Sympathetic nerve contact alters membrane resistance of cells of the RBL-2H3 mucosal mast cell line

Effects of Stress on Itch

PURPOSE

Psychological stress and ensuing modulation of the immune and nervous systems can have a significant impact on itch. Stress can exacerbate itch and vice versa, resulting in a vicious cycle that can greatly impair a patient's quality of life. This review summarizes the association between stress and itch, elucidates the mechanism by which these two phenomena influence one another, and explores treatment modalities that aim to reduce stress-induced itch.

METHODS

A complete search of the PubMed and Google Scholar databases was completed and literature pertinent to this review was compiled.

FINDINGS

Both acute and chronic stress can significantly affect itch in healthy individuals and in those diagnosed with itchy skin diseases as well as systemic diseases, thus resulting in a vicious cycle in which stress exacerbates itch and vice versa. The mechanisms by which stress induces or aggravates itch include both central and peripheral activation of the hypothalamic-pituitary-adrenal axis and sympathetic nervous system. Activation of these systems, in turn, affects the mast cells, keratinocytes, and nerves that secrete neuropeptides, such as substance P, nerve growth factor, acetylcholine, histamine, and itchy cytokines. A dysfunctional parasympathetic response is thought to be involved in the chronic stress/itch response. Brain structures associated with emotion, such as the limbic system and periaqueductal gray, which work on the descending facilitation of itch, play a significant role in stress-induced itch.

IMPLICATIONS

As specific brain structures are associated with stress, drug treatments targeting these areas (ie, γ-aminobutyric acid-ergic drugs, serotonin and norepinephrine reuptake inhibitors) may help to modulate itch. Stress can also be combatted using nonpharmacologic treatments such as cognitive-behavioral therapies and stress-relieving holistic approaches (eg, yoga, acupuncture).

An aberrant parasympathetic response: a new perspective linking chronic stress and itch

Perceived stress has long been known to alter the dynamic equilibrium established between the nervous, endocrine and immune system and is widely recognised to trigger or enhance pruritus. However, the exact mechanism of how the major stress response systems, such as the hypothalamus-pituitary adrenal (HPA) axis and the autonomic nervous system induce or aggravate chronic itch, has not been elucidated. The limbic regions of the brain such as the prefrontal cortex and hippocampus are deeply involved in the regulation of the stress response and intersect with circuits that are responsible for memory and reward. According to the 'Polyvagal Theory', certain limbic structures that serve as a 'higher brain equivalent of the parasympathetic nervous system' play a foremost role in maintaining body homoeostasis by functioning as an active vagal brake. In addition, the limbic system has been postulated to regulate two distinct, yet related aspects of itch: (i) the sensory-discriminative aspect; and (ii) the affective-cognitive aspect. Chronic stress-induced itch is hypothesised to be caused by stress-related changes in limbic structure with subsequent rewiring of both the peripheral and central pruriceptive circuits. Herein, we review data suggesting that a dysfunctional parasympathetic nervous system associated with chronic stress may play a critical role in the regulatory control of key candidate molecules, receptors and brain structures involved in chronic itch.

Sympathetic nervous system modulation of inflammation and remodeling in the hypertensive heart

Chronic activation of the sympathetic nervous system is a key component of cardiac hypertrophy and fibrosis. However, previous studies have provided evidence that also implicate inflammatory cells, including mast cells (MCs), in the development of cardiac fibrosis. The current study investigated the potential interaction of cardiac MCs with the sympathetic nervous system. Eight-week-old male spontaneously hypertensive rats were sympathectomized to establish the effect of the sympathetic nervous system on cardiac MC density, myocardial remodeling, and cytokine production in the hypertensive heart. Age-matched Wistar Kyoto rats served as controls. Cardiac fibrosis and hypertension were significantly attenuated and left ventricular mass normalized, whereas cardiac MC density was markedly increased in sympathectomized spontaneously hypertensive rats. Sympathectomy normalized myocardial levels of interferon-gamma, interleukin 6, and interleukin 10, but had no effect on interleukin 4. The effects of norepinephrine and substance P on isolated cardiac MC activation were investigated as potential mechanisms of interaction between the two. Only substance P elicited MC degranulation. Substance P was also shown to induce the production of angiotensin II by a mixed population of isolated cardiac inflammatory cells, including MCs, lymphocytes, and macrophages. These results demonstrate the ability of neuropeptides to regulate inflammatory cell function, providing a potential mechanism by which the sympathetic nervous system and afferent nerves may interact with inflammatory cells in the hypertensive heart.

