Sleep-like concentrations of growth hormone and cortisol modulate type1 and type2 in-vitro cytokine production in human T cells

Sleep and neuroimmunology: a narrative review

Numerous neuroimmunological disorders present with sleep-related symptoms. The identification of novel autoantibodies introduces new clinical categories in autoimmune diseases of the central nervous system and generates interest in the dynamic interaction between sleep and the immune system. In this review, the complex relationship among sleep, immune regulation, and neuroimmunological disorders was examined with emphasis on the vital role of sleep in modulating immune function and its influence on these conditions, This relationship emphasizes the importance of assessments and management of sleep quality in the treatment approaches for neuroimmunological disorders.

Temporal trends in sleep pattern among Chinese adults between 2010 and 2018: findings from five consecutive nationally representative surveys

OBJECTIVES

This study aimed to comprehensively analyze the time trends in average sleep duration and prevalence of short sleep, poor sleep quality, and high sleep debt among Chinese adults.

STUDY DESIGN

This was a cross-sectional study.

METHODS

The study used nationally representative data from Chinese Family Panel Survey (CFPS) among adults aged ≥18 years. Linear regression and logistic regression were used to calculate P-values for trends across waves, and absolute difference in prevalences were calculated by linear regression. Poisson regression analysis was used to calculate the prevalence ratios of sleep-related problems.

RESULTS

In 2018, the estimated average sleep duration in adults was 7.6 h/d. A shorter sleep duration, higher proportion of short sleep, and poor sleep quality were observed in people aged ≥65 years, women, people with primary school education or below, and residents in Liaoning province. The average sleep duration slightly decreased from 8.2 h/d in 2010 to 7.6 h/d in 2016, and then remained stable from 2016 to 2018. The prevalence of short sleep duration has markedly increased from 11.8% in 2010 to 24.1% in 2016, and then there was a decline in prevalence from 2016 to 2018, although this decrease was not significant. The prevalence of high sleep debt among employed people increased from 6.2% in 2010 to 8.6% in 2018 (absolute difference, 2.4 p.p; P trend = 0.063). In addition, the prevalence of poor sleep quality increased from 15.6% in 2012 to 21.3% in 2018 (absolute difference of 5.7 p.p; P trend<0.001). For all the sleep-related variables, the degree of changes varied by sociodemographic subgroups.

CONCLUSIONS

In this nationally representative survey of the Chinese population, the average sleep duration slightly decreased from 2010 to 2016, and then remained stable from 2016 to 2018. Poor sleep quality, and high sleep debt increased among most of the sociodemographic subgroups. Future studies are needed to understand the drivers of changes in sleep health among Chinese adults.

Sleep Disorders in Patients after COVID-19

Healthy sleep is required to ensure the body’s homeostatic stability, the consistency of immunological reactions, and optimum functioning of the internal organs, the nervous system, and cognitive functions. Patterns of changes to the circadian rhythms have been studied in many diseases, though infection with SARS-CoV-2 is a new reality and the basic mechanisms of functioning of the body in this pathology require deeper investigation. Despite the difficulty of analytical investigations in pandemic conditions, experience of the diagnosis of COVID-19 has now been acquired and treatment algorithms have been developed for different clinical situations; vaccines have been developed. Least studied are questions of the long-term sequelae of COVID-19. At the same time, there are good grounds for suggesting that patients need long-term rehabilitation in the post-covid period of SARS-CoV-2, for reasons including damage to the nervous system. Analysis of publications – from descriptions of clinical cases to literature reviews – allows empirical experience to be accumulated, providing the opportunity for future identification of prognostic markers for the disease for effective prevention of long-term sequelae. The results of current prospective studies draw attention to the occurrence of dyssomnia and obstructive sleep apnea not only as a common consequence of coronavirus infection, but also as a factor significantly worsening the prognosis in the acute period of illness. It has repeatedly been shown that sleep deprivation has adverse influences on the body’s resistance, including to SARS-CoV-2, and requires correction to improve prognoses in the acute and long-term periods of illness in COVID-19 patients.

