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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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2
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Ahor HS, Vivekanandan M, Harelimana JDD, Owusu DO, Adankwah E, Seyfarth J, Phillips R, Jacobsen M. Immunopathology in human pulmonary tuberculosis: Inflammatory changes in the plasma milieu and impaired host immune cell functions. Immunology 2024; 172:198-209. [PMID: 38317426 DOI: 10.1111/imm.13761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 01/17/2024] [Indexed: 02/07/2024] Open
Abstract
Host immune response is key for protection in tuberculosis, but the causative agent, Mycobacterium (M.) tuberculosis, manages to survive despite immune surveillance. Key mechanisms of immune protection have been identified, but the role of immunopathology in the peripheral blood of tuberculosis patients remains unclear. Tuberculosis immunopathology in the blood is characterised by patterns of immunosuppression and hyperinflammation. These seemingly contradictory findings and the pronounced heterogeneity made it difficult to interpret the results from previous studies and to derive implications of immunopathology. However, novel approaches based on comprehensive data analyses and revitalisation of an ancient plasma milieu in vitro assay connected inflammation with immunosuppressive factors in tuberculosis. Moreover, interrelations between the aberrant plasma milieu and immune cell pathology were observed. This review provides an overview of studies on changes in plasma milieu and discusses recent findings linking plasma factors to T-cell and monocyte/macrophage pathology in pulmonary tuberculosis patients.
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Affiliation(s)
- Hubert Senanu Ahor
- Department of General Pediatrics, Neonatology, and Pediatric Cardiology, Medical Faculty, University Hospital Duesseldorf, Heinrich-Heine-University, Duesseldorf, Germany
| | - Monika Vivekanandan
- Department of General Pediatrics, Neonatology, and Pediatric Cardiology, Medical Faculty, University Hospital Duesseldorf, Heinrich-Heine-University, Duesseldorf, Germany
| | - Jean De Dieu Harelimana
- Department of General Pediatrics, Neonatology, and Pediatric Cardiology, Medical Faculty, University Hospital Duesseldorf, Heinrich-Heine-University, Duesseldorf, Germany
| | - Dorcas O Owusu
- Kumasi Centre for Collaborative Research in Tropical Medicine (KCCR), Kumasi, Ghana
| | - Ernest Adankwah
- Kumasi Centre for Collaborative Research in Tropical Medicine (KCCR), Kumasi, Ghana
| | - Julia Seyfarth
- Department of General Pediatrics, Neonatology, and Pediatric Cardiology, Medical Faculty, University Hospital Duesseldorf, Heinrich-Heine-University, Duesseldorf, Germany
| | - Richard Phillips
- Kumasi Centre for Collaborative Research in Tropical Medicine (KCCR), Kumasi, Ghana
- School of Medicine and Dentistry, College of Health Sciences, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - Marc Jacobsen
- Department of General Pediatrics, Neonatology, and Pediatric Cardiology, Medical Faculty, University Hospital Duesseldorf, Heinrich-Heine-University, Duesseldorf, Germany
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3
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Yeasmin S, Ullah A, Wu B, Zhang X, Cheng LJ. Hybrid Functional Polymer-Enabled Multiplexed Chemosensor Patch for Wearable Adrenocortex Stress Profiling. ACS APPLIED MATERIALS & INTERFACES 2023; 15:50034-50046. [PMID: 37851924 DOI: 10.1021/acsami.3c11374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
Measuring bioactive stress hormones, including cortisol and dehydroepiandrosterone (DHEA), allows for evaluating the hypothalamic-pituitary-adrenal (HPA) axis functioning, offering valuable insights into an individual's stress response through adrenocortex stress profiles (ASPs). Conventional methods for detecting steroid hormones involve sample collections and competitive immunoassays, which suffer from drawbacks such as time-consuming labeling and binding procedures, reliance on unstable biological receptors, and the need for sophisticated instruments. Here, we report a label-free and external redox reagent-free amperometric assay directly detecting sweat cortisol and DHEA levels on the skin. The approach utilizes multitarget sensors based on redox-active molecularly imprinted polymers (redox MIPs) capable of selectively binding cortisol and DHEA, inducing changes in electrochemical redox features. The redox MIP consists of imprinted cavities for specific capture of cortisol or DHEA in a poly(pyrrole-co-(dimethylamino)pyrrole) copolymer containing hydrophobic moieties to enhance affinity toward steroid hormones. The polymer matrix also incorporates covalently linked interpenetrating redox-active polyvinylferrocene, offering a stable electrochemical redox feature that enables sensitive current change in response to the target capture in the vicinity. The multiplexed sensor detects cortisol and DHEA within 5 min, with detection limits of 115 and 390 pM, respectively. Through the integration of redox MIP sensors into a wireless wearable sensing system, we successfully achieved ambulatory detection of these two steroid hormones in sweat directly on the skin. The new sensing method facilitates rapid, robust determination of the cortisol-DHEA ratio, providing a promising avenue for point-of-care assessment of an individual's physiological state.
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Affiliation(s)
- Sanjida Yeasmin
- School of Electrical Engineering and Computer Science, Oregon State University, Corvallis, Oregon 97331, United States
| | - Ahasan Ullah
- School of Electrical Engineering and Computer Science, Oregon State University, Corvallis, Oregon 97331, United States
| | - Bo Wu
- School of Electrical Engineering and Computer Science, Oregon State University, Corvallis, Oregon 97331, United States
| | - Xueqiao Zhang
- School of Electrical Engineering and Computer Science, Oregon State University, Corvallis, Oregon 97331, United States
| | - Li-Jing Cheng
- School of Electrical Engineering and Computer Science, Oregon State University, Corvallis, Oregon 97331, United States
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4
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Lewis ME. Exploring adolescence as a key life history stage in bioarchaeology. AMERICAN JOURNAL OF BIOLOGICAL ANTHROPOLOGY 2022; 179:519-534. [PMCID: PMC9825885 DOI: 10.1002/ajpa.24615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 08/05/2022] [Accepted: 08/17/2022] [Indexed: 04/16/2024]
Abstract
Adolescence is a unique period in the life history of an individual. It is characterized by a myriad of changes that bioarchaeologists are only just coming to appreciate, related to sexual maturation, linear growth, immunological transformation, and emotional and cognitive development. New methods allow us to measure this age of transition through the stages of the adolescent growth, as a proxy for the physical development associated with sexual maturation (puberty). This review outlines ways bioarchaeologists may draw on research developments from the fields of human biology, evolutionary theory and neurobiology to advance a more holistic approach to the study of adolescence in the past. It considers current theoretical and analytical approaches to highlight the research potential of this critical stage of life history. This synthesis integrates the most recent research in the medical sciences concerned with body and brain development, and outlines the biological processes involved with sexual and physical maturation of the adolescent. The goal of this review is to help inform potentially rewarding areas of research that bioarchaeologists can contribute to and draw from, as well as the challenges and limitations, theoretical and methodological questions, and ways in which we can develop the study of adolescence in the discipline going forward.
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Affiliation(s)
- Mary E. Lewis
- Department of ArchaeologyUniversity of ReadingReadingUK
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5
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Gallucci G, Díaz A, Fernandez RDV, Bongiovanni B, Imhoff M, Massa E, Santucci N, Bértola D, Lioi S, Bay ML, Bottasso O, D'Attilio L. Differential expression of genes regulated by the glucocorticoid receptor pathway in patients with pulmonary tuberculosis. Life Sci 2022; 301:120614. [PMID: 35526591 DOI: 10.1016/j.lfs.2022.120614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 04/19/2022] [Accepted: 05/01/2022] [Indexed: 11/25/2022]
Abstract
AIMS Previous studies in TB patients showed an immuno-endocrine imbalance characterized by a disease-severity associated increase in plasma levels of proinflammatory cytokines and glucocorticoids (GCs). To analyze the potential immunomodulatory effect of circulating GCs over peripheral blood mononuclear cells (PBMC) from TB patients, we investigated the expression of positively (anti-inflammatory-related genes ANXA1; FKBP51; GILZ, NFKBIA, and NFKBIB) and negatively (inflammatory genes: IL-6, IL-1β, and IFN-γ) Glucocorticoids Receptors (GR)-regulated genes. Plasma concentrations of cytokines and hormones, together with specific lymphoproliferation were also assessed. MATERIALS AND METHODS Gene expression was quantified by RT-qPCR, specific lymphoproliferation by 3H-thymidine incorporation, whereas plasma cytokines and hormones levels by ELISA. KEY FINDINGS Transcripts of ANXA1, GILZ, NFKBIB, and NFKBIA appeared significantly increased in patients, whereas FKBP51, IL-6, IL-1β, and NF-κB remained unchanged. Upon analyzing according to disease severity, mRNA levels for ANXA1 and NFKBIB were even higher in moderate and severe patients. GILZ was increased in moderate cases, with NFKBIA and IL-1 β being higher in severe ones, who also displayed increased GRβ transcripts. TB patients had reduced plasma DHEA concentrations together with increased pro and anti-inflammatory cytokines (IFN-γ, IL-6, and IL-10) cortisol and cortisol/DHEA ratio, more evident in progressive cases, in whom their PBMC also showed a decreased mycobacterial-driven proliferation. The cortisol/DHEA ratio and GRα expression were positively correlated with GR-regulated genes mainly in moderate patients. SIGNIFICANCE The increased expression of cortisol-regulated anti-inflammatory genes in TB patients-PBMC, predominantly in progressive disease, seems compatible with a relatively insufficient attempt to downregulate the accompanying inflammation.
