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Clapp C, Adán N, Ledesma-Colunga MG, Solís-Gutiérrez M, Triebel J, Martínez de la Escalera G. The role of the prolactin/vasoinhibin axis in rheumatoid arthritis: an integrative overview. Cell Mol Life Sci 2016; 73:2929-48. [PMID: 27026299 PMCID: PMC11108309 DOI: 10.1007/s00018-016-2187-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 03/08/2016] [Accepted: 03/18/2016] [Indexed: 12/29/2022]
Abstract
Rheumatoid arthritis (RA) is a chronic, autoimmune, inflammatory disease destroying articular cartilage and bone. The female preponderance and the influence of reproductive states in RA have long linked this disease to sexually dimorphic, reproductive hormones such as prolactin (PRL). PRL has immune-enhancing properties and increases in the circulation of some patients with RA. However, PRL also suppresses the immune system, stimulates the formation and survival of joint tissues, acquires antiangiogenic properties upon its cleavage to vasoinhibins, and protects against joint destruction and inflammation in the adjuvant-induced model of RA. This review addresses risk factors for RA linked to PRL, the effects of PRL and vasoinhibins on joint tissues, blood vessels, and immune cells, and the clinical and experimental data associating PRL with RA. This information provides important insights into the pathophysiology of RA and highlights protective actions of the PRL/vasoinhibin axis that could lead to therapeutic benefits.
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MESH Headings
- Angiogenesis Inhibitors/immunology
- Animals
- Arthritis, Rheumatoid/epidemiology
- Arthritis, Rheumatoid/immunology
- Arthritis, Rheumatoid/pathology
- Arthritis, Rheumatoid/physiopathology
- Cartilage, Articular/blood supply
- Cartilage, Articular/immunology
- Cartilage, Articular/pathology
- Cartilage, Articular/physiopathology
- Female
- Humans
- Immune Tolerance
- Immunity, Cellular
- Inflammation/epidemiology
- Inflammation/immunology
- Inflammation/pathology
- Inflammation/physiopathology
- Joints/blood supply
- Joints/immunology
- Joints/pathology
- Joints/physiopathology
- Male
- Prolactin/immunology
- Reproduction
- Sex Factors
- Stress, Physiological
- Stress, Psychological
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Affiliation(s)
- Carmen Clapp
- Instituto de Neurobiología, Universidad Nacional Autónoma de México (UNAM), Campus UNAM, Juriquilla, 76230, Querétaro, Mexico.
| | - Norma Adán
- Instituto de Neurobiología, Universidad Nacional Autónoma de México (UNAM), Campus UNAM, Juriquilla, 76230, Querétaro, Mexico
| | - María G Ledesma-Colunga
- Instituto de Neurobiología, Universidad Nacional Autónoma de México (UNAM), Campus UNAM, Juriquilla, 76230, Querétaro, Mexico
| | - Mariana Solís-Gutiérrez
- Instituto de Neurobiología, Universidad Nacional Autónoma de México (UNAM), Campus UNAM, Juriquilla, 76230, Querétaro, Mexico
| | - Jakob Triebel
- Institute for Clinical Chemistry, Laboratory Medicine and Transfusion Medicine, Paracelsus Medical University, Nuremberg, Germany
| | - Gonzalo Martínez de la Escalera
- Instituto de Neurobiología, Universidad Nacional Autónoma de México (UNAM), Campus UNAM, Juriquilla, 76230, Querétaro, Mexico
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Pathophysiology of the Behçet's Disease. PATHOLOGY RESEARCH INTERNATIONAL 2011; 2012:493015. [PMID: 21977335 PMCID: PMC3184427 DOI: 10.1155/2012/493015] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2011] [Revised: 07/21/2011] [Accepted: 07/23/2011] [Indexed: 01/05/2023]
Abstract
Behçet's disease (BD) is a multisystemic disease of unknown etiology characterized by chronic relapsing oral-genital ulcers and uveitis. Multiple systemic associations including articular, gastrointestinal, cardiopulmonary, neurologic, and vascular involvement are also observed in BD. Although the etiopathogenesis of the disease remains unknown, increased neutrophil functions such as chemotaxis, phagocytosis, and excessive production of reactive oxygen species (ROS), including superoxide anion, which may be responsible for oxidative tissue damage seen in BD, and also immunological alterations, T lymphocyte abnormalities in both subpopulation and function have been considered to be correlated with the etiopathogenesis of BD. There is some clinical evidence suggesting that emotional stress and hormonal alterations can influence the course and disease activity of BD.