Potential Role of Sleep Deficiency in Inducing Immune Dysfunction

Sleep deficiency and insomnia deteriorate the quality of patients’ lives, yet the exact influence of these factors on the immune system has only begun to gain interest in recent years. Growing evidence shows that insomnia is a risk factor for numerous diseases, including common infections and autoimmune diseases. Levels of inflammatory markers also seem to be abnormal in sleep deficient individuals, which may lead to low-grade inflammation. The interpretation of studies is difficult due to the equivocal term “sleep disturbances,” as well as due to the various criteria used in studies. This narrative review aims to summarize the available knowledge regarding the bidirectional influence of the immune system and sleep disturbances.

Sleep disruption induces activation of inflammation and heightens risk for infectious disease: Role of impairments in thermoregulation and elevated ambient temperature

Thermoregulation and sleep are tightly coordinated, with evidence that impairments in thermoregulation as well as increases in ambient temperature increase the risk of sleep disturbance. As a period of rest and low demand for metabolic resources, sleep functions to support host responses to prior immunological challenges. In addition by priming the innate immune response, sleep prepares the body for injury or infection which might occur the following day. However when sleep is disrupted, this phasic organization between nocturnal sleep and the immune system becomes misaligned, cellular and genomic markers of inflammation are activated, and increases of proinflammatory cytokines shift from the nighttime to the day. Moreover, when sleep disturbance is perpetuated due to thermal factors such as elevated ambient temperature, the beneficial crosstalk between sleep and immune system becomes further imbalanced. Elevations in proinflammatory cytokines have reciprocal effects and induce sleep fragmentation with decreases in sleep efficiency, decreases in deep sleep, and increases in rapid eye movement sleep, further fomenting inflammation and inflammatory disease risk. Under these conditions, sleep disturbance has additional potent effects to decrease adaptive immune response, impair vaccine responses, and increase vulnerability to infectious disease. Behavioral interventions effectively treat insomnia and reverse systemic and cellular inflammation. Further, insomnia treatment redirects the misaligned inflammatory- and adaptive immune transcriptional profiles with the potential to mitigate risk of inflammation-related cardiovascular, neurodegenerative, and mental health diseases, as well as susceptibility to infectious disease.

Occipital sleep spindles predict sequence learning in a visuo-motor task

STUDY OBJECTIVES

The brain appears to use internal models to successfully interact with its environment via active predictions of future events. Both internal models and the predictions derived from them are based on previous experience. However, it remains unclear how previously encoded information is maintained to support this function, especially in the visual domain. In the present study, we hypothesized that sleep consolidates newly encoded spatio-temporal regularities to improve predictions afterwards.

METHODS

We tested this hypothesis using a novel sequence-learning paradigm that aimed to dissociate perceptual from motor learning. We recorded behavioral performance and high-density electroencephalography (EEG) in male human participants during initial training and during testing two days later, following an experimental night of sleep (n = 16, including high-density EEG recordings) or wakefulness (n = 17).

RESULTS

Our results show sleep-dependent behavioral improvements correlated with sleep-spindle activity specifically over occipital cortices. Moreover, event-related potential (ERP) responses indicate a shift of attention away from predictable to unpredictable sequences after sleep, consistent with enhanced automaticity in the processing of predictable sequences.

CONCLUSIONS

These findings suggest a sleep-dependent improvement in the prediction of visual sequences, likely related to visual cortex reactivation during sleep spindles. Considering that controls in our experiments did not fully exclude oculomotor contributions, future studies will need to address the extent to which these effects depend on purely perceptual versus oculomotor sequence learning.

Cell Autonomous Circadian Systems and Their Relation to Inflammation

All living beings on earth have an important mechanism of 24-h periodicity, which controls their physiology, metabolism, and behavior. In humans, 24-h periodicity is regulated by the superchiasmatic nucleus (SCN) through external and environmental cues. Peripheral organs demonstrate circadian rhythms and circadian clock functions, and these are also observed in cultured cell lines. Every cell contains a CLOCK: BMAL1 loop for the generation of circadian rhythms. In this review, we focused on cell autonomous circadian rhythms in immune cells, the inflammatory diseases caused by disruption of circadian rhythms in hormones, and the role of clock genes in inflammatory diseases.