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Affiliation(s)
- Georgina Gallucci
- Instituto de Inmunología Clínica y Experimental Rosario (IDICER), CONICET-UNR, Rosario, Argentina
| | - Ariana Díaz
- Instituto de Inmunología Clínica y Experimental Rosario (IDICER), CONICET-UNR, Rosario, Argentina; Facultad de Ciencias Médicas, Universidad Nacional de Rosario, Rosario, Argentina
| | | | - Bettina Bongiovanni
- Instituto de Inmunología Clínica y Experimental Rosario (IDICER), CONICET-UNR, Rosario, Argentina; Facultad de Ciencias Médicas, Universidad Nacional de Rosario, Rosario, Argentina
| | - Matilde Imhoff
- Facultad de Ciencias Médicas, Universidad Nacional de Rosario, Rosario, Argentina
| | - Estefanía Massa
- Instituto de Inmunología Clínica y Experimental Rosario (IDICER), CONICET-UNR, Rosario, Argentina
| | - Natalia Santucci
- Instituto de Inmunología Clínica y Experimental Rosario (IDICER), CONICET-UNR, Rosario, Argentina; Facultad de Ciencias Médicas, Universidad Nacional de Rosario, Rosario, Argentina
| | - Diego Bértola
- Servicio de Clínica Médica, Hospital Provincial del Centenario, Rosario, Santa Fe, Argentina
| | - Susana Lioi
- Laboratorio Central, Hospital Provincial del Centenario, Rosario, Argentina
| | - María Luisa Bay
- Instituto de Inmunología Clínica y Experimental Rosario (IDICER), CONICET-UNR, Rosario, Argentina; Facultad de Ciencias Médicas, Universidad Nacional de Rosario, Rosario, Argentina
| | - Oscar Bottasso
- Instituto de Inmunología Clínica y Experimental Rosario (IDICER), CONICET-UNR, Rosario, Argentina; Facultad de Ciencias Médicas, Universidad Nacional de Rosario, Rosario, Argentina
| | - Luciano D'Attilio
- Instituto de Inmunología Clínica y Experimental Rosario (IDICER), CONICET-UNR, Rosario, Argentina; Facultad de Ciencias Médicas, Universidad Nacional de Rosario, Rosario, Argentina.
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6
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Bongiovanni B, Díaz A, Santucci N, D’Attilio LD, Bottasso O, Hernández Pando R, Bay ML. The Immunoregulatory Actions of DHEA in Tuberculosis, A Tool for Therapeutic Intervention? Front Endocrinol (Lausanne) 2022; 13:892270. [PMID: 35733782 PMCID: PMC9207529 DOI: 10.3389/fendo.2022.892270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 05/03/2022] [Indexed: 11/13/2022] Open
Abstract
Dehydroepiandrosterone (DHEA) is an androgen synthesized by the adrenal cortex, which is an intermediary in the biosynthesis of sex hormones, such as testosterone and estradiol. DHEA mostly circulates as a conjugated ester, in the form of sulfate (DHEA-S). There exist several endogenous factors able to influence its synthesis, the most common ones being the corticotrophin-releasing hormone (CRH), adrenocorticotrophin (ACTH), growth factors, and proinflammatory cytokines, among others. Like other steroid hormones, DHEA, can alter the functioning of immune cells and therefore the course of diseases exhibiting an immune-inflammatory component, mostly from autoimmune or infectious nature. We herein review the role played by DHEA during a major infectious disease like tuberculosis (TB). Data recorded from TB patients, mouse models, or in vitro studies show that DHEA is likely to be implied in better disease control. This provides a stimulating background for carrying out clinical studies aimed at assessing the usefulness of DHEA as an adjuvant in TB patients.
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Affiliation(s)
- Bettina Bongiovanni
- Instituto de Inmunología Clínica y Experimental de Rosario (IDICER CONICET-UNR), Rosario, Argentina
- Facultad de Cs. Médicas, UNR, Rosario, Argentina
- Facultad de Cs. Bioquímicas y Farmacéuticas, Universidad Nacional de Rosario (UNR), Rosario, Argentina
| | - Ariana Díaz
- Instituto de Inmunología Clínica y Experimental de Rosario (IDICER CONICET-UNR), Rosario, Argentina
- Facultad de Cs. Médicas, UNR, Rosario, Argentina
| | - Natalia Santucci
- Instituto de Inmunología Clínica y Experimental de Rosario (IDICER CONICET-UNR), Rosario, Argentina
- Facultad de Cs. Médicas, UNR, Rosario, Argentina
| | - Luciano David D’Attilio
- Instituto de Inmunología Clínica y Experimental de Rosario (IDICER CONICET-UNR), Rosario, Argentina
- Facultad de Cs. Médicas, UNR, Rosario, Argentina
| | - Oscar Bottasso
- Instituto de Inmunología Clínica y Experimental de Rosario (IDICER CONICET-UNR), Rosario, Argentina
- Facultad de Cs. Médicas, UNR, Rosario, Argentina
| | - Rogelio Hernández Pando
- Sección de Patología Experimental, Departamento de Patología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México, Mexico
- *Correspondence: María Luisa Bay, ; Rogelio Hernández Pando,
| | - María Luisa Bay
- Instituto de Inmunología Clínica y Experimental de Rosario (IDICER CONICET-UNR), Rosario, Argentina
- Facultad de Cs. Médicas, UNR, Rosario, Argentina
- *Correspondence: María Luisa Bay, ; Rogelio Hernández Pando,
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7
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Rojas LZ, Gómez-Ochoa SA, Echeverría LE, Bautista-Niño PK, Hunziker L, Eisenga MF, Muka T. Circulating DHEA-S levels and major cardiovascular outcomes in chronic Chagas cardiomyopathy: A prospective cohort study. Int J Cardiol 2021; 349:90-95. [PMID: 34838827 DOI: 10.1016/j.ijcard.2021.11.054] [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: 10/15/2021] [Revised: 11/18/2021] [Accepted: 11/22/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To analyze the association of circulating dehydroepiandrosterone sulfate (DHEA-S) levels with cardiovascular outcomes in patients with chronic Chagas cardiomyopathy (CCM) diagnosis. BACKGROUND DHEA-S is among the main endogenous steroid hormones. Some studies have suggested a relevant role of this hormone in infections and the setting of CCM. Nevertheless, no study has evaluated the prognostic role of DHEA-S in CCM patients. METHODS Prospective cohort study. Patients with CCM and reduced ejection fraction were included. We explored the association of DHEA-S levels with NT-proBNP levels and echocardiographic variables using linear regression models. Next, by using Cox Proportional Hazard models, we examined whether levels of DHEA-S could predict a composite outcome (CO) including all-cause mortality, cardiac transplantation, and implantation of a left ventricular assist device (LVAD). RESULTS Seventy-four patients were included (59% males, median age: 64 years). After adjustment for confounding factors, high DHEA-S levels were associated with better LVEF, lower left atrium volume, end-systolic volume of the left ventricle and lower NT-proBNP levels. 43% of patients experienced the CO during a median follow-up of 40 months. Increased levels of DHEA-S were associated with a lower risk of developing the CO (HR 0.43; 95%CI 0.21-0.86). Finally, adding DHEA-S to the multivariate model did not improve the prediction of the CO, but substituting NT-proBNP in the model with DHEA-S showed similar performance. CONCLUSIONS In patients with CCM, higher DHEA-S levels were associated with lower mortality, heart transplantation, and LVAD implantation. Further larger studies are required to confirm our results and assess causality.
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Affiliation(s)
- Lyda Z Rojas
- Research Group and Development of Nursing Knowledge (GIDCEN-FCV), Research Center, Cardiovascular Foundation of Colombia, Floridablanca, Santander, Colombia
| | | | - Luis E Echeverría
- Heart Failure and Heart Transplant Clinic, Fundación Cardiovascular de Colombia, Floridablanca, Colombia
| | | | - Lukas Hunziker
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Michele F Eisenga
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Taulant Muka
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland.
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8
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Gallucci G, Santucci N, Díaz A, Bongiovanni B, Bértola D, Gardeñez W, Rassetto M, Bay ML, Bottasso O, D’Attilio L. Increased levels of circulating LPS during Tuberculosis prevails in patients with advanced pulmonary involvement. PLoS One 2021; 16:e0257214. [PMID: 34506568 PMCID: PMC8432878 DOI: 10.1371/journal.pone.0257214] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 08/25/2021] [Indexed: 11/18/2022] Open
Abstract
Our earlier studies in tuberculosis (TB) patients indicate that in those where the process evolves to a larger pulmonary involvement, the immune endocrine response may promote an unfavorable environment. Chronic infectious diseases, and their persistent proinflammatory response, may affect mucosal barriers integrity favoring the translocation of gastrointestinal bacteria, leading to an increase of circulating lipopolysaccharides (LPS). Consequently, we quantified LPS levels in TB patients, with different degrees of pulmonary involvement, and controls (Co) and analyzed the possible relationship between LPS and inflammatory mediators i.e., C reactive protein (CRP), interleukin 6 (IL-6) and Interferon-gamma (IFN-γ), Erythrocyte Sedimentation Rate (ESR), steroid hormones (Cortisol and Dehydroepiandrosterone, DHEA), and inflammatory transcripts from peripheral blood mononuclear cells (IL-1β, IL-6, IFN-γ). LPS was assessed by the Limulus amoebocyte lysate assay and the ELISA technique was used to quantify hormones and cytokines in the plasma samples. Cytokine transcripts from PBMC were evaluated by qRT-PCR. Non-parametric tests were used. LPS levels were increased in TB patients, as did levels of CRP, IL-6, IFN-γ, cortisol and ESR. Severe patients had the highest amounts of circulating LPS; with moderate and severe cases showing much higher levels of CRP, ESR, IL-6, IFN-γ and cortisol/DHEA ratio, as an endocrine imbalance. Only in PBMC from severe cases was mRNA for IL-1β increased. Correlation analysis showed that levels of LPS from severe patients were positively associated with IL-6 and IFN-γ plasma concentrations and with IL-1β transcripts, while IL-6 had a positive correlation with the cortisol/DHEA ratio. The higher levels of circulating LPS during progressive TB may emerge as a contributing factor for the persistence of the greater immune endocrine imbalance distinctive of advanced disease, which might suggest a vicious cycle among LPS, inflammation and endocrine imbalance.
