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Surgery, pain, and immune function.

Research findings have demonstrated that surgery negatively affects immune function. Pain also has deleterious effects on immune function. Most research in this area has been conducted on animals. Psychoneuroimmunology provides the framework for this article. Psychoneurological phenomena, such as stress, depression, and pain, can influence immune system functioning through neuroendocrine pathways. Biological and behavioral processes appear to be closely related and need to be jointly considered when planning and providing anesthesia care. The anesthesia planning process increasingly involves aggressive assessment and treatment of postoperative pain, which may benefit immune function.

Anesthesia↗

Illness, the mind, and the body: cancer and immunology: an introduction.

From the sixties on it has become clear how the human physical condition could be influenced by human behavior. Although hypothesis were lacking to understand these connections, nursing research especially proved how systematically introduced patient behavior during illness and hospitalization could induce better recovery results and better prognosis for the patient. Information and attitude proved to be crucial elements in these processes of improved patient expectations. It took less than two decades to get to the insights we have in 1994. Recent research shows the interlocking mechanisms of nervous and endocrine systems with the immune system as significantly being influenced by behavior and especially psychic and or psychosocial stress. This special issue of Theoretical Medicine briefly describes the historical development with contributions on the most recent state of the scientific art. These developments are emphasized by discussion on the clinical reality of the (breast) cancer patient and recent findings on the complexity of the prevalence of cancer in epidemiology. An attempt is made to consider practical consequences of the actual knowledge if applied to patient care.

Animals↗

Behavioral, neuroendocrine, and immunological outcomes of escapable or inescapable shocks.

The present study was designed to evaluate the effects of repeated exposure to escapable or inescapable shocks on subsequent behavior in an activity cage, and on the reactivity of the hypothalamic-pituitary-adrenocortical (HPA) axis and the immune system. We also studied the possible influence of behavioral factors on the behavioral and physiological impact of stress. Although exposure to different stressful situations pointed out marked differential effects in subsequent behavior, it failed to elicit differences in the neuroendocrine and immunological parameters studied. However, interesting results were found in analyzing the influence of behavioral factors. The degree of control exerted over the shock was inversely related to ACTH and corticosterone levels. In addition, individual differences in the exploratory activity to novelty were correlated with poststress lymphoproliferation and antibody formation. These data indicate that the behavioral and physiological outcomes of stress depend on the interrelations between environmental and individual factors (including both preexisting individual differences and the coping responses during stress).

Adrenocorticotropic Hormone↗

Reduced aggressiveness and low testosterone levels in autoimmune MRL-lpr males.

Autoimmune, lupus-prone MRL-lpr mice float excessively in the forced swim test, explore novel objects and places less, and show blunted responsiveness to palatable stimuli, which is consistent with the hypothesis that the development of chronic autoimmune disease alters emotional reactivity and/or motivation. The present study measures isolation-induced fighting, a model of "affective" aggression, in lupus-prone MRL-lpr and control MRL +/+ males. When compared with controls, autoimmune MRL-lpr mice show reduced aggressiveness, as evidenced by fewer fighting contacts, longer attack latency, shorter fighting episodes and shorter duration of fighting. In addition, reduced testosterone levels accompany serological signs of autoimmunity in the MRL-lpr males. The present results support the hypothesis that affective responsiveness is altered in lupus-prone mice and may suggest limbic system dysfunction during chronic autoimmune/inflammatory disease. The question of whether immune activation alters behavior by a direct effect on the nervous system, or also via the endocrine system, requires further study.

Aggression↗

Contemporary classification of histiocytic disorders. The WHO Committee On Histiocytic/Reticulum Cell Proliferations. Reclassification Working Group of the Histiocyte Society.

Pathologists and pediatric hematologist/ oncologists of the World Health Organization's Committee on Histiocytic/Reticulum Cell Proliferations and the Reclassification Working Group of the Histiocyte Society present a classification of the histiocytic disorders that primarily affect children. Nosology, based on the lineage of lesional cells and biological behavior, is related to the ontogeny of histiocytes (macrophages and dendritic cells of the immune system). Dendritic cell-related disorders of varied biological behavior are dominated by Langerhans cell histiocytosis, but separate secondary proliferations of dendritic cells must be differentiated. Juvenile xanthogranuloma represents a disorder of dermal dendrocytes, another dendritic cell of skin. The hemophagocytic syndromes are the most common of the macrophage-related disorders of varied biological behavior. Guidelines for distinguishing the exceedingly rare malignant diseases of histiocytes from large cell lymphomas through the use of a battery of special studies are provided.

