Maternal immune activation increases the corticosterone response to acute stress without affecting the hypothalamic monoamine content and sleep patterns in male mice offspring

Background/Aims: Early life experiences are homeostatic determinants for adult organisms. We evaluated the impact of prenatal immune activation during late gestation on the neuroimmune-endocrine function of adult offspring and its interaction with acute stress. Methods: Pregnant Swiss mice received saline or lipopolysaccharide (LPS) on gestational day 17. Adult male offspring were assigned to the control or restraint stress condition. We analyzed plasmatic corticosterone and catecholamine levels, the monoamine content in the hypothalamus, striatum and frontal cortex, and the sleep-wake cycle before and after acute restraint stress. Results and Conclusion: Offspring from LPS-treated dams had increased baseline norepinephrine levels and potentiated corticosterone secretion after the acute stressor, and no effect was observed on hypothalamic monoamine content or sleep behavior. The offspring of immune-activated dams exhibited impairments in stress-induced serotonergic and dopaminergic alterations in the striatum and frontal cortex. The data demonstrate a distinction between the plasmatic levels of corticosterone in response to acute stress and the hypothalamic monoamine content and sleep patterns. We provide new evidence regarding the influence of immune activation during late gestation on the neuroendocrine homeostasis of offspring.

Proline dehydrogenase regulates redox state and respiratory metabolism in Trypanosoma Cruzi

Over the past three decades, L-proline has become recognized as an important metabolite for trypanosomatids. It is involved in a number of key processes, including energy metabolism, resistance to oxidative and nutritional stress and osmoregulation. In addition, this amino acid supports critical parasite life cycle processes by acting as an energy source, thus enabling host-cell invasion by the parasite and subsequent parasite differentiation. In this paper, we demonstrate that L-proline is oxidized to Δ(1)-pyrroline-5-carboxylate (P5C) by the enzyme proline dehydrogenase (TcPRODH, E.C. 1.5.99.8) localized in Trypanosoma cruzi mitochondria. When expressed in its active form in Escherichia coli, TcPRODH exhibits a Km of 16.58±1.69 µM and a Vmax of 66±2 nmol/min mg. Furthermore, we demonstrate that TcPRODH is a FAD-dependent dimeric state protein. TcPRODH mRNA and protein expression are strongly upregulated in the intracellular epimastigote, a stage which requires an external supply of proline. In addition, when Saccharomyces cerevisiae null mutants for this gene (PUT1) were complemented with the TcPRODH gene, diminished free intracellular proline levels and an enhanced sensitivity to oxidative stress in comparison to the null mutant were observed, supporting the hypothesis that free proline accumulation constitutes a defense against oxidative imbalance. Finally, we show that proline oxidation increases cytochrome c oxidase activity in mitochondrial vesicles. Overall, these results demonstrate that TcPRODH is involved in proline-dependant cytoprotection during periods of oxidative imbalance and also shed light on the participation of proline in energy metabolism, which drives critical processes of the T. cruzi life cycle.

Salute e sicurezza sul lavoro: significati e problemi della valutazione dei rischi da stress lavoro-correlato nelle aziende sanitarie

Work environment changes bring new risks, in particular an increase in certain diseases and illnesses caused by stress. The European Agreement of October 2004 defines stress as “a state accompanied by physical, psychological or social dysfunctions, due to the fact that people do not feel able to overcome the gap in relation to requests or expectations for them”. A new strategy aims to reduce accidents and occupational illnesses through a series of actions at European level. The approaches to prevent work related stress must specifically aim to face up organizational and social aspects, to provide training to managers and employees on management of stress, to reduce the impact and to develop suitable systems for rehabilitation and return to work for those who suffered health problems. The enterprises will have to carry out the obligations laid down by legislation, adopting detection systems customised on their size and on their specific interests. Currently manifold tools and methodologies are proposed from different subjects as employer associations, advisors for safety, psychologists etc., but none of these has been identified as a model to follow. After the reconstruction of the theoretical framework where the theme is placed in, the thesis, through a background analysis done by collecting the comments of experts who are involved in the management of occupational safety and the examination of a concrete assessment of work-related stress risk, carried out at a local health authority of Emilia-Romagna region, aims to highlight the main sociological implications related to the emergence of these new risks.