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Affiliation(s)
- Georgina Gallucci
- Instituto de Inmunología Clínica y Experimental Rosario (IDICER), CONICET-UNR, Rosario, Santa Fe, Argentina
| | - Natalia Santucci
- Instituto de Inmunología Clínica y Experimental Rosario (IDICER), CONICET-UNR, Rosario, Santa Fe, Argentina
- Facultad de Ciencias Médicas, Universidad Nacional de Rosario, Rosario, Santa Fe, Argentina
| | - Ariana Díaz
- Instituto de Inmunología Clínica y Experimental Rosario (IDICER), CONICET-UNR, Rosario, Santa Fe, Argentina
- Facultad de Ciencias Médicas, Universidad Nacional de Rosario, Rosario, Santa Fe, Argentina
| | - Bettina Bongiovanni
- Instituto de Inmunología Clínica y Experimental Rosario (IDICER), CONICET-UNR, Rosario, Santa Fe, Argentina
| | - Diego Bértola
- Servicio de Clínica Médica, Hospital Provincial del Centenario, Rosario, Santa Fe, Argentina
| | - Walter Gardeñez
- Servicio de Neumología, Hospital Provincial del Centenario, Rosario, Santa Fe, Argentina
| | - Mauricio Rassetto
- Centro de investigación y biotecnología (CIBIO) Wiener Lab, Rosario, Argentina
| | - María Luisa Bay
- Instituto de Inmunología Clínica y Experimental Rosario (IDICER), CONICET-UNR, Rosario, Santa Fe, Argentina
- Facultad de Ciencias Médicas, Universidad Nacional de Rosario, Rosario, Santa Fe, Argentina
| | - Oscar Bottasso
- Instituto de Inmunología Clínica y Experimental Rosario (IDICER), CONICET-UNR, Rosario, Santa Fe, Argentina
- Facultad de Ciencias Médicas, Universidad Nacional de Rosario, Rosario, Santa Fe, Argentina
| | - Luciano D’Attilio
- Instituto de Inmunología Clínica y Experimental Rosario (IDICER), CONICET-UNR, Rosario, Santa Fe, Argentina
- Facultad de Ciencias Médicas, Universidad Nacional de Rosario, Rosario, Santa Fe, Argentina
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9
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Marin-Luevano SP, Rodriguez-Carlos A, Jacobo-Delgado Y, Valdez-Miramontes C, Enciso-Moreno JA, Rivas-Santiago B. Steroid hormone modulates the production of cathelicidin and human β-defensins in lung epithelial cells and macrophages promoting Mycobacterium tuberculosis killing. Tuberculosis (Edinb) 2021; 128:102080. [PMID: 33799143 DOI: 10.1016/j.tube.2021.102080] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 03/18/2021] [Accepted: 03/19/2021] [Indexed: 11/18/2022]
Abstract
Several studies have documented the interaction between the immune and endocrine systems as an effective defense strategy against tuberculosis, involving the production of several molecules and immunological processes. In this study, we determined the effect of cortisol and dehydroepiandrosterone (DHEA) on the production of antimicrobial peptides such as cathelicidin and human β-defensin (HBD) -2, and HBD-3 and their effect on intracellular growth of Mycobacterium tuberculosis (Mtb) in lung epithelial cells and macrophages. Our results showed that DHEA promotes the production of these antimicrobial peptides in infected cells, correlating with the decrease of Mtb bacilli loads. These results suggest the use of exogenous DHEA as an adjuvant for tuberculosis therapy.
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Affiliation(s)
- Sara P Marin-Luevano
- Medical Research Unit-Zacatecas, Mexican Institute for Social Security-IMSS, Zacatecas, Mexico; Center for Research in Health Sciences and Biomedicine, Autonomous University of San Luis Potosí, Mexico
| | - Adrian Rodriguez-Carlos
- Medical Research Unit-Zacatecas, Mexican Institute for Social Security-IMSS, Zacatecas, Mexico
| | - Yolanda Jacobo-Delgado
- Medical Research Unit-Zacatecas, Mexican Institute for Social Security-IMSS, Zacatecas, Mexico
| | | | - Jose A Enciso-Moreno
- Medical Research Unit-Zacatecas, Mexican Institute for Social Security-IMSS, Zacatecas, Mexico
| | - Bruno Rivas-Santiago
- Medical Research Unit-Zacatecas, Mexican Institute for Social Security-IMSS, Zacatecas, Mexico.
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10
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Immune variations throughout the course of tuberculosis treatment and its relationship with adrenal hormone changes in HIV-1 patients co-infected with Mycobacterium tuberculosis. Tuberculosis (Edinb) 2021; 127:102045. [PMID: 33434785 DOI: 10.1016/j.tube.2020.102045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 12/17/2020] [Accepted: 12/23/2020] [Indexed: 01/08/2023]
Abstract
HIV infection is a major risk factor predisposing for Mycobacterium tuberculosis infection and progression to active tuberculosis (TB). As host immune response defines the course of infection, we aimed to identify immuno-endocrine changes over six-months of anti-TB chemotherapy in HIV+ people. Plasma levels of cortisol, DHEA and DHEA-S, percentages of CD4+ regulatory T cell subsets and number of IFN-γ-secreting cells were determined. Several cytokines, chemokines and C-reactive protein levels were measured. Results were correlated with clinical parameters as predictors of infection resolution and compared to similar data from HIV+ individuals, HIV-infected persons with latent TB infection and healthy donors. Throughout the course of anti-TB/HIV treatment, DHEA and DHEA-S plasma levels raised while cortisol diminished, which correlated to predictive factors of infection resolution. Furthermore, the balance between cortisol and DHEA, together with clinical assessment, may be considered as an indicator of clinical outcome after anti-TB treatment in HIV+ individuals. Clinical improvement was associated with reduced frequency of unconventional Tregs, increment in IFN-γ-secreting cells, diminution of systemic inflammation and changes of circulating cytokines and chemokines. This study suggests that the combined anti-HIV/TB therapies result in partial restoration of both, immune function and adrenal hormone plasma levels.
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11
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Defolie C, Merkling T, Fichtel C. Patterns and variation in the mammal parasite-glucocorticoid relationship. Biol Rev Camb Philos Soc 2020; 95:74-93. [PMID: 31608587 DOI: 10.1111/brv.12555] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 08/23/2019] [Accepted: 09/03/2019] [Indexed: 01/24/2023]
Abstract
Parasites are ubiquitous and can strongly affect their hosts through mechanisms such as behavioural changes, increased energetic costs and/or immunomodulation. When parasites are detrimental to their hosts, they should act as physiological stressors and elicit the release of glucocorticoids. Alternatively, previously elevated glucocorticoid levels could facilitate parasite infection due to neuroimmunomodulation. However, results are equivocal, with studies showing either positive, negative or no relationship between parasite infection and glucocorticoid levels. Since factors such as parasite type, infection severity or host age and sex can influence the parasite-glucocorticoid relationship, we review the main mechanisms driving this relationship. We then perform a phylogenetic meta-analysis of 110 records from 65 studies in mammalian hosts from experimental and observational studies to quantify the general direction of this relationship and to identify ecological and methodological drivers of the observed variability. Our review produced equivocal results concerning the direction of the relationship, but there was stronger support for a positive relationship, although causality remained unclear. Mechanisms such as host manipulation for parasite survival, host response to infection, cumulative effects of multiple stressors, and neuro-immunomodulatory effects of glucocorticoids could explain the positive relationship. Our meta-analysis results revealed an overall positive relationship between glucocorticoids and parasitism among both experimental and observational studies. Because all experimental studies included were parasite manipulations, we conclude that parasites caused in general an increase in glucocorticoid levels. To obtain a better understanding of the directionality of this link, experimental manipulation of glucocorticoid levels is now required to assess the causal effects of high glucocorticoid levels on parasite infection. Neither parasite type, the method used to assess parasite infection nor phylogeny influenced the relationship, and there was no evidence for publication bias. Future studies should attempt to be as comprehensive as possible, including moderators potentially influencing the parasite-glucocorticoid relationship. We particularly emphasise the importance of testing hosts of a broad age range, concomitantly measuring sex hormone levels or at least reproductive status, and for observational studies, also considering food availability, host body condition and social stressors to obtain a better understanding of the parasite-glucocorticoid relationship.
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Affiliation(s)
- Charlotte Defolie
- Sociobiology/Anthropology Department, University of Göttingen, Kellnerweg 6, 37077, Göttingen, Germany.,Behavioral Ecology & Sociobiology Unit, German Primate Center, Leibniz Institute for Primate Research, Kellnerweg 4, 37077, Göttingen, Germany.,Leibniz ScienceCampus "Primate Cognition", German Primate Center, Kellnerweg 4, 37077, Göttingen, Germany
| | - Thomas Merkling
- Department of Natural Resource Sciences, McGill University, Macdonald-Stewart Building, 21111 Lakeshore Road, Ste. Anne de Bellevue, Québec, H9X 3V9, Canada
| | - Claudia Fichtel
- Behavioral Ecology & Sociobiology Unit, German Primate Center, Leibniz Institute for Primate Research, Kellnerweg 4, 37077, Göttingen, Germany.,Leibniz ScienceCampus "Primate Cognition", German Primate Center, Kellnerweg 4, 37077, Göttingen, Germany
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12
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The prevalence of depression among patients with tuberculosis: a systematic review and meta-analysis. Ann Gen Psychiatry 2020; 19:30. [PMID: 32419837 PMCID: PMC7206806 DOI: 10.1186/s12991-020-00281-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 04/29/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Evidence has shown that the prevalence of depression is much higher among patients with tuberculosis (TB) and this, in turn, may adversely impact compliance with anti-TB medications. Therefore, this systematic review and meta-analysis aimed to quantitatively summarize epidemiologic evidence on the prevalence of depression among patients with TB and formulate a recommendation for future clinical practice as well as research. METHODS We followed the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines to conduct this review. We searched PubMed, EMBASE, SCOPUS and Psych INFO to identify relevant studies that investigated the prevalence of depression among TB patients. We also supplemented our electronic search with manual searching to include all pertinent studies in the analysis. We used a Comprehensive Meta-Analysis software version 3.0 (CMA 3.0) to conduct a meta-analysis. We conducted a subgroup and sensitivity analysis and Cochran's Q- and the I 2-statistics were used to assess heterogeneity. The evidence for the presence of publication bias was checked by using Egger's test and visual inspection of the symmetry in funnel plots. RESULTS We identified a total of 25 studies that included 4903 participants across seven countries. In our analysis, the pooled estimated prevalence of depression among TB patients was found to be 45.19% (95% CI 38.04-52.55). The prevalence was higher in MDR-TB 52.34% (95% CI 38.09-66.22) than non-MDR-TB 43.47% (95% CI 35.88-51.37) patients. We also found that the pooled prevalence of depression was higher among females 51.54% (95% CI 40.34-62.60) when compared to males 45.25% (95% CI 35.19-55.71). The pooled prevalence of depression was 45.45% as measured by HRDS, and it was 55.62%, 45.52%, and 38.36% as measured by BDI, HADS and PHQ-9, respectively. CONCLUSION Our finding suggested that the pooled estimated prevalence of depression among tuberculosis patients was relatively high. Screening and management of depression among TB patients were warranted to alleviate suffering. Moreover, the integration of tuberculosis program with regular psychiatry services may substantially reduce the burden.