Sleep Disturbance during Infection Compromises Tfh Differentiation and Impacts Host Immunity

Although the influence of sleep quality on the immune system is well documented, the mechanisms behind its impact on natural host immunity remain unclear. Meanwhile, it has been suggested that neuroimmune interactions play an important role in this phenomenon. To evaluate the impact of stress-induced sleep disturbance on host immunity, we used a murine model of rapid eye movement sleep deprivation (RSD) integrated with a model of malaria blood-stage infection. We demonstrate that sleep disturbance compromises the differentiation of T follicular helper cells, increasing host susceptibility to the parasite. Chemical inhibition of glucocorticoid (Glcs) synthesis showed that abnormal Glcs production compromised the transcription of Tfh-associated genes resulting in impaired germinal center formation and humoral immune response. Our data demonstrate that RSD-induced abnormal activation of the hypothalamic-pituitary-adrenal axis drives host susceptibility to infection. Understanding the impact of sleep quality in natural resistance to infection may provide insights for disease management.

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REM sleep deprivation (RSD) worsens malaria induced by Plasmodium yoelii infection

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RSD decreases germinal center formation and impairs specific antibody production

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Exacerbated glucocorticoid production impairs T lymphocyte differentiation

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The relationship between sleep and immunity is a target for malaria management

Sleep and COVID-19: considerations about immunity, pathophysiology, and treatment

The fear and uncertainty caused by the coronavirus disease 2019 (COVID-19) pandemic, threats to survival are one of the main problems of everyday life; however, mental health care must also be considered a priority. During social isolation also called self-quarantine, the restricted mobility and social contact, concern about financial resources and availability of supplies, fear of infection, questions about the duration of self-quarantine, cause anxiety, depression, stress, insomnia and reduced the quality and quantity of sleep, that may present a greater risk to the health of the general population. Sleep disorders are increasingly becoming a major health issue in modern society, and are influenced by retinal stimulation by electronic devices, as well extended and/or night shift-work, which may aggravate the systemic and lung inflammation during viral infections. Sleep disorders can induce pro-inflammatory states and be harmful during the COVID-19 pandemic. The possible interactions between many drugs used to treat COVID-19, and those used to treat sleep disorders are unknown, mostly due to the lack of a standard protocol to treat these patients. Insufficient sleep or irregular sleep-wake cycles may impair health, immune system, induce pro-inflammation state, and may lead to increased vulnerability to viral infections, involving inflammatory and oxidative/antioxidant imbalance. In this sense, obstructive sleep apnea has been associated with recognized COVID-19 risk comorbidities and considered a risk factor for COVID-19. During the COVID-19 pandemic, health care cannot stop, and telemedicine has presented itself as an alternative method of delivering services. When a face-to-face visit is mandatory, or in locations with minimal community transmission where sleep centers have resumed activities, it is important that the sleep center facilities are properly prepared to receive the patients during the COVID-19 pandemic, and follow all relevant safety rules. In this work we gathered a group of researchers, specialists in aspects related to chronobiology, sleep, sleep disorders, and the immune system. Thus, we conducted a narrative review in order to address the relationship between COVID-19 and sleep, as well as its immunological aspects and strategies that may be applied in order to mitigate the harmful effects on health that affects everyone during the pandemic.

The immune-sleep crosstalk in inflammatory bowel disease

Sleep disorders are progressively common and sometimes are associated with aberrant regulation of the adaptive and innate immune responses. Sleep interruption can increase the inflammatory burden by enhancing the pro-inflammatory cytokines particularly in patients with chronic diseases such as inflammatory bowel disease (IBD). IBD is a chronic inflammatory disease characterized by immune dysregulation, dysbiosis of gut microbiome, and poor-quality life. Therefore, this review highlights the crosstalk between sleep and immune responses during the progression of IBD.

Sleep and inflammation: partners in sickness and in health

The discovery of reciprocal connections between the central nervous system, sleep and the immune system has shown that sleep enhances immune defences and that afferent signals from immune cells promote sleep. One mechanism by which sleep is proposed to provide a survival advantage is in terms of supporting a neurally integrated immune system that might anticipate injury and infectious threats. However, in modern times, chronic social threats can drive the development of sleep disturbances in humans, which can contribute to the dysregulation of inflammatory and antiviral responses. In this Review, I describe our current understanding of the relationship between sleep dynamics and host defence mechanisms, with a focus on cytokine responses, the neuroendocrine and autonomic pathways that connect sleep with the immune system and the role of inflammatory peptides in the homeostatic regulation of sleep. Furthermore, I discuss the therapeutic potential of harnessing these reciprocal mechanisms of sleep-immune regulation to mitigate the risk of inflammatory and infectious diseases.