Analisi spazio-temporale degli effetti di stress di origine antropica sull’ecosistema intertidale di spiagge sabbiose nell’alto Adriatico

Il presente lavoro di tesi si inserisce all’interno del progetto Europeo Theseus (Innovative technologies for European coasts in a changing climate), volto a fornire una metodologia integrata per la pianificazione sostenibile di strategie di difesa per la gestione dell’erosione costiera e delle inondazioni che tengano in conto non solo gli aspetti tecnici ma anche quelli sociali, economici e ambientali/ecologici. L'area oggetto di studio di questo elaborato di tesi è la zona costiera della Regione Emilia Romagna, costituita unicamente da spiagge sabbiose. In particolare si è focalizzata l’attenzione sulla zona intertidale, in quanto, essendo l’ambiente di transizione tra l’ambiente marino e quello terrestre può fornire indicazioni su fenomeni erosivi di una spiaggia e cambiamenti del livello del mare, unitamente alla risposta agli interventi antropici. Gli obiettivi della tesi sono sostanzialmente tre: un primo obiettivo è confrontare ecosistemi di spiagge dove sono presenti strutture di difesa costiera rispetto a spiagge che ne erano invece prive. Il secondo obiettivo è valutare l’impatto provocato sugli ecosistemi di spiaggia dall’attività stagionale del “bulldozing” e in ultimo proporre un sistema esperto di nuova concezione in grado di prevedere statisticamente la risposta delle comunità bentoniche a diversi tipi di interventi antropici. A tal fine è stato pianificato un disegno di campionamento dove sono stati indagati tre siti differenti per morfologia e impatto antropico: Cesenatico (barriere e pratica bulldozing), Cervia, dissipativa e non soggetta a erosione (assenza di barriere e ma con pratica del bulldozing) e Lido di Dante, tendenzialmente soggetta a erosione (senza barriere e senza pratica del bulldozing). Il campionamento è stato effettuato in 4 tempi (due prima del “bulldozing” e due dopo) nell’arco di 2 anni. In ciascun sito e tempo sono stati campionati 3 transetti perpendicolari alla linea di costa, e per ogni transetto sono stati individuati tre punti relativi ad alta, media e bassa marea. Per ogni variabile considerata sono stati prelevati totale di 216 campioni. Io personalmente ho analizzato i campioni dell’ultima campagna di campionamento, ma ho analizzato l’insieme dei dati. Sono state considerate variabili relative ai popolamenti macrobentonici quali dati di abbondanza, numero di taxa e indice di diversità di Shannon e alcune variabili abiotiche descrittive delle caratteristiche morfologiche dell’area intertidale quali granulometria (mediana, classazione e asimmetria), detrito conchigliare, contenuto di materia organica (TOM), pendenza e lunghezza della zona intertidale, esposizione delle spiagge e indici morfodinamici. L'elaborazione dei dati è stata effettuata mediante tecniche di analisi univariate e multivariate sia sui dati biotici che sulle variabili ambientali, “descrittori dell’habitat”, allo scopo di mettere in luce le interazioni tra le variabili ambientali e le dinamiche dei popolamenti macrobentonici. L’insieme dei risultati delle analisi univariate e multivariate sia dei descrittori ambientali che di quelli biotici, hanno evidenziato, come la risposta delle variabili considerate sia complessa e non lineare. Nonostante non sia stato possibile evidenziare chiari pattern di interazione fra “protezione” e “bulldozing”, sono comunque emerse delle chiare differenze fra i tre siti indagati sia per quanto riguarda le variabili “descrittori dell’habitat” che quelle relative alla struttura dei popolamenti. In risposta a quanto richiesto in contesto water framework directive e in maniera funzionale all’elevate complessità del sistema intertidale è stato proposto un sistema esperto basato su approccio congiunto fuzzy bayesiano (già utilizzato con altre modalità all’interno del progetto Theseus). Con il sistema esperto prodotto, si è deciso di simulare nel sito di Cesenatico due ripascimenti virtuali uno caratterizzato da una gralometria fine e da uno con una granulometria più grossolana rispetto a quella osservata a Cesenatico. Il sistema fuzzy naïve Bayes, nonostante al momento sia ancora in fase di messa a punto, si è dimostrato in grado di gestire l'elevato numero di interazioni ambientali che caratterizzano la risposta della componente biologica macrobentonica nell'habitat intertidale delle spiagge sabbiose.