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13
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Immune-neuroendocrine and metabolic disorders in human and experimental T. cruzi infection: New clues for understanding Chagas disease pathology. Biochim Biophys Acta Mol Basis Dis 2019; 1866:165642. [PMID: 31866417 DOI: 10.1016/j.bbadis.2019.165642] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 12/13/2019] [Indexed: 12/12/2022]
Abstract
Studies in mice undergoing acute Trypanosoma cruzi infection and patients with Chagas disease, led to identify several immune-neuroendocrine disturbances and metabolic disorders. Here, we review relevant findings concerning such abnormalities and discuss their possible influence on disease physiopathology.
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14
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Holt MR, Miles JJ, Inder WJ, Thomson RM. Exploring immunomodulation by endocrine changes in Lady Windermere syndrome. Clin Exp Immunol 2019; 196:28-38. [PMID: 30697704 DOI: 10.1111/cei.13265] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2019] [Indexed: 12/18/2022] Open
Abstract
Lung disease due to nontuberculous mycobacteria (NTM) occurs with disproportionate frequency in postmenopausal women with a unique phenotype and without clinically apparent predisposing factors. Dubbed 'Lady Windermere syndrome', the phenotype includes low body mass index (BMI), tall stature and higher than normal prevalence of scoliosis, pectus excavatum and mitral valve prolapse. Although the pathomechanism for susceptibility to NTM lung disease in these patients remains uncertain, it is likely to be multi-factorial. A role for the immunomodulatory consequences of oestrogen deficiency and altered adipokine production has been postulated. Altered levels of adipokines and dehydroepiandrosterone have been demonstrated in patients with NTM lung disease. Case reports of NTM lung disease in patients with hypopituitarism support the possibility that altered endocrine function influences disease susceptibility. This paper catalogues the evidence for immunomodulatory consequences of predicted endocrine changes in Lady Windermere syndrome, with emphasis on the immune response to NTM. Collectively, the data warrant further exploration of an endocrine link to disease susceptibility in Lady Windermere syndrome.
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Affiliation(s)
- M R Holt
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Gallipoli Medical Research Institute, Greenslopes Private Hospital, Brisbane, Queensland, Australia
| | - J J Miles
- Centre for Biodiscovery and Molecular Development of Therapeutics, Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, Queensland, Australia
| | - W J Inder
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Department of Diabetes and Endocrinology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - R M Thomson
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Gallipoli Medical Research Institute, Greenslopes Private Hospital, Brisbane, Queensland, Australia
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15
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Ning P, Zheng Y, Luo Q, Liu X, Kang Y, Zhang Y, Zhang R, Xu Y, Yang D, Xi W, Wang K, Chen Y, An S, Gao Z. Metabolic profiles in community-acquired pneumonia: developing assessment tools for disease severity. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2018; 22:130. [PMID: 29759075 PMCID: PMC5952829 DOI: 10.1186/s13054-018-2049-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Accepted: 04/23/2018] [Indexed: 01/11/2023]
Abstract
Background This study aimed to determine whether community-acquired pneumonia (CAP) had a metabolic profile and whether this profile can be used for disease severity assessment. Methods A total of 175 individuals including 119 CAP patients and 56 controls were enrolled and divided into two cohorts. Serum samples from a discovery cohort (n = 102, including 38 non-severe CAP, 30 severe CAP, and 34 age and sex-matched controls) were determined by untargeted ultra-high-performance liquid chromatography with tandem mass spectrometry (LC-MS/MS)-based metabolomics. Selected differential metabolites between CAP patients versus controls, and between the severe CAP group versus non-severe CAP group, were confirmed by targeted mass spectrometry assays in a validation cohort (n = 73, including 32 non-severe CAP, 19 severe CAP and 22 controls). Pearson’s correlation analysis was performed to assess relationships between the identified metabolites and clinical severity of CAP. The area under the curve (AUC), sensitivity and specificity of the metabolites for predicting the severity of CAP were also investigated. Results The metabolic signature was markedly different between CAP patients and controls. Fifteen metabolites were found to be significantly dysregulated in CAP patients, which were mainly mapped to the metabolic pathways of sphingolipid, arginine, pyruvate and inositol phosphate. The alternation trends of five metabolites among the three groups including sphinganine, p-Cresol sulfate, dehydroepiandrosterone sulfate (DHEA-S), lactate and l-arginine in the validation cohort were consistent with those in the discovery cohort. Significantly lower concentrations of sphinganine, p-Cresol sulfate and DHEA-S were observed in CAP patients than in controls (p < 0.05). Serum lactate and sphinganine levels were positively correlated with confusion, urea level, respiratory rate, blood pressure, and age > 65 years (CURB-65), pneumonia severity index (PSI) and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, while DHEA-S inversely correlated with the three scoring systems. Combining lactate, sphinganine and DHEA-S as a metabolite panel for discriminating severe CAP from non-severe CAP exhibited a better AUC of 0.911 (95% confidence interval 0.825–0.998) than CURB-65, PSI and APACHE II scores. Conclusions This study demonstrates that serum metabolomics approaches based on the LC-MS/MS platform can be applied as a tool to reveal metabolic changes during CAP and establish a metabolite signature related to disease severity. Trial registration ClinicalTrials.gov, NCT03093220. Registered retrospectively on 28 March 2017. Electronic supplementary material The online version of this article (10.1186/s13054-018-2049-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Pu Ning
- Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Beijing, 100044, China
| | - Yali Zheng
- Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Beijing, 100044, China
| | - Qiongzhen Luo
- Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Beijing, 100044, China
| | - Xiaohui Liu
- National Protein Science Technology Center, Tsinghua University, Beijing, China.,School of Life Sciences, Tsinghua University, Beijing, China
| | - Yu Kang
- CAS Key Laboratory of Genome Sciences and Information, Beijing Institute of Genomics, Chinese Academy of Sciences, Beijing, China
| | - Yan Zhang
- National Engineering Research Center for Beijing Biochip Technology, Beijing, China
| | - Rongbao Zhang
- Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Beijing, 100044, China
| | - Yu Xu
- Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Beijing, 100044, China
| | - Donghong Yang
- Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Beijing, 100044, China
| | - Wen Xi
- Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Beijing, 100044, China
| | - Keqiang Wang
- Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Beijing, 100044, China
| | - Yusheng Chen
- Department of Respiratory Medicine, Fujian Provincial Hospital, Fuzhou, China
| | - Shuchang An
- Department of Respiratory Medicine, First Hospital of Tsinghua University, Beijing, China
| | - Zhancheng Gao
- Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Beijing, 100044, China.
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16
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Sweetland AC, Kritski A, Oquendo MA, Sublette ME, Norcini Pala A, Silva LRB, Karpati A, Silva EC, Moraes MO, Silva JRLE, Wainberg ML. Addressing the tuberculosis-depression syndemic to end the tuberculosis epidemic. Int J Tuberc Lung Dis 2018; 21:852-861. [PMID: 28786792 DOI: 10.5588/ijtld.16.0584] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Tuberculosis (TB) and depression act synergistically via social, behavioral, and biological mechanisms to magnify the burden of disease. Clinical depression is a common, under-recognized, yet treatable condition that, if comorbid with TB, is associated with increased morbidity, mortality, community TB transmission, and drug resistance. Depression may increase risk of TB reactivation, contribute to disease progression, and/or inhibit the physiological response to anti-tuberculosis treatment because of poverty, undernutrition, immunosuppression, and/or negative coping behaviors, including substance abuse. Tuberculous infection and/or disease reactivation may precipitate depression as a result of the inflammatory response and/or dysregulation of the hypothalamic-pituitary-adrenal axis. Clinical depression may also be triggered by TB-related stigma, exacerbating other underlying social vulnerabilities, and/or may be attributed to the side effects of anti-tuberculosis treatment. Depression may negatively impact health behaviors such as diet, health care seeking, medication adherence, and/or treatment completion, posing a significant challenge for global TB elimination. As several of the core symptoms of TB and depression overlap, depression often goes unrecognized in individuals with active TB, or is dismissed as a normative reaction to situational stress. We used evidence to reframe TB and depression comorbidity as the 'TB-depression syndemic', and identified critical research gaps to further elucidate the underlying mechanisms. The World Health Organization's Global End TB Strategy calls for integrated patient-centered care and prevention linked to social protection and innovative research. It will require multidisciplinary approaches that consider conditions such as TB and depression together, rather than as separate problems and diseases, to end the global TB epidemic.
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Affiliation(s)
- A C Sweetland
- Department of Psychiatry, Columbia College of Physicians and Surgeons, New York, New York, USA; New York State Psychiatric Institute, New York, New York, USA
| | - A Kritski
- Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil TB Research Network (REDE-TB), Rio de Janeiro, Rio de Janeiro, Brazil
| | - M A Oquendo
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - M E Sublette
- Department of Psychiatry, Columbia College of Physicians and Surgeons, New York, New York, USA; New York State Psychiatric Institute, New York, New York, USA
| | - A Norcini Pala
- Department of Psychiatry, Columbia College of Physicians and Surgeons, New York, New York, USA; New York State Psychiatric Institute, New York, New York, USA
| | - L R Batista Silva
- Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Rio de Janeiro, Brazil
| | - A Karpati
- Vital Strategies, New York, New York, USA
| | - E C Silva
- State University of North Fluminense Darcy Ribeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - M O Moraes
- Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Rio de Janeiro, Brazil
| | - J R Lapa E Silva
- Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - M L Wainberg
- Department of Psychiatry, Columbia College of Physicians and Surgeons, New York, New York, USA; New York State Psychiatric Institute, New York, New York, USA
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17
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Mansukoski L, Sparacello VS. Smaller long bone cross-sectional size in people who died of tuberculosis: Insights on frailty factors from a 19th and early 20th century Finnish population. INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2018; 20:38-44. [PMID: 29496214 DOI: 10.1016/j.ijpp.2017.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 12/26/2017] [Accepted: 12/26/2017] [Indexed: 06/08/2023]
Abstract
There is little research on how individuals suffering from tuberculosis may differ from those not infected in terms of overall skeletal morphology. Tuberculosis was endemic in 19th and early 20th century Finland making documented skeletal collections of Finns ideal to study effects of the disease on bone. The present study compares long bone cross-sectional total area between individuals who died of tuberculosis and those with another recorded cause of death in a Finnish sample. Adult male individuals (N = 105) were selected for analysis. Complete humeri (N = 56), femora (N = 66) and tibiae (N = 64) were 3D scanned using a laser scanner and total cross-sectional areas calculated with AsciiSection software. Individuals who died of tuberculosis (N = 24, 15 humeri, 14 femora, 13 tibiae) had, when standardized for body size, significantly smaller total cross-sectional femoral and humeral, but not tibial, areas. The mechanisms behind the observed relationship may reflect a combination of biological 'frailty' in terms of susceptibility to infection, reduced childhood activity and/or vitamin D deficiency, which possibly influenced both subperiosteal development during adolescence and, later, susceptibility to contracting and dying of TB. Due to the relatively small sample future studies are needed to further investigate the relationship between TB and bone cross-sectional size.
