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Jung DK, Tan ST, Hemlock C, Mertens AN, Stewart CP, Rahman MZ, Ali S, Raqib R, Grembi JA, Karim MR, Shahriar S, Roy AK, Abdelrahman S, Shoab AK, Famida SL, Hossen MS, Mutsuddi P, Akther S, Rahman M, Unicomb L, Hester L, Granger DA, Erhardt J, Naved RT, Al Mamun MM, Parvin K, Colford JM, Fernald LC, Luby SP, Dhabhar FS, Lin A. Micronutrient status during pregnancy is associated with child immune status in rural Bangladesh. Curr Dev Nutr 2023; 7:101969. [PMID: 37560460 PMCID: PMC10407622 DOI: 10.1016/j.cdnut.2023.101969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/26/2023] [Accepted: 06/30/2023] [Indexed: 08/11/2023] Open
Abstract
Background Poor immune function increases children's risk of infection and mortality. Several maternal factors during pregnancy may affect infant immune function during the postnatal period. Objectives We aimed to evaluate whether maternal micronutrients, stress, estriol, and immune status during the first or second trimester of pregnancy were associated with child immune status in the first two years after birth. Methods We conducted observational analyses within the water, sanitation, and hygiene (WASH) Benefits Bangladesh randomized controlled trial. We measured biomarkers in 575 pregnant women and postnatally in their children. Maternal biomarkers measured during the first and second trimester of pregnancy included nutrition status via vitamin D (25-hydroxy-D [25(OH)D]), ferritin, soluble transferrin receptor (sTfR), and retinol-binding protein (RBP); cortisol; estriol. Immune markers were assessed in pregnant women at enrollment and their children at ages 14 and 28 mo, including C-reactive protein (CRP), alpha-1-acid glycoprotein (AGP), and 13 cytokines (including IFN-γ). We generated a standardized sum score of log-transformed cytokines. We analyzed IFN-γ individually because it is a critical immunoregulatory cytokine. All outcomes were prespecified. We used generalized additive models and reported the mean difference and 95% confidence intervals at the 25th and 75th percentiles of exposure distribution. Results At child age 14 mo, concentrations of maternal RBP were inversely associated with the cytokine sum score in children (-0.34 adjusted difference between the 25th and 75th percentile [95% confidence interval -0.61, -0.07]), and maternal vitamin A deficiency was positively associated with the cytokine sum score in children (1.02 [0.13, 1.91]). At child age of 28 mo, maternal RBP was positively associated with IFN-γ in children (0.07 [0.01, 0.14]), whereas maternal vitamin A deficiency was negatively associated with child AGP (-0.07 [-0.13, -0.02]). Maternal iron deficiency was associated with higher AGP concentrations in children at age 14 mo (0.13 [0.04, 0.23]), and maternal sTfR concentrations were positively associated with child CRP concentrations at age 28 mo (0.18 [0, 0.36]). Conclusion Maternal deficiencies in vitamin A or iron during the first 2 trimesters of pregnancy may shape the trajectory of a child's immune status.
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Affiliation(s)
- Da Kyung Jung
- Division of Epidemiology and Biostatistics, School of Public Health, University of California Berkeley, Berkeley, CA, United States
| | - Sophia T. Tan
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA, United States
| | - Caitlin Hemlock
- Division of Epidemiology and Biostatistics, School of Public Health, University of California Berkeley, Berkeley, CA, United States
| | - Andrew N. Mertens
- Division of Epidemiology and Biostatistics, School of Public Health, University of California Berkeley, Berkeley, CA, United States
| | - Christine P. Stewart
- Institute for Global Nutrition, University of California Davis, Davis, CA, United States
| | - Md Ziaur Rahman
- Environmental Interventions Unit, Infectious Diseases Division, icddr,b, Dhaka 1212, Bangladesh
| | - Shahjahan Ali
- Environmental Interventions Unit, Infectious Diseases Division, icddr,b, Dhaka 1212, Bangladesh
| | - Rubhana Raqib
- Environmental Interventions Unit, Infectious Diseases Division, icddr,b, Dhaka 1212, Bangladesh
| | - Jessica A. Grembi
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA, United States
| | - Mohammed Rabiul Karim
- Environmental Interventions Unit, Infectious Diseases Division, icddr,b, Dhaka 1212, Bangladesh
| | - Sunny Shahriar
- Environmental Interventions Unit, Infectious Diseases Division, icddr,b, Dhaka 1212, Bangladesh
| | - Anjan Kumar Roy
- Environmental Interventions Unit, Infectious Diseases Division, icddr,b, Dhaka 1212, Bangladesh
| | - Sarah Abdelrahman
- Division of Epidemiology and Biostatistics, School of Public Health, University of California Berkeley, Berkeley, CA, United States
| | - Abul K. Shoab
- Environmental Interventions Unit, Infectious Diseases Division, icddr,b, Dhaka 1212, Bangladesh
| | - Syeda L. Famida
- Environmental Interventions Unit, Infectious Diseases Division, icddr,b, Dhaka 1212, Bangladesh
| | - Md Saheen Hossen
- Environmental Interventions Unit, Infectious Diseases Division, icddr,b, Dhaka 1212, Bangladesh
| | - Palash Mutsuddi
- Environmental Interventions Unit, Infectious Diseases Division, icddr,b, Dhaka 1212, Bangladesh
| | - Salma Akther
- Environmental Interventions Unit, Infectious Diseases Division, icddr,b, Dhaka 1212, Bangladesh
| | - Mahbubur Rahman
- Environmental Interventions Unit, Infectious Diseases Division, icddr,b, Dhaka 1212, Bangladesh
| | - Leanne Unicomb
- Environmental Interventions Unit, Infectious Diseases Division, icddr,b, Dhaka 1212, Bangladesh
| | - Lisa Hester
- Department of Medicine, University of Maryland, Baltimore, MD USA
| | - Douglas A. Granger
- Institute for Interdisciplinary Salivary Bioscience Research, University of California Irvine, Irvine, CA, United States
| | | | | | - Md Mahfuz Al Mamun
- Health System and Population Studies Division, icddr,b, Dhaka, Bangladesh
| | - Kausar Parvin
- Health System and Population Studies Division, icddr,b, Dhaka, Bangladesh
| | - John M. Colford
- Division of Epidemiology and Biostatistics, School of Public Health, University of California Berkeley, Berkeley, CA, United States
| | - Lia C.H. Fernald
- Division of Community Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, CA, United States
| | - Stephen P. Luby
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA, United States
| | - Firdaus S. Dhabhar
- Department of Psychiatry & Behavioral Sciences, Department of Microbiology and Immunology, Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Audrie Lin
- Department of Microbiology and Environmental Toxicology, University of California, Santa Cruz, CA, United States
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2
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Becker M, Mayo JA, Phogat NK, Quaintance CC, Laborde A, King L, Gotlib IH, Gaudilliere B, Angst MS, Shaw GM, Stevenson DK, Aghaeepour N, Dhabhar FS. Deleterious and Protective Psychosocial and Stress-Related Factors Predict Risk of Spontaneous Preterm Birth. Am J Perinatol 2023; 40:74-88. [PMID: 34015838 PMCID: PMC11036409 DOI: 10.1055/s-0041-1729162] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The aim of the study was to: (1) Identify (early in pregnancy) psychosocial and stress-related factors that predict risk of spontaneous preterm birth (PTB, gestational age <37 weeks); (2) Investigate whether "protective" factors (e.g., happiness/social support) decrease risk; (3) Use the Dhabhar Quick-Assessment Questionnaire for Stress and Psychosocial Factors (DQAQ-SPF) to rapidly quantify harmful or protective factors that predict increased or decreased risk respectively, of PTB. STUDY DESIGN This is a prospective cohort study. Relative risk (RR) analyses investigated association between individual factors and PTB. Machine learning-based interdependency analysis (IDPA) identified factor clusters, strength, and direction of association with PTB. A nonlinear model based on support vector machines was built for predicting PTB and identifying factors that most strongly predicted PTB. RESULTS Higher levels of deleterious factors were associated with increased RR for PTB: General anxiety (RR = 8.9; 95% confidence interval [CI] = 2.0,39.6), pain (RR = 5.7; CI = 1.7,17.0); tiredness/fatigue (RR = 3.7; CI = 1.09,13.5); perceived risk of birth complications (RR = 4; CI = 1.6,10.01); self-rated health current (RR = 2.6; CI = 1.0,6.7) and previous 3 years (RR = 2.9; CI = 1.1,7.7); and divorce (RR = 2.9; CI = 1.1,7.8). Lower levels of protective factors were also associated with increased RR for PTB: low happiness (RR = 9.1; CI = 1.25,71.5); low support from parents/siblings (RR = 3.5; CI = 0.9,12.9), and father-of-baby (RR = 3; CI = 1.1,9.9). These factors were also components of the clusters identified by the IDPA: perceived risk of birth complications (p < 0.05 after FDR correction), and general anxiety, happiness, tiredness/fatigue, self-rated health, social support, pain, and sleep (p < 0.05 without FDR correction). Supervised analysis of all factors, subject to cross-validation, produced a model highly predictive of PTB (AUROC or area under the receiver operating characteristic = 0.73). Model reduction through forward selection revealed that even a small set of factors (including those identified by RR and IDPA) predicted PTB. CONCLUSION These findings represent an important step toward identifying key factors, which can be assessed rapidly before/after conception, to predict risk of PTB, and perhaps other adverse pregnancy outcomes. Quantifying these factors, before, or early in pregnancy, could identify women at risk of delivering preterm, pinpoint mechanisms/targets for intervention, and facilitate the development of interventions to prevent PTB. KEY POINTS · Newly designed questionnaire used for rapid quantification of stress and psychosocial factors early during pregnancy.. · Deleterious factors predict increased preterm birth (PTB) risk.. · Protective factors predict decreased PTB risk..
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Affiliation(s)
- Martin Becker
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Jonathan A. Mayo
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Nisha K. Phogat
- Department of Psychiatry and Behavioral Sciences and Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, Florida
| | - Cecele C. Quaintance
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Ana Laborde
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Lucy King
- Department of Psychology, Stanford University, Stanford, California
| | - Ian H. Gotlib
- Department of Psychology, Stanford University, Stanford, California
| | - Brice Gaudilliere
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Martin S. Angst
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Gary M. Shaw
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - David K. Stevenson
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Nima Aghaeepour
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Firdaus S. Dhabhar
- Department of Psychiatry and Behavioral Sciences and Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, Florida
- Department of Microbiology & Immunology, Miller School of Medicine, Univ. of Miami, Miami, Florida
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3
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Becker M, Dai J, Chang AL, Feyaerts D, Stelzer IA, Zhang M, Berson E, Saarunya G, De Francesco D, Espinosa C, Kim Y, Marić I, Mataraso S, Payrovnaziri SN, Phongpreecha T, Ravindra NG, Shome S, Tan Y, Thuraiappah M, Xue L, Mayo JA, Quaintance CC, Laborde A, King LS, Dhabhar FS, Gotlib IH, Wong RJ, Angst MS, Shaw GM, Stevenson DK, Gaudilliere B, Aghaeepour N. Revealing the impact of lifestyle stressors on the risk of adverse pregnancy outcomes with multitask machine learning. Front Pediatr 2022; 10:933266. [PMID: 36582513 PMCID: PMC9793100 DOI: 10.3389/fped.2022.933266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 11/14/2022] [Indexed: 12/15/2022] Open
Abstract
UNLABELLED Psychosocial and stress-related factors (PSFs), defined as internal or external stimuli that induce biological changes, are potentially modifiable factors and accessible targets for interventions that are associated with adverse pregnancy outcomes (APOs). Although individual APOs have been shown to be connected to PSFs, they are biologically interconnected, relatively infrequent, and therefore challenging to model. In this context, multi-task machine learning (MML) is an ideal tool for exploring the interconnectedness of APOs on the one hand and building on joint combinatorial outcomes to increase predictive power on the other hand. Additionally, by integrating single cell immunological profiling of underlying biological processes, the effects of stress-based therapeutics may be measurable, facilitating the development of precision medicine approaches. OBJECTIVES The primary objectives were to jointly model multiple APOs and their connection to stress early in pregnancy, and to explore the underlying biology to guide development of accessible and measurable interventions. MATERIALS AND METHODS In a prospective cohort study, PSFs were assessed during the first trimester with an extensive self-filled questionnaire for 200 women. We used MML to simultaneously model, and predict APOs (severe preeclampsia, superimposed preeclampsia, gestational diabetes and early gestational age) as well as several risk factors (BMI, diabetes, hypertension) for these patients based on PSFs. Strongly interrelated stressors were categorized to identify potential therapeutic targets. Furthermore, for a subset of 14 women, we modeled the connection of PSFs to the maternal immune system to APOs by building corresponding ML models based on an extensive single cell immune dataset generated by mass cytometry time of flight (CyTOF). RESULTS Jointly modeling APOs in a MML setting significantly increased modeling capabilities and yielded a highly predictive integrated model of APOs underscoring their interconnectedness. Most APOs were associated with mental health, life stress, and perceived health risks. Biologically, stressors were associated with specific immune characteristics revolving around CD4/CD8 T cells. Immune characteristics predicted based on stress were in turn found to be associated with APOs. CONCLUSIONS Elucidating connections among stress, multiple APOs simultaneously, and immune characteristics has the potential to facilitate the implementation of ML-based, individualized, integrative models of pregnancy in clinical decision making. The modifiable nature of stressors may enable the development of accessible interventions, with success tracked through immune characteristics.
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Affiliation(s)
- Martin Becker
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, CA, United States.,Department of Pediatrics, Stanford University, Palo Alto, CA, United States.,Department of Biomedical Data Science, Stanford University, Palo Alto, CA, United States.,Chair for Intelligent Data Analytics, Institute for Visual and Analytic Computing, Department of Computer Science and Electrical Engineering, University of Rostock, Rostock, Germany
| | - Jennifer Dai
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, CA, United States.,Department of Pediatrics, Stanford University, Palo Alto, CA, United States.,Department of Biomedical Data Science, Stanford University, Palo Alto, CA, United States
| | - Alan L Chang
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, CA, United States.,Department of Pediatrics, Stanford University, Palo Alto, CA, United States.,Department of Biomedical Data Science, Stanford University, Palo Alto, CA, United States
| | - Dorien Feyaerts
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, CA, United States
| | - Ina A Stelzer
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, CA, United States
| | - Miao Zhang
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, CA, United States.,Department of Pediatrics, Stanford University, Palo Alto, CA, United States.,Department of Biomedical Data Science, Stanford University, Palo Alto, CA, United States
| | - Eloise Berson
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, CA, United States.,Department of Pediatrics, Stanford University, Palo Alto, CA, United States.,Department of Pathology, Stanford University, Palo Alto, CA, United States
| | - Geetha Saarunya
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, CA, United States.,Department of Pediatrics, Stanford University, Palo Alto, CA, United States.,Department of Biomedical Data Science, Stanford University, Palo Alto, CA, United States
| | - Davide De Francesco
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, CA, United States.,Department of Pediatrics, Stanford University, Palo Alto, CA, United States.,Department of Biomedical Data Science, Stanford University, Palo Alto, CA, United States
| | - Camilo Espinosa
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, CA, United States.,Department of Pediatrics, Stanford University, Palo Alto, CA, United States.,Department of Biomedical Data Science, Stanford University, Palo Alto, CA, United States
| | - Yeasul Kim
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, CA, United States.,Department of Pediatrics, Stanford University, Palo Alto, CA, United States.,Department of Biomedical Data Science, Stanford University, Palo Alto, CA, United States
| | - Ivana Marić
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, CA, United States.,Department of Pediatrics, Stanford University, Palo Alto, CA, United States.,Department of Biomedical Data Science, Stanford University, Palo Alto, CA, United States
| | - Samson Mataraso
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, CA, United States.,Department of Pediatrics, Stanford University, Palo Alto, CA, United States.,Department of Biomedical Data Science, Stanford University, Palo Alto, CA, United States
| | - Seyedeh Neelufar Payrovnaziri
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, CA, United States.,Department of Pediatrics, Stanford University, Palo Alto, CA, United States.,Department of Biomedical Data Science, Stanford University, Palo Alto, CA, United States
| | - Thanaphong Phongpreecha
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, CA, United States.,Department of Biomedical Data Science, Stanford University, Palo Alto, CA, United States.,Department of Pathology, Stanford University, Palo Alto, CA, United States
| | - Neal G Ravindra
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, CA, United States.,Department of Pediatrics, Stanford University, Palo Alto, CA, United States.,Department of Biomedical Data Science, Stanford University, Palo Alto, CA, United States
| | - Sayane Shome
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, CA, United States.,Department of Pediatrics, Stanford University, Palo Alto, CA, United States.,Department of Biomedical Data Science, Stanford University, Palo Alto, CA, United States
| | - Yuqi Tan
- Department of Microbiology & Immunology, Stanford University, Palo Alto, CA, United States.,Baxter Laboratory for Stem Cell Biology, Stanford University, Palo Alto, CA, United States
| | - Melan Thuraiappah
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, CA, United States.,Department of Pediatrics, Stanford University, Palo Alto, CA, United States.,Department of Biomedical Data Science, Stanford University, Palo Alto, CA, United States
| | - Lei Xue
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, CA, United States.,Department of Pediatrics, Stanford University, Palo Alto, CA, United States.,Department of Biomedical Data Science, Stanford University, Palo Alto, CA, United States
| | - Jonathan A Mayo
- Department of Pediatrics, Stanford University, Palo Alto, CA, United States
| | | | - Ana Laborde
- Department of Pediatrics, Stanford University, Palo Alto, CA, United States
| | - Lucy S King
- Department of Psychology, Stanford University, Palo Alto, CA, United States
| | - Firdaus S Dhabhar
- Department of Psychiatry & Behavioral Science, University of Miami, Miami, FL, United States.,Department of Microbiology & Immunology, University of Miami, Miami, FL, United States.,Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, United States.,Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Ian H Gotlib
- Department of Psychology, Stanford University, Palo Alto, CA, United States
| | - Ronald J Wong
- Department of Biomedical Data Science, Stanford University, Palo Alto, CA, United States
| | - Martin S Angst
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, CA, United States
| | - Gary M Shaw
- Department of Pediatrics, Stanford University, Palo Alto, CA, United States
| | - David K Stevenson
- Department of Pediatrics, Stanford University, Palo Alto, CA, United States
| | - Brice Gaudilliere
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, CA, United States.,Department of Pediatrics, Stanford University, Palo Alto, CA, United States
| | - Nima Aghaeepour
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, CA, United States.,Department of Pediatrics, Stanford University, Palo Alto, CA, United States.,Department of Biomedical Data Science, Stanford University, Palo Alto, CA, United States
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4
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Lalonde CS, Mekawi Y, Ethun KF, Beurel E, Gould F, Dhabhar FS, Schultebraucks K, Galatzer-Levy I, Maples-Keller JL, Rothbaum BO, Ressler KJ, Nemeroff CB, Stevens JS, Michopoulos V. Sex Differences in Peritraumatic Inflammatory Cytokines and Steroid Hormones Contribute to Prospective Risk for Nonremitting Posttraumatic Stress Disorder. Chronic Stress (Thousand Oaks) 2021; 5:24705470211032208. [PMID: 34595364 PMCID: PMC8477354 DOI: 10.1177/24705470211032208] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Women are at higher risk for developing posttraumatic stress disorder (PTSD) compared to men, yet little is known about the biological contributors to this sex difference. One possible mechanism is differential immunological and neuroendocrine responses to traumatic stress exposure. In the current prospective study, we aimed to identify whether sex is indirectly associated with the probability of developing nonremitting PTSD through pro-inflammatory markers and whether steroid hormone concentrations influence this effect. Female (n = 179) and male (n = 197) trauma survivors were recruited from an emergency department and completed clinical assessment within 24 h and blood samples within ∼three hours of trauma exposure. Pro-inflammatory cytokines (IL-6, IL-1 β , TNF, IFNγ), and steroid hormone (estradiol, testosterone, progesterone, cortisol) concentrations were quantified in plasma. Compared to men, women had a higher probability of developing nonremitting PTSD after trauma (p = 0.04), had lower pro-inflammatory cytokines and testosterone (p's<0.001), and had higher cortisol and progesterone (p's<0.001) concentrations. Estradiol concentrations were not different between the sexes (p = 0.24). Pro-inflammatory cytokines were a significant mediator in the relationship between sex and probability of developing nonremitting PTSD (p < 0.05), such that men had higher concentrations of pro-inflammatory cytokines which were associated with lower risk of nonremitting PTSD development. This effect was significantly moderated by estradiol (p < 0.05), as higher estradiol levels in men were associated with higher pro-inflammatory cytokine concentrations and lower risk for developing nonremitting PTSD. The current results suggest that sex differences in the pro-inflammatory cytokine response to trauma exposure partially mediate the probability of developing nonremitting PTSD, and that the protective ability to mount an pro-inflammatory cytokine response in men may depend on higher estradiol levels in the aftermath of trauma exposure.
