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Käver L, Voelz C, Specht HE, Thelen AC, Keller L, Dahmen B, Andreani NA, Tenbrock K, Biemann R, Borucki K, Dempfle A, Baines JF, Beyer C, Herpertz-Dahlmann B, Trinh S, Seitz J. Cytokine and Microbiome Changes in Adolescents with Anorexia Nervosa at Admission, Discharge, and One-Year Follow-Up. Nutrients 2024; 16:1596. [PMID: 38892530 PMCID: PMC11174589 DOI: 10.3390/nu16111596] [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: 04/25/2024] [Revised: 05/12/2024] [Accepted: 05/17/2024] [Indexed: 06/21/2024] Open
Abstract
Anorexia nervosa (AN) is a severe eating disorder that predominantly affects females and typically manifests during adolescence. There is increasing evidence that serum cytokine levels are altered in individuals with AN. Previous research has largely focused on adult patients, assuming a low-grade pro-inflammatory state. The serum levels of the cytokine tumour necrosis factor-alpha (TNF-α), interleukin (IL)-1β, IL-6 and IL-15, which are pro-inflammatory, were examined in 63 female adolescents with AN and 41 age-matched healthy controls (HC). We included three time points (admission, discharge, and 1-year follow-up) and investigated the clinical data to assess whether the gut microbiota was associated with cytokine alterations. Relative to the HC group, serum levels of IL-1β and IL-6 were significantly lower during the acute phase (admission) of AN. IL-1β expression was normalised to control levels after weight recovery. TNF-α levels were not significantly different between the AN and HC groups. IL-15 levels were significantly elevated in patients with AN at all time points. We found associations between cytokines and bodyweight, illness duration, depressive symptoms, and the microbiome. In contrast to most findings for adults, we observed lower levels of the pro-inflammatory cytokines IL-1β and IL-6 in adolescent patients, whereas the level of IL-15 was consistently increased. Thus, the presence of inflammatory dysregulation suggests a varied rather than uniform pro-inflammatory state.
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Affiliation(s)
- Larissa Käver
- Institute of Neuroanatomy, RWTH Aachen University, Wendlingweg 2, 52074 Aachen, Germany
- West German Center for Child and Adolescent Health (WZKJ), University Hospital Cologne, Kerpener Str. 62, 50931 Cologne, Germany
| | - Clara Voelz
- Institute of Neuroanatomy, RWTH Aachen University, Wendlingweg 2, 52074 Aachen, Germany
- West German Center for Child and Adolescent Health (WZKJ), University Hospital Cologne, Kerpener Str. 62, 50931 Cologne, Germany
| | - Hannah E. Specht
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital RWTH Aachen, Neuenhofer Weg 21, 52074 Aachen, Germany
| | - Anna C. Thelen
- Institute of Neuroanatomy, RWTH Aachen University, Wendlingweg 2, 52074 Aachen, Germany
| | - Lara Keller
- West German Center for Child and Adolescent Health (WZKJ), University Hospital Cologne, Kerpener Str. 62, 50931 Cologne, Germany
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital RWTH Aachen, Neuenhofer Weg 21, 52074 Aachen, Germany
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, LVR University Hospital Essen, Virchowstrasse 174, 45147 Essen, Germany
| | - Brigitte Dahmen
- West German Center for Child and Adolescent Health (WZKJ), University Hospital Cologne, Kerpener Str. 62, 50931 Cologne, Germany
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital RWTH Aachen, Neuenhofer Weg 21, 52074 Aachen, Germany
| | - Nadia Andrea Andreani
- Max Planck Institute for Evolutionary Biology, August-Thienemann-Str. 2, 24306 Plön, Germany
- Institute for Experimental Medicine, Kiel University, Christian-Albrechts-Platz 4, 24118 Kiel, Germany
| | - Klaus Tenbrock
- West German Center for Child and Adolescent Health (WZKJ), University Hospital Cologne, Kerpener Str. 62, 50931 Cologne, Germany
- Department of Pediatrics, Medical Faculty, RWTH Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany
- Department of Pediatrics, Pediatric Rheumatology, Inselspital University of Bern, Freiburgstrasse 15, 3010 Bern, Switzerland
| | - Ronald Biemann
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University of Leipzig, Paul-List-Straße 13/15, 04103 Leipzig, Germany
| | - Katrin Borucki
- Institute for Clinical Chemistry and Pathobiochemistry, Otto-von-Guericke University Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany
| | - Astrid Dempfle
- Institute of Medical Informatics and Statistics, Kiel University, Brunswicker Str. 10, 24105 Kiel, Germany
| | - John F. Baines
- Max Planck Institute for Evolutionary Biology, August-Thienemann-Str. 2, 24306 Plön, Germany
- Institute for Experimental Medicine, Kiel University, Christian-Albrechts-Platz 4, 24118 Kiel, Germany
| | - Cordian Beyer
- Institute of Neuroanatomy, RWTH Aachen University, Wendlingweg 2, 52074 Aachen, Germany
| | - Beate Herpertz-Dahlmann
- West German Center for Child and Adolescent Health (WZKJ), University Hospital Cologne, Kerpener Str. 62, 50931 Cologne, Germany
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital RWTH Aachen, Neuenhofer Weg 21, 52074 Aachen, Germany
| | - Stefanie Trinh
- Institute of Neuroanatomy, RWTH Aachen University, Wendlingweg 2, 52074 Aachen, Germany
- West German Center for Child and Adolescent Health (WZKJ), University Hospital Cologne, Kerpener Str. 62, 50931 Cologne, Germany
| | - Jochen Seitz
- West German Center for Child and Adolescent Health (WZKJ), University Hospital Cologne, Kerpener Str. 62, 50931 Cologne, Germany
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital RWTH Aachen, Neuenhofer Weg 21, 52074 Aachen, Germany
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, LVR University Hospital Essen, Virchowstrasse 174, 45147 Essen, Germany
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Díaz-Marsá M, Ayad-Ahmed W, López-Villatoro JM, Fernández-Rodrigues V, Ruiz-Guerrero F, Gómez Del Barrio A, Beato-Fernández L, Polo-Montes F, León-Velasco M, Torre-Luque ADL, Carrasco JL, Caso JR, MacDowell KS, Leza JC. Inflammatory profiles in women with eating disorder: Linking inflammatory biomarkers to clinical phenotypes. Psychoneuroendocrinology 2024; 162:106956. [PMID: 38218002 DOI: 10.1016/j.psyneuen.2023.106956] [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: 11/11/2023] [Revised: 12/25/2023] [Accepted: 12/30/2023] [Indexed: 01/15/2024]
Abstract
INTRODUCTION Eating disorders (ED) represent a group of very complex and serious diagnoses characterized by emotional dysregulation and impulsivity. New approaches are necessary to achieve effective diagnosis and treatments. Shifting biomarker research away from the constraints of diagnostic categories may effectively contribute to a dimensional differentiation across disorders according to neurobiology (e.g., inflammatory biomarkers). Thus, the aim of our study was to identify inflammatory profiles in patients with ED. METHODS A sample of 100 women with an ED (23.4 ± 8.55 years) and 59 healthy controls (HC) (20.22 ± 4.18 years) was used. K-means cluster analysis was followed to identify inflammatory clusters considering seven blood biomarkers (iNOS, TNFα, COX2, p38, ERK, TBARS and PPARγ). Moreover, a wide assessment of clinical features was conducted. RESULTS Two distinct clusters were identified. Cluster 1 patients were characterized by higher inflammatory levels of TNF-α, COX2, p38, and ERK, and had more restrictive anorexia diagnosis than cluster 2. Cluster 2 participants showed higher inflammatory levels of iNOS and were older than cluster 1 and controls and had lower BMI than HC. In addition, they had higher levels of bulimic symptoms than those from the cluster 1 and HC, and higher impulsivity than HC. All ED patients (regardless of cluster) showed higher ED symptoms and more trauma than HC. CONCLUSIONS Our study revealed that inflammatory dysfunction may be linked with clinical endophenotypes in ED, one more restrictive (cluster 1) with an inflammation/oxidative endophenotype more cytokine and MAPK/ERK mediated, and the other more impulsive, with more bulimic symptoms (cluster 2) with NO free radical high output source iNOS. Trauma seems to be a vulnerability factor for both endophenotypes.
