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Perrin AJ, Horowitz MA, Roelofs J, Zunszain PA, Pariante CM. Glucocorticoid Resistance: Is It a Requisite for Increased Cytokine Production in Depression? A Systematic Review and Meta-Analysis. Front Psychiatry 2019; 10:423. [PMID: 31316402 PMCID: PMC6609575 DOI: 10.3389/fpsyt.2019.00423] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 05/28/2019] [Indexed: 12/29/2022] Open
Abstract
Background: Glucocorticoid resistance-reduced function of the glucocorticoid receptor (GR)-is seen in many depressed patients. It is argued that this resistance to glucocorticoids leads to failure of normal feedback regulation on the immune system. High levels of pro-inflammatory cytokines result. Purpose: We sought to identify evidence supporting or refuting a link between glucocorticoid resistance and immune dysregulation in depression and to summarize retrieved evidence in aggregate form. Methods: We systematically reviewed and meta-analyzed studies that examined cytokine levels in depressed patients compared with controls and that also reported a measure of glucocorticoid resistance. These measures included plasma cortisol, the dexamethasone suppression test (DST), GR expression levels, and the results of in vitro assays of GR function. We conducted four separate meta-analyses to test for moderating effects of glucocorticoid resistance on cytokine production in depression. Results: After sub-grouping 32 studies by the ratio of cortisol levels in patients compared with controls, we observed a trend for increasing glucocorticoid resistance (i.e., the most hypercortisolemic patients) to be associated with increased production of interleukin (IL)-6 [d = 0.94; 95% CI (0.29, 1.59)] and tumour necrosis factor (TNF)-α [d = 0.46; 95% CI (0.12, 0.79)]. We stratified nine studies that reported DST results by relative glucocorticoid resistance between patients and controls, identifying a trend for higher glucocorticoid resistance in patients, compared with controls, to be associated with higher cytokine production in patients (170 patients and 187 controls). This was particularly evident when studies were sub-grouped by source of cytokine-plasma (d = 1.04; 95% CI, 0.57-1.50) versus in vitro (d = 0.24; 95% CI, -0.20 to 0.67). Stratifying the four studies (147 patients and 118 controls) that used in vitro assays of GR function or GR expression to quantify glucocorticoid resistance revealed variable contributions to cytokine production in patients compared with controls (overall effect size: d = 1.35; 95% CI 0.53-2.18). Combining our analyses of studies that reported DST results with those that used in vitro assays of GR function or GR expression to quantify glucocorticoid resistance (302 patients and 277 controls), we noted that although depressed patients produced more cytokines than controls (d = 1.02; 95% CI, 0.55-1.49), there was no evident positive correlation between glucocorticoid resistance and inflammation. Conclusions: Our work provides some support for a model conceptualizing glucocorticoid resistance as a requisite for increased inflammation in depression. The limited number of studies identified highlights the need for purpose-designed investigations that directly examine the relationship between glucocorticoid resistance and cytokine production in depression.
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Affiliation(s)
- Andrew J. Perrin
- Stress, Psychiatry and Immunology Laboratory, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
- Clinician Investigator Program and Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Mark A. Horowitz
- Stress, Psychiatry and Immunology Laboratory, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Jacob Roelofs
- Stress, Psychiatry and Immunology Laboratory, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Patricia A. Zunszain
- Stress, Psychiatry and Immunology Laboratory, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Carmine M. Pariante
- Stress, Psychiatry and Immunology Laboratory, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
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Latysheva NV, Filatova EG, Osipova DV. Chronic pain, depression and cognitive impairment: a close relationship. ACTA ACUST UNITED AC 2018. [DOI: 10.17650/2222-8721-2018-8-3-34-42] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Over a half of chronic pain (CP) patients present with cognitive complaints, which increase their disability and impact quality of life. The paper reviews objective impairments in memory, attention, processing speed and executive function demonstrated in the CP population. The paper also reviews common pathology underlying cognitive impairment and CP: neuroplasticity in the shared brain areas, neurotransmitter and other molecular mechanisms. Common mechanisms in CP and depression precipitating cognitive impairment are also discussed. The paper also compares the potential of different antidepressants to improve cognitive functions in depression and CP.