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Affiliation(s)
- Liina Mansukoski
- Department of Anthropology, Durham University, Dawson Building South Road, Durham, DH1 3LE, United Kingdom; School of Sport, Exercise and Health Sciences, Loughborough University, Ashby Road, Loughborough, Leicestershire, LE11 3TU, United Kingdom.
| | - Vitale Stefano Sparacello
- UMR5199 PACEA, Univ. Bordeaux, Batiment B8, Avenue Geoffroy Saint Hilaire, CS 50023, 33615 Pessac Cedex, France
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18
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Tsai MH, Huang HC, Peng YS, Chen YC, Tian YC, Yang CW, Lien JM, Fang JT, Wu CS, Hsieh SY, Lee FY. Dehydroepiandrosterone sulfate and dehydroepiandrosterone sulfate/cortisol ratio in cirrhotic patients with septic shock: another sign of hepatoadrenal syndrome? Crit Care 2017; 21:214. [PMID: 28810889 PMCID: PMC5557480 DOI: 10.1186/s13054-017-1768-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 06/20/2017] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Cirrhotic patients are susceptible to sepsis and critical illness-related corticosteroid insufficiency (CIRCI). Dehydroepiandrosterone sulfate (DHEAS) is a corticotropin-dependent adrenal androgen, which has immunostimulating and antiglucocorticoid effects. Considering the synchronized synthesis of cortisol and DHEAS and their opposing effects to each other, investigators have proposed measuring these two hormones as a ratio. Severe sepsis has been associated with low DHEAS, especially relative to high cortisol. Despite growing interest in the role of adrenal androgen replacement in critical illness, there have been no data about DHEAS and the DHEAS/cortisol ratio in patients with liver cirrhosis. We studied whether low concentrations of DHEAS and decreased DHEAS/cortisol ratio are associated with poor outcome in patients with liver cirrhosis and septic shock. METHODS We recruited 46 cirrhotic patients with septic shock, and 46 noncirrhotic counterparts matched by age and sex. We evaluated adrenal function using the short corticotropin stimulation test and analyzed the relation between DHEAS and cortisol. RESULTS While the nonsurvivors in the cirrhotic group had significantly lower baseline DHEAS, lower baseline DHEAS/cortisol ratio, and reduced increments of both DHEAS and cortisol upon corticotropin stimulation, the survivors had lower baseline cortisol. Cirrhotic patients with lower DHEAS/cortisol ratio (<1.50) had higher levels of interleukin-6 and tumor necrosis factor alpha, higher Sequential Organ Failure Assessment scores, and higher rates of CIRCI and hospital mortality. Using the area under the receiver operating characteristic (AUROC) curve, both DHEAS and the DHEAS/cortisol ratio demonstrated a good discriminative power for predicting hospital survival (AUROC 0.807 and 0.925 respectively). The cirrhotic group had lower DHEAS and DHEAS/cortisol ratio but higher rates of CIRCI and hospital mortality, compared to the noncirrhotic group. CONCLUSIONS There is dissociation between cortisol (increased) and DHEAS (decreased) in those cirrhotic patients who succumb to septic shock. Low DHEAS/cortisol ratios are associated with more severe diseases, inflammation, and CIRCI and can serve as a prognostic marker. More investigations are needed to evaluate the role of adrenal androgen in this clinical setting.
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Affiliation(s)
- Ming-Hung Tsai
- Division of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Hui-Chun Huang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taipei Veteran General Hospital, No. 201, Section 2, Shih-Pai Road, Taipei, 11217 Taiwan
- Faculty of Medicine, Yang-Ming University School of Medicine, Taipei, Taiwan
- Division of General Medicine, Department of Medicine, Taipei Veteran General Hospital, Taipei, Taiwan
| | - Yun-Shing Peng
- Division of Endocrinology, Chang Gung Memorial Hospital, Chia-Yi, Taiwan
- Chang Gung University, Taoyuan, Taiwan
| | - Yung-Chang Chen
- Chang Gung University, Taoyuan, Taiwan
- Division of Critical Care Nephrology, Kidney Institute, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Ya-Chung Tian
- Chang Gung University, Taoyuan, Taiwan
- Division of Critical Care Nephrology, Kidney Institute, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Chih-Wei Yang
- Chang Gung University, Taoyuan, Taiwan
- Division of Critical Care Nephrology, Kidney Institute, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Jau-Min Lien
- Division of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Ji-Tseng Fang
- Chang Gung University, Taoyuan, Taiwan
- Division of Critical Care Nephrology, Kidney Institute, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Cheng-Shyong Wu
- Chang Gung University, Taoyuan, Taiwan
- Division of Gastroenterology, Chang Gung Memorial Hospital, Chia-Yi, Taiwan
| | - Sen-Yung Hsieh
- Division of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Fa-Yauh Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taipei Veteran General Hospital, No. 201, Section 2, Shih-Pai Road, Taipei, 11217 Taiwan
- Faculty of Medicine, Yang-Ming University School of Medicine, Taipei, Taiwan
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19
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Díaz A, Bongiovanni B, D’Attilio L, Santucci N, Dídoli G, Fernández RDV, Kovalevski L, Lioi S, Gardeñez W, Brandan N, Nannini LJ, Besedovsky H, del Rey A, Bottasso O, Bay ML. The clinical recovery of tuberculosis patients undergoing specific treatment is associated with changes in the immune and neuroendocrine responses. Pathog Dis 2017; 75:4033034. [DOI: 10.1093/femspd/ftx087] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 07/21/2017] [Indexed: 01/18/2023] Open
Affiliation(s)
- Ariana Díaz
- Instituto de Inmunología Clínica y Experimental de Rosario, UNR-CONICET, 2000 Rosario, Santa Fe, Argentina
| | - Bettina Bongiovanni
- Instituto de Inmunología Clínica y Experimental de Rosario, UNR-CONICET, 2000 Rosario, Santa Fe, Argentina
| | - Luciano D’Attilio
- Instituto de Inmunología Clínica y Experimental de Rosario, UNR-CONICET, 2000 Rosario, Santa Fe, Argentina
| | - Natalia Santucci
- Instituto de Inmunología Clínica y Experimental de Rosario, UNR-CONICET, 2000 Rosario, Santa Fe, Argentina
| | - Griselda Dídoli
- Instituto de Inmunología Clínica y Experimental de Rosario, UNR-CONICET, 2000 Rosario, Santa Fe, Argentina
| | - Rocío del Valle Fernández
- Instituto de Inmunología Clínica y Experimental de Rosario, UNR-CONICET, 2000 Rosario, Santa Fe, Argentina
| | - Leandro Kovalevski
- Facultad de Ciencias Económicas y Estadística, UNR, Escuela de Estadística, 2000 Rosario, Santa Fe, Argentina
| | - Susana Lioi
- Laboratorio Central Rosario, Hospital Provincial del Centenario, 2000 Rosario, Santa Fe, Argentina
| | - Walter Gardeñez
- Servicio de Neumonología, Hospital Provincial del Centenario, 2000 Rosario, Santa Fe, Argentina
| | - Nadia Brandan
- Servicio de Neumonología, Hospital Escuela Eva Perón, 2152 Granadero Baigorria, Santa Fe, Argentina
| | - Luis J Nannini
- Servicio de Neumonología, Hospital Escuela Eva Perón, 2152 Granadero Baigorria, Santa Fe, Argentina
| | - Hugo Besedovsky
- Institute of Physiology and Pathophysiology, Philipps University, Faculty of Medicine, 35037 Marburg, Germany
| | - Adriana del Rey
- Institute of Physiology and Pathophysiology, Philipps University, Faculty of Medicine, 35037 Marburg, Germany
| | - Oscar Bottasso
- Instituto de Inmunología Clínica y Experimental de Rosario, UNR-CONICET, 2000 Rosario, Santa Fe, Argentina
| | - María Luisa Bay
- Instituto de Inmunología Clínica y Experimental de Rosario, UNR-CONICET, 2000 Rosario, Santa Fe, Argentina
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20
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Opolot JO, Theron AJ, MacPhail P, Feldman C, Anderson R. Effect of smoking on acute phase reactants, stress hormone responses and vitamin C in pulmonary tuberculosis. Afr Health Sci 2017; 17:337-345. [PMID: 29062328 DOI: 10.4314/ahs.v17i2.7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Chronic inflammation, possibly exacerbated by cigarette smoking, is considered to be the primary cause of pulmonary damage in patients with tuberculosis (TB). However, the mechanisms which underpin these harmful inflammatory responses, have not been well documented. OBJECTIVES The current study was undertaken to determine possible associations between systemic biomarkers of inflammation (acute phase reactants, stress hormones, leukocyte vitamin C) and smoking status in patients (n=71, 20 smokers) with newly-diagnosed pulmonary TB presenting at a tertiary hospital, Johannesburg, South Africa. METHODS Plasma concentrations of C-reactive protein (CRP), ferritin, cortisol, epinephrine, norepinephrine, dopamine and leukocyte vitamin C were measured using a combination of immunonephelometric, radioimmunoassay, immunochromatographic and spectrophotometric procedures. Demographic, clinical and laboratory data was captured and analysed by parametric and non-parametric analyses where appropriate. RESULTS Smokers were predominantly males (P<0.0001), of older age (P<0.0003) with a significantly lower body mass index (P<0.03). Plasma levels of CRP, ferritin and dopamine were higher in the group of smokers in the setting of lower levels of epinephrine, and leukocyte vitamin C, with CRP and vitamin C attaining statistical significance (P<0.04 and P<0.02 respectively). Those of cortisol and norepinephrine were comparable to those of non-smokers, as were radiographic changes and clinical indices of disease activity. CONCLUSION Cigarette smoking is associated with an exaggerated systemic inflammatory response in pulmonary TB in the setting of decreased concentrations of leukocyte vitamin C. Although no significant associations with radiographic changes and most clinical indices of disease activity were evident on presentation, these pro-inflammatory interactions may have prognostic significance.
