Quercitin as effective as resveratrol for inflammation with diabetes and obesity

Posted on October 27, 2010 by Dr. Jonathan

There has been a lot of interesting science, some of it reported here, documenting the benefits of resveratrol for factors contributing to inflammation, insulin resistance, obesity, diabetes and longevity. A paper just published in the American Journal of Clinical Nutrition offers evidence that the valuable phenolic compound quercitin may be even more effective than resveratrol for reducing the inflammation associated with insulin resistance and diabetes. The authors state:

“Quercetin and trans-resveratrol (trans-RSV) are plant polyphenols reported to reduce inflammation or insulin resistance associated with obesity. Recently, we showed that grape powder extract, which contains quercetin and trans-RSV, attenuates markers of inflammation in human adipocytes and macrophages and insulin resistance in human adipocytes…The aim of this study was to examine the extent to which quercetin and trans-RSV prevented inflammation or insulin resistance in primary cultures of human adipocytes [fat cells] treated with tumor necrosis factor-{alpha} (TNF-{alpha})—an inflammatory cytokine elevated in the plasma and adipose tissue of obese, diabetic individuals.”

They stimulated fat cells with TNF-{alpha} to promote inflammation after pretreatment with quercetin and trans-RSV, then measured gene and protein markers of inflammation and insulin resistance. What did the data show?

Quercetin, and to a lesser extent trans-RSV, attenuated the TNF-{alpha}–induced expression of inflammatory genes such as interleukin (IL)-6, IL-1β, IL-8, and monocyte chemoattractant protein-1 (MCP-1) and the secretion of IL-6, IL-8, and MCP-1… Quercetin, but not trans-RSV, decreased TNF-{alpha}–induced nuclear factor-{kappa}B transcriptional activity. Quercetin and trans-RSV attenuated the TNF-{alpha}–mediated suppression of peroxisome proliferator–activated receptor {gamma} (PPAR{gamma}) and PPAR{gamma} target genes and of PPAR{gamma} protein concentrations and transcriptional activity….”

Quercitin is known to be helpful for gut inflammation associated with food allergies, and I have found it to be a surprisingly helpful palliative for airborne allergies. In light of this the authors’ conclusion is not a surprise:

“These data suggest that quercetin is equally ormore effective than trans-RSV in attenuating TNF- ${alpha}$ –mediatedinflammation and insulin resistance in primary human adipocytes.”

The role of autoimmunity and brain inflammation in disorders of learning, behavior and autism

Posted on September 4, 2010 by Dr. Jonathan

There is a large and growing body of evidence for the role of brain inflammation due to immune dysregulation in disorders of learning, behavior and autism. A study recently published in the journal Biological Psychiatry shows how the microglia (immune cells in the brain) are activated and increased in the prefrontal cortex in autism:

“In the neurodevelopmental disorder autism, several neuroimmune abnormalities have been reported. However, it is unknown whether microglial somal volume or density are altered in the cortex and whether any alteration is associated with age or other potential covariates.”

The authors used advanced immunochemistry and nuclear imaging techniques to compare microglial activation and volume in autistic and normal brains. Their conclusion:

“Given its early presence, microglial activation may play a central role in the pathogenesis of autism in a substantial proportion of patients.”

Autoimmune activity may manifest through a variety of autoantibodies to neural tissues in autistic spectrum disorders, epilepsy, Landau-Kleffner Syndrome (infantile acquired aphasia), etc. An earlier paper in Biological Psychiatry documents abnormal immune markers in the serum in association with these disorders:

“Brain derived neurotrophic factor (BDNF) elevation in newborn sera predicts intellectual/social developmental abnormalities. Other autoantibodies (AAs) to endothelial cells (ECs) and myelin basic protein (MBP) are also elevated in some children. We tested relationships between BDNF, BDNF AAs, and other AAs in children with these disorders.“

The authors measured these immune ‘attack molecules’ in measured in children with autism, childhood disintegrative disorder (CDD), pervasive developmental delay-not otherwise specified (PDD-nos), acquired epilepsy, Landau-Kleffner syndrome (LKS); healthy children (HC), and children with non-neurological illnesses (NNI). The data showed significant elevations. Their conclusion:

“Children with developmental disorders and epilepsy have higher AAs to several neural antigens compared to controls. The presence of both BDNF AAs and elevated BDNF levels in some children with autism and CDD suggests a previously unrecognized interaction between the immune system and BDNF.”

