Impact of environmental stress on the expression of insulin-dependent diabetes mellitus

Parental history of psychiatric disorders and risk of type 1 diabetes in the offspring

OBJECTIVE

To examine risk of type 1 diabetes mellitus (T1DM) in the offspring of parents with a psychiatric history at the birth of the child, which would suggest potential shared familial or environmental risk factors between T1DM and psychiatric disorders.

METHODS

We established a cohort including all children born in Sweden in 1997-2016, and their parents. Children were followed up from birth until 31 Dec 2017, using national registers. Relative risk for T1DM was estimated by incidence rate ratios (RR) with 95% confidence intervals (CI), calculated from Poisson regression. We examined psychiatric subtypes, T1DM risk within subgroups and in relation to the timing of exposure.

RESULTS

The study cohort included 1,497,949 children. During follow-up, 7,794 cases of T1DM were identified. Children of mothers with psychiatric disorders at delivery had a higher risk of T1DM (RR 1.10 [95%CI 1.01-1.20]). Psychiatric diagnoses in fathers or assigned after delivery was not associated with increased T1DM risk. The observed association disappeared after adjusting for T1DM in parents; however, remained significant in female offspring. Maternal eating disorder (RR 1.53 [1.17-2.00]) and obsessive-compulsive disorder (RR 1.62 [1.02-2.58]) were associated with offspring T1DM, independent of parental T1DM.

CONCLUSION

Our results do not support a strong genetic link between psychiatric conditions and T1DM. However, the risks of offspring T1DM were increased in subgroups of female offspring and in offspring of mothers with a history of eating disorder or obsessive-compulsive disorder, independent of heredity for T1DM, which may warrant further investigation in future studies.

The Effect of Early Neurological Stimulation on Puppy Welfare in Commercial Breeding Kennels

Throughout their lives, dogs may experience various stressful events. Early neurological stimulation (ENS), which was shown to alter stress responses beneficially in some animals, has not been fully explored in dogs. Seventy-six small-breed puppies from one commercial breeding kennel were divided into three treatment groups: ENS, held, and control. Puppies in the ENS group received 30 s of handling exercises for 21 days after birth; puppies in the held group were simply held for the same amount of time. Puppies in the control group were managed as per normal breeder practices (i.e., routine husbandry and physical health checks). Physical health was assessed weekly, and puppies were generally healthy and clean. Behavioral responses to stranger approach and isolation tests were evaluated pre- and post-ground-transportation to a distributor. Puppies were more affiliative toward a stranger post-isolation than pre-isolation (p < 0.001), and post-transport than pre-transport (p < 0.001). At the distributor, puppies in the isolation test spent less time in exploratory locomotion (p < 0.001) and vocalized more than at the breeder’s kennel (p = 0.011). Treatment did not affect these results. Overall, the results suggest that the type of ENS used in this study may not provide the purported benefits to puppies’ stress responses in commercial breeding populations.

Changes in the presentation of newly diagnosed type 1 diabetes in children during the COVID-19 pandemic in a tertiary center in Southern Turkey

OBJECTIVES

The COVID-19 pandemic is a global health problem with high morbidity and mortality. This study aimed to investigate patients who were diagnosed with type 1 diabetes during the pandemic and evaluate the effect of the pandemic on the clinical findings of these patients by comparing them with findings from a year prior.

METHODS

Patients diagnosed with type 1 diabetes mellitus between 2019 and 2021 were separated into two groups: Patients diagnosed prepandemic and those diagnosed during the pandemic.

RESULTS

The number of newly diagnosed diabetes cases increased from 46 in the prepandemic period to 74 in the pandemic period. The number of cases diagnosed with diabetic ketoacidosis (DKA) in the clinic increased from 58.7 to 91.9%. We found that moderate and severe DKA rates from 18.5 and 14.8% to 23.5 and 22.1%, respectively. Besides, the average HbA1c was higher, while the average bicarbonate was lower in cases diagnosed during the pandemic period compared to the prepandemic period (p=0.048 and p<0.001, respectively). We found that celiac autoantibody positivity antibodies to glutamic acid decarboxylase (anti GAD) positivity, and islet cell antibodies (ICA), ICA and anti GAD positivity coexistence were higher (p=0.045, p=0.008, and p=0.007, respectively) among the patients diagnosed during the pandemic.

