exposure to an acoustic rodent repellent provokes stress reaction in exposed animals. In addition to the activated hypothalamic-pituitary-adrenal (HPA) axis, exposed animals had pathological reactions in the reproductive organs, bronchia and skin. Here, we examined the effect of above stress model on the auditory system of Wistar rats. We found that 24-h stress decreases the thresholds and increases the amplitudes of auditory brainstem responses and distortion product otoacoustic emissions. Resultant auditory hypersensitivity was transient and most pronounced between 3 and 6h post-stress, returning to control levels one week later. The concentration of corticosterone and tumor necrosis factor alpha was systemically elevated in stressed animals between 3 and 6h post-stress, confirming the activation of the HPA axis. In addition, expression of the HPA-axis-associated genes: glucocorticoid receptor (GR) and hypoxia-inducible factor 1 alpha (Hif1a) was modulated in the auditory tissues. In detail, in the inferior colliculus, we found an up-regulation of GR mRNA 3h post-stress and continuous up-regulation of Hif1a up to 24h post-stress. In the spiral ganglion, we found no differences in gene expression between stressed and control animals. In the organ of Corti, expression of GR mRNA remained stable, whereas that of Hif1a was significantly down-regulated one week after stress. In addition, the expression of an outer hair cell marker prestin was significantly up-regulated 6h post-stress. We conclude that 24-h stress induces transient hypersensitivity of the auditory system and modulates gene expression in a tissue-specific manner. Stress-induced auditory hypersensitivity could have evolutionary consequence by giving animals an advantage of hearing better under stress conditions.
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Affiliation(s)
- Birgit Mazurek
- Molecular Biology Research Laboratory, Department of Otorhinolaryngology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
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Determinants of the NF-kappaB response to acute psychosocial stress in humans. Brain Behav Immun 2009; 23:742-9. [PMID: 18848620 DOI: 10.1016/j.bbi.2008.09.009] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2008] [Revised: 08/14/2008] [Accepted: 09/17/2008] [Indexed: 12/21/2022] Open
Abstract
Previous research has shown that psychosocial stress is associated with an increased activity of the transcription factor nuclear factor-kappaB (NF-kappaB), a major inducer of inflammatory genes. While considerable individual variation has been noted, factors contributing to this variation have not been described so far. Therefore, 29 healthy participants (35.8+/-12 yrs) were exposed to the Trier Social Stress Test. Blood was collected before and repeatedly afterward for determination of NF-kappaB activity, leukocyte subset numbers, cortisol, norepinephrine, and in vitro-stimulated IL-6 production. Additionally, age, sex, and ratings of perceived chronic and acute stress were assessed. Regression analyses revealed that older participants showed a lower NF-kappaB stress response compared to younger adults (beta= -.42, p=.026). Higher NF-kappaB stress responses were associated with lower cortisol stress responses (beta= -.37, p=.05), higher pre-stress IL-6 production (beta=.38, p=.043), and high chronic in combination with low acute stress, or vice versa (beta= -.61, p=.06). Norepinephrine and sex were not associated with NF-kappaB stress responses (all p.13). In summary, the present study shows for the first time in human psychosocial stress the negative association of cortisol and NF-kappaB. This parallels results from in vitro studies. Our finding of lower NF-kappaB stress responses in older age and in people with high chronic and acute stress might be interpreted as an adaptive dampening of NF-kappaB activity. In the absence of longitudinal data, however, this interpretation remains speculative.