Immune dysregulation can manifest on a spectrum of developmental dysfunction from very mild development and learning disorders to full-blown autism. A recent paper in the same journal presents the evidence for immune dysfunction in healthy siblings of autistic kids:

“Endophenotypes are simple biological aspects of a disease that can be observed in unaffected relatives…an “autism endophenotype” justifies the observation that a mild reduction in ideational fluency and nonverbal generativity might be observed in healthy, unaffected relatives of children with autism…we examined whether the “autism endophenotype” would extend its effects on the immune system.“

The authors tested multiple immune parameters in autistic kids and their siblings in comparison to healthy ‘controls’ without a family history for autism and came to this conclusion:

“Results of this pilot study indicate that a complex immune dysfunction is present both in autistic children and in their non-autistic siblings and show the presence of an “autism endophenotype” that expands its effects on immunologic functions.”

An early paper published in Pediatric Neurology provides evidence of neuroinflammation in the cerebrospinal fluid in autism:

“In order to find evidence for neuroinflammation, we compared levels of sensitive indicators of immune activation: quinolinic acid, neopterin, and biopterin, as well as multiple cytokines and cytokine receptors, in cerebrospinal fluid and serum from children with autism, to control subjects with other neurologic disorders.”

Neopterin and biopterin are easily measured in the urine. What did the data show?

“In cerebrospinal fluid from 12 children with autism, quinolinic acid and neopterin were decreased, and biopterin was elevated, compared with control subjects.”

Subsequent research published in the same journal revealed the role of the pro-inflammatory cytokine tumor necrosis factor-alpha (TNF-α) in cases of autism that became worse:

“Recent reports implicating elevated cytokines in the central nervous system in a small number of patients studied with autism have reported clinical regression.”

The authors’ measurements of TNF-α in the serum and CSF of autistic children resulted in data that painted this picture:

“Elevation of cerebrospinal fluid levels of tumor necrosis factor-alpha was significantly higher than concurrent serum levels in all of the patients studied. The ratio of the cerebrospinal fluid levels to serum levels averaged 53.7:1…This observation may offer a unique insight into central nervous system inflammatory mechanisms that may contribute to the onset of autism and may serve as a potential clinical marker.”

Research just published in the journal Brain, Behavior, and Immunity reports the role of other pro-inflammatory cytokines in worsening cases of autistic spectrum disorder.

“A potential role for immune dysfunction has been suggested in Autism spectrum disorders (ASD). To test this hypothesis, we investigated evidence of differential cytokine release in plasma samples obtained from 2 to 5 year-old children with ASD compared with age-matched typically developing (TD) children and children with developmental disabilities other than autism.”

The data painted an unmistakable and compelling picture:

“Observations indicate significant increases in plasma levels of a number of cytokines, including IL-1β, IL-6, IL-8 and IL-12p40 in the ASD group compared with TD controls. Moreover, when the ASD group was separated based on the onset of symptoms, it was noted that the increased cytokine levels were predominantly in ASD children who had a regressive form of ASD. In addition, increasing cytokine levels were associated with more impaired communication and aberrant behaviors.“

Their conclusion is important for every clinician and parent to bear in mind:

“In conclusion, using larger number of participants than previous studies, we report significantly shifted cytokine profiles in ASD. These findings suggest that ongoing inflammatory responses may be linked to disturbances in behavior and require confirmation in larger replication studies. The characterization of immunological parameters in ASD has important implications for diagnosis, and should be considered when designing therapeutic strategies to treat core symptoms and behavioral impairments of ASD.”

We can also be informed by a fascinating study published in Biological Psychiatry confirming that behavioral abnormalities are associated with autoimmune attack on hormones in the brain and periphery. The authors set out to resolve the biological mechanism involved in aggressive behavior:

“Altered stress response is characteristic for subjects with abnormal aggressive and antisocial behavior…We hypothesized that autoantibodies (autoAbs) directed against several stress-related neurohormones may exist in aggressive subjects.”

Assays for antibodies revealed a definite pattern for both conduct disorder and prisoners groups leading the authors to conclude:

“High levels of ACTH-reactive autoAbs as well as altered levels of oxytocin- and vasopressin-reactive autoAbs found in aggressive subjects may interfere with the neuroendocrine mechanisms of stress and motivated behavior. Our data suggest a new biological mechanism of human aggressive behavior that involves autoAbs directed against several stress-related neurohormones.”

We can also appreciate the evidence presented the Journal of Neuroimmunology that autism is characterized by a deficit in the ability to dampen autoimmune attack on the brain by the cytokine transforming growth factor beta-1 (TGFβ1):

“Autism spectrum disorders (ASD) are characterized by impairment in social interactions, communication deficits, and restricted repetitive interests and behaviors. There is evidence of both immune dysregulation and autoimmune phenomena in autism. We examined the regulatory cytokine transforming growth factor beta-1 (TGFβ1) because of its role in controlling immune responses.”

The authors compared plasma levels of active TGFβ1 were in 75 children with ASD to 68 controls, finding that they were significantly lower in the ASD group. Moreover…

“…there were significant correlations between psychological measures and TGFβ1 levels, such that lower TGFβ1 levels were associated with lower adaptive behaviors and worse behavioral symptoms. The data suggest that immune responses in autism may be inappropriately regulated due to reductions in TGFβ1.”

