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Tattersall MC, Jarjour NN, Busse PJ. Systemic Inflammation in Asthma: What Are the Risks and Impacts Outside the Airway? THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:849-862. [PMID: 38355013 PMCID: PMC11219096 DOI: 10.1016/j.jaip.2024.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 01/19/2024] [Accepted: 02/02/2024] [Indexed: 02/16/2024]
Abstract
Airway inflammation in asthma has been well recognized for several decades, with general agreement on its role in asthma pathogenesis, symptoms, propensity toward exacerbation, and decline in lung function. This has led to universal recommendation in asthma management guidelines to incorporate the use of inhaled corticosteroid as an anti-inflammatory therapy for all patients with persistent asthma symptoms. However, there has been limited attention paid to the presence and potential impact of systemic inflammation in asthma. Accumulating evidence from epidemiological observations and cohort studies points to a host of downstream organ dysfunction in asthma especially among patients with longstanding or more severe disease, frequent exacerbations, and underlying risk factors for organ dysfunction. Most studies to date have focused on cognitive impairment, depression/anxiety, metabolic syndrome, and cardiovascular abnormalities. In this review, we summarize some of the evidence demonstrating these abnormalities and highlight the proposed mechanisms and potential benefits of treatment in limiting these extrapulmonary abnormalities in patients with asthma. The goal of this commentary is to raise awareness of the importance of recognizing potential extrapulmonary conditions associated with systemic inflammation of asthma. This area of treatment of patients with asthma is a large unmet need.
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Affiliation(s)
- Matthew C Tattersall
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis.
| | - Nizar N Jarjour
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Paula J Busse
- Department of Medicine, Division of Clinical Immunology, Icahn School of Medicine at Mount Sinai School of Medicine, New York, NY
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Vafaee F, Shirzad S, Shamsi F, Boskabady MH. Neuroscience and treatment of asthma, new therapeutic strategies and future aspects. Life Sci 2021; 292:120175. [PMID: 34826435 DOI: 10.1016/j.lfs.2021.120175] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 11/11/2021] [Accepted: 11/19/2021] [Indexed: 12/14/2022]
Abstract
AIMS Asthma is an airway inflammatory disease that is affected by neurological and psychological factors. The aim of present review is to investigating the relationship between neural functions and neurobiological changes and asthma symptoms. MAIN METHODS The information in this article is provided from articles published in English and reputable database using appropriate keywords from 1970 to October 2020. KEY FINDINGS The symptoms of asthma such as cough, difficult breathing, and mucus secretion get worse when a person is suffering from stress, anxiety, and depression. The function of the insula, anterior cingulate cortex, and hypothalamic-pituitary-adrenal axis changes in response to stress and psychological disease; then the stress hormones are produced from neuroendocrine system, which leads to asthma exacerbation. The evidence represents that psychological therapies or neurological rehabilitation reduces the inflammation through modulating the activity of neurocircuitry and the function of brain centers involved in asthma. Moreover, the neurotrophins and neuropeptides are the key mediators in the neuro-immune interactions, which secrete from the airway nerves in response to brain signals, and they could be the target of many new therapies in asthma. SIGNIFICANCE This review provides an insight into the vital role of the central and peripheral nervous system in development and exacerbation of asthma and provides practical approaches and strategies on neural networks to improve the airway inflammation and asthma severity.
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Affiliation(s)
- Farzaneh Vafaee
- Neuroscience Research Center, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Neuroscience, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Shima Shirzad
- Neuroscience Research Center, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Neuroscience, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fatemeh Shamsi
- Department of Neuroscience, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran; Neuroscience Laboratory (Brain, Cognition and Behavior), Department of Neuroscience, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Hossein Boskabady
- Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Physiology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
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von Muecke-Heim IA, Ries C, Urbina L, Deussing JM. P2X7R antagonists in chronic stress-based depression models: a review. Eur Arch Psychiatry Clin Neurosci 2021; 271:1343-1358. [PMID: 34279714 PMCID: PMC8429152 DOI: 10.1007/s00406-021-01306-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 07/12/2021] [Indexed: 12/17/2022]
Abstract
Depression affects around 320 million people worldwide. Growing evidence proposes the immune system to be the core interface between psychosocial stress and the neurobiological and behavioural features of depression. Many studies have identified purinergic signalling via the P2X7 receptor (P2X7R) to be of great importance in depression genesis yet only a few have evaluated P2X7R antagonists in chronic stress-based depression models. This review summarizes their findings and analyses their methodology. The four available studies used three to nine weeks of unpredictable, chronic mild stress or unpredictable, chronic stress in male mice or rats. Stress paradigm composition varied moderately, with stimuli being primarily psychophysical rather than psychosocial. Behavioural testing was performed during or after the last week of stress application and resulted in depressive-like behaviours, immune changes (NLRP3 assembly, interleukin-1β level increase, microglia activation) and neuroplasticity impairment. During the second half of each stress paradigm, a P2X7R antagonist (Brilliant Blue G, A-438079, A-804598) was applied. Studies differed with regard to antagonist dosage and application timing. Nonetheless, all treatments attenuated the stress-induced neurobiological changes and depressive-like behaviours. The evidence at hand underpins the importance of P2X7R signalling in chronic stress and depression. However, improvements in study planning and reporting are necessary to minimize experimental bias and increase data purview. To achieve this, we propose adherence to the Research Domain Criteria and the STRANGE framework.
