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Ozpolat C, Okcay Y, Ulusoy KG, Yildiz O. A narrative review of the placebo effect: historical roots, current applications, and emerging insights. Eur J Clin Pharmacol 2025; 81:625-645. [PMID: 40080139 DOI: 10.1007/s00228-025-03818-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2024] [Accepted: 02/23/2025] [Indexed: 03/15/2025]
Abstract
PURPOSE Placebo is a term to define physiologically inactive compounds used in treatment that causes physical and emotional changes. The placebo effect, driven by expectation and conditioning, plays a significant role in various conditions like pain, depression, and Parkinson's disease, while the nocebo effect can hinder treatment outcomes. Understanding mechanisms such as neuromodulation and genetics has gained importance in modern medicine. This review aims to explore the clinical relevance of placebo responses, particularly in neuropsychiatric disorders, and their potential in personalized medicine. By integrating placebo research into healthcare, it highlights opportunities to enhance treatment efficacy, improve patient well-being, and reduce reliance on pharmacological interventions. METHODS A comprehensive literature search was conducted in PubMed, Scopus, and Google Scholar databases. Recent studies were reviewed to evaluate placebo effects, and the variability of the placebo response in neuropsychiatric disorders was summarized. RESULTS Placebo effects significantly impact treatment outcomes across various conditions, including Parkinson's disease, depression, pain syndromes, and epilepsy. The mechanisms involve neurobiological and psychological factors, with evidence suggesting that placebo interventions can modulate neurotransmitter activity and improve patient well-being. CONCLUSION Integrating placebo research into clinical practice may enhance treatment outcomes, reduce drug dependency, and support personalized medicine by tailoring interventions to individual placebo responsiveness. Understanding placebo and nocebo mechanisms can optimize therapeutic strategies while minimizing unnecessary pharmacological treatments.
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Affiliation(s)
- Cagri Ozpolat
- Department of Medical Pharmacology, Gulhane Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Yagmur Okcay
- Department of Pharmacology, University of Health Sciences Gulhane Faculty of Pharmacy, Ankara, Turkey
| | - Kemal Gokhan Ulusoy
- Department of Medical Pharmacology, Gulhane Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Oğuzhan Yildiz
- Department of Medical Pharmacology, Gulhane Faculty of Medicine, University of Health Sciences, Ankara, Turkey.
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2
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Keller JK, Diekhof EK. Visual cues of respiratory contagion: Their impact on neuroimmune activation and mucosal immune responses in humans. Brain Behav Immun 2025; 125:398-409. [PMID: 39870198 DOI: 10.1016/j.bbi.2025.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2024] [Revised: 12/12/2024] [Accepted: 01/21/2025] [Indexed: 01/29/2025] Open
Abstract
This study investigated the neural correlates of perceiving visual contagion cues characteristic of respiratory infections through functional magnetic resonance imaging (fMRI). Sixty-two participants (32f/ 30 m; ∼25 years on average) watched short videos depicting either contagious or non-contagious everyday situations, while their brain activation was continuously measured. We further measured the release of secretory immunoglobulin A (sIgA) in saliva to examine the first-line defensive response of the mucosal immune system. Perceiving sneezing and sick individuals compared to non-contagious individuals triggered increased activation in the anterior insula and other regions of the neuroimmune axis, that have been implicated in the somatosensory representation of the respiratory tract, and further led to increased release of sIgA. In line with predictions, this contagion cue-related activation of the insula was positively correlated with both perceived contagiousness and disgust evoked by the videos, as well as with the mucosal sIgA response. In contrast, the amygdala exhibited heightened activation to all videos featuring humans, regardless of explicit signs of contagion, indicating a nonspecific alertness to human presence. Nevertheless, amygdala activation was also correlated with the disgust ratings of each video. Collectively, these findings outline a neuroimmune mechanism for the processing of respiratory contagion cues. While the insula coordinates central and peripheral immune activation to match the perceived contagion threat, supposedly by triggering both increased sIgA release and contagion-related cognitions, the amygdala may rather act as an alerting system for social situations with a heightened transmission risk. This proactive neuroimmune response may help humans to manage contagion risks, that are difficult to avoid, by activating physiological and cognitive countermeasures in reaction to typical symptoms of respiratory infection, which prepares the organism for subsequent pathogen exposure.
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Affiliation(s)
- Judith K Keller
- Department of Biology, Neuroendocrinology and Human Biology Unit, Institute for Animal Cell- and Systems Biology, Faculty of Mathematics, Informatics and Natural Sciences, Universität Hamburg, D-22085 Hamburg, Germany.
| | - Esther K Diekhof
- Department of Biology, Neuroendocrinology and Human Biology Unit, Institute for Animal Cell- and Systems Biology, Faculty of Mathematics, Informatics and Natural Sciences, Universität Hamburg, D-22085 Hamburg, Germany.
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3
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Kayyal H, Cruciani F, Chandran SK, Edry E, Schif-Zuck S, Koren T, Yiannakas A, Rolls A, Ariel A, Rosenblum K. Retrieval of conditioned immune response in male mice is mediated by an anterior-posterior insula circuit. Nat Neurosci 2025; 28:589-601. [PMID: 39870921 DOI: 10.1038/s41593-024-01864-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 12/05/2024] [Indexed: 01/29/2025]
Abstract
To protect the body from infections, the brain has evolved the ability to coordinate behavioral and immunological responses. The conditioned immune response (CIR) is a form of Pavlovian conditioning wherein a sensory (for example, taste) stimulus, when paired with an immunomodulatory agent, evokes aversive behavior and an anticipatory immune response after re-experiencing the taste. Although taste and its valence are represented in the anterior insular cortex and immune response in the posterior insula and although the insula is pivotal for CIRs, the precise circuitry underlying CIRs remains unknown. Here, we demonstrated that a bidirectional circuit connecting the anterior and posterior (aIC-pIC) insula mediates the CIR in male mice. Retrieving the behavioral dimension of the association requires activity of aIC-to-pIC neurons, whereas modulating the anticipatory immunological dimension requires bidirectional projections. These results illuminate a mechanism by which experience shapes interactions between sensory internal representations and the immune system. Moreover, this newly described intrainsular circuit contributes to the preservation of brain-dependent immune homeostasis.
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Affiliation(s)
- Haneen Kayyal
- Sagol Department of Neuroscience, The Integrated Brain and Behavior Center, University of Haifa, Haifa, Israel.
| | - Federica Cruciani
- Sagol Department of Neuroscience, The Integrated Brain and Behavior Center, University of Haifa, Haifa, Israel.
| | | | - Efrat Edry
- Sagol Department of Neuroscience, The Integrated Brain and Behavior Center, University of Haifa, Haifa, Israel
- Center for Gene Manipulation in the Brain, University of Haifa, Haifa, Israel
| | - Sagie Schif-Zuck
- Department of Biology, Faculty of Natural Sciences, University of Haifa, Haifa, Israel
- Departments of Human Biology, University of Haifa, Haifa, Israel
| | - Tamar Koren
- Department of Immunology, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Department of Neuroscience, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Adonis Yiannakas
- Sagol Department of Neuroscience, The Integrated Brain and Behavior Center, University of Haifa, Haifa, Israel
- European University of Cyprus Medical School, Frankfurt am Main, Germany
| | - Asya Rolls
- Department of Immunology, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Department of Neuroscience, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Amiram Ariel
- Department of Biology, Faculty of Natural Sciences, University of Haifa, Haifa, Israel
- Departments of Human Biology, University of Haifa, Haifa, Israel
| | - Kobi Rosenblum
- Sagol Department of Neuroscience, The Integrated Brain and Behavior Center, University of Haifa, Haifa, Israel.
- Center for Gene Manipulation in the Brain, University of Haifa, Haifa, Israel.
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4
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Madison AA. A social science: Using psychoneuroimmunology principles to promote career longevity, productivity, and meaning. COMPREHENSIVE PSYCHONEUROENDOCRINOLOGY 2024; 19:100246. [PMID: 39220347 PMCID: PMC11361868 DOI: 10.1016/j.cpnec.2024.100246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Revised: 06/16/2024] [Accepted: 06/23/2024] [Indexed: 09/04/2024] Open
Abstract
Over the past several decades, psychoneuroimmunologists have uncovered key principles (e.g., social support and stress management) that can inform future research content and conduct. That is, psychoneuroimmunology (PNI) can inform how scientists from all disciplines engage in the scientific method in a more sustainable manner. Dr. Janice Kiecolt-Glaser, a PNI pioneer, recently ended her long and celebrated career. Her unique engagement in the scientific method, including her mentorship style, is worthy of closer examination. As her final graduate student, I observed Dr. Kiecolt-Glaser's science and mentorship style at their full maturity. Her scientific content, remarkable in its own right, is the subject of commentaries and accolades; yet, her scientific conduct - the foundation of her success and innovation - deserves further consideration. This article outlines ten research conduct principles that Dr. Kiecolt-Glaser explicitly and implicitly taught: (1) applying the literature to one's own health behaviors; (2) knowing and remembering "the why" behind the science; (3) developing and adhering to a vision; (4) creating a streamlined workflow; (5) embracing team science; (6) pursuing depth and breadth; (7) communicating ideas clearly; (8) engaging in a daily rhythm of science; (9) treating trainees like future primary investigators; and (10) working toward clinical meaningfulness. These principles correspond to PNI findings and account for her health and longevity as a scientist.
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Affiliation(s)
- Annelise A. Madison
- The Ohio State University, United States
- VA Boston Healthcare System, United States
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5
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Lauten TH, Natour T, Case AJ. Innate and adaptive immune system consequences of post-traumatic stress disorder. Auton Neurosci 2024; 252:103159. [PMID: 38428324 PMCID: PMC11494466 DOI: 10.1016/j.autneu.2024.103159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 01/06/2024] [Accepted: 02/21/2024] [Indexed: 03/03/2024]
Abstract
In the field of psychiatry, biological markers are rarely, if ever, used in the diagnosis of mental health disorders. Clinicians rely primarily on patient histories and behavioral symptoms to identify specific psychopathologies, which makes diagnosis highly subjective. Moreover, therapies for mental health disorders are aimed specifically at attenuating behavioral manifestations, which overlooks the pathophysiological indices of the disease. This is highly evident in posttraumatic stress disorder (PTSD) where inflammation and immune system perturbations are becoming increasingly described. Further, patients with PTSD possess significantly elevated risks of developing comorbid inflammatory diseases such as autoimmune and cardiovascular diseases, which are likely linked (though not fully proven) to the apparent dysregulation of the immune system after psychological trauma. To date, there is little to no evidence that demonstrates current PTSD therapies are able to reverse the increased risk for psychological trauma-induced inflammatory diseases, which suggests the behavioral and somatic consequences of PTSD may not be tightly coupled. This observation provides an opportunity to explore unique mechanisms outside of the brain that contribute to the long-term pathology of PTSD. Herein, we provide an overview of neuroimmune mechanisms, describe what is known regarding innate and adaptive immunity in PTSD, and suggest new directions that are needed to advance the understanding, diagnosis, and treatment of PTSD moving forward.
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Affiliation(s)
- Tatlock H Lauten
- Department of Psychiatry and Behavioral Sciences, Texas A&M University, Bryan, TX, United States; Department of Medical Physiology, Texas A&M University, Bryan, TX, United States
| | - Tamara Natour
- Department of Psychiatry and Behavioral Sciences, Texas A&M University, Bryan, TX, United States; Department of Medical Physiology, Texas A&M University, Bryan, TX, United States
| | - Adam J Case
- Department of Psychiatry and Behavioral Sciences, Texas A&M University, Bryan, TX, United States; Department of Medical Physiology, Texas A&M University, Bryan, TX, United States.