Integrazione di misure NMR e microscopiche per la descrizione quantitativa degli effetti di stress esterni su colture cellulari

La tesi si occupa dell’integrazione di misure NMR e microscopiche per la descrizione quantitativa degli effetti di stress esterni su colture cellulari. Una maggiore comprensione dei dati ricavati tramite NMR potrebbe consentire di interpretare la vitalità e funzionalità cellulare attraverso la localizzazione spaziale degli idrogeni. L'ipotesi di partenza è che la compartimentazione degli idrogeni (associati a molecole di acqua) nel citoplasma possa fornire una stima del numero di cellule vitali (e quindi in grado di mantenere l'acqua al proprio interno mediante processi attivi). I risultati NMR, prodotti dal gruppo di ricerca del Dipartimento di Fisica e Astronomia dell’Università di Bologna della Prof.ssa Fantazzini, sono stati comparati con le informazioni acquisite dal candidato tramite metodologie di conteggio cellulare (sia vive che morte) presenti in un campione sottoposto a forte e prolungato stress (assenza di terreno di coltura e di bilanciamento del sistema tampone tramite CO2 per 400 ore). Cellule da una linea di glioblastoma multiforme (T98G) mantenute in condizioni di coltura standard sono state preparate secondo lo stesso protocollo per entrambe le tecniche di indagine, e monitorate per intervalli di tempo paragonabili. Le immagini delle cellule ottenute al microscopio ottico in modalità “contrasto di fase” sono state acquisite e utilizzate per l’analisi. Una volta definito un metodo di conteggio sperimentale, è stato possibile dedurre il comportamento delle concentrazioni di cellule sopravvissute in funzione del tempo di campionamento. Da una serie ripetuta di esperimenti è stato caratterizzato un andamento nel tempo di tipo esponenziale decrescente per il numero di cellule vive, permettendo la stima della costante di decadimento in buon accordo tra i vari esperimenti. Un analogo modello esponenziale è stato utilizzato per la descrizione dell'aumento del numero di cellule morte. In questo caso, la difficoltà nell'individuare cellule morte integre (per la frammentazione delle membrane cellulari dopo la morte) ha contribuito a determinare una sistematica sottostima nei conteggi. Il confronto dei risultati NMR e microscopici indica che la diminuzione del numero di cellule vive corrisponde ad una analoga diminuzione degli H1 compartimentalizzati fino ad un tempo specifico di circa 50-60 ore in tutti gli esperimenti. Oltre questo tempo, i dati di NMR mostrano invece un incremento di H1 compartimentalizzati, quando invece il numero di cellule vive continua a diminuire in modo monotono. Per interpretare i risultati ottenuti, è stato quindi ipotizzato che, a partire da cellule morte frammentate, strutture micellari e liposomiali formate dai lipidi di membrana in soluzione possano intrappolare gli H1 liberi, aumentando il segnale di risposta della componente compartimentalizzata come evidenziato in NMR.

Stress abiotici e trattamenti ultra-diluiti: effetti fisiologici e molecolari sulla crescita in vitro di frumento

Gli stress abiotici determinando modificazioni a livello fisiologico, biochimico e molecolare delle piante, costituiscono una delle principali limitazioni per la produzione agricola mondiale. Nel 2007 la FAO ha stimato come solamente il 3,5% della superficie mondiale non sia sottoposta a stress abiotici. Il modello agro-industriale degli ultimi cinquant'anni, oltre ad avere contribuito allo sviluppo economico dell'Europa, è stato anche causa di inquinamento di acqua, aria e suolo, mediante uno sfruttamento indiscriminato delle risorse naturali. L'arsenico in particolare, naturalmente presente nell'ambiente e rilasciato dalle attività antropiche, desta particolare preoccupazione a causa dell'ampia distribuzione come contaminante ambientale e per gli effetti di fitotossicità provocati. In tale contesto, la diffusione di sistemi agricoli a basso impatto rappresenta una importante risorsa per rispondere all'emergenza del cambiamento climatico che negli anni a venire sottoporrà una superficie agricola sempre maggiore a stress di natura abiotica. Nello studio condotto è stato utilizzato uno stabile modello di crescita in vitro per valutare l'efficacia di preparati ultra diluiti (PUD), che non contenendo molecole chimiche di sintesi ben si adattano a sistemi agricoli sostenibili, su semi di frumento preventivamente sottoposti a stress sub-letale da arsenico. Sono state quindi condotte valutazioni sia a livello morfometrico (germinazione, lunghezza di germogli e radici) che molecolare (espressione genica valutata mediante analisi microarray, con validazione tramite Real-Time PCR) arricchendo la letteratura esistente di interessanti risultati. In particolare è stato osservato come lo stress da arsenico, determini una minore vigoria di coleptile e radici e a livello molecolare induca l'attivazione di pathways metabolici per proteggere e difendere le cellule vegetali dai danni derivanti dallo stress; mentre il PUD in esame (As 45x), nel sistema stressato ha indotto un recupero nella vigoria di germoglio e radici e livelli di espressione genica simili a quelli riscontrati nel controllo suggerendo un effetto "riequilibrante" del metabolismo vegetale.

