Dynamics of stress-related decrease of salivary immunoglobulin A (sIgA): relationship to symptoms of the common cold and studying behavior

Salivary IgA as a Potential Biomarker in the Evaluation of Respiratory Tract Infection Risk in Athletes

In recent years, there has been attention focused on the value of salivary IgA (sIgA) as a potential biomarker for the identification of athletes who may be at increased risk of developing respiratory tract infection (RTI). The utility of sIgA, in this context, is based on biological plausibility and several observational studies revealing an apparent association between sIgA and RTI susceptibility. The overall published evidence evaluating the value of sIgA in this context is however conflicting, and there is currently a lack of clear guidance as to whether this marker has a place in the health surveillance and care of athletes. In this review, we critically appraise the literature assessing the potential for sIgA to be used in this context, evaluating it against 4 key biomarker characteristics, including its (1) practicality, (2) reproducibility, (3) specificity/sensitivity, and (4) potential clinical impact and relevance. This process reveals that although there is an apparent association between respiratory illness and sIgA in many studies, with some promising results, overall there remains a paucity of evidence supporting its overall value in this context. Key deficiencies in the metrics employed to endorse a valid biomarker are apparent, including a lack of reproducibility and low specificity and sensitivity in the detection of RTI susceptibility. The review outlines these issues and makes future recommendations.

Feasibility and acceptability of intensive, real-time biobehavioral data collection using ecological momentary assessment, salivary biomarkers, and accelerometers among middle-aged African Americans

Perceived racial discrimination is linked to unhealthy behaviors and stress-related morbidities. A compelling body of research indicates that perceived racial discrimination may contribute to health disparities among African Americans (AAs). The purposes of this study were to describe the study protocol including data collection procedures and study measures and to evaluate the feasibility and acceptability of intensive biobehavioral data collection using ecological momentary assessment (EMA), salivary biomarkers, and accelerometers over 7 days among middle-aged AAs with a goal of understanding the relationships between perceived racial discrimination and biobehavioral responses to stress. Twelve AA men and women participated in the feasibility/acceptability study. They completed surveys, anthropometrics, and received in-person training in EMA and saliva sample collection at baseline. Participants were asked to respond to the random prompt text message-based EMA five times a day, wear an accelerometer daily for 7 days, and to self-collect saliva samples four times a day for 4 consecutive days. The EMA surveys included perceived racial discrimination, affective states, lifestyle behaviors, and social and physical contexts. The mean EMA response rate was 82.8%. All participants collected saliva samples four times a day for 4 consecutive days. About 83% of participants wore the accelerometer on the hip 6 out of 7 days. Despite the perception that the intensive nature of assessments would result in high participant burden, the acceptability of the study procedures was uniformly favorable.

Salivary secretory immunoglobulin A variation between female varsity athletes and nonathletes

OBJECTIVES

Exercise can lead to changes in immune function. To further investigate this relationship, we examined possible differences in salivary secretory immunoglobulin A (sIgA) secretion rates among female college athletes and nonathlete students. We predicted that athletes would have higher sIgA secretion rates than nonathletes and show greater declines in sIgA during the study period as intensive exercise training continued.

METHODS

We recruited 52 female participants aged 18-22 years (13 swimmers, 20 runners, and 19 nonathletes). We collected two saliva samples from each participant: baseline and a second sample 2 weeks later. Additionally, participants reported minutes of cardiovascular activity performed per week and completed a survey that included a modified Profile of Mood States and the Undergraduate Stress Questionnaire.

RESULTS

We found no significant differences in mean salivary sIgA secretion rates between athletes and nonathletes. Salivary sIgA significantly increased between sample collections for both groups, with nonathletes exhibiting a greater increase in sIgA than athletes. Cardiovascular activity was not associated with sIgA secretion rates. Illness status was a significant positive predictor of sIgA secretion rates.

CONCLUSIONS

Cardiovascular activity did not predict salivary sIgA secretion rates in this sample of female college students, and athletes did not show significantly different sIgA secretion rates than nonathletes. Together, these findings suggest that exercise may not be associated with altered immune function in well-nourished college-aged women. The increase in secretion rates among both athletes and nonathletes suggests that additional factors shared by both groups may have led to increases.

The development of an immunoassay to measure immunoglobulin A in Asian elephant feces, saliva, urine and serum as a potential biomarker of well-being

Additional measures of well-being would be beneficial to the management of a variety of species in human care, including elephants. Immunoglobulin A (IgA) is an immune protein associated with pathogen defense, which has been demonstrated to decrease during times of stress, and increase in response to positive stimuli. This paper describes the development and validation of an enzyme immunoassay (EIA) for the quantification of Asian elephant (Elephas maximus) IgA in feces, saliva, urine, and serum. Samples were collected weekly from four females for 6 months to assess IgA and glucocorticoid (GC) concentrations, establish relationships between these two biomarkers, and determine variability in IgA within and between individuals, and across sample types. IgA was quantified in all four sample types, although urinary concentrations were low and sometimes undetectable in individual samples. Concentrations were highly variable within and between individuals, with fecal, salivary and serum IgA, and fecal, salivary and urinary GCs all differing significantly across individuals. Contrary to previous findings, IgA and GC were generally not correlated. Serum IgA was less variable within individuals, with the exception of one female that experienced a brief illness during the study. However, marked inter-individual differences were still apparent. When data from all individuals were combined, fecal IgA was significantly predicted by salivary and urinary IgA; however, this relationship did not hold when individuals were analyzed separately. Analysis of a fifth female that exhibited a more severe systemic illness demonstrated clear increases in fecal IgA and GC, suggesting these may also be useful health biomarkers. Further investigation is needed to determine what sample type is most reflective of biological state in elephants, and how IgA concentrations are associated with health and positive and negative welfare states. Based on observed variability, a longitudinal approach likely will be necessary to use IgA as a measure of well-being.

