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- fibromyalgia (3) (remove)
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.
The aim of the thesis was to investigate the role of the immune system in fibromyalgia (FM), as part of a dynamic co-regulation between different bodily systems. FM is a chronic musculoskeletal disorder characterized by widespread pain and specific tender points, combined with other symptoms including fatigue, sleep disturbances, morning stiffness and anxiety. The main goal of the work was to identify possible dysregulation of peripheral immune and endocrine parameters in patients with FM compared to matched healthy controls. Moreover, the possible relation between symptom complaints and the specific parameters measured was also evaluated. A first approach was to investigate possible differences between FM patients and controls in the expression of cytokines, as they have been implicated in the occurrence of several of the symptoms associated with FM. Furthermore, adhesion molecules which are involved in cell-to-cell communication and immune cell trafficking were also studied. The latter are known to be regulated by both cytokines and glucocorticoids (GCs) and their expression is often found altered in patients with immune dysregulation. It was expected that subjects with FM would have an increased production of proinflammatory cytokines and/or a reduced antiinflammatory cytokine production and that certain cytokines and/or adhesion molecules would be differently regulated by dexamethasone (DEX). Unstimulated blood was used in the analysis of adhesion molecule expression by flow cytometry while stimulated whole blood cell cultures were used in cytokine flow cytometry assays. Peripheral blood mononuclear cells (PBMCs) were also cultured and the supernatants collected to determine the concentration of cytokines by biochip protein array. In addition, serum samples were used in enzyme-linked immunosorbent assays (ELISA) for quantification of soluble adhesion molecules. L-selectin was found elevated on monocytes and neutrophils of FM patients. A bias toward lower IL-4 levels was observed in FM patients. Based on studies showing differences in glucocorticoid receptor (GR) affinity and disturbances associated with loss of hypothalamic-pituitary-adrenal (HPA) axis resiliency in FM, it was hypothesized whether FM would be associated with abnormalities in glucocorticoid sensitivity. Total plasma cortisol and salivary free cortisol were quantified by ELISA and time-resolved fluorescence immunoassay, respectively. GR sensitivity through DEX inhibition of IL-6, in stimulated whole blood, was evaluated after cytokine quantification by ELISA. The corticosteroid receptors, GR alpha and mineralocorticoid receptor (MR), as well as the glucocorticoid-induced leucine zipper (GILZ) and the FK506 binding protein 5 mRNA expression were assessed in PBMCs by real-time reverse transcription-polymerase chain reaction (RT-PCR). Furthermore, sequencing of RT-PCR products and/or genomic DNA was used for mutational analysis of the corticosteroid receptors. We observed lower basal plasma cortisol levels (borderline statistical significance) and a lower expression of corticosteroid receptors and GILZ in FM patients when compared to healthy controls. The minor allele of the MR single nucleotide polymorphism (SNP) rs5522 was found more often in FM patients than in controls. In addition, female carriers of this SNP seemed to have reduced salivary cortisol responses to a strong psychological stressor (Trier Social Stress Test) compared to non-carriers. FM patient carriers of an MR intronic SNP (rs17484245), before exon 3, were associated with significantly higher scores of depression symptoms compared to patient non-carriers. The thesis includes also a comprehensive analysis of the complexity of GR regulation and the role of alternative mRNA splicing. It focuses on the differential expression of the untranslated GR first exons, their high sequence homology among different species and how genetic determinants, without apparent relevance, may have implications in health and disease. In FM patients, GR exon 1-C expression was found lower and a significant difference was observed when comparing GR 1-C expression between antidepressant-free and patients who had taken antidepressants until two weeks before sample collection. In summary, the study shows a slight disturbance of some components of the innate immune system of FM patients and suggests an enhanced adhesion and possible recruitment of leukocytes to inflammatory sites. The reduced expression of corticosteroid receptors and possibly the reduced MR function may be associated with an impaired function of the HPA axis in these patients. A hyporesponsiveness of the HPA axis under stress or disturbances of the stress response could make these patients more vulnerable to cytokines and inflammation which, compounded by lower antiinflammatory mediators, may sustain some of the symptoms that contribute to the clinical picture of FM.
In jüngerer Zeit wurde in der neuroendokrinologischen Forschung das Phänomen eines Hypocortisolismus bei verschiedenen Störungen, die mit Stress assoziiert sind, beschrieben. Insbesondere bei der Posttraumatischen Belastungsstörung (PTSD) wurde eine verringerte adrenale Aktivität berichtet. Aber auch bei Patienten mit verschiedenen körperlichen Beschwerden wurden ähnliche neuroendokrine Veränderungen gefunden. Dazu zählen unter anderem das Fibromyalgiesyndrom (FMS) und chronische Unterbauchbeschwerden (CUBB). Die Mechanismen, welche dem Hypocortisolismus zugrunde liegen, sind bislang sowohl für die PTSD als auch für stressabhängige körperliche Beschwerden nicht abschließend geklärt. Weiterhin besteht Unklarheit darüber, inwieweit eine Vergleichbarkeit dieser Mechanismen zwischen den verschiedenen Störungsbildern besteht. Die Entstehung und Aufrechterhaltung dieser Erkrankungen scheinen somit ein sehr komplexes Zusammenspiel verschiedener Faktoren darzustellen. Andererseits weisen die Überlappungen hinsichtlich symptomatologischer, psychologischer und endokrinologischer Variablen zwischen PTSD, FMS und CUBB auf die Existenz störungsübergreifender Subgruppen hin. In der vorliegenden Studie wurden psychologische und endokrinologische Auffälligkeiten bei PTSD, FMS und CUBB weiter untersucht. Vorrangiges Ziel war, zu überprüfen, inwieweit störungsübergreifende Subgruppen mit vergleichbaren psychoendokrinologischen Auffälligkeiten bestehen. Insgesamt wurden 59 Patientinnen mittels verschiedener endokrinologischer Tests untersucht und mit 30 gesunden Kontrollfrauen verglichen. Mit einer Clusteranalyse konnten drei unabhängige störungsübergreifende Subgruppen identifiziert werden, die sich hinsichtlich ihrer Reaktionen in den endokrinologischen Tests unterschieden. Es konnte somit gezeigt werden, dass es sich bei den untersuchten Störungsgruppen weder um eine Störungsfamilie mit identischen endokrinen Auffälligkeiten noch um isolierte, d.h. distinkte, von einander unabhängige Erkrankungen handelt. Vielmehr scheinen störungsübergreifende Subgruppen zu bestehen. Weitere Studien sollten die gefunden Muster replizieren und gegebenenfalls erweitern.