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Affiliation(s)
- Chloe S Lalonde
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Yara Mekawi
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Kelly F Ethun
- Yerkes National Primate Research Center, Atlanta, Georgia, USA.,Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Eleonore Beurel
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA.,Department of Biochemistry and Molecular Biology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Felicia Gould
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Firdaus S Dhabhar
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA.,Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, USA.,Department of Psychology, University of Miami, Coral Gables, Florida, USA
| | - Katharina Schultebraucks
- Department of Emergency Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Isaac Galatzer-Levy
- Department of Psychiatry, New York University School of Medicine, New York, New York, USA
| | - Jessica L Maples-Keller
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Barbara O Rothbaum
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Kerry J Ressler
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, USA.,Mclean Hospital, Harvard Medical School, Belmont, Massachusetts, USA
| | - Charles B Nemeroff
- Department of Psychiatry and Behavioral Sciences, University of Texas at Austin, Dell Medical School, Austin, Texas, USA
| | - Jennifer S Stevens
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Vasiliki Michopoulos
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, USA.,Yerkes National Primate Research Center, Atlanta, Georgia, USA
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5
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Lin A, Mertens AN, Arnold BF, Tan S, Lin J, Stewart CP, Hubbard AE, Ali S, Benjamin-Chung J, Shoab AK, Rahman MZ, Famida SL, Hossen MS, Mutsuddi P, Akther S, Rahman M, Unicomb L, Naved RT, Mamun MMA, Parvin K, Dhabhar FS, Kariger P, Fernald LC, Luby SP, Colford JM. Telomere length is associated with growth in children in rural Bangladesh. eLife 2021; 10:60389. [PMID: 34494545 PMCID: PMC8494482 DOI: 10.7554/elife.60389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 09/04/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Previously, we demonstrated that a water, sanitation, handwashing, and nutritional intervention improved linear growth and was unexpectedly associated with shortened childhood telomere length (TL) (Lin et al., 2017). Here, we assessed the association between TL and growth. Methods: We measured relative TL in whole blood from 713 children. We reported differences between the 10th percentile and 90th percentile of TL or change in TL distribution using generalized additive models, adjusted for potential confounders. Results: In cross-sectional analyses, long TL was associated with a higher length-for-age Z score at age 1 year (0.23 SD adjusted difference in length-for-age Z score [95% CI 0.05, 0.42; FDR-corrected p-value = 0.01]). TL was not associated with other outcomes. Conclusions: Consistent with the metabolic telomere attrition hypothesis, our previous trial findings support an adaptive role for telomere attrition, whereby active TL regulation is employed as a strategy to address ‘emergency states’ with increased energy requirements such as rapid growth during the first year of life. Although short periods of active telomere attrition may be essential to promote growth, this study suggests that a longer overall initial TL setting in the first 2 years of life could signal increased resilience against future telomere erosion events and healthy growth trajectories. Funding: Funded by the Bill and Melinda Gates Foundation. Clinical trial number: NCT01590095
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Affiliation(s)
- Audrie Lin
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, Berkeley, United States
| | - Andrew N Mertens
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, Berkeley, United States
| | - Benjamin F Arnold
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, United States
| | - Sophia Tan
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, Berkeley, United States
| | - Jue Lin
- Department of Biochemistry and Biophysics, University of California, San Francisco, San Francisco, United States
| | - Christine P Stewart
- Department of Nutrition, University of California, Davis, Davis, United States
| | - Alan E Hubbard
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, Berkeley, United States
| | - Shahjahan Ali
- Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Jade Benjamin-Chung
- Department of Epidemiology & Population Health, Stanford University, Stanford, United States
| | - Abul K Shoab
- Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Md Ziaur Rahman
- Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Syeda L Famida
- Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Md Saheen Hossen
- Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Palash Mutsuddi
- Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Salma Akther
- Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Mahbubur Rahman
- Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Leanne Unicomb
- Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Ruchira Tabassum Naved
- Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Md Mahfuz Al Mamun
- Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Kausar Parvin
- Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Firdaus S Dhabhar
- Department of Psychiatry & Behavioral Sciences, Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, United States
| | - Patricia Kariger
- Division of Community Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, United States
| | - Lia Ch Fernald
- Division of Community Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, United States
| | - Stephen P Luby
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, United States
| | - John M Colford
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, Berkeley, United States
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Dhabhar FS, Danese A, Felger JC, Miller AH. Remembering Bruce S. McEwen - A tribute from psychoneuroimmunology. Brain Behav Immun 2021; 94:11-14. [PMID: 33516920 DOI: 10.1016/j.bbi.2021.01.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 01/16/2021] [Indexed: 10/22/2022] Open
Affiliation(s)
- Firdaus S Dhabhar
- Departments of Psychiatry & Behavioral Sciences, Microbiology & Immunology, and the Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, United States.
| | - Andrea Danese
- Social, Genetic and Developmental Psychiatry (SGDP) Centre and Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Jennifer C Felger
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
| | - Andrew H Miller
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
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7
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Shields GS, Skwara AC, King BG, Zanesco AP, Dhabhar FS, Saron CD. Deconstructing the effects of concentration meditation practice on interference control: The roles of controlled attention and inflammatory activity. Brain Behav Immun 2020; 89:256-267. [PMID: 32640286 DOI: 10.1016/j.bbi.2020.06.034] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 06/23/2020] [Accepted: 06/30/2020] [Indexed: 12/11/2022] Open
Abstract
Prior work has linked meditation practice to improvements in interference control. However, the mechanisms underlying these improvements are relatively unknown. In the context of meditation training, improvements in interference control could result eitherfrom increases in controlled attention to goal-relevant stimuli, or from reductions in automatic capture by goal-irrelevant stimuli. Moreover, few studies have linked training-related changes in attention to physiological processes, such as inflammatory activity, that are thought to influence cognitive function. This study addresses these gaps by examining associations between cognitive performance and cytokines in the context of an intensive meditation retreat. Participants were randomly assigned to complete 3 months of meditation training first, or to serve as waitlist controls. The waitlist-control participants then later completed a separate 3-month training intervention. We assessed participants' interference control with a flanker task and used computational modeling to derive component processes of controlled and automatic attention. We also collected blood samples at the beginning, middle, and end of training to quantify changes in cytokine activity. Participants who completed training evidenced better controlled attention than waitlist controls during the first retreat intervention, and controls showed significant improvements in controlled attention when they completed their own, second retreat. Importantly, inflammatory activity was inversely associated with controlled attention during both interventions. Our results suggest that practice of concentration meditation influences interference control by enhancing controlled attention to goal-relevant task elements, and that inflammatory activity relates to individual differences in controlled attention.
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Affiliation(s)
- Grant S Shields
- Department of Psychological Science, University of Arkansas, Fayetteville, AR, USA.
| | - Alea C Skwara
- Center for Mind and Brain, University of California, Davis, CA, USA; Department of Psychology, University of California, Davis, CA, USA
| | - Brandon G King
- Center for Mind and Brain, University of California, Davis, CA, USA
| | - Anthony P Zanesco
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Firdaus S Dhabhar
- Department of Psychiatry & Behavioral Sciences, Department of Microbiology & Immunology, and The Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Clifford D Saron
- Center for Mind and Brain, University of California, Davis, CA, USA.
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8
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Abstract
The authors highlight, from a firsthand perspective, Bruce S. McEwen's seminal influence on the field of stress neurobiology and beyond, and how these investigations have yielded important insights, principles and critical questions that continue to guide stress research today. Featured are discussion of: 1) the important inverted-U relationship between stress/glucocorticoids and optimal physiological function, 2) stress adaptation and the role of adaptive stress responses, 3) mechanisms by which the short-term stress response promotes heightened immune function and immunity, and 4) the far reaching impact of the theoretical framework of allostasis and allostatic load-concepts that have created new bridges between stress physiology, biomedical sciences, health psychology and sociology.
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Affiliation(s)
- Firdaus S Dhabhar
- Departments of Psychiatry & Behavioral Sciences, Microbiology & Immunology, Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miama, FL, USA
| | - Michael J Meaney
- Faculty of Medicine, McGill University, Montreal, Canada
- Translational Neuroscience Programme, Singapore Institute of Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore
| | - Robert M Sapolsky
- John A. and Cynthia Fry Gunn Professor of Biological Sciences Departments of Biology, Neurology and Neurological Sciences, and Neurosurgery, Stanford University, Stanford, CA, USA
| | - Robert L Spencer
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, USA
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9
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Grudet C, Wolkowitz OM, Mellon SH, Malm J, Reus VI, Brundin L, Nier BM, Dhabhar FS, Hough CM, Westrin Å, Lindqvist D. Vitamin D and inflammation in major depressive disorder. J Affect Disord 2020; 267:33-41. [PMID: 32063570 PMCID: PMC10662683 DOI: 10.1016/j.jad.2020.01.168] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 12/06/2019] [Accepted: 01/28/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Increased inflammation is reported in Major Depressive Disorder (MDD), which may be more pronounced in suicidal subjects. Vitamin D deficiency may drive this pro-inflammatory state due to vitamin D's anti-inflammatory effects. METHODS We quantified plasma 25-hydroxyvitamin D (25(OH)D) and inflammatory markers interleukin (IL)-6 and tumor necrosis factor (TNF)-α, and other inflammatory indices, neutrophil-to-lymphocyte ratio (NLR) and white blood cell count (WBC) in 48 un-medicated MDD subjects (n = 17 with mild-to-moderate suicidal ideation [SI]) and 54 controls. IL-6 and TNF-α were combined into a composite inflammation score. RESULTS There were no significant differences in 25(OH)D levels between MDD and controls (p = 0.24) or between MDD with and without SI (p = 0.61). However, 25(OH)D was negatively correlated with all measured inflammatory markers; these correlations were stronger in MDD subjects, and particularly in those with SI. MDD status significantly moderated the relationships between 25(OH)D and NLR (p = 0.03), and 25(OH)D and WBC (p < 0.05), and SI significantly moderated the relationship between 25(OH)D and NLR (p = 0.03). LIMITATIONS The study was cross-sectional, thereby limiting causal inference, and had a small sample size. Only seventeen of the MDD subjects had SI. CONCLUSION While 25(OH)D levels did not significantly differ in MDD vs. controls, or in MDD with or without SI, lower 25(OH)D was associated with indices of immune activation in MDD, especially in cases with SI. Although our findings do not address causality, they are consistent with findings that relatively low 25(OH)D levels in MDD are associated with a pro-inflammatory state.
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Affiliation(s)
- Cécile Grudet
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Psychiatry, Lund, Sweden
| | - Owen M Wolkowitz
- Weill Institute for Neurosciences/ Department of Psychiatry, University of California San Francisco (UCSF) School of Medicine, San Francisco, CA, USA
| | - Synthia H Mellon
- Department of OB/GYN and Reproductive Sciences, University of California San Francisco (UCSF) School of Medicine, San Francisco, CA, USA
| | - Johan Malm
- Department of Translational Medicine, Section for Clinical Chemistry, Lund University, Malmö, Sweden
| | - Victor I Reus
- Weill Institute for Neurosciences/ Department of Psychiatry, University of California San Francisco (UCSF) School of Medicine, San Francisco, CA, USA
| | - Lena Brundin
- Center for Neurodegenerative Science, Van Andel Institute, Grand Rapids, MI, USA
| | - Brenton M Nier
- Weill Institute for Neurosciences/ Department of Psychiatry, University of California San Francisco (UCSF) School of Medicine, San Francisco, CA, USA
| | - Firdaus S Dhabhar
- Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, Miami, USA
| | - Christina M Hough
- Weill Institute for Neurosciences/ Department of Psychiatry, University of California San Francisco (UCSF) School of Medicine, San Francisco, CA, USA; University of California, Los Angeles (UCLA), Department of Psychology, Los Angeles, CA, USA
| | - Åsa Westrin
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Psychiatry, Lund, Sweden; Office of Psychiatry and Habilitation, Region Skåne, Sweden
| | - Daniel Lindqvist
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Psychiatry, Lund, Sweden; Weill Institute for Neurosciences/ Department of Psychiatry, University of California San Francisco (UCSF) School of Medicine, San Francisco, CA, USA; Office of Psychiatry and Habilitation, Region Skåne, Sweden.
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10
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Michopoulos V, Beurel E, Gould F, Dhabhar FS, Schultebraucks K, Galatzer-Levy I, Rothbaum BO, Ressler KJ, Nemeroff CB. Association of Prospective Risk for Chronic PTSD Symptoms With Low TNFα and IFNγ Concentrations in the Immediate Aftermath of Trauma Exposure. Am J Psychiatry 2020; 177:58-65. [PMID: 31352811 DOI: 10.1176/appi.ajp.2019.19010039] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Although several reports have documented heightened systemic inflammation in posttraumatic stress disorder (PTSD), few studies have assessed whether inflammatory markers serve as prospective biomarkers for PTSD risk. The present study aimed to characterize whether peripheral immune factors measured in blood samples collected in an emergency department immediately after trauma exposure would predict later chronic development of PTSD. METHODS Participants (N=505) were recruited from a hospital emergency department and underwent a 1.5-hour assessment. Blood samples were drawn, on average, about 3 hours after trauma exposure. Follow-up assessments were conducted 1, 3, 6, and 12 months after trauma exposure. Latent growth mixture modeling was used to identify classes of PTSD symptom trajectories. RESULTS Three distinct classes of PTSD symptom trajectories were identified: chronic (N=28), resilient (N=160), and recovery (N=85). Multivariate analyses of covariance revealed a significant multivariate main effect of PTSD symptom trajectory class membership on proinflammatory cytokines. Univariate analyses showed a significant main effect of trajectory class membership on plasma concentrations of proinflammatory tumor necrosis factor α (TNFα) and interferon-γ (IFNγ). Concentrations of proinflammatory TNFα and IFNγ were significantly lower in individuals in the chronic PTSD class compared with those in the recovery and resilient classes. There were no significant differences in interleukin (IL) 1β and IL-6 concentrations by PTSD symptom trajectory class. Anti-inflammatory and other cytokines, as well as chemokines and growth factor concentrations, were not associated with development of chronic PTSD. CONCLUSIONS Overall, the study findings suggest that assessing the proinflammatory immune response to trauma exposure immediately after trauma exposure, in the emergency department, may help identify individuals most at risk for developing chronic PTSD in the aftermath of trauma.