Na +-coupled betaine symporters involved in osmotic stress response in prokaryotes and eukaryotes

The betaine/GABA transporter BGT1 is one of the most important osmolyte transporters in the kidney. BGT1 is a member of the neurotransmitter sodium symporter (NSS) family, facilitates Na+/Cl--coupled betaine uptake to cope with hyperosmotic stress. Betaine transport in kidney cells is upregulated under hypertonic conditions by a yet unknown mechanism when increasing amounts of intracellular BGT1 are inserted into the plasma membrane. Re-establishing isotonicity results in ensuing depletion of BGT1 from the membrane. BGT1 phosphorylation on serines and threonines might be a regulation mechanism. In the present study, four potential PKC phosphorylation sites were mutated to alanines and the responses to PKC activators, phorbol 12-myristate acetate (PMA) and dioctanoyl-sn-glycerol (DOG) were determined. GABA-sensitive currents were diminished after 30 min preincubation with these PKC activators. Staurosporine blocked the response to DOG. Three mutants evoked normal GABA-sensitive currents but currents in oocytes expressing the mutant T40A were greatly diminished. [3H]GABA uptake was also determined in HEK-293 cells expressing EGFP-tagged BGT1 with the same mutations. Three mutants showed normal upregulation of GABA uptake after hypertonic stress, and downregulation by PMA was normal compared to EGFP-BGT1. In contrast, GABA uptake by the T40A mutant showed no response to hypertonicity or PMA. Confocal microscopy of the EGFP-BGT1 mutants expressed in MDCK cells, grown on glass or filters, revealed that T40A was present in the cytoplasm after 24 h hypertonic stress while the other mutants and EGFP-BGT1 were predominantely present in the plasma membrane. All four mutants co-migrated with EGFP-BGT1 on Western blots suggesting they are full-length proteins. In conclusion, T235, S428, and S564 are not involved in downregulation of BGT1 due to phosphorylation by PKC. However, T40 near the N-terminus may be part of a hot spot important for normal trafficking or insertion of BGT1 into the plasma membrane. Additionally, a link between substrate transport regulation, insertion of BGT1 into the plasma membrane and N-glycosylation in the extracellular loop 2 (EL2) could be revealed. The functional importance of two predicted N-glycosylation sites, which are conserved in EL2 within the NSS family were investigated for trafficking, transport and regulated plasma membrane insertion by immunogold-labelling, electron microscopy, mutagenesis, two-electrode voltage clamp measurements in Xenopus laevis oocytes and uptake of radioactive-labelled substrate into MDCK cells. Trafficking and plasma membrane insertion of BGT1 was clearly promoted by proper N-glycosylation in both, oocytes and MDCK cells. De-glycosylation with PNGase F or tunicamycin led to a decrease in substrate affinity and transport rate. Mutagenesis studies revealed that in BGT1 N183 is the major N-glycosylation site responsible for full protein activity. Replacement of N183 with aspartate resulted in a mutant, which was not able to bind N-glycans suggesting that N171 is a non-glycosylated site in BGT1. N183D exhibited close to WT transport properties in oocytes. Surprisingly, in MDCK cells plasma membrane insertion of the N183D mutant was no longer regulated by osmotic stress indicating unambiguously that association with N-glycans at this position is linked to osmotic stress-induced transport regulation in BGT1. The molecular transport mechanism of BGT1 remains largely unknown in the absence of a crystal structure. Therefore investigating the structure-function relationship of BGT1 by a combination of structural biology (2D and 3D crystallization) and membrane protein biochemistry (cell culture, substrate transport by radioactive labeled GABA uptake into cells and proteoliposomes) was the aim of this work. While the functional assays are well established, structure determination of eukaryotic membrane transporters is still a challenge. Therefore, a suitable heterologous expression system could be defined, starting with cloning and overexpression of an optimized gene. The achieved expression levels in P. pastoris were high enough to proceed with isolation of BGT1. Furthermore, purification protocols could be established and resulted in pure protein, which could even be reconstituted in an active form. The quality and homogeneity of the protein allowed already 2D and 3D crystallization, in which initial crystals could be obtained. Interestingly, the striking structural similarity of BGT1 to the bacterial betaine transporter BetP, which became a paradigm for osmoregulated betaine transport, provided information on substrate coordination in BGT1. The structure of a BetP mutant that showed activity for GABA was solved to 3.2Å in complex with GABA in an inward facing open state. This structure shed some light into the molecular transport mechanisms in BGT1 and might help in future to design conformationally locked BGT1 to enforce the on-going structure determination.