Maternal immune and affiliative biomarkers and sensitive parenting mediate the effects of chronic early trauma on child anxiety

BACKGROUND

Chronic early trauma alters children's stress reactivity and increases the prevalence of anxiety disorders; yet the neuroendocrine and immune mechanisms underpinning this effect are not fully clear. Animal studies indicate that the mother's physiology and behavior mediate offspring stress in a system-specific manner, but few studies tested this external-regulatory maternal role in human children exposed to chronic stress.

METHODS

We followed a unique cohort of children exposed to continuous wartime trauma (N = 177; exposed; N = 101, controls; N = 76). At 10 years, maternal and child's salivary immunoglobulin A (s-IgA) and oxytocin (OT), biomarkers of the immune and affiliation systems, were assayed, maternal and child relational behaviors observed, mother and child underwent psychiatric diagnosis, and child anxiety symptoms assessed.

RESULTS

War-exposed mothers had higher s-IgA, lower OT, more anxiety symptoms, and their parenting was characterized by reduced sensitivity. Exposed children showed higher s-IgA, more anxiety disorders and post traumatic stress disorder, and more anxiety symptoms. Path analysis model defined three pathways by which maternal physiology and behavior impacted child anxiety; (a) increasing maternal s-IgA, which led to increased child s-IgA, augmenting child anxiety; (b) reducing maternal OT, which linked with diminished child OT and social repertoire; and (c) increasing maternal anxiety, which directly impacted child anxiety.

CONCLUSIONS

Our findings, the first to measure immune and affiliation biomarkers in mothers and children, detail their unique and joint effects on children's anxiety in response to stress; highlight the relations between chronic stress, immune activation, and anxiety in children; and describe how processes of biobehavioral synchrony shape children's long-term adaptation.

Exhaled nitric oxide and vascular endothelial growth factor as predictors of cold symptoms after stress

OBJECTIVE

Prior research has demonstrated that psychosocial stress is associated with respiratory infections. Immunologic, endocrine, and cardiovascular predictors of such infections have been explored with varying success. We therefore sought to study the unexplored role of airway mucosal immunity factors, nitric oxide (NO) and vascular endothelial growth factor (VEGF). NO is secreted by airway epithelial cells as part of the first line of defense against bacteria, viruses, and fungi. VEGF is expressed by mast cells in respiratory infections and recruits immune cells to infected sites, but in excess lead to vulnerability of the airway epithelium.

METHODS

In this proof-of-concept study we measured exhaled NO, exhaled breath condensate (EBC) VEGF, salivary VEGF, and salivary cortisol in 36 students undergoing final academic examinations at three occasions: a low-stress baseline during the term, an early phase of finals, and a late phase of finals. Participants also reported on cold symptoms at these time points and approximately 5 and 10days after their last academic examination.

RESULTS

Higher baseline NO was associated with fewer cold symptoms after stress, whereas higher baseline VEGF in EBC and saliva were associated with more cold symptoms after stress. Perceived stress at baseline as well as salivary VEGF and cortisol late in the finals also contributed to the prediction of later cold symptoms.

CONCLUSION

Basal levels of NO and VEGF may inform about mucosal immunocompetence and add to preventative treatments against airway infections from periods of stress in daily life.

Sleep, biological stress, and health among toddlers living in socioeconomically disadvantaged homes: A research protocol

Healthy sleep is important to behavioral, neurobiological, and physiologic health. In older children and adults, stress biomarkers, such as cortisol and C-reactive protein, increase when they do not practice healthy sleep habits. However, little is known about the relationships among sleep health, stress, and health outcomes among very young children living with socioeconomic adversity, a group that is particularly at risk for poor future health. The NIH-funded study described in this protocol addresses this scientific gap to improve understanding of these relationships during a critical developmental period in children's lives-toddlerhood. We will use a longitudinal design with repeated measures to prospectively examine the relationships among sleep health, stress, and toddlers' health from age 12 to 24 months, to address the following aims: i) examine changes in subjective and objective sleep health measures; ii) examine changes in stress biomarkers; iii) examine the cross-sectional and longitudinal relationships between sleep health measures and stress response; and iv) examine the cross-sectional and longitudinal relationships between sleep health measures, stress biomarkers, and toddlers' behavioral health. The sample will include 113 toddlers and their caregivers. We are collecting subjective and objective data on sleep health, multi-systemic biomarkers of stress, and toddlers' behavioral health. Generalized linear models will be used in the data analyses. Results from this study will be used to support development and testing of interventions, such as those that may improve sleep, among young children at risk for toxic stress.

Does waterfall aerosol influence mucosal immunity and chronic stress? A randomized controlled clinical trial

BACKGROUND

The specific microclimate of alpine waterfalls with high levels of ionized water aerosols has been suggested to trigger beneficial immunological and psychological effects. In the present three-armed randomized controlled clinical study, we focused on effects on (i) immunological reagibility, on (ii) physiological stress responses, and on (iii) stress-related psychological parameters.

METHODS

People with moderate to high stress levels (n = 65) spent an active sojourn with daily hiking tours in the National Park Hohe Tauern (Großkirchheim, Austria). Half of the group was exposed to water aerosol of an alpine waterfall for 1 h/day (first arm, n = 33), whereas the other half spent the same time at a distant site (second arm, n = 32). A third arm (control, n = 26) had no intervention (except vaccination) and stayed at home, maintaining their usual lifestyle. The effect of the interventions on the immune system was tested by oral vaccination with an approved cholera vaccine and measuring specific salivary IgA antibody titers. Lung function was determined by peak expiratory flow measurement. Electric skin conductance, heart rate, and adaption of respiration rate were assessed as physiological stress parameters. Psychological stress-related parameters were analyzed by questionnaires and scales.