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Affiliation(s)
- Vasiliki Michopoulos
- The Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta (Michopoulos, Rothbaum, Ressler); the Yerkes National Primate Research Center, Atlanta (Michopoulos); the Department of Psychiatry and Behavioral Sciences (Beurel, Gould, Dhabhar), the Department of Biochemistry and Molecular Biology (Beurel), and the Sylvester Comprehensive Cancer Center (Dhabhar), University of Miami Miller School of Medicine, Miami; the Department of Psychology, University of Miami, Coral Gables, Fla. (Dhabhar); the Department of Psychiatry, New York University School of Medicine, New York (Schultebraucks, Galatzer-Levy); Mclean Hospital, Harvard Medical School, Belmont, Mass. (Ressler); the Department of Psychiatry, Dell Medical School, and the Institute for Early Life Adversity Research, University of Texas at Austin (Nemeroff)
| | - Eleonore Beurel
- The Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta (Michopoulos, Rothbaum, Ressler); the Yerkes National Primate Research Center, Atlanta (Michopoulos); the Department of Psychiatry and Behavioral Sciences (Beurel, Gould, Dhabhar), the Department of Biochemistry and Molecular Biology (Beurel), and the Sylvester Comprehensive Cancer Center (Dhabhar), University of Miami Miller School of Medicine, Miami; the Department of Psychology, University of Miami, Coral Gables, Fla. (Dhabhar); the Department of Psychiatry, New York University School of Medicine, New York (Schultebraucks, Galatzer-Levy); Mclean Hospital, Harvard Medical School, Belmont, Mass. (Ressler); the Department of Psychiatry, Dell Medical School, and the Institute for Early Life Adversity Research, University of Texas at Austin (Nemeroff)
| | - Felicia Gould
- The Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta (Michopoulos, Rothbaum, Ressler); the Yerkes National Primate Research Center, Atlanta (Michopoulos); the Department of Psychiatry and Behavioral Sciences (Beurel, Gould, Dhabhar), the Department of Biochemistry and Molecular Biology (Beurel), and the Sylvester Comprehensive Cancer Center (Dhabhar), University of Miami Miller School of Medicine, Miami; the Department of Psychology, University of Miami, Coral Gables, Fla. (Dhabhar); the Department of Psychiatry, New York University School of Medicine, New York (Schultebraucks, Galatzer-Levy); Mclean Hospital, Harvard Medical School, Belmont, Mass. (Ressler); the Department of Psychiatry, Dell Medical School, and the Institute for Early Life Adversity Research, University of Texas at Austin (Nemeroff)
| | - Firdaus S Dhabhar
- The Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta (Michopoulos, Rothbaum, Ressler); the Yerkes National Primate Research Center, Atlanta (Michopoulos); the Department of Psychiatry and Behavioral Sciences (Beurel, Gould, Dhabhar), the Department of Biochemistry and Molecular Biology (Beurel), and the Sylvester Comprehensive Cancer Center (Dhabhar), University of Miami Miller School of Medicine, Miami; the Department of Psychology, University of Miami, Coral Gables, Fla. (Dhabhar); the Department of Psychiatry, New York University School of Medicine, New York (Schultebraucks, Galatzer-Levy); Mclean Hospital, Harvard Medical School, Belmont, Mass. (Ressler); the Department of Psychiatry, Dell Medical School, and the Institute for Early Life Adversity Research, University of Texas at Austin (Nemeroff)
| | - Katharina Schultebraucks
- The Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta (Michopoulos, Rothbaum, Ressler); the Yerkes National Primate Research Center, Atlanta (Michopoulos); the Department of Psychiatry and Behavioral Sciences (Beurel, Gould, Dhabhar), the Department of Biochemistry and Molecular Biology (Beurel), and the Sylvester Comprehensive Cancer Center (Dhabhar), University of Miami Miller School of Medicine, Miami; the Department of Psychology, University of Miami, Coral Gables, Fla. (Dhabhar); the Department of Psychiatry, New York University School of Medicine, New York (Schultebraucks, Galatzer-Levy); Mclean Hospital, Harvard Medical School, Belmont, Mass. (Ressler); the Department of Psychiatry, Dell Medical School, and the Institute for Early Life Adversity Research, University of Texas at Austin (Nemeroff)
| | - Isaac Galatzer-Levy
- The Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta (Michopoulos, Rothbaum, Ressler); the Yerkes National Primate Research Center, Atlanta (Michopoulos); the Department of Psychiatry and Behavioral Sciences (Beurel, Gould, Dhabhar), the Department of Biochemistry and Molecular Biology (Beurel), and the Sylvester Comprehensive Cancer Center (Dhabhar), University of Miami Miller School of Medicine, Miami; the Department of Psychology, University of Miami, Coral Gables, Fla. (Dhabhar); the Department of Psychiatry, New York University School of Medicine, New York (Schultebraucks, Galatzer-Levy); Mclean Hospital, Harvard Medical School, Belmont, Mass. (Ressler); the Department of Psychiatry, Dell Medical School, and the Institute for Early Life Adversity Research, University of Texas at Austin (Nemeroff)
| | - Barbara O Rothbaum
- The Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta (Michopoulos, Rothbaum, Ressler); the Yerkes National Primate Research Center, Atlanta (Michopoulos); the Department of Psychiatry and Behavioral Sciences (Beurel, Gould, Dhabhar), the Department of Biochemistry and Molecular Biology (Beurel), and the Sylvester Comprehensive Cancer Center (Dhabhar), University of Miami Miller School of Medicine, Miami; the Department of Psychology, University of Miami, Coral Gables, Fla. (Dhabhar); the Department of Psychiatry, New York University School of Medicine, New York (Schultebraucks, Galatzer-Levy); Mclean Hospital, Harvard Medical School, Belmont, Mass. (Ressler); the Department of Psychiatry, Dell Medical School, and the Institute for Early Life Adversity Research, University of Texas at Austin (Nemeroff)
| | - Kerry J Ressler
- The Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta (Michopoulos, Rothbaum, Ressler); the Yerkes National Primate Research Center, Atlanta (Michopoulos); the Department of Psychiatry and Behavioral Sciences (Beurel, Gould, Dhabhar), the Department of Biochemistry and Molecular Biology (Beurel), and the Sylvester Comprehensive Cancer Center (Dhabhar), University of Miami Miller School of Medicine, Miami; the Department of Psychology, University of Miami, Coral Gables, Fla. (Dhabhar); the Department of Psychiatry, New York University School of Medicine, New York (Schultebraucks, Galatzer-Levy); Mclean Hospital, Harvard Medical School, Belmont, Mass. (Ressler); the Department of Psychiatry, Dell Medical School, and the Institute for Early Life Adversity Research, University of Texas at Austin (Nemeroff)
| | - Charles B Nemeroff
- The Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta (Michopoulos, Rothbaum, Ressler); the Yerkes National Primate Research Center, Atlanta (Michopoulos); the Department of Psychiatry and Behavioral Sciences (Beurel, Gould, Dhabhar), the Department of Biochemistry and Molecular Biology (Beurel), and the Sylvester Comprehensive Cancer Center (Dhabhar), University of Miami Miller School of Medicine, Miami; the Department of Psychology, University of Miami, Coral Gables, Fla. (Dhabhar); the Department of Psychiatry, New York University School of Medicine, New York (Schultebraucks, Galatzer-Levy); Mclean Hospital, Harvard Medical School, Belmont, Mass. (Ressler); the Department of Psychiatry, Dell Medical School, and the Institute for Early Life Adversity Research, University of Texas at Austin (Nemeroff)
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11
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Allen AM, Wang Y, Chae DH, Price MM, Powell W, Steed TC, Rose Black A, Dhabhar FS, Marquez‐Magaña L, Woods‐Giscombe CL. Cover Image, Volume 1457, Issue 1. Ann N Y Acad Sci 2019. [DOI: 10.1111/nyas.14294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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12
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Allen AM, Wang Y, Chae DH, Price MM, Powell W, Steed TC, Black AR, Dhabhar FS, Marquez-Magaña L, Woods-Giscombe CL. Racial discrimination, the superwoman schema, and allostatic load: exploring an integrative stress-coping model among African American women. Ann N Y Acad Sci 2019; 1457:104-127. [PMID: 31403707 PMCID: PMC6904516 DOI: 10.1111/nyas.14188] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 05/30/2019] [Accepted: 06/11/2019] [Indexed: 12/12/2022]
Abstract
Racial discrimination has been linked to allostatic load (i.e., cumulative biological stress) among African American women. However, limited attention has been given to psychosocial processes involved in the stress response-critical for understanding biological pathways to health-in studies examining racial discrimination as a social determinant of health. We examined whether the superwoman schema (SWS), a multidimensional culture-specific framework characterizing psychosocial responses to stress among African American women, modifies the association between racial discrimination and allostatic load. We used purposive sampling to recruit a community sample of African American women ages 30-50 from five San Francisco Bay Area counties (n = 208). Path analysis was used to test for interactions while accounting for the covariance among SWS subscales using both linear and quadratic models. Significant interactions were observed between racial discrimination and four of the five SWS subscales. Feeling obligated to present an image of strength and an obligation to suppress emotions were each protective whereas feeling an intense motivation to succeed and feeling an obligation to help others exacerbated the independent health risk associated with experiencing racial discrimination. Our findings affirm the need to consider individual variability in coping and potentially other psychosocial processes involved in the stress response process, and offer several insights that may help elucidate the mechanisms by which racial discrimination gets "under the skin."
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Affiliation(s)
- Amani M. Allen
- Divisions of Community Health Sciences and Epidemiology,
University of California Berkeley School of Public Health, Berkeley,
California
| | - Yijie Wang
- Department of Human Development and Family Studies,
Michigan State University, East Lansing, Michigan
| | - David H. Chae
- Department of Human Development and Family Studies, College
of Human Sciences, Auburn University, Auburn, Alabama
| | - Melisa M. Price
- Phil R. Lee Institute for Health Policy Studies, University
of California, San Francisco, California
| | - Wizdom Powell
- Department of Psychiatry and Health Disparities Institute,
UConn Health
| | - Teneka C. Steed
- Department of Educational Research Methodology, University of North Carolina at Greensboro, Greensboro, North Carolina
| | - Angela Rose Black
- University of Wisconsin-Madison Department of Family
Medicine and Community Health, Madison, Wisconsin
| | - Firdaus S. Dhabhar
- Department of Psychiatry and Behavioral Sciences, Sylvester
Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami,
Florida
| | - Leticia Marquez-Magaña
- Department of Cell and Molecular Biology, San Francisco
State University, San Francisco, California
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13
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Affiliation(s)
- Firdaus S Dhabhar
- a Department of Psychiatry and Behavioral Sciences, Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami , Miami , FL , USA
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14
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Antoni MH, Dhabhar FS. The impact of psychosocial stress and stress management on immune responses in patients with cancer. Cancer 2019; 125:1417-1431. [PMID: 30768779 DOI: 10.1002/cncr.31943] [Citation(s) in RCA: 142] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 07/22/2018] [Accepted: 08/16/2018] [Indexed: 12/20/2022]
Abstract
The range of psychosocial stress factors/processes (eg, chronic stress, distress states, coping, social adversity) were reviewed as they relate to immune variables in cancer along with studies of psychosocial interventions on these stress processes and immune measures in cancer populations. The review includes molecular, cellular, and clinical research specifically examining the effects of stress processes and stress-management interventions on immune variables (eg, cellular immune function, inflammation), which may or may not be changing directly in response to the cancer or its treatment. Basic psychoneuroimmunologic research on stress processes (using animal or cellular/tumor models) provides leads for investigating biobehavioral processes that may underlie the associations reported to date. The development of theoretically driven and empirically supported stress-management interventions may provide important adjuncts to clinical cancer care going forward.
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Affiliation(s)
- Michael H Antoni
- Department of Psychology, University of Miami and Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, Florida
| | - Firdaus S Dhabhar
- Department of Psychiatry and Behavioral Sciences and Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, Florida
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15
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Prather AA, Epel ES, Parra EP, Coccia M, Puterman E, Aiello AE, Dhabhar FS. Associations between chronic caregiving stress and T cell markers implicated in immunosenescence. Brain Behav Immun 2018; 73:546-549. [PMID: 29935942 PMCID: PMC6129414 DOI: 10.1016/j.bbi.2018.06.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 06/15/2018] [Accepted: 06/20/2018] [Indexed: 12/27/2022] Open
Abstract
Chronic psychological stress is associated with accelerated biological aging, immune dysfunction, and premature morbidity and mortality. Changes in the relative proportions of T cell subpopulations are thought to be a characteristic of immunological aging; however, understanding of whether these changes are associated with chronic psychological stress is incomplete. This study investigated associations between chronic caregiving stress and distributions of T cell phenotypes in a sample of high stress mothers of children with Autism Spectrum Disorder (caregivers; n = 91) and low stress mothers of neurotypical children (controls; n = 88). Immune markers assessed were naïve (CD45RA + CD62L+), central memory (CD45RA-CD62L+), and effector memory (CD45RA-CD62L-) CD4+ and CD8+ T cells. We also examined the ratio of effector to naïve (E:N) CD4+ and CD8+ T cells. In models adjusted for age, body mass index, race/ethnicity, and antidepressant use, caregivers displayed higher percentages of effector memory CD8+ and CD4+ T cells as well as lower percentages of naïve CD8+ T cells and central memory CD8+ and CD4+ T cells compared to controls. Caregivers also displayed significantly higher E:N ratios for both CD4+ and CD8+ T cells. These findings were also independent of cytomegalovirus infection status. Furthermore, higher parental stress, across both groups, was related to several immune parameters. These findings provide preliminary evidence that chronic parental caregiving stress is associated with changes in relative proportions of T cell subpopulations that are consistent with accelerated immunological aging.
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Affiliation(s)
- Aric A. Prather
- Center for Health and Community, University of California, San Francisco
| | - Elissa S. Epel
- Center for Health and Community, University of California, San Francisco
| | | | - Michael Coccia
- Center for Health and Community, University of California, San Francisco
| | - Eli Puterman
- Department of Kinesiology, University of British Columbia
| | - Allison E. Aiello
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill
| | - Firdaus S. Dhabhar
- Department of Psychiatry and Behavioral Sciences, Sylvester Comprehensive Cancer Center, University of Miami School of Medicine
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16
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Dhabhar FS. The short-term stress response - Mother nature's mechanism for enhancing protection and performance under conditions of threat, challenge, and opportunity. Front Neuroendocrinol 2018; 49:175-192. [PMID: 29596867 PMCID: PMC5964013 DOI: 10.1016/j.yfrne.2018.03.004] [Citation(s) in RCA: 120] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 03/23/2018] [Accepted: 03/23/2018] [Indexed: 02/07/2023]
Abstract
Our group has proposed that in contrast to chronic stress that can have harmful effects, the short-term (fight-or-flight) stress response (lasting for minutes to hours) is nature's fundamental survival mechanism that enhances protection and performance under conditions involving threat/challenge/opportunity. Short-term stress enhances innate/primary, adaptive/secondary, vaccine-induced, and anti-tumor immune responses, and post-surgical recovery. Mechanisms and mediators include stress hormones, dendritic cell, neutrophil, macrophage, and lymphocyte trafficking/function and local/systemic chemokine and cytokine production. Short-term stress may also enhance mental/cognitive and physical performance through effects on brain, musculo-skeletal, and cardiovascular function, reappraisal of threat/anxiety, and training-induced stress-optimization. Therefore, short-term stress psychology/physiology could be harnessed to enhance immuno-protection, as well as mental and physical performance. This review aims to provide a conceptual framework and targets for further investigation of mechanisms and conditions under which the protective/adaptive aspects of short-term stress/exercise can be optimized/harnessed, and for developing pharmacological/biobehavioral interventions to enhance health/healing, and mental/cognitive/physical performance.
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Affiliation(s)
- Firdaus S Dhabhar
- Department of Psychiatry & Behavioral Sciences, Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Mail Stop M877, 1550 NW 10th Avenue, Miami, FL 33136-1000, United States.
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Lindqvist D, Mellon SH, Dhabhar FS, Yehuda R, Grenon SM, Flory JD, Bierer LM, Abu-Amara D, Coy M, Makotkine I, Reus VI, Aschbacher K, Bersani FS, Marmar CR, Wolkowitz OM. Increased circulating blood cell counts in combat-related PTSD: Associations with inflammation and PTSD severity. Psychiatry Res 2017; 258:330-336. [PMID: 28942957 DOI: 10.1016/j.psychres.2017.08.052] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Revised: 08/18/2017] [Accepted: 08/20/2017] [Indexed: 12/18/2022]
Abstract
Inflammation is reported in post-traumatic stress disorder (PTSD). Few studies have investigated circulating blood cells that may contribute to inflammation. We assessed circulating platelets, white blood cells (WBC) and red blood cells (RBC) in PTSD and assessed their relationship to inflammation and symptom severity. One-hundred and sixty-three male combat-exposed veterans (82 PTSD, 81 non-PTSD) had blood assessed for platelets, WBC, and RBC. Data were correlated with symptom severity and inflammation. All cell counts were significantly elevated in PTSD. There were small mediation effects of BMI and smoking on these relationships. After adjusting for these, the differences in WBC and RBC remained significant, while platelet count was at trend level. In all subjects, all of the cell counts correlated significantly with inflammation. Platelet count correlated with inflammation only in the PTSD subjects. Platelet count, but none of the other cell counts, was directly correlated with PTSD severity ratings in the PTSD group. Combat PTSD is associated with elevations in RBC, WBC, and platelets. Dysregulation of all three major lineages of hematopoietic cells in PTSD, as well as their significant correlation with inflammation, suggest clinical significance of these changes.