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6
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Chen BR, Wu T, Chen TH, Wang Y. Neuroimmune interactions and their roles in neurodegenerative diseases. FUNDAMENTAL RESEARCH 2024; 4:251-261. [PMID: 38933502 PMCID: PMC11197660 DOI: 10.1016/j.fmre.2023.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 02/10/2023] [Accepted: 04/03/2023] [Indexed: 06/28/2024] Open
Abstract
The nervous system possesses bidirectional, sophisticated and delicate communications with the immune system. These neuroimmune interactions play a vitally important role in the initiation and development of many disorders, especially neurodegenerative diseases. Although scientific advancements have made tremendous progress in this field during the last few years, neuroimmune communications are still far from being elucidated. By organizing recent research, in this review, we discuss the local and intersystem neuroimmune interactions and their roles in Alzheimer's disease, Parkinson's disease and amyotrophic lateral sclerosis. Unveiling these will help us gain a better understanding of the process of interplay inside the body and how the organism maintains homeostasis. It will also facilitate a view of the diseases from a holistic, pluralistic and interconnected perspective, thus providing a basis of developing novel and effective methods to diagnose, intervene and treat diseases.
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Affiliation(s)
- Bai-Rong Chen
- Neuroscience Research Institute and Department of Neurobiology, School of Basic Medical Sciences, Key Laboratory for Neuroscience, Ministry of Education/National Health Commission and State Key Laboratory of Natural and Biomimetic Drugs, Peking University, Beijing 100083, China
| | - Ting Wu
- Neuroscience Research Institute and Department of Neurobiology, School of Basic Medical Sciences, Key Laboratory for Neuroscience, Ministry of Education/National Health Commission and State Key Laboratory of Natural and Biomimetic Drugs, Peking University, Beijing 100083, China
| | - Ting-Hui Chen
- Neuroscience Research Institute and Department of Neurobiology, School of Basic Medical Sciences, Key Laboratory for Neuroscience, Ministry of Education/National Health Commission and State Key Laboratory of Natural and Biomimetic Drugs, Peking University, Beijing 100083, China
| | - Yun Wang
- Neuroscience Research Institute and Department of Neurobiology, School of Basic Medical Sciences, Key Laboratory for Neuroscience, Ministry of Education/National Health Commission and State Key Laboratory of Natural and Biomimetic Drugs, Peking University, Beijing 100083, China
- PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing 100871, China
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7
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Guo M, Wang W, Tu X, Jiang M, Zhang CJ. Catecholaminergic neurons orchestrate fasting-induced immune harmony. BIOPHYSICS REPORTS 2024; 10:57-59. [PMID: 38737472 PMCID: PMC11079597 DOI: 10.52601/bpr.2024.240901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 01/31/2024] [Indexed: 05/14/2024] Open
Affiliation(s)
- Mengdi Guo
- Department of Neurology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 611731, China
| | - Weiyan Wang
- Department of Neurology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 611731, China
| | - Xiao Tu
- Department of Neurology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 611731, China
| | - Meiling Jiang
- Department of Science and Technology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 611731, China
| | - Cun-Jin Zhang
- Department of Neurology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 611731, China
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8
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Bavbek S, Ozyigit LP, Baiardini I, Braido F, Roizen G, Jerschow E. Placebo, Nocebo, and Patient-Reported Outcome Measures in Drug Allergy. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:371-379. [PMID: 36521832 DOI: 10.1016/j.jaip.2022.11.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 11/24/2022] [Accepted: 11/30/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Sevim Bavbek
- Division of Allergy and Clinical of Immunology, Department of Chest Diseases, Ankara University, School of Medicine, Ankara, Turkey.
| | - Leyla Pur Ozyigit
- Adult Allergy Service, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Ilaria Baiardini
- Istituti di Ricovero e Cura a Carattere Scientifico, Ospedale Policlinico San Martino, Genova, Italy; Università di Genova, (DIMI), Genova, Italy
| | - Fulvio Braido
- Istituti di Ricovero e Cura a Carattere Scientifico, Ospedale Policlinico San Martino, Genova, Italy; Università di Genova, (DIMI), Genova, Italy
| | - Gigia Roizen
- Department of Immunology, Clinica Alemana De Santiago, Santiago, Chile
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9
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Anja Juran S, Tognetti A, Lundström JN, Kumar L, Stevenson RJ, Lekander M, Olsson MJ. Disgusting odors trigger the oral immune system. Evol Med Public Health 2022; 11:8-17. [PMID: 36789013 PMCID: PMC9912705 DOI: 10.1093/emph/eoac042] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 11/10/2022] [Indexed: 12/23/2022] Open
Abstract
Recent research has characterized the behavioral defense against disease. In particular the detection of sickness cues, the adaptive reactions (e.g. avoidance) to these cues and the mediating role of disgust have been the focus. A presumably important but less investigated part of a behavioral defense is the immune system response of the observer of sickness cues. Odors are intimately connected to disease and disgust, and research has shown how olfaction conveys sickness cues in both animals and humans. This study aims to test whether odorous sickness cues (i.e. disgusting odors) can trigger a preparatory immune response in humans. We show that subjective and objective disgust measures, as well as TNFα levels in saliva increased immediately after exposure to disgusting odors in a sample of 36 individuals. Altogether, these results suggest a collaboration between behavioral mechanisms of pathogen avoidance in olfaction, mediated by the emotion of disgust, and mechanisms of pathogen elimination facilitated by inflammatory mediators. Disgusting stimuli are associated with an increased risk of infection. We here test whether disgusting odors, can trigger an immune response in the oral cavity. The results indicate an increase level of TNFα in the saliva. This supports that disease cues can trigger a preparatory response in the oral cavity.
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Affiliation(s)
| | - Arnaud Tognetti
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Johan N Lundström
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Lalit Kumar
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Mats Lekander
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden,Department of Psychology, Stockholm University, Stockholm, Sweden,Osher Center for Integrative Health, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Mats J Olsson
- Corresponding author: Department of Clinical Neuroscience, Karolinska Institutet, Stockholm SE 17177, Sweden. Tel: +46 707 135205; E-mail:
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10
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Zunhammer M, Goltz G, Schweifel M, Stuck BA, Bingel U. Savor the flavor: A randomized double-blind study assessing taste-enhanced placebo analgesia in healthy volunteers. Clin Transl Sci 2022; 15:2709-2719. [PMID: 36088659 PMCID: PMC9652436 DOI: 10.1111/cts.13397] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 07/01/2022] [Accepted: 08/06/2022] [Indexed: 01/26/2023] Open
Abstract
Placebo effects substantially contribute to analgesic treatment outcomes and might be leveraged to enhance gold-standard treatments. The taste of oral medications has been proposed to boost placebo effects. Here, we aimed at estimating how far the taste of an oral medication enhances placebo analgesia. We conducted a randomized, double-blind, between-group, single-visit study, with pre-treatment baseline. Over the course of three substudies, 318 healthy volunteers (297 included) were tested in a clinical trial setting. Participants were subjected to experimental tonic cold water pain (cold pressor test) before and after receiving taste-neutral (water), or bitter (quinine), or sweet (saccharin), or no placebo drops. Pre- versus post-treatment changes in area under the pain rating curve, the main outcome, indicated that placebo treatment showed a small analgesic effect versus no treatment. Added taste induced placebo enhancement in the very small effect size range, but accounted for a substantial portion of the overall placebo effect. No noteworthy advantage of sweet over bitter placebo was observed. An exploration of heart rate (HR) recordings indicated that placebo treatments were associated with an increase in peak HR-response to cold water, but these were not associated with placebo analgesia at an individual level. Placebo treatments were associated with minimal side effects. These results indicate that added taste may be an easy-to-implement, cost-effective, and safe way to optimize treatment outcomes and that taste-neutral preparations may reduce placebo-related outcome variance in clinical trials. Further studies are needed to test if these findings can be translated into clinical scenarios.
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Affiliation(s)
- Matthias Zunhammer
- Department of Neurology, Center for Translational Neuro‐ and Behavioral Sciences (C‐TNBS)University Hospital EssenEssenGermany
| | - Gerrit Goltz
- Department of Neurology, Center for Translational Neuro‐ and Behavioral Sciences (C‐TNBS)University Hospital EssenEssenGermany
| | - Maximilian Schweifel
- Department of Neurology, Center for Translational Neuro‐ and Behavioral Sciences (C‐TNBS)University Hospital EssenEssenGermany
| | - Boris A. Stuck
- Department of Otolaryngology, Head and Neck Surgery, University Hospital MarburgPhilipps‐Universität MarburgMarburgGermany
| | - Ulrike Bingel
- Department of Neurology, Center for Translational Neuro‐ and Behavioral Sciences (C‐TNBS)University Hospital EssenEssenGermany
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11
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Ponce-Regalado MD, Pérez-Sánchez G, Rojas-Espinosa O, Arce-Paredes P, Girón-Peréz MI, Pavón-Romero L, Becerril-Villanueva E. NeuroImmunoEndocrinology: A brief historic narrative. J Leukoc Biol 2022; 112:97-114. [PMID: 35098580 DOI: 10.1002/jlb.5mr1221-287r] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Although no precise moment or unique event marks its birth, neuroimmunoendocrinology arguably shares a great deal of history with other medical and biologic disciplines. It originated from empirical observations and suppositions that failed to prevail upon the existing axioms. Despite the widespread resistance to embracing novel ideas, the seeming defeats inspired visionary researchers. Those pioneers managed to systematize the emerging knowledge and were able to contribute to science with real foundations. In consequence, new concepts and ideas arose in physiology, anatomy, endocrinology and early immunology. Together, they gave rise to a budding approach on the integration between the nervous, immune and endocrine systems. Then, neuroimmunoendocrinology emerged as a discipline integrating an intricate system with multidirectional functions and interactions that allow for responding to internal and external threats. Such response is mediated by cytokines, hormones and neurotransmitters, involved in different physiologic mechanisms of the organism homeostasis. Neuroimmunoendocrinology is no longer an area of scientific skepticism; on the contrary, it has cemented its position as a biomedical discipline worldwide for the past 70 years. Now, it offers a better understanding of pathologic processes.
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Affiliation(s)
- María Dolores Ponce-Regalado
- Departamento de Ciencias de la Salud, Centro Universitario de los Altos, Universidad de Guadalajara Centro Universitario de los Altos Av, Tepatitlán de Morelos, Jalisco, Mexico
| | - Gilberto Pérez-Sánchez
- Laboratory of Psychoimmunology, National Institute of Psychiatry "Ramón de la Fuente", Mexico City, Mexico
| | - Oscar Rojas-Espinosa
- Departamento de Inmunología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Mexico City, Mexico
| | - Patricia Arce-Paredes
- Departamento de Inmunología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Mexico City, Mexico
| | - M Iván Girón-Peréz
- Laboratorio de Inmunotoxicología, Secretaría de Investigación y Posgrado Universidad Autónoma de Nayarit, Tepic, Nayarit, Mexico
| | - Lenin Pavón-Romero
- Departamento de Ciencias de la Salud, Centro Universitario de los Altos, Universidad de Guadalajara Centro Universitario de los Altos Av, Tepatitlán de Morelos, Jalisco, Mexico
| | - Enrique Becerril-Villanueva
- Departamento de Ciencias de la Salud, Centro Universitario de los Altos, Universidad de Guadalajara Centro Universitario de los Altos Av, Tepatitlán de Morelos, Jalisco, Mexico
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12
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Rudzki S. Is PTSD an Evolutionary Survival Adaptation Initiated by Unrestrained Cytokine Signaling and Maintained by Epigenetic Change? Mil Med 2022; 188:usac095. [PMID: 35446412 DOI: 10.1093/milmed/usac095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 03/01/2022] [Accepted: 03/24/2022] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Treatment outcomes for PTSD with current psychological therapies are poor, with very few patients achieving sustained symptom remission. A number of authors have identified physiological and immune disturbances in Post Traumatic Stress Disorder (PTSD) patients, but there is no unifying hypothesis that explains the myriad features of the disorder. MATERIALS AND METHODS The medical literature was reviewed over a 6-year period primarily using the medical database PUBMED. RESULTS The literature contains numerous papers that have identified a range of physiological and immune dysfunction in association with PTSD. This paper proposes that unrestrained cytokine signaling induces epigenetic changes that promote an evolutionary survival adaptation, which maintains a defensive PTSD phenotype. The brain can associate immune signaling with past threat and initiate a defensive behavioral response. The sympathetic nervous system is pro-inflammatory, while the parasympathetic nervous system is anti-inflammatory. Prolonged cholinergic withdrawal will promote a chronic inflammatory state. The innate immune cytokine IL-1β has pleiotropic properties and can regulate autonomic, glucocorticoid, and glutamate receptor functions, sleep, memory, and epigenetic enzymes. Changes in epigenetic enzyme activity can potentially alter phenotype and induce an adaptation. Levels of IL-1β correlate with severity and duration of PTSD and PTSD can be prevented by bolus administration of hydrocortisone in acute sepsis, consistent with unrestrained inflammation being a risk factor for PTSD. The nervous and immune systems engage in crosstalk, governed by common receptors. The benefits of currently used psychiatric medication may arise from immune, as well as synaptic, modulation. The psychedelic drugs (3,4-Methylenedioxymethamphetamine (MDMA), psilocybin, and ketamine) have potent immunosuppressive and anti-inflammatory effects on the adaptive immune system, which may contribute to their reported benefit in PTSD. There may be distinct PTSD phenotypes induced by innate and adaptive cytokine signaling. CONCLUSION In order for an organism to survive, it must adapt to its environment. Cytokines signal danger to the brain and can induce epigenetic changes that result in a persistent defensive phenotype. PTSD may be the price individuals pay for the genomic flexibility that promotes adaptation and survival.