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Affiliation(s)
- Iven-Alex von Muecke-Heim
- Max Planck Institute of Psychiatry, Molecular Neurogenetics, Munich, Germany.
- International Max Planck Research School for Translational Psychiatry (IMPRS-TP), Munich, Germany.
| | - Clemens Ries
- Max Planck Institute of Psychiatry, Molecular Neurogenetics, Munich, Germany
- International Max Planck Research School for Translational Psychiatry (IMPRS-TP), Munich, Germany
- Graduate School of Systemic Neurosciences, University of Munich (LMU), Munich, Germany
| | - Lidia Urbina
- Max Planck Institute of Psychiatry, Molecular Neurogenetics, Munich, Germany
- Graduate School of Systemic Neurosciences, University of Munich (LMU), Munich, Germany
| | - Jan M Deussing
- Max Planck Institute of Psychiatry, Molecular Neurogenetics, Munich, Germany.
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Association Between Depression, Lung Function, and Inflammatory Markers in Patients with Asthma and Occupational Asthma. J Occup Environ Med 2020; 61:453-460. [PMID: 30855523 DOI: 10.1097/jom.0000000000001562] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Depression is associated with autonomic and immune dysregulation, yet this remains poorly explored in asthma. We assessed associations between depressive disorder, lung function, and inflammatory markers in patients under investigation for occupational asthma (OA). METHODS One hundred twelve patients under investigation for OA (60% men) underwent a psychiatric interview to assess depressive disorder, and spirometry, a methacholine test, sputum induction, and specific inhalation challenge (SIC) to assess OA. Blood and sputum inflammatory markers were assessed. RESULTS There was a statistically significant association between depressive disorder (P = 0.0195) and forced expiratory volume in 1 second (FEV1) responses, with the drop in FEV1 post-SIC smaller in patients with OA and depression, versus OA with no depression (P < 0.001). CONCLUSION The presence of depressive disorder may influence FEV1 in patients with OA, which may be via autonomic pathways. However, further studies are warranted in order to determine the mechanisms that underlie these effects.
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Rothe N, Steffen J, Penz M, Kirschbaum C, Walther A. Examination of peripheral basal and reactive cortisol levels in major depressive disorder and the burnout syndrome: A systematic review. Neurosci Biobehav Rev 2020; 114:232-270. [DOI: 10.1016/j.neubiorev.2020.02.024] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 01/27/2020] [Accepted: 02/19/2020] [Indexed: 12/15/2022]
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Hsu CY, Lehman HK, Wood BL, Benipal J, Humayun Q, Miller BD. Comorbid Obesity and Depressive Symptoms in Childhood Asthma: A Harmful Synergy. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:2689-2697. [PMID: 32304840 DOI: 10.1016/j.jaip.2020.03.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 03/03/2020] [Accepted: 03/19/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND Overweight/obesity (OV/OB) and depression have each been separately associated with worsened childhood asthma severity and control. Pathways by which these factors may jointly affect childhood asthma have not been elucidated. OBJECTIVE To examine the interrelationship of OV/OB and depressive symptoms with childhood asthma and explore associated psychobiologic pathways. The present study investigated whether comorbid OV/OB and depressive symptoms are associated with impaired baseline lung function and increased airway resistance during emotional stress, and to assess whether such effects may be mediated by autonomic nervous system (ANS) dysregulation, specifically through predominance of vagal over sympathetic reactivity (vagal bias). METHODS A total of 250 children with asthma, aged 7 to 17, were assessed for OV/OB using body mass index, depressive symptoms using the Children's Depression Inventory (CDI), and asthma severity using National Asthma Education and Prevention Program Expert Panel Report 3 criteria. Baseline pulmonary function (forced expiratory volume in 1 second [FEV1]) was assessed. The film "E.T. the Extra-Terrestrial" was used in a laboratory paradigm to evoke emotional stress/arousal. Airway resistance (Rint) was measured before and after the film to determine changes in airway function. ANS reactivity was assessed by measuring parasympathetic/vagal and sympathetic reactivity throughout the film. RESULTS In OV/OB children with asthma, depressive symptoms predicted lower baseline FEV1 (β = -0.67, standard error [SE] = 0.24, P = .008), CDI predicted vagal bias under emotion stress/arousal (β = 0.27, SE = 0.09, P = .009), and vagal bias predicted increased Rint (β = 3.55, SE = 1.54, P = .023). CONCLUSION This study is the first to link OV/OB and depressive symptoms in their relationship to childhood asthma. In OV/OB children with asthma, depression may potentiate airway compromise, mediated by vagal bias. Use of antidepressant and anticholinergic therapies should be studied in this subgroup of patients.