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Affiliation(s)
- Daniel Lindqvist
- Department of Psychiatry, University of California San Francisco (UCSF), School of Medicine, San Francisco, CA, United States; Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Psychiatry, Lund, Sweden
| | - Synthia H Mellon
- Department of OB/GYN and Reproductive Sciences, University of California San Francisco (UCSF), School of Medicine, San Francisco, CA, United States
| | - Firdaus S Dhabhar
- Department of Psychiatry & Behavioral Sciences, Sylvester Comprehensive Cancer Center, University of Miami, FL, United States
| | - Rachel Yehuda
- James J. Peters Veterans Administration Medical Center Bronx, New York, United States; Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - S Marlene Grenon
- Department of Surgery, University of California, San Francisco, San Francisco, CA, United States; Department of Surgery, Veterans Affairs Medical Center, San Francisco, CA, United States
| | - Janine D Flory
- James J. Peters Veterans Administration Medical Center Bronx, New York, United States; Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Linda M Bierer
- James J. Peters Veterans Administration Medical Center Bronx, New York, United States; Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Duna Abu-Amara
- Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, Department of Psychiatry, NYU, New York, United States
| | - Michelle Coy
- Department of Psychiatry, University of California San Francisco (UCSF), School of Medicine, San Francisco, CA, United States
| | - Iouri Makotkine
- James J. Peters Veterans Administration Medical Center Bronx, New York, United States; Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Victor I Reus
- Department of Psychiatry, University of California San Francisco (UCSF), School of Medicine, San Francisco, CA, United States
| | - Kirstin Aschbacher
- Department of Psychiatry, University of California San Francisco (UCSF), School of Medicine, San Francisco, CA, United States
| | - F Saverio Bersani
- Department of Psychiatry, University of California San Francisco (UCSF), School of Medicine, San Francisco, CA, United States; Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Charles R Marmar
- Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, Department of Psychiatry, NYU, New York, United States.
| | - Owen M Wolkowitz
- Department of Psychiatry, University of California San Francisco (UCSF), School of Medicine, San Francisco, CA, United States.
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Lin A, Arnold BF, Mertens AN, Lin J, Benjamin-Chung J, Ali S, Hubbard AE, Stewart CP, Shoab AK, Rahman MZ, Hossen MS, Mutsuddi P, Famida SL, Akther S, Rahman M, Unicomb L, Dhabhar FS, Fernald LCH, Colford JM, Luby SP. Effects of water, sanitation, handwashing, and nutritional interventions on telomere length among children in a cluster-randomized controlled trial in rural Bangladesh. eLife 2017; 6:29365. [PMID: 28980942 PMCID: PMC5675593 DOI: 10.7554/elife.29365] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 10/03/2017] [Indexed: 01/17/2023] Open
Abstract
Background: Shorter childhood telomere length (TL) and more rapid TL attrition are widely regarded as manifestations of stress. However, the potential effects of health interventions on child TL are unknown. We hypothesized that a water, sanitation, handwashing (WSH), and nutritional intervention would slow TL attrition during the first two years of life. Methods: In a trial in rural Bangladesh, we randomized geographical clusters of pregnant women into individual water treatment, sanitation, handwashing, nutrition, combined WSH, combined nutrition plus WSH (N + WSH), or control arms. We conducted a substudy enrolling children from the control arm and the N + WSH intervention arm. Participants and outcome assessors were not masked; analyses were masked. Relative TL was measured at 1 and 2 years after intervention, and the change in relative TL was reported. Analysis was intention-to-treat. Results: Between May 2012 and July 2013, in the overall trial, we randomized 720 geographical clusters of 5551 pregnant women to a control or an intervention arm. In this substudy, after 1 year of intervention, we assessed a total of 662 children (341 intervention and 321 control) and 713 children after 2 years of intervention (383 intervention and 330 control). Children in the intervention arm had significantly shorter relative TL compared with controls after 1 year of intervention (difference −163 base pairs (bp), p=0.001). Between years 1 and 2, TL increased in the intervention arm (+76 bp) and decreased in the controls (−23 bp) (p=0.050). After 2 years, there was no difference between the arms (p=0.305). Conclusions: Our unexpected finding of increased telomere attrition during the first year of life in the intervention group suggests that rapid telomere attrition during this critical period could reflect the improved growth in the intervention group, rather than accumulated stress. Funding: Funded by The Bill and Melinda Gates Foundation. Clinical trial number: NCT01590095. Stress negatively affects health by causing changes in cells. As a result, excess stress may predispose people to fall ill more often or age faster. It is difficult to measure stress. Some studies suggest that measuring the ends of chromosomes, known as telomeres, may be one way to measure stress. Like the plastic tips on shoelaces, telomeres protect chromosomes from fraying. All peoples’ telomeres shorten over their lifetime with each cell division. Many studies show that telomeres shorten faster in people who experience more stress. When telomeres become too short, cells die faster without being replaced, and the body ages. Most studies on telomere length have looked at adults. Few studies have looked at children early in life or asked whether there are ways to intervene to stop or reverse stress-related telomere shortening. The first two years of life are a crucial period for the developing brain and immune system, which could set children on a lifelong course toward health or disease. Young children living in low-resource settings often encounter many sources of stress, like poor nutrition, infectious diseases or violence. Studies are needed to determine if interventions in early childhood aimed at reducing some sources of stress improve telomere length or long-term health. Now, Lin et al. show that interventions to provide safe water, sanitation, handwashing facilities, and better nutrition to children in rural Bangladesh unexpectedly shortened telomeres. As part of a larger study, pregnant women in rural Bangladesh were divided, at random, into groups. One group received a suite of interventions, which included more sanitary toilets, handwashing facilities, and nutritional supplements for their infants. Another group served as a control and did not receive this extra help. Lin et al. looked at telomere length, growth, and infections in a subset of 713 children whose mothers participated in the study. Children who got the extra help grew faster and were less likely to get diarrhea or parasitic infections than the children in the control group. Unexpectedly, children in the intervention group had shorter telomeres at 14 months of age than the children in the control group. Lin et al. suggest that the telomere shortening in the intervention group might be a consequence of rapid growth and immune system development in the first year of life rather than resulting from biological stress. More studies are needed to ask whether telomere shortening is indeed linked to faster growth and development early in life. The strong and unexpected findings highlight how little is known about how the length of telomeres can be used to predict future health or disease. Interpreting the length of telomeres over a person’s lifetime could prove more nuanced than originally thought.
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Affiliation(s)
- Audrie Lin
- School of Public Health, University of California, Berkeley, Berkeley, United States
| | - Benjamin F Arnold
- School of Public Health, University of California, Berkeley, Berkeley, United States
| | - Andrew N Mertens
- School of Public Health, University of California, Berkeley, Berkeley, United States
| | - Jue Lin
- Department of Biochemistry and Biophysics, University of California, San Francisco, San Francisco, United States
| | - Jade Benjamin-Chung
- School of Public Health, University of California, Berkeley, Berkeley, United States
| | - Shahjahan Ali
- Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Alan E Hubbard
- School of Public Health, University of California, Berkeley, Berkeley, United States
| | - Christine P Stewart
- Department of Nutrition, University of California, Davis, Davis, United States
| | - Abul K Shoab
- Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Md Ziaur Rahman
- Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Md Saheen Hossen
- Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Palash Mutsuddi
- Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Syeda L Famida
- Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Salma Akther
- Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Mahbubur Rahman
- Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Leanne Unicomb
- Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Firdaus S Dhabhar
- Sylvester Comprehensive Cancer Center, Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, Miami, United States
| | - Lia C H Fernald
- School of Public Health, University of California, Berkeley, Berkeley, United States
| | - John M Colford
- School of Public Health, University of California, Berkeley, Berkeley, United States
| | - Stephen P Luby
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, United States
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Lindqvist D, Dhabhar FS, James SJ, Hough CM, Jain FA, Bersani FS, Reus VI, Verhoeven JE, Epel ES, Mahan L, Rosser R, Wolkowitz OM, Mellon SH. Oxidative stress, inflammation and treatment response in major depression. Psychoneuroendocrinology 2017; 76:197-205. [PMID: 27960139 PMCID: PMC5272818 DOI: 10.1016/j.psyneuen.2016.11.031] [Citation(s) in RCA: 292] [Impact Index Per Article: 41.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 11/24/2016] [Accepted: 11/28/2016] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Increased inflammation and oxidative stress have been shown in Major Depressive Disorder (MDD), although there is significant heterogeneity across studies. Whether markers of inflammation and oxidative stress are associated with antidepressant treatment response in MDD is currently unclear. The goals of the present study are to investigate markers of inflammation and oxidative stress in unmedicated MDD subjects and controls and test the relationship between these markers and antidepressant response in MDD subjects. METHODS Interleukin (IL)-6, tumor necrosis factor (TNF)-α, C-reactive protein, F2-isoprostanes, 8-OH 2-deoxyguanosine (8-OHdG), glutathione peroxidase, glutathione, and vitamin C were quantified in blood samples from 50 unmedicated MDD subjects and 55 healthy controls. Depression symptom severity was rated with the 17-item Hamilton Depression Rating Scale (HDRS). All subjects were somatically healthy and free from medications that could interfere with inflammation and oxidative stress markers. A subgroup of 22 MDD subjects underwent open-label selective serotonin reuptake inhibitor (SSRI) antidepressant treatment for eight weeks, after which blood sampling and the HDRS were repeated. Antidepressant treatment "response" was defined as ≥50% decrease in HDRS ratings over 8 weeks of treatment. RESULTS After controlling for the effects of age, sex, body mass index and smoking, MDD subjects had significantly higher levels of IL-6 (p<0.001), TNF-α (p<0.001), 8-OHdG (p=0.018), and F2-isoprostanes (p=0.012). Compared to Responders, Non-responders to SSRI antidepressant treatment had higher levels of F2-isoprostanes at baseline (p=0.006), and after eight weeks of treatment (p=0.031). Non-responders showed a significant increase in 8-OHdG over the course of treatment (p=0.021), whereas Responders showed a significant decrease in IL-6 over the course of treatment (p=0.019). CONCLUSION Our results are in line with previous reports of increased levels of markers of inflammation and oxidative stress in MDD. Moreover, poorer antidepressant treatment response was related to higher baseline levels of the major oxidative stress marker, F2-isoprostanes, in vivo. Further, antidepressant response was associated with changes in oxidative (8-OHdG) and inflammatory (IL-6) markers.
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Affiliation(s)
- Daniel Lindqvist
- Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California San Francisco (UCSF) School of Medicine, San Francisco, CA, United States; Lund University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry, Lund, Sweden.
| | - Firdaus S. Dhabhar
- Department of Psychiatry & Behavioral Sciences, Sylvester Comprehensive Cancer Center, University of Miami, Florida, United States of America
| | - S. Jill James
- Arkansas Children's Research Institute, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America
| | - Christina M. Hough
- Department of Psychiatry, University of California San Francisco (UCSF) School of Medicine, San Francisco, California, United States of America
| | - Felipe A. Jain
- Department of Psychiatry, University of California San Francisco (UCSF) School of Medicine, San Francisco, California, United States of America
| | - F. Saverio Bersani
- Department of Psychiatry, University of California San Francisco (UCSF) School of Medicine, San Francisco, California, United States of America,Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Victor I. Reus
- Department of Psychiatry, University of California San Francisco (UCSF) School of Medicine, San Francisco, California, United States of America
| | - Josine E. Verhoeven
- Department of Psychiatry, University of California San Francisco (UCSF) School of Medicine, San Francisco, California, United States of America,Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
| | - Elissa S. Epel
- Department of Psychiatry, University of California San Francisco (UCSF) School of Medicine, San Francisco, California, United States of America
| | - Laura Mahan
- Department of Psychiatry, University of California San Francisco (UCSF) School of Medicine, San Francisco, California, United States of America
| | - Rebecca Rosser
- Department of Psychiatry, University of California San Francisco (UCSF) School of Medicine, San Francisco, California, United States of America
| | - Owen M. Wolkowitz
- Department of Psychiatry, University of California San Francisco (UCSF) School of Medicine, San Francisco, California, United States of America
| | - Synthia H. Mellon
- Department of OB/GYN and Reproductive Sciences, University of California San Francisco (UCSF) School of Medicine, San Francisco, California, United States of America
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Lindqvist D, Dhabhar FS, Mellon SH, Yehuda R, Grenon SM, Flory JD, Bierer LM, Abu-Amara D, Coy M, Makotkine I, Reus VI, Bersani FS, Marmar CR, Wolkowitz OM. Increased pro-inflammatory milieu in combat related PTSD - A new cohort replication study. Brain Behav Immun 2017; 59:260-264. [PMID: 27638184 DOI: 10.1016/j.bbi.2016.09.012] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 08/30/2016] [Accepted: 09/12/2016] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Several lines of evidence indicate that increased inflammation is associated with Post-Traumatic Stress Disorder (PTSD). We have previously reported that peripheral inflammatory markers are significantly higher in combat-exposed veterans with than without PTSD. This study was designed to replicate these findings in a new study cohort using the same population and recruitment strategies. METHODS Sixty-one male war veterans (31 PTSD and 30 control subjects) were included in this replication study. Levels of Interleukin-6, Tumor Necrosis Factor-alpha, Gamma interferon, and high-sensitivity C-reactive protein were quantified in blood samples. A standardized "total pro-inflammatory score" was calculated to limit the number of statistical comparisons. The Clinician Administered PTSD Scale (CAPS) rating scale was used to assess PTSD symptom severity. RESULTS PTSD subjects had significantly higher total pro-inflammatory scores compared to non-PTSD subjects in unadjusted analysis (Cohen's d=0.75, p=0.005) as well as after adjusting for potentially confounding effects of age, BMI, smoking, and potentially interfering medications and somatic co-morbidities (p=0.023). There were no significant correlations between inflammatory markers and severity of symptoms within the PTSD group. CONCLUSIONS We replicated, in a new sample, our previous finding of increased inflammatory markers in combat-exposed PTSD subjects compared to combat-exposed non-PTSD controls. These findings strongly add to the growing literature suggesting that immune activation may be an important aspect of PTSD pathophysiology, although not directly correlated with current PTSD symptom levels in the PTSD group.
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Affiliation(s)
- Daniel Lindqvist
- Department of Psychiatry, University of California San Francisco (UCSF) School of Medicine, San Francisco, CA, United States; Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Psychiatry, Lund, Sweden
| | - Firdaus S Dhabhar
- Department of Psychiatry & Behavioral Sciences, Sylvester Comprehensive Cancer Center, University of Miami, FL, United States
| | - Synthia H Mellon
- Department of OB/GYN and Reproductive Sciences, University of California San Francisco (UCSF) School of Medicine, San Francisco, CA, United States
| | - Rachel Yehuda
- James J. Peters Veterans Administration Medical Center Bronx, New York, United States; Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - S Marlene Grenon
- Department of Surgery, University of California, San Francisco, San Francisco, CA, United States; Department of Surgery, Veterans Affairs Medical Center, San Francisco, CA, United States
| | - Janine D Flory
- James J. Peters Veterans Administration Medical Center Bronx, New York, United States; Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Linda M Bierer
- James J. Peters Veterans Administration Medical Center Bronx, New York, United States; Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Duna Abu-Amara
- Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, Department of Psychiatry, NYU, New York, United States
| | - Michelle Coy
- Department of Psychiatry, University of California San Francisco (UCSF) School of Medicine, San Francisco, CA, United States
| | - Iouri Makotkine
- James J. Peters Veterans Administration Medical Center Bronx, New York, United States; Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Victor I Reus
- Department of Psychiatry, University of California San Francisco (UCSF) School of Medicine, San Francisco, CA, United States
| | - F Saverio Bersani
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Charles R Marmar
- Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, Department of Psychiatry, NYU, New York, United States.
| | - Owen M Wolkowitz
- Department of Psychiatry, University of California San Francisco (UCSF) School of Medicine, San Francisco, CA, United States.
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Rebholz WN, Cash E, Zimmaro LA, Bayley-Veloso R, Phillips K, Siwik C, Chagpar AB, Dhabhar FS, Spiegel D, Bell BS, Sephton SE. Distress and quality of life in an ethnically diverse sample awaiting breast cancer surgery. J Health Psychol 2016; 23:1438-1451. [PMID: 27466289 DOI: 10.1177/1359105316659916] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Poor breast cancer-related quality of life is associated with flattened cortisol rhythms and inflammation in breast cancer survivors and women with advanced disease. We explored the associations of cancer-specific distress (Impact of Events Scale), mood (Profile of Mood States), activity/sleep (wake after sleep onset, 24-hour autocorrelation coefficient) and cortisol (diurnal slope) circadian rhythms, and inflammation (interleukin-6) with quality of life (Functional Assessment of Cancer Therapy-Breast) among patients awaiting breast cancer surgery ( N = 57). Models were adjusted for differences in age and cancer stage. Distress and mood disturbance were significantly correlated with lower quality of life. Ethnic differences in the relationship between distress and mood disturbance with global quality of life and subscales of quality of life were observed. Actigraphic measures showed that in comparison with non-Hispanic patients, African Americans had significantly poorer activity/sleep (wake after sleep onset, 24-hour autocorrelation coefficient). Circadian disruption and inflammation were not associated with quality of life. Physiological dysregulation and associated comorbidities may take time to develop over the course of disease and treatment.