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Affiliation(s)
- Stephan Rudzki
- Canberra Sports Medicine, Deakin, Australian Capital Territory 2600, Australia
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13
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Prossin A, Koch A, Campbell P, Laumet G, Stohler CS, Dantzer R, Zubieta JK. Effects of placebo administration on immune mechanisms and relationships with central endogenous opioid neurotransmission. Mol Psychiatry 2022; 27:831-839. [PMID: 34716408 PMCID: PMC9054677 DOI: 10.1038/s41380-021-01365-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 10/05/2021] [Accepted: 10/14/2021] [Indexed: 12/19/2022]
Abstract
Behavioral conditioning and expectation can have profound impact on animal and human physiology. Placebo, administered under positive expectation in clinical trials, can have potent effects on disease pathology, obscuring active medications. Emerging evidence suggests placebo-responsive neurotransmitter systems (e.g., endogenous opioid) regulate immune function by manipulating inflammatory proteins including IL-18, a potent pro-inflammatory, nociceptive cytokine implicated in pathophysiology of various diseases. Validation that neuroimmune interactions involving brain μ-opioid receptor (MOR) activity and plasma IL-18 underlie placebo analgesic expectation could have widespread clinical applications. Unfortunately, current lack of mechanistic clarity obfuscates clinical translation. To elucidate neuroimmune interactions underlying placebo analgesia, we exposed 37 healthy human volunteers to a standardized pain challenge on each of 2 days within a Positron Emission Tomography (PET) neuroimaging paradigm using the MOR selective radiotracer, 11C-Carfentanil (CFN). Each day volunteers received an intervention (placebo under analgesic expectation or no treatment), completed PET scanning, and rated their pain experience. MOR BPND parametric maps were generated from PET scans using standard methods. Results showed placebo reduced plasma IL-18 during pain (W74 = -3.7, p < 0.001), the extent correlating with reduction in pain scores. Placebo reduction in IL-18 covaried with placebo-induced endogenous opioid release in the left nucleus accumbens (T148 = 3.33; puncorr < 0.001) and left amygdala (T148 = 3.30; puncorr < 0.001). These findings are consistent with a modulating effect of placebo (under analgesic expectation in humans) on a potent nociceptive, pro-inflammatory cytokine (IL-18) and underlying relationships with endogenous opioid activity, a neurotransmitter system critically involved in pain, stress, and mood regulation.
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Affiliation(s)
- Alan Prossin
- Department of Psychiatry and Behavioral Sciences, University of Texas McGovern Medical School, Houston, TX, USA. .,Translational Imaging Center, Houston Methodist Research Institute, Weill Cornell College of Medicine, Houston, TX, USA.
| | - Alisa Koch
- grid.214458.e0000000086837370Department of Internal Medicine, Division of Rheumatology, University of Michigan Medical School, Ann Arbor, MI USA
| | - Phillip Campbell
- grid.214458.e0000000086837370Department of Internal Medicine, Division of Rheumatology, University of Michigan Medical School, Ann Arbor, MI USA
| | - Geoffroy Laumet
- grid.17088.360000 0001 2150 1785Department of Physiology, Michigan State University, East Lansing, MI USA
| | - Christian S. Stohler
- grid.21729.3f0000000419368729College of Dental Medicine, Columbia University, New York, NY USA
| | - Robert Dantzer
- grid.240145.60000 0001 2291 4776Department of Symptom Research, Division of Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Jon-Kar Zubieta
- grid.416477.70000 0001 2168 3646Department of Psychiatry, John T Mather Memorial Hospital, Northwell Health, Port Jefferson, NY USA
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Tekampe J, van Middendorp H, Biermasz NR, Sweep FCGJ, Meijer OC, Pelsma ICM, Pereira AM, Hermus ARMM, Evers AWM. Conditioning cortisol in healthy young women - A randomized controlled trial. Psychoneuroendocrinology 2021; 124:105081. [PMID: 33340878 DOI: 10.1016/j.psyneuen.2020.105081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 11/16/2020] [Accepted: 11/23/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Learned placebo effects induced by pharmacological conditioning affect immune and endocrine outcomes and may offer new possibilities for clinical applications. Whether or not cortisol is subject to this type of associative learning processes, and whether conditioning may affect responses to stress, is currently unclear. METHOD A randomized placebo-controlled trial was conducted in 48 healthy young women. During acquisition, participants received a pill containing either 100 mg hydrocortisone (unconditioned stimulus) or placebo, paired with a gustatory conditioned stimulus on three consecutive days. During evocation, all participants received placebo paired with the conditioned stimulus, again on three consecutive days. During the third evocation trial, participants underwent a psychosocial stress task. The main outcome parameter salivary cortisol and secondary outcome parameters salivary alpha-amylase, self-reported positive affect and tension, heart rate, and skin conductance level were measured at several time points. RESULTS Significant baseline group differences on cortisol were found at several time points, which complicate the interpretation of group differences. During the first evocation session, the conditioned group showed a moderately smaller cumulative decrease in salivary cortisol from baseline than the placebo control group. No significant differences were found between the groups on cortisol during the second and third evocation or in response to stress, nor on other outcome measures. CONCLUSION Although the results provide potential further indications for effects of conditioning on cortisol, baseline differences make it impossible to draw clear conclusions. No indications for possible effects of conditioning on the cortisol stress response or autonomous or affective responses to stress were found.
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Affiliation(s)
- Judith Tekampe
- Heath Medical and Neuropsychology Unit, Leiden University, Leiden, The Netherlands; Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands.
| | | | - Nienke R Biermasz
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Center for Endocrine Tumors Leiden (CETL), Leiden University Medical Center, The Netherlands.
| | - Fred C G J Sweep
- Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Onno C Meijer
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Center for Endocrine Tumors Leiden (CETL), Leiden University Medical Center, The Netherlands.
| | - Iris C M Pelsma
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Center for Endocrine Tumors Leiden (CETL), Leiden University Medical Center, The Netherlands.
| | - Alberto M Pereira
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Center for Endocrine Tumors Leiden (CETL), Leiden University Medical Center, The Netherlands.
| | - Ad R M M Hermus
- Division of Endocrinology, Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Andrea W M Evers
- Heath Medical and Neuropsychology Unit, Leiden University, Leiden, The Netherlands; Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands.
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15
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Smits RM, Veldhuijzen DS, van Middendorp H, van der Heijden MJE, van Dijk M, Evers AWM. Integrating Placebo Effects in General Practice: A Cross-Sectional Survey to Investigate Perspectives From Health Care Professionals in the Netherlands. Front Psychiatry 2021; 12:768135. [PMID: 35095592 PMCID: PMC8790122 DOI: 10.3389/fpsyt.2021.768135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 12/17/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: Placebo effects, beneficial treatment outcomes due to non-active treatment components, play an important role in the overall treatment response. To facilitate these beneficial effects it is important to explore the perspectives of health care professionals (HCPs) on the integration of placebo effects in clinical care. Three themes were investigated: knowledge about placebo effects and factors that contribute to these, frequency of placebo use, and attitudes toward acceptability and transparency of placebo use in treatment. Methods: A cross-sectional survey, according to the Checklist for Reporting Results of Internet E-Surveys guidelines and STrengthening the Reporting of OBservational Studies in Epidemiology (STROBE), was conducted in the Netherlands in 2020. The survey was conducted in two samples: a (nested) short survey in 78 nurses during working shifts (sample 1) and an extended online survey in 47 general HCPs e.g., medical psychologists, oncologists, surgeons (sample 2). Results: Respondents from both samples reported to be somewhat or quite familiar with placebo effects (24.0 and 47.2%, respectively). From the six placebo mechanisms that were presented, mind-body interaction, positive expectations, and brain activity involved in placebo effects were rated as the most influential factors in placebo effects [F(5,119) = 20.921, p < 0.001]. The use of placebo effects was reported in 53.8% (n = 42) of the nurses (e.g., by inducing positive expectations), and 17.4% of the HCPs (n = 8 reported to make use of pure placebos and 30.4% of impure placebos (n = 14). Attitudes toward placebo use in treatment were acceptant, and transparency was highly valued (both up to 51%). Conclusions: The findings from this study address knowledge gaps in placebo effects in practice and provide insights in attitudes toward the integration of placebo effects from HCPs. Altogether, integrating these findings may potentially optimize treatment outcomes.
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Affiliation(s)
- Rosanne M Smits
- Health, Medical and Neuropsychology Unit, Leiden University, Leiden, Netherlands.,Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, Utrecht, Netherlands.,Leiden Institute for Brain and Cognition (LIBC), Leiden University, Leiden, Netherlands
| | - Dieuwke S Veldhuijzen
- Health, Medical and Neuropsychology Unit, Leiden University, Leiden, Netherlands.,Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, Utrecht, Netherlands.,Leiden Institute for Brain and Cognition (LIBC), Leiden University, Leiden, Netherlands
| | - Henriët van Middendorp
- Health, Medical and Neuropsychology Unit, Leiden University, Leiden, Netherlands.,Leiden Institute for Brain and Cognition (LIBC), Leiden University, Leiden, Netherlands
| | - Marianne J E van der Heijden
- Department of Internal Medicine, Nursing Science, Erasmus Medical Center, Rotterdam, Netherlands.,Department of Pediatric Surgery, Erasmus Medical Center - Sophia Children's Hospital, Rotterdam, Netherlands
| | - Monique van Dijk
- Department of Internal Medicine, Nursing Science, Erasmus Medical Center, Rotterdam, Netherlands.,Department of Pediatric Surgery, Erasmus Medical Center - Sophia Children's Hospital, Rotterdam, Netherlands
| | - Andrea W M Evers
- Health, Medical and Neuropsychology Unit, Leiden University, Leiden, Netherlands.,Leiden Institute for Brain and Cognition (LIBC), Leiden University, Leiden, Netherlands.,Department of Psychiatry, Leiden University Medical Center, Leiden, Netherlands
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Petzschner FH, Garfinkel SN, Paulus MP, Koch C, Khalsa SS. Computational Models of Interoception and Body Regulation. Trends Neurosci 2021; 44:63-76. [PMID: 33378658 PMCID: PMC8109616 DOI: 10.1016/j.tins.2020.09.012] [Citation(s) in RCA: 102] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 08/01/2020] [Accepted: 09/30/2020] [Indexed: 02/07/2023]
Abstract
To survive, organisms must effectively respond to the challenge of maintaining their physiological integrity in the face of an ever-changing environment. Preserving this homeostasis critically relies on adaptive behavior. In this review, we consider recent frameworks that extend classical homeostatic control via reflex arcs to include more flexible forms of adaptive behavior that take interoceptive context, experiences, and expectations into account. Specifically, we define a landscape for computational models of interoception, body regulation, and forecasting, address these models' unique challenges in relation to translational research efforts, and discuss what they can teach us about cognition as well as physical and mental health.