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Affiliation(s)
- Chiun Yu Hsu
- Neuroscience Program, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY; Child and Family Asthma Studies Center, Oishei Children's Hospital, Buffalo, NY
| | - Heather K Lehman
- Child and Family Asthma Studies Center, Oishei Children's Hospital, Buffalo, NY; Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY; Allergy & Immunology, Oishei Children's Hospital, Buffalo, NY
| | - Beatrice L Wood
- Neuroscience Program, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY; Child and Family Asthma Studies Center, Oishei Children's Hospital, Buffalo, NY; Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY; Department of Psychiatry, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY
| | - Jaspreet Benipal
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY
| | - Quratulain Humayun
- Child and Family Asthma Studies Center, Oishei Children's Hospital, Buffalo, NY
| | - Bruce D Miller
- Neuroscience Program, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY; Child and Family Asthma Studies Center, Oishei Children's Hospital, Buffalo, NY; Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY; Department of Psychiatry, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY.
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Lee CH, Giuliani F. The Role of Inflammation in Depression and Fatigue. Front Immunol 2019; 10:1696. [PMID: 31379879 PMCID: PMC6658985 DOI: 10.3389/fimmu.2019.01696] [Citation(s) in RCA: 317] [Impact Index Per Article: 63.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 07/08/2019] [Indexed: 12/13/2022] Open
Abstract
Depression and fatigue are conditions responsible for heavy global societal burden, especially in patients already suffering from chronic diseases. These symptoms have been identified by those affected as some of the most disabling symptoms which affect the quality of life and productivity of the individual. While many factors play a role in the development of depression and fatigue, both have been associated with increased inflammatory activation of the immune system affecting both the periphery and the central nervous system (CNS). This is further supported by the well-described association between diseases that involve immune activation and these symptoms in autoimmune disorders, such as multiple sclerosis and immune system activation in response to infections, like sepsis. Treatments for depression also support this immunopsychiatric link. Antidepressants have been shown to decrease inflammation, while higher levels of baseline inflammation predict lower treatment efficacy for most treatments. Those patients with higher initial immune activation may on the other hand be more responsive to treatments targeting immune pathways, which have been found to be effective in treating depression and fatigue in some cases. These results show strong support for the hypothesis that depression and fatigue are associated with an increased activation of the immune system which may serve as a valid target for treatment. Further studies should focus on the pathways involved in these symptoms and the development of treatments that target those pathways will help us to better understand these conditions and devise more targeted treatments.
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Affiliation(s)
- Chieh-Hsin Lee
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
| | - Fabrizio Giuliani
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada.,Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
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Perrin AJ, Horowitz MA, Roelofs J, Zunszain PA, Pariante CM. Glucocorticoid Resistance: Is It a Requisite for Increased Cytokine Production in Depression? A Systematic Review and Meta-Analysis. Front Psychiatry 2019; 10:423. [PMID: 31316402 PMCID: PMC6609575 DOI: 10.3389/fpsyt.2019.00423] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 05/28/2019] [Indexed: 12/29/2022] Open
Abstract
Background: Glucocorticoid resistance-reduced function of the glucocorticoid receptor (GR)-is seen in many depressed patients. It is argued that this resistance to glucocorticoids leads to failure of normal feedback regulation on the immune system. High levels of pro-inflammatory cytokines result. Purpose: We sought to identify evidence supporting or refuting a link between glucocorticoid resistance and immune dysregulation in depression and to summarize retrieved evidence in aggregate form. Methods: We systematically reviewed and meta-analyzed studies that examined cytokine levels in depressed patients compared with controls and that also reported a measure of glucocorticoid resistance. These measures included plasma cortisol, the dexamethasone suppression test (DST), GR expression levels, and the results of in vitro assays of GR function. We conducted four separate meta-analyses to test for moderating effects of glucocorticoid resistance on cytokine production in depression. Results: After sub-grouping 32 studies by the ratio of cortisol levels in patients compared with controls, we observed a trend for increasing glucocorticoid resistance (i.e., the most hypercortisolemic patients) to be associated with increased production of interleukin (IL)-6 [d = 0.94; 95% CI (0.29, 1.59)] and tumour necrosis factor (TNF)-α [d = 0.46; 95% CI (0.12, 0.79)]. We stratified nine studies that reported DST results by relative glucocorticoid resistance between patients and controls, identifying a trend for higher glucocorticoid resistance in patients, compared with controls, to be associated with higher cytokine production in patients (170 patients and 187 controls). This was particularly evident when studies were sub-grouped by source of cytokine-plasma (d = 1.04; 95% CI, 0.57-1.50) versus in vitro (d = 0.24; 95% CI, -0.20 to 0.67). Stratifying the four studies (147 patients and 118 controls) that used in vitro assays of GR function or GR expression to quantify glucocorticoid resistance revealed variable contributions to cytokine production in patients compared with controls (overall effect size: d = 1.35; 95% CI 0.53-2.18). Combining our analyses of studies that reported DST results with those that used in vitro assays of GR function or GR expression to quantify glucocorticoid resistance (302 patients and 277 controls), we noted that although depressed patients produced more cytokines than controls (d = 1.02; 95% CI, 0.55-1.49), there was no evident positive correlation between glucocorticoid resistance and inflammation. Conclusions: Our work provides some support for a model conceptualizing glucocorticoid resistance as a requisite for increased inflammation in depression. The limited number of studies identified highlights the need for purpose-designed investigations that directly examine the relationship between glucocorticoid resistance and cytokine production in depression.