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Affiliation(s)
- John O Opolot
- Division of Pulmonology, Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Annette J Theron
- Department of Immunology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
- Tshwane Academic Division of the National Health Laboratory Service, Pretoria, South Africa
| | - Patrick MacPhail
- Division of Haematology/Oncology, Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Charles Feldman
- Division of Pulmonology, Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ronald Anderson
- Department of Immunology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
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Kamin HS, Kertes DA. Cortisol and DHEA in development and psychopathology. Horm Behav 2017; 89:69-85. [PMID: 27979632 DOI: 10.1016/j.yhbeh.2016.11.018] [Citation(s) in RCA: 167] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 11/19/2016] [Accepted: 11/30/2016] [Indexed: 01/01/2023]
Abstract
Dehydroepiandrosterone (DHEA) and cortisol are the most abundant hormones of the human fetal and adult adrenals released as end products of a tightly coordinated endocrine response to stress. Together, they mediate short- and long-term stress responses and enable physiological and behavioral adjustments necessary for maintaining homeostasis. Detrimental effects of chronic or repeated elevations in cortisol on behavioral and emotional health are well documented. Evidence for actions of DHEA that offset or oppose those of cortisol has stimulated interest in examining their levels as a ratio, as an alternate index of adrenocortical activity and the net effects of cortisol. Such research necessitates a thorough understanding of the co-actions of these hormones on physiological functioning and in association with developmental outcomes. This review addresses the state of the science in understanding the role of DHEA, cortisol, and their ratio in typical development and developmental psychopathology. A rationale for studying DHEA and cortisol in concert is supported by physiological data on the coordinated synthesis and release of these hormones in the adrenal and by their opposing physiological actions. We then present evidence that researching cortisol and DHEA necessitates a developmental perspective. Age-related changes in DHEA and cortisol are described from the perinatal period through adolescence, along with observed associations of these hormones with developmental psychopathology. Along the way, we identify several major knowledge gaps in the role of DHEA in modulating cortisol in typical development and developmental psychopathology with implications for future research.
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Affiliation(s)
- Hayley S Kamin
- Department of Psychology, University of Florida, Gainesville, FL 32611, USA
| | - Darlene A Kertes
- Department of Psychology, University of Florida, Gainesville, FL 32611, USA; University of Florida Genetics Institute, University of Florida, Gainesville, FL 32611, USA.
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Paudel S, Brown JL, Thapaliya S, Dhakal IP, Mikota SK, Gairhe KP, Shimozuru M, Tsubota T. Comparison of cortisol and thyroid hormones between tuberculosis-suspect and healthy elephants of Nepal. J Vet Med Sci 2016; 78:1713-1716. [PMID: 27452878 PMCID: PMC5138427 DOI: 10.1292/jvms.16-0212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We compared cortisol and thyroid hormone (T3 and T4) concentrations between tuberculosis
(TB)-suspected (n=10) and healthy (n=10) elephants of Nepal. Whole blood was collected
from captive elephants throughout Nepal, and TB testing was performed using the ElephantTB
STAT-PAK® and DPP VetTB® serological assays that detect antibodies
against Mycobacterium tuberculosis and M. bovis in
elephant serum. Cortisol, T3 and T4 were quantified by competitive enzyme immunoassays,
and the results showed no significant differences in hormone concentrations between
TB-suspect and healthy elephants. These preliminary data suggest neither adrenal nor
thyroid function is altered by TB disease status. However, more elephants, including those
positively diagnosed for TB by trunk wash cultures, need to be evaluated over time to
confirm results.
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Affiliation(s)
- Sarad Paudel
- Laboratory of Wildlife Biology and Medicine, Graduate School of Veterinary Medicine, Hokkaido University, Kita 18, Nishi 9, Kita-ku, Sapporo, Hokkaido 060-0818, Japan
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Normal estrogen, but low dehydroepiandrosterone levels, in women with pulmonary Mycobacterium avium complex. A preliminary study. Ann Am Thorac Soc 2015; 11:908-14. [PMID: 24963545 DOI: 10.1513/annalsats.201312-422oc] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE For unclear reasons, the phenotypical hosts for nontuberculous mycobacterial lung infection are often thin, elderly, white women without underlying lung disease. As these women are usually postmenopausal, we hypothesized that a state of relative hormone deficiency may predispose some women to pulmonary nontuberculous mycobacterial infection. OBJECTIVES To conduct a prospective cross-sectional study to assess for alterations in systemic levels of sex hormones in patients with confirmed pulmonary Mycobacterium avium complex infection compared with healthy control subjects. METHODS Female patients with pulmonary M. avium complex infection (n = 35) were recruited along with similar-aged control subjects (n = 27) without lung disease from the general population of our institution. Levels of dehydroepiandrosterone-sulfate (DHEA-S), estrone, and ultrasensitive estradiol were measured from sampled blood. MEASUREMENTS AND MAIN RESULTS DHEA-S levels of patients with M. avium complex infection were significantly lower than control subjects (mean 33 μg/dl vs. 59 μg/dl, P = 0.001). No significant difference was found in the levels of estrone (mean, 27 pg/ml vs. 28 pg/ml, P = 0.665) or ultrasensitive estradiol (mean, 9 pg/ml vs. 9 pg/ml, P = 0.364). Patients with M. avium complex had a lower body mass index (BMI) than control subjects (mean, 22 vs. 26, P = 0.001). There was no association between levels of DHEA-S, estrone, or estradiol, and BMI or age. CONCLUSIONS Women with M. avium complex infection had lower DHEA-S levels, but not lower estrogen levels, compared with control subjects. There was no relationship between BMI and hormone levels in the study population. Further study of these hormonal effects on immune function in nontuberculous mycobacterial infection is warranted.
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Adrenal steroids modulate the immune response during Brucella abortus infection by a mechanism that depends on the regulation of cytokine production. Infect Immun 2015; 83:1973-82. [PMID: 25733519 DOI: 10.1128/iai.03090-14] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 02/16/2015] [Indexed: 01/18/2023] Open
Abstract
Human brucellosis is a protean disease with a diversity of clinical signs and symptoms resulting from infection with Brucella species. Recent reports suggest a cross-regulation between adrenal steroids (cortisol and dehydroepiandrosterone [DHEA]) and the immune system. Monocytes and macrophages are the main replication niche for Brucella. Therefore, we investigated the role of adrenal hormones on the modulation of the immune response mediated by macrophages in B. abortus infection. Cortisol treatment during B. abortus infection significantly inhibits cytokine, chemokine, and MMP-9 secretion. In contrast, DHEA treatment had no effect. However, DHEA treatment increases the expression of costimulatory molecules (CD40, CD86), the adhesion molecule CD54, and major histocompatibility complex class I (MHC-I) and MHC-II expression on the surface of B. abortus-infected monocytes. It is known that B. abortus infection inhibits MHC-I and MHC-II expression induced by gamma interferon (IFN-γ) treatment. DHEA reverses B. abortus downmodulation of the MHC-I and -II expression induced by IFN-γ. Taken together, our data indicate that DHEA immune intervention may positively affect monocyte activity during B. abortus infection.
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D'Attilio L, Díaz A, Santucci N, Bongiovanni B, Gardeñez W, Marchesini M, Bogué C, Dídoli G, Bottasso O, Bay ML. Levels of inflammatory cytokines, adrenal steroids, and mRNA for GRα, GRβ and 11βHSD1 in TB pleurisy. Tuberculosis (Edinb) 2013; 93:635-41. [PMID: 23988280 DOI: 10.1016/j.tube.2013.07.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 07/12/2013] [Accepted: 07/30/2013] [Indexed: 12/25/2022]
Abstract
Our previous work on the immune-endocrine features of patients with pulmonary tuberculosis (TB) showed markedly decreased plasma levels of dehydroepiandrosterone (DHEA) together with augmented concentrations of Cortisol and pro- and anti-inflammatory cytokines. Studies in peripheral blood mononuclear cells (PBMC) indicated a lower mRNA α/β ratio of glucocorticoid receptors -GR- together with a higher 11β-hydroxysteroid dehydrogenase type 1 (11βHSD1) mRNA expression in cases with severe pulmonary TB. Since Pleural TB (PLTB) is a rather benign manifestation of TB, we now analyzed the systemic and local immune-endocrine profile as well as the GRα, GRβ, 11βHSD1 and 11βHSD2 transcripts in PBMC and pleural effusion mononuclear cells (PEMC) of patients with PLTB. PLTB patients had increased levels of IL-1β, IL-6 and IFNγ together with reduced Cortisol and DHEA concentrations in pleural fluids. Also, a significantly increased expression of 11βHSD1 and GRα was found in PEMC compared to PBMC. Findings point out to an appropriate immune response and a substantial inflammatory reaction, wherein the low Cortisol concentrations may be equally effective, because of the increased expression of GRα and 11βHSD1 transcripts which may optimize the immunomodulatory properties of Cortisol.
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Affiliation(s)
- Luciano D'Attilio
- Institute of Immunology, School of Medical Sciences, National University of Rosario, Santa Fe 3100, CUAS IV 2° Flor, Rosario 2000, Argentina.
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Angerami M, Suarez G, Pascutti MF, Salomon H, Bottasso O, Quiroga MF. Modulation of the phenotype and function of Mycobacterium tuberculosis-stimulated dendritic cells by adrenal steroids. Int Immunol 2013; 25:405-11. [PMID: 23446847 DOI: 10.1093/intimm/dxt004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Cell-mediated immunity, cytokines induced during the specific immune response and T-cell populations are crucial factors for containing Mycobacterium tuberculosis infection. Recent reports suggest a cross-regulation between adrenal steroids (glucocorticoids and dehydroepiandrosterone, DHEA) and the function of antigen-presenting cells (APCs). Therefore, we investigated the role of adrenal hormones on the functional capacity of M. tuberculosis-induced dendritic cells (DCs). Cortisol significantly inhibited the functions of M. tuberculosis-induced DCs. Interestingly, the presence of DHEA enhanced the M. tuberculosis-induced expression of MHC I, MHC II and CD86 and also increased ERK1/2 phosphorylation. Moreover, DHEA improved the production of IL-12 in response to M. tuberculosis stimulation, diminished IL-10 secretion and could not modify TNF-α synthesis. Importantly, we observed that DHEA enhanced the antigen-specific T-cell proliferation and IFN-γ production induced by M. tuberculosis-stimulated DC. These data show for the first time the relevance of the adrenal axis (especially of DHEA) in the modulation of DC function in the context of tuberculosis, a disease where the induction of a Th1 environment by APCs is crucial for the development of an effective immune response to the mycobacteria.