Their findings likely apply to a range of developmental, learning and behavioral disorders:

“Such immune dysregulation may predispose to the development of possible autoimmune responses and/or adverse neuroimmune interactions during critical windows in development.“

Along these lines, a paper published in Biological Psychiatry describes the impaired immune tolerance due to deficiencies in regulatory T cells, another critical immune regulating factor in children with Tourette Syndrome. The authors state:

“Since regulatory T (T reg) cells play a major role in preventing autoimmunity, we hypothesized that a defect in T reg cells may be present in children with Tourette syndrome (TS).”

They analyzed the peripheral blood of TS kids compared to matched control subjects on multiple occasions to determine the numbers of CD4+CD25+CD69− T reg cells. The results were clear:

“A significant decrease in T reg cells was observed in patients with moderate to severe TS symptoms compared with healthy age-matched control children. A decrease in T reg cell number was also noted during symptom exacerbations in five out of six patients.”

Their conclusion affirms the role of autoimmunity in Tourette syndrome:

“These data support our hypothesis that at least some TS patients may have a decreased capacity to inhibit autoreactive lymphocytes through a deficit in T reg cells. Interactions of host T cell immunity and microbial factors may also contribute to the pathogenesis of TS.”

Early evidence for the role of autoimmunity in autism was presented in the journal Neuroscience Letters. The authors state:

“It is well established that increased neopterin levels are associated with activation of the cellular immune system and that reduced biopterins are essential for neurotransmitter synthesis. It has been suggested that some autistic children may be suffering from an autoimmune disorder.”

They measured these pterins in the urine of pre-school autistic children, their siblings and age-matched control children and found:

“Both urinary neopterin and biopterin were raised in the autistic children compared to controls and the siblings showed intermediate values. This supports the possible involvement of cell-mediated immunity in the aetiology of autism.”

The finding for the non-autistic siblings shows again that brain autoimmunity can manifest on a wide spectrum.

Yet more evidence for autoimmune dysfunction in both kids with autism and their siblings was offered in a study published in the Journal of Neuroimmunology on antibrain antibodies:

“Serum autoantibodies to human brain, identified by ELISA and Western immunoblotting, were evaluated in 29 children with autism spectrum disorder (22 with autistic disorder), 9 non-autistic siblings and 13 controls.”

The authors sum up the abnormalities found by concluding:

“Results suggest that children with autistic disorder and their siblings exhibit differences compared to controls in autoimmune reactivity to specific epitopes located in distinct brain regions.”

No discussion of autoimmunity and the brain would be complete without considering the role of the gut, the site of 60-80% of all the immune system tissue in the body. A paper published in the Journal of Clinical Immunology describes the corresponding autoimmune intestinal inflammation in children with autism.

“A lymphocytic enterocolitis has been reported in a cohort of children with autistic spectrum disorder (ASD) and gastrointestinal (GI) symptoms. This study tested the hypothesis that dysregulated intestinal mucosal immunity with enhanced pro-inflammatory cytokine production is present in these ASD children.”

The authors performed duodenal biopsies and measured CD3+ lymphocytes in the colonic mucosa for the presence of the pro-inflammatory cytokines TNF-α, IL-2, IL-4, IFN-γ and the anti-inflammatory IL-10. Again we see a clear expression of autoimmunity:

“Duodenal and colonic mucosal CD3+ lymphocyte counts were elevated in ASD children compared with noninflamed controls. In the duodenum…epithelial TNF-α+ cells in ASD children [were] significantly greater compared with noninflamed controls but not coeliac disease controls…IL-10+ cells were fewer in ASD children than in noninflamed controls. In the colon,TNF-α+ and CD3+IFN-γ+ were more frequent in ASD children than in noninflamed controls.”

Note the similar findings for ASD and celiac disease. In striking accordance with with the authors found:

“There was a significantly greater proportion of TNF-α+ cells in colonic mucosa in those ASD children who had no dietary exclusion compared with those on a gluten and/or casein free diet. There is a consistent profile of lymphocyte cytokines in the small and large intestinal mucosa of these ASD children, involving increased pro-inflammatory and decreased regulatory activities.”

It would be a shame for any clinician or parent to be unaware of their conclusion:

“The data provide further evidence of a diffuse mucosal immunopathology in some ASD children and the potential for benefit of dietary and immunomodulatory therapies.“

Regarding the link between autoimmune inflammation in the gut and brain it’s important to remember that the classical IgE-mediated food allergy diagnosed by skin prick is not usually the concern. Two papers published the Annals of Allergy, Asthma & Immunology illustrate the point. In IgE and non-IgE food allergy the authors note that:

“Food allergy (FA) is characterized by an abnormal immunologic reactivity to food proteins. The gastro-intestinal tract serves not only a nutritive function but also is a major immunologic organ. Although previously thought to be triggered primarily by an IgE-mediated mechanism of injury, considerable evidence now suggests that non-IgE mechanisms may also be involved in the pathogenesis of FA.”