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In search of the optimal perfusion pressure--does the microcirculation give us the answer? Crit Care Med 2009; 37:2120-1. [PMID: 19448465 DOI: 10.1097/ccm.0b013e3181a5c2b8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Sexual dimorphism in the effect of sound stress on neutrophil function. J Neuroimmunol 2008; 205:25-31. [DOI: 10.1016/j.jneuroim.2008.08.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2008] [Revised: 07/11/2008] [Accepted: 08/11/2008] [Indexed: 11/23/2022]
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Maclullich AMJ, Ferguson KJ, Miller T, de Rooij SEJA, Cunningham C. Unravelling the pathophysiology of delirium: a focus on the role of aberrant stress responses. J Psychosom Res 2008; 65:229-38. [PMID: 18707945 PMCID: PMC4311661 DOI: 10.1016/j.jpsychores.2008.05.019] [Citation(s) in RCA: 266] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2008] [Revised: 05/09/2008] [Accepted: 05/15/2008] [Indexed: 01/01/2023]
Abstract
Delirium is a common and serious acute neuropsychiatric syndrome with core features of inattention and cognitive impairment, and associated features including changes in arousal, altered sleep-wake cycle, and other changes in mental status. The main risk factors are old age, cognitive impairment, and other comorbidities. Though delirium has consistent core clinical features, it has a very wide range of precipitating factors, including acute illness, surgery, trauma, and drugs. The molecular mechanisms by which these precipitating factors lead to delirium are largely obscure. In this article, we attempt to narrow down some specific causal pathways. We propose a basic classification for the etiological factors: (a) direct brain insults and (b) aberrant stress responses. Direct brain insults are largely indiscriminate and include general and regional energy deprivation (e.g., hypoxia, hypoglycaemia, stroke), metabolic abnormalities (e.g., hyponatraemia, hypercalcaemia), and the effects of drugs. Aberrant stress responses are conceptually and mechanistically distinct in that they constitute adverse effects of stress-response pathways, which, in health, are adaptive. Ageing and central nervous system disease, two major predisposing factors for delirium, are associated with alterations in the magnitude or duration of stress and sickness behavior responses and increased vulnerability to the effects of these responses. We discuss in detail two stress response systems that are likely to be involved in the pathophysiology of delirium: inflammation and the sickness behavior response, and activity of the limbic-hypothalamic-pituitary-adrenal axis. We conclude by discussing the implications for future research and the development of new therapies for delirium.
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Affiliation(s)
- Alasdair M J Maclullich
- Geriatric Medicine/MRC Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, Scotland, UK.
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de Coupade C, Brown AS, Dazin PF, Levine JD, Green PG. beta(2)-Adrenergic receptor-dependent sexual dimorphism for murine leukocyte migration. J Neuroimmunol 2007; 186:54-62. [PMID: 17442405 PMCID: PMC1994158 DOI: 10.1016/j.jneuroim.2007.02.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2006] [Revised: 02/15/2007] [Accepted: 02/28/2007] [Indexed: 01/03/2023]
Abstract
In wild-type FVB mice, leukocyte recruitment to lipopolysaccharide was sexually dimorphic, with a greater number of leukocytes recruited in females. In male beta(2)-adrenergic receptor knock out mice (bred on a congenic FVB background) the number of leukocytes recruited was increased approximately 4-fold, while in females there was no change, eliminating sexual dimorphism in leukocyte migration. While there were significantly fewer recruited CD62L(+) and CD11a(+) leukocytes in wild-type males, only in male beta-adrenergic receptor knock out mice was there an increase in the number of recruited CD11a(+) leukocytes, again eliminating sexual dimorphism. Thus, leukocyte migration and CD11a(+) adhesion molecule expression in male, but not in female, leukocytes is beta-adrenergic receptor-dependent. Our findings provide support for a role of beta(2)-adrenergic receptor mechanisms in the inflammatory response, and suggest that beta(2)-adrenergic receptor on male leukocytes contributes to sexual dimorphism in the effect of stress on inflammatory diseases.
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Affiliation(s)
- Catherine de Coupade
- Department of Medicine and Oral and Maxillofacial Surgery, University of California San Francisco, San Francisco, CA 94143
| | - Adrienne S. Brown
- Department of Medicine and Oral and Maxillofacial Surgery, University of California San Francisco, San Francisco, CA 94143
| | - Paul F. Dazin
- Howard Hughes Medical Institute, University of California San Francisco, San Francisco, CA 94143, USA
| | - Jon D. Levine
- Department of Medicine and Oral and Maxillofacial Surgery, University of California San Francisco, San Francisco, CA 94143
| | - Paul G. Green
- *Corresponding author: Department of Medicine and Oral and Maxillofacial Surgery, 521 Parnassus Avenue, UCSF, San Francisco, CA 94143, USA. Tel: +1 415 476 4902; Fax: 415-476-6305, E-mail:
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Selhub E. Toward Optimal Health: Eva Selhub, M.D., Discusses Mind-Body Medicine for Women. J Womens Health (Larchmt) 2006; 15:1111-5. [PMID: 17199451 DOI: 10.1089/jwh.2006.15.1111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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