CONCLUSIONS

We observed an increase in the number of patients newly diagnosed with type 1 diabetes mellitus, an increase in autoantibody positivity, and higher rates and severity of DKA during the COVID-19 pandemic period compared to the prepandemic period.

Psychological stress and type 1 diabetes mellitus: what is the link?

INTRODUCTION

Type 1 diabetes mellitus (T1DM) is a chronic disease characterized by the destruction of insulin-producing β-cells of the pancreas. The current paradigm in this disease's etiopathogenesis points toward the interplay of genetic and environmental factors. Among the environmental variables, dietary factors, intestinal microbiota, toxins, and psychological stress have been implicated in disease onset. Areas covered: This review aims to investigate the relationship between psychological stress and T1DM by presenting evidence from epidemiological studies, animal models, and to provide the mechanism involved in this association. The literature search was conducted through PubMed to identify studies that investigate the connection between stress and T1DM. Experimental designs, such as case-control, and retrospective and prospective cohorts studies, were included. Expert commentary: A wide array of evidence, ranging from epidemiological to animal models, points toward the role of psychological stressors in T1DM pathogenesis. Various mechanisms have been proposed, including the hypothalamic-pituitary-adrenal (HPA) axis, influence of the nervous system on immune cells, and insulin resistance. Further research could investigate the gene-stress interactions to evaluate the risk of T1DM development.

NOD mouse model for Sjögren's syndrome: lack of longitudinal stability

OBJECTIVES

The non-obese diabetic (NOD) mouse is not only a widely used model for diabetes mellitus type I, but also for the chronic autoimmune disease Sjögren's syndrome (SS), mainly affecting salivary and lacrimal glands. We studied the efficacy of local recombinant serotype 2 adeno-associated viral (rAAV2) vector transfer of immunomodulatory transgenes to alter the SS-like disease in NOD mice. Data collected over a 2-year period indicated a changing SS phenotype in these mice and this phenomenon was investigated.

METHODS

10(10) particles rAAV2LacZ/gland were delivered to both submandibular glands (SMGs) of NOD/LtJ mice at 8 weeks (before sialadenitis onset) of age. Salivary flow rates were determined at 8 weeks and time of killing. Blood glucose levels and body weights were measured weekly. After killing, saliva and SMGs were harvested. Analyses of salivary output, inflammatory infiltrates (focus score), SMG cytokine profile, body weight, and diabetes mellitus status were performed. Data from six different experimental studies over 2 years were analyzed and compared.

RESULTS

Salivary flow rate, focus score, and SMG cytokines interleukin (IL)-2, IL-4, IL-6, IL-10, IL-12(p70), tumor necrosis factor-alpha and IFNgamma showed changes over time. There were no differences for body weight, diabetes mellitus prevalence, or blood glucose level of non-diabetic mice.

CONCLUSION

This retrospective report is the first to describe longitudinal variability in the NOD mouse as a model for SS. We advise other investigators to continuously monitor the SS phenotype parameters and include appropriate controls when studying this disease in NOD mice.

Depression and diabetes in children and adolescents

PURPOSE OF REVIEW

Diabetes and depression are each public health concerns. They frequently co-occur, compounding complications of each disease. This review provides recent information regarding the mechanisms of association between the disorders and the availability and effectiveness of interventions for youth with diabetes who are depressed. Implications for primary care physicians are considered, particularly in relation to recognition of depression, and also to preventive strategies that increase the patient's self-efficacy (evidence-based confidence in his/her ability to manage diabetes) and serve as protective factors in the development of depression.

RECENT FINDINGS

Depressive symptoms are strongly associated with diabetes complications. To date, no studies have tested effectiveness of interventions with depressed youth with diabetes. Clinical trials with adults have shown the effectiveness of pharmacotherapy, but those with more complications show the least improvement, and health gains do not persist. In the absence of other data, these findings suggest that it would be prudent to identify and treat comorbid depression in children with diabetes early in the course of their illness, before medical complications develop.