RESULTS

Compared to the control group, both intervention groups showed improvement of the lung function and of most physiological stress test parameters. Analysis of the mucosal immune response revealed a waterfall-specific beneficial effect with elevated IgA titers in the waterfall group. In line with these results, exposure to waterfall revealed an additional benefit concerning psychological parameters such as subjective stress perception (measured via visual analog scale), the Global Severity Index (GSI), and the Positive Symptom Total (PST).

CONCLUSIONS

Our study provides new data, which strongly support an "added value" of exposure to waterfall microclimate when combined with a therapeutic sojourn at high altitude including regular physical activity.

Secretory Ig a in Saliva and Academic Stress

Several reports have proposed that the concentration of secretory immunoglobulin A (S-IgA) in saliva is an indicator of psychological stress. With this in mind, we decided to examine it in 10 second year medical student volunteers at Kawasaki Medical School course between May 4 and July 13, 2000 and discussed the relationship between S-IgA and the stress from academic examinations. Saliva was collected three times (on rising, at forenoon, and at bedtime) every Thursday. During this period, sporadic academic examinations were held twice and term-end examinations occurred during the last two weeks. Results showed the concentration of S-IgA significantly higher at the on rising time-point than at the other two time-points. There was also a tendency for the S-IgA level in saliva to be higher on the day before academic examinations and during them and lower on the days between these examinations. In addition, daily variations in the S-IgA concentration sometimes seemed to be disturbed by other academic stress. Therefore, it may be possible to use this measurement to monitor psychological stress in students and workers.

Non-invasive quantification of immunoglobulin A in chimpanzees (Pan troglodytes schweinfurthii) at Gombe National Park, Tanzania

Immunoglobulin A (IgA) is the primary antibody responsible for mucosal defense in mammals and has been used as a marker for chronic stress and immune status. Therefore, this antibody may provide a more reliable indicator of an individual's immunocompetence than is currently available through other methods. Immunoglobulin A has never before been quantified in a wild population of non-human primates using non-invasive sample collection techniques. In this study, we present methodology for non-invasive IgA extraction in the field and provide quantification of mean fecal IgA concentrations in wild chimpanzees (Pan troglodytes schweinfurthii). During the study period (November 2009-October 2010), we collected fecal samples (N = 1463) from 59 individuals at Gombe National Park, Tanzania. We modified a field extraction technique for steroidal hormones to extract IgA from the fecal samples and then quantified mean IgA concentrations (ng/g) using a commercial human IgA enzyme immunoassay. Mean IgA concentration varied among individuals but not by sex or reproductive status. Mature animals tended toward higher mean IgA concentration than immature. Mean IgA concentration differed by quartile season, following a similar pattern previously observed for respiratory illness rates in this population, with the late dry season having significantly higher averages than the late wet. A circadian rhythm was also evident with mean IgA concentrations higher in samples collected in the latter half of the day. These demographic and temporal patterns of IgA concentration provide baseline values necessary to interpret future results, which may be combined with other health values to better understand the role of health and long-term stress in wild great ape populations. Am. J. Primatol. 80:e22558, 2018. © 2016 Wiley Periodicals, Inc.

Alteration of consciousness via diverse photo-acoustic stimulatory patterns. Phenomenology and effect on salivary flow rate, alpha-amylase and total protein levels

Long-term photo-acoustic stimulation is used for the induction of altered states of consciousness for both therapeutic and experimental purposes. Long-term photo-acoustic stimulation also leads to changes in the composition of saliva which have a key contribution to the efficiency of this technique in easing mucosal symptoms of oral psychosomatic patients. The aim of this study is to find out whether there is any cumulative effect of repeated stimulation and whether there are any detectable differences between diverse stimulatory patterns of long lasting photo-acoustic stimulation on the phenomenology of the appearing trance state and on salivary secretion. There was significant cumulative effect in relation with the appearance of day dreaming as phenomenological parameter, and in relation with protein output and amylase/protein ratio as salivary parameter. Pattern specific effect was detectable in relation with salivary flow rate only. Although our results clearly indicate the existence of certain cumulative and stimulation-pattern specific effects of repeated photo-acoustic stimulation, the absolute values of all these effects were relatively small in this study. Therefore, in spite of their theoretical importance there are no direct clinical consequences of these findings. However, our data do not exclude at all the possibility that repeated stimulation with other stimulatory parameters may lead to more pronounced effects. Further studies are needed to make clear conclusion in this respect.

Catecholamine metabolites in urine, as chronic stress biomarkers, are associated with higher risk of chronic periodontitis in adults

BACKGROUND

The purpose of this case-control study is to investigate the association between stress and periodontitis by determining stress biomarkers in saliva and urine and to determine whether oral hygiene, gingival inflammation, and tooth loss are correlated with stress biomarkers in patients with periodontitis.

METHODS

A total of 77 patients (41 cases [with periodontitis] and 36 controls) participated in this study. Periodontal examination findings included probing depth, clinical attachment loss, bleeding on probing (BOP), plaque index (PI), and tooth loss. Secretory immunoglobulin (sIg)A and cortisol were determined in saliva. Cortisol, creatinine-adjusted cortisol, metanephrine, normetanephrine, and total metanephrines were measured in urine.

RESULTS

Urinary metanephrine (P = 0.013) and total metanephrine (P = 0.023) levels were higher in the case group. In cases, salivary cortisol was correlated with PI (r = 0.464, P <0.01), BOP (r = 0.401, P <0.05), and tooth loss (r = 0.245, P <0.05). Urinary metanephrine levels above the median were associated with a 3.4-fold higher risk of periodontitis (95% confidence interval [CI] = 1.1 to 10.2; P = 0.029), with an 82% increase in risk for each increment of 0.05 µg/24 hours. Urinary total metanephrine levels above the median were associated with a five-fold higher risk of periodontitis (95% CI = 1.6 to 15.7; P = 0.006).