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Zeitzer JM, Nouriani B, Rissling MB, Sledge GW, Kaplan KA, Aasly L, Palesh O, Jo B, Neri E, Dhabhar FS, Spiegel D. Aberrant nocturnal cortisol and disease progression in women with breast cancer. Breast Cancer Res Treat 2016; 158:43-50. [PMID: 27314577 DOI: 10.1007/s10549-016-3864-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 06/09/2016] [Indexed: 02/07/2023]
Abstract
While a relationship between disruption of circadian rhythms and the progression of cancer has been hypothesized in field and epidemiologic studies, it has never been unequivocally demonstrated. We determined the circadian rhythm of cortisol and sleep in women with advanced breast cancer (ABC) under the conditions necessary to allow for the precise measurement of these variables. Women with ABC (n = 97) and age-matched controls (n = 24) took part in a 24-h intensive physiological monitoring study involving polysomnographic sleep measures and high-density plasma sampling. Sleep was scored using both standard clinical metrics and power spectral analysis. Three-harmonic regression analysis and functional data analysis were used to assess the 24-h and sleep-associated patterns of plasma cortisol, respectively. The circadian pattern of plasma cortisol as described by its timing, timing relative to sleep, or amplitude was indistinguishable between women with ABC and age-matched controls (p's > 0.11, t-tests). There was, however, an aberrant spike of cortisol during the sleep of a subset of women, during which there was an eightfold increase in the amount of objectively measured wake time (p < 0.004, Wilcoxon Signed-Rank). This cortisol aberration was associated with cancer progression such that the larger the aberration, the shorter the disease-free interval (time from initial diagnosis to metastasis; r = -0.30, p = 0.004; linear regression). The same aberrant spike was present in a similar percent of women without ABC and associated with concomitant sleep disruption. A greater understanding of this sleep-related cortisol abnormality, possibly a vulnerability trait, is likely important in our understanding of individual variation in the progression of cancer.
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Affiliation(s)
- Jamie M Zeitzer
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, 94305, USA.
- Mental Illness Research Education and Clinical Center, VA Palo Alto Health Care System, 3801 Miranda Avenue (151Y), Palo Alto, CA, 94304, USA.
| | - Bita Nouriani
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, 94305, USA
| | - Michelle B Rissling
- Mental Illness Research Education and Clinical Center, VA Palo Alto Health Care System, 3801 Miranda Avenue (151Y), Palo Alto, CA, 94304, USA
- Durham VA Medical Center, Durham, NC, 27705, USA
| | - George W Sledge
- Department of Medicine/Oncology, Stanford University, Stanford, CA, 94305, USA
| | - Katherine A Kaplan
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, 94305, USA
| | - Linn Aasly
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, 94305, USA
- Columbia University, New York, NY, 10027, USA
| | - Oxana Palesh
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, 94305, USA
| | - Booil Jo
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, 94305, USA
| | - Eric Neri
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, 94305, USA
| | - Firdaus S Dhabhar
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, 94305, USA
| | - David Spiegel
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, 94305, USA
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Cash E, Sephton SE, Chagpar AB, Spiegel D, Rebholz WN, Zimmaro LA, Tillie JM, Dhabhar FS. Circadian disruption and biomarkers of tumor progression in breast cancer patients awaiting surgery. Brain Behav Immun 2015; 48:102-14. [PMID: 25728235 DOI: 10.1016/j.bbi.2015.02.017] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 02/09/2015] [Accepted: 02/20/2015] [Indexed: 02/08/2023] Open
Abstract
Psychological distress, which can begin with cancer diagnosis and continue with treatment, is linked with circadian and endocrine disruption. In turn, circadian/endocrine factors are potent modulators of cancer progression. We hypothesized that circadian rest-activity rhythm disruption, distress, and diurnal cortisol rhythms would be associated with biomarkers of tumor progression in the peripheral blood of women awaiting breast cancer surgery. Breast cancer patients (n=43) provided actigraphic data on rest-activity rhythm, cancer-specific distress (IES, POMS), saliva samples for assessment of diurnal cortisol rhythm, cortisol awakening response (CAR), and diurnal mean. Ten potential markers of tumor progression were quantified in serum samples and grouped by exploratory factor analysis. Analyses yielded three factors, which appear to include biomarkers reflecting different aspects of tumor progression. Elevated factor scores indicate both high levels and strong clustering among serum signals. Factor 1 included VEGF, MMP-9, and TGF-β; suggesting tumor invasion/immunosuppression. Factor 2 included IL-1β, TNF-α, IL-6R, MCP-1; suggesting inflammation/chemotaxis. Factor 3 included IL-6, IL-12, IFN-γ; suggesting inflammation/TH1-type immunity. Hierarchical regressions adjusting age, stage and socioeconomic status examined associations of circadian, distress, and endocrine variables with these three factor scores. Patients with poor circadian coordination as measured by rest-activity rhythms had higher Factor 1 scores (R(2)=.160, p=.038). Patients with elevated CAR also had higher Factor 1 scores (R(2)=.293, p=.020). These relationships appeared to be driven largely by VEGF concentrations. Distress was not related to tumor-relevant biomarkers, and no other significant relationships emerged. Women with strong circadian activity rhythms showed less evidence of tumor promotion and/or progression as indicated by peripheral blood biomarkers. The study was not equipped to discern the cause of these associations. Circadian/endocrine aberrations may be a manifestation of systemic effects of aggressive tumors. Alternatively, these results raise the possibility that, among patients with active breast tumors, disruption of circadian activity rhythms and elevated CAR may facilitate tumor promotion and progression.
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Affiliation(s)
- E Cash
- Department of Surgery, Division of Otolaryngology-HNS, University of Louisville School of Medicine, Louisville, KY, United States; Department of Psychological & Brain Sciences, University of Louisville, Louisville, KY, United States; James Graham Brown Cancer Center, University of Louisville, Louisville, KY, United States
| | - S E Sephton
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, KY, United States; James Graham Brown Cancer Center, University of Louisville, Louisville, KY, United States.
| | - A B Chagpar
- The Breast Center - Smilow Cancer Hospital at Yale-New Haven, Department of Surgery, Yale University School of Medicine, New Haven, CT, United States
| | - D Spiegel
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States; Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, United States
| | - W N Rebholz
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, KY, United States
| | - L A Zimmaro
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, KY, United States
| | - J M Tillie
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - F S Dhabhar
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States; Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, United States; Institute for Immunity, Transplantation, and Infection, Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, United States.
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Puterman E, Epel ES, O’Donovan A, Prather AA, Aschbacher K, Dhabhar FS. Anger is associated with increased IL-6 stress reactivity in women, but only among those low in social support. Int J Behav Med 2014; 21:936-45. [PMID: 24357433 PMCID: PMC4406249 DOI: 10.1007/s12529-013-9368-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Social connections moderate the effects of high negative affect on health. Affective states (anger, fear, and anxiety) predict interleukin-6 (IL-6) reactivity to acute stress; in turn, this reactivity predicts risk of cardiovascular disease progression. PURPOSE Here, we examined whether perceived social support mitigates the relationship between negative affect and IL-6 stress reactivity. METHOD Forty-eight postmenopausal women completed a standardized mental lab stressor with four blood draws at baseline and 30, 50, and 90 min after the onset of the stressor and anger, anxiety, and fear were assessed 10 min after task completion. Participants self-rated levels of social support within a week prior to the stressor. RESULTS Only anger was related to IL-6 stress reactivity-those experiencing high anger after the stressor had significant increases in IL-6. IL-6 reactivity was marginally associated with perceived support, but more strikingly, perceived support mitigated anger associations with IL-6 stress reactivity. CONCLUSION Supportive ties can dampen the relationship of anger to pro-inflammatory reactivity to acute stress. Implications to cardiovascular disease are discussed.
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Affiliation(s)
- Eli Puterman
- Department of Psychiatry, School of Medicine, University of California, San Francisco, CA, USA
| | - Elissa S. Epel
- Department of Psychiatry, School of Medicine, University of California, San Francisco, CA, USA
| | - Aoife O’Donovan
- Department of Psychiatry, School of Medicine, University of California, San Francisco, CA, USA
- SF Veteran’s Affairs Medical Center, San Francisco, CA, USA
| | - Aric A. Prather
- Department of Psychiatry, School of Medicine, University of California, San Francisco, CA, USA
| | - Kirstin Aschbacher
- Department of Psychiatry, School of Medicine, University of California, San Francisco, CA, USA
| | - Firdaus S. Dhabhar
- Stanford Cancer Institute, Stanford University, Stanford, CA, USA
- Department of Psychiatry and Behavioral Sciences, Institute for Immunity, Transplantation, and Infection, Stanford University School of Medicine, 259 Campus Drive, MC 5135, Stanford, CA 94305-5135, USA
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Lindqvist D, Wolkowitz OM, Mellon S, Yehuda R, Flory JD, Henn-Haase C, Bierer LM, Abu-Amara D, Coy M, Neylan TC, Makotkine I, Reus VI, Yan X, Taylor NM, Marmar CR, Dhabhar FS. Proinflammatory milieu in combat-related PTSD is independent of depression and early life stress. Brain Behav Immun 2014; 42:81-8. [PMID: 24929195 DOI: 10.1016/j.bbi.2014.06.003] [Citation(s) in RCA: 156] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Revised: 05/20/2014] [Accepted: 06/02/2014] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Chronic inflammation may be involved in combat-related post-traumatic stress disorder (PTSD) and may help explain comorbid physical diseases. However, the extent to which combat exposure per se, depression, or early life trauma, all of which are associated with combat PTSD, may confound the relationship between PTSD and inflammation is unclear. METHODS We quantified interleukin (IL)-6, IL-1β, tumor necrosis factor (TNF)-α, interferon (IFN)-γ, and C-reactive protein (CRP) in 51 combat-exposed males with PTSD and 51 combat-exposed males without PTSD, and assessed PTSD and depression severity as well as history of early life trauma. To decrease the possibility of Type I errors, we summed standardized scores of IL-1β, IL-6, TNFα, IFNγ and CRP into a total "pro-inflammatory score". PTSD symptom severity was assessed with the Clinician Administered PTSD Scale (CAPS) rating scale. RESULTS Subjects with PTSD had significantly higher pro-inflammatory scores compared to combat-exposed subjects without PTSD (p=0.006), and even after controlling for early life trauma, depression diagnosis and severity, body mass index, ethnicity, education, asthma/allergies, time since combat and the use of possibly confounding medications (p=0.002). Within the PTSD group, the pro-inflammatory score was not significantly correlated with depressive symptom severity, CAPS total score, or with the number of early life traumas. CONCLUSIONS Combat-related PTSD in males is associated with higher levels of pro-inflammatory cytokines, even after accounting for depression and early life trauma. These results, from one of the largest studies of inflammatory cytokines in PTSD to date, suggest that immune activation may be a core element of PTSD pathophysiology more so than a signature of combat exposure alone.
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Affiliation(s)
- Daniel Lindqvist
- Department of Psychiatry, University of California, San Francisco (UCSF), School of Medicine, San Francisco, CA, United States; Department of Clinical Sciences, Section for Psychiatry, Lund University, Lund, Sweden
| | - Owen M Wolkowitz
- Department of Psychiatry, University of California, San Francisco (UCSF), School of Medicine, San Francisco, CA, United States.
| | - Synthia Mellon
- Department of OB/GYN and Reproductive Sciences, University of California, San Francisco (UCSF), School of Medicine, San Francisco, CA, United States
| | - Rachel Yehuda
- Department of Psychiatry, MSSM/James J. Peters Veterans Administration Medical Center, NY, United States
| | - Janine D Flory
- Department of Psychiatry, MSSM/James J. Peters Veterans Administration Medical Center, NY, United States
| | - Clare Henn-Haase
- Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, Department of Psychiatry, NYU, NY, United States
| | - Linda M Bierer
- Department of Psychiatry, MSSM/James J. Peters Veterans Administration Medical Center, NY, United States
| | - Duna Abu-Amara
- Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, Department of Psychiatry, NYU, NY, United States
| | - Michelle Coy
- Department of Psychiatry, University of California, San Francisco (UCSF), School of Medicine, San Francisco, CA, United States
| | - Thomas C Neylan
- Department of Psychiatry, University of California, San Francisco (UCSF), School of Medicine, San Francisco, CA, United States
| | - Iouri Makotkine
- Department of Psychiatry, MSSM/James J. Peters Veterans Administration Medical Center, NY, United States
| | - Victor I Reus
- Department of Psychiatry, University of California, San Francisco (UCSF), School of Medicine, San Francisco, CA, United States
| | - Xiaodan Yan
- Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, Department of Psychiatry, NYU, NY, United States
| | - Nicole M Taylor
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Charles R Marmar
- Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, Department of Psychiatry, NYU, NY, United States.
| | - Firdaus S Dhabhar
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
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Sudheimer KD, O'Hara R, Spiegel D, Powers B, Kraemer HC, Neri E, Weiner M, Hardan A, Hallmayer J, Dhabhar FS. Cortisol, cytokines, and hippocampal volume interactions in the elderly. Front Aging Neurosci 2014; 6:153. [PMID: 25071562 PMCID: PMC4079951 DOI: 10.3389/fnagi.2014.00153] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Accepted: 06/17/2014] [Indexed: 01/01/2023] Open
Abstract
Separate bodies of literature report that elevated pro-inflammatory cytokines and cortisol negatively affect hippocampal structure and cognitive functioning, particularly in older adults. Although interactions between cytokines and cortisol occur through a variety of known mechanisms, few studies consider how their interactions affect brain structure. In this preliminary study, we assess the impact of interactions between circulating levels of IL-1Beta, IL-6, IL-8, IL-10, IL-12, TNF-alpha, and waking cortisol on hippocampal volume. Twenty-eight community-dwelling older adults underwent blood draws for quantification of circulating cytokines and saliva collections to quantify the cortisol awakening response. Hippocampal volume measurements were made using structural magnetic resonance imaging. Elevated levels of waking cortisol in conjunction with higher concentrations of IL-6 and TNF-alpha were associated with smaller hippocampal volumes. In addition, independent of cortisol, higher levels of IL-1beta and TNF-alpha were also associated with smaller hippocampal volumes. These data provide preliminary evidence that higher cortisol, in conjunction with higher IL-6 and TNF-alpha, are associated with smaller hippocampal volume in older adults. We suggest that the dynamic balance between the hypothalamic-pituitary adrenal axis and inflammation processes may explain hippocampal volume reductions in older adults better than either set of measures do in isolation.
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Affiliation(s)
- Keith D Sudheimer
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford University Stanford, CA, USA
| | - Ruth O'Hara
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford University Stanford, CA, USA
| | - David Spiegel
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford University Stanford, CA, USA
| | - Bevin Powers
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford University Stanford, CA, USA
| | - Helena C Kraemer
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford University Stanford, CA, USA
| | - Eric Neri
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford University Stanford, CA, USA
| | - Michael Weiner
- Department of Radiology, University of California San Francisco, CA, USA ; Department of Veterans Affairs Medical Center, Center for Imaging of Neurodegenerative Diseases San Francisco, CA, USA
| | - Antonio Hardan
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford University Stanford, CA, USA
| | - Joachim Hallmayer
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford University Stanford, CA, USA
| | - Firdaus S Dhabhar
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford University Stanford, CA, USA ; Institute for Immunity, Transplantation, and Infection, Stanford University Stanford, CA, USA
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Prather AA, Puterman E, Epel ES, Dhabhar FS. Poor sleep quality potentiates stress-induced cytokine reactivity in postmenopausal women with high visceral abdominal adiposity. Brain Behav Immun 2014; 35:155-62. [PMID: 24060585 PMCID: PMC3962521 DOI: 10.1016/j.bbi.2013.09.010] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 09/10/2013] [Accepted: 09/16/2013] [Indexed: 02/04/2023] Open
Abstract
Sleep disturbance is a key behavioral risk factor for chronic medical conditions observed at high rates among overweight and obese individuals. Systemic inflammation, including that induced by stress, may serve as a common biological mechanism linking sleep, adiposity, and disease risk. To investigate these relationships, 48 postmenopausal women (mean age=61.8) completed a standardized laboratory stress task during which time blood was collected at baseline and 30, 50 and 90+ min after stressor onset to assess circulating levels of interleukin (IL)-6, IL-10, and IL-6/IL-10 ratio. Self-reported global sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) while adiposity was estimated by body mass index. Sagittal diameter was obtained in clinic to estimate visceral abdominal adiposity. Multi-level growth curve models revealed that poorer self-reported sleep quality was associated with greater stress-induced increases in IL-6/IL-10 ratio. In terms of adiposity, higher sagittal diameter, but not BMI, was associated with greater IL-6 reactivity (p's<0.05). Further, associations between sleep quality and cytokine reactivity varied as a function of sagittal diameter. Among poor sleepers (1 SD above mean of PSQI score), stress-induced increases in IL-6 and IL-6/IL-10 ratio were significantly steeper in those with high visceral adiposity (1 SD above the mean of sagittal diameter) compared to those with low visceral adiposity (1 SD below the mean of sagittal diameter). In sum, poorer sleep quality and greater visceral adiposity, separately and especially in combination, are associated with greater stress-related increases in systemic inflammation. This research may help elucidate the complex link between sleep, obesity and inflammatory disease risk.