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Affiliation(s)
- Matias Angerami
- Instituto de Investigaciones Biomédicas en Retrovirus y SIDA, University of Buenos Aires, Buenos Aires, Argentina
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Bottasso O, Bay ML, Besedovsky H, Del Rey A. Adverse neuro-immune-endocrine interactions in patients with active tuberculosis. Mol Cell Neurosci 2012; 53:77-85. [PMID: 23147110 DOI: 10.1016/j.mcn.2012.11.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Revised: 11/01/2012] [Accepted: 11/02/2012] [Indexed: 12/21/2022] Open
Abstract
The nervous, endocrine and immune systems play a crucial role in maintaining homeostasis and interact with each other for a successful defensive strategy against injurious agents. However, the situation is different in long-term diseases with marked inflammation, in which defensive mechanisms become altered. In the case of tuberculosis (TB), this is highlighted by several facts: an imbalance of plasma immune and endocrine mediators, that results in an adverse environment for mounting an adequate response against mycobacteria and controlling inflammation; the demonstration that dehidroepiandrosterone (DHEA) secretion by a human adrenal cell line can be inhibited by culture supernatants from Mycobacterium tuberculosis-stimulated peripheral blood mononuclear cells - PBMC - of TB patients, with this effect being partly reverted when neutralizing transforming growth factor-β in such supernantants; the in vitro effects of adrenal steroids on the specific immune response of PBMC from TB patients, that is a cortisol inhibition of mycobacterial antigen-driven lymphoproliferation and interferon-γ production as well as a suppression of TGF-β production in DHEA-treated PBMC; and lastly the demonstration that immune and endocrine compounds participating in the regulation of energy sources and immune activity correlated with the consumption state of TB patients. Collectively, immune-endocrine disturbances of TB patients are involved in critical components of disease pathology with implications in the impaired clinical status and unfavorable disease outcome. This article is part of a Special Issue entitled 'Neuroinflammation in neurodegeneration and neurodysfunction'.
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Affiliation(s)
- Oscar Bottasso
- Instituto de Inmunología, Facultad de Ciencias Médicas, Universidad Nacional de Rosario, Argentina.
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Laver PN, Ganswindt A, Ganswindt SB, Alexander KA. Non-invasive monitoring of glucocorticoid metabolites in banded mongooses (Mungos mungo) in response to physiological and biological challenges. Gen Comp Endocrinol 2012; 179:178-83. [PMID: 22926328 DOI: 10.1016/j.ygcen.2012.08.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Revised: 07/27/2012] [Accepted: 08/05/2012] [Indexed: 10/28/2022]
Abstract
Free-ranging banded mongooses are infected by the novel pathogen, Mycobacterium mungi in northern Botswana. A reliable method for determining stress-related physiological responses in banded mongooses will increase our understanding of the stress response in M. mungi infection. Therefore, our aim was to examine the suitability of four enzyme immunoassays (EIAs) for monitoring adrenocortical endocrine function in captive and free-ranging banded mongooses based on fecal glucocorticoid metabolite (FGM) analysis. A conducted adrenocorticotropic hormone challenge revealed suitability of a valid measurement of FGM levels in banded mongoose feces for all four tested EIAs, with an 11-oxoetiocholanolone assay detecting 11,17-dioxoandrostanes (11,17-DOA) performing best. Subsequent analyses using only this EIA showed the expected decrease in FGM concentrations 48 h after administering dexamethasone sodium phosphate. Furthermore, captive mongooses showed higher FGM concentrations during reproductive activity, agonistic encounters and depredation events. Finally, a late-stage, tuberculosis-infected moribund mongoose in a free-ranging troop had a 54-fold elevation in FGM levels relative to the rest of the troop. Measurements of gastrointestinal transit times and FGM metabolism post-defecation indicate that the time delay of FGM excretion approximately corresponded with food transit time and that FGM metabolism is minimal up to 8h post-defecation. The ability to reliably assess adrenocortical endocrine function in banded mongoose now provides a solid basis for advancing our understanding of infectious disease and endocrinology in this species.
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Affiliation(s)
- Peter N Laver
- Department of Fish and Wildlife Conservation, 100 Cheatham Hall, Virginia Tech, Blacksburg, VA 24061-0321, USA.
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D’Attilio L, Bozza VV, Santucci N, Bongiovanni B, Dídoli G, Radcliffe S, Besedovsky H, del Rey A, Bottasso O, Bay ML. TGF-β neutralization abrogates the inhibited DHEA production mediated by factors released from M. tuberculosis-stimulated PBMC. Ann N Y Acad Sci 2012; 1262:1-9. [DOI: 10.1111/j.1749-6632.2012.06644.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Bongiovanni B, Díaz A, D’Attilio L, Santucci N, Dídoli G, Lioi S, Nannini LJ, Gardeñez W, Bogue C, Besedovsky H, del Rey A, Bottasso O, Bay ML. Changes in the immune and endocrine responses of patients with pulmonary tuberculosis undergoing specific treatment. Ann N Y Acad Sci 2012; 1262:10-5. [DOI: 10.1111/j.1749-6632.2012.06643.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Quiroga MF, Angerami MT, Santucci N, Ameri D, Francos JL, Wallach J, Sued O, Cahn P, Salomón H, Bottasso O. Dynamics of adrenal steroids are related to variations in Th1 and Treg populations during Mycobacterium tuberculosis infection in HIV positive persons. PLoS One 2012; 7:e33061. [PMID: 22431997 PMCID: PMC3303789 DOI: 10.1371/journal.pone.0033061] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Accepted: 02/03/2012] [Indexed: 12/11/2022] Open
Abstract
Tuberculosis (TB) remains the most frequent cause of illness and death from an infectious agent, and its interaction with HIV has devastating effects. We determined plasma levels of dehydroepiandrosterone (DHEA), its circulating form DHEA-suphate (DHEA-s) and cortisol in different stages of M. tuberculosis infection, and explored their role on the Th1 and Treg populations during different scenarios of HIV-TB coinfection, including the immune reconstitution inflammatory syndrome (IRIS), a condition related to antiretroviral treatment. DHEA levels were diminished in HIV-TB and HIV-TB IRIS patients compared to healthy donors (HD), HIV+ individuals and HIV+ individuals with latent TB (HIV-LTB), whereas dehydroepiandrosterone sulfate (DHEA-s) levels were markedly diminished in HIV-TB IRIS individuals. HIV-TB and IRIS patients presented a cortisol/DHEA ratio significantly higher than HIV+, HIV-LTB and HD individuals. A positive correlation was observed between DHEA-s and CD4 count among HIV-TB individuals. Conversely, cortisol plasma level inversely correlated with CD4 count within HIV-TB individuals. M. tuberculosis-specific Th1 lymphocyte count was increased after culturing PBMC from HIV-TB individuals in presence of DHEA. We observed an inverse correlation between DHEA-s plasma level and Treg frequency in co-infected individuals, and CD4+FoxP3+ Treg frequency was increased in HIV-TB and IRIS patients compared to other groups. Strikingly, we observed a prominent CD4+CD25-FoxP3+ population across HIV-TB and HIV-TB IRIS patients, which frequency correlated with DHEA plasma level. Finally, DHEA treatment negatively regulated FoxP3 expression without altering Treg frequency in co-infected patients. These data suggest an enhancing role for DHEA in the immune response against M. tuberculosis during HIV-TB coinfection and IRIS.
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Affiliation(s)
- Maria Florencia Quiroga
- Department of Microbiology, National Reference Center for AIDS, University of Buenos Aires School of Medicine, Buenos Aires, Argentina.
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Duell BL, Tan CK, Carey AJ, Wu F, Cripps AW, Ulett GC. Recent insights into microbial triggers of interleukin-10 production in the host and the impact on infectious disease pathogenesis. ACTA ACUST UNITED AC 2012; 64:295-313. [PMID: 22268692 DOI: 10.1111/j.1574-695x.2012.00931.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Revised: 01/17/2012] [Accepted: 01/17/2012] [Indexed: 02/06/2023]
Abstract
Since its initial description as a Th2-cytokine antagonistic to interferon-alpha and granulocyte-macrophage colony-stimulating factor, many studies have shown various anti-inflammatory actions of interleukin-10 (IL-10), and its role in infection as a key regulator of innate immunity. Studies have shown that IL-10 induced in response to microorganisms and their products plays a central role in shaping pathogenesis. IL-10 appears to function as both sword and shield in the response to varied groups of microorganisms in its capacity to mediate protective immunity against some organisms but increase susceptibility to other infections. The nature of IL-10 as a pleiotropic modulator of host responses to microorganisms is explained, in part, by its potent and varied effects on different immune effector cells which influence antimicrobial activity. A new understanding of how microorganisms trigger IL-10 responses is emerging, along with recent discoveries of how IL-10 produced during disease might be harnessed for better protective or therapeutic strategies. In this review, we summarize studies from the past 5 years that have reported the induction of IL-10 by different classes of pathogenic microorganisms, including protozoa, nematodes, fungi, viruses and bacteria and discuss the impact of this induction on the persistence and/or clearance of microorganisms in the host.
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Affiliation(s)
- Benjamin L Duell
- School of Medical Sciences, Centre for Medicine and Oral Health, Griffith University, Gold Coast Campus, Gold Coast, Qld, Australia
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Santucci N, D'Attilio L, Kovalevski L, Bozza V, Besedovsky H, del Rey A, Bay ML, Bottasso O. A multifaceted analysis of immune-endocrine-metabolic alterations in patients with pulmonary tuberculosis. PLoS One 2011; 6:e26363. [PMID: 22022605 PMCID: PMC3192801 DOI: 10.1371/journal.pone.0026363] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Accepted: 09/25/2011] [Indexed: 12/16/2022] Open
Abstract
Our study investigated the circulating levels of factors involved in immune-inflammatory-endocrine-metabolic responses in patients with tuberculosis with the aim of uncovering a relation between certain immune and hormonal patterns, their clinical status and in vitro immune response. The concentration of leptin, adiponectin, IL-6, IL-1β, ghrelin, C-reactive protein (CRP), cortisol and dehydroepiandrosterone (DHEA), and the in vitro immune response (lymphoproliferation and IFN-γ production) was evaluated in 53 patients with active untreated tuberculosis, 27 household contacts and 25 healthy controls, without significant age- or sex-related differences. Patients had a lower body mass index (BMI), reduced levels of leptin and DHEA, and increased concentrations of CRP, IL-6, cortisol, IL-1β and nearly significant adiponectin values than household contacts and controls. Within tuberculosis patients the BMI and leptin levels were positively correlated and decreased with increasing disease severity, whereas higher concentrations of IL-6, CRP, IL-1β, cortisol, and ghrelin were seen in cases with moderate to severe tuberculosis. Household contacts had lower DHEA and higher IL-6 levels than controls. Group classification by means of discriminant analysis and the k-nearest neighbor method showed that tuberculosis patients were clearly different from the other groups, having higher levels of CRP and lower DHEA concentration and BMI. Furthermore, plasma leptin levels were positively associated with the basal in vitro IFN-γ production and the ConA-driven proliferation of cells from tuberculosis patients. Present alterations in the communication between the neuro-endocrine and immune systems in tuberculosis may contribute to disease worsening.