Changes in chronic neck pain following the introduction of a visco-elastic polyurethane foam pillow and/or chiropractic treatment

Background

Sleep ergonomics are increasingly prescribed as an adjunct treatment to chronic neck pain. Postulated benefits to maintaining the ideal sleeping posture are improved tissue repair in and around the facet joints, decrease in tension of associated musculature and better quality sleep.

Aim

The purpose of this study was to determine if the inclusion of a visco-elastic polyurethane (VEP) pillow could benefit the chiropractic treatment of chronic neck pain.

Setting

The study took place at a chiropractic training clinic in Johannesburg.

Method

Participants were randomly assigned to either a chiropractic treatment only group (CHI) (n = 15) or a chiropractic treatment with a VEP pillow group (CHI+P) (n = 15). Both groups underwent six chiropractic treatments spaced at 3-4-day intervals and the CHI+P were provided with a VEP pillow. Baseline and post-test measurements consisted of the initial Numerical Pain Rating Scale (NRS) and the Vernon-Mior Neck Pain and Disability Index (NDI).

Results

Both the CHI and CHI+P groups significantly (p ≤ 0.05) improved their NRS (p = 0.001 for both groups) and NDI (p = 0.001 and p = 0.000, respectively) scores. Furthermore, post hoc analysis indicated a significant difference at post-test between the two groups for NRS (p = 0.015), but not for NDI (p = 0.195). The CHI+P demonstrated an improved minimum clinically important difference (MCID) (43% vs. 73% for NRS and 59% vs. 71% for the NDI).

Conclusion

Findings of this study suggest that a VEP pillow could be included as an adjunct management tool to chiropractic treatment of chronic neck pain.

The Sleep-Immune Crosstalk in Health and Disease

Sleep and immunity are bidirectionally linked. Immune system activation alters sleep, and sleep in turn affects the innate and adaptive arm of our body's defense system. Stimulation of the immune system by microbial challenges triggers an inflammatory response, which, depending on its magnitude and time course, can induce an increase in sleep duration and intensity, but also a disruption of sleep. Enhancement of sleep during an infection is assumed to feedback to the immune system to promote host defense. Indeed, sleep affects various immune parameters, is associated with a reduced infection risk, and can improve infection outcome and vaccination responses. The induction of a hormonal constellation that supports immune functions is one likely mechanism underlying the immune-supporting effects of sleep. In the absence of an infectious challenge, sleep appears to promote inflammatory homeostasis through effects on several inflammatory mediators, such as cytokines. This notion is supported by findings that prolonged sleep deficiency (e.g., short sleep duration, sleep disturbance) can lead to chronic, systemic low-grade inflammation and is associated with various diseases that have an inflammatory component, like diabetes, atherosclerosis, and neurodegeneration. Here, we review available data on this regulatory sleep-immune crosstalk, point out methodological challenges, and suggest questions open for future research.

Circadian rhythm in atopic dermatitis-Pathophysiology and implications for chronotherapy

Circadian rhythm is a biological clock that controls a wide range of physiological functions throughout the body, including various skin functions. A 24-h diurnal cycle, governed by an endogenous clock in the brain, largely controls cutaneous diurnal rhythm, which external factors, including temperature, humidity, diet, and stress, also modulate locally. Circadian rhythm influences cutaneous blood flow and properties of skin barrier function, such as transepidermal water loss and capacitance, and has important implications in atopic dermatitis (AD). This review explores how aberrations in circadian rhythm may play a role in the pathogenesis of AD and proposes implementation of chronotherapy to improve treatment outcomes in patients with AD.

Sleep deprivation predisposes allergic mice to neutrophilic lung inflammation

BACKGROUND

Although different studies associated sleep deprivation (SD) with systemic inflammatory changes, the effect of sleep duration on the pathology of allergic chronic diseases is poorly understood.

OBJECTIVE

We sought to evaluate the influence of SD on allergen-induced pulmonary inflammation.

METHODS

Ovalbumin (OVA)-sensitized C57BL/6 mice were exposed to a first set of intranasal OVA challenge under SD or healthy sleep (HS) conditions, followed by a second OVA challenge, 1 week apart. Some groups were subjected to corticosteroid treatment with dexamethasone.