Bone marrow-derived mast cells in mice respond in co-culture to scorpion venom activation of superior cervical ganglion neurites according to level of expression of NK-1 receptors

In virtually all tissues of the body, mast cells are closely associated with nerve fibers, mostly of sensory origin. While mast cells can be activated by substance P, evidence for the involvement of NK-1 receptors is very limited. To study functional interactions between mast cells and peripheral nerves, bone marrow-derived mast cells (BMMC) and superior cervical ganglia (SCG) were co-cultured. Murine bone marrow-derived mast cells are homologues for mucosal mast cells and have recently been shown to express NK-1 receptors. Bi-directional interaction was studied using a fluorescent calcium indicator as an index of cellular activation. Scorpion venom, not affecting BMMC by itself, caused a rapid increase in neurite fluorescence subsequently followed by activation of the mast cell. The latter was inhibited by the NK-1 receptor antagonist SR140333, showing the direct involvement of substance P and its receptor in this co-culture system. Activation of BMMC seemed to be directly correlated with extent of NK-1 receptor expression. Immature c-kit positive cells not expressing NK-1 gave a negligible response to neurite activation. In addition, there was a maximum stimulation occurring when NK-1 expression exceeded 16% on BMMC after cytokine stimulation. Our findings show that the expression of NK-1 receptors appears to be important for nerve-mast cell communication.

The tachykinin NK1 receptor is crucial for the development of non-atopic airway inflammation and hyperresponsiveness

Mast cell activation, bronchoconstriction, inflammation and airway hyperreactivity are prominent features of non-atopic hypersensitivity reactions in mouse airways. We studied the role of tachykinin receptors in mice that were skin-sensitized with dinitrofluorobenzene (or vehicle) and challenged intranasally with dinitrobenzene sulfonic acid. Tachykinin NK1 receptor blockade, by treatment with the antagonist RP67580, or absence of the tachykinin NK1 receptor resulted in a strong reduction in the accumulation of neutrophils in the bronchoalveolar lavage fluid, and in the development of tracheal hyperreactivity in mice 48 h after challenge. In contrast, treatment with the tachykinin NK2 receptor antagonist SR48968 did not affect the dinitrofluorobenzene-induced hypersensitivity reaction. We have previously shown that mast cells play a crucial role in the development of non-atopic asthma. However, we did not observe an inhibitory effect of the tachykinin receptor antagonists or the genetic absence of tachykinin NK1 receptors on mast cell protease release. In conclusion, distal from mast cell activation, the tachykinin NK1 receptor is crucial for the infiltration of pulmonary neutrophils and the development of tracheal hyperreactivity in non-atopic asthma.

Serotonin in an antigen-induced arthritis of the rabbit temporomandibular joint

The aim was to investigate the joint perfusate concentration of serotonin (5-HT) in antigen-induced monoarthritis of the rabbit temporomandibular joint (TMJ) and knee joint. Thirty adult male New Zealand White rabbits, of whom eight were first used as healthy controls, were divided into TMJ and knee arthritis groups. Unilateral arthritis was induced with ovalbumin intra-articularly and the contralateral joint was sham-induced. The joints were perfused with saline (flow rate, 0.05 ml/min; 10-min intervals during 50 min) 3 weeks later and the 5-HT concentration analysed. After the perfusion, the joints were evaluated histologically. The 5-HT concentration in the initial perfusate from the arthritic TMJ was higher than in both sham-induced and healthy control joints, and from the knee joint arthritis higher than in sham-induced joints. No histological difference in the arthritis was observed between the two groups. This study shows that the 5-HT concentration found immediately after puncture is increased in antigen-induced arthritis of the rabbit TMJ and knee joint.

Distribution and local differentiation of mast cells in the parenchyma of the forebrain

Mast cells are found in the brain of many species. Although a considerable body of information is available concerning the development and differentiation of peripheral mast cells, little is known about brain mast cells. In the present study, the ontogeny of mast cells in the dove brain was followed by using three markers: acidic toluidine blue, alcian blue/safranin, and an antiserum to gonadotropin-releasing hormone (GnRH). Mast cells first appear in the pia on embryonic day (E)13-14 in ovo, then along blood vessels extending from the pia into the telencephalon on posthatch day 4-5, and in the medial habenula at week 3. Medial habenular mast cell numbers increase during development, peaking in peripubertal birds, and declining thereafter. Several measures indicate that mast cells mature within the medial habenula: there is an increase in the intensity of metachromasia, a switch from alcian blue granules in young animals to mixed alcian blue and safranin granules in older animals, and an increase in GnRH-like immunoreactivity. These results were extended by using electron microscopy. The architecture of mast cell granules evolved from electron lucent with small electron dense deposits at E15 to more electron dense granules with complex patterns of internal structure by 2 months. Ultrastructural immunocytochemistry for the GnRH-like peptide at 1 month revealed both immunopositive and negative cells, suggesting that the acquisition of this phenotype is not simultaneous across the population. Thus, immature mast cells infiltrate the central nervous system and undergo in situ differentiation within the neuropil.

Substance P selectively activates TNF-alpha mRNA in rat uterine immune cells: a neuroimmune link

Substance P (SP) is a neuropeptide which influences the interaction between the nervous and immune systems. It is an important modulator of cytokines, including tumour necrosis factor-alpha (TNF-alpha) whose role during the reproductive processes has been established. We have investigated the effects of SP on TNF-alpha mRNA expression in macrophages and mast cells (MC) isolated from rat peritoneum and uterus. Cell supernatants were analysed for their histamine content as a measure of stimulation. SP alone increased TNF-alpha expression in peritoneal MC but not in peritoneal macrophages. The addition of SP resulted in a six-fold enhancement of TNF-alpha expression in uterine MC whereas no stimulation was observed in macrophages as determined by competitive polymerase chain reaction (PCR).