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Affiliation(s)
- Aric A. Prather
- Department of Psychiatry, University of California, San Francisco,Corresponding Authors: Aric A. Prather, PhD, Department of Psychiatry, University of California, San Francisco, 3333 California St., Suite 465, San Francisco, CA 94118, (415) 476-7758, Firdaus S. Dhabhar, PhD, Department of Psychiatry & Behavioral Sciences, Stanford University, Institute for Immunity, Transplantation & Infection, Stanford University School of Medicine, 259 Campus Drive, MC 5135, Stanford, CA 94305-5135, (650) 736-8565
| | - Eli Puterman
- Department of Psychiatry, University of California, San Francisco
| | - Elissa S. Epel
- Department of Psychiatry, University of California, San Francisco,Corresponding Authors: Aric A. Prather, PhD, Department of Psychiatry, University of California, San Francisco, 3333 California St., Suite 465, San Francisco, CA 94118, (415) 476-7758, Firdaus S. Dhabhar, PhD, Department of Psychiatry & Behavioral Sciences, Stanford University, Institute for Immunity, Transplantation & Infection, Stanford University School of Medicine, 259 Campus Drive, MC 5135, Stanford, CA 94305-5135, (650) 736-8565
| | - Firdaus S. Dhabhar
- Department of Psychiatry and Behavioral Sciences,Institute of Immunity, Transplantation, and Infection,Cancer Center, Stanford University,Corresponding Authors: Aric A. Prather, PhD, Department of Psychiatry, University of California, San Francisco, 3333 California St., Suite 465, San Francisco, CA 94118, (415) 476-7758, Firdaus S. Dhabhar, PhD, Department of Psychiatry & Behavioral Sciences, Stanford University, Institute for Immunity, Transplantation & Infection, Stanford University School of Medicine, 259 Campus Drive, MC 5135, Stanford, CA 94305-5135, (650) 736-8565
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Hahm BJ, Jo B, Dhabhar FS, Palesh O, Aldridge-Gerry A, Bajestan SN, Neri E, Nouriani B, Spiegel D, Zeitzer JM. Bedtime misalignment and progression of breast cancer. Chronobiol Int 2013; 31:214-21. [PMID: 24156520 DOI: 10.3109/07420528.2013.842575] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Disruption of circadian rhythms, which frequently occurs during night shift work, may be associated with cancer progression. The effect of chronotype (preference for behaviors such as sleep, work, or exercise to occur at particular times of day, with an associated difference in circadian physiology) and alignment of bedtime (preferred vs. habitual), however, have not yet been studied in the context of cancer progression in women with breast cancer. Chronotype and alignment of actual bedtime with preferred chronotype were examined using the Morningness-Eveningness Scale (MEQ) and sleep-wake log among 85 women with metastatic breast cancer. Their association with disease-free interval (DFI) was retrospectively examined using the Cox proportional hazards model. Median DFI was 81.9 months for women with aligned bedtimes ("going to bed at preferred bedtime") (n = 72), and 46.9 months for women with misaligned bedtimes ("going to bed later or earlier than the preferred bedtime") (n = 13) (log rank p = 0.001). In a multivariate Cox proportional hazard model, after controlling for other significant predictors of DFI, including chronotype (morning type/longer DFI; HR = 0.539, 95% CI = 0.320-0.906, p = 0.021), estrogen receptor (ER) status at initial diagnosis (negative/shorter DFI; HR = 2.169, 95% CI = 1.124-4.187, p = 0.028) and level of natural-killer cell count (lower levels/shorter DFI; HR = 1.641, 95% CI = 1.000-2.695, p = 0.050), misaligned bedtimes was associated with shorter DFI, compared to aligned bedtimes (HR = 3.180, 95% CI = 1.327-7.616, p = 0.018). Our data indicate that a misalignment of bedtime on a daily basis, an indication of circadian disruption, is associated with more rapid breast cancer progression as measured by DFI. Considering the limitations of small sample size and study design, a prospective study with a larger sample is necessary to explore their causal relationship and underlying mechanisms.
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Affiliation(s)
- Bong-Jin Hahm
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine , Stanford, CA , USA
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Abstract
Stress is thought to suppress immune function and increase susceptibility to infections and cancer. Paradoxically, stress is also known to exacerbate autoimmune/proinflammatory disorders (eg, psoriasis, atopic dermatitis) that should be ameliorated by immunosuppression. Here we review studies showing that although chronic stress (lasting for weeks/months/years) can suppress/dysregulate immune function, acute stress (lasting for minutes to hours) can have immunoenhancing effects. Short-term stress experienced at the time of immune activation enhances dendritic cell, neutrophil, macrophage, and lymphocyte trafficking, maturation, and function, and has been shown to augment innate and adaptive immunity; therefore, depending on the conditions of immune activation, and the nature of the activating antigen, short-term stress can enhance the acquisition and expression of immunoprotection or immunopathology. In contrast, chronic stress suppresses or dysregulates innate and adaptive immune responses by altering the Type 1-Type 2 cytokine balance, inducing low-grade chronic increases in proinflammatory factors, and suppressing numbers, trafficking, and function of immunoprotective cells. Chronic stress also increases susceptibility to skin cancer by suppressing Type 1 cytokines and protective T cells while increasing regulatory/suppressor T cell number/function. It is important to recognize that the adaptive function of a physiological stress response is to promote survival. Stress-related neurotransmitters, hormones, and factors act as biological alarm signals that prepare the immune and other physiological systems for potential challenges (eg, wounding or infection) perceived by the brain (eg, detection of an attacker); however, this may exacerbate immunopathology (eg, psoriasis, atopic dermatitis) if the enhanced immune response is directed against innocuous or self-antigens, or if the system is chronically activated as seen during long-term stress. In view of the ubiquitous nature of stress and its significant effects on immunoprotection and immunopathology, it is important to further elucidate the mechanisms mediating both the salubrious and the harmful effects of stress, and to meaningfully translate findings from bench to bedside.
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Affiliation(s)
- Firdaus S Dhabhar
- Department of Psychiatry and Behavioral Sciences, Institute for Immunity Transplantation and Infection, Stanford Cancer Institute, Stanford University School of Medicine, 259 Campus Drive, MC 5135, Stanford, CA 94305-5135, USA.
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Gerry AA, Palesh O, Rissling M, Zeitzer JM, Dhabhar FS, Jo B, Neri E, Nouriani B, Spiegel D. Losing sleep over cancer: Relationships with negative affect, blood pressure, and disease-free interval among women with metastatic breast cancer. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.9504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9504 Background: Few studies have examined how polysomnographic (PSG) measured sleep disturbance is associated with negative affect and markers of health status among women with metastatic breast cancer (MBC). Methods: 91 women with MBC (aged 57.9 ± 7.3 yrs) and Karnofsky ratings of at least 70 were recruited. We used latent profile analysis to identify distinct patterns of in-lab sleep disturbance. These profiles were used to predict affect (measured by PANAS), blood pressure, and disease progression (disease free months before metastases). Results: Two classes of women emerged and were distinguished as “severely disturbed sleepers” (n = 24) or “mildly disturbed sleepers” (n = 67). Severely disturbed sleepers had worse quality of sleep (e.g., sleep efficiency=54% vs. 69%) and spent significantly and less time in slow wave and REM sleep. One-way ANOVA revealed that severely disturbed sleepers reported significantly more negative affect (p < .05). Specifically, they reported greater negative affect in the afternoon (2-3pm) and evening (6:30-7pm) prior to lab-sleep, and the morning (9:30-10:30am) and afternoon (12:30pm and 2pm) following lab-sleep. In addition, severely disturbed sleepers had higher systolic blood pressure (M=140 vs. M=124, p = .001) measured the afternoon prior to lab-sleep. Strikingly, women with severely disturbed sleep had significantly shorter disease free intervals (49 months vs. 80 months, p < .05), and worse Karnofsky ratings (p < .05) indicating worse medical prognosis than mildly disturbed sleepers. Conclusions: Women with MBC and severely disturbed sleep experienced more negative affect prior to and following a poor night’s sleep. In addition, they exhibited hypertension and accelerated cancer progression relative to women with mild sleep disruption. These detrimental changes may be an indication of the effects of chronic sleep disruption. Understanding the role of daily negative affect in conjunction with physiological markers of disease progression may inform better treatment methods for women with MBC experiencing severe sleep disruption.
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Affiliation(s)
| | - Oxana Palesh
- Stanford University, School of Medicine, Stanford, CA
| | | | - Jamie M. Zeitzer
- Stanford University, School of Medicine; Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | | | - Booil Jo
- Stanford University, School of Medicine, Stanford, CA
| | - Eric Neri
- Stanford University, School of Medicine, Stanford, CA
| | - Bita Nouriani
- Stanford University, School of Medicine, Stanford, CA
| | - David Spiegel
- Stanford Universtiy, School of Medicine, Stanford, CA
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Sephton SE, Lush E, Dedert EA, Floyd AR, Rebholz WN, Dhabhar FS, Spiegel D, Salmon P. Diurnal cortisol rhythm as a predictor of lung cancer survival. Brain Behav Immun 2013; 30 Suppl:S163-70. [PMID: 22884416 DOI: 10.1016/j.bbi.2012.07.019] [Citation(s) in RCA: 183] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Revised: 06/30/2012] [Accepted: 07/23/2012] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Poorly coordinated diurnal cortisol and circadian rest-activity rhythms predict earlier mortality in metastatic breast and colorectal cancer, respectively. We examined the prognostic value of the diurnal cortisol rhythm in lung cancer. METHODS Lung cancer patients (n=62, 34 female) were within 5 years of diagnosis and had primarily non small-cell lung cancer, with disease stage ranging from early to advanced. Saliva collected over two days allowed calculation of the diurnal cortisol slope and the cortisol awakening response (CAR). Lymphocyte numbers and subsets were measured by flow cytometry. Survival data were obtained for 57 patients. Cox Proportional Hazards analyses were used to test the prognostic value of the diurnal cortisol rhythm on survival calculated both from study entry and from initial diagnosis. RESULTS The diurnal cortisol slope predicted subsequent survival over three years. Early mortality occurred among patients with higher slopes, or relatively "flat" rhythms indicating lack of normal diurnal variation (Cox Proportional Hazards p=.009). Cortisol slope also predicted survival time from initial diagnosis (p=.012). Flattened profiles were linked with male gender (t=2.04, df=59, p=.046) and low total and cytotoxic T cell lymphocyte counts (r=-.39 and -.30, p=.004 and .035, respectively). After adjustment for possible confounding factors, diurnal slope remained a significant, independent predictor of survival. CONCLUSIONS Flattening of the diurnal cortisol rhythm predicts early lung cancer death. Data contribute to growing evidence that circadian disruption accelerates tumor progression.
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Affiliation(s)
- Sandra E Sephton
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY 40292-0001, USA.
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Kesler S, Janelsins M, Koovakkattu D, Palesh O, Mustian K, Morrow G, Dhabhar FS. Reduced hippocampal volume and verbal memory performance associated with interleukin-6 and tumor necrosis factor-alpha levels in chemotherapy-treated breast cancer survivors. Brain Behav Immun 2013; 30 Suppl:S109-16. [PMID: 22698992 PMCID: PMC3665606 DOI: 10.1016/j.bbi.2012.05.017] [Citation(s) in RCA: 212] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Revised: 05/29/2012] [Accepted: 05/31/2012] [Indexed: 11/16/2022] Open
Abstract
Many survivors of breast cancer show significant cognitive impairments, including memory deficits. Inflammation induced by chemotherapy may contribute to hippocampal changes that underlie these deficits. In this cross-sectional study, we measured bilateral hippocampal volumes from high-resolution magnetic resonance images in 42 chemotherapy-treated breast cancer survivors and 35 healthy female controls. Patients with breast cancer were, on average, 4.8 ± 3.4 years off-therapy. In a subset of these participants (20 breast cancer, 23 controls), we quantified serum cytokine levels. Left hippocampal volumes and memory performance were significantly reduced and interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNFα) concentrations were significantly elevated in the breast cancer group compared to controls. In the breast cancer group, lower left hippocampal volume was associated with higher levels of TNFα and lower levels of IL-6 with a significant interaction between these two cytokines suggesting a potential modulatory effect of IL-6 on TNFα. Verbal memory performance was associated with cytokine levels and left hippocampal volume in both groups. These findings provide evidence of altered hippocampal volume and verbal memory difficulties following breast cancer chemotherapy that may be mediated by TNFα and IL-6.
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Affiliation(s)
- Shelli Kesler
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA.
| | - Michelle Janelsins
- Department of Radiation Oncology, University of Rochester, Rochester, NY 14642, United States
| | - Della Koovakkattu
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, United States
| | - Oxana Palesh
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, United States
| | - Karen Mustian
- Department of Radiation Oncology, University of Rochester, Rochester, NY 14642, United States
| | - Gary Morrow
- Department of Radiation Oncology, University of Rochester, Rochester, NY 14642, United States
| | - Firdaus S. Dhabhar
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, United States
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Abstract
Stress may be defined as a sequence of events, that begins with a stimulus (stressor), that is recognized by the brain (stress perception), and which results in the activation of physiologic fight/flight/fright systems within the body (stress response). Many evolutionary selection pressures are stressors, and one of the primary functions of the brain is to perceive stress, warn the body of danger, and enable an organism to respond. We hypothesized that under acute conditions, just as the stress response prepares the cardiovascular and musculoskeletal systems for fight or flight, it may also prepare the immune system for challenges (e.g., wounding) which may be imposed by a stressor (e.g., an aggressor). Initial studies showed that acute (2h) stress induced a significant trafficking of immune cells to the skin. Since the skin is an organism's major protective barrier, we hypothesized that this leukocyte redistribution may serve to enhance skin immunity during acute stress. We tested this hypothesis using the delayed type hypersensitivity (DTH) reaction, which mediates resistance to various infectious agents, as a model for skin immune function. Acute stress administered immediately before antigen exposure significantly enhanced skin DTH. Adrenalectomy (ADX) eliminated the stress-induced enhancement of DTH while administration of physiological doses of corticosterone and/or epinephrine to ADX animals enhanced skin DTH in the absence of stress. These studies showed that changes in leukocyte distribution and circulating stress hormones are systemic mediators of the immunoenhancing effects of acute stress. We recently identified gamma interferon as a local cytokine mediator of a stress-induced immunoenhancement. Our results suggest that during acute stress the brain sends preparatory warning signals to the immune system just as it does to other fight/flight systems of the body.
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Affiliation(s)
- Firdaus S Dhabhar
- College of Medicine & College of Dentistry, Ohio State University, 4179 Postle Hall, 305 W. 12th. Ave., Box 18257, Columbus, Ohio 43218-2357
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Dhabhar FS, Malarkey WB, Neri E, McEwen BS. Stress-induced redistribution of immune cells--from barracks to boulevards to battlefields: a tale of three hormones--Curt Richter Award winner. Psychoneuroendocrinology 2012; 37:1345-68. [PMID: 22727761 PMCID: PMC3412918 DOI: 10.1016/j.psyneuen.2012.05.008] [Citation(s) in RCA: 341] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Revised: 05/14/2012] [Accepted: 05/16/2012] [Indexed: 01/13/2023]
Abstract
BACKGROUND The surveillance and effector functions of the immune system are critically dependent on the appropriate distribution of immune cells in the body. An acute or short-term stress response induces a rapid and significant redistribution of immune cells among different body compartments. Stress-induced leukocyte redistribution may be a fundamental survival response that directs leukocyte subpopulations to specific target organs during stress, and significantly enhances the speed, efficacy and regulation of an immune response. Immune responses are generally enhanced in compartments (e.g., skin) that are enriched with leukocytes, and suppressed in compartments that are depleted of leukocytes during/following stress. The experiments described here were designed to elucidate the: (1) Time-course, trajectory, and subpopulation-specificity of stress-induced mobilization and trafficking of blood leukocytes. (2) Individual and combined actions of the principal stress hormones, norepinephrine (NE), epinephrine (EPI), and corticosterone (CORT), in mediating mobilization or trafficking of specific leukocyte subpopulations. (3) Effects of stress/stress hormones on adhesion molecule, L-selectin (CD62L), expression by each subpopulation to assess its adhesion/functional/maturation status. METHODS Male Sprague Dawley rats were stressed (short-term restraint, 2-120 min), or adrenalectomized and injected with vehicle (VEH), NE, EPI, CORT, or their combinations, and blood was collected for measurement of hormones and flow cytometric quantification of leukocyte subpopulations. RESULTS Acute stress induced an early increase/mobilization of neutrophils, lymphocytes, helper T cells (Th), cytolytic T cells (CTL), and B cells into the blood, followed by a decrease/trafficking of all cell types out of the blood, except neutrophil numbers that continued to increase. CD62L expression was increased on neutrophils, decreased on Th, CTL, and natural killer (NK) cells, and showed a biphasic decrease on monocytes & B cells, suggesting that CD62L is involved in mediating the redistribution effects of stress. Additionally, we observed significant differences in the direction, magnitude, and subpopulation specificity of the effects of each hormone: NE increased leukocyte numbers, most notably CD62L⁻/⁺ neutrophils and CD62L⁻ B cells. EPI increased monocyte and neutrophil numbers, most notably CD62L⁻/⁺ neutrophils and CD62L⁻ monocytes, but decreased lymphocyte numbers with CD62L⁻/⁺ CTL and CD62L⁺ B cells being especially sensitive. CORT decreased monocyte, lymphocyte, Th, CTL, and B cell numbers with CD62L⁻ and CD62L⁺ cells being equally affected. Thus, naïve (CD62L⁺) vs. memory (CD62L⁻) T cells, classical (CD62L⁺) vs. non-classical (CD62L⁻) monocytes, and similarly distinct functional subsets of other leukocyte populations are differentially mobilized into the blood and trafficked to tissues by stress hormones. CONCLUSION Stress hormones orchestrate a large-scale redistribution of immune cells in the body. NE and EPI mobilize immune cells into the bloodstream, and EPI and CORT induce traffic out of the blood possibly to tissue surveillance pathways, lymphoid tissues, and sites of ongoing or de novo immune activation. Immune cell subpopulations appear to show differential sensitivities and redistribution responses to each hormone depending on the type of leukocyte (neutrophil, monocyte or lymphocyte) and its maturation/functional characteristics (e.g., non-classical/resident or classical/inflammatory monocyte, naïve or central/effector memory T cell). Thus, stress hormones could be administered simultaneously or sequentially to induce specific leukocyte subpopulations to be mobilized into the blood, or to traffic from blood to tissues. Stress- or stress hormone-mediated changes in immune cell distribution could be clinically harnessed to: (1) Direct leukocytes to sites of vaccination, wound healing, infection, or cancer and thereby enhance protective immunity. (2) Reduce leukocyte traffic to sites of inflammatory/autoimmune reactions. (3) Sequester immune cells in relatively protected compartments to minimize exposure to cytotoxic treatments like radiation or localized chemotherapy. (4) Measure biological resistance/sensitivity to stress hormones in vivo. In keeping with the guidelines for Richter Award manuscripts, in addition to original data we also present a model and synthesis of findings in the context of the literature on the effects of short-term stress on immune cell distribution and function.