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Affiliation(s)
- Frederike H Petzschner
- Translational Neuromodeling Unit (TNU), Institute for Biomedical Engineering, University of Zurich, ETH Zurich, Switzerland.
| | - Sarah N Garfinkel
- Department of Neuroscience, Brighton and Sussex Medical School, University of Sussex, Falmer, UK; Sussex Partnership NHS Foundation Trust, Brighton, UK
| | - Martin P Paulus
- Laureate Institute for Brain Research, Tulsa, OK, USA; Oxley College of Health Sciences, University of Tulsa, Tulsa, OK, USA
| | | | - Sahib S Khalsa
- Laureate Institute for Brain Research, Tulsa, OK, USA; Oxley College of Health Sciences, University of Tulsa, Tulsa, OK, USA
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17
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Meeuwis SH, van Middendorp H, Pacheco-Lopez G, Ninaber MK, Lavrijsen APM, van der Wee N, Veldhuijzen DS, Evers AWM. Antipruritic Placebo Effects by Conditioning H1-antihistamine. Psychosom Med 2020; 81:841-850. [PMID: 31490841 PMCID: PMC6844655 DOI: 10.1097/psy.0000000000000743] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 07/15/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Allergic rhinitis symptoms can be reduced by behaviorally conditioning antihistamine. It is unclear whether these findings extend to histamine-induced itch or work when participants are informed about the conditioning procedure (open-label conditioning). The current study aims to investigate the efficacy of (open-label) antipruritic behavioral conditioning for histamine-induced itch. METHODS Healthy participants (n = 92; 84% female) were randomized to I) an open-label conditioned, II) closed-label conditioned, III) conditioned-not-evoked control, or IV) nonconditioned control group. A two-phase conditioning paradigm was used. During acquisition, a conditioned stimulus (CS; distinctively tasting beverage) was repeatedly paired with the H1-antihistamine levocetirizine (groups I-III). During evocation, the CS was paired with placebo (I, II), or instead of the CS, water was paired with placebo (III). The nonconditioned control group (IV) received CS with placebo in both phases. Itch after histamine iontophoresis and physiological data (i.e., spirometry, heart rate, skin conductance) were assessed. Combined conditioned and combined control groups were first compared, and analyses were repeated for separate groups. RESULTS Marginally lower itch was reported in the combined conditioned compared with the control groups (F(1,88) = 2.10, p = .076, ηpartial = 0.02); no differences between separate groups were found. No effects on physiological data were found, except for heart rate, which reduced significantly and consistently for control groups, and less consistently for conditioned groups (group by time interaction: F(7,80) = 2.35, p = .031, ηpartial = 0.17). CONCLUSION Limited support was found for the efficacy of antipruritic behavioral conditioning, regardless of whether participants were informed about the conditioning procedure. The application of open-label conditioning in patient populations should be further researched. TRIAL REGISTRATION www.trialregister.nl; ID NTR5544.
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Affiliation(s)
- Stefanie H Meeuwis
- From the Health, Medical and Neuropsychology Unit, Institute Psychology, Faculty of Social and Behavioural Sciences, (Meeuwis, van Middendorp, Pacheco-Lopez, Veldhuijzen, Evers), Leiden University; Leiden Institute for Brain and Cognition (Meeuwis, van Middendorp, Veldhuijzen, Evers), Leiden University Medical Center, Leiden, The Netherlands; Health Sciences Department, Campus Lerma (Pacheco-Lopez), Metropolitan Autonomous University, Lerma, Edo Mex, Mexico; and Departments of Pulmonology (Ninaber), Dermatology (Lavrijsen), and of Psychiatry (van der Wee, Evers), Leiden University Medical Center, Leiden, The Netherlands
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18
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Lückemann L, Stangl H, Straub RH, Schedlowski M, Hadamitzky M. Learned Immunosuppressive Placebo Response Attenuates Disease Progression in a Rodent Model of Rheumatoid Arthritis. Arthritis Rheumatol 2020; 72:588-597. [PMID: 31509354 DOI: 10.1002/art.41101] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 09/03/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Patients with chronic inflammatory autoimmune diseases benefit from a broad spectrum of immunosuppressive and antiproliferative medication available today. However, nearly all of these therapeutic compounds have unwanted toxic side effects. Recent knowledge about the neurobiology of placebo responses indicates that associative learning procedures can be utilized for dose reduction in immunopharmacotherapy while simultaneously maintaining treatment efficacy. This study was undertaken to examine whether and to what extent a 75% reduction of pharmacologic medication in combination with learned immunosuppression affects the clinical outcome in a rodent model of type II collagen-induced arthritis. METHODS An established protocol of taste-immune conditioning was applied in a disease model of chronic inflammatory autoimmune disease (type II collagen-induced arthritis) in rats, where a novel taste (saccharin; conditioned stimulus [CS]) was paired with an injection of the immunosuppressive drug cyclosporin A (CSA) (unconditioned stimulus [US]). Following conditioning with 3 CS/US pairings (acquisition), the animals were immunized with type II collagen and Freund's incomplete adjuvant. Fourteen days later, at the first occurrence of clinical symptoms, retrieval was started by presenting the CS together with low-dose CSA as reminder cues to prevent the conditioned response from being extinguished. RESULTS This "memory-updating" procedure stabilized the learned immune response and significantly suppressed disease progression in immunized rats. Clinical arthritis score and histologic inflammatory symptoms (both P < 0.05) were significantly diminished by learned immunosuppression in combination with low-dose CSA (25% of the full therapeutic dose) via β-adrenoceptor-dependent mechanisms, to the same extent as with full-dose (100%) pharmacologic treatment. CONCLUSION These results indicate that learned immunosuppression appears to be mediated via β-adrenoceptors and might be beneficial as a supportive regimen in the treatment of chronic inflammatory autoimmune diseases by diminishing disease exacerbation.
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Affiliation(s)
- Laura Lückemann
- University Hospital Essen and University of Duisburg-Essen, Essen, Germany
| | | | | | | | - Martin Hadamitzky
- University Hospital Essen and University of Duisburg-Essen, Essen, Germany
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19
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Abstract
The learned placebo response of the immune system is based on the mutual interaction between the brain and the immune system; both systems continually exchange information via humoral and neural communication pathways. This communication network enables the modification, i.e. suppression or stimulation, of peripheral immune functions by classical or Pavlov's conditioning. The present article provides an overview of the results of recent experimental animal studies, which also document the potential clinical relevance of learned immune responses. Learned immunological responses mediated by classical conditioning have also been demonstrated in humans. The knowledge gained from experimental data and clinical observations paves the way for a potential implementation of learned immune responses as supportive measures to standard immunopharmacological treatment strategies to reduce drug dosage as well as adverse side effects while simultaneously maximizing the therapeutic effect.
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20
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Smits RM, Veldhuijzen DS, van Middendorp H, Hissink Muller PCE, Armbrust W, Legger E, Wulffraat NM, Evers AWM. Pharmacological conditioning for juvenile idiopathic arthritis: a potential solution to reduce methotrexate intolerance. Pediatr Rheumatol Online J 2020; 18:12. [PMID: 32033577 PMCID: PMC7006148 DOI: 10.1186/s12969-020-0407-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 02/03/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Methotrexate (MTX) therapy has proven to be a successful and safe treatment for Juvenile Idiopathic Arthritis (JIA). Despite the high efficacy rates of MTX, treatment outcomes are often complicated by burdensome gastro-intestinal side effects. Intolerance rates for MTX in children are high (approximately 50%) and thus far no conclusive effective treatment strategies to control for side effects have been found. To address this need, this article proposes an innovative research approach based on pharmacological conditioning, to reduce MTX intolerance. PRESENTATION OF THE HYPOTHESIS A collaboration between medical psychologists, pediatric rheumatologists, pharmacologists and patient groups was set up to develop an innovative research design that may be implemented to study potential improved control of side effects in JIA, by making use of the psychobiological principles of pharmacological conditioning. In pharmacological conditioning designs, learned positive associations from drug therapies (conditioning effects) are integrated in regular treatment regimens to maximize treatment outcomes. Medication regimens with immunosuppressant drugs that made use of pharmacological conditioning principles have been shown to lead to optimized therapeutic effects with reduced drug dosing, which might ultimately cause a reduction in side effects. TESTING THE HYPOTHESIS This research design is tailored to serve the needs of the JIA patient group. We developed a research design in collaboration with an interdisciplinary research group consisting of patient representatives, pediatric rheumatologists, pharmacologists, and medical psychologists. IMPLICATIONS OF THE HYPOTHESIS Based on previous experimental and clinical findings of pharmacological conditioning with immune responses, we propose that the JIA patient group is particularly suited to benefit from a pharmacological conditioning design. Moreover, findings from this study may potentially also be promising for other patient groups that endure long-lasting drug therapies.
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Affiliation(s)
- Rosanne M. Smits
- 0000 0001 2312 1970grid.5132.5Health, Medical and Neuropsychology unit, Leiden University, Leiden, P.O. Box 9500, The Netherlands ,Leiden Institute for Brain and Cognition, Leiden, P.O. Box 9600, The Netherlands ,0000000090126352grid.7692.aDepartment Pediatric Rheumatology and Immunology, University Medical Center Utrecht, Utrecht, P.O. Box 85090, The Netherlands
| | - Dieuwke S. Veldhuijzen
- 0000 0001 2312 1970grid.5132.5Health, Medical and Neuropsychology unit, Leiden University, Leiden, P.O. Box 9500, The Netherlands ,Leiden Institute for Brain and Cognition, Leiden, P.O. Box 9600, The Netherlands ,0000000090126352grid.7692.aDepartment Pediatric Rheumatology and Immunology, University Medical Center Utrecht, Utrecht, P.O. Box 85090, The Netherlands
| | - Henriet van Middendorp
- 0000 0001 2312 1970grid.5132.5Health, Medical and Neuropsychology unit, Leiden University, Leiden, P.O. Box 9500, The Netherlands ,Leiden Institute for Brain and Cognition, Leiden, P.O. Box 9600, The Netherlands
| | - Petra C. E. Hissink Muller
- 0000000089452978grid.10419.3dDepartment Pediatric Rheumatology and Immunology, Leiden University Medical Center, Leiden, P.O. Box 9600, The Netherlands
| | - Wineke Armbrust
- 0000 0000 9558 4598grid.4494.dDepartment Pediatric Rheumatology and Immunology, University Medical Centre Groningen, Groningen, P.O. Box 30.001, The Netherlands
| | - Elizabeth Legger
- 0000 0000 9558 4598grid.4494.dDepartment Pediatric Rheumatology and Immunology, University Medical Centre Groningen, Groningen, P.O. Box 30.001, The Netherlands
| | - Nico M. Wulffraat
- 0000000090126352grid.7692.aDepartment Pediatric Rheumatology and Immunology, University Medical Center Utrecht, Utrecht, P.O. Box 85090, The Netherlands
| | - Andrea W. M. Evers
- 0000 0001 2312 1970grid.5132.5Health, Medical and Neuropsychology unit, Leiden University, Leiden, P.O. Box 9500, The Netherlands ,Leiden Institute for Brain and Cognition, Leiden, P.O. Box 9600, The Netherlands ,0000000089452978grid.10419.3dDepartment of Psychiatry, Leiden University Medical Center, Leiden, P.O. Box 9600, The Netherlands
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Hadamitzky M, Lückemann L, Pacheco-López G, Schedlowski M. Pavlovian Conditioning of Immunological and Neuroendocrine Functions. Physiol Rev 2020; 100:357-405. [DOI: 10.1152/physrev.00033.2018] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The phenomenon of behaviorally conditioned immunological and neuroendocrine functions has been investigated for the past 100 yr. The observation that associative learning processes can modify peripheral immune functions was first reported and investigated by Ivan Petrovic Pavlov and his co-workers. Their work later fell into oblivion, also because so little was known about the immune system’s function and even less about the underlying mechanisms of how learning, a central nervous system activity, could affect peripheral immune responses. With the employment of a taste-avoidance paradigm in rats, this phenomenon was rediscovered 45 yr ago as one of the most fascinating examples of the reciprocal functional interaction between behavior, the brain, and peripheral immune functions, and it established psychoneuroimmunology as a new research field. Relying on growing knowledge about efferent and afferent communication pathways between the brain, neuroendocrine system, primary and secondary immune organs, and immunocompetent cells, experimental animal studies demonstrate that cellular and humoral immune and neuroendocrine functions can be modulated via associative learning protocols. These (from the classical perspective) learned immune responses are clinically relevant, since they affect the development and progression of immune-related diseases and, more importantly, are also inducible in humans. The increased knowledge about the neuropsychological machinery steering learning and memory processes together with recent insight into the mechanisms mediating placebo responses provide fascinating perspectives to exploit these learned immune and neuroendocrine responses as supportive therapies, the aim being to reduce the amount of medication required, diminishing unwanted drug side effects while maximizing the therapeutic effect for the patient’s benefit.