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Affiliation(s)
- Andrew J. Perrin
- Stress, Psychiatry and Immunology Laboratory, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
- Clinician Investigator Program and Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Mark A. Horowitz
- Stress, Psychiatry and Immunology Laboratory, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Jacob Roelofs
- Stress, Psychiatry and Immunology Laboratory, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Patricia A. Zunszain
- Stress, Psychiatry and Immunology Laboratory, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Carmine M. Pariante
- Stress, Psychiatry and Immunology Laboratory, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
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Pan LY, Han YQ, Wang YZ, Chen QQ, Wu Y, Sun Y. Mechanism of Yanghe Pingchuan granules treatment for airway remodeling in asthma. DRUG DESIGN DEVELOPMENT AND THERAPY 2018; 12:1941-1951. [PMID: 29983548 PMCID: PMC6027695 DOI: 10.2147/dddt.s159428] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Purpose Yanghe Pingchuan granules (YPG), a hospital preparation developed by The First Affiliated Hospital, Anhui University of Chinese Medicine, has been used for the clinical treatment of bronchial asthma (BA) for several decades. This study aimed to explore the mechanism of action of YPG in the treatment of BA. Materials and methods Male Sprague Dawley rats (n=60) were randomly divided into six groups (n=10 per group): control, a BA model, positive drug control (Guilong Kechuanning capsules; a proven effective treatment for BA), and model rats treated with a high, medium, or low dose of YPG. H&E staining was used to detect pathological changes in the bronchial tubes. The mRNA expression levels of PI3K, PKB, PCNA, and AR were determined by real-time PCR, and the protein levels of phospho- (p-)PI3K, p-PKB, p-PCNA, and p-AR were detected by Western blotting. ELISAs were used to detect the expression of PIP2, PIP3 IL-6, IL-8, IL-1β, and epinephrine (EPI). Results H&E staining demonstrated that BA can be ameliorated using YPG. Real-time PCR, Western blotting, and ELISA indicated that use of YPG decreased expression of the phosphoinositide 3-kinase (PI3K) signaling pathway and PCNA, and can also ameliorate the condition kidney Yang deficiency, which is associated with BA in Chinese traditional medicine. Conclusion YPG can attenuate BA therapeutically in a dose-dependent manner. The mechanism underlying its therapeutic effect comprises influences on three features that contribute to BA: the PI3K signaling pathway, cell proliferation, and “kidney-Yang deficiency”.