The authors gathered extensive data on a range of disorders including attention-deficit-hyperactivity disorder and behavioral disorders, and correlated them with immunologic deviations to Th1 or Th2 mechanisms of FA. Their conclusion is crucial knowledge for anyone treating food allergy mediated disorders:

“The results of this review allow the construction of a central, unifying hypothesis for a new classification of FA as follows: the clinical manifestations of FA, expressed in affected target organs, may be the result of immunologic injury mediated by interaction of food antigens with contiguous elements of mucosal associated lymphoid tissue. These appear to be modulated by relative imbalances of the Th1/Th2 paradigm, which may be the ultimate determinant governing the expression of FA as IgE-mediated, non-IgE-mediated, or mixed forms of IgE/non-IgE mechanisms of FA.”

This is critically important because Th1 and Th2 imbalances require different interventions; it also offers a partial explanation of why antibody tests for food allergy are not reliable. The recent post on why autoimmune and allergic diseases are on the rise is of interest in this context. We also see in the same issue of Annals of Allergy, Asthma & Immunology a paper on the link between non-IgE-mediated food allergies and the inflamed lymphoid intestinal tissue that was described above in the report on mucosal immune activation and autism. Here the authors conclude:

“These studies suggest that abnormalities in Th1 function may not only play a role in some patients with non—IgE-mediated FA in whom decreased Th1 function is seen, but also in patients with celiac disease in whom an increased Th1 function is seen. The studies also suggest that lymphonodular hyperplasia may be a hallmark histologic lesion in patients with non—IgE-mediated FA.”

What does lymphonodular hyperplasia feel like? Sometimes nothing more than a little bloating. All of this helps us to appreciate the significance of neurologic disorders with gluten sensitivity. This was explored in a paper published in the journal Pediatrics more than six years ago:

“During the past 2 decades, celiac disease (CD) has been recognized as a multisystem autoimmune disorder. A growing body of distinct neurologic conditions such as cerebellar ataxia, epilepsy, myoclonic ataxia, chronic neuropathies, and dementia have been reported, mainly in middle-aged adults. There still are insufficient data on the association of CD with various neurologic disorders in children, adolescents, and young adults, including more common and “soft” neurologic conditions, such as headache, learning disorders, attention-deficit/hyperactivity disorder (ADHD), and tic disorders. The aim of the present study is to look for a broader spectrum of neurologic disorders in CD patients, most of them children or young adults.”

The authors found that kids with CD were far more likely to develop neurologic disorders than the control subjects, including hypotonia, developmental delay, learning disorders and ADHD, headache, and cerebellar ataxia. Thus their conclusion:

“This study suggests that the variability of neurologic disorders that occur in CD is broader than previously reported and includes “softer” and more common neurologic disorders, such as chronic headache, developmental delay, hypotonia, and learning disorders or ADHD.”

Research published in the journal Nutritional Neuroscience clarifies one of the mechanisms behind autoimmune reaction to nervous system antigens in autism:

“We assessed the reactivity of sera from 50 autism patients and 50 healthy controls to specific peptides from gliadin and the cerebellum. A significant percentage of autism patients showed elevations in antibodies against gliadin and cerebellar peptides simultaneously.“

The authors employed detailed antigen-antibody probes with confirmation by sophisticated DOT-immunoblot and inhibition studies to reach their conclusion:

“We conclude that a subgroup of patients with autism produce antibodies against Purkinje cells [a type of brain cell] and gliadin peptides, which may be responsible for some of the neurological symptoms in autism. “

Gliadin is the immunoreactive antigen contained in gluten.

Mention should also be made of the ability of infections to sometimes trigger an autoimmune disorder as discussed in a study published in the Journal of Child Psychology and Psychiatry on PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcus infections).

“…(PANDAS) is a recently recognized syndrome in which pre-adolescent children have abrupt onsets of tics and/or obsessive-compulsive symptoms, a recurring and remitting course of illness temporally related to streptococcal infections, and associated neurologic findings including adventitious movements, hyperactivity and emotional lability.

The authors undertook a search for clinical and laboratory evidence and found consistent clinical findings have been described in a large case series, including magnetic resonance imaging that shows inflammatory changes in the basal ganglia, along with anti-basal ganglia antibodies have been found in some acute cases that were similar to those against streptococcal antigens. They note in their conclusion:

“PANDAS…has stimulated new research endeavors into the possible links between bacterial pathogens, autoimmune reactions, and neuropsychiatric symptoms.”