RESULTS

OVA-sensitized mice with SD had more severe airway inflammation than the allergic group with HS. Analysis of lung parenchyma revealed that the inflammation in allergic mice with SD was marked by an influx of neutrophils (mainly) and eosinophils and secretion of IL-6, TNF-α, and IL-17 in contrast to the eosinophilic inflammation and IL-4 production observed in allergic mice with HS. The same cytokine profile was observed in ex vivo culture of cervical lymph node cells and splenocytes, indicating that in allergic mice SD favors immune responses toward a proinflammatory T_H17 profile. This idea is supported by the fact that disruption of IL-17 signaling (IL-17 receptor A^-/-) prevented airway neutrophilia in allergic mice with SD. Furthermore, allergic mice with SD became refractory to corticosteroid treatment in contrast to the allergic group with HS.

CONCLUSION

Collectively, our data show that sleep quality participates in the progression of allergen-induced eosinophilic lung inflammation to corticosteroid-refractory neutrophilic manifestation.

Sleep Health: Reciprocal Regulation of Sleep and Innate Immunity

Sleep disturbances including insomnia independently contribute to risk of inflammatory disorders and major depressive disorder. This review and overview provides an integrated understanding of the reciprocal relationships between sleep and the innate immune system and considers the role of sleep in the nocturnal regulation of the inflammatory biology dynamics; the impact of insomnia complaints, extremes of sleep duration, and experimental sleep deprivation on genomic, cellular, and systemic markers of inflammation; and the influence of sleep complaints and insomnia on inflammaging and molecular processes of cellular aging. Clinical implications of this research include discussion of the contribution of sleep disturbance to depression and especially inflammation-related depressive symptoms. Reciprocal action of inflammatory mediators on the homeostatic regulation of sleep continuity and sleep macrostructure, and the potential of interventions that target insomnia to reverse inflammation, are also reviewed. Together, interactions between sleep and inflammatory biology mechanisms underscore the implications of sleep disturbance for inflammatory disease risk, and provide a map to guide the development of treatments that modulate inflammation, improve sleep, and promote sleep health.

Why sleep is important for health: a psychoneuroimmunology perspective

Sleep has a critical role in promoting health. Research over the past decade has documented that sleep disturbance has a powerful influence on the risk of infectious disease, the occurrence and progression of several major medical illnesses including cardiovascular disease and cancer, and the incidence of depression. Increasingly, the field has focused on identifying the biological mechanisms underlying these effects. This review highlights the impact of sleep on adaptive and innate immunity, with consideration of the dynamics of sleep disturbance, sleep restriction, and insomnia on (a) antiviral immune responses with consequences for vaccine responses and infectious disease risk and (b) proinflammatory immune responses with implications for cardiovascular disease, cancer, and depression. This review also discusses the neuroendocrine and autonomic neural underpinnings linking sleep disturbance and immunity and the reciprocal links between sleep and inflammatory biology. Finally, interventions are discussed as effective strategies to improve sleep, and potential opportunities are identified to promote sleep health for therapeutic control of chronic infectious, inflammatory, and neuropsychiatric diseases.

Sleep and circadian rhythm regulate circulating complement factors and immunoregulatory properties of C5a

The sleep-wake cycle is characterized by complex interactions among the central nervous, the endocrine and the immune systems. Continuous 24-h wakefulness prevents sleep-associated hormone regulation resulting in impaired pro-inflammatory cytokine production. Importantly, cytokines and hormones also modulate the complement system, which in turn regulates several adaptive immune responses. However, it is unknown whether sleep affects the activation and the immunoregulatory properties of the complement system. Here, we determined whether the 24-h sleep-wake cycle has an impact on: (i) the levels of circulating complement factors; and (ii) TLR4-mediated IL-12 production from human IFN-γ primed monocytes in the presence or absence of C5a receptor signaling. For this purpose, we analyzed the blood and blood-derived monocytes of 13 healthy donors during a regular sleep-wake cycle in comparison to 24 h of continuous wakefulness. We found decreased plasma levels of C3 and C4 during nighttime hours that were not affected by sleep. In contrast, sleep was associated with increased complement activation as reflected by elevated C3a plasma levels during nighttime sleep. Sleep deprivation prevented such activation. At the cellular level, C5a negatively regulated TLR4-mediated IL-12p40 and p70 production from human monocytes. Importantly, this regulatory effect of C5a on IL-12p70 production was effective only during daytime hours. Thus, similar to hormones, some complement factors and immunoregulatory properties of C5a are influenced by sleep and the circadian rhythm. Our findings that continuous wakefulness has a negative impact on complement activation may provide a rationale for the immunosupportive functions of sleep.