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Blackman MR, Muniyappa R, Wilson M, Moquin BE, Baldwin HL, Wong KA, Snyder C, Magalnick M, Alli S, Reynolds J, Steinberg SM, Goldbach-Mansky R. Diurnal secretion of growth hormone, cortisol, and dehydroepiandrosterone in pre- and perimenopausal women with active rheumatoid arthritis: a pilot case-control study. Arthritis Res Ther 2008; 9:R73. [PMID: 17662149 PMCID: PMC2206381 DOI: 10.1186/ar2271] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2007] [Revised: 06/28/2007] [Accepted: 07/28/2007] [Indexed: 11/23/2022] Open
Abstract
Rheumatoid arthritis (RA) is associated with neuroendocrine and immunologic dysfunction leading to rheumatoid cachexia. Although excess proinflammatory cytokines can decrease somatotropic axis activity, little is known about the effects of RA on growth hormone/insulin-like growth factor-1 (GH/IGF-I) axis function. We tested the hypothesis that patients with active RA exhibit decreased GH/IGF-I axis activity. To do so, we conducted a pilot case-control study at a clinical research center in 7 pre- and perimenopausal women with active RA and 10 age- and body mass index-matched healthy women. Participants underwent blood sampling every 20 minutes for 24 hours (8 a.m. to 8 a.m.), and sera were assayed for GH, cortisol, and dehydroepiandrosterone (DHEA). Sera obtained after overnight fasting were assayed for IGF-I, IGF-binding protein (IGFBP)-1, IGFBP-3, C-reactive protein (CRP), interleukin-6 (IL-6), glucose, insulin, and lipids. Body composition and bone mineral density were evaluated by DEXA (dual emission x-ray absorptiometry) scans. In patients with RA, mean disease duration was 7.6 ± 6.8 years, and erythrocyte sedimentation rate, CRP, and IL-6 were elevated. GH half-life was shorter than in control subjects (p = 0.0037), with no other significant group differences in GH deconvolution parameters or approximate entropy scores. IGF-I (p = 0.05) and IGFBP-3 (p = 0.058) were lower, whereas IGFBP-1 tended to be higher (p = 0.066), in patients with RA, with nonsignificantly increased 24-hour total GH production rates. There were no significant group differences in cortisol or DHEA secretion. Lean body mass was lower in patients with RA (p = 0.019), particularly in the legs (p = 0.01). Women with active RA exhibit a trend toward GH insensitivity and relatively diminished diurnal cortisol and DHEA secretion for their state of inflammation. Whether these changes contribute to rheumatoid cachexia remains to be determined. NCT00034060.
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Affiliation(s)
- Marc R Blackman
- Endocrine Section, Laboratory of Clinical Investigation, National Center for Complementary and Alternative Medicine, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20892, USA
| | - Ranganath Muniyappa
- Endocrine Section, Laboratory of Clinical Investigation, National Center for Complementary and Alternative Medicine, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20892, USA
| | - Mildred Wilson
- Office of the Clinical Director, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20892, USA
| | - Barbara E Moquin
- Endocrine Section, Laboratory of Clinical Investigation, National Center for Complementary and Alternative Medicine, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20892, USA
| | - Howard L Baldwin
- Endocrine Section, Laboratory of Clinical Investigation, National Center for Complementary and Alternative Medicine, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20892, USA
| | - Kelli A Wong
- Endocrine Section, Laboratory of Clinical Investigation, National Center for Complementary and Alternative Medicine, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20892, USA
| | - Christopher Snyder
- Office of the Clinical Director, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20892, USA
| | - Michael Magalnick
- Office of the Clinical Director, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20892, USA
| | - Shaan Alli
- Office of the Clinical Director, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20892, USA
| | - James Reynolds
- Department of Radiology, Warren Magnuson Clinical Center, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20892, USA
| | - Seth M Steinberg
- Biostatistics and Data Management Section, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20892, USA
| | - Raphaela Goldbach-Mansky
- Office of the Clinical Director, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20892, USA
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Colak R, Ozkan Y, Cengiz SU, Saral Y, Kandi BC, Halifeoglu I. A comparison between the effects of low (1 microg) and standard dose (250 microg) ACTH stimulation tests on adrenal cortex functions with Behçet's disease. J Eur Acad Dermatol Venereol 2006; 20:721-5. [PMID: 16836503 DOI: 10.1111/j.1468-3083.2006.01626.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Behçet's disease is a rare, chronic disorder. The cause of Behçet's disease is unknown. It is believed to be caused by an autoimmune reaction. As in other chronic autoimmune diseases, Behçet's disease may show a subclinical adrenal failure and some changes in cortisol levels. We aimed to evaluate adrenal gland function in Behçet's disease patients. MATERIAL AND METHOD This study included 18 Behçet's disease patients and 15 healthy controls. Patient and control groups were administered i.v. 1 microg low dose test (LDT) and 250 microg standard dose test (SDT) adrenocorticotropic hormone (ACTH) stimulation test after 12 h of night fasting with an interval of 3-days and cortisol responses in the 0th, 30th and 60th minutes were evaluated. RESULTS There was no statistically significant difference between basal cortisol values of Behçet's disease and control groups. Cortisol values in the 60th minute in LDT were significantly lower in Behçet's disease group than in the control group. In the peak cortisol responses to LDT, a significant decrease was found in Behçet's disease group. CONCLUSION These findings suggest that hypothalamo-pituitary adrenal axis is partially suppressed in Behçet's disease.