SUMMARY

Primary care physicians are in an important position to recognize early signs of depression in youth with diabetes and refer them for treatment. Furthermore, the literature provides numerous strategies that can be employed by primary care doctors that may enhance diabetes management as well as protect against depression.

Stress and thyroid autoimmunity

While many studies have shown a connection between stress and autoimmune disease, most of the evidence for stress contributing to the onset and course of autoimmune disease is circumstantial and the mechanisms by which stress affects autoimmune disease are not fully understood. The best circumstantial evidence for an effect of stress on autoimmune thyroid disease is the well-known relationship between the onset of Graves' hyperthyroidism and major stress but even this is debated. However, most of the recent case-control studies have supported stress as a factor that affects the onset and clinical course of Graves' disease. On the other hand, there have been few reports concerning the possible relationship between stress and Hashimoto's thyroiditis. Because the onset and course of Hashimoto's thyroiditis is generally insidious, the effect of stress on Hashimoto's thyroiditis might be overlooked. Numerous human and animal studies have demonstrated that psychological and physiologic stressors induce various immunologic changes. Stress affects the immune system either directly or indirectly through the nervous and endocrine systems. These immune modulations may contribute to the development of autoimmunity as well as the susceptibility to autoimmune disease in genetically predisposed individuals. Stress can be one of the environmental factors for thyroid autoimmunity.

Personality and personality disorders in chronic pain

Personality characteristics and disorders have long been noted in the chronic pain population. Clinicians and researchers alike will attest to the high rates of personality difficulties encountered in these individuals. Historically, it has been found that certain personality styles such as hypochondriasis and hysteria are common in chronic pain suffers. In addition, the prevalence of personality disorders (PDs) is significantly greater in the pain population than in the general population or in medical or psychiatric populations. A diathesis-stress model has been suggested to account for this finding and is discussed in this article, with implications for both treatment and research.

Stress, adaptation, and disease. Allostasis and allostatic load

Adaptation in the face of potentially stressful challenges involves activation of neural, neuroendocrine and neuroendocrine-immune mechanisms. This has been called "allostasis" or "stability through change" by Sterling and Eyer (Fisher S., Reason J. (eds): Handbook of Life Stress, Cognition and Health. J. Wiley Ltd. 1988, p. 631), and allostasis is an essential component of maintaining homeostasis. When these adaptive systems are turned on and turned off again efficiently and not too frequently, the body is able to cope effectively with challenges that it might not otherwise survive. However, there are a number of circumstances in which allostatic systems may either be overstimulated or not perform normally, and this condition has been termed "allostatic load" or the price of adaptation (McEwen and Stellar, Arch. Int. Med. 1993; 153: 2093.). Allostatic load can lead to disease over long periods. Types of allostatic load include (1) frequent activation of allostatic systems; (2) failure to shut off allostatic activity after stress; (3) inadequate response of allostatic systems leading to elevated activity of other, normally counter-regulated allostatic systems after stress. Examples will be given for each type of allostatic load from research pertaining to autonomic, CNS, neuroendocrine, and immune system activity. The relationship of allostatic load to genetic and developmental predispositions to disease is also considered.

Levels of analysis in health science. A framework for integrating sociobehavioral and biomedical research

One of the principal goals of the Office of Behavioral and Social Sciences Research at the National Institutes of Health is to facilitate interdisciplinary research between social, behavioral, and biomedical scientists. The purpose of this paper is to provide a framework for such interdisciplinary health research. The essence of this framework is the concept of levels of analysis in the health sciences. These levels include the social/environment, behavioral/psychological, organ systems, cellular, and molecular. The interdependence of these five levels of analysis suggests that advances in the health sciences may be accelerated by a more integrated, multilevel approach to research. The principles of integrated, multilevel research are outlined, and examples of research that support this approach are presented. Finally, some of the activities of the Office of Behavioral and Social Sciences Research that will further interdisciplinary research across levels of analysis are summarized.