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Affiliation(s)
- Marina Díaz-Marsá
- Network Center for Biomedical Research in Mental Health, Institute of Health "Carlos III" (CIBERSAM, ISCIII), Madrid, Spain; Department of Legal Medicine, Psychiatry, and Pathology, School of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain; IIS Hospital Clínico San Carlos, Madrid, Spain
| | | | - José Manuel López-Villatoro
- Department of Legal Medicine, Psychiatry, and Pathology, School of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain; IIS Hospital Clínico San Carlos, Madrid, Spain.
| | | | - Francisco Ruiz-Guerrero
- Hospital Universitario Marqués de Valdecilla, Santander, Spain; Valdecilla Biomedical Research Institute (IDIVAL), Santander, Spain
| | - Andrés Gómez Del Barrio
- Network Center for Biomedical Research in Mental Health, Institute of Health "Carlos III" (CIBERSAM, ISCIII), Madrid, Spain; Hospital Universitario Marqués de Valdecilla, Santander, Spain; Valdecilla Biomedical Research Institute (IDIVAL), Santander, Spain
| | | | | | | | - Alejandro de la Torre-Luque
- Network Center for Biomedical Research in Mental Health, Institute of Health "Carlos III" (CIBERSAM, ISCIII), Madrid, Spain; Department of Legal Medicine, Psychiatry, and Pathology, School of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain
| | - José Luis Carrasco
- Network Center for Biomedical Research in Mental Health, Institute of Health "Carlos III" (CIBERSAM, ISCIII), Madrid, Spain; Department of Legal Medicine, Psychiatry, and Pathology, School of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain; IIS Hospital Clínico San Carlos, Madrid, Spain
| | - Javier R Caso
- Network Center for Biomedical Research in Mental Health, Institute of Health "Carlos III" (CIBERSAM, ISCIII), Madrid, Spain; Department of Pharmacology and Toxicology, School of Medicine, UCM, Madrid, Spain; IIS Hospital 12 de Octubre (Imas12), IUIN-UCM, Madrid, Spain
| | - Karina S MacDowell
- Network Center for Biomedical Research in Mental Health, Institute of Health "Carlos III" (CIBERSAM, ISCIII), Madrid, Spain; Department of Pharmacology and Toxicology, School of Medicine, UCM, Madrid, Spain; IIS Hospital 12 de Octubre (Imas12), IUIN-UCM, Madrid, Spain
| | - Juan C Leza
- Network Center for Biomedical Research in Mental Health, Institute of Health "Carlos III" (CIBERSAM, ISCIII), Madrid, Spain; Department of Pharmacology and Toxicology, School of Medicine, UCM, Madrid, Spain; IIS Hospital 12 de Octubre (Imas12), IUIN-UCM, Madrid, Spain
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Ertuglu LA, Deger SM, Alsouqi A, Hung A, Gamboa J, Mambungu C, Sha F, Siew E, Abumrad NN, Ikizler TA. A randomized controlled pilot trial of anakinra and pioglitazone for protein metabolism in patients on maintenance haemodialysis. J Cachexia Sarcopenia Muscle 2024; 15:401-411. [PMID: 38178557 PMCID: PMC10834322 DOI: 10.1002/jcsm.13395] [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: 05/10/2023] [Revised: 09/17/2023] [Accepted: 11/02/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Chronic inflammation and insulin resistance are highly prevalent in patients on maintenance haemodialysis (MHD) and are strongly associated with protein energy wasting. We conducted a pilot, randomized, placebo-controlled trial of recombinant human interleukin-1 receptor antagonist (IL-1ra) and pioglitazone to explore the safety, feasibility and efficacy for insulin-mediated protein metabolism in patients undergoing MHD. METHODS Twenty-four patients were randomized to receive IL-1ra, pioglitazone or placebo for 12 weeks. Changes in serum inflammatory markers and insulin-mediated protein synthesis, breakdown and net balance in the whole-body and skeletal muscle compartments were assessed using hyperinsulinaemic-hyperaminoacidemic clamp technique at baseline and Week 12. RESULTS Among 24 patients, median (interquartile range) age was 51 (40, 61), 79% were African American and 21% had diabetes mellitus. All patients initiated on intervention completed the study, and no serious adverse events were observed. There was a statistically significant decrease in serum high-sensitivity C-reactive protein in the pioglitazone group compared with placebo, but not in the IL-1ra group. No significant differences in the changes of whole-body or skeletal muscle protein synthesis, breakdown and net balance were found between the groups. CONCLUSIONS In this pilot study, there were no statistically significant effects of 12 weeks of IL-1ra or pioglitazone on protein metabolism in patients on MHD. CLINICALTRIALS gov registration: NCT02278562.
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Affiliation(s)
- Lale A Ertuglu
- Department of Medicine, Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Serpil Muge Deger
- Department of Nephrology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Aseel Alsouqi
- Department of Medicine, Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, TN, USA
- Now with Department of Medicine, Division of Hematology and Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Adriana Hung
- Department of Medicine, Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Center Kidney Disease, Vanderbilt University Medical Center, Nashville, TN, USA
- Veterans Administration Tennessee Valley Healthcare System, Nashville, TN, USA
| | - Jorge Gamboa
- Department of Medicine, Division of Clinical Pharmacology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Cindy Mambungu
- Department of Medicine, Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Center Kidney Disease, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Feng Sha
- Department of Medicine, Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Center Kidney Disease, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Edward Siew
- Department of Medicine, Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Center Kidney Disease, Vanderbilt University Medical Center, Nashville, TN, USA
- Veterans Administration Tennessee Valley Healthcare System, Nashville, TN, USA
| | - Naji N Abumrad
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - T Alp Ikizler
- Department of Medicine, Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Center Kidney Disease, Vanderbilt University Medical Center, Nashville, TN, USA
- Veterans Administration Tennessee Valley Healthcare System, Nashville, TN, USA
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Rodríguez-Quiroga A, MacDowell KS, Leza JC, Carrasco JL, Díaz-Marsá M. Childhood trauma determines different clinical and biological manifestations in patients with eating disorders. Eat Weight Disord 2021; 26:847-857. [PMID: 32424563 DOI: 10.1007/s40519-020-00922-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 05/06/2020] [Indexed: 12/17/2022] Open
Abstract
PURPOSE There is a significant relationship between childhood trauma and the development of an eating disorder in adolescence or adulthood, possibly influenced by circulating levels of inflammatory parameters. The main objective is to identify and describe a subgroup of patients with eating disorders and a history of trauma in childhood or adolescence with differential clinical features. METHODS An observational study on a sample of 55 patients who met the diagnostic criteria for any DSM-5 eating disorder was carried out. Inflammatory parameters in white blood cells were examined. Patients underwent different assessments, including clinical and personality scales. RESULTS Patients with a history of trauma had higher scores in the delirious and narcissistic items of the Millon Clinical Multiaxial Inventory (MCMI-II) (p < 0.05) and a higher score in the paranoid item of the SCID-5 Personality Disorders Version (SCID-5-PD) (p < 0.05). Patients with distinguishing personality features were grouped according to the Childhood Trauma Questionnaire sexual subscale. Tumor necrosis alpha (TNF-α) showed a significant association with childhood trauma history. CONCLUSIONS There is a profile of patients with eating disorders who have increased activity in the inflammatory pathways that, if identified precociously, can benefit from specifically aimed interventions. LEVEL OF EVIDENCE Level V, observational study.
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Affiliation(s)
- Alberto Rodríguez-Quiroga
- Department of Psychiatry, Hospital Universitario Infanta Leonor, Gran Vía del Este 80, 28030, Madrid, Spain. .,Department of Psychiatry and Psychology, Medical School, Complutense University, Av. Séneca, 2, 28040, Madrid, Spain.
| | - Karina S MacDowell
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.,Department of Pharmacology, Medical School, Complutense University, Av. Séneca, 2, 28040, Madrid, Spain.,Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Av. Cordoba, s/n, 28041, Madrid, Spain
| | - Juan C Leza
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.,Department of Pharmacology, Medical School, Complutense University, Av. Séneca, 2, 28040, Madrid, Spain.,Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Av. Cordoba, s/n, 28041, Madrid, Spain
| | - José Luis Carrasco
- Department of Psychiatry and Psychology, Medical School, Complutense University, Av. Séneca, 2, 28040, Madrid, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.,Department of Psychiatry, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Hospital Clínico San Carlos, Calle del Prof Martín Lagos, s/n, 28040, Madrid, Spain
| | - Marina Díaz-Marsá
- Department of Psychiatry and Psychology, Medical School, Complutense University, Av. Séneca, 2, 28040, Madrid, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.,Department of Psychiatry, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Hospital Clínico San Carlos, Calle del Prof Martín Lagos, s/n, 28040, Madrid, Spain
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Caso JR, Graell M, Navalón A, MacDowell KS, Gutiérrez S, Soto M, Leza JC, Carrasco JL, Marsá MD. Dysfunction of inflammatory pathways in adolescent female patients with anorexia nervosa. Prog Neuropsychopharmacol Biol Psychiatry 2020; 96:109727. [PMID: 31398429 DOI: 10.1016/j.pnpbp.2019.109727] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 08/03/2019] [Accepted: 08/03/2019] [Indexed: 01/23/2023]
Abstract
BACKGROUND The pathogenesis of Eating Disorders is still unknown. However, a growing body of evidence shows that there are changes in cytokine levels and an alteration in the stress response in patients with anorexia nervosa (AN). For this reason, we decided to test whether there are differences in immune parameters involved in the regulation of the inflammatory response between female adolescents with AN and healthy adolescents. METHODS The sample 27 drug-naïve AN patients the study sample included 27 AN patients at a very early stage of the disease and 23 healthy controls. Plasma and peripheral blood mononuclear cells (PBMCs) were obtained for biochemical study. RESULTS Plasma levels of the pro-inflammatory cytokines TNF-α and IL-1β were significantly increased in patients with AN, while the levels of prostaglandins PGE2 (proinflammatory) and 15d-PGJ2, (anti-inflammatory) were lower compared with controls. Protein expression in PBMCs of cyclooxygenase-2 (COX-2) and the activated forms of the mitogen-activated protein kinases p38 and ERK were also increased in the AN group. Expression levels of the anti-inflammatory factor peroxisome proliferator-activated receptor gamma (PPARγ) were significantly decreased in patients. Plasma levels of lipid peroxidation markers -TBARS- were not increased in patients with AN. Components of the biochemical inflammatory response (COX-2, PGE2, TBARS, 15d-PGJ2, ERK, p65 NFκB) and glucocorticoid receptor -GR- expression and the scores on the impulsivity measures in the BARRATT, EDI and BITE questionnaires showed a significant correlation within the AN patients group. CONCLUSIONS The results for female adolescent patients with AN indicate that there is a dysfunction of intra- and intercellular inflammatory pathways characterized by higher levels of pro-inflammatory parameters in plasma and a decrease in one of the controlling cytoplasmic-nuclear pathways implicated in their modulation (i.e. PPARγ) with, at this very early stage of the disease, no effect on oxidative stress markers plasma levels. Most notably, higher severity of illness (restrictive and purging behaviour) correlated with higher levels of inflammatory markers.