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Affiliation(s)
- Natalia Santucci
- Instituto de Inmunología, Facultad de Ciencias Médicas, Universidad Nacional de Rosario, Rosario, Argentina
| | - Luciano D'Attilio
- Instituto de Inmunología, Facultad de Ciencias Médicas, Universidad Nacional de Rosario, Rosario, Argentina
| | - Leandro Kovalevski
- Instituto de Investigaciones Teóricas y Aplicadas, Escuela de Estadística, Facultad de Ciencias Económicas y Estadística, Universidad Nacional de Rosario, Rosario, Argentina
| | - Verónica Bozza
- Instituto de Inmunología, Facultad de Ciencias Médicas, Universidad Nacional de Rosario, Rosario, Argentina
| | - Hugo Besedovsky
- Institute of Physiology and Pathophysiology, Marburg, Germany
| | - Adriana del Rey
- Institute of Physiology and Pathophysiology, Marburg, Germany
| | - María Luisa Bay
- Instituto de Inmunología, Facultad de Ciencias Médicas, Universidad Nacional de Rosario, Rosario, Argentina
| | - Oscar Bottasso
- Instituto de Inmunología, Facultad de Ciencias Médicas, Universidad Nacional de Rosario, Rosario, Argentina
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Pérez AR, Bertoya AA, Revelli S, García F. A high corticosterone/DHEA-s ratio in young rats infected with Trypanosoma cruzi is associated with increased susceptibility. Mem Inst Oswaldo Cruz 2011; 106:416-23. [DOI: 10.1590/s0074-02762011000400006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2010] [Accepted: 04/20/2011] [Indexed: 11/22/2022] Open
Affiliation(s)
- Ana Rosa Pérez
- Universidad Nacional de Rosario, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas, Argentina
| | | | | | - Fabiana García
- Universidad Nacional de Rosario, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas, Argentina
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Pérez AR, Silva-Barbosa SD, Berbert LR, Revelli S, Beloscar J, Savino W, Bottasso O. Immunoneuroendocrine alterations in patients with progressive forms of chronic Chagas disease. J Neuroimmunol 2011; 235:84-90. [PMID: 21496931 DOI: 10.1016/j.jneuroim.2011.03.010] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2010] [Revised: 03/01/2011] [Accepted: 03/21/2011] [Indexed: 01/10/2023]
Abstract
We studied the features of parallel immunoneuroendocrine responses in patients with different degrees of chronic Chagas myocarditis (indeterminate, mild/moderate or severe). A systemic inflammatory scenario was evident in patients with severe myocarditis compared to healthy subjects. This was paralleled by a disrupted activation of the hypothalamus-pituitary-adrenal axis, characterized by decreased concentrations of dehydroepiandrosterone-sulfate (DHEA-s) and an unbalanced cortisol/DHEA-s ratio, reinforcing the view that severe Chagas disease is devoid of an adequate anti-inflammatory milieu, likely involved in pathology. Our study constitutes the first demonstration of neuroendocrine disturbances, in parallel to a systemic inflammatory profile, during progressive human Chagas disease.
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Affiliation(s)
- A R Pérez
- Instituto de Inmunología, Facultad de Ciencias Médicas, Universidad Nacional de Rosario, Argentina.
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D'Attilio L, Trini E, Bongiovanni B, Dídoli G, Gardeñez W, Nannini LJ, Giri A, Bottasso OA, Bay ML. mRNA expression of alpha and beta isoforms of glucocorticoid receptor in peripheral blood mononuclear cells of patients with tuberculosis and its relation with components of the immunoendocrine response. Brain Behav Immun 2011; 25:461-7. [PMID: 21093577 DOI: 10.1016/j.bbi.2010.11.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2010] [Revised: 10/31/2010] [Accepted: 11/10/2010] [Indexed: 12/22/2022] Open
Abstract
We have analyzed the expression of glucocorticoid receptor (GR) isoforms by real time RT-qPCR in PBMCs from 19 controls (HCo) and 28 TB patients (8 mild; 12 moderate; 8 severe), HIV(-) and similar sex and age distribution. mRNA hGRα/β ratios were found higher in TB patients respect to those in HCo. However, when analyzing for disease severity such overall trend was at the expense of mild and moderate patients, with severe cases showing a lower mRNA hGRα/β ratio with respect to the other patient groups. This suggested some degree of resistance to endogenous glucocorticoids in patients with severe TB, since hGRαα dimer mediates the biological functions of GC, with the GRβ isoform acting as an inhibitor of GC activity. Levels of IL-6, IL-18, IFN-γ and Cortisol were significantly increased in severe and moderate cases, whereas DHEA values were found decreased in them (p<0.05 respect to HCo). Analysis on the relationship between plasma levels of these immuno-endocrine mediators with the mRNA expression of hGRα and hGRβ showed that IL-6 was positively associated with hGRα in mild TB patients (p<0.01), whereas a negative correlation between IFN-γ and hGRβ was observed in severe cases (p<0.01). As regard to hormones, DHEA was positively associated with hGRα in moderate and severe cases (p<0.01). This group also showed a negative correlation between hGRα and Cortisol/DHEA ratios (p<0.05). Changes in the systemic levels of cytokine and adrenal hormones are likely to affect GR expression in a differential fashion and according to the amount of pulmonary involvement.
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Affiliation(s)
- Luciano D'Attilio
- Instituto de Inmunología, Facultad de Ciencias Médicas, Universidad Nacional de Rosario, 2000 Rosario, Argentina
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Niro S, Hennebert O, Morfin R. New insights into the protective effects of DHEA1). Horm Mol Biol Clin Investig 2010; 4:489-98. [PMID: 25961225 DOI: 10.1515/hmbci.2010.050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2010] [Accepted: 09/27/2010] [Indexed: 11/15/2022]
Abstract
Numerous studies investigated the effects of pharmacological doses of DHEA in animals. Among protective effects, antiglucocorticoid potencies, triggering and modulation of immunity and anticancerous effects were reported. Because DHEA levels decrease in aging humans, this steroid has been assayed as replacement therapy in elderly volunteers without striking evidence for beneficial effects. Examination of the investigations carried out in animals lead to suspect that, rather than DHEA, its metabolites produced in tissues could be responsible for some of the observed effects. Known as the "mother steroid", DHEA is a precursor for androgenic and estrogenic steroid hormones. In addition, DHEA is hydroxylated at the 7α position by the cytochrome P450 7B1 (CYP7B1), and the 7α-hydroxy-DHEA produced is a substrate for the 11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1) which converts it into 7β-hydroxy-DHEA. Both 7-hydroxylated metabolites were shown to favor the onset of immunity in mice and the activation of memory T cells in humans. Other DHEA and testosterone-derived metabolites, namely epiandrosterone and 5α-androstane-3β,17β-diol, are also substrates for the CYP7B1 and their 7α-hydroxylated products were also converted into the 7β epimer by the 11β-HSD1. When assayed at doses 104 lower than DHEA, 7β-hydroxy-epiandrosterone was shown to shift the prostaglandin metabolism patterns from prostaglandin E2 (PGE2) to PGD2 production, thus triggering the resolution of inflammation. In addition, 7β-hydroxy-epiandrosterone (1 nM) exerted the same effects as tamoxifen (1 μM) on the proliferation of MCF-7 and MDA-231 human breast cancer cells. These findings suggest that the observed effects of 7β-hydroxy-epiandrosterone could be mediated by estrogen receptors. This overview of recent research implies that DHEA does not act directly and that its effects are due to its metabolites when produced in tissues. Treatments with DHEA should take into account the target tissue abilities to produce the desired metabolites through the two key enzymes, CYP7B1 and 11β-HSD1.
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Affiliation(s)
- Peter R Donald
- Department of Paediatrics and Child Health, Health Sciences Faculty, Stellenbosch University, 7505 Tygerberg, South Africa.
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Choi IS, Cui Y, Koh YA, Lee HC, Cho YB, Won YH. Effects of dehydroepiandrosterone on Th2 cytokine production in peripheral blood mononuclear cells from asthmatics. Korean J Intern Med 2008; 23:176-81. [PMID: 19119254 PMCID: PMC2687683 DOI: 10.3904/kjim.2008.23.4.176] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS The androgen dehydroepiandrosterone (DHEA) attenuates allergic inflammatory airway reactions by down-regulating the Th2 response in mice. The purpose of this study was to investigate whether DHEA suppresses Th2 cytokine production in cultured peripheral blood mononuclear cells (PBMCs) from asthmatic patients. METHODS Sixty-one consecutive suspected asthmatic or non-asthmatic men underwent tests for asthma. PBMCs from each subject were cultured with and without DHEA (0.01~10 microM) for 48 h. The concentrations of interferon (IFN)-gamma, interleukin (IL)-5, and IL-10 in the culture supernatant were measured via an enzyme-linked immunosorbent assay. RESULTS In PBMCs from subjects exhibiting methacholine airway hyperresponsiveness (AHR), DHEA significantly suppressed IL-10, IL-5, and IFN-gamma production in a dose-dependent manner (all p<0.001) and tended to increase the IFN-gamma/IL-5 ratio (p=0.087). DHEA (10 microM) suppressed cytokine production to a greater degree in subjects with AHR compared with those without AHR (IL-5: 24.0+/-7.8% vs. 40.9+/-3.6%, p<0.01; IFN-gamma: 29.7+/-7.0% vs. 54.5+/-5.1%, p<0.01). Cytokine suppression was significantly related to AHR, serum total IgE levels, and skin reactivity to house dust mites. CONCLUSIONS DHEA suppressed both Th1 and Th2 responses, with a Th1 bias, and the degree of suppression was associated with the severity of AHR or atopy. Therefore, DHEA may be a useful therapy for asthma.
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Affiliation(s)
- Inseon S Choi
- Department of Allergy, Chonnam National University Medical School, Gwangju, Korea.
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