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- immune system (2) (entfernen)
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- Psychologie (1)
- Universitätsbibliothek (1)
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.
Early life adversity (ELA) is associated with a higher risk for diseases in adulthood. Changes in the immune system have been proposed to underlie this association. Although higher levels of inflammation and immunosenescence have been reported, data on cell-specific immune effects are largely absent. In addition, stress systems and health behaviors are altered in ELA, which may contribute to the generation of the "ELA immune phenotype". In this thesis, we have investigated the ELA immune phenotype on a cellular level and whether this is an indirect consequence of changes in behavior or stress reactivity. To address these questions the EpiPath cohort was established, consisting of 115 young adults with or without ELA. ELA participants had experienced separation from their parents in early childhood and were subsequently adopted, which is a standard model for ELA, whereas control participants grew up with their biological parents. At a first visit, blood samples were taken for analysis of epigenetic markers and immune parameters. A selection of the cohort underwent a standardized laboratory stress test (SLST). Endocrine, immune, and cardiovascular parameters were assessed at several time points before and after stress. At a second visit, participants underwent structural clinical interviews and filled out psychological questionnaires. We observed a higher number of activated T cells in ELA, measured by HLA-DR and CD25 expression. Neither cortisol levels nor health-risk behaviors explained the observed group differences. Besides a trend towards higher numbers of CCR4+CXCR3-CCR6+ CD4 T cells in ELA, relative numbers of immune cell subsets in circulation were similar between groups. No difference was observed in telomere length or in methylation levels of age-related CpGs in whole blood. However, we found a higher expression of senescence markers (CD57) on T cells in ELA. In addition, these cells had an increased cytolytic potential. A mediation analysis demonstrated that cytomegalovirus infection " an important driving force of immunosenescence " largely accounted for elevated CD57 expression. The psychological investigations revealed that after adoption, family conditions appeared to have been similar to the controls. However, PhD thesis MMC Elwenspoek 18 ELA participants scored higher on a depression index, chronic stress, and lower on self-esteem. Psychological, endocrine, and cardiovascular parameters significantly responded to the SLST, but were largely similar between the two groups. Only in a smaller subset of groups matched for gender, BMI, and age, the cortisol response seemed to be blunted in ELA participants. Although we found small differences in the methylation level of the GR promoter, GR sensitivity and mRNA expression levels GR as well as expression of the GR target genes FKBP5 and GILZ were similar between groups. Taken together, our data suggest an elevated state of immune activation in ELA, in which particularly T cells are affected. Furthermore, we found higher levels of T cells immunosenescence in ELA. Our data suggest that ELA may increase the risk of cytomegalovirus infection in early childhood, thereby mediating the effect of ELA on T cell specific immunosenescence. Importantly, we found no evidence of HPA dysregulation in participants exposed to ELA in the EpiPath cohort. Thus, the observed immune phenotype does not seem to be secondary to alterations in the stress system or health-risk behaviors, but rather a primary effect of early life programming on immune cells. Longitudinal studies will be necessary to further dissect cause from effect in the development of the ELA immune phenotype.