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Affiliation(s)
- Martin Hadamitzky
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, Essen, Germany; Health Sciences Department, Metropolitan Autonomous University (UAM), Campus Lerma, Mexico; and Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Laura Lückemann
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, Essen, Germany; Health Sciences Department, Metropolitan Autonomous University (UAM), Campus Lerma, Mexico; and Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Gustavo Pacheco-López
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, Essen, Germany; Health Sciences Department, Metropolitan Autonomous University (UAM), Campus Lerma, Mexico; and Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Manfred Schedlowski
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, Essen, Germany; Health Sciences Department, Metropolitan Autonomous University (UAM), Campus Lerma, Mexico; and Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, Sweden
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Hörbelt T, Martínez-Gómez EM, Hadamitzky M, Schedlowski M, Lückemann L. Behaviorally conditioned immunosuppression with cyclosporine A forms long lasting memory trace. Behav Brain Res 2019; 376:112208. [DOI: 10.1016/j.bbr.2019.112208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 09/02/2019] [Accepted: 09/02/2019] [Indexed: 01/26/2023]
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Gaab J, Bürgin D, Locher C, Werner C, Urech S, Bratschi C, Garcia LB, Hauke M, Bitter S, Bohny M, Bentz D. Endogenous cortisol and conditioned placebo effects on pain - A randomized trial. J Psychosom Res 2019; 123:109739. [PMID: 31376878 DOI: 10.1016/j.jpsychores.2019.109739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 06/07/2019] [Accepted: 06/12/2019] [Indexed: 10/26/2022]
Abstract
Placebo effects can be induced by learning and conditioning processes, which in turn are influenced and modulated by glucocorticoids. Accordingly, previous research has shown that intervention-related associative learning can be modulated through exogenous as well as endogenous glucocorticoids. Thus, the aim of this study was to elucidate whether placebo effects induced by conditioning is modulated by daily fluctuations of endogenous cortisol levels in healthy male and female subjects. Overall 77 participants underwent a two-phased placebo conditioning paradigm for pain analgesia. Subjects were randomized in two groups, which underwent placebo preconditioning either in the morning (08:00-10:00, i.e. with high endogenous cortisol levels) or in the afternoon (16:00-18:00, i.e. with low endogenous cortisol levels). Placebo effects were assessed two days later at noontime (12:00-13:00), with possible differences between groups as an indicator of glucocorticoid modulation on the placebo learning. Results indicated a significant conditioned placebo-induced analgesia, resulting in a placebo effect of small to medium size. Cortisol levels on conditioning day significantly differed between groups and cortisol levels were similar during assessment of placebo effects. Groups did not differ in their mean reduction in pain sensation, thus the placebo effect was not affected by differences in cortisol levels during the conditioning of placebo effects. The present study does not indicate a moderation of placebo conditioning by endogenous glucocorticoid levels.
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Affiliation(s)
- Jens Gaab
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Switzerland.
| | - David Bürgin
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Switzerland
| | - Cosima Locher
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Switzerland
| | - Christoph Werner
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Switzerland
| | - Stefanie Urech
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Switzerland
| | - Christine Bratschi
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Switzerland
| | - Lorena Bartolomé Garcia
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Switzerland
| | - Milena Hauke
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Switzerland
| | - Salome Bitter
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Switzerland
| | - Marc Bohny
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Switzerland
| | - Dorothée Bentz
- Division of Cognitive Neuroscience, Faculty of Psychology, University of Basel, Switzerland; Psychiatric University Clinics, University of Basel, Switzerland
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Gano A, Pautassi RM, Doremus-Fitzwater TL, Barney TM, Vore AS, Deak T. Conditioning the neuroimmune response to ethanol using taste and environmental cues in adolescent and adult rats. Exp Biol Med (Maywood) 2019; 244:362-371. [PMID: 30808184 PMCID: PMC6488863 DOI: 10.1177/1535370219831709] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 01/28/2019] [Indexed: 11/16/2022] Open
Abstract
IMPACT STATEMENT A combined odor and taste cue was paired with a binge-like ethanol exposure (4 g/kg intraperitoneal) using a single-trial learning paradigm. Re-exposure to the CS alone was sufficient to evoke a conditioned Interleukin (IL)-6 elevation in the amygdala in adolescents, an effect that was not observed in young adults. This demonstrates a particular sensitivity of adolescents to alcohol-associated cues and neuroimmune learning, whereas prior work indicated that adults require multiple pairings of ethanol to the CS in order to achieve a conditioned amygdala IL-6 response. While the role of immune conditioning has been studied in other drugs of abuse, these findings highlight a previously unknown aspect of alcohol-related learning. Given the emergent importance of the neuroimmune system in alcohol abuse, these findings may be important for understanding cue-induced reinstatement of alcohol intake among problem drinkers.
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Affiliation(s)
- Anny Gano
- Department of Psychology, Developmental Exposure Alcohol
Research Center (DEARC), Behavioral Neuroscience Program, Binghamton University,
Binghamton, NY 13902-6000, USA
| | - Ricardo M Pautassi
- Instituto de Investigación Médica M. y M. Ferreyra
(INIMEC–CONICET-Universidad Nacional de Córdoba) and Facultad de Psicología,
UNC, Córdoba, CP 5000, Argentina
| | | | - Thaddeus M Barney
- Department of Psychology, Developmental Exposure Alcohol
Research Center (DEARC), Behavioral Neuroscience Program, Binghamton University,
Binghamton, NY 13902-6000, USA
| | - Andrew S Vore
- Department of Psychology, Developmental Exposure Alcohol
Research Center (DEARC), Behavioral Neuroscience Program, Binghamton University,
Binghamton, NY 13902-6000, USA
| | - Terrence Deak
- Department of Psychology, Developmental Exposure Alcohol
Research Center (DEARC), Behavioral Neuroscience Program, Binghamton University,
Binghamton, NY 13902-6000, USA
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Tekampe J, van Middendorp H, Sweep FCGJ, Roerink SHPP, Hermus ARMM, Evers AWM. Conditioning cortisol in humans: design and pilot study of a randomized controlled trial. Pilot Feasibility Stud 2019; 5:9. [PMID: 30680223 PMCID: PMC6337859 DOI: 10.1186/s40814-018-0382-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 12/07/2018] [Indexed: 11/18/2022] Open
Abstract
Background Conditioning of physiological responses can be achieved by repeatedly pairing a previously neutral conditioned stimulus with the administration of a pharmacologically salient unconditioned stimulus. This type of conditioning has been effective for specific immune and endocrine responses, but results with regard to conditioning of cortisol, a key stress-regulatory parameter, are currently unclear. This paper describes a pharmacological conditioning design, optimized for the examination of effects of cortisol conditioning under both basal conditions and in response to stress. Methods A double-blind randomized controlled conditioning paradigm aimed at conditioning of cortisol is conducted in 48 healthy female volunteers. During the acquisition phase, a gustatory stimulus (conditioned stimulus) is paired with hydrocortisone (100 mg, capsulated, unconditioned stimulus) three times before being administered together with placebo during three evocation sessions. To investigate possible effects of cortisol conditioning in response to stress, participants are exposed to the Trier Social Stress Test during the third evocation session. Primary outcome measure of this study is the mean area under the curve of salivary cortisol during the first two evocation sessions. As secondary outcomes, self-reported affect and stress as well as alpha-amylase are investigated. A pilot study was conducted to ensure that this design is feasible to be used in a larger study. Discussion This study design provides an innovative opportunity to examine the conditioning of cortisol under basal conditions and in response to stress. Also, the possible effect of cortisol conditioning on secondary outcomes of self-reported affect and alpha-amylase can be investigated. If cortisol could successfully be conditioned, this would be of conceptual relevance, showing that hypothalamic pituitary adrenal (HPA) axis regulation can be influenced by associative learning processes. Eventually, this could also have important clinical implications for understanding and treating stress-related disorders in which HPA axis dysregulation might play a role. Trial registration Nederlands Trial Register, NTR4651. Registered on 29 July 2014 Electronic supplementary material The online version of this article (10.1186/s40814-018-0382-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- J Tekampe
- 1Health, Medical and Neuropsychology Unit, Faculty of Social and Behavioural Sciences, Institute of Psychology, Leiden University, P.O. Box 9555, 2300 RB, Leiden, The Netherlands.,2Department of Medical Psychology, Radboud university medical center, Nijmegen, The Netherlands
| | - H van Middendorp
- 1Health, Medical and Neuropsychology Unit, Faculty of Social and Behavioural Sciences, Institute of Psychology, Leiden University, P.O. Box 9555, 2300 RB, Leiden, The Netherlands.,2Department of Medical Psychology, Radboud university medical center, Nijmegen, The Netherlands
| | - F C G J Sweep
- 3Department of Laboratory Medicine, Radboud university medical center, Nijmegen, The Netherlands
| | - S H P P Roerink
- 4Division of Endocrinology, Department of Internal Medicine, Radboud university medical center, Nijmegen, The Netherlands
| | - A R M M Hermus
- 4Division of Endocrinology, Department of Internal Medicine, Radboud university medical center, Nijmegen, The Netherlands
| | - A W M Evers
- 1Health, Medical and Neuropsychology Unit, Faculty of Social and Behavioural Sciences, Institute of Psychology, Leiden University, P.O. Box 9555, 2300 RB, Leiden, The Netherlands.,2Department of Medical Psychology, Radboud university medical center, Nijmegen, The Netherlands.,5Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
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Are Adverse Events Induced by the Acute Administration of Calcineurin Inhibitor Cyclosporine A Behaviorally Conditioned in Healthy Male Volunteers? Clin Ther 2018; 40:1868-1877. [PMID: 30376962 DOI: 10.1016/j.clinthera.2018.09.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 09/14/2018] [Accepted: 09/15/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE The learned immunosuppressive placebo response has been demonstrated in experimental animals, healthy humans, and patients, and is suggested as a therapy for improving immunopharmacologic treatment. It remains unclear, however, whether potential adverse events induced by the drug are also behaviorally conditioned. Employing an established taste-immune learning paradigm in healthy humans using the calcineurin inhibitor and immunosuppressive drug cyclosporine A (CsA) as an unconditioned stimulus, we investigated whether and to what extent perceived adverse events induced by acute CsA administration are behaviorally conditioned. METHODS A total of 68 healthy male subjects were exposed to the established taste-immune learning paradigm, receiving either placebo or CsA (10 mg/kg) as an unconditioned stimulus, and a novel-tasting drink as a conditioned stimulus. FINDINGS Subjects repeatedly receiving CsA during acquisition reported significantly more adverse events than did placebo-receiving subjects. However, during reexposure to the conditioned stimulus, the reported adverse events did not differ from those in the placebo control condition. IMPLICATIONS These data indicate that acute adverse events are not behaviorally conditioned during the learned immunosuppressive response. Our results further strengthen the great potential clinical relevance of employing the learned immunosuppressive placebo response as a therapy to support immunopharmacologic regimens, ultimately aiming to reduce the medical dosages required, thereby minimizing adverse drug events while maximizing the therapeutic benefit in patients. German Clinical Trial Register (www.drks.de) identifier: DRKS00007693.