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Affiliation(s)
- Javier R Caso
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain; Dept. of Pharmacology & Toxicology, Faculty of Medicine, Complutense University (UCM), IUIN-UCM, IIS Hospital 12 de Octubre (i+12). Madrid, Spain
| | - Montserrat Graell
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain; Child and Adolescent Psychiatry and Psychology Service, Child Hospital Niño Jesús, Madrid, Spain
| | - Aida Navalón
- Dept. of Psychiatry, Legal Medicine & Pathology, Faculty of Medicine, (UCM), IIS Hospital Clínico San Carlos, Madrid, Spain
| | - Karina S MacDowell
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain; Dept. of Pharmacology & Toxicology, Faculty of Medicine, Complutense University (UCM), IUIN-UCM, IIS Hospital 12 de Octubre (i+12). Madrid, Spain
| | - Silvia Gutiérrez
- Child and Adolescent Psychiatry and Psychology Service, Child Hospital Niño Jesús, Madrid, Spain
| | - Marta Soto
- Dept. of Psychiatry, Legal Medicine & Pathology, Faculty of Medicine, (UCM), IIS Hospital Clínico San Carlos, Madrid, Spain
| | - Juan C Leza
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain; Dept. of Pharmacology & Toxicology, Faculty of Medicine, Complutense University (UCM), IUIN-UCM, IIS Hospital 12 de Octubre (i+12). Madrid, Spain
| | - José L Carrasco
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain; Dept. of Psychiatry, Legal Medicine & Pathology, Faculty of Medicine, (UCM), IIS Hospital Clínico San Carlos, Madrid, Spain
| | - Marina Díaz Marsá
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain; Dept. of Psychiatry, Legal Medicine & Pathology, Faculty of Medicine, (UCM), IIS Hospital Clínico San Carlos, Madrid, Spain.
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Gibson D, Mehler PS. Anorexia Nervosa and the Immune System-A Narrative Review. J Clin Med 2019; 8:jcm8111915. [PMID: 31717370 PMCID: PMC6912362 DOI: 10.3390/jcm8111915] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 10/24/2019] [Accepted: 11/04/2019] [Indexed: 12/13/2022] Open
Abstract
The pathogenesis of an increasing number of chronic diseases is being attributed to effects of the immune system. However, its role in the development and maintenance of anorexia nervosa is seemingly under-appreciated. Yet, in examining the available research on the immune system and genetic studies in anorexia nervosa, one becomes increasingly suspicious of the immune system’s potential role in the pathophysiology of anorexia nervosa. Specifically, research is suggestive of increased levels of various pro-inflammatory cytokines as well as the spontaneous production of tumor necrosis factor in anorexia nervosa; genetic studies further support a dysregulated immune system in this disorder. Potential contributors to this dysregulated immune system are discussed including increased oxidative stress, chronic physiological/psychological stress, changes in the intestinal microbiota, and an abnormal bone marrow microenvironment, all of which are present in anorexia nervosa.
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Affiliation(s)
- Dennis Gibson
- Assistant Medical Director, ACUTE Center for Eating Disorders @ Denver Health; Assistant Professor of Medicine, University of Colorado School of Medicine; 777 Bannock St., Denver, CO 80204, USA
- Correspondence: ; Tel.: +303-602-5067; Fax: +303-602-3811
| | - Philip S Mehler
- President, Eating Recovery Center; Founder and Executive Medical Director, ACUTE Center for Eating Disorders @ Denver Health; Glassman Professor of Medicine, University of Colorado School of Medicine; 7351 E Lowry Blvd, Suite 200, Denver, CO 80230, USA;
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Dalton B, Whitmore V, Patsalos O, Ibrahim MAA, Schmidt U, Himmerich H. A systematic review of in vitro cytokine production in eating disorders. Mol Cell Endocrinol 2019; 497:110308. [PMID: 30296466 DOI: 10.1016/j.mce.2018.10.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 08/24/2018] [Accepted: 10/04/2018] [Indexed: 01/02/2023]
Abstract
BACKGROUND Eating disorders (EDs) have been associated with alterations in cytokine concentrations and production. This review examines whether in vitro cytokine production (i) is altered in people with EDs compared to healthy participants; and (ii) changes in response to treatment? METHODS Using PRISMA guidelines, we systematically reviewed articles reporting group comparisons or longitudinal assessments of spontaneous and/or stimulated cytokine production in vitro in people with EDs. RESULTS Twelve studies were included. Cross-sectional results were mixed in anorexia nervosa. Only one study measured cytokine production in bulimia nervosa. Two longitudinal studies showed that daily yoghurt consumption increases phytohemagglutinin-stimulated interferon-γ production in anorexia nervosa. CONCLUSION The mixed results could be accounted for by variations in experimental design. Our findings suggest that cytokine production could possibly be modulated through dietary interventions. However, due to the methodological heterogeneity and shortcomings of the included studies, it seems unreasonable to draw further conclusions.
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Affiliation(s)
- Bethan Dalton
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
| | - Victoria Whitmore
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Faculty of Life Sciences and Medicine, King's College London, UK
| | - Olivia Patsalos
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Mohammad A A Ibrahim
- Department of Clinical Immunological Medicine and Allergy, King's Health Partners, King's College Hospital, London, UK
| | - Ulrike Schmidt
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; South London and Maudsley NHS Foundation Trust, London, UK
| | - Hubertus Himmerich
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; South London and Maudsley NHS Foundation Trust, London, UK
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Grosman-Rimon L, Wright E, Freedman D, Kachel E, Hui S, Epstein I, Gutterman D, Eilat-Adar S. Can improvement in hormonal and energy balance reverse cardiovascular risk factors in athletes with amenorrhea? Am J Physiol Heart Circ Physiol 2019; 317:H487-H495. [PMID: 31322425 DOI: 10.1152/ajpheart.00242.2019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Female athletes display a high prevalence of hypothalamic amenorrhea as a result of energy imbalance. In these athletes with amenorrhea, decreased luteinizing hormone/follicule-stimulating hormone secretion leads to deficiency in endogenous estrogen. The severe estrogen deficiency in these athletes may increase cardiovascular risk similar to that in postmenopausal women. This review discusses the potential cardiovascular risk factors in athletes with amenorrhea as a result of hypoestrogenism, which include endothelial dysfunction and unfavorable lipid profiles. We also consider the potential to reverse the cardiovascular risk by restoring energy or hormonal imbalance along the reproductive axis in athletes with amenorrhea.
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Affiliation(s)
- Liza Grosman-Rimon
- Cardiovascular Department and Research Center of Baruch Padeh Medical Center, Poriya, Tiberias, Israel.,The Academic College at Wingate, Wingate Institute, Netanya, Israel
| | - Evan Wright
- Technion American Medical School, Ruth and Bruce Rappaport Faculty of Medicine, St. Bat Galim, Haifa, Israel
| | - Danit Freedman
- Schulich School of Medicine and Dentistry at the University of Western Ontario, Toronto, Canada
| | - Erez Kachel
- Cardiovascular Department and Research Center of Baruch Padeh Medical Center, Poriya, Tiberias, Israel
| | - Sarah Hui
- Schulich School of Medicine and Dentistry at the University of Western Ontario, Toronto, Canada
| | - Iris Epstein
- School of Nursing, Faculty of Health, York University, Toronto, Canada
| | - David Gutterman
- Cardiovascular Center, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Sigal Eilat-Adar
- The Academic College at Wingate, Wingate Institute, Netanya, Israel
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9
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Caroleo M, Carbone EA, Greco M, Corigliano DM, Arcidiacono B, Fazia G, Rania M, Aloi M, Gallelli L, Segura-Garcia C, Foti DP, Brunetti A. Brain-Behavior-Immune Interaction: Serum Cytokines and Growth Factors in Patients with Eating Disorders at Extremes of the Body Mass Index (BMI) Spectrum. Nutrients 2019; 11:E1995. [PMID: 31450770 PMCID: PMC6770139 DOI: 10.3390/nu11091995] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 08/19/2019] [Accepted: 08/21/2019] [Indexed: 12/14/2022] Open
Abstract
Alterations of the immune system are known in eating disorders (EDs), however the importance of cytokine balance in this context has not been clarified. We compared cytokines and growth factors at opposite ends of BMI ranges, in 90 patients classified in relation to BMI, depressive and EDs comorbidities. Serum concentrations of interleukin (IL)-1α, IL-1β, IL-2, IL-4, IL-6, IL-8, IL-10, interferon-gamma (IFN-γ), tumor necrosis factor-alpha (TNF-α), monocyte chemoattractant protein-1 (MCP-1), vascular endothelial growth factor (VEGF), and epidermal growth factor (EGF) were determined by a biochip analyzer (Randox Labs). Differences were calculated through ANOVA. Possible predictors of higher cytokine levels were evaluated through regression analysis. IL-1α, IL-10, EGF, and IFN-γ were altered individuals with anorexia nervosa (AN) and binge eating disorder (BED). Night-eating was associated with IL-8 and EGF levels, IL-10 concentrations with post-dinner eating and negatively with sweet-eating, long fasting with higher IFN-γ levels. IL-2 increase was not linked to EDs, but to the interaction of depression and BMI. Altogether, for the first time, IL-1α, IL-10, EGF, and IFN-γ were shown to differ between AN and HCs, and between AN and individuals with obesity with or without BED. Only IL-2 was influenced by depression. Dysfunctional eating behaviors predicted abnormal concentrations of IL-10, EGF, IL-8 and IFN-γ.