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Affiliation(s)
- Ling Yu Pan
- Grade 3 Preparation Laboratory of State Administration of TCM, The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, Anhui 230031, China,
| | - Yan Quan Han
- Grade 3 Preparation Laboratory of State Administration of TCM, The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, Anhui 230031, China,
| | - Yong Zhong Wang
- Grade 3 Preparation Laboratory of State Administration of TCM, The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, Anhui 230031, China,
| | - Qian Qian Chen
- Anhui University of Chinese Medicine, Hefei, Anhui 230031, China
| | - Ying Wu
- Anhui University of Chinese Medicine, Hefei, Anhui 230031, China
| | - Yuan Sun
- Anhui University of Chinese Medicine, Hefei, Anhui 230031, China
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Yang CJ, Liu D, Xu ZS, Shi SX, Du YJ. The pro-inflammatory cytokines, salivary cortisol and alpha-amylase are associated with generalized anxiety disorder (GAD) in patients with asthma. Neurosci Lett 2017; 656:15-21. [PMID: 28716529 DOI: 10.1016/j.neulet.2017.07.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 06/30/2017] [Accepted: 07/14/2017] [Indexed: 01/08/2023]
Abstract
Generalized anxiety disorder (GAD) is common in patients with asthma. High levels of GAD may lead both to exacerbation of the condition and poor management. However, the physiological mechanisms of GAD in asthma patient is unclear. This study investigated the associations between the diurnal rhythm of sputum cytokines, salivary cortisol, α-amylase and GAD in asthma patients. Patients with co-morbid GAD and asthma showed higher sputum IL-1 AUC, sputum IL-6 AUC and sAA AUC. And there were positive correlations between Hamilton anxiety scale (HAMA) scores and sputum IL-1 AUC concentrations (r=0.37, P=0.002), HAMA scores and sputum IL-6 AUC (r=0.56, P<0.001), HAMA scores and sAA AUC (r=0.75, P<0.001). Also, there were positive correlations between Sputum IL-1 AUC and sAA AUC (r=0.40, P<0.001), between Sputum IL-6 AUC and sAA AUC. Stepwise multiple regression analyses showed the combination of sputum sAA AUC, IL-1 AUC, IL-6 AUC and cortisol AUC was the best predictor of HAMA scores (ΔR2=0.439, F(4,63)=14.086, p<0.001). Therefore, pro-inflammatory cytokines, salivary cortisol and alpha-amylase may all be involved in the occurrence of GAD in asthma patients.
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Affiliation(s)
- Chang-Jiang Yang
- Faculty of Education, East China Normal University, Shanghai, China
| | - Di Liu
- Faculty of Education, East China Normal University, Shanghai, China.
| | - Zhen-Sheng Xu
- The medical examination center of Huashan Hospital, Fudan University, Shanghai, China
| | - Shen-Xun Shi
- Department of Psychiatry, Huashan Hospital, Fudan University, Shanghai, China
| | - Yi-Jie Du
- Lab of Integrative Medicine for Lung, Inflammation and Cancers, Huashan Hospital, Fudan University, Shanghai, China.
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11
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Kong L, Zhang H, Cao Y, Le J, Wu J, Liu B, Chen M, Du Y, Wang J, Wang G, Yi T, Zhou X, Wang G, Miao Q, Li S, Zhao N, Dong J. The Anti-Inflammatory Effects of Invigorating Kidney and Supplementing Qi Chinese Herbal Formulae in Asthma Patients. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2017; 2017:3754145. [PMID: 28740537 PMCID: PMC5504930 DOI: 10.1155/2017/3754145] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Accepted: 03/27/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND The theories of Shen-reinforcement and Qi-supplementation are important in asthma treatment based on traditional Chinese medicine theories. Early studies suggested that Invigorating Kidney and Supplementing Qi herbal formulae, Bu Shen Fang Chuan (BSFC) and Bu Shen Yi Qi (BSYQ), conveyed promising results in asthma treatment. However, the efficacy and safety of the formulae need to be further investigated by a randomized double-blind clinical trial. METHODS 328 eligible patients were randomly sent to BSFC, BSYQ, and placebo group. The two formulae were received as add-on therapy. The primary endpoints were rate of asthma exacerbation and Hamilton Rating Scale for Depression (HAM-D) score. The secondary endpoints included HPA axis function and inflammatory cytokine production profile. All indexes were measured before and after treatment. RESULTS The primary endpoints were not improved in both groups; however, the depression levels of subgroup patients with HAM-D score > 5 were improved in BSFC group. HPA axis functions and inflammatory cytokines level were also improved by two formulae. The incidences of adverse events were similar among groups. CONCLUSIONS The two formulae had multiple advantage effects on neuroendocrine-immune system. They are worth used as a replacement therapy in asthma. TRIAL REGISTRATION This trial is registered with clinical trial number ChiCTR-PRC-09000529.
