610 Medizin und Gesundheit
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During pregnancy every eighth woman is treated with glucocorticoids. Glucocorticoids inhibit cell division but are assumed to accelerate the differentiation of cells. In this review animal models for the development of the human fetal and neonatal hypothalamic-pituitary-adrenal (HPA) axis are investigated. It is possible to show that during pregnancy in humans, as in most of the here-investigated animal models, a stress hyporesponsive period (SHRP) is present. In this period, the fetus is facing reduced glucocorticoid concentrations, by low or absent fetal glucocorticoid synthesis and by reduced exposure to maternal glucocorticoids. During that phase, sensitive maturational processes in the brain are assumed, which could be inhibited by high glucocorticoid concentrations. In the SHRP, species-specific maximal brain growth spurt and neurogenesis of the somatosensory cortex take place. The latter is critical for the development of social and communication skills and the secure attachment of mother and child. Glucocorticoid treatment during pregnancy needs to be further investigated especially during this vulnerable SHRP. The hypothalamus and the pituitary stimulate the adrenal glucocorticoid production. On the other hand, glucocorticoids can inhibit the synthesis of corticotropin-releasing hormone (CRH) in the hypothalamus and of adrenocorticotropic hormone (ACTH) in the pituitary. Alterations in this negative feedback are assumed among others in the development of fibromyalgia, diabetes and factors of the metabolic syndrome. In this work it is shown that the fetal cortisol surge at the end of gestation is at least partially due to reduced glucocorticoid negative feedback. It is also assumed that androgens are involved in the control of fetal glucocorticoid synthesis. Glucocorticoids seem to prevent masculinization of the female fetus by androgens during the sexual gonadal development. In this work a negative interaction of glucocorticoids and androgens is detectable.
The allergic contact dermatitis (ACD) to small molecular weight compounds is a common inflammatory skin reaction. ACD is restricted to industrialized countries, has an enormous sociomedical and socioeconomic impact. About 2,800 compounds from the six million chemicals known in our environment are believed to have allergic, and to a lesser degree also contact-sensitizing or immunogenic properties causing allergic contact dermatitis. ACD results from T cell responses to harmless, low molecular weight chemicals (haptens) applied to the skin. Haptens are not directly recognized by the cells of the immune system. They need to be presented by subsets of antigen presenting cells to the cells of the immune system. In this regard, epidermal Langerhans cells (LC) and the cells into which they mature (dendritic cells) are believed to play a pivotal role in the sensitization process for ACD. LC are able to bind the haptens, internalize them, and present them to naive T cells and induce thereby the development of effector T cells. They are so-called professional antigen presenting cells. This process is initiated and maintained by the release of several mediators, which are released by various cells after their contact with the haptens. One of the first proteins secreted into the environment is interleukin (IL)-1ß. This cytokine is produced and secreted minutes after an antigen enters the cell. It is commonly believed that the large amounts of this protein and other cytokines such as granulocyte-colony stimulation factor (GM-CSF) and tumor necrosis factor alpha (TNF-ï¡) needed for the initiation and activation of ACD are coming first from other cells residing in the skin, e.g., keratinocytes, monocytes and macrophages. These cytokines provide the danger signals needed for the activation of the Langerhans cell (LC), which then produce via a positive feedback loop various cytokines themselves. In addition, other proteins such as chemokines influence the generation of danger signals, migration, homing of T cells in the local lymph nodes as well as the recruitment of T cells into the skin. Thus, a small molecular compounds or hapten needs to be able to induce danger signals in order to become immunogenic. In this study, we investigated whether para-phenylenediamine (PPD), an arylamine and common contact allergen, is able to induce danger signals and likely provide the signals needed for an initiation of an immune response[162, 163]. PPD is used as an antioxidant, an ingredient of hair dyes, intermediate of dyestuff, and PPD is found in chemicals used for photographic processing. But up to date, it has not been clearly demonstrated if PPD itself is a sensitizing agent. Thus, this study aimed on the potential of PPD to provide the danger signals by studying IL-1β, TNF-ï¡, and monocyte chemoattractant proteins (MCP-1) in human monocytes, peripheral blood mononuclear cells (PBMC) from healthy volunteers, and also in two human monocyte cell lines namely U937, and THP-1. This study found that PPD decreased dose- and time-dependently the expression and release of three relevant mediators involved in the generation of danger signals. Namely, PPD reduced the mRNA and protein levels for IL-1ß, TNF-ï¡, and MCP-1 in primary human monocytes from various donors. These findings were extended and validated by investigations using the cell line U937. The data were highly specific for PPD, and no such results were gained for its known auto oxidation product called Bandrowski- base or for meta-phenylenediamine (MPD), and ortho-phenylenediamine (OPD). Therefore, we can speculate that this effect is likely to be dependent on the para-substitution. Based on these results we conclude that PPD itself is not able to mount a cascade for the induction of danger signals. It should be mentioned that it is still possible that PPD induces danger signals for sensitization by other unknown processes. Therefore, more research is still needed focusing on this subject especially in professional antigen presenting cells in order to solve the still open question whether PPD itself sensitizes naive T cells or if PPD is solely an allergen. Independently we found unexpectedly that PPD as well as other haptens such as 2, 4-Dinitrochlorobenzene, nickelsulfate, as well as some terpenoide increased clearly the expression of CC chemokin receptor 2 (CCR2), the receptor for the chemokine MCP-1. Up to date, the main importance for the CCR2 receptor comes from results demonstrating that CCR2 is critical for the migration of monocytes after encounter with bacterial lipopolysaccharides. Under these circumstances the receptor disappears from the cell surface and is down regulated. An up regulation of CCR2 has not been reported for haptens, and deserves further investigations.