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Abstract
Pharmacological strategies for pain management have primarily focused on dampening ascending neurotransmission and on opioid receptor-mediated therapies. Little is known about the contribution of endogenous descending modulatory systems to clinical pain outcomes and why some patients are mildly affected while others suffer debilitating pain-induced dysfunctions. Placebo effects that arise from patients' positive expectancies and the underlying endogenous modulatory mechanisms may in part account for the variability in pain experience and severity, adherence to treatment, distinct coping strategies, and chronicity. Expectancy-induced analgesia and placebo effects in general have emerged as useful models to assess individual endogenous pain modulatory systems. Different systems and mechanisms trigger placebo effects that highly impact pain processing, clinical outcomes, and sense of well-being. This review illustrates critical elements of placebo mechanisms that inform the methodology of clinical trials, the discovery of new therapeutic targets, and the advancement of personalized pain management.
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Affiliation(s)
- Luana Colloca
- Department of Pain and Translational Symptom Science, School of Nursing; Department of Anesthesiology, School of Medicine; and Center to Advance Chronic Pain Research, University of Maryland, Baltimore, Maryland 21201, USA;
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Smits RM, Veldhuijzen DS, Wulffraat NM, Evers AWM. The role of placebo effects in immune-related conditions: mechanisms and clinical considerations. Expert Rev Clin Immunol 2018; 14:761-770. [DOI: 10.1080/1744666x.2018.1516144] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Rosanne M. Smits
- Faculty of Social and Behavioural Sciences, Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden, The Netherlands
- Department Pediatric Rheumatology and Immunolgy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Dieuwke S. Veldhuijzen
- Faculty of Social and Behavioural Sciences, Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden, The Netherlands
| | - Nico M. Wulffraat
- Department Pediatric Rheumatology and Immunolgy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Andrea W. M. Evers
- Faculty of Social and Behavioural Sciences, Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden, The Netherlands
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
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Neuroimmunology Research. A Report from the Cuban Network of Neuroimmunology. Behav Sci (Basel) 2018; 8:bs8050047. [PMID: 29738432 PMCID: PMC5981241 DOI: 10.3390/bs8050047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 04/23/2018] [Accepted: 04/25/2018] [Indexed: 11/17/2022] Open
Abstract
Neuroimmunology can be traced back to the XIX century through the descriptions of some of the disease’s models (e.g., multiple sclerosis and Guillain Barret syndrome, amongst others). The diagnostic tools are based in the cerebrospinal fluid (CSF) analysis developed by Quincke or in the development of neuroimmunotherapy with the earlier expression in Pasteur’s vaccine for rabies. Nevertheless, this field, which began to become delineated as an independent research area in the 1940s, has evolved as an innovative and integrative field at the shared edges of neurosciences, immunology, and related clinical and research areas, which are currently becoming a major concern for neuroscience and indeed for all of the scientific community linked to it. The workshop focused on several topics: (1) the molecular mechanisms of immunoregulation in health and neurological diseases, (like multiple sclerosis, autism, ataxias, epilepsy, Alzheimer and Parkinson’s disease); (2) the use of animal models for neurodegenerative diseases (ataxia, fronto-temporal dementia/amyotrophic lateral sclerosis, ataxia-telangiectasia); (3) the results of new interventional technologies in neurology, with a special interest in the implementation of surgical techniques and the management of drug-resistant temporal lobe epilepsy; (4) the use of non-invasive brain stimulation in neurodevelopmental disorders; as well as (5) the efficacy of neuroprotective molecules in neurodegenerative diseases. This paper summarizes the highlights of the symposium.
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Abstract
Akin to other physiological responses, immune functions can be modified in humans through associative conditioning procedures as part of a learned placebo response. However, it is unclear whether learned immune responses can be produced in patient populations already receiving an immunosuppressive regimen. In the present study, we demonstrate in renal transplant patients who were already receiving immunosuppressive treatment that learned immunosuppressive placebo responses increased efficacy of immunosuppressive medication. These data demonstrate that behavioral conditioning of drug responses may be a promising tool that could be used as a placebo-based dose-reduction strategy in an ongoing immunopharmacological regimen, the aim being to limit unwanted drug adverse effects and to improve treatment efficacy. Patients after organ transplantation or with chronic, inflammatory autoimmune diseases require lifelong treatment with immunosuppressive drugs, which have toxic adverse effects. Recent insight into the neurobiology of placebo responses shows that associative conditioning procedures can be employed as placebo-induced dose reduction strategies in an immunopharmacological regimen. However, it is unclear whether learned immune responses can be produced in patient populations already receiving an immunosuppressive regimen. Thus, 30 renal transplant patients underwent a taste-immune conditioning paradigm, in which immunosuppressive drugs (unconditioned stimulus) were paired with a gustatory stimulus [conditioned stimulus (CS)] during the learning phase. During evocation phase, after patients were reexposed to the CS, T cell proliferative capacity was significantly reduced in comparison with the baseline kinetics of T cell functions under routine drug intake (ƞp2 = 0.34). These data demonstrate, proof-of-concept, that learned immunosuppressive placebo responses can be used as a supportive, placebo-based, dose-reduction strategy to improve treatment efficacy in an ongoing immunopharmacological regimen.
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Tekampe J, van Middendorp H, Sweep FC, Roerink SH, Hermus AR, Evers AW. Human Pharmacological Conditioning of the Immune and Endocrine System: Challenges and Opportunities. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2018; 138:61-80. [DOI: 10.1016/bs.irn.2018.01.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Petrakova L, Boy K, Kügler M, Benson S, Engler H, Möller L, Schedlowski M. Plasma cortisol response cannot be classically conditioned in a taste-endocrine paradigm in humans. Psychopharmacology (Berl) 2017; 234:3249-3257. [PMID: 28804807 DOI: 10.1007/s00213-017-4718-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 08/02/2017] [Indexed: 11/25/2022]
Abstract
RATIONALE Peripheral immune responses can be modified by associative learning procedures. Less is known, however, whether and to what extent neuroendocrine parameters can be classically conditioned. OBJECTIVES In this randomized double-blind study, we modified an established paradigm to behaviorally condition endocrine responses in humans. METHODS Thirty-one healthy male participants received a distinctively flavored green drink as the conditioned stimulus (CS) and intravenous injections of corticotropin-releasing hormone (CRH) (CRH group, N = 17) or NaCl (placebo group, N = 14) as the unconditioned stimulus (US) during two subsequent acquisition trials. Plasma levels of cortisol and noradrenaline, heart rate, and psychological parameters were analyzed before and 15, 30, 60, 120, and 180 min after injection. The two acquisition trials were followed by two evocation trials, during which participants underwent the same procedure but now receiving NaCl injections. RESULTS CRH administration induced pronounced increases in cortisol and noradrenaline plasma concentrations, heart rate, and anxiety levels. However, re-exposure to the CS during evocations trials did not provoke conditioned increases in neuroendocrine parameters. Median split of the CRH group based on the cortisol baseline level into "cort-high" and "cort-low" subgroups showed that the "cort-high" subgroup displayed a significantly increased cortisol production on evocation days compared to the "cort-low" subgroup and the placebo group. CONCLUSION This taste-endocrine paradigm employing CRH injection as the US in healthy male volunteers failed to induce a behaviorally conditioned cortisol release as a learned endocrine response. Future studies should clarify a possible role of higher baseline cortisol levels in perhaps facilitating a conditioned cortisol response.
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Affiliation(s)
- Liubov Petrakova
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, University of Duisburg-Essen, 45147, Essen, Germany
| | - Karoline Boy
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, University of Duisburg-Essen, 45147, Essen, Germany
| | - Marisa Kügler
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, University of Duisburg-Essen, 45147, Essen, Germany
| | - Sven Benson
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, University of Duisburg-Essen, 45147, Essen, Germany
| | - Harald Engler
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, University of Duisburg-Essen, 45147, Essen, Germany
| | - Lars Möller
- Clinic for Endocrinology, University Hospital Essen, Essen, Germany
| | - Manfred Schedlowski
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, University of Duisburg-Essen, 45147, Essen, Germany.
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Geuter S, Koban L, Wager TD. The Cognitive Neuroscience of Placebo Effects: Concepts, Predictions, and Physiology. Annu Rev Neurosci 2017; 40:167-188. [PMID: 28399689 DOI: 10.1146/annurev-neuro-072116-031132] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Placebos have been used ubiquitously throughout the history of medicine. Expectations and associative learning processes are important psychological determinants of placebo effects, but their underlying brain mechanisms are only beginning to be understood. We examine the brain systems underlying placebo effects on pain, autonomic, and immune responses. The ventromedial prefrontal cortex (vmPFC), insula, amygdala, hypothalamus, and periaqueductal gray emerge as central brain structures underlying placebo effects. We argue that the vmPFC is a core element of a network that represents structured relationships among concepts, providing a substrate for expectations and a conception of the situation-the self in context-that is crucial for placebo effects. Such situational representations enable multidimensional predictions, or priors, that are combined with incoming sensory information to construct percepts and shape motivated behavior. They influence experience and physiology via descending pathways to physiological effector systems, including the spinal cord and other peripheral organs.
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Affiliation(s)
- Stephan Geuter
- Institute of Cognitive Science, University of Colorado, Boulder, Colorado 80309; , , .,Department of Psychology and Neuroscience, University of Colorado, Boulder, Colorado 80309
| | - Leonie Koban
- Institute of Cognitive Science, University of Colorado, Boulder, Colorado 80309; , , .,Department of Psychology and Neuroscience, University of Colorado, Boulder, Colorado 80309
| | - Tor D Wager
- Institute of Cognitive Science, University of Colorado, Boulder, Colorado 80309; , , .,Department of Psychology and Neuroscience, University of Colorado, Boulder, Colorado 80309
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Ashar YK, Chang LJ, Wager TD. Brain Mechanisms of the Placebo Effect: An Affective Appraisal Account. Annu Rev Clin Psychol 2017; 13:73-98. [PMID: 28375723 DOI: 10.1146/annurev-clinpsy-021815-093015] [Citation(s) in RCA: 108] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Placebos are sham medical treatments. Nonetheless, they can have substantial effects on clinical outcomes. Placebos depend on a person's psychological and brain responses to the treatment context, which influence appraisals of future well-being. Appraisals are flexible cognitive evaluations of the personal meaning of events and situations that can directly impact symptoms and physiology. They also shape associative learning processes by guiding what is learned from experience. Appraisals are supported by a core network of brain regions associated with the default mode network involved in self-generated emotion, self-evaluation, thinking about the future, social cognition, and valuation of rewards and punishment. Placebo treatments for acute pain and a range of clinical conditions engage this same network of regions, suggesting that placebos affect behavior and physiology by changing how a person evaluates their future well-being and the personal significance of their symptoms.