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Affiliation(s)
- Mariarita Caroleo
- Department of Health Sciences, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy
| | - Elvira Anna Carbone
- Department of Health Sciences, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy
| | - Marta Greco
- Department of Health Sciences, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy
| | | | - Biagio Arcidiacono
- Department of Health Sciences, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy
| | - Gilda Fazia
- Department of Health Sciences, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy
| | - Marianna Rania
- Department of Health Sciences, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy
| | - Matteo Aloi
- Department of Health Sciences, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy
| | - Luca Gallelli
- Department of Health Sciences, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy
| | - Cristina Segura-Garcia
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy.
| | - Daniela Patrizia Foti
- Department of Health Sciences, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy
| | - Antonio Brunetti
- Department of Health Sciences, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy
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10
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Decline of Plasma Concentrations of Interleukin-18 in Severely Malnourished Patients with Anorexia Nervosa: Exploratory Analysis. Nutrients 2019; 11:nu11030540. [PMID: 30832404 PMCID: PMC6471691 DOI: 10.3390/nu11030540] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 02/28/2019] [Accepted: 02/28/2019] [Indexed: 11/17/2022] Open
Abstract
Multiple studies on the dynamics of inflammatory cytokines in patients with anorexia nervosa (AN) have been published, although results are not consistent among reports. Thus the pathophysiologic roles of these cytokines are not clear. We performed an exploratory analysis that included (1) comparisons of plasma interleukin-18 (IL-18) concentrations between patients with AN (n = 21) and healthy controls (n = 39), and (2) correlations between body mass index (BMI) and IL-18 concentrations in both groups, exploring the relationship between malnourishment and IL-18. Plasma IL-18 levels were significantly decreased in patients with AN compared with controls. Plasma IL-18 levels correlated to BMI in controls, but not in patients with AN. These results suggest that a decline in plasma IL-18 levels in patients with AN is not only due to malnourishment, but other pathophysiologic changes as well. IL-18 has a role in the brain’s reaction to sadness and chronic stress. Therefore, decreased levels of IL-18 may commonly occur in patients with chronic AN.
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11
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Can Gut Microbiota and Lifestyle Help Us in the Handling of Anorexia Nervosa Patients? Microorganisms 2019; 7:microorganisms7020058. [PMID: 30813265 PMCID: PMC6406897 DOI: 10.3390/microorganisms7020058] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 02/08/2019] [Accepted: 02/20/2019] [Indexed: 12/11/2022] Open
Abstract
Gut microbiota is composed of different microorganisms that play an important role in the host. New research shows that bidirectional communications happen between intestinal microbiota and the brain, which is known as the gut⁻brain axis. This communication is significant and could have a negative or positive effect depending on the state of the gut microbiota. Anorexia nervosa (AN) is a mental illness associated with metabolic, immunologic, biochemical, sensory abnormalities, and extremely low body weight. Different studies have shown a dysbiosis in patients with AN. Due to the gut⁻brain axis, it was observed that some of the symptoms could be improved in these patients by boosting their gut microbiota. This paper highlights some evidence connecting the role of microbiota in the AN onset and disease progress. Finally, a proposal is done to include the microbiota analysis as part of the recovery protocol used to treat AN patients. When conducting clinical studies of gut microbiota in AN patients, dysbiosis is expected to be found. Then the prescription of a personalized treatment rich in prebiotics and probiotics could be proposed to reverse the dysbiosis.
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12
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Gabriel T, Paul S, Berger A, Massoubre C. Anorexia Nervosa and Autism Spectrum Disorders: Future Hopes Linked to Mucosal Immunity. Neuroimmunomodulation 2019; 26:265-275. [PMID: 31715599 DOI: 10.1159/000502997] [Citation(s) in RCA: 4] [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: 01/08/2019] [Accepted: 08/28/2019] [Indexed: 11/19/2022] Open
Abstract
Mental health is becoming a public health priority worldwide. Anorexia nervosa and autism spectrum disorders are 2 important types of childhood disorders with a bad prognosis. They share cognitive impairments and, in both cases, the microbiota appears to be a crucial factor. Alteration of the microbiota-gut-brain axis is an appealing hypothesis to define new pathophysiological mechanisms. Mucosal immunity plays a key role between the microbiota and the brain. The mucosal immune system receives and integrates messages from the intestinal microenvironment and the microbiota and then transmits the information to the nervous system. Abnormalities in this sensorial system may be involved in the natural history of mental diseases and might play a role in their maintenance. This review aims to highlight data about the relationship between intestinal mucosal immunity and these disorders. We show that shared cognitive impairments could be found in these 2 disorders, which both present dysbiosis. This literature review provides details on the immune status of anorexic and autistic patients, with a focus on intestinal mucosal factors. Finally, we suggest future research hypotheses that seem important for understanding the implication of the gut-brain-axis in psychiatric diseases.
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Affiliation(s)
- Tristan Gabriel
- Laboratoire d'Immunologie, GIMAP/EA3064, Université de Lyon, CIC 1408 Vaccinology, Saint-Etienne, France
- Centre Référent des Troubles du Comportement Alimentaire, CHU Saint Etienne Hôpital Nord, Saint-Etienne, France
| | - Stéphane Paul
- Laboratoire d'Immunologie, GIMAP/EA3064, Université de Lyon, CIC 1408 Vaccinology, Saint-Etienne, France
| | - Anne Berger
- Laboratoire d'Immunologie, GIMAP/EA3064, Université de Lyon, CIC 1408 Vaccinology, Saint-Etienne, France
| | - Catherine Massoubre
- Centre Référent des Troubles du Comportement Alimentaire, CHU Saint Etienne Hôpital Nord, Saint-Etienne, France,
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13
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Zerwas S, Larsen JT, Petersen L, Thornton LM, Quaranta M, Koch SV, Pisetsky D, Mortensen PB, Bulik CM. Eating Disorders, Autoimmune, and Autoinflammatory Disease. Pediatrics 2017; 140:peds.2016-2089. [PMID: 29122972 PMCID: PMC5703777 DOI: 10.1542/peds.2016-2089] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/16/2017] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES Identifying factors associated with risk for eating disorders is important for clarifying etiology and for enhancing early detection of eating disorders in primary care. We hypothesized that autoimmune and autoinflammatory diseases would be associated with eating disorders in children and adolescents and that family history of these illnesses would be associated with eating disorders in probands. METHODS In this large, nationwide, population-based cohort study of all children and adolescents born in Denmark between 1989 and 2006 and managed until 2012, Danish medical registers captured all inpatient and outpatient diagnoses of eating disorders and autoimmune and autoinflammatory diseases. The study population included 930 977 individuals (48.7% girls). Cox proportional hazards regression models and logistic regression were applied to evaluate associations. RESULTS We found significantly higher hazards of eating disorders for children and adolescents with autoimmune or autoinflammatory diseases: 36% higher hazard for anorexia nervosa, 73% for bulimia nervosa, and 72% for an eating disorder not otherwise specified. The association was particularly strong in boys. Parental autoimmune or autoinflammatory disease history was associated with significantly increased odds for anorexia nervosa (odds ratio [OR] = 1.13, confidence interval [CI] = 1.01-1.25), bulimia nervosa (OR = 1.29; CI = 1.08-1.55) and for an eating disorder not otherwise specified (OR = 1.27; CI = 1.13-1.44). CONCLUSIONS Autoimmune and autoinflammatory diseases are associated with increased risk for eating disorders. Ultimately, understanding the role of immune system disturbance for the etiology and pathogenesis of eating disorders could point toward novel treatment targets.