An evolution-based hypothesis on the origin and mechanisms of autoimmune disease

The pathogenesis of autoimmune disease remains an enigma. Here, the condition is analysed from an evolutionary standpoint, and the thesis developed that viruses, in particular retroviruses, are important to our evolution, and that their inappropriate re-expression by repetitive (? ischaemic) cell damage in individuals of appropriate major histocompatibility type, leads to autoimmune disease. Such a view requires a slight adjustment to traditional ways of seeing Darwinian evolution, but one which makes real sense of the MHC-restricted nature of the adaptive immune response.

Animal models provide insight into psychosomatic factors in diabetes

OBJECTIVE

To review the literature regarding the use of animal models in research addressing psychosomatic aspects of diabetes.

METHOD

We examine the key findings in animal model vs. human research in the area of stress and diabetes. Previous research has suggested that stress is a potential contributor to chronic hyperglycemia in diabetes. Stress affects metabolic activity via the stimulation of a variety of hormones that can result in elevated blood glucose levels. In patients with diabetes, due to a relative or absolute lack of insulin, stress-induced increases in glucose cannot be properly metabolized. Additionally, regulation of these stress hormones may be abnormal in diabetes.

RESULTS

Human studies on the role of stress in the onset and course of type II diabetes are few and are limited by the constraints and logistics of examining life stress in humans. However, animal research allows for tight experimental control and the manipulation of factors that may contribute to the development and/or course of diabetes, such as stress, eating behavior, the nutrient content of food, and physical activity. Disease processes can be examined at a mechanistic level in animals which is typically limited in human research.

CONCLUSIONS

There is a large body of animal work to support the notion that stress reliably produces hyperglycemia in type II diabetes. Furthermore, there is evidence that the autonomic nervous system plays a role in the pathophysiology of this condition in both animals and humans. Examination of eating behavior and nutrient content of food in animal models of diabetes has shed light on the role of these factors in the development of diabetes, as well as obesity. Finally, genetic research using animal models of diabetes will provide new directions for research in humans to delineate the genetic contribution to the development of diabetes.

Psychoneuroimmunology: animal models of disease

OBJECTIVE

Psychoneuroimmunology, which investigates the bidirectional communication between the central nervous system and the immune system, has been greatly advanced by the use of animal models. The objective of this paper is to describe animal models of disease that can or might be utilized to elucidate neural-immune interactions that alter pathogenesis.

METHODS

This paper reviews animal studies that have demonstrated a link among the brain, behavior, immunity, and disease, highlighting models in which the potential contribution of CNS-immune interactions has not yet been explored.

RESULTS

Animal studies allow for careful control of environmental stimuli, genetic background, and immunological challenge. As such, they are an important component of psychoneuroimmunology research. Models in which one might study the role of psychosocial factors in immunologically mediated disease processes, as in the case of other pathophysiologic processes, profit from an ability to manipulate both stressful events and the magnitude of the challenge to the immune system.

CONCLUSIONS

Animal studies in psychoneuroimmunology highlight the complexity of the interactions among behavior, the brain, the immune system, and pathogen. The genetic background of the animal (both in terms of central nervous and immune system responses), its previous history, the nature of the stressor, the nature of the pathogen and the type of immune response generated are some of the interacting factors that determine the magnitude and direction of stress-induced changes in disease outcome.

Environmental and experimental procedures leading to variations in the incidence of diabetes in the nonobese diabetic (NOD) mouse

Environmental factors appear to be nongenetic risks of importance in the progression of insulin-dependent diabetes mellitus (IDDM) or type 1 diabetes, whose mechanisms are not yet well understood. Stressful life events, in particular, have been linked to the expression of overt diabetes in humans. However, in rodent models of IDDM, contradictory data exist concerning the effects of stress on the disease. Here, we show that a stressor, such as long-term repeated injections of vehicle (0.9% saline), was able to delay the appearance and/or decrease the incidence of diabetes in both sexes of NOD mice. Short-term chronic stress applied from the 6th to the 8th week of age by a combination of multiple stressors (overcrowding + immobilization + cold exposure + anesthesia) protected NOD mice from diabetes, particularly males. In contrast, prenatal stress, induced by immobilization of the mothers during the third part of pregnancy, accelerated the onset and increased the prevalence of diabetes at 30 weeks of age in NOD females, while it had no effect in males. Finally, adrenalectomy appears to aggravate the development of diabetes in NOD mice, particularly in males. In conclusion, these data demonstrate that the appearance of diabetes in NOD mice is extremely sensitive to various experimental and environmental conditions. These results are discussed in the context of the complex neuroendocrine-immune interactions which occur during the progression of IDDM, with a particular focus on glucocorticoids and cytokines.