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Affiliation(s)
- Lingwen Kong
- Institute of Integrated Traditional Chinese and Western Medicine, Huashan Hospital Affiliated to Fudan University, Shanghai 200040, China
- Department of Integrated Traditional Chinese and Western Medicine, Huashan Hospital Affiliated to Fudan University, Shanghai 200040, China
| | - Hongying Zhang
- Institute of Integrated Traditional Chinese and Western Medicine, Huashan Hospital Affiliated to Fudan University, Shanghai 200040, China
- Department of Integrated Traditional Chinese and Western Medicine, Huashan Hospital Affiliated to Fudan University, Shanghai 200040, China
| | - Yuxue Cao
- Institute of Integrated Traditional Chinese and Western Medicine, Huashan Hospital Affiliated to Fudan University, Shanghai 200040, China
- Department of Integrated Traditional Chinese and Western Medicine, Huashan Hospital Affiliated to Fudan University, Shanghai 200040, China
| | - Jingjing Le
- Institute of Integrated Traditional Chinese and Western Medicine, Huashan Hospital Affiliated to Fudan University, Shanghai 200040, China
- Department of Integrated Traditional Chinese and Western Medicine, Huashan Hospital Affiliated to Fudan University, Shanghai 200040, China
| | - Jinfeng Wu
- Institute of Integrated Traditional Chinese and Western Medicine, Huashan Hospital Affiliated to Fudan University, Shanghai 200040, China
- Department of Integrated Traditional Chinese and Western Medicine, Huashan Hospital Affiliated to Fudan University, Shanghai 200040, China
| | - Baojun Liu
- Institute of Integrated Traditional Chinese and Western Medicine, Huashan Hospital Affiliated to Fudan University, Shanghai 200040, China
- Department of Integrated Traditional Chinese and Western Medicine, Huashan Hospital Affiliated to Fudan University, Shanghai 200040, China
| | - Meixia Chen
- Institute of Integrated Traditional Chinese and Western Medicine, Huashan Hospital Affiliated to Fudan University, Shanghai 200040, China
- Department of Integrated Traditional Chinese and Western Medicine, Huashan Hospital Affiliated to Fudan University, Shanghai 200040, China
| | - Yijie Du
- Institute of Integrated Traditional Chinese and Western Medicine, Huashan Hospital Affiliated to Fudan University, Shanghai 200040, China
- Department of Integrated Traditional Chinese and Western Medicine, Huashan Hospital Affiliated to Fudan University, Shanghai 200040, China
| | - Jia Wang
- Institute of Integrated Traditional Chinese and Western Medicine, Huashan Hospital Affiliated to Fudan University, Shanghai 200040, China
- Department of Integrated Traditional Chinese and Western Medicine, Huashan Hospital Affiliated to Fudan University, Shanghai 200040, China
| | - Genfa Wang
- Institute of Integrated Traditional Chinese and Western Medicine, Huashan Hospital Affiliated to Fudan University, Shanghai 200040, China
- Department of Integrated Traditional Chinese and Western Medicine, Huashan Hospital Affiliated to Fudan University, Shanghai 200040, China
| | - Tao Yi
- Institute of Integrated Traditional Chinese and Western Medicine, Huashan Hospital Affiliated to Fudan University, Shanghai 200040, China
- Department of Integrated Traditional Chinese and Western Medicine, Huashan Hospital Affiliated to Fudan University, Shanghai 200040, China
| | - Xianmei Zhou
- Pneumology Department, Jiangsu Provincial Hospital of TCM, Nanjing 210029, China
| | - Gang Wang
- Pneumology Department, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Qing Miao
- Pneumology Department, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing 100091, China
| | - Suyun Li
- Pneumology Department, The First Affiliated Hospital of Henan University of TCM, Zhengzhou City, Henan Province 450008, China
| | - Naiqing Zhao
- Department of Statistics, Fudan University, Shanghai 200032, China
| | - Jingcheng Dong
- Institute of Integrated Traditional Chinese and Western Medicine, Huashan Hospital Affiliated to Fudan University, Shanghai 200040, China
- Department of Integrated Traditional Chinese and Western Medicine, Huashan Hospital Affiliated to Fudan University, Shanghai 200040, China
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Du YJ, Yang CJ, Li B, Wu X, Lv YB, Jin HL, Cao YX, Sun J, Luo QL, Gong WY, Zhang HY, Liu BJ, Wu JF, Dong JC. Association of pro-inflammatory cytokines, cortisol and depression in patients with chronic obstructive pulmonary disease. Psychoneuroendocrinology 2014; 46:141-52. [PMID: 24882166 DOI: 10.1016/j.psyneuen.2014.04.020] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 04/23/2014] [Accepted: 04/23/2014] [Indexed: 10/25/2022]
Abstract
Evidence suggests that pro-inflammatory cytokines and cortisol play a crucial role in the etiology of chronic obstructive pulmonary disease (COPD) and depression. Depression occurs commonly among COPD patients and an earlier diagnosis would be beneficial. This study investigated the associations between depression, sputum cytokines and salivary cortisol in COPD patients. The diurnal rhythms of sputum IL-1, IL-6, TNF-α and salivary cortisol were measured in COPD patients with depression compared to those only with depression, or COPD and healthy controls. The area under the diurnal variation curves (AUC) over the 24h time course and relative diurnal variation (VAR) were calculated while correlation and regression analysis were performed. Patients with co-morbid depression and COPD showed an increasing sputum IL-1, sputum TNF-α AUC and a decreasing salivary cortisol VAR (P<0.001). The combination of sputum TNF-α AUC, sputum IL-1 AUC, sputum IL-6 AUC and salivary cortisol VAR performed best as a potential biomarker in the diagnosis of depression in COPD patients, with a sensitivity of 94.74% and a specificity of 96.67%. Positive correlations were found between sputum IL-1 AUC and sputum TNF-α AUC versus depressive symptoms, respectively a negative correlation was found between salivary cortisol VAR and depression. They were independently associated with depression in logistic regression models. Depression in COPD is associated with higher 24-h overall levels of sputum IL-1, TNF-α and flattened diurnal salivary cortisol. These non-invasive sputum and salivary biomarkers may serve as a simple clinical tool for the early diagnosis of depression in COPD patients.