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Affiliation(s)
| | - Janne Tidselbak Larsen
- National Centre for Register-Based Research,,The Lundbeck Foundation Initiative for Integrative Psychiatric Research, and
| | - Liselotte Petersen
- National Centre for Register-Based Research,,The Lundbeck Foundation Initiative for Integrative Psychiatric Research, and
| | | | - Michela Quaranta
- Department of Neuroscience, Azienda Ospedaliero-Universitaria San Giovanni Battista and University of Turin, Turin, Italy
| | - Susanne Vinkel Koch
- Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark;,Mental Health Centre for Child and Adolescent Psychiatry, Copenhagen, Denmark
| | - David Pisetsky
- Medical Research Service, Durham Veterans Administration Medical Center and Division of Rheumatology and Immunology, Duke University, Durham, North Carolina; and
| | - Preben Bo Mortensen
- National Centre for Register-Based Research,,The Lundbeck Foundation Initiative for Integrative Psychiatric Research, and,Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark
| | - Cynthia M. Bulik
- Departments of Psychiatry and,Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina;,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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14
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Miłkowska P, Popko K, Demkow U, Wolańczyk T. Pro-Inflammatory Cytokines in Psychiatric Disorders in Children and Adolescents: A Review. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017. [PMID: 28456928 DOI: 10.1007/5584_2017_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
Cytokines are a large group of small proteins which play a significant role in cell signaling and regulate a variety of processes in organisms, including proliferation and differentiation of many cells, mediation in defense reactions and regulation of hematopoiesis. Cytokines can be divided into those with pro- and those with anti-inflammatory properties. In the group of pro-inflammatory cytokines the most important are: IL-1 beta, IL-6, TNF-alpha, and IFN-gamma. Pro-inflammatory cytokines might be involved in the pathophysiology of many psychiatric conditions in adults, but their role in children and adolescents is less clear. The aim of this article is to demonstrate the patterns of pro-inflammatory cytokines in children and adolescents.
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Affiliation(s)
- Paulina Miłkowska
- Department of Child Psychiatry, Warsaw Medical University, 63A Zwirki i Wigury Street, 02-091, Warsaw, Poland.
| | - Katarzyna Popko
- Department of Laboratory Diagnostics and Clinical Immunology of Developmental Age, Warsaw Medical University, 63A Zwirki i Wigury Street, 02-091, Warsaw, Poland
| | - Urszula Demkow
- Department of Laboratory Diagnostics and Clinical Immunology of Developmental Age, Warsaw Medical University, 63A Zwirki i Wigury Street, 02-091, Warsaw, Poland
| | - Tomasz Wolańczyk
- Department of Child Psychiatry, Warsaw Medical University, 63A Zwirki i Wigury Street, 02-091, Warsaw, Poland
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15
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Elegido A, Graell M, Andrés P, Gheorghe A, Marcos A, Nova E. Increased naive CD4 + and B lymphocyte subsets are associated with body mass loss and drive relative lymphocytosis in anorexia nervosa patients. Nutr Res 2017; 39:43-50. [PMID: 28385288 DOI: 10.1016/j.nutres.2017.02.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 12/12/2016] [Accepted: 02/03/2017] [Indexed: 12/12/2022]
Abstract
Anorexia nervosa (AN) is an atypical form of malnutrition with peculiar changes in the immune system. We hypothesized that different lymphocyte subsets are differentially affected by malnutrition in AN, and thus, our aim was to investigate the influence of body mass loss on the variability of lymphocyte subsets in AN patients. A group of 66 adolescent female patients, aged 12-17 years, referred for their first episode of either AN or feeding or eating disorders not elsewhere classified were studied upon admission (46 AN-restricting subtype, 11 AN-binge/purging subtype, and 9 feeding or eating disorders not elsewhere classified). Ninety healthy adolescents served as controls. White blood cells and lymphocyte subsets were analyzed by flow cytometry. Relationships with the body mass index (BMI) z score were assessed in linear models adjusted by diagnostic subtype and age. Leukocyte numbers were lower in AN patients than in controls, and relative lymphocytosis was observed in AN-restricting subtype. Lower CD8+, NK, and memory CD8+ counts were found in eating disorder patients compared with controls. No differences were found for CD4+ counts or naive and memory CD4+ subsets between the groups. Negative associations between lymphocyte percentage and the BMI z score, as well as between the B cell counts, naive CD4+ percentage and counts, and the BMI z score, were found. In conclusion, increased naive CD4+ and B lymphocyte subsets associated with body mass loss drive the relative lymphocytosis observed in AN patients, which reflects an adaptive mechanism to preserve the adaptive immune response.
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Affiliation(s)
- Ana Elegido
- Immunonutrition Research Group, Department of Metabolism and Nutrition, Institute of Food Science, Technology and Nutrition (ICTAN)-CSIC, C/José Antonio Novais 10, 28040, Madrid, Spain
| | - Montserrat Graell
- Eating Disorders Unit, Child and Adolescent Psychiatry and Psychology Department, Children University Hospital Niño Jesús, Av Menéndez Pelayo, 65, 28009 Madrid, Spain; CIBERSAM, Biomedical Research Networking Centre for Mental Health, Ministry of Health, Spain
| | - Patricia Andrés
- Eating Disorders Unit, Child and Adolescent Psychiatry and Psychology Department, Children University Hospital Niño Jesús, Av Menéndez Pelayo, 65, 28009 Madrid, Spain
| | - Alina Gheorghe
- Immunonutrition Research Group, Department of Metabolism and Nutrition, Institute of Food Science, Technology and Nutrition (ICTAN)-CSIC, C/José Antonio Novais 10, 28040, Madrid, Spain
| | - Ascensión Marcos
- Immunonutrition Research Group, Department of Metabolism and Nutrition, Institute of Food Science, Technology and Nutrition (ICTAN)-CSIC, C/José Antonio Novais 10, 28040, Madrid, Spain
| | - Esther Nova
- Immunonutrition Research Group, Department of Metabolism and Nutrition, Institute of Food Science, Technology and Nutrition (ICTAN)-CSIC, C/José Antonio Novais 10, 28040, Madrid, Spain.
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16
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Miłkowska P, Popko K, Demkow U, Wolańczyk T. Pro-inflammatory Cytokines in Psychiatric Disorders in Children and Adolescents: A Review. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 1021:73-80. [PMID: 28405892 DOI: 10.1007/5584_2017_32] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Cytokines are a large group of small proteins which play a significant role in cell signaling and regulate a variety of processes in organisms, including proliferation and differentiation of many cells, mediation in defense reactions and regulation of hematopoiesis. Cytokines can be divided into those with pro- and those with anti-inflammatory properties. In the group of pro-inflammatory cytokines the most important are: IL-1 beta, IL-6, TNF-alpha, and IFN-gamma. Pro-inflammatory cytokines might be involved in the pathophysiology of many psychiatric conditions in adults, but their role in children and adolescents is less clear. The aim of this article is to demonstrate the patterns of pro-inflammatory cytokines in children and adolescents.
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Affiliation(s)
- Paulina Miłkowska
- Department of Child Psychiatry, Warsaw Medical University, 63A Zwirki i Wigury Street, 02-091, Warsaw, Poland.
| | - Katarzyna Popko
- Department of Laboratory Diagnostics and Clinical Immunology of Developmental Age, Warsaw Medical University, 63A Zwirki i Wigury Street, 02-091, Warsaw, Poland
| | - Urszula Demkow
- Department of Laboratory Diagnostics and Clinical Immunology of Developmental Age, Warsaw Medical University, 63A Zwirki i Wigury Street, 02-091, Warsaw, Poland
| | - Tomasz Wolańczyk
- Department of Child Psychiatry, Warsaw Medical University, 63A Zwirki i Wigury Street, 02-091, Warsaw, Poland
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17
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Germain N, Viltart O, Loyens A, Bruchet C, Nadin K, Wolowczuk I, Estour B, Galusca B. Interleukin-7 Plasma Levels in Human Differentiate Anorexia Nervosa, Constitutional Thinness and Healthy Obesity. PLoS One 2016; 11:e0161890. [PMID: 27611669 PMCID: PMC5017702 DOI: 10.1371/journal.pone.0161890] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 08/12/2016] [Indexed: 02/05/2023] Open
Abstract
Introduction Interleukin-7 (IL-7) is a cytokine involved in energy homeostasis as demonstrated in rodents. Anorexia nervosa is characterized by restrained eating behavior despite adaptive orexigenic regulation profile including high ghrelin plasma levels. Constitutional thinness is a physiological condition of resistance to weight gain with physiological anorexigenic profile including high Peptide YY plasma level. Healthy obesity can be considered as a physiological state of resistance to weight loss with opposite appetite regulating profile to constitutional thinness including low Peptide YY plasma level. No studies in IL-7 are yet available in those populations. Therefore we evaluated circadian plasma levels of IL-7 in anorexia nervosa compared to constitutional thinness, healthy obese and control females. Materials and Methods 10 restrictive-type anorexia nervosa women, 5 bingeing/purging anorexia nervosa woman, 5 recovered restrictive anorexia nervosa women, 4 bulimic females, 10 constitutional thinness women, 7 healthy obese females, and 10 normal weight women controls were enrolled in this cross-sectional study, performed in endocrinology unit and academic laboratory. Twelve-point circadian profiles of plasma IL-7 levels were measured in each subject. Results 24h mean IL-7 plasma levels (pg/ml, mean±SEM) were decreased in restrictive-type anorexia nervosa (123.4±14.4, p<0.0037), bingeing/purging anorexia nervosa (24.2±5.6, p<0.001), recovered restrictive anorexia nervosa (64.2±16.1, p = 0.01) and healthy obese patients (51±3.2, p<0.001) compared to controls (187.7±28.6). Bulimic patients (197.4±42.7) and constitutional thinness patients (264.3±35.8) were similar to controls. Conclusions Low IL-7 is part of the adaptive profile in restrictive-type anorexia nervosa, confirming its difference with constitutional thinness. Healthy obesity, with low IL-7, is once again in mirror image of constitutional thinness with normal high IL-7.