Cell Lineage↗

[The effect of "cognitive" and "noncognitive" exposures on the sensitivity to stressor hormones and the choice of adaptation strategy].

Experimental data have shown that repeated exposure to both "cognitive" (recognized by the nervous system) and "noncognitive" (recognized by the immune system) stimuli induces so-called "tolerant (resource-preserving adaptation strategy". This strategy is characterized by enhanced hypoxia tolerance, reduced sensitivity to stress (catabolic) hormones, such as glucocorticoids and adrenomimetics, and increased sensitivity to insulin (central anabolic hormone). Such shifts appear more pronounced in case of "noncognitive" stimulation, which is also capable of inducing a hypocatabolic state. Nonspecific immunostimulation associated with repeated stress is considered as an appreciable stress-limiting process despite initial "cognitivity" of stressogenic stimulation.

Adaptation, Physiological↗

Stability analysis of simple models for immune cells interacting with normal pathogens and immune system retroviruses.

A mathematical analysis is presented for several simple dynamical systems that might be considered as crude descriptions for the situation when an immune system retrovirus, immune cells, and normal autonomously replicating pathogens interact. By stability analysis of the steady-state solutions, the destabilizing effect of the immune system retrovirus is described. The qualitative behavior of the solutions depending on the system parameters is analyzed in terms of trajectories moving in a phase space in which the axes are defined by the population numbers of the interacting biological entities.

HIV↗

Immunological responses of breast cancer patients to behavioral interventions.

This article reports the results of an 18-month study of immune system and psychological changes in stage 1 breast cancer patients provided with relaxation, guided imagery, and biofeedback training. Thirteen lymph node negative patients who had recovered from a modified radical mastectomy were randomly assigned to either an immediate treatment or a delayed treatment control group. Multiple pre-post psychological measures were performed. Significant effects were found in natural killer cell (NK) activity (p < .017), mixed lymphocyte responsiveness (MLR) (p < .001), concanavalin A (Con-A) responsiveness (p < .001), and the number of peripheral blood lymphocytes (PBL) (p < .01). No significant psychological changes were detected; however, reductions were seen in psychological inventory scales measuring anxiety. The results show that behavioral interventions can be correlated with immune system measures, thereby replicating the results of an earlier pilot study from our Center. Discussion is provided on differential T-cell and B-cell responsiveness to behavioral interventions.

Adult↗

Making sense of the combined effect of interleukin-2 and interleukin-4 on lymphocytes using a mathematical model.

The cytokines are the information superhighway of the immune system. They are an important component of the integrated behavior of the system. In order to be able to have a good understanding of the immune system, we must be able to model the effect of cytokines and their combined effect. This work is a step in that direction. We study the combined effect of two cytokines: interleukin-2 (IL-2) and interleukin-4 (IL-4) on some cells of the immune system. Interleukin-2 and interleukin-4 are important growth and differentiation factors for B and T cells. Interleukin-4 antagonizes the effect of interleukin-2 on B cells and some T cells while it synergizes with interleukin-2 on other T cells. We build a mathematical model of the interaction of both cytokines on T and B cells as a building block toward a model of the Th1/Th2 cross-regulation. The response of a given cell to the combination of interleukin-2 and interleukin-4 is shown to involve competing dynamical effects which can lead to either antagonistic or synergistic combined effect.

Animals↗

[Experimental studies on the interaction between sleep and the immune system in humans].

Sleepiness and increased sleep pressure are typical symptoms of inflammation and infection. Moreover, it is a pre-scientific belief that sleep supports host defense. The present paper summarizes the experimental evidence regarding the interaction between sleep and the immune system in humans. Sleep-wake behavior is very sensitive to experimental host defense activation, for example, by bacterial endotoxin. When the injection of endotoxin is accompanied by fever and a prominent neuroendocrine activation, sleep continuity will be disturbed. When the production of inflammatory cytokines is stimulated by smaller amounts of endotoxin, but no fever and no neuroendocrine activation are apparent, the nonREM-sleep amount will increase. This is possibly due to changes in the biological activity of the tumor necrosis factor-alpha (TNF-alpha) system. Besides their important function in sleep regulation during acute immune response, cytokines also seem to be involved in physiological sleep regulation, although there still is not very much data on this issue. So far, it remains largely unknown whether or not sleep supports host defense. In humans, for example, acute sleep deprivation up to 55 hours has only minor effects on endotoxin-induced host responses. In contrast, there is preliminary and yet inconsistent evidence that sleep deprivation might impair antibody formation in response to viral challenges.