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Affiliation(s)
- N. V. Latysheva
- I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia; Alexander Vein Headache Clinic
| | - E. G. Filatova
- I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia; Alexander Vein Headache Clinic
| | - D. V. Osipova
- I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia
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Zhang HX, Xu YQ, Li YY, Lu MF, Shi SX, Ji JL, Wang LW. Difference in proinflammatory cytokines produced by monocytes between patients with major depressive disorder and healthy controls. J Affect Disord 2018; 234:305-310. [PMID: 29587166 DOI: 10.1016/j.jad.2017.12.099] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 11/29/2017] [Accepted: 12/31/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND Immune activation and suppression in patients with major depressive disorders (MDD) have been both reported in different studies. We assume that these findings may indicate innate immunological tolerance in MDD, with subclinical elevated level of proinflammatory cytokines and the decrease in innate immune response while encountering pathogens. METHODS Peripheral monocytes of 50 untreated patients with MDD and 40 healthy controls were isolated and cultured, with or without 10 ng/ml lipopolysacchride (LPS) for 6 h (6 h, LPS+/-), and with LPS for 18 h (18, LPS+). The cell culture supernatants were collected to measure concentrations of tumor necrosis factor-alpha (TNF-α), interleukin 6 (IL-6), and interleukin 1 beta (IL-1β). RESULTS The baseline concentrations of IL-6 and IL-1β (6 h, LPS-) were significantly higher in the MDD group than those in the control group. There was no significant difference of TNF-α between the two groups. The fold changes of LPS-induced secretion of IL-6 and TNF-α from monocytes cultured for 6 and 18 h were all lower in the patient groups, and that was true for IL-1β as monocytes cultured for 18 h. LIMITATIONS Given the gap between the results of in vitro experiments and the actual response that happens in vivo when the immune system encounters pathogens from the external world, future research should include in vivo methods to test the results of the current study. CONCLUSIONS Patients with MDD may have subclinical inflammation during a depressive episode, and the reduced response to LPS in monocytes indicates innate immunological tolerance.
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Affiliation(s)
- Hong-Xia Zhang
- Department of Psychiatry, Huashan Hospital, Fudan University, Shanghai, China
| | - Ye-Qing Xu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuan-Yuan Li
- Department of Psychological Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ming-Fang Lu
- Department of Immunology, Shanghai Medical School, Fudan University, Shanghai, China
| | - Shen-Xun Shi
- Department of Psychiatry, Huashan Hospital, Fudan University, Shanghai, China
| | - Jian-Lin Ji
- Department of Psychological Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.
| | - Li-Wei Wang
- Department of Psychiatry, Huashan Hospital, Fudan University, Shanghai, China.
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Mrugacz M, Ostrowska L, Bryl A, Szulc A, Zelazowska-Rutkowska B, Mrugacz G. Pro-inflammatory cytokines associated with clinical severity of dry eye disease of patients with depression. Adv Med Sci 2017; 62:338-344. [PMID: 28511072 DOI: 10.1016/j.advms.2017.03.003] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 01/16/2017] [Accepted: 03/09/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE The aim of this study was to assess the correlation of inflammatory cytokines levels in tears with severity of dry eye disease in a cohort of patients with depression. MATERIAL AND METHODS Tear fluid samples were collected from 32 patients with depression treated with antidepressants, and 34 healthy subjects. Cytokines were assessed by ELISA. All the subjects completed the Beck Depression Inventory and performed the ophthalmic examination, including dry eye tests. RESULTS The tear fluid levels of IL-6, IL-17 and TNF-α in depressive patients were higher than in controls. The clinical severity of dry eye disease correlated significantly with the IL-17 and TNF-α levels. CONCLUSIONS Our results suggest a crucial role of inflammatory cytokines, especially IL-17 and TNF-α, in the development of severe dry eye disease in patients with depression. Clarification of the role pro-inflammatory cytokines in the pathogenesis of ocular findings in depressive patients may be useful in establishing immunotherapeutic strategies for this disease.