Espressione di geni correlati allo stress ossidativo nell'ascidia coloniale Botryllus schlosseri esposta a diverse condizioni ambientali nella Laguna di Venezia

I pattern di espressione genica permettono di valutare se gli organismi siano soggetti a stress ambientali, spesso associati a stress ossidativo e produzione di specie reattive dell’ossigeno, che possono essere analizzate per studiare gli effetti sub-letali indotti dall’ambiente negli organismi. Scopo di questa ricerca è stato valutare la possibilità di utilizzo dell’ascidia coloniale B. schlosseri come biomarker in ambiente lagunare. Le colonie, esposte a diverse condizioni ambientali nella Laguna di Venezia, sono state confrontate con esemplari allevati in condizioni di controllo. La ricerca si è concentrata in 2 siti con diverso grado di idrodinamicità e impatto antropico. Mentre nel sito 1, più vicino alla bocca di porto, si è rilevata la presenza di Tunicati, il sito 2 ne è privo. Il sito 2 ha registrato valori di pH e temperatura più alti. Inoltre, nel sito 2 è stata rilevata una mortalità maggiore delle colonie e alterazioni della morfologia nelle colonie sopravvissute. Ciò suggerisce che il sito 2 presenti condizioni avverse per B. schlosseri. Sui campioni di B. schlosseri sono state eseguite PCR semiquantitative per analizzare l’espressione di un gruppo di geni coinvolto nella risposta allo stress ossidativo: la glutammato cistein ligasi la glutatione sintetasi, 2 isoforme di glutatione perossidasi e la superossido dismutasi (SOD). Tutti i geni presentano livelli di trascrizione doppi nelle colonie del sito 1 rispetto al controllo. Viceversa, il sito 2 mostra livelli di espressione di poco superiori al controllo. Analisi spettrofotometriche evidenziano che le attività enzimatiche di SOD e catalasi sono più alte nel sito 2 rispetto al sito 1. Si può pertanto ipotizzare che le colonie esposte al sito 2 siano soggette a un maggiore stress. B. schlosseri appare dunque un buon indicatore dello stato ecologico dell’ambiente lagunare, entro parametri di pH e temperatura in cui abitualmente vive.

Stress hormones in patients with posttraumatic stress disorder caused by myocardial infarction and role of comorbid depression

Chronic posttraumatic stress disorder (PTSD) has been associated with perturbed hypothalamic-pituitary-adrenal (HPA) axis function and a hyperadrenergic state. We hypothesized that patients with PTSD attributable to myocardial infarction (MI) would show peripheral hypocortisolemia and increased norepinephrine levels, whereby taking into account that depressive symptoms would affect this relationship.

Psychosocial stress and cardiovascular risk : current opinion

Cardiovascular disease (CVD) is a major cause of morbidity and mortality worldwide. Epidemiologic research of the last half-century has clearly shown that psychosocial factors related to the social environment, personality characteristics, and negative affect increase the risk of incident CVD and also impact prognosis of cardiac patients. Several mechanisms may explain this link, including a genetic predisposition, poor lifestyle choices, low adherence to health recommendations, and direct pathophysiologic perturbations. The latter include alteration of the hypothalamic-pituitary adrenal axis and autonomic dysfunction resulting in endothelial dysfunction, inflammation, and a prothrombotic state further downstream. Screening for psychosocial factors seems appropriate as part of the standard history and based on the clinician's knowledge of the patient and the purpose of the visit. Psychological interventions generally alleviate distress in cardiac patients, but whether they reduce the risk of hard cardiovascular endpoints and all-cause mortality is less evident. Cardiac patients with more severe depression may particularly profit from antidepressant medications. Due to their pharmacologic properties, selective serotonin reuptake inhibitors were shown to improve cardiovascular outcome. The most effective psychosocial treatment is multicomponent therapy that combines elements of cognitive behaviour therapy ("stress management") and changes in health behaviours, including the adoption of a regular exercise regimen. Gender-specific issues should probably be considered. The field of behavioural cardiology has accumulated a wealth of epidemiological, mechanistic and clinical knowledge that undoubtedly has furthered our understanding about the important role of psychosocial risk factors in patients with a heart disease.