Cytokines↗

Behavioral factors in stress-induced immunomodulation.

Individual differences in the exploratory response to novelty were found to be related with the vulnerability to develop stress-induced immunological alterations. We studied the effect of exposure to inescapable shock on antibody formation against sheep red blood cells (SRBC) in rats selected according to their locomotor activity in a novel situation. Interestingly, antibody titers were only enhanced in shocked animals with the highest locomotor activity. These results emphasize the importance of taking into account individual differences for the study of the mechanisms involved in stress-induced immunomodulation, suggesting a behavioral procedure (novelty reactions) to deal with individual variability in the effects of stress on the immune system.

Animals↗

Evaluation of a campaign to improve immunization in a rural headstart program.

This study evaluated an intervention to improve immunization rates in a high poverty, medically underserved rural area employing a pretest-posttest design. The intervention expanded immunization availability, established walk-in appointment policies, and introduced intensified parent education. Formative evaluation indicated specific messages with high salience to parents. As a result, the susceptibility and severity of childhood infectious disease, the outcome efficacy of vaccines, and methods to reduce barriers to immunization were emphasized in communications with parents. Data on DTP1-4, OPV1-3, and MMR were obtained from preschools, local health departments and private medical practices before (n = 567) and after the intervention (n = 331). Following adjustment for birth order and demographics, at post-intervention a significantly greater proportion of children received 6 of 8 vaccines on time. Effect sizes were large. For example, post MMR rates were at least 2X greater than pre rates. Time-series analysis of trend data on local newspaper coverage of child health topics suggested history was not a major threat to the internal validity of this pre-post only design. The findings indicate that comprehensive intervention, targeting improvements in the availability of pediatric care, health system policies and parent behavior, can improve immunization.

Attitude to Health↗

Behavioral effects of lipopolysaccharide in rats: involvement of endogenous opioids.

Activation of the immune system in response to either infection or lipopolysaccharide (LPS) produces neurophysiological, neuroendocrine and behavioral changes. Some of the physiological consequences of LPS are mediated by endogenous opioid peptides. The following studies were designed to characterize the effects of LPS in several behavioral paradigms, and to determine the role of opioids in mediating these effects. The effects of LPS on locomotor and self-care activity were assessed in the open field test. Rats were injected with either saline or a dose of LPS (25, 50, 100, or 1000 micrograms/kg). 4 h later, the animals were placed in an open field and the numbers of line crossings, rearings and grooming episodes were counted. LPS significantly suppressed the three open field behaviors in a dose-related manner. The effect of LPS on sensitivity to pain was determined using the hot-plate and tail-flick tests. Administration of LPS (200 micrograms/kg) increased pain sensitivity in the hot plate test 30 min after drug administration, but produced a significant analgesic response 4 h after drug administration in both tests. Further characterization of LPS-induced analgesia demonstrated that it began about 2 h after and disappeared 30 h after the administration of LPS. Administration of naltrexone completely blocked the analgesic effects of LPS 4 h after its administration, but had no effect on LPS-induced suppression of activity in the open field. The effect of LPS on body temperature was biphasic, producing hypothermia at 2 h and hyperthermia at 8-30 h after its administration. Naltrexone had no effect on the body temperature changes induced by LPS.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

The Peculiarities of the Immune Status in Mice with Different Level of Behavioral Reactions.

Within the framework of the problem of neuroimmune interrelationships we studied the peculiarities of the immune status in mice with different level of behavioral reactions. The parameters of humoral and cellular immunity, immunohaematological values and thymus weight in mice were investigated. Using the "open field" we estimated the exploratory behavior, general locomotor activity and emotional state in mice. It was found that (CBA x C57Bl/6)F1 mice may be divided into 3 following groups: with high, medium and low level according to a degree of pronounced signs of behavioral reactions. C57Bl/6 and Balb/c mice appeared to be opposite towards manifestation of studied behavioral reactions. All mice showed direct dependence between the initial level of exploratory behavior, general locomotor activity and pronounced signs of delayed type hypersensitivity as well as indirect dependence of this immunological parameter on the degree of emotional state. Thus, it can be concluded that there is a close link between functional activity of nervous system and expression of cellular immunity. The influence of immune system on the formation of the initial behavioral status in mice is supposed.

Journal Article↗

An evolutionary perspective on signaling in behavior and immunology.