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Affiliation(s)
- Natacha Germain
- Division of Endocrinology, Diabetes, Metabolism and Eating Disorders, CHU Saint-Etienne, Saint-Etienne, France
- TAPE (Eating Disorders, Addictions & Extreme Bodyweight) Research Group EA 7423, Saint-Etienne, France
- * E-mail:
| | - Odile Viltart
- Univ. Lille, INSERM, CHU Lille, UMR-S 1172 - JPArc - Jean-Pierre AUBERT Research Center, Neurosciences and Cancer, F-59000, Lille, France
| | - Anne Loyens
- Univ. Lille, INSERM, CHU Lille, UMR-S 1172 - JPArc - Jean-Pierre AUBERT Research Center, Neurosciences and Cancer, F-59000, Lille, France
| | - Céline Bruchet
- Division of Endocrinology, Diabetes, Metabolism and Eating Disorders, CHU Saint-Etienne, Saint-Etienne, France
- TAPE (Eating Disorders, Addictions & Extreme Bodyweight) Research Group EA 7423, Saint-Etienne, France
| | - Katia Nadin
- Division of Endocrinology, Diabetes, Metabolism and Eating Disorders, CHU Saint-Etienne, Saint-Etienne, France
- TAPE (Eating Disorders, Addictions & Extreme Bodyweight) Research Group EA 7423, Saint-Etienne, France
| | - Isabelle Wolowczuk
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019 - UMR8204 - CIIL - Center for Infection and Immunity of Lille, F-59000, Lille, France
| | - Bruno Estour
- Division of Endocrinology, Diabetes, Metabolism and Eating Disorders, CHU Saint-Etienne, Saint-Etienne, France
- TAPE (Eating Disorders, Addictions & Extreme Bodyweight) Research Group EA 7423, Saint-Etienne, France
| | - Bogdan Galusca
- Division of Endocrinology, Diabetes, Metabolism and Eating Disorders, CHU Saint-Etienne, Saint-Etienne, France
- TAPE (Eating Disorders, Addictions & Extreme Bodyweight) Research Group EA 7423, Saint-Etienne, France
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18
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The Intestinal Microbiota in Acute Anorexia Nervosa and During Renourishment: Relationship to Depression, Anxiety, and Eating Disorder Psychopathology. Psychosom Med 2015; 77:969-81. [PMID: 26428446 PMCID: PMC4643361 DOI: 10.1097/psy.0000000000000247] [Citation(s) in RCA: 194] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The relevance of the microbe-gut-brain axis to psychopathology is of interest in anorexia nervosa (AN), as the intestinal microbiota plays a critical role in metabolic function and weight regulation. METHODS We characterized the composition and diversity of the intestinal microbiota in AN, using stool samples collected at inpatient admission (T1; n = 16) and discharge (T2; n = 10). At T1, participants completed the Beck Depression and Anxiety Inventories and the Eating Disorder Examination-Questionnaire. Patients with AN were compared with healthy individuals who participated in a previous study (healthy comparison group; HCG). Genomic DNA was isolated from stool samples, and bacterial composition was characterized by 454 pyrosequencing of the 16S rRNA gene. Sequencing results were processed by the Quantitative Insights Into Microbial Ecology pipeline. We compared T1 versus T2 samples, samples from both points were compared with HCG (n = 12), and associations between psychopathology and T1 samples were explored. RESULTS In patients with AN, significant changes emerged between T1 and T2 in taxa abundance and beta (between-sample) diversity. Patients with AN had significantly lower alpha (within-sample) diversity than did HCG at both T1 (p = .0001) and T2 (p = .016), and differences in taxa abundance were found between AN patients and HCG. Levels of depression, anxiety, and eating disorder psychopathology at T1 were associated with composition and diversity of the intestinal microbiota. CONCLUSIONS We provide evidence of an intestinal dysbiosis in AN and an association between mood and the enteric microbiota in this patient population. Future directions include mechanistic investigations of the microbe-gut-brain axis in animal models and association of microbial measures with metabolic changes and recovery indices.
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19
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Nova E, Marcos A. Immunocompetence to assess nutritional status in eating disorders. Expert Rev Clin Immunol 2014; 2:433-44. [DOI: 10.1586/1744666x.2.3.433] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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20
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Assessment of gene expression in peripheral blood using RNAseq before and after weight restoration in anorexia nervosa. Psychiatry Res 2013; 210:287-93. [PMID: 23778302 PMCID: PMC3805820 DOI: 10.1016/j.psychres.2013.05.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Revised: 05/06/2013] [Accepted: 05/20/2013] [Indexed: 12/30/2022]
Abstract
We examined gene expression in the blood of six females with anorexia nervosa (AN) before and after weight restoration using RNAseq. AN cases (aged 19-39) completed clinical assessments and had blood drawn for RNA at hospital admission (T1,<~75% ideal body weight, IBW) and again at discharge (T2,≥ ~ 85% IBW). To examine the relationship between weight restoration and differential gene expression, normalized gene expression levels were analyzed using a paired design. We found 564 genes whose expression was nominally significantly different following weight restoration (p<0.01, 231 increased and 333 decreased). With a more stringent significance threshold (false discovery rate q<0.05), 67 genes met criteria for differential expression. Of the top 20 genes, CYP11A1, C16orf11, LINC00235, and CPA3 were down-regulated more than two-fold after weight restoration while multiple olfactory receptor genes (OR52J3, OR51L1, OR51A4, and OR51A2) were up-regulated more than two-fold after weight restoration. Pathway analysis revealed up-regulation of two broad pathways with largely overlapping genes, one related to protein secretion and signaling and the other associated with defense response to bacterial regulation. Although results are preliminary secondary to a small sample size, these data provide initial evidence of transcriptional alterations during weight restoration in AN.
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21
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Inflammatory activation and cholinergic anti-inflammatory system in eating disorders. Brain Behav Immun 2013; 32:33-9. [PMID: 23624297 DOI: 10.1016/j.bbi.2013.04.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Revised: 04/08/2013] [Accepted: 04/10/2013] [Indexed: 11/21/2022] Open
Abstract
Dysfunctional serotoninergic regulation and hypothalamic-pituitary-adrenal (HPA) axis overreactivity have been consistently reported in research studies with eating disorders (ED). In addition, the links between stress response, serotonin function, HPA axis and inflammatory mechanisms in ED have also been suggested in a number of studies. In our study, inflammatory parameters in white blood cells were investigated in 26 female patients with ED and 25 healthy control subjects matched for sex, age and ethnicity. Patients were free of medication for at least two weeks at the time of the study. Results showed a significant increase in plasma levels of the proinflammatory cytokine IL1β and the protein expression of cyclooxygenase 2 (COX2) in peripheral mononuclear blood cells (PMBCs) in ED patients compared with controls. As well as a significant increase of the oxidative-nitrosative marker TBARS (Thiobarbituric Acid Reactive Substances) in plasma. These findings were associated with increased expression of the alpha7 subunit of the nicotinic receptor (α7nAChR) in PMBC in ED patients independent of plasma cotinine levels. These results suggest that a pro-inflammatory and oxidant phenotype might be present in ED patients. Further research on cellular inflammatory and anti-inflammatory pathways might be oriented to investigate differences between ED subtypes and to search for new potential targets for pharmacological treatment.
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Agnello E, Malfi G, Costantino AM, Massarenti P, Pugliese M, Fortunati N, Catalano MG, Palmo A. Tumour necrosis factor alpha and oxidative stress as maintaining factors in the evolution of anorexia nervosa. Eat Weight Disord 2012; 17:e194-9. [PMID: 23086255 DOI: 10.1007/bf03325347] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Aim of the study was to evaluate tumour necrosis factor α (TNF-α) axis and oxidative status in patients with anorexia nervosa (AN) seeking a possible correlation with both nutritional status and evolution of the disease. SUBJECTS AND METHODS Thirty-nine consecutive women with AN and an age-matched healthy control group were studied. Patients were 26±9 yr, with a body mass index (BMI) of 13.9±2 kg/m(2). TNF-α, its receptors TNF-R55 and TNF-R75, and oxidative status markers (selenium, ascorbic/ dehydroascorbic acid, retinol, α-tocopherol, selenium-dependent gluthatione peroxidase, reduced/oxidated gluthatione) were measured. A correlation with both nutritional indexes (body weight, BMI, albumin, prealbumin, transferrin, lymphocyte count) and disease duration was investigated. Pearson's correlation and unpaired Student's t-test were used to compare patients and controls. RESULTS TNF-α and oxidative status markers were significantly higher in patients than controls and TNF-α was directly related to dehydroascorbic acid (p<0.05). Both TNF-R55 and TNF-R75 were higher in patients with duration of disease longer than one year as compared to controls and patients with shorter duration. Receptors inversely correlated with BMI (p<0.05 and p<0.01) and directly with disease duration (p<0.05). Inverse correlation between disease duration and BMI was present (p<0.01). CONCLUSIONS The study showed activation of TNF-α axis and oxidative stress in AN patients, as well as correlation between the two systems. Due to the correlation between TNF receptors and both BMI and disease duration, a possible role of pro-inflammatory cytokines in the evolution of the eating disorder is suggested.
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Affiliation(s)
- E Agnello
- Dietetics and Clinical Nutrition Unit, A.O.U. San Giovanni Battista of Turin, Turin, Italy.