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Affiliation(s)
- R Colak
- Firat University Facuty of Medicine, Department of Endocrinology, Elazig, Turkey
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Geenen R, Van Middendorp H, Bijlsma JWJ. The Impact of Stressors on Health Status and Hypothalamic-Pituitary-Adrenal Axis and Autonomic Nervous System Responsiveness in Rheumatoid Arthritis. Ann N Y Acad Sci 2006; 1069:77-97. [PMID: 16855136 DOI: 10.1196/annals.1351.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The hypothalamic-pituitary-adrenal (HPA) axis and the autonomic nervous system (ANS) are critically involved in inflammation and are activated by stress. This suggests that stressful circumstances may affect the chronic inflammation of rheumatoid arthritis (RA). Fifty-six scientific publications of the past 15 years were reviewed to get insight into the possible impact of stressors (grouped in five categories) on the health status and HPA axis and ANS functioning of adult patients with RA. Our findings in this review were: (1) In response to mental and physical effort and applied physiological stressors, patients demonstrate ANS hyporesponsiveness and "too normal" HPA axis responsiveness considering the elevated immune activity. A premorbid defect, past and current inflammatory activity, past and current stress, and physical deconditioning may explain disturbed physiological responses. (2) After brief naturalistic stressors, self-perceived and clinician's ratings of disease activity are increased; inflammation parameters have been insufficiently examined. (3) Major life events do not univocally affect disease status, but appear able to modify disease activity in a positive or negative way, depending on the nature, duration, and dose of the accompanying physiological stress response. (4) Enduring (e.g., work-related or interpersonal) stressors are associated with perceived health. Because this stressor category mingles with personality variables, the mere observation of a correlation does not prove that chronic stressors provoke health changes, although this might be the case. (5) Not one study rigorously examined the prospective hypothesis that past stressors (e.g., childhood victimization or pre-onset stressful incidents) may trigger RA or aggravate existing RA, which is a realistic belief for some patients.
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Affiliation(s)
- Rinie Geenen
- Department of Clinical and Health Psychology, Utrecht University, P.O.Box 80140, 3508TC Utrecht, Netherlands.
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Imrich R. Hypoglycemia, an Old Tool for New Findings in the Adrenomedullary Hormonal System in Patients with Rheumatic Diseases. Ann N Y Acad Sci 2006; 1069:98-108. [PMID: 16855137 DOI: 10.1196/annals.1351.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Over the past decades, research in patients with rheumatic disorders showed enormous progress in detecting various perturbations of the neuroendocrine system including those affecting autonomic nervous function. There is, however, a substantial lack of data on adrenomedullary hormonal system (AMHS) function in those patients. Insulin-induced hypoglycemia (IIH) represents a metabolic stressor, which elicits a counterregulatory stress response not only of the hypothalamic-pituitary axis but also of the AMHS. Therefore, in addition to traditional testing of hypothalamic-pituitary function, IIH can be used as a well-controlled functional test of the AMHS. Our recent studies showed, for the first time, attenuated epinephrine and norepinephrine responses to IIH in premenopausal females with rheumatoid arthritis (RA) and systemic sclerosis (SSc). These findings are suggestive of downregulation, or possibly defects, of the AMHS in those patients. This article reviews mechanism of the AMHS activation during IIH and demonstrates applications of the test in neuroendocrine-immune research.
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Affiliation(s)
- Richard Imrich
- Institute of Experimental Endocrinology, Slovak Academy of Sciences, Vlarska 3, 83306 Bratislava, Slovakia.
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Abstract
We have summarised evidence in the literature for modulatory effects of stress on inflammatory autoimmune disease. We find that overall there is strong evidence for such an interrelationship. Apparent discrepancies between groups and studies are probably due to differences in experimental design, whether longitudinal or retrospective. Other important variables are the specific effects of different types of stress and the intensity and timing of the stressor relative to onset of inflammation. We conclude that there is much of benefit to be learned from scientific study of stress, such as harnessing and rationalising of stressful experiences through self-expression in patients, or the identification of novel anti-inflammatory compounds activated by stress.
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Affiliation(s)
- D S Jessop
- Henry Wellcome Laboratories for Integrative Neuroscience and Endocrinology, University of Bristol, UK.
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