Changes in gut flora can ‘turn on’ autoimmune genes

Posted on August 6, 2010 by Dr. Jonathan

A fascinating study just published in the journal Cell sheds light on how the genetic susceptibility to autoimmune disease can be activated by changes in gut flora, in this case the interaction of a virus with intestinal bacteria. The authors describe their findings:

“Here we demonstrate that an interaction between a specific virus infection and a mutation in the Crohn’s disease susceptibility gene Atg16L1 induces intestinal pathologies in mice…These pathologies triggered by virus-plus-susceptibility gene interaction were dependent on TNFα and IFNγ [pro-inflammatory cytokines] and were prevented by treatment with broad spectrum antibiotics. Thus, we provide a specific example of how a virus-plus-susceptibility gene interaction can, in combination with additional environmental factors and commensal bacteria, determine the phenotype [functional expression] of hosts carrying common risk alleles [genotype] for inflammatory disease.”

A perspective on this work published in Science Translational Medicine helps us to appreciate the significance of this research:

“…these findings link host genotype and viral infection with a response to chemical challenge, resulting in Crohn’s-like symptoms, a virus–plus–susceptibility gene interaction. However, the story gets even more complicated, because this interaction was shown to depend not only on the host inflammatory cytokines TNF-α and interferon-γ, but also on the gut microbiome…These findings are consistent with other models of IBD that are clearly dependent on the presence of gut bacteria and can be produced in germ-free mice colonized with defined bacterial consortia in the absence of a viral trigger.”

The practical message for the clinician and patient is that genetic susceptibility to an autoimmune disease can be triggered by alterations in the gut flora with compromise of the intestinal barrier (‘leaky gut’):

“These studies suggest that the microbiota is a key component of colitis; in mouse models, colitis develops in the context of abnormal adaptive or innate immune responses that fail to prevent translocation across the epithelial layer and the presentation of gut bacteria to immune cells ['leaky gut'], or result in excess activation of the adaptive immune system [dysregulated immune response].”

As we know, once these genes are ‘turned on’ they can’t be turned off. Autoimmune disease can be managed with the correct functional approach; the term ‘cure’ is not justified:

“A fascinating observation from Cadwell et al. is that susceptibility to colitis induction can be switched from off to on; mice in a colitis-resistant state before infection with the virus become susceptible to injury-induced colitis after viral infection, and, once the colitis-sensitive state is induced, cannot go back to a colitis-resistant state.”

Rational therapy that offers the chance to manage autoimmune disease for a much higher quality of life must address the microflora and their interactions with the human immune system along with other factors that modify the expression of the autoimmune potential:

“All of these diverse findings suggest that it is necessary to take into account multiple facets of the human microbiome when considering complex diseases such as Crohn’s. Polymorphisms in key susceptibility genes in our human genome, such as ATG16L1, may only serve to weaken the first link in the chain that protects the intestinal epithelia from a combination of viral infection, microbial stimulation of inflammation, and other dietary or xenobiotic factors.”

Immunepheresis: a vastly under-utilized cancer therapy that deserves far more attention

Posted on August 2, 2010 by Dr. Jonathan

It has long been known that tumor cells defy destruction by immune cells by producing cytokine ‘decoys’ called soluble TNF-α (tumor necrosis factor-alpha) receptors. TNF-α is a ‘guidance system’ for the immune attack that seeks its receptors on malignant cell membranes. The soluble receptors (TNF-R) shed by tumor cells into their local environment divert the TNF-α by binding them. A paper published sixteen years ago in the British Journal of Cancer documents their presence in breast cancer:

“The expression of tumour necrosis factor alpha (TNF-alpha) and its two distinct receptors, TNF-R p55 and TNF-R p75 [soluble receptors], was…was not detectable in normal breast tissue or in non-malignant breast tissue adjacent to the tumours.”

It was a different story for the tumors examined:

“TNF-R p55 was expressed by a population of stromal cells in all the tumours examined, and a varying proportion of neoplastic cells in 75% of these tissues. TNF-R p75 was detected in about 70% of the tumours…”

It has been known for just as long that the presence of soluble tumour necrosis factor receptors can predict the outcome for a cancer patient. A paper published in The Lancet around the same time references a number of earlier studies on the topic.

A couple years later a similar observation was reported in a paper published in the European Journal of Cancer for melanoma. The authors note:

“It has been recently suggested that soluble tumour necrosis factor receptors (sTNF-Rs) may represent prognostic factors in cancer.”