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Affiliation(s)
- Firdaus S Dhabhar
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305-5135, USA.
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Dhabhar FS, Saul AN, Holmes TH, Daugherty C, Neri E, Tillie JM, Kusewitt D, Oberyszyn TM. High-anxious individuals show increased chronic stress burden, decreased protective immunity, and increased cancer progression in a mouse model of squamous cell carcinoma. PLoS One 2012; 7:e33069. [PMID: 22558071 PMCID: PMC3338811 DOI: 10.1371/journal.pone.0033069] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Accepted: 02/03/2012] [Indexed: 12/30/2022] Open
Abstract
In spite of widespread anecdotal and scientific evidence much remains to be understood about the long-suspected connection between psychological factors and susceptibility to cancer. The skin is the most common site of cancer, accounting for nearly half of all cancers in the US, with approximately 2-3 million cases of non-melanoma cancers occurring each year worldwide. We hypothesized that a high-anxious, stress-prone behavioral phenotype would result in a higher chronic stress burden, lower protective-immunity, and increased progression of the immuno-responsive skin cancer, squamous cell carcinoma. SKH1 mice were phenotyped as high- or low-anxious at baseline, and subsequently exposed to ultraviolet-B light (1 minimal erythemal dose (MED), 3 times/week, 10-weeks). The significant strengths of this cancer model are that it uses a normal, immunocompetent, outbred strain, without surgery/injection of exogenous tumor cells/cell lines, and produces lesions that resemble human tumors. Tumors were counted weekly (primary outcome), and tissues collected during early and late phases of tumor development. Chemokine/cytokine gene-expression was quantified by PCR, tumor-infiltrating helper (Th), cytolytic (CTL), and regulatory (Treg) T cells by immunohistochemistry, lymph node T and B cells by flow cytometry, adrenal and plasma corticosterone and tissue vascular-endothelial-growth-factor (VEGF) by ELISA. High-anxious mice showed a higher tumor burden during all phases of tumor development. They also showed: higher corticosterone levels (indicating greater chronic stress burden), increased CCL22 expression and Treg infiltration (increased tumor-recruited immuno-suppression), lower CTACK/CCL27, IL-12, and IFN-γ gene-expression and lower numbers of tumor infiltrating Th and CTLs (suppressed protective immunity), and higher VEGF concentrations (increased tumor angiogenesis/invasion/metastasis). These results suggest that the deleterious effects of high trait anxiety could be: exacerbated by life-stressors, accentuated by the stress of cancer diagnosis/treatment, and mediate increased tumor progression and/or metastasis. Therefore, it may be beneficial to investigate the use of chemotherapy-compatible anxiolytic treatments immediately following cancer diagnosis, and during cancer treatment/survivorship.
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Affiliation(s)
- Firdaus S Dhabhar
- Department of Psychiatry & Behavioral Sciences, Stanford University, Stanford, California, United States of America.
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Dedert E, Lush E, Chagpar A, Dhabhar FS, Segerstrom SC, Spiegel D, Dayyat E, Daup M, McMasters K, Sephton SE. Stress, Coping, and Circadian Disruption Among Women Awaiting Breast Cancer Surgery. Ann Behav Med 2012; 44:10-20. [DOI: 10.1007/s12160-012-9352-y] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Wolkowitz OM, Mellon SH, Epel ES, Lin J, Reus VI, Rosser R, Burke H, Compagnone M, Nelson JC, Dhabhar FS, Blackburn EH. Resting leukocyte telomerase activity is elevated in major depression and predicts treatment response. Mol Psychiatry 2012; 17:164-72. [PMID: 21242992 PMCID: PMC3130817 DOI: 10.1038/mp.2010.133] [Citation(s) in RCA: 101] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Telomeres are DNA-protein complexes that cap linear DNA strands, protecting DNA from damage. When telomeres critically shorten, cells become susceptible to senescence and apoptosis. Telomerase, a cellular ribonucleoprotein enzyme, rebuilds the length of telomeres and promotes cellular viability. Leukocyte telomeres are reportedly shortened in major depression, but telomerase activity in depression has not been previously reported. Further, there are no published reports of the effects of antidepressants on telomerase activity or on the relationship between telomerase activity and antidepressant response. Peripheral blood mononuclear cell (PBMC) telomerase activity was assessed in 20 medication-free depressed individuals and 18 controls. In total, 16 of the depressed individuals were then treated with sertraline in an open-label manner for 8 weeks, and PBMC telomerase activity was reassessed in 15 of these individuals after treatment. Pre- and post-treatment symptom severity was rated with the Hamilton Depression Rating Scale. All analyses were corrected for age and sex. Pre-treatment telomerase activity was significantly elevated in the depressed individuals compared with the controls (P=0.007) and was directly correlated with depression ratings (P<0.05) across all subjects. In the depressed group, individuals with relatively lower pre-treatment telomerase activity and with relatively greater increase in telomerase activity during treatment, showed superior antidepressant responses (P<0.05 and P<0.005, respectively). This is the first report characterizing telomerase activity in depressed individuals. PBMC telomerase activity might reflect a novel aspect of depressive pathophysiology and might represent a novel biomarker of antidepressant responsiveness.
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Affiliation(s)
- OM Wolkowitz
- Department of Psychiatry, University of California, San Francisco (UCSF), School of Medicine, San Francisco, CA, USA
| | - SH Mellon
- Department of OB-GYN and Reproductive Sciences, UCSF School of Medicine, San Francisco, CA, USA
| | - ES Epel
- Department of Psychiatry and Health Psychology Program, UCSF School of Medicine, San Francisco, CA, USA
| | - J Lin
- Department of Biochemistry and Biophysics, UCSF School of Medicine, San Francisco, CA, USA
| | - VI Reus
- Department of Psychiatry, University of California, San Francisco (UCSF), School of Medicine, San Francisco, CA, USA
| | - R Rosser
- Department of Psychiatry, University of California, San Francisco (UCSF), School of Medicine, San Francisco, CA, USA
| | - H Burke
- Department of Psychiatry and Health Psychology Program, UCSF School of Medicine, San Francisco, CA, USA
| | - M Compagnone
- Department of Psychiatry, University of California, San Francisco (UCSF), School of Medicine, San Francisco, CA, USA
| | - JC Nelson
- Department of Psychiatry, University of California, San Francisco (UCSF), School of Medicine, San Francisco, CA, USA
| | - FS Dhabhar
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - EH Blackburn
- Department of Biochemistry and Biophysics, UCSF School of Medicine, San Francisco, CA, USA
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Aschbacher K, Epel E, Wolkowitz OM, Prather AA, Puterman E, Dhabhar FS. Maintenance of a positive outlook during acute stress protects against pro-inflammatory reactivity and future depressive symptoms. Brain Behav Immun 2012; 26:346-52. [PMID: 22119400 PMCID: PMC4030538 DOI: 10.1016/j.bbi.2011.10.010] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Revised: 10/18/2011] [Accepted: 10/28/2011] [Indexed: 12/28/2022] Open
Abstract
UNLABELLED Cognitive and affective responses to acute stress influence pro-inflammatory cytokine reactivity, and peripheral cytokines (particularly interleukin-1 beta (IL-1β)), can act on the brain to promote depressive symptoms. It is unknown whether acute stress-induced changes in positive affect and cognitions (POS) and pro-inflammatory reactivity predict future depressive symptoms. We examined acute stress responses among women, to determine prospective predictors of depressive symptoms. HYPOTHESES (1) Stress-induced decreases in POS will be associated with stress-related increases in circulating IL-1β. (2) Acute stress-induced decreases in POS and increases in IL-1β reactivity will predict increases in depressive symptoms 1 year later. Thirty-five post-menopausal women were exposed to acute stress with the Trier Social Stress Task (TSST) and provided blood samples under resting conditions and 30 min after the conclusion of the TSST, which were assayed for IL-1β. IL-1β reactivity was quantified as post minus pre-TSST. Failure to maintain POS was quantified as the decrease in POS during the TSST. Change in depressive symptoms from the study baseline to the following year was determined. Greater acute stress-induced declines in POS were significantly associated with increased IL-1β reactivity (p≤.02), which significantly predicted increases in depressive symptoms over the following year (p<.01), controlling for age, body mass index, chronic stress, antidepressant use and baseline depressive symptoms. IL-1β reactivity was a significant mediator of the relationship between POS decline and future increases in depressive symptoms (p=.04). Difficulty maintaining positivity under stress and heightened pro-inflammatory reactivity may be markers and/or mechanisms of risk for future increases in depressive symptoms.
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Affiliation(s)
- K Aschbacher
- Department of Psychiatry, School of Medicine, University of California San Francisco, CA 94143-0848, USA.
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Tomiyama AJ, O'Donovan A, Lin J, Puterman E, Lazaro A, Chan J, Dhabhar FS, Wolkowitz O, Kirschbaum C, Blackburn E, Epel E. Does cellular aging relate to patterns of allostasis? An examination of basal and stress reactive HPA axis activity and telomere length. Physiol Behav 2011; 106:40-5. [PMID: 22138440 DOI: 10.1016/j.physbeh.2011.11.016] [Citation(s) in RCA: 154] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2011] [Revised: 11/09/2011] [Accepted: 11/16/2011] [Indexed: 10/14/2022]
Abstract
Long-term exposure to stress and its physiological mediators, in particular cortisol, may lead to impaired telomere maintenance. In this study, we examine if greater cortisol responses to an acute stressor and/or dysregulated patterns of daily cortisol secretion are associated with shorter telomere length. Twenty-three postmenopausal women comprising caregivers for dementia partners (n=14) and age- and BMI-matched non-caregivers provided home sampling of cortisol-saliva samples at waking, 30 min after waking, and bedtime, and a 12-hour overnight urine collection. They were also exposed to an acute laboratory stressor throughout which they provided saliva samples. Peripheral blood mononuclear cells were isolated from a fasting blood sample and assayed for telomere length. As hypothesized, greater cortisol responses to the acute stressor were associated with shorter telomeres, as were higher overnight urinary free cortisol levels and flatter daytime cortisol slopes. While robust physiological responses to acute stress serve important functions, the long-term consequences of frequent high stress reactivity may include accelerated telomere shortening.
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Wolkowitz OM, Mellon SH, Epel ES, Lin J, Dhabhar FS, Su Y, Reus VI, Rosser R, Burke HM, Kupferman E, Compagnone M, Nelson JC, Blackburn EH. Leukocyte telomere length in major depression: correlations with chronicity, inflammation and oxidative stress--preliminary findings. PLoS One 2011; 6:e17837. [PMID: 21448457 PMCID: PMC3063175 DOI: 10.1371/journal.pone.0017837] [Citation(s) in RCA: 314] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2010] [Accepted: 02/15/2011] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Depression is associated with an unusually high rate of aging-related illnesses and early mortality. One aspect of "accelerated aging" in depression may be shortened leukocyte telomeres. When telomeres critically shorten, as often occurs with repeated mitoses or in response to oxidation and inflammation, cells may die. Indeed, leukocyte telomere shortening predicts early mortality and medical illnesses in non-depressed populations. We sought to determine if leukocyte telomeres are shortened in Major Depressive Disorder (MDD), whether this is a function of lifetime depression exposure and whether this is related to putative mediators, oxidation and inflammation. METHODOLOGY Leukocyte telomere length was compared between 18 unmedicated MDD subjects and 17 controls and was correlated with lifetime depression chronicity and peripheral markers of oxidation (F2-isoprostane/Vitamin C ratio) and inflammation (IL-6). Analyses were controlled for age and sex. PRINCIPAL FINDINGS The depressed group, as a whole, did not differ from the controls in telomere length. However, telomere length was significantly inversely correlated with lifetime depression exposure, even after controlling for age (p<0.05). Average telomere length in the depressed subjects who were above the median of lifetime depression exposure (≥9.2 years' cumulative duration) was 281 base pairs shorter than that in controls (p<0.05), corresponding to approximately seven years of "accelerated cell aging." Telomere length was inversely correlated with oxidative stress in the depressed subjects (p<0.01) and in the controls (p<0.05) and with inflammation in the depressed subjects (p<0.05). CONCLUSIONS These preliminary data indicate that accelerated aging at the level of leukocyte telomeres is proportional to lifetime exposure to MDD. This might be related to cumulative exposure to oxidative stress and inflammation in MDD. This suggest that telomere shortening does not antedate depression and is not an intrinsic feature. Rather, telomere shortening may progress in proportion to lifetime depression exposure.
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Affiliation(s)
- Owen M Wolkowitz
- Department of Psychiatry, University of California San Francisco School of Medicine, San Francisco, California, United States of America.
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Spencer RL, Kalman BA, Dhabhar FS. Role of Endogenous Glucocorticoids in Immune System Function: Regulation and Counterregulation. Compr Physiol 2011. [DOI: 10.1002/cphy.cp070418] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Walsh NP, Gleeson M, Pyne DB, Nieman DC, Dhabhar FS, Shephard RJ, Oliver SJ, Bermon S, Kajeniene A. Position statement. Part two: Maintaining immune health. Exerc Immunol Rev 2011; 17:64-103. [PMID: 21446353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The physical training undertaken by athletes is one of a set of lifestyle or behavioural factors that can influence immune function, health and ultimately exercise performance. Others factors including potential exposure to pathogens, health status, lifestyle behaviours, sleep and recovery, nutrition and psychosocial issues, need to be considered alongside the physical demands of an athlete's training programme. The general consensus on managing training to maintain immune health is to start with a programme of low to moderate volume and intensity; employ a gradual and periodised increase in training volumes and loads; add variety to limit training monotony and stress; avoid excessively heavy training loads that could lead to exhaustion, illness or injury; include non-specific cross-training to offset staleness; ensure sufficient rest and recovery; and instigate a testing programme for identifying signs of performance deterioration and manifestations of physical stress. Inter-individual variability in immunocompetence, recovery, exercise capacity, non-training stress factors, and stress tolerance likely explains the different vulnerability of athletes to illness. Most athletes should be able to train with high loads provided their programme includes strategies devised to control the overall strain and stress. Athletes, coaches and medical personnel should be alert to periods of increased risk of illness (e.g. intensive training weeks, the taper period prior to competition, and during competition) and pay particular attention to recovery and nutritional strategies.
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Affiliation(s)
- Neil P Walsh
- School of Sport, Health and Exercise Sciences, Bangor University, UK.
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Rosenberger PH, Dhabhar FS, Epel E, Jokl P, Ickovics JR. Sex differences in factors influencing recovery from arthroscopic knee surgery. Clin Orthop Relat Res 2010; 468:3399-405. [PMID: 20848242 PMCID: PMC2974898 DOI: 10.1007/s11999-010-1562-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2009] [Accepted: 08/26/2010] [Indexed: 01/31/2023]
Abstract
BACKGROUND Many factors affect recovery from arthroscopic partial meniscectomy, including patient sex. However, sex differences in time to maximal recovery of knee function and factors influencing differential rates of recovery are unknown. QUESTIONS/PURPOSES We determined (1) preoperative sex differences, (2) sex differences in rate and extent of recovery through 1 year postoperatively, and (3) clinical and fitness variables that could explain potential sex differences in recovery from partial meniscectomy. PATIENTS AND METHODS The study sample consisted of 180 patients undergoing arthroscopic partial meniscectomy. Sex, age, body mass index, history of prior injury, length of time between knee injury/impairment and surgical evaluation, weekly exercise frequency, and self-reported fitness were assessed preoperatively, and extent of osteoarthritis was recorded postoperatively. We used the Tegner-Lysholm scale to assess knee function preoperatively and postoperatively at weeks 1, 3, 8, 16, 24, and 48 followups. RESULTS Females had worse knee function and delayed maximal recovery, requiring 1 year, compared with males, who required only 4 months. History of prior knee injury and lower self-reported fitness were associated with slower recovery in females but not in males. Osteoarthritis was associated with slower recovery but not related to sex. Body mass index, length of time between injury/impairment and surgical evaluation, and weekly exercise frequency did not influence rate of recovery. CONCLUSIONS Females have delayed recovery after arthroscopic partial meniscectomy. Prior knee injury and self-reported low fitness are associated with delayed recovery for females but not for males.