CONCLUSIONS

The present results offer new evidence of the association between urinary concentrations of catecholamine metabolites (metanephrine and total metanephrines) and chronic periodontitis. Salivary IgA level showed no statistical difference between the cases and controls. Salivary cortisol levels in the patients with periodontitis were correlated with worse PI, higher gingival inflammation, and greater tooth loss.

Mucosal Immunity and B Cells in Teleosts: Effect of Vaccination and Stress

Fish are subjected to several insults from the environment, which may endanger animal survival. Mucosal surfaces are the first line of defense against these threats, acting as a physical barrier to protect the animal but also functioning as an active immune tissue. Thus, four mucosal-associated lymphoid tissues (MALTs), which lead the immune responses in gut, skin, gills, and nose, have been described in fish. Humoral and cellular immunity, as well as their regulation and the factors that influence the response in these mucosal lymphoid tissues, are still not well known in most fish species. Mucosal B-lymphocytes and immunoglobulins (Igs) are key players in the immune response that takes place in those MALTs. The existence of IgT as a mucosal specialized Ig gives us the opportunity of measuring specific responses after infection or vaccination, a fact that was not possible until recently in most fish species. The vaccination process is influenced by several factors, being stress one of the main stimuli determining the success of the vaccine. Thus, one of the major goals in a vaccination process is to avoid possible situations of stress, which might interfere with fish immune performance. However, interaction between immune and neuroendocrine systems at mucosal tissues is still unknown. In this review, we will summarize the latest findings about B-lymphocytes and Igs in mucosal immunity and the effect of stress and vaccination on B-cell response at mucosal sites. It is important to point out that a limited number of studies have been published regarding stress in mucosa and very few about the influence of stress over mucosal B-lymphocytes.

Salivary mental stress proteins

Of the major diagnostic specimen types, saliva is one of the most easily collected. Many studies have focused on the evaluation of salivary proteins secreted by healthy people and patients with various diseases during responses to acute mental stress. In particular, such studies have focused on cortisol, α-amylase, chromogranin A (CgA), and immunoglobulin A (IgA) as salivary stress markers. Each of these salivary stress markers has its own strengths and weaknesses as well as data gaps related to many factors including collection technique. In this review, we summarize the critical knowledge of the positive and negative attributes and data gaps pertaining to each salivary stress marker.

Secretory IgA in saliva can be a useful stress marker

To evaluate secretory immunoglobulin A (slgA) in saliva as an immunological stress marker, we reviewed the literature on slgA and its variation caused by psychosocial factors. Among the studies on the effect of academic stress on slgA secretion, we could distinguish two kinds of stress effects: the immediate stress effect which increases slgA secretion immediately after stress, and the delayed stress effect which decreases slgA secretion several days after stress. On the basis of production and secretion mechanisms of slgA, we also speculated on possible mechanisms that underlie the variations of slgA caused by stress. Eventually, we concluded diat slgA in saliva can be a useful stress marker if we analyze the delayed stress effect on slgA separately from the immediate stress effect on slgA.

Perturbation of secretory Ig A in saliva and its daily variation by academic stress

OBJECTIVES

Several studies have reported that the secretory immunoglobulin A (S-IgA) concentration in saliva is an indicator of psychological stress. The aim of this study was to clarify the relationship between S-IgA and the stress from academic examinations.

METHODS

S-IgA levels in 10 medical student volunteers from the second year course between May 4 and July 13, 2000 were examined using the ELISA method.

RESULTS

There was a tendency for S-IgA in saliva to be higher on the day before academic examinations and during them, and lower on the days between these examinations.

CONCLUSIONS

It may be possible to use this measurement to monitor psychological stress in students and workers.

Effects of high and low stress on proinflammatory and antiinflammatory cytokines

The effects of stress, which varies throughout an academic year, on proinflammatory and antiinflammatory cytokines were examined in 44 medical students. This was tested by comparing stimulated cytokines during a baseline period, stress period, and poststress vacation period. During the stress period, compared with the baseline period, levels of IL-6 were reduced, while levels of IL-10 were elevated. During the poststress vacation period, compared with the stress period, levels of IL-6 and TNF-α were increased. However, the changes in stress-related psychological and physiological variables were not significantly associated with changes in levels of proinflammatory and antiinflammatory cytokines. These results suggest that vacation is more likely to have a counterstress effect on proinflammatory cytokines than on an antiinflammatory cytokine and that a stressor may affect changes in immune function independently of self-reported stress.

Levels of salivary stress markers in patients with anxiety about halitosis

OBJECTIVE

To investigate the relationship between salivary stress markers and mental stress states in patients complaining of oral malodour. The utility of the salivary stress markers in assessment of mental conditions of those patients was also investigated.

DESIGN

The study population included 74 patients, aged 20-59 years, who complained of oral malodour and were referred to the Breath Odor Clinic at Tokushima University Hospital. Patients were classified into two groups, genuine halitosis (GH) and psychosomatic halitosis (PH), according to the results of organoleptic rating measurement. All patients were subjected to examination by the Cornell Medical Index (CMI) Health Questionnaire. Resting saliva was collected and levels of salivary IgA, cortisol and chromogranin A were determined by ELISA. Twenty-three volunteers not complaining of halitosis were included as the control group. Kruskal-Wallis test and Mann-Whitney's U-test were used for statistical analysis.

RESULTS

A significant increase was observed in the concentrations of salivary cortisol in the PH group as compared with GH and control groups (p<0.05). Concentrations of IgA and chromogranin A in saliva were not significantly different among the three groups. In addition, higher salivary cortisol concentrations were found in CMI scale III and IV (tendency towards neurosis) than in scale I and II (normal) (p<0.05). Since salivary cortisol reflects a status of chronic stress condition, psychosomatic halitosis might be closely related to this state of chronic stress.

CONCLUSIONS

Determination of cortisol levels in saliva may provide useful information for evaluating the mental status of patients complaining of halitosis.

