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Ruiz-Pablos M, Paiva B, Zabaleta A. Hypocortisolemic ASIA: a vaccine- and chronic infection-induced syndrome behind the origin of long COVID and myalgic encephalomyelitis. Front Immunol 2024; 15:1422940. [PMID: 39044822 PMCID: PMC11263040 DOI: 10.3389/fimmu.2024.1422940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 06/25/2024] [Indexed: 07/25/2024] Open
Abstract
Myalgic encephalomyelitis or chronic fatigue syndrome (ME/CFS), long COVID (LC) and post-COVID-19 vaccine syndrome show similarities in their pathophysiology and clinical manifestations. These disorders are related to viral or adjuvant persistence, immunological alterations, autoimmune diseases and hormonal imbalances. A developmental model is postulated that involves the interaction between immune hyperactivation, autoimmune hypophysitis or pituitary hypophysitis, and immune depletion. This process might begin with a deficient CD4 T-cell response to viral infections in genetically predisposed individuals (HLA-DRB1), followed by an uncontrolled immune response with CD8 T-cell hyperactivation and elevated antibody production, some of which may be directed against autoantigens, which can trigger autoimmune hypophysitis or direct damage to the pituitary, resulting in decreased production of pituitary hormones, such as ACTH. As the disease progresses, prolonged exposure to viral antigens can lead to exhaustion of the immune system, exacerbating symptoms and pathology. It is suggested that these disorders could be included in the autoimmune/adjuvant-induced inflammatory syndrome (ASIA) because of their similar clinical manifestations and possible relationship to genetic factors, such as polymorphisms in the HLA-DRB1 gene. In addition, it is proposed that treatment with antivirals, corticosteroids/ginseng, antioxidants, and metabolic precursors could improve symptoms by modulating the immune response, pituitary function, inflammation and oxidative stress. Therefore, the purpose of this review is to suggest a possible autoimmune origin against the adenohypophysis and a possible improvement of symptoms after treatment with corticosteroid replacement therapy.
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Affiliation(s)
- Manuel Ruiz-Pablos
- Faculty of Biological Sciences, Universidad Complutense de Madrid, Madrid, Spain
| | - Bruno Paiva
- Centro de Investigación Médica Aplicada (CIMA), IdiSNA, Instituto de Investigación Sanitaria de Navarra, Clinica Universidad de Navarra, Pamplona, Spain
| | - Aintzane Zabaleta
- Centro de Investigación Médica Aplicada (CIMA), IdiSNA, Instituto de Investigación Sanitaria de Navarra, Clinica Universidad de Navarra, Pamplona, Spain
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Pantell MS, Silveira PP, de Mendonça Filho EJ, Wing H, Brown EM, Keeton VF, Pokhvisneva I, O'Donnell KJ, Neuhaus J, Hessler D, Meaney MJ, Adler NE, Gottlieb LM. Associations between Social Adversity and Biomarkers of Inflammation, Stress, and Aging in Children. Pediatr Res 2024; 95:1553-1563. [PMID: 38233512 PMCID: PMC11126389 DOI: 10.1038/s41390-023-02992-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 10/17/2023] [Accepted: 11/11/2023] [Indexed: 01/19/2024]
Abstract
BACKGROUND Prior work has found relationships between childhood social adversity and biomarkers of stress, but knowledge gaps remain. To help address these gaps, we explored associations between social adversity and biomarkers of inflammation (interleukin-1β [IL-1β], IL-6, IL-8, tumor necrosis factor-alpha [TNF-α], and salivary cytokine hierarchical "clusters" based on the three interleukins), neuroendocrine function (cortisol, cortisone, dehydroepiandrosterone, testosterone, and progesterone), neuromodulation (N-arachidonoylethanolamine, stearoylethanolamine, oleoylethanolamide, and palmitoylethanolamide), and epigenetic aging (Pediatric-Buccal-Epigenetic clock). METHODS We collected biomarker samples of children ages 0-17 recruited from an acute care pediatrics clinic and examined their associations with caregiver-endorsed education, income, social risk factors, and cumulative adversity. We calculated regression-adjusted means for each biomarker and compared associations with social factors using Wald tests. We used logistic regression to predict being in the highest cytokine cluster based on social predictors. RESULTS Our final sample included 537 children but varied based on each biomarker. Cumulative social adversity was significantly associated with having higher levels of all inflammatory markers and with cortisol, displaying a U-shaped distribution. There were no significant relationships between cumulative social adversity and cortisone, neuromodulation biomarkers or epigenetic aging. CONCLUSION Our findings support prior work suggesting that social stress exposures contribute to increased inflammation in children. IMPACT Our study is one of the largest studies examining associations between childhood social adversity and biomarkers of inflammation, neuroendocrine function, neuromodulation, and epigenetic aging. It is one of the largest studies to link childhood social adversity to biomarkers of inflammation, and the first of which we are aware to link cumulative social adversity to cytokine clusters. It is also one of the largest studies to examine associations between steroids and epigenetic aging among children, and one of the only studies of which we are aware to examine associations between social adversity and endocannabinoids among children. CLINICAL TRIAL REGISTRATION NCT02746393.