They proceed to describe increased concentrations of soluble TNF receptors in association with adhesion molecules that also participate in tumor development:

“We report in this study the serum concentrations of sTNF-R1 and sTNF-R2 in 32 patients with primary melanoma and in 21 patients with metastatic melanoma, in correlation with those of soluble ICAM-1 (sICAM-1). Significantly raised sTNF-Rl levels were detected only in patients with metastatic melanoma compared with normal controls, whereas sTNF-R2 levels were increased both in primary and metastatic melanoma…A correlation between sTNF-Rs and sICAM-1 concentrations in patients’ sera was observed in metastatic melanoma. The combined adverse effects of these soluble proteins on normal immune effector functions may contribute to tumour progression.”

These observations were soon followed by research that further confirmed the blockade of anti-tumor immune mechanisms by soluble TNF receptors. A paper published in the journal Immunology also mentions early trials of ultrapheresis (another term for immunepheresis = filtering from the blood of soluble TNF receptor ‘decoys’):

“Soluble tumour necrosis factor receptor type I (sTNFRI) is a potent inhibitor of TNF with the potential to suppress a variety of effector mechanisms important in tumour immunity. That sTNFRI influences tumour survival in vivo is suggested by results from human clinical trials of Ultrapheresis, an experimental extracorporeal treatment for cancer.”

The authors designed their study to resolve definitive proof that sTNFRI specifically blocks immune efforts at tumor removal (full text available here):

“While the considerable clinical benefit provided by Ultrapheresis is correlated with the removal of plasma sTNFRI, there is no direct evidence that sTNFRI inhibits immune mechanisms which mediate tumour cell elimination.”

Their findings proved that soluble TNF receptor (sTNFRI)-secreting tumor cells resisted destruction by TNF:

“These findings confirm the suggestion that sTNFRI inhibits immunological mechanisms important in tumour cell eradication, and further support a role for sTNFRI in tumour survival in vivo. In addition, these observations suggest the development of methods for more specific removal and/or inactivation of sTNFRI as promising new avenues for cancer immunotherapy.”

We have another interesting study published just weeks ago in the journal Clinical Chemistry and Laboratory Medicine that adds more evidence that soluble tumour necrosis factor receptor type I concentrations are a powerful predictor of outcome in breast cancer.

“The aim of this study was to exploit the potential clinical use of circulating cytokine assessment in patients with breast cancer.”

The authors surveyed cytokines in breast cancer patients including interleukin 6 (IL-6), tumour necrosis factor-α (TNFα), interleukin 8 (IL-8), soluble tumour necrosis factor receptor type I (sTNF RI), sTNF RII, interleukin 1 receptor antagonist (IL-1ra), interleukin 10 (IL-10), macrophage colony-stimulating factor, vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF)and followed them for ten years. Their data led them to this conclusion:

“…a significant value of pretreatment serum sTNF RI concentrations, next to stage and oestrogen receptors status, was its utility as an independent prognostic factor of the overall survival in patients with breast cancer… Serum sTNF RI may be considered an additional, independent and clinically useful factor of poor prognosis in patients with breast cancer.”

In other words, the soluble TNF receptors, the worse the breast cancer patient will do. But what about other types of cancer? A research article published in the Journal of Surgical Oncology shows the link between serum cytokine receptor levels and bone sarcoma:

“We analyzed the correlations between pretreatment serum levels of 11 cytokines and soluble cytokine receptors (interleukin 6 (IL-6); interleukin 8 (IL-8); interleukin 10 (IL-10); vascular endothelial growth factor (VEGF); basic fibroblast growth factor (bFGF); macrophage colony-stimulating factor (M-CSF); granulocyte colony-stimulating factor (G-CSF); interleukin 1 receptor antagonist (IL-1ra); sIL-2R; tumor necrosis factor receptor I (TNF RI), and TNF RII) with clinico-pathological features and survival of patients with bone sarcomas.”

They used multiple metrics to show the association between cytokines and soluble receptors and tumor characteristics along with overall outcome. Their data led to this conclusion:

“These findings indicate that cytokines and soluble cytokine receptors, both physiologically involved in bone destruction and bone formation, have an essential role in the progression of malignant bone tumors.”

A research article published in the journal Tumor Biology finds the same kind of evidence for colorectal cancer. While they found a correlation with a number of circulating cytokines, their summary observations are the most striking:

“sTNF RI (soluble TNF receptor 1), IL-8, IL-6 and vascular endothelial growth factor measurements demonstrated the highest diagnostic sensitivity. sTNF RI was found elevated in the greatest percentage of all CRC [colorectal cancer] patients, in the greatest proportion of stage I patients and presented the best diagnostic sensitivity. In addition, the sTNF RI level strongly correlated with tumor grade and invasion and proved to be an independent prognostic factor.”