Psychoneuroimmunology of autoimmune disorders

The interactions between the immune system and psychological states are both intricate and intriguing. Research at a molecular level has thrown considerable light on the previously ill-defined area of psychoneuroimmunology. In this report, we explore the psychoneuroimmunology of autoimmune disorders, particularly rheumatoid arthritis and lupus erythematosus. Animal models of these diseases have provided a particularly useful window on complex psychoneuroimmunological interactions. Observations about the effect of stress on the onset and course of autoimmune disorders has added to our understanding of psychoneuroimmunological interactions. These interactions are bi-directional, as reflected in the autoimmune-mediated neuropsychiatric manifestations of systemic lupus. Exploring the role of various neurotransmitters and neuromodulators in the stress response may have important therapeutic implications for autoimmune disorders.

Interdependence of the endocrine and immune systems

The cross-talk involving the endocrine and immune systems is now largely established. These systems actually use similar ligands and receptors to establish a physiological intra- and inter-system communication circuitry, which apparently plays a relevant role in homeostasis (reviewed in Blalock, 1992). Accordingly, classical hormones such as prolactin (PRL), growth hormone (GH) and even glucocorticoids (GC) can be produced by cells of the immune system, whereas a variety of cytokines, originally described as being produced by cells of the immune system, are synthesized and released by a variety of endocrine glands and nervous tissue. Moreover, specific receptors for such distinct molecular families can be detected in both the immune and endocrine systems.

Effect of chronic stress and exogenous glucocorticoids on regional fat distribution and metabolism

It has been proposed that increased glucocorticoid hormones and decreased sex hormones affect regional fat metabolism and distribution. In the present work, it was hypothesized that chronic, uncontrollable stress, known to affect the pituitary-adrenal and pituitary-gonadal axes might, therefore, lead to differences in regional fat accumulation. In comparison with controls, male Sprague-Dawley rats stressed for 28 days, had significantly larger adipocytes. In addition, a tendency for a heavier fat pad and an increased lipoprotein lipase activity in the mesenteric depot was suggested. No significant changes were seen in epididymal, retroperitoneal, and inguinal regions. In order to study if the effects observed could be attributed to increased glucocorticoids, the response to a direct administration of supraphysiological doses of corticosterone, given either in the drinking water or via subcutaneous implantation of corticosterone pellets, was studied. Increased fat accumulation was shown in all fat depots in a dose-response fashion, but was significantly more pronounced in the mesenteric region. It was concluded that mesenteric fat tissue may respond to stress in a different manner from other fat depots. Glucocorticoids seem to be partly, but not solely, responsible for the changes observed in adipose tissue metabolism and distribution following exposure to uncontrollable stress.

Maternal involvement in the development of cardiovascular phenotype

Over the past 20 years, laboratory studies of genetically defined animal models of human essential hypertension have provided valuable information on the pathophysiology of this disturbance in cardiovascular regulation. Relatively fewer studies have examined the impact of preweaning factors on the developing cardiovascular system of hypertensive animals. In our laboratory studies, we have utilized two inbred genetically hypertensive models: the spontaneously hypertensive (SHR) rat and its Wistar/Kyoto (WKY) normotensive control strain as well as the Dahl hypertension-sensitive (SS/Jr) and hypertension-resistant (SR/Jr) strains. To manipulate the preweaning maternal environment, we have employed the technique of reciprocal cross-fostering of litters between hypertensive and matched normotensive mothers. Our findings to date point to the maternal environment as a powerful influence on the development of high blood pressure in genetically hypertensive rats. In general, hypertensive rats reared by normotensive foster mothers have significant reductions in arterial blood pressure in adulthood. Thus, the progression of hypertensive disease is not strictly predetermined by genotypic factors. Rather, a genetic predisposition to hypertension interacts with preweaning environmental factors to determine an animal's cardiovascular phenotype in adulthood.