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Affiliation(s)
- Matthew S Pantell
- Division of Pediatric Hospital Medicine, Department of Pediatrics, University of California, San Francisco, CA, USA.
- Center for Health and Community, University of California, San Francisco, San Francisco, CA, USA.
- Social Interventions Research and Evaluation Network, University of California, San Francisco, CA, USA.
| | - Patricia P Silveira
- Douglas Mental Health University Institute, Douglas Research Center, McGill University, Montreal, QC, Canada
- Ludmer Centre for Neuroinformatics and Mental Health and Department of Psychiatry, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Euclides José de Mendonça Filho
- Douglas Mental Health University Institute, Douglas Research Center, McGill University, Montreal, QC, Canada
- Ludmer Centre for Neuroinformatics and Mental Health and Department of Psychiatry, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Holly Wing
- Center for Health and Community, University of California, San Francisco, San Francisco, CA, USA
- Social Interventions Research and Evaluation Network, University of California, San Francisco, CA, USA
| | | | - Victoria F Keeton
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, 490 Illinois St, Box 2930, 94143, San Francisco, CA, USA
| | - Irina Pokhvisneva
- Douglas Mental Health University Institute, Douglas Research Center, McGill University, Montreal, QC, Canada
| | - Kieran J O'Donnell
- Douglas Mental Health University Institute, Douglas Research Center, McGill University, Montreal, QC, Canada
- Ludmer Centre for Neuroinformatics and Mental Health and Department of Psychiatry, Faculty of Medicine, McGill University, Montreal, QC, Canada
- Yale Child Study Center & Department of Obstetrics, Gynecology & Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
| | - John Neuhaus
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Danielle Hessler
- Social Interventions Research and Evaluation Network, University of California, San Francisco, CA, USA
- Department of Family and Community Medicine, University of California, San Francisco, CA, USA
| | - Michael J Meaney
- Douglas Mental Health University Institute, Douglas Research Center, McGill University, Montreal, QC, Canada
- Ludmer Centre for Neuroinformatics and Mental Health and Department of Psychiatry, Faculty of Medicine, McGill University, Montreal, QC, Canada
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, Republic of Singapore
| | - Nancy E Adler
- Center for Health and Community, University of California, San Francisco, San Francisco, CA, USA
| | - Laura M Gottlieb
- Center for Health and Community, University of California, San Francisco, San Francisco, CA, USA
- Social Interventions Research and Evaluation Network, University of California, San Francisco, CA, USA
- Department of Family and Community Medicine, University of California, San Francisco, CA, USA
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Zhou H, Lin X. Oral mucosal diseases and psychosocial factors: progress in related neurobiological mechanisms. J Int Med Res 2023; 51:3000605231218619. [PMID: 38150546 PMCID: PMC10754026 DOI: 10.1177/03000605231218619] [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: 07/28/2023] [Accepted: 11/13/2023] [Indexed: 12/29/2023] Open
Abstract
The aetiology of oral mucosal diseases, such as recurrent aphthous ulcer (RAU), oral lichen planus (OLP) and burning mouth syndrome (BMS), involves many factors, and it remains difficult for clinicians to effectively relieve disease symptoms and formulate coping strategies. With the rapid development of psychology, the role of mental and psychological factors in RAU, OLP and BMS has gradually attracted researchers attention, but the specific mechanism has not been completely determined. This narrative review describes the potential neurobiological mechanism of oral mucosal diseases and detailed psychological factors after introducing relevant research into psychological factors and oral mucosal diseases. Future research strategies and innovations needed to understand and treat oral mucosal diseases and psychological factors, as well as how to prevent oral mucosal diseases by regulation of the neuroendocrine system, are also discussed.