And another paper published in the same journal concludes with concordant evidence for solid carcinomas in general:

“…for the soluble tumor necrosis factor (TNF) receptors type I (p55) and type II (p75) and IL·2 receptor we determined their levels in the plasma of 378 patients with various solid carcinomas, 56 patients with benign tumors, and 241 healthy controls. The plasma concentrations of both TNF receptors as well as the IL-2 receptor were significantly higher in the cancer patients than in the healthy controls, independent of the origin or histology of the tumor. The incidence and the extent of the receptor increase correlated with the extent of the disease. In the patients with benign tumors plasma levels of TNF receptor p75 and IL·2 receptor were not significantly different from the controls.”

A study published around the same time in the journal Oncology makes the same case for non-small cell lung cancer (NSCLC) as well, with an interesting comparison to the standard markers:

“…increases in IL-6, IL-8 and sTNF RI were noted in the greatest proportion of stage I patients. Most cytokine/cytokine receptor levels revealed higher sensitivity than the standard tumor markers…A significant prognostic value of pretreatment serum M-CSF and CEA levels in NSCLC patients has been shown, but only M-CSF proved to be an independent prognostic factor.”

We also have the evidence from a study published in the journal Cellular Immunology in which the authors blocked the decoy effect of soluble tumor necrosis factor receptor type I (sTNFRI)receptors with neutralizing antibodies and observed the effect. Their data led to this conclusion:

“These data demonstrate that sTNFRI directly influences tumor formation and persistence in vivo and suggest the selective removal and/or inactivation of sTNFRI as a promising new avenue for cancer immunotherapy.”

Obviously an intervention that gets rid of the ‘decoy’ receptors so the immune system can effectively attack the tumor makes excellent sense. In a paper published in the Proceedings of the National Academy of Sciences (USA) we have early evidence that the soluble tumor necrosis factor receptors can be filtered out of the blood of human cancer patients:

“Serum ultrafiltrates (SUF) from human patients with different types of cancer contain a blocking factor (BF) that inhibits the cytolytic activity of human tumor necrosis factor alpha (TNF-alpha) in vitro.”

The investigators proceeded to show that the blocking factor is derived from malignant cell membrane TNF receptors. They further observed that:

“Purified BF blocks the lytic [malignant cell destroying] activity of recombinant human and mouse TNF-alpha…The BF also inhibits the necrotizing activity of recombinant human TNF-alpha… The BF may have an important role in…interaction between the tumor and the host antitumor mechanisms…”

A paper published in 2002 by a leader in the field of immunepheresis in the journal Therapeutic Apheresis and Dialysis documents the emerging insights and outstanding outcomes with cancer patients that were already being accomplished:

“Immunosuppression is a hallmark of advanced malignancies in man. Over the past 40 years, many investigators have identified soluble immunosuppressive factors in blood, serum, ascitic fluid, and pleural fluid from cancers in man and other species. Suppressive factors have also been identified that are produced by tumors.”

The author also draws attention to the similarity of immunologic tolerance in cancer and pregnancy (which has also been referred to as the ‘trophoblastic theory‘):

“The description of immunosuppressive factors in the blood of vertebrates who either have cancer or who are pregnant is significant, for only in pregnancy and cancer does a seemingly normal immune system tolerate immunogenic neoantigen. Tumor necrosis factors (TNFs) are …thought to be suppressed in patients who have cancer or who are pregnant. Recently, elevated blood levels of soluble tumor necrosis factor receptors (sTNFRs) have been reported in the blood in a variety of cancers and pregnancy.”

He notes that much evidence has accumulated validating the connection between elevations of sTNFRs and a poor prognosis:

“In 1990, after our initial publication of the discovery of sTNFRs in the serum and low molecular weight ultrafiltrates of serum from a variety of cancer patients, others confirmed significant elevations of sTNFRs in cancer patients. This elevation was found to correlate with a poor prognosis.”

The author then reviews the suppressive role of soluble receptors shed from tumor cells and the positive effects of ultrapheresis—filtering the blood to remove reduce these suppressive molecules. A few years a ago a paper published in the same journal reported advances in the filtering technology:

“Using these methods, an improvement in performance status and clinical symptoms and reduction of tumor size have been observed.”

Two years ago further advances and positive clinical outcomes were reported in Therapeutic Apheresis and Dialysis in a paper presented by the same pioneer mentioned above:

“Mean reductions in sTNF-R1 (48%), sTNF-R2 (55%), and sIL2-R levels (72%) were observed … Clinical findings indicated tumor inflammation and necrosis in most patients. Side-effects were low-grade fever, flu-like symptoms; tumor pain and redness, warmth, tenderness, and edema. The column demonstrated safety and efficacy in lowering plasma sTNF-R1, sTNF-R2, and sIL2-R levels.”

Personally I know of patients who have undergone this procedure who have had outstanding outcomes characterized by dramatic reductions in tumor mass.