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Kudinova AY, Deak T, Hueston CM, McGeary JE, Knopik VS, Palmer RHC, Gibb BE. Cross-species evidence for the role of interleukin-33 in depression risk. JOURNAL OF ABNORMAL PSYCHOLOGY 2016; 125:482-94. [PMID: 27054346 DOI: 10.1037/abn0000158] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Extensive evidence highlights the role of inflammatory processes in major depressive disorder (MDD). However, most studies have examined a consistent set of inflammatory cytokines and there is evidence that other immune-derived products may play a role in MDD. In this article, we present data from 3 complimentary studies that support the role of a novel cytokine, interleukin-33 (IL-33), in depression risk. First, we show that a 2-SNP haplotype in the IL-33 gene (rs11792633 and rs7044343) moderated the link between women's history of childhood abuse and their history of recurrent MDD (rMDD), such that the link between childhood abuse and rMDD was stronger among women with fewer copies of the protective IL-33 CT haplotype. Second, linking these findings to differences in circulating cytokine levels, we show in a separate sample that those with a history of rMDD had higher peripheral levels of IL-33 and IL-1β compared with women with a single MDD episode or no history of MDD. Third, providing initial evidence of brain regions underlying these effects using archival rat brain tissue, we show that an acute stressor increased IL-33 expression in the paraventricular nucleus of the hypothalamus and, to a lesser extent, the prefrontal cortex, key brain regions underlying stress response and emotion regulation. These findings provide converging support for the potential role of IL-33 in risk for recurrent MDD. (PsycINFO Database Record
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Affiliation(s)
| | - Terrence Deak
- Center for Affective Science, Binghamton University (SUNY)
| | - Cara M Hueston
- Center for Affective Science, Binghamton University (SUNY)
| | | | | | | | - Brandon E Gibb
- Center for Affective Science, Binghamton University (SUNY)
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Munzer A, Sack U, Mergl R, Schönherr J, Petersein C, Bartsch S, Kirkby KC, Bauer K, Himmerich H. Impact of antidepressants on cytokine production of depressed patients in vitro. Toxins (Basel) 2013; 5:2227-40. [PMID: 24257035 PMCID: PMC3847723 DOI: 10.3390/toxins5112227] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Revised: 11/08/2013] [Accepted: 11/12/2013] [Indexed: 12/14/2022] Open
Abstract
The interplay between immune and nervous systems plays a pivotal role in the pathophysiology of depression. In depressive episodes, patients show increased production of pro-inflammatory cytokines such as interleukin (IL)-1β and tumor necrosis factor (TNF)-α. There is limited information on the effect of antidepressant drugs on cytokines, most studies report on a limited sample of cytokines and none have reported effects on IL-22. We systematically investigated the effect of three antidepressant drugs, citalopram, escitalopram and mirtazapine, on secretion of cytokines IL-1β, IL-2, IL-4, IL-6, IL-17, IL-22 and TNF-α in a whole blood assay in vitro, using murine anti-human CD3 monoclonal antibody OKT3, and 5C3 monoclonal antibody against CD40, to stimulate T and B cells respectively. Citalopram increased production of IL-1β, IL-6, TNF-α and IL-22. Mirtazapine increased IL-1β, TNF-α and IL-22. Escitalopram decreased IL-17 levels. The influence of antidepressants on IL-2 and IL-4 levels was not significant for all three drugs. Compared to escitalopram, citalopram led to higher levels of IL-1β, IL-6, IL-17 and IL-22; and mirtazapine to higher levels of IL-1β, IL-17, IL-22 and TNF-α. Mirtazapine and citalopram increased IL-22 production. The differing profile of cytokine production may relate to differences in therapeutic effects, risk of relapse and side effects.
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Affiliation(s)
- Alexander Munzer
- Department of Psychiatry, University of Leipzig, Semmelweisstr. 10, 04103 Leipzig, Germany; E-Mails: (A.M.); (R.M.); (J.S); (C.P.); (S.B.)
| | - Ulrich Sack
- Institute of Immunology, University of Leipzig, Johannisallee 30, 04103 Leipzig, Germany; E-Mails: (U.S.); (K.B.)
| | - Roland Mergl
- Department of Psychiatry, University of Leipzig, Semmelweisstr. 10, 04103 Leipzig, Germany; E-Mails: (A.M.); (R.M.); (J.S); (C.P.); (S.B.)
| | - Jeremias Schönherr
- Department of Psychiatry, University of Leipzig, Semmelweisstr. 10, 04103 Leipzig, Germany; E-Mails: (A.M.); (R.M.); (J.S); (C.P.); (S.B.)
| | - Charlotte Petersein
- Department of Psychiatry, University of Leipzig, Semmelweisstr. 10, 04103 Leipzig, Germany; E-Mails: (A.M.); (R.M.); (J.S); (C.P.); (S.B.)
| | - Stefanie Bartsch
- Department of Psychiatry, University of Leipzig, Semmelweisstr. 10, 04103 Leipzig, Germany; E-Mails: (A.M.); (R.M.); (J.S); (C.P.); (S.B.)
| | - Kenneth C. Kirkby
- Department of Psychiatry, University of Tasmania, Hobart, Tasmania, Australia; E-Mail:
| | - Katrin Bauer
- Institute of Immunology, University of Leipzig, Johannisallee 30, 04103 Leipzig, Germany; E-Mails: (U.S.); (K.B.)
| | - Hubertus Himmerich
- Department of Psychiatry, University of Leipzig, Semmelweisstr. 10, 04103 Leipzig, Germany; E-Mails: (A.M.); (R.M.); (J.S); (C.P.); (S.B.)