Sleep deprivation affects inflammatory marker expression in adipose tissue

Sleep deprivation has been shown to increase inflammatory markers in rat sera and peripheral blood mononuclear cells. Inflammation is a condition associated with pathologies such as obesity, cancer, and cardiovascular diseases. We investigated changes in the pro and anti-inflammatory cytokines and adipokines in different depots of white adipose tissue in rats. We also assessed lipid profiles and serum levels of corticosterone, leptin, and adiponectin after 96 hours of sleep deprivation.

Methods

The study consisted of two groups: a control (C) group and a paradoxical sleep deprivation by 96 h (PSD) group. Ten rats were randomly assigned to either the control group (C) or the PSD. Mesenteric (MEAT) and retroperitoneal (RPAT) adipose tissue, liver and serum were collected following completion of the PSD protocol. Levels of interleukin (IL)-6, interleukin (IL)-10 and tumour necrosis factor (TNF)-α were analysed in MEAT and RPAT, and leptin, adiponectin, glucose, corticosterone and lipid profile levels were analysed in serum.

Results

IL-6 levels were elevated in RPAT but remained unchanged in MEAT after PSD. IL-10 protein concentration was not altered in either depot, and TNF-α levels decreased in MEAT. Glucose, triglycerides (TG), VLDL and leptin decreased in serum after 96 hours of PSD; adiponectin was not altered and corticosterone was increased.

Conclusion

PSD decreased fat mass and may modulate the cytokine content in different depots of adipose tissue. The inflammatory response was diminished in both depots of adipose tissue, with increased IL-6 levels in RPAT and decreased TNF-α protein concentrations in MEAT and increased levels of corticosterone in serum.

Effects of sleep and circadian rhythm on the human immune system

Many immune parameters show systematic fluctuations over the 24-h day in human blood. Circulating naive T-cells and production of proinflammatory cytokines, like interleukin-12 (IL-12), peak during nighttime, whereas cytotoxic effector leukocytes and production of the anti-inflammatory cytokine IL-10 peak during daytime. These temporal changes originate from a combined influence of the circadian system and sleep. Both brain functions act synergistically and share neuroendocrine effector mechanisms to convey control over immune functions. Sympathetic tone and cortisol levels show a circadian nadir during nighttime and are further suppressed by sleep, whereas growth hormone and prolactin show a circadian peak during nighttime and are further enhanced by sleep. Thus, the circadian system and sleep jointly evoke a unique endocrine constellation that is extremely effective in inducing changes in leukocyte traffic and a shift toward proinflammatory type 1-cytokines during the nocturnal period of sleep, that is, an action with strong clinical implications.

Inhibitory effects of thyroxine on cytokine production by T cells in mice

As a sensitive factor of endocrine system, thyroxine exerts regulatory activities on a variety of cell types in immune system including T lymphocytes. Cytokines secreted by T lymphocytes are widely involved in numerous mechanisms, which are crucial for homeostasis at various statuses. Here we investigated the effects of thyroxine on the cytokine production of T lymphocytes in vivo and in vitro, using BALB/c mice with thyroxine treatment. We examined the IFN-gamma, IL-2, IL-4 and IL-10 of T-cell type cytokines transcriptions and the proportions of IFN-gamma, IL-4 and IL-10-secreting CD4(+)/CD8(+) T cells. The results showed that the administration of high-level thyroxine induced weakly expression of T-cell type cytokine in transcriptional level together with impaired responsibility to mitogen (Con A) stimulation. Along with the severe suppression on T-cell type cytokine transcription, the proportions of IFN-gamma, IL-4 and IL-10-producing T lymphocytes were markedly attenuated and the productions of serum IFN-gamma and IL-10 were significantly decreased synchronously. The repressive effects of thyroxine on T-cell type cytokine were seen both in mRNA and protein level. The results suggested that T lymphocytes under normal condition appear to be sensitive to suppression of high-level thyroxine administration.