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Affiliation(s)
- Huirong Zhou
- Department of Stomatology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xiaoping Lin
- Department of Stomatology, Shengjing Hospital of China Medical University, Shenyang, China
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Agorastos A, Heinig A, Sommer A, Wiedemann K, Demiralay C. Morning salivary dehydroepiandrosterone (DHEA) qualifies as the only neuroendocrine biomarker separating depressed patients with and without prior history of depression: An HPA axis challenge study. J Psychiatr Res 2023; 161:449-454. [PMID: 37059029 DOI: 10.1016/j.jpsychires.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 04/05/2023] [Indexed: 04/16/2023]
Abstract
BACKGROUND Hypothalamic-pituitary-adrenal (HPA) axis abnormalities in major depression (MDD) have been consistently reported in psychiatry and extend to several neurosteroids. However, recurrence and chronicity may heavily influence HPA axis dynamics in MDD along its course and also explain conflicting results in literature. Thus, the mechanistic understanding of HPA axis (re)activity changes over time could be of major importance for unravelling the dynamic pathophysiology of MDD. METHODS This study simultaneously assessed several baseline and dynamic HPA-axis-related endocrine biomarkers in both saliva (dehydroepiandrosterone, DHEA; sulfated DHEA, DHEA-s; cortisol, CORT) and plasma (CORT; adrenocorticotropic hormone, ACTH; copeptin, CoP) over three consecutive days using overnight HPA axis stimulation (metyrapone) and suppression (dexamethasone) challenges in order to investigate differences between antidepressant-free MDD patients (n = 14) with and without history of prior depressive episodes (i.e., first vs. recurrent episode). RESULTS Our results suggest group differences only with respect to saliva DHEA levels, with recurrent-episode MDD patients showing overall lower saliva DHEA levels across the three days, and statistically significant differences mainly at day 1 (baseline) across all three timepoints (awakening, +30 min, +60 min), even after adjustment for confounders. CONCLUSIONS Our study supports that salivary DHEA levels could represent a significant biomarker of MDD progression and individual stress resilience. DHEA deserves additional attention in the research of pathophysiology, staging and individualized treatment of MDD. Prospective longitudinal studies are needed to evaluate HPA axis reactivity along MDD course and progression to better understand temporal effects on stress-system-related alterations, related phenotypes and appropriate treatment.
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Affiliation(s)
- Agorastos Agorastos
- II. Department of Psychiatry, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, GR-54124, Thessaloniki, Greece; Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, D-20246, Hamburg, Germany; VA Center of Excellence for Stress and Mental Health (CESAMH), VA San Diego Healthcare System, CA, 29161, San Diego, USA.