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Nogueira JP, Maraninchi M, Lorec AM, Corroller ABL, Nicolay A, Gaudart J, Portugal H, Barone R, Vialettes B, Valéro R. Specific adipocytokines profiles in patients with hyperactive and/or binge/purge form of anorexia nervosa. Eur J Clin Nutr 2010; 64:840-4. [DOI: 10.1038/ejcn.2010.66] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Abstract
OBJECTIVE Changes of the peripheral blood cell count in patients with anorexia nervosa (AN) are frequent. Anemia and leukopenia are observed in one-third of these patients. Examination of the bone marrow reveals in almost 50% of the patients with AN signs of bone marrow atrophy and can additionally suffer from a gelatinous bone marrow transformation. METHOD Published studies and investigations concerning hematological changes in patients with AN were reviewed. RESULTS Anemia and mild neutropenia are detectable in almost one-third of these patients, whereas thrombocytopenia is rather uncommon. The exact mechanism for these findings is still unclear, but 50% of AN-patients with hematological changes display morphological signs of partial bone marrow atrophy. DISCUSSION Changes of the peripheral blood cell count in patients with AN is a frequent observation but the peripheral blood cell count cannot predict the severity of bone marrow atrophy. All hematological and morphological alterations disappear completely and rapidly after sufficient refeeding.
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Affiliation(s)
- Gero Hütter
- Department of Internal Medicine III Hematology, Oncology, and Transfusion Medicine, Charité Campus Benjamin Franklin, Berlin, Germany.
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Brown RF, Bartrop R, Birmingham CL. Immunological disturbance and infectious disease in anorexia nervosa: a review. Acta Neuropsychiatr 2008; 20:117-28. [PMID: 26951035 DOI: 10.1111/j.1601-5215.2008.00286.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Severely malnourished patients with anorexia nervosa (AN) are reported to show fewer symptomatic viral infections and a poorer response to bacterial infection than controls. They are also reported to show mild immune system changes, although the relevance of these to altered infection disease presentation in AN and AN pathophysiology is unknown. Thus, in this paper, we suggest a range of immune system changes that might underpin these altered responses to common pathogens, and review a number of recent infectious disease findings for their utility in explaining the pathophysiology of AN. METHODS A systematic review of the literature pertaining to immunity and infectious disease in AN was performed. RESULTS AN is associated with leucopenia, and the increased spontaneous and stimulated levels of proinflammatory cytokines [i.e. interleukin (IL)-1β, IL-6 and tumour necrosis factor α). A range of less consistent findings are also reviewed. Most of these data were not controlled for length of illness, degree of malnutrition, micronutrient or vitamin deficiencies or recent refeeding and starvation. CONCLUSION Cytokine disturbances have been suggested to be causally related to AN symptomatology and pathophysiology of AN, although the evidence supporting this assertion is lacking. Immune and cytokine changes in AN do, however, occur in association with a decreased incidence of symptomatic viral infection, decreased clinical response to bacterial infection leading to delayed diagnosis and increased morbidity and mortality associated with the infections.
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Affiliation(s)
- Rhonda F Brown
- 1School of Behavioural, Cognitive and Social Sciences, University of New England, Armidale, New South Wales, Australia
| | - Roger Bartrop
- 2Department of Psychological Medicine, Royal North Shore Hospital, University of Sydney, New South Wales, Australia
| | - C Laird Birmingham
- 3Eating Disorders Program, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
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Abstract
The immunomodulatory properties of lactic acid bacteria (LAB) and foods containing them (e.g., fermented milks) is a topic currently under investigation. Individuals could potentially benefit from the inclusion of LAB in the diet at different times during the life cycle. One of the most accepted specific uses of probiotic bacteria is the prevention of atopic eczema in infants with family history of the disease who receive the probiotic bacteria early, through supplementation of the gestating mother and orally after birth. Immune enhancing effects have also been suggested to be beneficial in diarrhoea treatment, especially in children infected with rotavirus and in malnourished patients, infants and adolescents, whose capacity to produce IFN-gamma can be increased after LAB-containing yoghurt intake. Regarding young people and adults, investigations have been conducted exploring the immunomodulation by LAB in subjects under stressful situations, in the prevention of urinary tract infections in fertile women and in the treatment of allergy. However, the beneficial effects of probiotics in these conditions remain controversial and the scientific evidence provided so far is not considered to be conclusive. The elderly population has been the focus of investigations aimed at identifying the capacity of probiotics to counteract the immunosenescence process by increasing phagocytic and natural killer (NK) cell activities and to protect against infection. The mechanisms involved in the different effects attributed to LAB remain to be clarified. Moreover, considering that the immunomodulatory properties are strain-specific, defining the optimal dose of a certain bacteria or combination of bacteria strains and the duration of treatment for a desired effect in a target population group is essential in order to substantiate health claims.
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Pászthy B, Svec P, Vásárhelyi B, Túry F, Mazzag J, Tulassay T, Treszl A. Investigation of regulatory T cells in anorexia nervosa. Eur J Clin Nutr 2007; 61:1245-9. [PMID: 17299482 DOI: 10.1038/sj.ejcn.1602651] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The aim of our study was to determine, how severe calorie restriction in anorexia nervosa (AN) may influence regulatory T (Treg) cells and their cellular networks, that is, their main inducers (dendritic cells (DC) and monocytes) and their target cells, CD4+ lymphocytes. DESIGN We measured the prevalence of Tregs, myeloid and plasmocytoid DC. The prevalence of tumor necrosis factor-alpha (TNF-alpha) and interleukin (IL)-12-positive monocytes, IL-2, IL-4 and interferon (IFN)-gamma positive CD4+ cells was determined by intracellular staining after activation. SETTING AND SUBJECTS In total, 21 AN patients and 19 healthy age-matched controls (body mass index values, median (range): 14.9 (11.1-17.4) vs 23.2 (19.5-27.4) kg/m(2)) have been recruited. RESULTS Prevalence of Tregs, DCs, TNF-alpha and IL-12-positive monocytes, IL-4 and IFN-gamma-producing CD4+ cells were similar in AN and controls. The prevalence of IL-2-positive CD4+ cells was somewhat lower in AN (% value, median (range): 12.05 (7.50-16.70) vs 14.40 (12.00-22.00), P<0.05). None of these parameters correlated with the patients' clinical characteristics. CONCLUSIONS Our results suggest that the antigen presenting cell - regulatory T cell - CD4+ lymphocyte axis is not affected by calorie and nutritional deficiency.
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Affiliation(s)
- B Pászthy
- Department of Pediatrics, Semmelweis University, Budapest, Hungary
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Dostalova I, Kunesova M, Duskova J, Papezova H, Nedvidkova J. Adipose tissue resistin levels in patients with anorexia nervosa. Nutrition 2006; 22:977-83. [PMID: 16889937 DOI: 10.1016/j.nut.2006.06.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2006] [Revised: 05/25/2006] [Accepted: 06/07/2006] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Resistin is a specific fat-derived hormone that affects fuel homeostasis and insulin action in rodents. However, its role in human physiology and pathophysiologic conditions, such as malnutrition, remains uncertain. METHODS To enhance understanding of the role of resistin in the pathophysiology of anorexia nervosa (AN), we measured plasma resistin levels in 13 women with a restrictive type of AN and in 16 healthy age-matched women (control). Further, we measured resistin levels in the subcutaneous adipose tissue of eight women from the AN group and eight women from the control group with an in vivo microdialysis technique (CMA/107 pump, CMA/60 catheters, CMA Microdialysis AB, Solna, Sweden). RESULTS Body mass index, percentage of body fat, fasting plasma leptin and insulin, and homeostasis model assessment index for insulin resistance were severely decreased in patients with AN compared with the control group. Plasma resistin levels were significantly decreased in patients with AN (P < 0.05), whereas subcutaneous adipose tissue resistin levels were significantly increased in patients with AN compared with the control group (P < 0.05). In both groups, plasma resistin levels showed no significant relation to resistin in dialysate, percentage of body fat, body mass index, homeostasis model assessment index for insulin resistance, and fasting plasma leptin levels. CONCLUSION We demonstrated that AN is associated with decreased plasma resistin levels and increased resistin levels in extracellular space of the abdominal adipose tissue. Plasma resistin levels in patients with AN or in healthy normal-weight women were not directly related to body mass index, percentage of body fat, plasma leptin levels, and insulin sensitivity.
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Affiliation(s)
- Ivana Dostalova
- Institute of Endocrinology, Laboratory of Clinical and Experimental Neuroendocrinology, Prague, Czech Republic.