Influence of psychological stress on upper respiratory infection--a meta-analysis of prospective studies

OBJECTIVE

To quantify the available evidence for the hypothesis that reduced resistance caused by psychological stress may influence the development of clinical disease in those exposed to an infectious agent.

METHODS

We conducted a systematic review and meta-analysis of 27 prospective studies examining the association between psychological stress and subsequent upper respiratory infection (URI).

RESULTS

The results revealed a significant overall main effect of psychological stress on the risk of developing URI (effect size correlation coefficient, 0.21; 95% confidence interval, 0.15-0.27). Further analyses showed that effect sizes for the association did not vary according to type of stress, how URI was assessed, or whether the studies had controlled for preexposure.

CONCLUSIONS

The meta-analytical findings confirmed the hypothesis that psychological stress is associated with increased susceptibility to URI, lending support to an emerging appreciation of the potential importance of psychological factors in infectious disease.

Relations between mucosal immunity and children's mental health: the role of child sex

This study examines relations between children's salivary interleukin-6 (IL-6) and secretory immunoglobulin A (SIgA) and mental health. Child sex was considered as a moderator of relations. Data were from 329 normally developing children (M age=9.85years; SD=.98years); 67% of children were European American and 33% were African American. Saliva samples were obtained during the afternoon and assayed for SIgA and IL-6. Parents completed questionnaire measures of child internalizing and externalizing symptoms, and children completed self-report measures of anxiety and depression. Structural equation models were fit to the data, and indicated that greater levels of salivary IL-6 and SIgA were associated with adjustment problems more strongly for girls than for boys.

Alterations of postawakening cortisol parameters during a prolonged stress period: Results of a prospective controlled study

Though postawakening cortisol is considered to be altered under chronic stress prospective studies proving this assumption is missing, so far. Furthermore, there is some uncertainty which aspects of postawakening cortisol alterations are strongest related to stress. The present study thus analyzed the cortisol concentration at awakening itself (0 min), the cortisol awakening response (CAR; i.e. the increase within 30 min after awakening), the area under the curve of the first hour after awakening (AUC(G)60) and the mean of samples taken 0 min and 30 min after awakening (AUC(G)30) in 12 exam students, participating in a major exam and 12 matched control students not participating in any exam. Saliva samples were taken on two consecutive days at 0, 15, 30, 45, and 60 min after awakening, respectively, at four time points (T1-T4): on the verge of exams, when students anticipated and prepared the exam (T1), in the middle of exams (T2), and shortly after (T3). T4 (weeks after exams) represents a reference measure. Repeated measures analyses of covariance revealed a significantly higher AUC(G)30 (p=0.007) and AUC(G)60 (p=0.011) and higher cortisol concentrations at awakening (p=0.016) in exam students and a significant time by group interaction for concentration at awakening (p=0.031). No effects were found for the CAR. The results of this prospective controlled study support notions that chronic stress induces increases of overall postawakening cortisol. They further indicate that the CAR is not affected by chronic stress and that the awakening concentration responds later than the AUC(G) to conditions of chronic stress as analyzed here.

Use of saliva for assessment of stress and its effect on the immune system prior to gross anatomy practical examinations

The objective of this study was to determine the longitudinal effects of a series of stressful gross anatomy tests on the immune system. Thirty-six freshman occupational therapy students completed a written stress evaluation survey, and saliva samples were obtained at baseline and prior to each of three timed-practical gross anatomy tests. Cortisol, secretory IgA (sIgA), and IL-12 concentrations were measured within the salivary samples by enzyme-linked immunosorbent assay. The total scores from the stress surveys were used as markers for environmental stress. Data were compiled for each student at baseline and prior to each examination and were compared by repeated-measures MANOVA and Pearson's correlation test. Following normalization for protein concentration and flow rate, the concentrations of IL-2, IL-6, IL-12, and sIgA progressively increased from baseline to the third test. Cortisol concentrations, following normalization for flow rate, were highest prior to the first test and became significantly reduced prior to second and third test. Prior to second and third test, salivary concentrations of IL-6, IL-2, IL-12, and sIgA were significantly correlated (P < 0.05). In contrast, prior to third test, there was a negative correlation between salivary concentrations of cortisol and IL-12 (P < 0.05). Progressive increases in salivary sIgA, IL-6, IL-2, and IL-12 concentrations from the first to the third test coincident to decreased salivary cortisol suggest that the initial examination stressors precede significant effects on the immune system. These data suggest that there may be latent effects of examination stress on the immune system and that saliva can be used to predict these effects.

[The effects of aromatherapy on stress and stress responses in adolescents]

PURPOSE

This study was done to examine the effects of aromatherapy on stress and stress responses in adolescents.

METHODS

A two-group cross-over design was used for this study. The experimental treatment was aroma essential oil inhalation and the placebo treatment was carrier oil inhalation using a necklace. The sample included 36 female high school students. Fisher's exact test, t-test, and paired t-test using SPSS/WIN program were used to analyze the data.

RESULTS

Stress levels were significantly lower when the students received the aroma treatment compared to when they received the placebo treatment. The stress responses except salivary IgA levels were significantly lower when the students received the aroma treatment.

CONCLUSION

Aroma inhalation could be a very effective stress management method for high school students. Therefore, it is recommended that this program be used in clinical practice as an effective nursing intervention for high school students.

Immunochromatographic assay using gold nanoparticles for measuring salivary secretory IgA in dogs as a stress marker

The concentration of salivary secretory immunoglobulin A (sIgA) is a well-known stress marker for humans. The concentration of salivary sIgA in dogs has also been reported as a useful stress marker. In addition, salivary sIgA in dogs has been used to determine the adaptive ability of dogs for further training. There are conventional procedures based on enzyme-linked immunosorbent assay (ELISA) for measuring salivary sIgA in dogs. However, ELISA requires long assay time, complicated operations and is costly. In the present study, we developed an immunochromatographic assay for measuring salivary sIgA in dogs using a dilution buffer containing a non-ionic surfactant. We determined 2500-fold dilution as the optimum condition for dog saliva using a phosphate buffer (50 mM, pH 7.2) containing non-ionic surfactant (3 wt% Tween 20). The results obtained from the saliva samples of three dogs using immunochromatographic assay were compared with those obtained from ELISA. It was found that the immunochromatographic assay is applicable to judge the change in salivary sIgA in each dog. The immunochromatographic assay for salivary sIgA in dogs is a promising tool, which should soon become commercially available for predicting a dog's psychological condition and estimating adaptive ability for training as guide or police dogs.

