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Numbers in parentheses indicate the pages on which the authors' contributions begin.
xvii
xviîî Contributors
There is increasing evidence that the central nervous system (CNS) can
influence the immune response, the body's defense against infectious and
malignant diseases. This book focuses on human studies, as well as relevant
animal models for human infectious and autoimmune illness. We chose to
highlight these particular animal models because they demonstrate the di
rect impact of various Stressors on the immune system and the subsequent
modulation of infectious and autoimmune diseases. In addition, these ani
mal studies help to demonstrate the range of physiological changes associ
ated with Stressors. We believe that the chapters in this book will provide
the reader with a current summary of the field of psychoneuroimmunology
as it pertains to stress and illness outcomes.
Psychological distress can lead to adverse immunological changes pro
viding one physiological pathway through which major and minor life
changes might result in an increased incidence of infectious and malignant
disease. However, most individuals who experience major life changes do
xxi
xxH Preface
not become ill, or they only experience short illness episodes. Actual organ
ically based episodes of illness are a function of differential exposure to
pathogens and/or carcinogens, genetics, as well as the prior health of the
individual, particularly regarding immune function. Thus, in individuals
with equal exposure to an infectious agent (e.g., a virus), the probability of
clinical illness and the intensity and duration of the illness are, in part, the
product of the prior status of the individual's immune system. Following
this line of reasoning, individuals who are presumably most likely to show
health changes in response to Stressors are those whose immune function is
already compromised to some extent, particularly the elderly, since aging is
associated with impaired immune function.
The adrenal cortex produces glucocorticoids in response to Stressors
through the hypothalemic-pituitary axis. Individuals with an adreno-
cortical insufficiency such as Addison's Disease have physiological difficulty
handling stress. In addition, an overabundance of glucocorticoids during
stress also can have major physiological consequences. Research on the
relationships among the CNS, immune system and endocrine systems pro
vides evidence of physiological pathways, including the glucocorticoids, and
other 'stress hormones" such as the catecholamines, prolactin, and growth
hormone, through which distress may modulate immune function.
There also are other pathways through which the CNS may influence
immune function, such as direct innervation of both primary and secondary
lymphoid organs. Our knowledge about the interactions among the CNS,
the immune system, and the endocrine system in regard to mechanisms of
action is still limited. However, there is an active and growing literature
describing such relationships, and their health-related consequences. These
and other issues are covered in the chapter in this book by well-known
experts in their respective areas.
Ronald Glaser
Janice K. Kiecolt-Glaser
D
Stress-Induced Modulation of Immune
Function in Mice
Jon A. Moynihan, GoryJ. Brenner, Robert Cocke, Jonothon 0. Korp,
Stephen M. Brenemon, JoelM. Oopp, Robert Ader, Nicholos Cohen,
Lee J. Groto, and Suzanne l Feiten
I. INTRODUCTION
nervous system and the immune system has advanced, to a large extent,
from studies utilizing Stressor administration in animal models. Application
of a Stressor in animals results in diverse changes in both specific humoral
and cell-mediated immune parameters, and in nonspecific natural killer
(NK) cell number and/or activity (reviewed in Kiecolt-Glaser &c Glaser,
1991; Shavit, 1991; Moynihan &c Cohen, 1992; Ader & Cohen, 1993).