Signaling and communication are important at different levels of biological organization. Signals exchanged between cells of the immune system initiate and coordinate the immune response; signals exchanged between individuals often coordinate social behavior. Behavioral ecologists interested in the evolution and functional design of signals exchanged between individuals have produced a theory of signaling and communication that stresses the importance of cooperation and conflict; if a conflict of interest between signaler and receiver is great enough, signals evolve towards greater reliability. We suggest that the application of signaling system theory to signals exchanged between cells within an individual will allow for a better understanding of immunity and intra-individual communication in general, with potential for novel approaches to the treatment of disease.

Allergy and Immunology↗

Increases in a marker of immune system reconstitution are predated by decreases in 24-h urinary cortisol output and depressed mood during a 10-week stress management intervention in symptomatic HIV-infected men.

BACKGROUND: Stress management interventions reduce distress symptoms and hypothalamic-pituitary-adrenal (HPA) axis hormones such as cortisol, which has been related to a down-regulation of immune system components relevant to the human immunodeficiency virus (HIV) infection. We previously showed that HIV+ men assigned to a 10-week cognitive behavioral stress management (CBSM) intervention showed more CD4+CD45RA+CD29+ lymphocytes, an indicator of immune system reconstitution, at a 6- to 12-month follow-up compared with controls. Here, we tested whether reductions in urinary cortisol output and depressed mood during the 10-week CBSM intervention period mediated its effects on this immune system reconstitution marker at follow-up. METHODS: Twenty-five HIV-infected men randomized to either a 10-week CBSM intervention or a wait-list control provided 24-h urine samples and psychological responses pre- to postintervention, which were related to changes in immune status over a 6- to 12-month follow-up period. RESULTS: Greater reductions in cortisol output and depressed mood during CBSM appeared to mediate the effects of this intervention on this indicator of immune system reconstitution over the 6- to 12-month follow-up period. Changes in mood were maintained over the follow-up period, although these did not add explanatory information beyond the cortisol and mood changes that were observed during the 10-week intervention period. These findings were not explained by the changes in medications or health behaviors during follow-up. CONCLUSION: A time-limited CBSM intervention may affect the rate of immune system reconstitution in HIV-infected men by modifying the stress of symptomatic disease. This intervention may work by decreasing depressed mood and normalizing HPA axis functioning.

Adolescent↗

Evaluation of drop versus trickle-feeding systems for crated or group-penned gestating sows.

A total of 160 gilts were used to evaluate the effects of pen vs. crated housing systems and drop- vs. trickle-fed feeding systems on sow productivity, occurrence of lesions during farrowing and weaning, immune measures, and behavioral responses during 2 consecutive gestation periods. Of the 160 eligible gilts, 117 farrowed in parity 1, and of those, 72 farrowed in parity 2. The gilts were randomly assigned to represent 1 of 4 factorially arranged treatment groups: pen drop-fed, crate drop-fed, pen trickle-fed, or crate trickle-fed. Replicate blocks were used for each parity with 5 sows per block initially in each treatment. At weaning, sows housed in pens had greater (P < 0.05) backfat thickness than sows housed in crates. The piglet weaning weight was greater (P < 0.05) for sows fed with the single drop compared with the trickle-feeding system. Lesions scores and all other productivity measures did not differ among treatments. An interaction was observed for percentage of neutrophil phagocytosis (P < 0.05) between penning and feeding systems. In pens, drop-fed sows had greater phagocytosis than trickle-fed sows, but in crates, drop-fed sows had a tendency for lower phagocytosis than trickle-fed sows. All other immune measures were not different among treatments. The occurrence of oral-nasal-facial (ONF) behaviors (chewing, rooting, and rubbing) and active behaviors increased, and lying behavior decreased (P < 0.05), from 0800 to 1200 for all sows. During the 0800 to 1200 period, crate drop-fed sows displayed more (P < 0.05) ONF and active behaviors than did sows in the 3 other treatments. Sows housed in groups of 5 had a greater (P < 0.05) duration of standing in the 0400 to 0800 period compared with crated sows. Housing systems had complex effects on sow behavioral sequences, but penned sows had more sequences associated with stress than did crated sows. Also, crate drop-fed gilts and sows expressed more ONF behaviors than gilts and sows in other treatments. Generally, productivity, skin lesions, and immune measures were not different, but behaviors at certain times of day and behavioral sequences were different for sows in pens and crates with drop or trickle-feeding systems. None of the environments evaluated were associated with significant physiological stress responses among the sows. Thus, sows were able to adapt within each environment through behavioral mechanisms without the need to invoke major physiological adjustments.

Animal Feed↗