Counter-stress effects of relaxation on proinflammatory and anti-inflammatory cytokines

The counter-stress effects of relaxation on proinflammatory and anti-inflammatory cytokines were examined. From 36 medical students, 18 were randomly assigned to the relaxation group, and 18 were randomly assigned to the non-relaxation group. Relaxation lasted for four weeks. The levels of stimulated production of IL-6, TNF-alpha, and IL-10, and blood pressure were measured during the non-examination period (baseline period) and the pre-examination period (stress period). The levels of perceived stress were assessed by the Global Assessment of Recent Stress (GARS) scale, the Stress Response Inventory (SRI) and the Symptom Checklist-90-Revised (SCL-90-R) anxiety subscale. Repeat measure ANOVA revealed that the SRI total score, scores of the SCL-90-R anxiety subscale and diastolic blood pressure were significantly higher during the stress period than during the baseline period regardless of groups. The level of IL-6 production was significantly lower but the level of IL-10 production was significantly higher during the stress period than during the baseline period. Significant reduction in the delta (stress period value minus baseline period value) in the total GARS score, systolic and diastolic blood pressure, the levels of IL-6 and TNF-alpha production but significant enhancement in the delta in the level of the IL-10 production were found in the relaxation group compared with the non-relaxation group. These results suggest that relaxation is associated with reduction in stress-induced psychological or physiological responses and proinflammatory cytokine alterations but with enhancement in stress-induced anti-inflammatory cytokine alteration. Therefore, relaxation is more likely to have counter-stress effect on proinflammatory cytokines than on anti-inflammatory cytokine.

Stress, distress and mucosal immunity in carers of a partner with fronto-temporal dementia

OBJECTIVES

This study investigates the psychological and physiological impact of caring for a partner with fronto-temporal dementia (FTD). Carers were expected to exhibit greater stress and poorer psychological well-being in comparison with non-carers, and suppressed mucosal immunity.

METHOD

Twenty-five carers and 36 non-carers completed standardised psychological assessments of perceived stress, psychological well-being, coping and social support. Levels of mucosal immunity were assessed in saliva samples collected over the 3 days of the study, alongside daily assessments of stress, arousal and mood.

RESULTS

Informal carers as a group reported greater stress and poorer psychological well-being, but there was considerable variation, with some carers reporting better psychological functioning than non-carers. Immune levels were not suppressed in carers compared with non-carers; counter to hypothesis, there was a positive correlation between immunity and poorer psychological well-being.

CONCLUSIONS

This research suggests that caring for a partner with FTD increases distress and carers might benefit from psychological intervention. However, the variation in psychological well-being requires explanation. Furthermore, this first examination of mucosal immunity employing participants experiencing enduring stress suggests that, in contrast to previous research, enduring stress does not lead to suppression of mucosal immunity and may actually enhance it.

Salivary Genomics, Transcriptomics and Proteomics: The Emerging Concept of the Oral Ecosystem and their Use in the Early Diagnosis of Cancer and other Diseases

There is an increasingly growing interest world-wide for the genomics, transcriptomics and proteomics of saliva and the oral cavity, since they provide a non-invasive source of unprecedently rich genetic information. The complexity of oral systems biology goes much beyond the human genome, transcriptome and proteome revealed by oral mucosal cells, gingival crevicular fluid, and saliva, and includes the complexity of the oral microbiota, the symbiotic assembly of bacterial, fungal and other microbial flora in the oral cavity. In our review we summarize the recent information on oral genomics, transcriptomics and proteomics, of both human and microbial origin. We also give an introduction and practical advice on sample collection, handling and storage for analysis. Finally, we show the usefulness of salivary and oral genomics in early diagnosis of cancer, as well as in uncovering other systemic diseases, infections and oral disorders. We close the review by highlighting a number of possible exploratory pathways in this emerging, hot research field.

Stressful life events are associated with low secretion rates of immunoglobulin A in saliva in the middle aged and elderly

Whether chronic stress experience is related to downregulation of secretory immunoglobulin A (S-IgA) was tested in two substantial cohorts, one middle aged (N = 640) and another elderly (N = 582), comprising similar numbers of men (N = 556) and women (N = 666) and manual (N = 606) and non-manual (N = 602) workers. Participants indicated from a list of major stressful life events, up to six, they had experienced in the past 2 years. They also rated how disruptive and stressful the events were, at the time and now, as well as their perceived seriousness; the products of these impact values and event frequency were adopted as measures of stress load. From unstimulated 2-min saliva samples, saliva volume and S-IgA concentration were measured, and S-IgA secretion rate determined as their product. There was a negative association between the stress load measures and the S-IgA secretion rate, still evident following adjustment for such variables as smoking and saliva volume. The associations also withstood adjustment for sex, cohort, and household occupational status. Although these associations are small in terms of the amount of variance explained, they nonetheless suggest that chronic stress experience either decreases IgA production by the local plasma cells or reduces the efficiency with which S-IgA is transported from the glandular interstitium into saliva. Given the importance of S-IgA in immune defence at mucosal surfaces and the frequency with which infections are initiated at these surfaces, S-IgA downregulation could be a means by which chronic stress increases susceptibility to upper respiratory tract infection.