Many of the studies that have addressed stress-induced changes in disease
outcome and/or immune function also illustrate the complexities of the
interactions between the central nervous and immune systems. It is certainly
apparent that: ( 1 ) not all Stressors produce the same pattern of neurochemi-
cal responses; (2) not all strains, species, or sex of animals respond to a
given Stressor in the same behavioral, neurochemical or immunological
manner; and (3) not all immune effector functions are equally affected by
Stressor application. Thus, in response to Stressors, immune effector func
tions are suppressed, enhanced, or unchanged. As outlined in Table 1, sev
eral variables have been demonstrated to be important determinants of the
immunological consequences of Stressor administration. These variables re
flect the complexity of both the neuroendocrine responses to a Stressor,
and the interaction of these responses with the cascade of molecular and
cellular immune responses to an antigen. This neuroendocrine complexity
can be highlighted by pointing out that, although in some studies, stressor-
associated immunomodulation correlates with altered levels of glucocor-
ticoids (Blecha, Kelley, & Satterlee, 1982; Keller, Weiss, Schleifer, Miller, &
Stein, 1983; Okimura, Ogawa, Yamauchi, &c Sasaki, 1986; Coe, Rosenberg,
A. Experimental subject
1. Species of subject
2. Strain of animal
3. Age and sex of animal
4. Previous history (e.g., other Stressors)
5. Orcadian and other rhythms
B. Stressor
1. Nature of the Stressor (e.g., physical versus psychosocial)
2. Duration of exposure
3. Intensity of Stressor
4. Timing of Stressor administration in relation to immune challenge
C. Immune measure
1. Choice of antigen and concentration of antigen
2. Lymphoid compartment examined
3. In vitro versus in vivo immunological assay
4. Type of immune response measured (e.g., humoral versus cell-
mediated)
1 ■ Stress-Induced Modulation of Immune Function in Mice 3
Fisher, &c Levine, 1987) or opioids (Shavit, Lewis, Terman, Gale, &C Lie
beskind, 1984; Shavit, 1991), altered levels of these glucocorticoids and/or
opioids have not been found in all studies that report effects of Stressors on
immune responses (Cunnick, Lysle, Armfield, & Rabin, 1988; Ben-Eliyahu,
Yirmiya, Shavit, &c Liebeskind, 1990; Rabin, Cunnick, & Lysle, 1990;
Moynihan & Cohen, 1992; Ader & Cohen, 1993). Further, at least 17
neuroendocrine peptides have immunomodulatory potential (Khansari,
Murgo, &c Faith, 1990), and many of these hormones or peptides are al
tered by Stressors. Finally, hypothalamic hormones such as corticotropin-
releasing hormone (CRH) may exert immunomodulatory effects via both
the pituitary-adrenal axis (Munck &c Guyre, 1991) and the sympathetic and
parasympathetic nervous system release of norepinephrine and other cate-
cholamines (Sundar, Cierpial, Kilts, Ritchie, &c Weiss, 1990; Irwin, Hauger,
Jones, Provencio, & Britton, 1990; Irwin, Vale, & Rivier, 1990). Thus,
multiple neuroendocrine pathways are undoubtedly involved in stress-
induced alteration of immune function.
Although it is critical to study stress-induced neurochemical changes
from the perspective of the immunologist it is also necessary to understand
what events in the immune cascade that are triggered by antigen or patho
gen are changed as a consequence of the stress response. Experimental
mechanistic approaches from this perspective are based on the awareness
that the immune system has levels of complexity that rival those of the
nervous system. This chapter will discuss our recent findings using Stressors
to alter antigen-driven events that lead to cellular and humoral immune
responses; illustrate some of the interactions between the variables listed in
Table 1; and highlight some of the possible immunological mechanisms
involved in stress-induced changes in immune function.
Early stress studies often used a simple, yet effective, method of psycho-
social stimulation, that is, picking up and holding an animal for a short
period. Many of these studies examined the effects of handling neonatal rats
or mice (Solomon, Levine, &c Kraft, 1968; Friedman, Glasgow, &c Ader,
1970; LaBarba, 1970; Michaut, Dechambre, Doumerc, Lesourd, Deville-
chabrolle, & Moulias, 1981; Lown &c Dutka, 1987). However, many stud
ies that have investigated handling of neonatal or adult rodents have not ex
amined immune function per se, but, for example have looked at changes in
survival time following tumor or viral challenge (Newton, Bly, & McCrary,
1962; Ader, 1965; Friedman et al., 1970). Our approach has been to study the
effects of repeated daily handling of adult mice on a number of specific and
nonspecific immune effector mechanisms or an antibody response, as well as
a tumor challenge (Moynihan, Brenner, Koota, Breneman, Cohen, &c Ader,
1990; Brenner, Cohen, Ader, &c Moynihan, 1990).