Fibromyalgia is a disorder of unknown etiology characterized by widespread, chronic musculoskeletal pain of at least three month duration and pressure hyperalgesia at specific tender points on clinical examination. The disorder is accompanied by a multitude of additional symptoms such as fatigue, sleep disturbances, morning stiffness, depression, and anxiety. In terms of biological disturbances, low cortisol concentrations have been repeatedly observed in blood and urine samples of fibromyalgia patients, both under basal and stress-induced conditions. The aim of this dissertation was to investigate the presence of low cortisol concentrations (hypocortisolism) and potential accompanying alterations on sympathetic and immunological levels in female fibromyalgia patients. Beside the expected hypocortisolism, a higher norepinephrine secretion and lower natural killer cell levels were found in the patient group compared to a control group consisting of healthy, age-matched women. In addition, an increased activity of some pro-inflammatory markers was observed thus leading to alterations in the balance of pro-/anti-inflammatory activity. The results underline the relevance of simultaneous investigations of interacting bodily systems for a better understanding of underlying biological mechanisms in stress-related disorders.
Stress related disorders increase continuously. It is not yet clear if stress also promotes breast cancer. This dissertation provides an analyses of the current state of research and focuses on the significance of pre-/postnatal stress factors and chronic stress. The derived hypotheses are empirically examined on breast cancer patients. The clinical study investigates the links between those factors and prognosis and outcome.
The role of cortisol and cortisol dynamics in patients after aneurysmal subarachnoid hemorrhage
(2011)
Spontaneous aneurysmal subarachnoid hemorrhage (SAH) is a form of stroke which constitutes a severe trauma to the brain and often leads to serious long-term medical and psychosocial sequels which persist for years after the acute event. Recently, adrenocorticotrophic hormone deficiency has been identified as one possible consequence of the bleeding and is assumed to occur in around 20% of all survivors. Additionally, a number of studies report a high prevalence of post-SAH symptoms such as lack of initiative, fatigue, loss of concentration, impaired quality of life and psychiatric symptoms such as depression. The overlap of these symptoms and those of patients with untreated partial or complete hypopituitarism lead to the suggestion that neuroendocrine dysregulations may contribute to the psychosocial sequels of SAH. Therefore, one of the aims of this work is to gain insights into the role of neuroendocrine dysfunction on quality of life and the prevalence of psychiatric sequels in SAH-patients. Additionally, as data on cortisol dynamics after SAH are scarce, diurnal cortisol profiles are investigated in patients in the acute and chronic phase, as well as the cortisol awakening response and feedback sensitivity in the chronic phase after SAH. As a result, it can be shown that some SAH patients exhibit lower serum cortisol levels but at the same time a higher cortisol awakening response in saliva than healthy controls. Also, patients in the chronic phase after SAH do have a stable diurnal cortisol rhythm while there are disturbances in around 50% of all patients in the acute phase, leading to the conclusion that a single baseline measurement of cortisol is of no substantial use for diagnosing cortisol dysregulations in the acute phase after SAH. It is assumed that in SAH patients endocrine changes occur over time and that a combination of adrenal exhaustion and a subsequent downregulation of corticosteroid binding globulin may be the most probable causes for the dissociation of serum cortisol concentrations and salivary cortisol profiles in the investigated SAH patients. These changes may be an emergency response after SAH and, as elevated free cortisol levels are connected to a better psychosocial outcome in patients in the chronic phase after SAH, this reaction may even be adaptive.
Fast and Slow Effects of Cortisol on Several Functions of the Central Nervous System in Humans
(2014)
Cortisol is one of the key substances released during stress to restore homeostasis. Our knowledge of the impact of this glucocorticoid on cognition and behavior in humans is, however, still limited. Two modes of action of cortisol are known, a rapid, nongenomic and a slow, genomic mode. Both mechanisms appear to be involved in mediating the various effects of stress on cognition. Here, three experiments are presented that investigated fast and slow effects of cortisol on several functions of the human brain. The first experiment investigated the interaction between insulin and slow, genomic cortisol effects on resting regional cerebral blood flow (rCBF) in 48 young men. A bilateral, locally distinct increase in rCBF in the insular cortex was observed 37 to 58 minutes after intranasal insulin admission. Cortisol did not influence rCBF, neither alone nor in interaction with insulin. This finding suggests that cortisol does not influence resting cerebral blood flow within a genomic timeframe. The second experiment examined fast cortisol effects on memory retrieval. 40 participants (20 of them female) learned associations between neutral male faces and social descriptions and were tested for recall one week later. Cortisol administered intravenously 8 minutes before retrieval influenced recall performance in an inverted U-shaped dose-response relationship. This study demonstrates a rapid, presumably nongenomic cortisol effect on memory retrieval in humans. The third experiment studied rapid cortisol effects on early multisensory integration. 24 male participants were tested twice in a focused cross-modal choice reaction time paradigm, once after cortisol and once after placebo infusion. Cortisol acutely enhanced the integration of visual targets and startling auditory distractors, when both stimuli appeared in the same sensory hemi-field. The rapidity of effect onset strongly suggests that cortisol changes multisensory integration by a nongenomic mechanism. The work presented in this thesis highlights the essential role of cortisol as a fast acting agent during the stress response. Both the second and the third experiment provide new evidence of nongenomic cortisol effects on human cognition and behavior. Future studies should continue to investigate the impact of rapid cortisol effects on the functioning of the human brain.