The impact of abbreviated progressive muscle relaxation on salivary cortisol and salivary immunoglobulin A (sIgA)

This study examined the acute effects of relaxation training on salivary cortisol and salivary immunoglobulin A (sIgA). Members of age- and gender-matched undergraduate student pairs were randomly assigned to an experimental or control group. Forty-one experimental subjects were led through Abbreviated Progressive Relaxation Training (APRT) during a 1-h laboratory session; 14 control subjects merely sat quietly in the laboratory for an equal amount of time. All subjects provided pre- and post-intervention saliva samples and self-report data on state anxiety, perceived stress, and relaxation levels. Heart rate was also monitored immediately before and after APRT or quiet sitting. Results indicated that a brief relaxation exercise led to experimental subjects having significantly lower levels of post-intervention salivary cortisol (p = .036) and significantly higher levels of post-intervention sIgA concentration (p < .001) and secretion rate (p < .001) than control subjects. The data suggest that relaxation training may play a role in immunoenhancement.

Psychosocial factors as risk indicators of periodontitis

OBJECTIVE

Cross-sectional investigation of associations between psychosocial and periodontal parameters.

METHODS

One hundred and ten patients 18-76 years of age were examined clinically and 57 radiographically at the Department of Conservative Dentistry of the University Hospital of Heidelberg: probing depths (PDs) and attachment level (PAL-V) were obtained at six sites per tooth. Inter-proximal bone loss was assessed in 57 patients on panoramic radiographs. Further chemical and general environmental sensitivity, somatization, and smoking status were assessed by several questionnaires.

RESULTS

Significant correlations between severe bone loss and age (r=0.38, p=0.004) were observed. PAL-V and PD also correlated with age (r=0.45, p<0.001; r=0.37, p<0.001) and pack years (r=0.21, p=0.031; r=0.3, p=0.002). After adjustment for age, smoking, and sex a negative correlation between chemical odour sensitivity and bone loss, PD=4 mm as well as PAL-V=4 mm was observed. Further, a negative correlation was observed between gastrointestinal sensitivity and PAL-V=4 mm. Psychological stress correlated positively with bone loss.

CONCLUSION

The results give evidence for associations of psychosocial factors and periodontal disease. Some environmental traits seem to be related to more favourable periodontal status.

Modulation of clinical expression of plaque-induced gingivitis: effects of personality traits, social support and stress

BACKGROUND

Studies have shown an association between an acute stressful event and gingivitis. However, the possible effects of personality traits associated with stress resistance/susceptibility and current level of stress on the clinical expression of plaque-induced inflammation remain to be examined. The aim of this study was to characterize the subject-based clinical behaviour of the gingiva during experimental gingivitis in relation to personality profile, psychological stress and coping behaviour.

METHODS

Ninety-six systemically and periodontally healthy subjects (mean age: 23.6+/-1.7 years), 46 males and 50 females, non-smokers, participated in a randomized, split-mouth, localized experimental gingivitis trial. Prior to the trial, subjects were asked to complete self-administered questionnaires evaluating personality traits (Hardiness scale and Courtauld Emotional Control Scale), subjective stress (Visual Analogue Scale-Total Distress), social support (Multidimensional Scale of Perceived Social Support, MSPSS) and life events (Life Experiences Survey (LES)). The influence of psychosocial factors was investigated in the overall population as well as in two sub-populations with different inflammatory response to plaque accumulation.

RESULTS

No significant relationships were found between gingival inflammation variables and psychological measures. No significant differences were detected between subjects with different susceptibilties to plaque-associated gingivitis for any considered psychological variable. A significant association between plaque variables and LES (negative) or MSPSS (positive) was found; however, the variance explained by the model was low.

CONCLUSIONS

Differences in the current level of stress and psychosocial variables indicative of stress susceptibility do not account for variability in plaque accumulation and gingival inflammation during experimental gingivitis in young adults.

Stress, oral health behaviour and clinical outcome

OBJECTIVE

Several studies indicate that stress adversely affects various health behaviours. Oral hygiene behaviour, however, has been rarely studied in this context. The present study thus aims to assess the effects of stress on oral hygiene behaviour and clinical outcome.

DESIGN

In a prospective matched controlled design 12 pairs of medical students, each consisting of 1 student participating in a major academic exam and 1 student not participating in any exams (control) were studied.

METHODS

A professional tooth cleaning was performed 4 weeks prior to exams to obtain plaque levels of 0 at all sites. Immediately prior to professional tooth cleaning and 4 weeks after exams plaque levels (as indicator of oral hygiene behaviour) and bleeding on probing (an indicator of gingivitis) were assessed.

RESULTS

No group differences were observed at the beginning of the exam period; after exams significant higher rates of plaque (p=.0005, d=1.74) and gingivitis (p=.016, d=1.01) were observed in exam students as compared with controls.

CONCLUSIONS

The study illustrates the clinical significance of stress effects on health behaviour. Stress should be included as a factor in models of patient compliance and health behaviour.

A Novel Method for Estimating the Adaptive Ability of Guide Dogs Using Salivary sIgA

Salivary secretory immunoglobulin A (sIgA) concentrations of prospective guide dogs for the blind were determined to clarify whether salivary sIgA is useful in evaluating the potential suitability of guide dogs for the blind. Saliva was collected from 73 prospective guide dogs in the kennel on day 1 (the day of separation from volunteer puppy-raisers), 2, 3, 7 and 14 during the estimation period (at about 1 year old). We selected particularly suitable dogs (superior dogs) and unsuitable dogs (inferior dogs) on the basis of the trainers' estimation. All dogs were divided into two groups, those were acceptable dogs would become the guide dogs and rejected dogs could not become guide dogs. The sIgA concentrations in superior dogs gradually increased from day 1 to 14 and those in inferior dogs remained at low levels. Moreover, the sIgA concentrations on day 14 in the acceptable dogs were significantly higher than those in rejected dogs. The cut-off point of sIgA concentrations on day 14 using an ROC curve was 90 EU/ml, and the specificity of the estimation at this point (70.4%) was higher than that of trainers' estimation (50%). Moreover, parallel testing using both trainers' estimation and sIgA estimation, showed that specificity was further improved (79.5%). The present study showed that sIgA concentration was extremely useful in estimating the adaptive ability for guide dogs for the blind.