4 Jan A. Moynihan et al.
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Handled Day 5
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150 225
FIGURE 2 In vitro KLH-induced IL-2 production in spleen cell cultures from handled versus
control BALB/c female mice. Mice {n = 6/group/time point) were handled as described earlier,
immunized following handling with 100 μg of KLH, and sacrificed 6, 9, 12, and 15 days
following immunization. Spleen cells were cultured in 96-well plates at 2 X 10 5 cells/well with
80 μg/ml of KLH. Supernatants were removed 24 h later and assayed for IL-2 using the IL-2-
dependent cell line CTLL (Mosmann, Cherwinski, Bond, Giedlin, & Coffman, 1986). Data are
expressed as mean ± SEM.
b.
140- ■■
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FIGURE 3 Pulmonary métastases in handled or unhandled control BALB/c female mice. Mice
(„ = 7-12/group/experiment) were injected intravenously following 2 weeks of handling with
10 5 line 1 cells. Mice were sacrificed 8 to 21 days later (the variability was between, not within,
experiments) and pulmonary métastases were enumerated (Brenner et al., 1990). Four replica
tions are shown (a-d). Data are expressed as mean±SEM.
150-
0)
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c
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en
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-16,-9,-2,+5
Injection period (day)
FIGURE 5 Pulmonary métastases in chemically sympathectomized versus control BALB/c
female mice. Mice (« = 18-20/group) were injected intraperitoneally with either 125 mg/kg
of the neurotoxin 6-hydroxydopamine (6-OHDA) or vehicle at the times indicated. Mice
were injected intravenously with 10 5 line 1 tumor cells on Day 0, sacrificed 14 days later,
and pulmonary métastases were enumerated (Brenner et al., 1992). Data are expressed as
mean ± SEM.
Thus far, this chapter has discussed the effects of physical Stressors on
immune function. In addition to these studies, we have recently focused on a
paradigm that does not involve physical pain or trauma, and is of clear
ethologic relevance to the rodent. The paradigm involves pheromonal stim
ulation of conspecifics. The olfactory system of a rodent is highly developed,
and is critical for communication among these animals (Harrington & Ro
sario, 1992). Other investigators have determined that odors (such as bo
tanical odors) can be immunoregulatory (Shibata, Fujiwara, Iwamoto, Mat-
suoka, & Yokoyama, 1990). Further, there is some evidence that the odors
of predators or of stressed conspecific animals can alter the number of
antibody forming cell to sheep red blood cells (SRBC, Zalcman, Kerr, &
Anisman, 1991). We have tested the hypothesis that odors or pheromones
produced by footshock-stressed mice result in altered immune function in
conspecific odor recipients. We hypothesize that this ethologically relevant
model of stress mimics components of a natural predator-prey situation.
Initially, we examined the responses of BALB/c male mice to odors
10 Jan A. Moynihan et al.
0.4
a.
0.3 H
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e
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m
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e
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Stress odor-exposed
n
< Control odor-exposed
0.0
Con A (ug/ml)
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E:T Ratio
FIGURE 6 (a) IL-2 production by spleen cells from stress versus control odor-exposed
BALB/c male mice. Mean (±SEM) absorbance for IL-2 produced by Con A-stimulated (0.3-5
μg/ml) spleen cells obtained from control odor-exposed (n = 12) and footshock stress odor-
exposed (n = 12) mice following a 24 h odor exposure (Coclee et al., 1993). IL-2 was assayed
using the CTLL bioassay. (b) NK cell cytotoxicity of spleen cells from odor-exposed mice.
Varying numbers of spleen cells from either stress odor-exposed (n = 12) or control odor-
exposed (n = 12) mice were incubated with YAC-1 lymphoma cells in a standard 6-h 51Cr-
release assay. Data are expressed as mean ± SEM.