Color variation in museum specimens of birds: effects of stress, pigmentation, and duration of storage

Animal coloration often serves as a signal to others that may communicate traits about the individual such as toxicity, status, or quality. Colorful ornaments in many animals are often honest signals of quality assessed by mates, and different colors may beproduced by different biochemical pigments. Investigations of the mechanisms responsible for variation in color expression among birds are best when including a geographically and temporally broad sample. In order to obtain such a sample, studies such as this often use museum specimens; however, in order for museum specimens toserve as an accurate replacement, they must accurately represent living birds, or we must understand the ways in which they differ. In this thesis, I investigated the link between feather corticosterone, a hormone secreted in response to stress, and carotenoid-basedcoloration in the Red-winged Blackbird (Agelaius phoeniceus) in order to explore a mechanistic link between physiological state and color expression. Male Red-winged Blackbirds with lower feather corticosterone had significantly brighter red epaulets than birds with higher feather corticosterone, while I found no significant changes in red chroma. I also performed a methodological comparison of color change in museum specimens among different pigment types (carotenoid and psittacofulvin) and pigments in different locations in the body (feather and bill carotenoids) in order to quantify colorchange over time. Carotenoids and psittacofulvins showed significant reductions in red brightness and chroma over time in the collection, and carotenoid color changed significantly faster than psittacofulvin color. Both bill and feather carotenoids showed significant reductions in red brightness and red chroma over time, but change of both red chroma and red brightness occurred at a similar rate in feathers and bills. In order to use museum specimens of ecological research on bird coloration specimen age must be accounted for before the data can be used; however, once this is accomplished, museum- based color data may be used to draw conclusions about wild populations.

Effect of the Various Degrees of Stress on Childrens Art Expression Through Drawings

One of the aims of this project was to understand the way in which external environment or situation affects children's behaviour. Emotional experiences are developed and acquired under the influence of the environment, and a good family relationship is necessary for young people to grow, develop and socialise at all ages. Stress causes specific negative emotions, including concern, anxiety, sorrow and hostility. A pathologic environment in childhood forces the development of special abilities, both creative and destructive, It supports the development of an abnormal state of mind in which the usual relations between body and mind, reality and imagination, knowledge and memory are changed. Here the environment considered was that of the war and aggression in Bosnia & Herzegovina, where children, particularly those from Podrinje, witnessed arrests, killing, deforming and slaughtering of adults and children, in many cases members of their immediate families. Sehovic analysed the content of drawings by children exposed to various degrees of stress, to discover how these indicate various degrees of stress with the aim of using these as a projective technique in diagnostic work with children. The sample included around 600 children expelled from their homes, of both sexes aged between 6 and 12.

Evidence for low-grade systemic proinflammatory activity in patients with posttraumatic stress disorder

Posttraumatic stress disorder (PTSD) may increase cardiovascular risk but the psychophysiological mechanisms involved are elusive. We hypothesized that proinflammatory activity is elevated in patients with PTSD as diagnosed by the Clinician Administered PTSD Scale (CAPS) interview. Plasma levels of proinflammatory C-reactive protein (CRP), interleukin (IL)-1beta, IL-6, and tumor necrosis factor (TNF)-alpha, and of anti-inflammatory IL-4 and IL-10 were measured in 14 otherwise healthy PTSD patients and in 14 age- and gender-matched healthy non-PTSD controls. Levels of TNF-alpha (p=0.038; effect size Cohen's d=0.58) and of IL-1beta (p=0.075, d=0.68) were higher in patients than in controls. CRP (d=0.10), IL-6 (d=0.18), IL-4 (d=0.42), and IL-10 (d=0.37) were not significantly different between groups. Controlling for traditional cardiovascular risk factors, mood, and time since trauma revealed lower IL-4 in patients than in controls (p=0.029) and rendered group differences in TNF-alpha and IL-1beta insignificant. In all subjects, TNF-alpha correlated with total (frequency and intensity) PTSD symptom cluster of re-experiencing (r=0.49, p=0.008), avoidance (r=0.37, p=0.050), and hyperarousal (r=0.42, p=0.026), and with PTSD total symptom score (r=0.37, p=0.054). Controlling for time since trauma attenuated these associations. The correlation between IL-1beta and total avoidance symptoms (r=0.42, p=0.028) became insignificant when controlling for anxiety and depression. IL-4 correlated with total hyperarousal symptoms (r=-0.38, p=0.047), and after controlling for systolic blood pressure and smoking status, with PTSD total symptom score (r=-0.41, p=0.035). PTSD patients showed a low-grade systemic proinflammatory state, which, moreover, was related to PTSD symptom levels suggesting one mechanism by which PTSD could contribute to atherosclerotic disease.