| | - Alexandra Heinig
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, D-20246, Hamburg, Germany
| | - Anne Sommer
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, D-20246, Hamburg, Germany
| | - Klaus Wiedemann
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, D-20246, Hamburg, Germany
| | - Cüneyt Demiralay
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, D-20246, Hamburg, Germany
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Ahmed T, Qassem M, Kyriacou PA. Measuring stress: a review of the current cortisol and dehydroepiandrosterone (DHEA) measurement techniques and considerations for the future of mental health monitoring. Stress 2023; 26:29-42. [PMID: 36625303 DOI: 10.1080/10253890.2022.2164187] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Psychological stress and its inevitable trajectory toward mental health deteriorations such as clinical and major depression has become an unprecedented global burden. The diagnostic procedures involved in the characterization of mental illnesses commonly follow qualitative and subjective measures of stress, often leading to greater socioeconomic burdens due to misdiagnosis and poor understanding of the severity of such illnesses, further fueled by the stigmatization surrounding mental health. In recent years, the application of cortisol and stress hormone measurements has given rise to an alternative, quantifiable approach for the psychological evaluation of stress and depression. This review comprehensively evaluates the current state-of-the-art technology for measuring cortisol and dehydroepiandrosterone (DHEA) and their applications within stress monitoring in humans. Recent advancements in these fields have shown the importance of measuring stress hormones for the characterization of stress manifestation within the human body, and its relevance in mental health decline. Preliminary results from studies considering multimodal approaches toward stress monitoring have showcased promising developments, emphasizing the need for further technological advancement in this field, which consider both neurochemical and physiological biomarkers of stress, for global benefit.
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Affiliation(s)
- Tashfia Ahmed
- Research Centre of Biomedical Engineering, University of London, London, UK
| | - Meha Qassem
- Research Centre of Biomedical Engineering, University of London, London, UK
| | - Panicos A Kyriacou
- Research Centre of Biomedical Engineering, University of London, London, UK
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Romanova Z, Hrivikova K, Riecansky I, Jezova D. Salivary testosterone, testosterone/cortisol ratio and non-verbal behavior in stress. Steroids 2022; 182:108999. [PMID: 35257713 DOI: 10.1016/j.steroids.2022.108999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 02/25/2022] [Accepted: 02/28/2022] [Indexed: 01/25/2023]
Abstract
The relationship between hormone release and non-verbal communication under stress conditions is still not sufficiently explored. The aim of the present study was to test the hypothesis that salivary testosterone concentrations and testosterone/cortisol (T/C) ratios correlate positively with assertive behavior representing a non-aggressive form of dominance during an acute stress situation. As a stress model, a socially evaluated cold pressor test was investigated in healthy men. The non-verbal behavior was analyzed according to the ethological coding system for interviews described by Troisi (1999). Salivary testosterone concentrations did not change throughout the stress test. The T/C ratios decreased significantly over time only in subjects showing high stress perception. The duration of affiliative and the frequency of flight behavior was higher in subjects with high stress perception compared to those with low stress perception. A significant positive correlation between the duration of prosocial behavior and values of T/C ratios was found in the whole sample. The area under the curve values of testosterone positively correlated with the duration of assertive behavior in the group with high stress perception and negatively in the other group. Our findings allow suggesting that the changes in non-verbal behavior during acute psychosocial stress situations may be more pronounced in subjects showing high stress perception. Obtained results motivate further research on a better understanding of the consequences of the lack of sense of full facial expressions, such as wearing face masks, on the balance between hormones and non-verbal behavior under stress conditions.
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Affiliation(s)
- Z Romanova
- Laboratory of Pharmacological Neuroendocrinology, Institute of Experimental Endocrinology, Biomedical Research Center, Slovak Academy of Sciences, Bratislava, Slovakia; Department of Pharmacology and Toxicology, Faculty of Pharmacy, Comenius University Bratislava, Slovakia
| | - K Hrivikova
- Laboratory of Pharmacological Neuroendocrinology, Institute of Experimental Endocrinology, Biomedical Research Center, Slovak Academy of Sciences, Bratislava, Slovakia
| | - I Riecansky
- Department of Behavioral Neuroscience, Institute of Normal and Pathological Physiology, Centre of Experimental Medicine, Slovak Academy of Sciences, Bratislava, Slovakia; Social, Cognitive and Affective Neuroscience Unit, Department of Cognition, Emotion, and Methods in Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - D Jezova
- Laboratory of Pharmacological Neuroendocrinology, Institute of Experimental Endocrinology, Biomedical Research Center, Slovak Academy of Sciences, Bratislava, Slovakia.
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