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Affiliation(s)
- Yoni K Ashar
- Department of Psychology and Neuroscience, University of Colorado, Boulder, Colorado 80309
| | - Luke J Chang
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover, New Hampshire 03755
| | - Tor D Wager
- Department of Psychology and Neuroscience, University of Colorado, Boulder, Colorado 80309.,Institute of Cognitive Science, University of Colorado, Boulder, Colorado 80309;
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Tekampe J, van Middendorp H, Meeuwis SH, van Leusden JWR, Pacheco-López G, Hermus ARMM, Evers AWM. Conditioning Immune and Endocrine Parameters in Humans: A Systematic Review. PSYCHOTHERAPY AND PSYCHOSOMATICS 2017; 86:99-107. [PMID: 28183096 DOI: 10.1159/000449470] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Accepted: 08/26/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Conditioned pharmacological effects may provide relevant clinical opportunities to improve treatment for patients with a variety of conditions. The aim of this systematic review was to create an overview of studies in this field of research and to investigate whether specific characteristics of the study design make for successful conditioning. METHODS The protocol of this review was registered in Prospero (PROSPERO 2015: CRD42015024148). A systematic literature search was conducted in the databases PubMed, Embase, and PsychInfo. Studies were included if they were placebo-controlled trials in humans in which the effects of a pharmacological agent on immune or endocrine outcomes (e.g., interleukin-2 and cortisol) were conditioned, using a specific conditioned stimulus. The risk of bias of each study was assessed using the Cochrane risk-of-bias tool. RESULTS The final selection included 16 studies. Overall, those studies indicate that conditioning of immunosuppression, conditioning of allergic responses, and conditioning of insulin and glycemic responses is possible. Regarding immunostimulants, antiallergic effects, and cortisol conditioning, the preliminary results are promising, but additional studies are needed. CONCLUSIONS This systematic review shows classical conditioning of immune and endocrine responses for various pharmaceutical substances. The studies reviewed here indicate that the number of acquisition and evocation sessions, and characteristics of the unconditioned and conditioned stimuli, are important determinants of the effectiveness of pharmacological conditioning on immune and endocrine parameters. In the future, conditioned pharmacological effects may be used clinically as adjunct therapy in various patient populations.
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Affiliation(s)
- Judith Tekampe
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, The Netherlands
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Lückemann L, Unteroberdörster M, Kirchhof J, Schedlowski M, Hadamitzky M. Applications and limitations of behaviorally conditioned immunopharmacological responses. Neurobiol Learn Mem 2017; 142:91-98. [PMID: 28216206 DOI: 10.1016/j.nlm.2017.02.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 02/10/2017] [Accepted: 02/15/2017] [Indexed: 12/17/2022]
Abstract
The importance of placebo responses for the treatment of various medical conditions has increasingly been recognized, whereas knowledge and systematic application in clinical settings are still sparse. One possible application for placebo responses in pharmacotherapy is given by learning paradigms, such as behaviorally conditioned immunosuppression, aiming at drug dose reduction while maintaining therapeutic efficacy of drug treatment. In an established learning paradigm of conditioned taste aversion/avoidance (CTA) in both, rats and humans, respectively, a novel-tasting drinking solution (conditioned stimulus, CS) is paired with an injection of the immunosuppressive drug cyclosporine A (CsA) as unconditioned stimulus (US). The conditioned response, evoked by re-presenting the CS alone at a later time, is reflected by avoidance behavior of consuming the solution (conditioned taste aversion; CTA) and a diminished interleukin (IL)-2 and interferon (IFN)-γ cytokine production as well as mRNA expression of rat splenic T cells or human peripheral T lymphocytes, closely mimicking the immunosuppressive effects of CsA. However, due to unreinforced CS-re-exposure conditioned responses progressively decreases over time (extinction), reflecting a considerable challenge for potential clinical applications of this learned immunosuppression. The present article discusses and critically reviews actual approaches, applications but also limitations of learning paradigms in immune pharmacotherapy.
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Affiliation(s)
- Laura Lückemann
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, University of Duisburg-Essen, 45122 Essen, Germany
| | - Meike Unteroberdörster
- Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, 45122 Essen, Germany
| | - Julia Kirchhof
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, University of Duisburg-Essen, 45122 Essen, Germany
| | - Manfred Schedlowski
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, University of Duisburg-Essen, 45122 Essen, Germany
| | - Martin Hadamitzky
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, University of Duisburg-Essen, 45122 Essen, Germany.
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Neural regulation of immunity: molecular mechanisms and clinical translation. Nat Neurosci 2017; 20:156-166. [PMID: 28092663 DOI: 10.1038/nn.4477] [Citation(s) in RCA: 354] [Impact Index Per Article: 44.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 12/12/2016] [Indexed: 12/14/2022]
Abstract
Studies bridging neuroscience and immunology have identified neural pathways that regulate immunity and inflammation. Recent research using methodological advances in molecular genetics has improved our understanding of the neural control of immunity. Here we outline mechanistic insights, focusing on translational relevance and conceptual developments. We also summarize findings from recent clinical studies of bioelectronic neuromodulation in inflammatory and autoimmune diseases.
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Gano A, Pautassi RM, Doremus-Fitzwater TL, Deak T. Conditioned effects of ethanol on the immune system. Exp Biol Med (Maywood) 2017; 242:718-730. [PMID: 28201924 DOI: 10.1177/1535370217694097] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Several studies indicate that the immune system can be subjected to classical conditioning. Acute ethanol intoxication significantly modulates several pro-inflammatory cytokines (e.g. interleukins-1 and 6 [IL-1β and IL-6, respectively] and tumor necrosis factor alpha [TNFα])) in several brain areas, including amygdala (AMG), paraventricular nucleus (PVN), and hippocampus (HPC). It is unknown, however, whether cues associated with ethanol can elicit conditioned alterations in cytokine expression. The present study analyzed, in male Sprague-Dawley rats, whether ethanol-induced changes in the central cytokine response may be amenable to conditioning. In Experiments 1 and 2, the rats were given one or two pairings between a distinctive odor (conditional stimulus, CS) and the post-absorptive effects of a high (3.0 or 4.0 g/kg, Experiments 1 and 2, respectively) ethanol dose. Neither of these experiments revealed conditioning of IL-6, IL-1β, or TNFα, as measured via mRNA levels. Yet, re-exposure to the lemon-odor CS in Experiment 1 significantly increased C-Fos levels in the PVN. In Experiment 3, the rats were given four pairings between an odor CS and a moderate ethanol dose (2.0 g/kg), delivered intraperitoneally (i.p.) or intragastrically (i.g.). Re-exposure to the odor CS significantly increased IL-6 levels in HPC and AMG, an effect only evident in paired rats administered ethanol i.p. Overall, this study suggests that ethanol exposure can regulate the levels of IL-6 at HPC and AMG via classical conditioning mechanisms. These ethanol-induced, conditioned alterations in cytokine levels may ultimately affect the intake and motivational effects of ethanol. Impact statement This study examines, across three experiments, whether odor cues associated with ethanol exposure can condition changes in cytokine expression. The analysis of ethanol-induced conditioning of immune responses is a novel niche that can help understand the transition from social drinking to alcohol abuse and dependence. Ethanol-induced conditioning of the immune system could likely exacerbate neuroinflammation and drug-related toxicity, which in turn may facilitate further engagement in ethanol intake. The main new finding of the present study was that, after four pairings of ethanol's unconditioned effects and a distinctive odor, the latter CS increased IL-6 levels in HPC and AMG. This suggests that ethanol's effects upon IL-6 in HPC and AMG may come under conditioned control, particularly after repeated pairings between distinctive odor cues and ethanol's effects. This article advances our knowledge of conditioned increases in cytokine responses, which should help understand the mechanisms underlying alcohol use, abuse, and relapse.
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Affiliation(s)
- Anny Gano
- 1 Department of Psychology, Developmental Exposure Alcohol Research Center, NY 13902-6000, USA
| | - Ricardo Marcos Pautassi
- 2 Instituto de Investigación Médica M. y M. Ferreyra, Universidad Nacional de Córdoba, C.P. 5000, Argentina.,3 Facultad de Psicología, Universidad Nacional de Córdoba, C.P. 5000, Argentina
| | | | - Terrence Deak
- 1 Department of Psychology, Developmental Exposure Alcohol Research Center, NY 13902-6000, USA
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Tuerkmen A, Bösche K, Lückemann L, Engler H, Schedlowski M, Hadamitzky M. Rats taste-aversive learning with cyclosporine a is not affected by contextual changes. Behav Brain Res 2016; 312:169-73. [DOI: 10.1016/j.bbr.2016.06.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 06/09/2016] [Accepted: 06/13/2016] [Indexed: 11/24/2022]
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Hadamitzky M, Orlowski K, Schwitalla JC, Bösche K, Unteroberdörster M, Bendix I, Engler H, Schedlowski M. Transient inhibition of protein synthesis in the rat insular cortex delays extinction of conditioned taste aversion with cyclosporine A. Neurobiol Learn Mem 2016; 133:129-135. [DOI: 10.1016/j.nlm.2016.06.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 05/29/2016] [Accepted: 06/12/2016] [Indexed: 12/19/2022]
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Lebonville CL, Jones ME, Hutson LW, Cooper LB, Fuchs RA, Lysle DT. Acquisition of heroin conditioned immunosuppression requires IL-1 signaling in the dorsal hippocampus. Brain Behav Immun 2016; 56:325-34. [PMID: 27072068 PMCID: PMC4917416 DOI: 10.1016/j.bbi.2016.04.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 03/31/2016] [Accepted: 04/08/2016] [Indexed: 12/31/2022] Open
Abstract
Opioid users experience increased incidence of infection, which may be partially attributable to both direct opiate-immune interactions and conditioned immune responses. Previous studies have investigated the neural circuitry governing opioid conditioned immune responses, but work remains to elucidate the mechanisms mediating this effect. Our laboratory has previously shown that hippocampal IL-1 signaling, specifically, is required for the expression of heroin conditioned immunosuppression following learning. The current studies were designed to further characterize the role of hippocampal IL-1 in this phenomenon by manipulating IL-1 during learning. Experiment 1 tested whether hippocampal IL-1 is also required for the acquisition of heroin conditioned immunosuppression, while Experiment 2 tested whether hippocampal IL-1 is required for the expression of unconditioned heroin immunosuppression. We found that blocking IL-1 signaling in the dorsal hippocampus with IL-1RA during each conditioning session, but not on interspersed non-conditioning days, significantly attenuated the acquisition of heroin conditioned immunosuppression. Strikingly, we found that the same IL-1RA treatment did not alter unconditioned immunosuppression to a single dose of heroin. Thus, IL-1 signaling is not a critical component of the response to heroin but rather may play a role in the formation of the association between heroin and the context. Collectively, these studies suggest that IL-1 signaling, in addition to being involved in the expression of a heroin conditioned immune response, is also involved in the acquisition of this effect. Importantly, this effect is likely not due to blocking the response to the unconditioned stimulus since IL-1RA did not affect heroin's immunosuppressive effects.
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Affiliation(s)
- Christina L Lebonville
- University of North Carolina at Chapel Hill, Department of Psychology and Neuroscience, CB#3270, Chapel Hill, NC 27599-3270, USA
| | - Meghan E Jones
- University of North Carolina at Chapel Hill, Department of Psychology and Neuroscience, CB#3270, Chapel Hill, NC 27599-3270, USA
| | - Lee W Hutson
- University of North Carolina at Chapel Hill, Department of Psychology and Neuroscience, CB#3270, Chapel Hill, NC 27599-3270, USA
| | - Letty B Cooper
- University of North Carolina at Chapel Hill, Department of Psychology and Neuroscience, CB#3270, Chapel Hill, NC 27599-3270, USA
| | - Rita A Fuchs
- Washington State University College of Veterinary Medicine, Department of Integrative Physiology and Neuroscience, PO Box 647620, Pullman, WA 99164-7620, USA
| | - Donald T Lysle
- University of North Carolina at Chapel Hill, Department of Psychology and Neuroscience, CB#3270, Chapel Hill, NC 27599-3270, USA.
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Andreasson A, Wicksell RK, Lodin K, Karshikoff B, Axelsson J, Lekander M. A global measure of sickness behaviour: Development of the Sickness Questionnaire. J Health Psychol 2016; 23:1452-1463. [PMID: 27458105 DOI: 10.1177/1359105316659917] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Symptoms after inflammatory activation, so-called sickness behaviour, overlap with trans-diagnostic complaints. As no self-report questionnaire to assess sickness behaviour exists, we aimed to develop such an instrument, the Sickness Questionnaire. Items responsive to experimentally induced inflammatory activation (randomized double-blind study endotoxin (0.6 ng/kg) versus placebo, n = 52) were selected and the statistical properties were examined in 172 primary care patients. A principal component analysis indicated a one-factor solution (Cronbach's alpha = .86). This 10-item scale correlated with depression ( β = .41, p < .001), anxiety ( β = .36, p < .001), self-rated health ( β = .28, p < .001) and a single item of feeling sick ( β = .55, p < .001). The results support the adequacy of Sickness Questionnaire as a brief assessment instrument of perceived sickness behaviour.