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Affiliation(s)
- Yi-jie Du
- Lab of Integrative Medicine for Lung, Inflammation and Cancers, Huashan Hospital, Fudan University, Shanghai, China
| | - Chang-jiang Yang
- Lab of Integrative Medicine for Lung, Inflammation and Cancers, Huashan Hospital, Fudan University, Shanghai, China; School of Preschool & Special Education, East China Normal University, Shanghai, China
| | - Bei Li
- Lab of Integrative Medicine for Lung, Inflammation and Cancers, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiao Wu
- Lab of Integrative Medicine for Lung, Inflammation and Cancers, Huashan Hospital, Fudan University, Shanghai, China
| | - Yu-bao Lv
- Lab of Integrative Medicine for Lung, Inflammation and Cancers, Huashan Hospital, Fudan University, Shanghai, China
| | - Hua-liang Jin
- Lab of Integrative Medicine for Lung, Inflammation and Cancers, Huashan Hospital, Fudan University, Shanghai, China
| | - Yu-xue Cao
- Lab of Integrative Medicine for Lung, Inflammation and Cancers, Huashan Hospital, Fudan University, Shanghai, China
| | - Jing Sun
- Lab of Integrative Medicine for Lung, Inflammation and Cancers, Huashan Hospital, Fudan University, Shanghai, China
| | - Qing-li Luo
- Lab of Integrative Medicine for Lung, Inflammation and Cancers, Huashan Hospital, Fudan University, Shanghai, China
| | - Wei-yi Gong
- Lab of Integrative Medicine for Lung, Inflammation and Cancers, Huashan Hospital, Fudan University, Shanghai, China
| | - Hong-ying Zhang
- Lab of Integrative Medicine for Lung, Inflammation and Cancers, Huashan Hospital, Fudan University, Shanghai, China
| | - Bao-jun Liu
- Lab of Integrative Medicine for Lung, Inflammation and Cancers, Huashan Hospital, Fudan University, Shanghai, China
| | - Jin-Ffng Wu
- Lab of Integrative Medicine for Lung, Inflammation and Cancers, Huashan Hospital, Fudan University, Shanghai, China
| | - Jing-cheng Dong
- Lab of Integrative Medicine for Lung, Inflammation and Cancers, Huashan Hospital, Fudan University, Shanghai, China.
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13
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Carroll KN. Can the blues make it harder to breathe? Am J Respir Crit Care Med 2014; 189:1013-4. [PMID: 24787060 DOI: 10.1164/rccm.201402-0320ed] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Kecia N Carroll
- 1 Department of Pediatrics Vanderbilt University Medical Center Nashville, Tennessee
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14
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Park EK, Jo EJ, Lee SE, Lee SG, Mok JH, Kim MH, Lee KH, Kim KU, Jeon DS, Kim YS, Lee MK, Park HK. Characteristics of depression and anxiety in elderly asthmatics. ALLERGY ASTHMA & RESPIRATORY DISEASE 2014. [DOI: 10.4168/aard.2014.2.3.194] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Eun Kyoung Park
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Eun Jung Jo
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Seung Eun Lee
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Seung Geun Lee
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Jeong Ha Mok
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Mi Hyun Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Kwang Ha Lee
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Ki Uk Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Doo Soo Jeon
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Yun Seong Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Min Ki Lee
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Hye-Kyung Park
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
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15
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Sputum interleukin-6, tumor necrosis factor-α and Salivary cortisol as new biomarkers of depression in lung cancer patients. Prog Neuropsychopharmacol Biol Psychiatry 2013; 47:69-76. [PMID: 23969030 DOI: 10.1016/j.pnpbp.2013.08.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Revised: 08/11/2013] [Accepted: 08/11/2013] [Indexed: 11/22/2022]
Abstract
Depression is common among lung cancer patients. Increasing evidence has suggested that hypothalamic-pituitary-adrenal (HPA) axis and pro-inflammatory cytokines may play a key role in the pathophysiology of depression as well as cancer. This pilot study investigated the efficacy of sputum interleukin (IL)-6, tumor necrosis factor (TNF)-α and salivary cortisol as new markers to support the diagnosis of depression in lung cancer patients. The diurnal rhythms of sputum IL-6, sputum TNF-α and salivary cortisol were measured in lung cancer patients with and without depression as well as depressed controls and healthy controls. The area under the diurnal variation curves (AUC) over the 24h time course and relative diurnal variation (VAR) were calculated. Receiver operating characteristic (ROC) analysis was performed. Patients with co-morbid depression and lung cancer showed highest level of sputum IL-6 AUC, sputum TNF-α AUC and lowest level of cortisol VAR (P<0.001). As a biomarker for depression, salivary cortisol VAR demonstrated an optimal cutoff point at 77.8% (AUC=0.94; 95% CI, 0.85-0.98), which is associated with a sensitivity of 82.1% and a specificity of 96.0%. Sputum IL-6 AUC demonstrated a sensitivity of 74.4% and a specificity of 92.0% (AUC=0.81; 95% CI, 0.69-0.90). These findings suggested that higher 24h overall levels of sputum IL-6, TNF-α and flattened diurnal salivary cortisol slopes were associated with depression in lung cancer patients. Sputum IL-6 AUC and salivary cortisol VAR performed best as biomarkers in the diagnosis of depression in lung cancer patients.
