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Salud Mental 2004; 27 (3)
Language: English
References: 87
Page: 19-25
PDF size: 77.31 Kb.
ABSTRACT
For 20 years, a great number of clinical and experimental evidence have shown the existence of a constant and bi-directional communication between the neuroendocrine system and the immune response, called neuroendocrineimmune (NEI) interactions. These interactions help the homeostasis maintenance to stressful stimuli, whether they are physical or systemic bacterial, viral or parasitical infections, as well as tissular injuries or psychological stress, that is secondary to the individual’s perception and processing.
Stress is a physicochemical or emotional process that induces tension. This process promotes the release of proinflamatory cytokines, hormones such as the corticotrophin-release hormone (CRH) and cortisol, and a wide number of neurotransmitters that are together responsible for some behavioral alterations. Both systemic and psychological stress elicits an equivalent response in an organism, but acute stressors have effects considered beneficial, while chronic stressors have nocive effects.
The adaptative response of the organism to a stressful stimulus consists of an increase of the sera levels of proinflammatory cytokines like tumor necrosis factor-alpha (TNF-α) and interleukine (IL)-1 and IL-6, produced by immune response cells like the lymphocytes and macrophages. When this proinflammatory cytokines reach a 10nM concentration, they bind to their receptors and can stimulate the Central Nervous System (CNS). Although the brain has specific cytokine receptors located in different anatomical regions, the most densely one is the hippocampus. In addition to the existence of a great number of cytokine receptors in the brain, this organ has the capacity to synthesize and secrete in situ a wide variety of cytokines, ability that makes it susceptible of being stimulated by both systemic and in situ produced cytokines.
The activity of the NEI interactions starts when systemic or psychological stressful stimuli lead to the release of proinflammatory cytokines. When these reach a 10nM concentration, they bind to their specific brain receptors, following different neural pathways and a cascade of events is thus triggered: 1) Neuroimmune events initiate the cytokine release within the brain, 2) neurochemical events initiate the release of neurotransmitters, such as norepinephrine (NE) and serotonine (5HT), 3) neuroendocrine events beginning with CRH secretion activate the hipotalamus-pituitary-adrenal (HPA) axis. The activity of the axis finishes when cortisol and anabolic androgens, such as dehydroepiandrosterone (DHEA), are released into the blood stream. All the previous events lead ultimately to 4) behavioral changes known as “sickness behavior”.
Both cortisol and DHEA have specific receptors in almost every cell, particularly those of the immune response like the T lymphocytes, which are highly susceptible to variations in the circulating levels of these molecules. At low concentrations and during short periods of time, cortisol acts as an immunostimulant, especially for a T lymphocyte subset known as T-helper 2 (TH2), involved in the humoral immune response, mainly mediated by antibodies. On the other hand, DHEA positively stimulates the T lymphocyte subset called T-helper 1 (TH1), which favors the cellular immune response.
The difference between TH1 and TH2 lymphocyte subsets lies in the profile of cytokines secreted by each one. TH1 cells secrete proinflammatory cytokines, such as IL-1, TNF-α and IL-6, while TH2 cells secrete antinflammatory cytokines, such as IL-10, IL-13 and IL-4, that are antagonist to those secreted by TH1 cells. The antagonism between cytokines is an important point of balance for the immune system and the NEI interactions.
Cortisol also has a high density of brain receptors located mainly in the hippocampus. Under normal conditions, when the stressful stimulus disappears, proinflammatory cytokine production decreases and cortisol leads the NEI interactions to the basal condition again.
The long-term presence of stressful stimuli causes the chronic increase of circulating cortisol, resulting in an impairment of the NEI interactions, which can originate infectious, chronic or autoimmune diseases, as well as psychiatric disorders like depression, schizophrenia, Alzheimer’s disease and anorexia.
Every one of us faces a series of systemic and psychological stressful stimuli all through our lives. The intensity and duration of those stimuli will depend on our capacity to cope with them; this capacity is sustained by our genetic background and the learning provided by our social and environmental experiences.
During these last years, the study of the NEI interactions has acquired great interest because the knowledge generated within this area will allow the development of new and efficient therapeutical approaches to improve and control several physical and psychiatric disorders.
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