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Nova E, Toro O, Varela P, López-Vidriero I, Morandé G, Marcos A. Effects of a nutritional intervention with yogurt on lymphocyte subsets and cytokine production capacity in anorexia nervosa patients. Eur J Nutr 2006; 45:225-33. [PMID: 16525751 DOI: 10.1007/s00394-006-0589-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2005] [Accepted: 12/01/2005] [Indexed: 11/28/2022]
Abstract
BACKGROUND The benefits of probiotic therapy in immunocompromised subjects still need strong scientific evidences. AIM OF THE STUDY To assess the effects of yogurt on certain immunological parameters in anorexia nervosa (AN) patients during refeeding. METHODS A parallel 10-week nutritional intervention with yogurt was conducted on a group of patients with AN and on a group of healthy adolescents (HA). In total, 16 AN patients and 16 HA consumed 375 g/d of yogurt containing L. bulgaricus and S. thermophilus (groups AN-y and HA-y, respectively). The control groups for AN patients (n = 14) and healthy subjects (n = 19) consumed 400 ml/d of semi-skimmed milk (groups AN-c and HA-c, respectively). Blood lymphocyte subsets were assessed by flow cytometry and the in vitro production of IL-2, IFN-gamma, IL-1, IL-6 and TNF-alpha by PHA-stimulated PBMC was measured by ELISA. RESULTS A significant combined effect of time and nutritional intervention was found for the CD8+ subset and IFN-gamma production, both in HA and AN patients. The CD8+ subset showed a significant increase after 10 weeks in HA-c and AN-c. As a consequence, the CD4+/CD8+ ratio was significantly lower in AN-c than in AN-y after treatment. A significant increase in IFN-gamma production was found after yogurt intake in AN-y, while it decreased significantly in AN-c. CONCLUSION The findings suggest that the inclusion of yogurt in the refeeding therapy of AN patients may exert positive effects on the immunological markers related to the nutritional status of these patients, such as the CD4+/CD8+ ratio and the production of IFN-gamma by lymphocytes.
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Affiliation(s)
- Esther Nova
- Dept. of Metabolism and Nutrition, Instituto del Frío (CSIC), C/Jose Antonio Novais, 10, 28040 Madrid, Spain.
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Slopien A, Rybakowski F, Dmitrzak-Weglarz M, Czerski P, Hauser J, Komorowska-Pietrzykowska R, Rajewski A. TNF-α and intPLA2 genes' polymorphism in anorexia nervosa. Acta Neuropsychiatr 2004; 16:290-4. [PMID: 26984541 DOI: 10.1111/j.0924-2708.2004.00104.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was the assessment of -308G/A tumor necrosis factor (TNF)-α gene polymorphism and intPLA2 gene polymorphism in patients with anorexia nervosa (AN) and healthy controls. SUBJECTS We studied 91 non-related patients with AN and 144 healthy women (blood donors and students). The mean age of women from study group was 18.22 years (SD ± 3.13 years) and from control group was 31.71 years (SD ± 8.22). METHODS Gene polymorphisms were studied with the use of polymerase chain reaction-restriction fragment length polymorphism method. TNF-α gene polymorphism consists of G/A substitution in -308 promoter region. IntPLA2 gene polymorphism is related to intron 1, in which restrictive region is found and recognized by BanI enzyme. RESULTS We did not obtain statistically significant differences in the frequency of genotypes and alleles of -308G/A TNF-α polymorphism between the study and control groups (genotypes: P = 0.106, alleles: P = 0.076). We did analogous analysis in the restrictive and bulimic subgroups. We did not observe statistically relevant differences in the frequency of genotypes (P = 0.700) and alleles (P = 0.305). We did not obtain statistically relevant difference in the frequency of genotypes and alleles of intPLA2 gene between the study group and controls (genotypes: P = 0.300, alleles: P = 0.331). We did analogous analysis in both subgroups of AN. We did not observe statistically relevant differences in the frequency of genotypes (P = 0.344) and alleles (P = 0.230). CONCLUSIONS There was no statistically relevant trend for the association between TNF-α polymorphism and AN. We did not find association between studied polymorphism of intPLA2 gene and risk of AN.
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Affiliation(s)
- Agnieszka Slopien
- 1Department of Child and Adolescent Psychiatry, University of Medical Sciences, Poznañ, Poland
| | - Filip Rybakowski
- 1Department of Child and Adolescent Psychiatry, University of Medical Sciences, Poznañ, Poland
| | - Monika Dmitrzak-Weglarz
- 1Department of Child and Adolescent Psychiatry, University of Medical Sciences, Poznañ, Poland
| | - Piotr Czerski
- 2Department of Adult Psychiatry, University of Medical Sciences, Poznañ, Poland
| | - Joanna Hauser
- 2Department of Adult Psychiatry, University of Medical Sciences, Poznañ, Poland
| | | | - Andrzej Rajewski
- 1Department of Child and Adolescent Psychiatry, University of Medical Sciences, Poznañ, Poland
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Vaisman N, Hahn T, Karov Y, Sigler E, Barak Y, Barak V. Changes in cytokine production and impaired hematopoiesis in patients with anorexia nervosa: the effect of refeeding. Cytokine 2004; 26:255-61. [PMID: 15183843 DOI: 10.1016/j.cyto.2004.03.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2003] [Revised: 02/26/2004] [Accepted: 03/16/2004] [Indexed: 11/20/2022]
Abstract
The changes in cytokines and hormones involved in hematopoiesis were studied in the serum of 7 girls with anorexia nervosa, 15-24 yr old, on admission and after 5% and 10% weight gain. Hematopoiesis was studied by in-vitro culturing of circulating granulocyte-macrophage colony forming cells and erythroid burst forming cells. Nutritional status was studied by anthropometric measurements and resting energy expenditure. On admission, granulocyte-macrophage colony forming cells and erythroid burst forming cells were significantly lower than in age-matched controls and increased significantly along weight gain. Blood leptin and erythropoietin levels increased significantly with weight gain. TNF-alpha levels tended to decrease while IL-1beta levels were lower than in the controls on admission (p <0.05) and did not change significantly during weight gain. IL-3, GM-CSF and IL-6 were undetected on admission or along weight gain. The changes in granulocyte-macrophage colony forming cells and erythroid burst forming cells positively correlated with changes in resting energy expenditure and fat free mass. These results may suggest that undernutrition affects hematopoiesis as indicated by the reduction of hematopoietic progenitor cells before treatment and the significant increase with weight gain. The changes in the levels of hormones and cytokines known to be involved in hematopoiesis along refeeding may suggest a role for these factors in anorexia nervosa.
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Affiliation(s)
- Nachum Vaisman
- Clinical Nutrition Unit, Sourasky Tel Aviv Medical Center, 6 Weizmann Street, Tel-Aviv 64239, Israel.
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Marcos A, Nova E, Montero A. Changes in the immune system are conditioned by nutrition. Eur J Clin Nutr 2003; 57 Suppl 1:S66-9. [PMID: 12947457 DOI: 10.1038/sj.ejcn.1601819] [Citation(s) in RCA: 130] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Undernutrition due to insufficient intake of energy and macronutrients and/or due to deficiencies in specific micronutrients impairs the immune system, suppressing immune functions that are fundamental to host protection. The most consistent abnormalities are seen in cell-mediated immunity, complement system, phagocyte function, cytokine production, mucosal secretory antibody response, and antibody affinity. There is a number of physiological situations such as ageing and performance of intense physical exercise associated with an impairment of some immune parameters' response. Nutrition can influence the extent of immune alteration in both of them. There are also numerous pathological situations in which nutrition plays a role as a primary or secondary determinant of some underlying immunological impairments. This includes obesity, eating disorders (anorexia nervosa and bulimia nervosa), food hypersensitivity and gastrointestinal disorders as some examples. The implications of nutrition on immune function in these disorders are briefly reviewed.
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Affiliation(s)
- A Marcos
- Grupo de Inmunonutrición, Departamento de Metabolismo y Nutrición, Instituto del Frio (CSIC), Madrid, Spain.
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Scacchi M, Pincelli AI, Cavagnini F. Nutritional status in the neuroendocrine control of growth hormone secretion: the model of anorexia nervosa. Front Neuroendocrinol 2003; 24:200-24. [PMID: 14596812 DOI: 10.1016/s0091-3022(03)00014-1] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Growth hormone (GH) plays a key role not only in the promotion of linear growth but also in the regulation of intermediary metabolism, body composition, and energy expenditure. On the whole, the hormone appears to direct fuel metabolism towards the preferential oxidation of lipids instead of glucose and proteins, and to convey the energy derived from metabolic processes towards the synthesis of proteins. On the other hand, body energy stores and circulating energetic substrates take an important part in the regulation of somatotropin release. Finally, central and peripheral peptides participating in the control of food intake and energy expenditure (neuropeptide Y, leptin, and ghrelin) are also involved in the regulation of GH secretion. Altogether, nutritional status has to be regarded as a major determinant in the regulation of the somatotropin-somatomedin axis in animals and humans. In these latter, overweight is associated with marked impairment of spontaneous and stimulated GH release, while acute dietary restriction and chronic undernutrition induce an amplification of spontaneous secretion together with a clear-cut decrease in insulin-like growth factor I (IGF-I) plasma levels. Thus, over- and undernutrition represent two conditions connoted by GH hypersensitivity and GH resistance, respectively. Anorexia nervosa (AN) is a psychiatric disorder characterized by peculiar changes of the GH-IGF-I axis. In these patients, low circulating IGF-I levels are associated with enhanced GH production rate, highly disordered mode of somatotropin release, and variability of GH responsiveness to different pharmacological challenges. These abnormalities are likely due not only to the lack of negative IGF-I feedback, but also to a primary hypothalamic alteration with increased frequency of growth hormone releasing hormone discharges and decreased somatostatinergic tone. Given the reversal of the above alterations following weight recovery, these abnormalities can be seen as secondary, and possibly adaptive, to nutritional deprivation. The model of AN may provide important insights into the pathophysiology of GH secretion, in particular as regards the mechanisms whereby nutritional status effects its regulation.
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Affiliation(s)
- Massimo Scacchi
- Chair of Endocrinology, University of Milan, Ospedale San Luca IRCCS, Istituto Auxologico Italiano, Milan, Italy
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