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16
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Chaitanya VS, Lavania M, Nigam A, Turankar RP, Singh I, Horo I, Sengupta U, Jadhav RS. Cortisol and proinflammatory cytokine profiles in type 1 (reversal) reactions of leprosy. Immunol Lett 2013; 156:159-67. [PMID: 24189521 DOI: 10.1016/j.imlet.2013.10.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 10/11/2013] [Accepted: 10/24/2013] [Indexed: 11/18/2022]
Abstract
PURPOSE Cortisol levels in the circulation and at the sites of peripheral inflammation regulate type 1 (Reversal) reactions in leprosy akin to delayed type hypersensitivity reactions (DTH). In this study we determine the extent to which the differential mRNA expression of genes encoding cortisone-cortisol shuttle enzymes (11 β hydroxysteriod dehydrogenase I & II (11 β HSD I & II)), circulatory levels of proinflammatory cytokines (IL-6, IL-7, IP-10, IL-17F, IL-23, TNF-α, IL-1β, PDGF BB and CRP) and cortisol are associated with development of type 1 reactions in leprosy. METHODS Urine, blood and incisional skin biopsy samples from site of lesions were collected from 49 newly diagnosed untreated leprosy cases in T1R and 51 cases not in reaction (NR). mRNA expression levels of genes encoding 11 β HSD I & II in skin biopsy samples were determined by realtime PCR. Cortisol levels from the lesional skin biopsies, serum and urine samples and serum proinflammatory cytokine levels were measured using ELISA. RESULTS The mean expression ratios of 11 β HSD I & II are significantly lower in leprosy cases with T1R when compared to the NR leprosy cases. Cortisol levels in lesional skin biopsies and in urine are significantly lower (p=0.001) in leprosy cases with T1R. Serum cytokine levels of IP-10, IL-17F, IL-IL-6 and TNF-α are significantly higher (p<0.05) in leprosy cases with T1R when compared the NR leprosy cases. CONCLUSION Our study indicated an association of urinary and lesional skin cortisol levels with the manifestation of T1R in leprosy. IP-10, IL-17F, IL-6 and TNF-α can be potential prognostic serological markers and gene expression markers for early detection of type 1 reactions in leprosy.
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Affiliation(s)
- V S Chaitanya
- Stanley Browne Laboratory, The Leprosy Mission Community Hospital, Nand Nagri, New Delhi 110093, India.
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17
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Liang W, Chikritzhs T. The association between hospitalization for asthma in childhood and alcohol use disorder hospitalization during adolescence and early adulthood among males in an Australian birth cohort. J Asthma 2013; 50:996-1001. [PMID: 23889369 DOI: 10.3109/02770903.2013.829090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Associations between asthma and a range of mental disorders have been increasingly reported from cross-sectional studies. The aim of this study is to investigate whether hospitalization for asthma during childhood is associated with an increased risk of hospitalization for alcohol use disorders during adolescence and early adulthood. METHOD This study used a population-based birth-cohort design and included males (n = 56369) born between 1980 and 1984 in Western Australia (WA). Hospitalizations for asthma and alcohol use disorders were identified using ICD-9 codes and ICD-10 codes. Survival analysis and multivariate Poisson regression model were used in the analysis. RESULTS The risk of alcohol use disorder hospitalization was significantly higher among participants who had been hospitalized for asthma during ages 3-6 years and 12-18 years. CONCLUSION In this cohort study of Western Australian males, hospitalizations for asthma during childhood were associated with an increased risk of alcohol use disorder hospitalization among males.
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Affiliation(s)
- Wenbin Liang
- National Drug Research Institute, Division of Health Science, Curtin University , Perth , Australia
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