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Lichtblau N, Schmidt FM, Schumann R, Kirkby KC, Himmerich H. Cytokines as biomarkers in depressive disorder: current standing and prospects. Int Rev Psychiatry 2013; 25:592-603. [PMID: 24151804 DOI: 10.3109/09540261.2013.813442] [Citation(s) in RCA: 104] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The frequently observed co-occurrence of depressive disorders and inflammatory diseases suggests a close connection between the nervous and the immune systems. Increased pro-inflammatory and type 1 cytokines, such as interleukin (IL)-1, tumour necrosis factor (TNF)-α and interferon (IFN)-γ, appear to be an important link. Cytokines are synthesized by immune cells in the blood and peripheral tissues and by glial cells in the central nervous system (CNS). Evidence suggests that the blood-brain barrier (BBB) is permeable to cytokines and immune cells, and that afferent nerves, e.g. the vagus nerve, mediate the communication between peripheral inflammatory processes and CNS. Cytokines such as IL-1ß, TNF-α and IFN-γ seem to contribute to the pathophysiology of depression by activating monoamine reuptake, stimulating the hypothalamic-pituitary-adrenocortical (HPA) axis and decreasing production of serotonin due to increased activity of indolamine-2,3-dioxygenase (IDO). However, critical appraisal of these hypotheses is required, because cytokine elevation is not specific to depression. Moreover, several effective antidepressants such as amitriptyline and mirtazapine have been shown to increase cytokine production. When applying immunomodulatory therapies, these drugs may increase the risk of specific side effects such as infections or interact with antidepressant drugs on important functions of the body such as the coagulation system.
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Affiliation(s)
- Nicole Lichtblau
- Department of Psychiatry and Psychotherapy, University Hospital Leipzig , Leipzig Germany
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A meta-analysis of cytokines in major depression. Biol Psychiatry 2010; 67:446-57. [PMID: 20015486 DOI: 10.1016/j.biopsych.2009.09.033] [Citation(s) in RCA: 3202] [Impact Index Per Article: 228.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2009] [Revised: 08/31/2009] [Accepted: 09/26/2009] [Indexed: 02/08/2023]
Abstract
BACKGROUND Major depression occurs in 4.4% to 20% of the general population. Studies suggest that major depression is accompanied by immune dysregulation and activation of the inflammatory response system (IRS). Our objective was to quantitatively summarize the data on concentrations of specific cytokines in patients diagnosed with a major depressive episode and controls. METHODS We performed a meta-analysis of studies measuring cytokine concentration in patients with major depression, with a database search of the English literature (to August 2009) and a manual search of references. RESULTS Twenty-four studies involving unstimulated measurements of cytokines in patients meeting DSM criteria for major depression were included in the meta-analysis; 13 for tumor necrosis factor (TNF)-alpha, 9 for interleukin (IL)-1beta, 16 for IL-6, 5 for IL-4, 5 for IL-2, 4 for IL-8, 6 for IL-10, and 4 for interferon (IFN)-gamma. There were significantly higher concentrations of TNF-alpha (p < .00001), weighted mean difference (WMD) (95% confidence interval) 3.97 pg/mL (2.24 to 5.71), in depressed subjects compared with control subjects (438 depressed/350 nondepressed). Also, IL-6 concentrations were significantly higher (p < .00001) in depressed subjects compared with control subjects (492 depressed/400 nondepressed) with an overall WMD of 1.78 pg/mL (1.23 to 2.33). There were no significant differences among depressed and nondepressed subjects for the other cytokines studied. CONCLUSIONS This meta-analysis reports significantly higher concentrations of the proinflammatory cytokines TNF-alpha and IL-6 in depressed subjects compared with control subjects. While both positive and negative results have been reported in individual studies, this meta-analytic result strengthens evidence that depression is accompanied by activation of the IRS.
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