Altered blood coagulation in patients with posttraumatic stress disorder

OBJECTIVE: Posttraumatic stress disorder (PTSD) has been associated with an increased cardiovascular risk, though the pathophysiologic mechanisms involved are elusive. A hypercoagulable state before occurrence of coronary thrombosis contributes to atherosclerosis development. We investigated whether PTSD would be associated with increased coagulation activity. METHODS: We measured resting plasma levels of clotting factor VII activity (FVII:C), FVIII:C, FXII:C, fibrinogen, and D-dimer in 14 otherwise healthy patients with PTSD and in 14 age- and gender-matched, trauma-exposed non-PTSD controls. Categorical and dimensional diagnoses of PTSD were made using the Clinician-Administered PTSD Scale (CAPS) interview. We also investigated to what extent the relationship between PTSD and coagulation measures would be confounded by demographics, cardiovascular risk factors, lifestyle variables, time since trauma, and mood. RESULTS: Coagulation factor levels did not significantly differ between patients with a categorical diagnosis of PTSD and controls while controlling for covariates. In all subjects, FVIII:C was predicted by hyperarousal severity (beta = 0.46, p = .014) independent of covariates and by overall PTSD symptom severity (beta = 0.38, p = .045); the latter association was of borderline significance when separately controlling for gender, smoking, exercise, and anxiety (p values <.07). In patients, fibrinogen was predicted by hyperarousal severity (beta = 0.70, p = .005) and by overall PTSD symptom severity (beta = 0.61, p = .020), with mood partially affecting these associations. FVII:C, fibrinogen, and D-dimer showed no independent association with PTSD symptoms. CONCLUSIONS: PTSD may elicit hypercoagulability, even at subthreshold levels, offering one psychobiological pathway by which posttraumatic stress might contribute to atherosclerosis progression and clinical cardiovascular disease.

Myocardial infarction and post-traumatic stress disorder: frequency, outcome, and atherosclerotic mechanisms

BACKGROUND: Post-traumatic stress disorder (PTSD) may develop in the aftermath of an acute myocardial infarction (MI). Whether PTSD is a risk factor for cardiovascular disease (CVD) is elusive. The biological mechanisms linking PTSD with atherosclerosis are unclear. DESIGN: A critical review of 31 studies in the English language pursuing three aims: (i) to estimate the prevalence of PTSD in post-MI patients; (ii) to investigate the association of PTSD with cardiovascular endpoints; and (iii) to search for low-grade systemic inflammatory changes in PTSD pertinent to atherosclerosis. METHODS: We located studies by PubMed electronic library search and through checking the bibliographies of these sources. RESULTS: The weighted prevalence of PTSD after MI was 14.7% (range 0-25%; a total of 13 studies and 827 post-MI patients). Two studies reported a prospective association between PTSD and an increased risk of cardiovascular readmission in post-MI patients and of cardiovascular mortality in combat veterans, respectively. In a total of 11 studies, patients with PTSD had increased rates of physician-rated and self-reported cardiovascular diseases. Various cytokines and C-reactive protein were investigated in a total of seven studies suggesting that PTSD confers a pro-inflammatory state. CONCLUSIONS: Increasing evidence suggests that PTSD specifically related to MI develops considerably frequently in post-MI patients. More research is needed in larger cohorts applying a population design to substantiate findings suggesting PTSD is an atherogenic risk factor and to understand better the suspected behavioural and biological mechanisms involved.