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Affiliation(s)
- Anna Andreasson
- 1 Karolinska Institutet, Sweden.,2 Stockholm University, Sweden
| | - Rikard K Wicksell
- 1 Karolinska Institutet, Sweden.,3 Karolinska University Hospital, Sweden
| | | | | | - John Axelsson
- 1 Karolinska Institutet, Sweden.,2 Stockholm University, Sweden
| | - Mats Lekander
- 1 Karolinska Institutet, Sweden.,2 Stockholm University, Sweden
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Winkler A, Rheker J, Doering BK, Rief W. Conditioning of amitriptyline-induced REM sleep suppression in healthy participants: A randomized controlled trial. Psychophysiology 2016; 53:1560-6. [PMID: 27354202 DOI: 10.1111/psyp.12695] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 05/30/2016] [Indexed: 01/29/2023]
Abstract
Clinical trials in sleep disorders report substantial improvement in symptoms in their placebo groups. Behavioral conditioning is one of the underlying mechanisms of the placebo response. However, we do not know whether, and if so, the extent to which sleep architecture is influenced by behavioral conditioning, similarly to other physiological responses (i.e., those in the immune system). We therefore applied a conditioning paradigm to 39 healthy adults pairing a novel-tasting drink (conditioned stimulus, CS) with the REM sleep suppressing tricyclic antidepressant amitriptyline as unconditioned stimulus during the acquisition phase. Subsequent sole presentation of the CS (together with a placebo pill) in an evocation night led to significantly more REM sleep in the amitriptyline group. Instead of the expected REM sleep suppression in the evocation night, we observed more REM sleep, indicating a rebound that interferes with the conditioned response.
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Affiliation(s)
- Alexander Winkler
- Department of Psychology, Philipps University Marburg, Marburg, Germany.
| | - Julia Rheker
- Department of Psychology, Philipps University Marburg, Marburg, Germany
| | - Bettina K Doering
- Department of Psychology, Philipps University Marburg, Marburg, Germany
| | - Winfried Rief
- Department of Psychology, Philipps University Marburg, Marburg, Germany
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Hadamitzky M, Bösche K, Wirth T, Buck B, Beetz O, Christians U, Schniedewind B, Lückemann L, Güntürkün O, Engler H, Schedlowski M. Memory-updating abrogates extinction of learned immunosuppression. Brain Behav Immun 2016; 52:40-48. [PMID: 26386321 DOI: 10.1016/j.bbi.2015.09.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 09/09/2015] [Accepted: 09/16/2015] [Indexed: 10/23/2022] Open
Abstract
When memories are recalled, they enter a transient labile phase in which they can be impaired or enhanced followed by a new stabilization process termed reconsolidation. It is unknown, however, whether reconsolidation is restricted to neurocognitive processes such as fear memories or can be extended to peripheral physiological functions as well. Here, we show in a paradigm of behaviorally conditioned taste aversion in rats memory-updating in learned immunosuppression. The administration of sub-therapeutic doses of the immunosuppressant cyclosporin A together with the conditioned stimulus (CS/saccharin) during retrieval blocked extinction of conditioned taste aversion and learned suppression of T cell cytokine (interleukin-2; interferon-γ) production. This conditioned immunosuppression is of clinical relevance since it significantly prolonged the survival time of heterotopically transplanted heart allografts in rats. Collectively, these findings demonstrate that memories can be updated on both neural and behavioral levels as well as on the level of peripheral physiological systems such as immune functioning.
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Affiliation(s)
- Martin Hadamitzky
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, University of Duisburg-Essen, 45122 Essen, Germany
| | - Katharina Bösche
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, University of Duisburg-Essen, 45122 Essen, Germany
| | - Timo Wirth
- Department of Pedriatric Rheumatology & Immunology, University Children's Hospital Münster, 48149 Münster, Germany
| | - Benjamin Buck
- Department of General, Visceral and Transplant Surgery, Hannover Medical School, 30625 Hannover, Germany
| | - Oliver Beetz
- Department of General, Visceral and Transplant Surgery, Hannover Medical School, 30625 Hannover, Germany
| | - Uwe Christians
- Clinical Research and Development, Department of Anesthesiology, University of Colorado, Aurora, CO 80045-7503, USA
| | - Björn Schniedewind
- Clinical Research and Development, Department of Anesthesiology, University of Colorado, Aurora, CO 80045-7503, USA
| | - Laura Lückemann
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, University of Duisburg-Essen, 45122 Essen, Germany
| | - Onur Güntürkün
- Department of Biopsychology, Faculty of Psychology, Ruhr-University Bochum, 44780 Bochum, Germany
| | - Harald Engler
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, University of Duisburg-Essen, 45122 Essen, Germany
| | - Manfred Schedlowski
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, University of Duisburg-Essen, 45122 Essen, Germany.
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Lueckemann L, Bösche K, Engler H, Schwitalla JC, Hadamitzky M, Schedlowski M. Pre-exposure to the unconditioned or conditioned stimulus does not affect learned immunosuppression in rats. Brain Behav Immun 2016; 51:252-257. [PMID: 26365026 DOI: 10.1016/j.bbi.2015.09.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 09/09/2015] [Accepted: 09/09/2015] [Indexed: 01/31/2023] Open
Abstract
In order to analyze the effects of pre-exposure to either the unconditioned (US) or conditioned stimulus (CS) on learned immunosuppression, we employed an established conditioned taste aversion (CTA) paradigm in rats. In our model, a sweet-tasting drinking solution (saccharin) serves as CS and injection of the immunosuppressive drug cyclosporine A (CsA) is used as US. The conditioned response is reflected by a pronounced CTA and diminished cytokine production by anti-CD3 stimulated splenic T cells. In the present study, experimental animals were exposed either to the US or the CS three times prior to the acquisition phase. On the behavioral level, we found a significantly diminished CTA when animals were pre-exposed to the US or the CS before acquisition. In contrast, US or CS pre-exposure did not affect the behaviorally conditioned suppression of interleukin (IL)-2 production. From the clinical perspective, our data may suggest that conditioning paradigms could be systemically integrated as supportive therapeutic interventions in patients that are already on immunosuppressive therapy or have had previous contact to the gustatory stimulus. Such supportive therapies to pharmacological regimens could not only help to reduce the amount of medication needed and, thus, unwanted toxic side effects, but may also maximize the therapeutic outcome.
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Affiliation(s)
- Laura Lueckemann
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany
| | - Katharina Bösche
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany
| | - Harald Engler
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany
| | - Jan-Claudius Schwitalla
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany
| | - Martin Hadamitzky
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany
| | - Manfred Schedlowski
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany.
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The neuroscience of placebo effects: connecting context, learning and health. Nat Rev Neurosci 2015; 16:403-18. [PMID: 26087681 DOI: 10.1038/nrn3976] [Citation(s) in RCA: 517] [Impact Index Per Article: 51.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Placebo effects are beneficial effects that are attributable to the brain-mind responses to the context in which a treatment is delivered rather than to the specific actions of the drug. They are mediated by diverse processes--including learning, expectations and social cognition--and can influence various clinical and physiological outcomes related to health. Emerging neuroscience evidence implicates multiple brain systems and neurochemical mediators, including opioids and dopamine. We present an empirical review of the brain systems that are involved in placebo effects, focusing on placebo analgesia, and a conceptual framework linking these findings to the mind-brain processes that mediate them. This framework suggests that the neuropsychological processes that mediate placebo effects may be crucial for a wide array of therapeutic approaches, including many drugs.
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Extinction of conditioned taste aversion is related to the aversion strength and associated with c-fos expression in the insular cortex. Neuroscience 2015; 303:34-41. [DOI: 10.1016/j.neuroscience.2015.06.040] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Revised: 05/05/2015] [Accepted: 06/22/2015] [Indexed: 12/19/2022]
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Schedlowski M, Enck P, Rief W, Bingel U. Neuro-Bio-Behavioral Mechanisms of Placebo and Nocebo Responses: Implications for Clinical Trials and Clinical Practice. Pharmacol Rev 2015; 67:697-730. [PMID: 26126649 DOI: 10.1124/pr.114.009423] [Citation(s) in RCA: 217] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The placebo effect has often been considered a nuisance in basic and particularly clinical research. This view has gradually changed in recent years due to deeper insight into the neuro-bio-behavioral mechanisms steering both the placebo and nocebo responses, the evil twin of placebo. For the neuroscientist, placebo and nocebo responses have evolved as indispensable tools to understand brain mechanisms that link cognitive and emotional factors with symptom perception as well as peripheral physiologic systems and end organ functioning. For the clinical investigator, better understanding of the mechanisms driving placebo and nocebo responses allow the control of these responses and thereby help to more precisely define the efficacy of a specific pharmacological intervention. Finally, in the clinical context, the systematic exploitation of these mechanisms will help to maximize placebo responses and minimize nocebo responses for the patient's benefit. In this review, we summarize and critically examine the neuro-bio-behavioral mechanisms underlying placebo and nocebo responses that are currently known in terms of different diseases and physiologic systems. We subsequently elaborate on the consequences of this knowledge for pharmacological treatments of patients and the implications for pharmacological research, the training of healthcare professionals, and for the health care system and future research strategies on placebo and nocebo responses.
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Affiliation(s)
- Manfred Schedlowski
- Institute of Medical Psychology and Behavioral Immunobiology (M.S.) and Department of Neurology (U.B.), University Clinic Essen, Essen, Germany; Department of Internal Medicine VI, Psychosomatic Medicine, University Hospital Tübingen, Tübingen, Germany (P.E.); and Department of Psychology, University of Marburg, Marburg, Germany (W.R.)
| | - Paul Enck
- Institute of Medical Psychology and Behavioral Immunobiology (M.S.) and Department of Neurology (U.B.), University Clinic Essen, Essen, Germany; Department of Internal Medicine VI, Psychosomatic Medicine, University Hospital Tübingen, Tübingen, Germany (P.E.); and Department of Psychology, University of Marburg, Marburg, Germany (W.R.)
| | - Winfried Rief
- Institute of Medical Psychology and Behavioral Immunobiology (M.S.) and Department of Neurology (U.B.), University Clinic Essen, Essen, Germany; Department of Internal Medicine VI, Psychosomatic Medicine, University Hospital Tübingen, Tübingen, Germany (P.E.); and Department of Psychology, University of Marburg, Marburg, Germany (W.R.)
| | - Ulrike Bingel
- Institute of Medical Psychology and Behavioral Immunobiology (M.S.) and Department of Neurology (U.B.), University Clinic Essen, Essen, Germany; Department of Internal Medicine VI, Psychosomatic Medicine, University Hospital Tübingen, Tübingen, Germany (P.E.); and Department of Psychology, University of Marburg, Marburg, Germany (W.R.)
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50
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Frisaldi E, Piedimonte A, Benedetti F. Placebo and nocebo effects: a complex interplay between psychological factors and neurochemical networks. AMERICAN JOURNAL OF CLINICAL HYPNOSIS 2015; 57:267-84. [PMID: 25928679 DOI: 10.1080/00029157.2014.976785] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Placebo and nocebo effects have recently emerged as an interesting model to understand some of the intricate underpinnings of the mind-body interaction. A variety of psychological mechanisms, such as expectation, conditioning, anxiety modulation, and reward, have been identified, and a number of neurochemical networks have been characterized across different conditions, such as pain and motor disorders. What has emerged from the recent insights into the neurobiology of placebo and nocebo effects is that the psychosocial context around the patient and the therapy, which represents the ritual of the therapeutic act, may change the biochemistry and the neuronal circuitry of the patient's brain. Furthermore, the mechanisms activated by placebos and nocebos have been found to be the same as those activated by drugs, which suggests a cognitive/affective interference with drug action. Overall, these findings highlight the important role of therapeutic rituals in the overall therapeutic outcome, including hypnosis, which may have profound implications both in routine medical practice and in the clinical trials setting.
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