Platelet-activating factor induces histamine release from human skin mast cells in vivo, which is reduced by local nerve blockade

BACKGROUND

Intradermal injection of platelet-activating factor (PAF) causes wheal and flare reactions, which are inhibited by antihistamines. However, PAF does not release histamine from human dispersed skin mast cells in vitro. The purpose of this study was to investigate the extent and possible mechanisms of PAF-induced histamine release in human skin in vivo with the use of dermal microdialysis.

METHODS

Hollow dialysis fibers were inserted into the upper dermis in forearm skin and each fiber was perfused with Krebs-Ringer bicarbonate solution at a rate of 3.0 microliters/min. PAF (4.5 to 36 mumol/L), lyso-PAF (36 mumol/L), vehicle (negative control), and codeine 750 or 250 mumol/L (positive control) were injected intradermally above separate fibers. Dialysate was collected in 2-minute fractions for 20 minutes and histamine analyzed spectrofluorometrically.

RESULTS

PAF, but not lyso-PAF, caused statistically significant dose-related histamine release and wheal and flare reactions. Intradermal mepivacaine administration significantly abrogated flare reactions by PAF and codeine and inhibited histamine release and wheal reactions by PAF but not by codeine. Long-term topical capsaicin administration inhibited histamine release and wheal reactions by PAF but not by codeine. It inhibited flare reactions induced by both compounds. PAF did not release histamine from blood basophils.

CONCLUSIONS

These data suggest that PAF induced histamine release from mast cells in intact human skin indirectly via neurogenic activation. Further, on the intradermal injection of PAF histamine release and the skin responses, the wheal and the flare, are differentially regulated by neurogenic components.

Paracrine Ca2+ signaling in vitro: serotonin-mediated cell-cell communication in mast cell/smooth muscle cocultures

Mast cells are tissue-resident immune cells that are capable of signaling many different cell types in vascularized tissue including epithelia and smooth muscle. We have developed an in vitro coculture system in which secretion of serotonin by a mucosal mast cell line (RBL-2H3) can be studied at a single cell level by measuring Ca2+ transients in fura-2 loaded mast cells and serotonin-sensitive A7r5 smooth muscle cells using fluorescence video microscopy and digital image processing. A7r5 cells elevate intracellular Ca2+ via 5HT2 receptors in response to bath-applied serotonin with an ED50 for serotonin of 550nM. Crosslinking IgE receptors with antigen caused Ca2+ transients in the mucosal mast cells. Ca2+ responses in the smooth muscle were detected approximately 30-240 sec after the initiation of the mast cell Ca2+ responses. Smooth muscle Ca2+ responses were dependent on preloading mast cells with serotonin and were blocked by the 5HT2 antagonist ketanserin. The timing and magnitude of the smooth muscle responses indicated that secretion from mast cells can lead to local concentrations of serotonin in the range of 300 nM within 1 min of antigen stimulation. This coculture technique has allowed the first direct demonstration of serotonin-mediated signaling between immune cells and vascular elements.

New transmitters and new targets in the autonomic nervous system

Several recent findings have made research into the autonomic nervous system even more exciting, such as the revelation that nitric oxide is a major neurotransmitter, the delineation of the physiological roles for purines and vasoactive intestinal peptide, and the discovery that the interstitial cells of Cajal are major target cells for enteric innervation. Nitric oxide is probably the major neurotransmitter evoking inhibitory junction potentials in smooth muscle. ATP is a mediator of non-adrenergic non-cholinergic enteric innervation, as well as being a fast neurotransmitter in peripheral and autonomic neuro-neuronal synapses. The interactions between enteric nerves and both immune cells and interstitial cells of Cajal (as pacemaker cells of gut smooth muscle) are forcing a rethink of many aspects of gut physiology.

Substance P induces whole cell current transients in RBL-2H3 cells

To investigate the basis of interactions between nerves and mast cells, we tested the actions of the neuropeptide substance P (SP) on whole cell current characteristics of RBL-2H3 cells (homologous to mucosal mast cells). Control RBL cells showed a K(+)-dependent inwardly rectified current. SP (10(-6) M) caused transient, frequently repetitive increases in current amplitude, which at a membrane potential (Vm) of -80 mV rose by -1,020.0 +/- 223.4 pA after SP application compared with -6.8 +/- 1.7 pA for control. This response was characterized by a lag phase of 102 +/- 16 s. Seventeen percent of cells showed spontaneous transients in the current amplitude from the beginning of the recording. After SP administration, the amplitude of these transients increased by 6.3 +/- 2.0-fold. Responses to SP were mimicked by the application of ionomycin. For both SP and ionomycin, there was a dose dependency of the lag phase. Removal of extracellular calcium abolished the response for 10(-6) M SP but not for 6.6 x 10(-6) M ionomycin. During current transients, the whole cell current had both inward and outward rectified components with the zero current Vm shifted from -87.3 +/- 3.2 mV at control to -10.8 +/- 1.7 mV. We compare the SP-evoked current responses in mucosal-type mast cells with those described in connective tissue type.