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Affiliation(s)
- Patricia H. Rosenberger
- Department of Psychiatry, Yale University, New Haven, CT USA ,VA Connecticut Healthcare System, 950 Campbell Avenue, Psychology 116B, West Haven, CT 06516 USA
| | - Firdaus S. Dhabhar
- Department of Psychiatry & Behavioral Sciences, Institute for Immunity, Transplantation, and Infection, Stanford University School of Medicine, Stanford, CA USA
| | - Elissa Epel
- Department of Psychiatry, University of California, San Francisco, CA USA
| | - Peter Jokl
- Department of Orthopaedics, Yale School of Medicine, New Haven, CT USA
| | - Jeannette R. Ickovics
- Departments of Epidemiology and Public Health and Psychology, Yale University, New Haven, CT USA
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Innominato PF, Palesh O, Dhabhar FS, Lévi F, Spiegel D. Regulation of circadian rhythms and hypothalamic-pituitary-adrenal axis: an overlooked interaction in cancer. Lancet Oncol 2010; 11:816-7. [PMID: 20816374 DOI: 10.1016/s1470-2045(10)70171-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Epel ES, Lin J, Dhabhar FS, Wolkowitz OM, Puterman E, Karan L, Blackburn EH. Dynamics of telomerase activity in response to acute psychological stress. Brain Behav Immun 2010; 24:531-9. [PMID: 20018236 PMCID: PMC2856774 DOI: 10.1016/j.bbi.2009.11.018] [Citation(s) in RCA: 162] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2009] [Revised: 11/17/2009] [Accepted: 11/26/2009] [Indexed: 12/26/2022] Open
Abstract
Telomerase activity plays an essential role in cell survival, by lengthening telomeres and promoting cell growth and longevity. It is now possible to quantify the low levels of telomerase activity in human leukocytes. Low basal telomerase activity has been related to chronic stress in people and to chronic glucocorticoid exposure in vitro. Here we test whether leukocyte telomerase activity changes under acute psychological stress. We exposed 44 elderly women, including 22 high stress dementia caregivers and 22 matched low stress controls, to a brief laboratory psychological stressor, while examining changes in telomerase activity of peripheral blood mononuclear cells (PBMCs). At baseline, caregivers had lower telomerase activity levels than controls, but during stress telomerase activity increased similarly in both groups. Across the entire sample, subsequent telomerase activity increased by 18% one hour after the end of the stressor (p<0.01). The increase in telomerase activity was independent of changes in numbers or percentages of monocytes, lymphocytes, and specific T cell types, although we cannot fully rule out some potential contribution from immune cell redistribution in the change in telomerase activity. Telomerase activity increases were associated with greater cortisol increases in response to the stressor. Lastly, psychological response to the tasks (greater threat perception) was also related to greater telomerase activity increases in controls. These findings uncover novel relationships of dynamic telomerase activity with exposure to an acute stressor, and with two classic aspects of the stress response - perceived psychological stress and neuroendocrine (cortisol) responses to the stressor.
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Affiliation(s)
- Elissa S. Epel
- University of California, San Francisco, Dept of Psychiatry, 3333 Calif St, Suite 465, San Francisco, CA 94143,Corresponding authors, Elissa Epel, 3333 Calif. St, Ste 465, San Francisco, CA 94143, , 415-476-7648, Fax: 415-476-7744, Elizabeth Blackburn, 600 16th St, Room S-312F, San Francisco, CA, 94107, , 415-476-4912, FAX: 415-514-2913
| | - Jue Lin
- University of California, San Francisco, Dept of Biochemistry and Biophysics
| | - Firdaus S. Dhabhar
- Dept. of Psychiatry & Behavioral Sciences, and Institute for Immunity, Transplantation, and Infection, Stanford University, 300 Pasteur Drive, MC 5135, Stanford, CA 94305
| | - Owen M. Wolkowitz
- University of California, San Francisco, Dept of Psychiatry, 3333 Calif St, Suite 465, San Francisco, CA 94143
| | - E Puterman
- University of California, San Francisco, Dept of Psychiatry, 3333 Calif St, Suite 465, San Francisco, CA 94143
| | - Lori Karan
- University of California, San Francisco, Dept of Psychiatry, 3333 Calif St, Suite 465, San Francisco, CA 94143
| | - Elizabeth H. Blackburn
- University of California, San Francisco, Dept of Biochemistry and Biophysics,Corresponding authors, Elissa Epel, 3333 Calif. St, Ste 465, San Francisco, CA 94143, , 415-476-7648, Fax: 415-476-7744, Elizabeth Blackburn, 600 16th St, Room S-312F, San Francisco, CA, 94107, , 415-476-4912, FAX: 415-514-2913
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Fredericks CA, Drabant EM, Edge MD, Tillie JM, Hallmayer J, Ramel W, Kuo JR, Mackey S, Gross JJ, Dhabhar FS. Healthy young women with serotonin transporter SS polymorphism show a pro-inflammatory bias under resting and stress conditions. Brain Behav Immun 2010; 24:350-7. [PMID: 19883751 PMCID: PMC2826575 DOI: 10.1016/j.bbi.2009.10.014] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2009] [Revised: 10/16/2009] [Accepted: 10/20/2009] [Indexed: 12/16/2022] Open
Abstract
The study of functionally relevant biological effects of serotonin transporter gene promoter region (5-HTTLPR) polymorphisms is especially important given the current controversy about the clinical relevance of these polymorphisms. Here we report an intrinsic immunobiological difference between individuals carrying two short (SS) versus long (LL) 5-HTTLPR alleles, that is observed in healthy subjects reporting low exposure to life stress. Given that 5-HTTLPR polymorphisms are thought to influence susceptibility to depression and are associated with robust neurobiological effects, that depression is associated with higher pro-inflammatory and lower anti-inflammatory cytokines, and that acute stressors increase circulating concentrations of pro-inflammatory cytokines, we hypothesized that compared to LL individuals, SS individuals may show a pro-inflammatory bias under resting conditions and/or during stress. 15 LL and 11 SS individuals participated in the Trier Social Stress Test (TSST). Serum IL-6 and IL-10 were quantified at baseline and 30, 60, 90, and 120min after beginning the 20-min stress test. Compared to LL individuals, SS individuals showed a higher IL-6/IL-10 ratio at baseline and during stress. Importantly, this pro-inflammatory bias was observed despite both groups being healthy, reporting similar intensities of stress and negative emotionality during the TSST, and reporting similar low exposures to early and recent life stress. To our knowledge, this is the first report of a pro-inflammatory bias/phenotype in individuals carrying the SS genotype of 5-HTTLPR. Thus, healthy SS individuals may be chronically exposed to a pro-inflammatory physiological burden under resting and stress conditions, which could increase their vulnerability to disorders like depression and other diseases that can be facilitated/exacerbated by a chronic pro-inflammatory state.
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Affiliation(s)
| | - Emily M. Drabant
- Department of Psychology, Stanford University, Stanford, CA 94305
| | - Michael D. Edge
- Department of Psychology, Stanford University, Stanford, CA 94305
| | - Jean M. Tillie
- Department of Psychiatry & Behavioral Sciences, Stanford University, Stanford, CA 94305
| | - Joachim Hallmayer
- Department of Psychiatry & Behavioral Sciences, Stanford University, Stanford, CA 94305
| | - Wiveka Ramel
- Department of Psychology, Stanford University, Stanford, CA 94305
| | - Janice R. Kuo
- Department of Psychology, Stanford University, Stanford, CA 94305
| | - Sean Mackey
- Department of Anesthesia, Stanford University, Stanford, CA 94305
| | - James J. Gross
- Department of Psychology, Stanford University, Stanford, CA 94305
| | - Firdaus S. Dhabhar
- Department of Psychiatry & Behavioral Sciences, Stanford University, Stanford, CA 94305,Institute for Immunity, Transplantation, and Infection, Stanford University, Stanford, CA 94305,Stanford Cancer Center, Stanford University, Stanford, CA 94305,Corresponding author: Firdaus S. Dhabhar, Stanford University, 300 Pasteur Drive, MC 5135, Stanford, CA 94305-5135.
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Dhabhar FS, Saul AN, Daugherty C, Holmes TH, Bouley DM, Oberyszyn TM. Short-term stress enhances cellular immunity and increases early resistance to squamous cell carcinoma. Brain Behav Immun 2010; 24:127-37. [PMID: 19765644 PMCID: PMC2788066 DOI: 10.1016/j.bbi.2009.09.004] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2009] [Revised: 09/08/2009] [Accepted: 09/08/2009] [Indexed: 01/02/2023] Open
Abstract
In contrast to chronic/long-term stress that suppresses/dysregulates immune function, an acute/short-term fight-or-flight stress response experienced during immune activation can enhance innate and adaptive immunity. Moderate ultraviolet-B (UV) exposure provides a non-invasive system for studying the naturalistic emergence, progression and regression of squamous cell carcinoma (SCC). Because SCC is an immunoresponsive cancer, we hypothesized that short-term stress experienced before UV exposure would enhance protective immunity and increase resistance to SCC. Control and short-term stress groups were treated identically except that the short-term stress group was restrained (2.5h) before each of nine UV-exposure sessions (minimum erythemal dose, 3-times/week) during weeks 4-6 of the 10-week UV exposure protocol. Tumors were measured weekly, and tissue collected at weeks 7, 20, and 32. Chemokine and cytokine gene expression was quantified by real-time PCR, and CD4+ and CD8+ T cells by flow cytometry and immunohistochemistry. Compared to controls, the short-term stress group showed greater cutaneous T-cell attracting chemokine (CTACK)/CCL27, RANTES, IL-12, and IFN-gamma gene expression at weeks 7, 20, and 32, higher skin infiltrating T cell numbers (weeks 7 and 20), lower tumor incidence (weeks 11-20) and fewer tumors (weeks 11-26). These results suggest that activation of short-term stress physiology increased chemokine expression and T cell trafficking and/or function during/following UV exposure, and enhanced Type 1 cytokine-driven cell-mediated immunity that is crucial for resistance to SCC. Therefore, the physiological fight-or-flight stress response and its adjuvant-like immuno-enhancing effects, may provide a novel and important mechanism for enhancing immune system mediated tumor-detection/elimination that merits further investigation.
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Affiliation(s)
- Firdaus S. Dhabhar
- Department of Psychiatry & Behavioral Sciences, Stanford University, Stanford, CA,Stanford Cancer Center, Stanford University, Stanford, CA,Institute for Immunity, Transplantation, & Infection, Stanford University, Stanford, CA
| | - Alison N. Saul
- College of Medicine and Public Health, The Ohio State University, Columbus, OH
| | - Christine Daugherty
- College of Medicine and Public Health, The Ohio State University, Columbus, OH
| | - Tyson H. Holmes
- Department of Psychiatry & Behavioral Sciences, Stanford University, Stanford, CA
| | - Donna M. Bouley
- Stanford Cancer Center, Stanford University, Stanford, CA,Department of Comparative Medicine, Stanford University School of Medicine, Stanford, CA
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Rosenberger PH, Ickovics JR, Epel E, Nadler E, Jokl P, Fulkerson JP, Tillie JM, Dhabhar FS. Surgical stress-induced immune cell redistribution profiles predict short-term and long-term postsurgical recovery. A prospective study. J Bone Joint Surg Am 2009; 91:2783-94. [PMID: 19952239 PMCID: PMC2780920 DOI: 10.2106/jbjs.h.00989] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The experience of undergoing surgery is known to induce a short-term, fight-or-flight physiological stress response. As an optimum immune response at the site of surgery would enhance tissue repair, we examined surgical stress-induced immune cell redistribution profiles as predictors, and potential mediators, of short and long-term postoperative recovery. We tested the a priori hypothesis that predefined adaptive immune cell redistribution profiles observed during surgery will predict enhanced postoperative recovery. METHODS This prospective longitudinal study involved fifty-seven patients undergoing meniscectomy. Knee function was assessed preoperatively and at one, three, eight, sixteen, twenty-four, and forty-eight weeks postoperatively with use of the clinically validated Lysholm scale, which assesses mechanical function, pain, mobility, and the ability to perform daily activities. Surgery-induced immune cell redistribution was measured in the blood at baseline, before surgery, and after surgery. RESULTS Mixed-model repeated-measures analyses revealed a main effect of immune cell redistribution: patients who showed the predefined "adaptive" lymphocyte and monocyte redistribution profiles during surgery showed enhanced recovery. Interesting differences were also observed between the sexes: women as a group showed less adaptive redistribution and correspondingly showed significantly delayed maximum recovery, requiring forty-eight weeks, compared with men, who required only sixteen weeks. Inter-individual differences in leukocyte redistribution predicted the rate of recovery across both sexes. CONCLUSIONS Immune cell redistribution that is induced by the stress of undergoing surgery can predict (and may partially mediate) postoperative healing and recovery. These findings may provide the basis for identifying patients (either prospectively or during surgery) who are likely to show good as opposed to poor recovery following surgery and for designing interventions that would maximize protective immune responses and enhance the rate and extent of recovery.
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Affiliation(s)
- Patricia H. Rosenberger
- Department of Psychiatry, Yale University, New Haven, Connecticut and VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT 06516
| | - Jeannette R. Ickovics
- Departments of Epidemiology and Public Health and Psychology, Yale School of Public Health, Yale University, 60 College Street, P.O. Box 208034, New Haven, CT 06520
| | - Elissa Epel
- Department of Psychiatry, University of California, 3333 California Street, Suite 465, San Francisco, CA 94143
| | - Eric Nadler
- Department of Psychiatry, University of California, 3333 California Street, Suite 465, San Francisco, CA 94143
| | - Peter Jokl
- Department of Orthopaedics, Yale School of Medicine, 800 Howard Avenue, P.O. Box 208071, New Haven CT 06520
| | - John P. Fulkerson
- Orthopaedic Associates of Hartford, and University of Connecticut Health Center, 85 Seymour Street, Suite 607, Hartford, CT 06106
| | - Jean M. Tillie
- Department of Psychiatry and Behavioral Sciences, Institute for Immunity, Transplantation, and Infection, Stanford University School of Medicine, 300 Pasteur Drive, MC 5135, Stanford, CA 94305-5135. E-mail address for F.S. Dhabhar:
| | - Firdaus S. Dhabhar
- Department of Psychiatry and Behavioral Sciences, Institute for Immunity, Transplantation, and Infection, Stanford University School of Medicine, 300 Pasteur Drive, MC 5135, Stanford, CA 94305-5135. E-mail address for F.S. Dhabhar:
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Dhabhar FS. A hassle a day may keep the pathogens away: The fight-or-flight stress response and the augmentation of immune function. Integr Comp Biol 2009; 49:215-36. [PMID: 21665815 DOI: 10.1093/icb/icp045] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Stress is known to suppress or dysregulate immune function and increase susceptibility to disease. Paradoxically, the short-term fight-or-flight stress response is one of nature's fundamental defense mechanisms that galvanizes the neuroendocrine, cardiovascular, and musculoskeletal systems into action to enable survival. Therefore, it is unlikely that short-term stress would suppress immune function at a time when it may be critically required for survival (e.g., in response to wounding and infection by a predator or aggressor). In fact, studies have shown that stress can enhance immune function under certain conditions. Several factors influence the direction (enhancing versus suppressive) of the effects of stress on immune function: (1) DURATION: acute or short-term stress experienced at the time of activation of an immune response enhances innate and adaptive immune responses. Chronic or long-term stress can suppress or dysregulate immune function. (2) Leukocyte distribution: compartments (e.g., skin), that are enriched with immune cells during acute stress show immuno-enhancement, while those that are depleted of leukocytes (e.g., blood), show immuno-suppression. (3) The differential effects of physiologic versus pharmacologic stress hormones: Endogenous hormones in physiological concentrations can have immuno-enhancing effects. Endogenous hormones at pharmacologic concentrations, and synthetic hormones, are immuno-suppressive. (4) Timing: immuno-enhancement is observed when acute stress is experienced during the early stages of an immune response while immuno-suppression may be observed at late stages. The type of immune response (protective, regulatory/inhibitory, or pathological) that is affected determines whether the effects of stress are ultimately beneficial or harmful for the organism. Arguments based on conservation of energy have been invoked to explain potential adaptive benefits of stress-induced immuno-suppression, but generally do not hold true because most mechanisms for immuno-suppression expend, rather than conserve, energy. We propose that it is important to study, and if possible, to clinically harness, the immuno-enhancing effects of the acute stress response that evolution has finely sculpted as a survival mechanism, just as we study its maladaptive ramifications (chronic stress) that evolution has yet to resolve.
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Affiliation(s)
- Firdaus S Dhabhar
- Department of Psychiatry & Behavioral Sciences and Stanford Institute for Immunity, Transplantation, & Infection, Stanford University, Stanford, CA 94305-5135, USA.
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