Effects of expression and inhibition of negative emotions on health, mood states, and salivary secretory immunoglobulin A in Japanese mildly depressed undergraduates

Previous studies have indicated that expression of negative emotions facilitates mental and physical health and inhibition of negative emotions increases susceptibility to illness. This study was conducted to examine whether those findings can be expanded to populations with non-Western cultural backgrounds. Specifically, we explored effects of expression and inhibition of negative emotions on health, mood states, and mucosal immune function in mildly depressed Japanese individuals. 16 depressed and 16 nondepressed female undergraduates were required either to write about their unpleasant experiences and superficial topics or to suppress any emotional responses and thoughts about them. Secretory immunoglobulin A (s-IgA) in saliva and psychological indices were measured at an experimental session and at a follow-up 1 wk. later. Beneficial effects of expression of emotions on subjective health were indicated in the nondepressed group, whereas harmful effects of inhibition on subjective health were shown in the depressed group. Emotional expression by writing improved mood states both in the depressed and nondepressed groups but induced elevation of salivary s-IgA only in the depressed group.

Social support and salivary secretory immunoglobulin A response in women to stress of making a public speech

Acute experimental stressors transiently increase volume of secretory immunoglobulin A (s-IgA) in saliva. The present study examined buffering effects of social support on response of s-IgA to a brief psychological stress (giving a public speech). 24 women were divided at random into three groups, an emotional support group, an informational support group and a no-support group (control). For each group, s-IgA measures were obtained from each person under baseline conditions, during preparation of a speech when social support or no support was given, immediately after the speech and during a 'recovery' period. Level of s-IgA in the control group significantly elevated during preparation for the speech and just after the speech compared to baseline, suggesting that the speech task stimulated secretory immune function. On the other hand, the subjects in the emotional support group showed increased s-IgA during the preparation period but secretion of s-IgA rapidly returned to the baseline after the speech task. Secretion of s-IgA in the informational social support group was unchanged at any measurement point. These results suggest that social support attenuates the affect of a stressor on somatic state.

Psychological stress and the human immune system: a meta-analytic study of 30 years of inquiry

The present report meta-analyzes more than 300 empirical articles describing a relationship between psychological stress and parameters of the immune system in human participants. Acute stressors (lasting minutes) were associated with potentially adaptive upregulation of some parameters of natural immunity and downregulation of some functions of specific immunity. Brief naturalistic stressors (such as exams) tended to suppress cellular immunity while preserving humoral immunity. Chronic stressors were associated with suppression of both cellular and humoral measures. Effects of event sequences varied according to the kind of event (trauma vs. loss). Subjective reports of stress generally did not associate with immune change. In some cases, physical vulnerability as a function of age or disease also increased vulnerability to immune change during stressors.

Psychological stress and the human immune system: a meta-analytic study of 30 years of inquiry

The present report meta-analyzes more than 300 empirical articles describing a relationship between psychological stress and parameters of the immune system in human participants. Acute stressors (lasting minutes) were associated with potentially adaptive upregulation of some parameters of natural immunity and downregulation of some functions of specific immunity. Brief naturalistic stressors (such as exams) tended to suppress cellular immunity while preserving humoral immunity. Chronic stressors were associated with suppression of both cellular and humoral measures. Effects of event sequences varied according to the kind of event (trauma vs. loss). Subjective reports of stress generally did not associate with immune change. In some cases, physical vulnerability as a function of age or disease also increased vulnerability to immune change during stressors.

Effect of metabolic cage housing on immunoglobulin A and corticosterone excretion in faeces and urine of young male rats

Six 8-week-old Sprague-Dawley rats were studied for 9 days divided into three periods of 3 days each: before transferral to metabolism cages, during metabolic cage housing and after return to their home cages. Faeces were collected daily when the animals were housed in their home cages and every 6 h when the animals were housed in metabolic cages during which time urine was also collected every 6 h. The rate of weight gain was slightly reduced during the 3 days in metabolic cages and the animals produced significantly larger amounts of faeces when housed in metabolic cages than when housed in their home cages. The total faecal excretion of corticosterone (nanograms excreted per hour per kilogram body weight) and immunoglobulin A (IgA) (milligrams excreted per hour per kg body weight) quantified by enzyme-linked immunosorbent assays (ELISAs) exhibited a clear diurnal rhythm in the metabolic cage. Urinary excretions of corticosterone and IgA also followed a clear diurnal cycle. The mean daily amounts of corticosterone excreted were not significantly affected by cage change and by housing in metabolic cages. However, the excretion of faecal IgA was significantly reduced during the 3 days after the period in metabolic cages. Taken together the results indicate that metabolic cage housing is mildly stressful for young adult male rats.

Odor from Industrial Hog Farming Operations and Mucosal Immune Function in Neighbors

The authors evaluated whether exposure to malodor from industrial hog farming operations has a psychophysiologically mediated immunosuppressive effect on secretory immunoglobulin A (sIgA) in neighbors. Fifteen adults living within 2.4 km (1.5 mi) of at least one hog farming operation rated odor intensity on a 9-point scale and provided saliva samples twice daily for two weeks. The authors used hierarchical regression to model the association between reported odor and sIgA; study participants were their own controls. The natural log of slgA concentration and secretion rate declined, on average, 0.058 (0.032) and 0.116 (0.103), respectively, for each incremental 1-unit increase in reported odor from 4 to 9, adjusted for time of day, suggesting reduced levels of sIgA in response to moderate or high odor. Findings support the hypothesized immunosuppressive effect of malodor on mucosal immunity and provide preliminary data useful in understanding health effects related to malodor from industrial hog farming operations.