Is this a safe treatment? A paper published in the Journal of Clinical Apheresis reports that, in contrast with chemotherapy, short term side-effects of immune activation were only mild-moderate, and there were no long-term side-effects at all:

“The most common side effects observed among 1,306 treatments were chills (28% of treatments), low grade fever (28%), and musculoskeletal pain (16%). Side effects were mild to moderate and required no treatment or only symptomatic treatment…Of 64 patients available for long-term follow-up evaluation (mean of 11 months), none exhibited evidence of long-term treatment-related side effects.”

Immunepheresis (therapeutic apheresis, ultrapheresis) is worthy of far more research resources and clinical utilization. For more information see the International Immunology Foundation. Treatment is available for suitable candidates from M. Rigdon Lentz, M.D. (an American oncologist and immunepheresis pioneer) and Kiran Lentz, M.D. at their clinic in Prien am Chiemsee, Bavaria, Germany. As usual, the papers presented above are a small selection from a much larger body of literature. A 170 page report by Dr. Ralph Moss of Cancer Decisions on the work of Dr. Lentz is available here.

Note: Removal of soluble receptor blockade to permit immune destruction of malignant cells is an elegant physiological intervention to reduce tumor burden. Practitioners and patients alike must also bear in mind the need to investigate and treat from a functional medicine perspective the underlying causal factors that develop malignancies in the first place and promote their recurrence.

These findings confirm the suggestion that sTNFRI inhibits immunological mechanisms important in tumour cell eradication, and further support a role for sTNFRI in tumour survival in vivo. In addition, these observations suggest the development of methods for more specific removal and/or inactivation of sTNFRI as promising new avenues for cancer immunotherapy.

Bipolar disorder and brain inflammation

Posted on July 16, 2010 by Dr. Jonathan

Neuroinflammation is being recognized as a fundamental cause for a range of psychiatric disorders. A paper recently published in the journal European Archives of Psychiatry and Clinical Neuroscience is a reminder that treatment for bipolar disorder is incomplete with addressing inflammation in the brain. The authors state:

“Bipolar disorder (BD) has been associated with a proinflammatory state in which TNF-α seems to play a relevant role. The aim of the present study was to evaluate the plasma levels of TNF-α and its soluble receptors (sTNFR1 and sTNFR2) in BD patients in mania and euthymia in comparison with control subjects.”

(TNF-α is a major proinflammatory cytokine.) As the data emerged they saw that:

“…higher sTNFR1 levels were found in BD patients. Of note, BD patients in mania had higher sTNFR1 levels than BD patients in euthymia and controls. The sTNFR1 and sTNFR2 levels correlated with BD duration, and sTNFR2 levels correlated with age of patients.”

The authors announce in their conclusion that:

“Our data indicate a proinflammatory status in BD patients during mania and further suggest that inflammatory mechanisms may be involved with the physiopathology of BD.”

The functional approach to BD, major depressive disorder, OCD, schizophrenia, and many more brain-based diagnoses must include a careful evaluation of each case for neuroinflammation and its causes.

Pro-inflammatory cytokines of rheumatoid arthritis reduced by Vitamin B6

Posted on July 11, 2010 by Dr. Jonathan

We’re always on the lookout for physiological agents that have the potential to calm the activity of pro-inflammatory cytokines when they are elevated in autoimmune disease. An exciting finding was reported in a paper just published in the European Journal of Clinical Nutrition:

“The purpose of this study was to investigate whether vitamin B6 supplementation had a beneficial effect on inflammatory and immune responses in patients with rheumatoid arthritis (RA).”

The control group of patients was given 5 mg/day of folic acid only while the study group was given 100 mg/day of vitamin B6 in addition for 12 weeks. Indicators of inflammation (C-reactive protein (hs-CRP), erythrocyte sedimentation rate (ESR), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) and lymphocyte subsets were measured on day 1 (week 0) and after 12 weeks (week 12) of the intervention.

At the end of twelves the data painted this picture:

“In the group receiving vitamin B6, plasma IL-6 and TNF-α levels significantly decreased at week 12. Plasma IL-6 level remained significantly inversely related to plasma PLP (pyridoxal 5′-phosphate, B6) after adjusting for confounders.”

The bottom line conclusion is worth bearing in mind when evaluating any autoimmune disorder because underlying causal factors are similar regardless of the specific tissue under attack:

“A large dose of vitamin B6 supplementation (100 mg/day) suppressed pro-inflammatory cytokines (that is, IL-6 and TNF-α) in patients with RA.”

Sesamin, a cancer chemopreventative

Posted on June 27, 2010 by Dr. Jonathan

As the authors of this paper published last month in Molecular Cancer Research state:

“Agents that are safe, affordable, and efficacious are urgently needed for the prevention of chronic diseases such as cancer.”

They establish their rationale for investigating the sesame seed lignan called sesamin as a cancer chemopreventative:

“Sesamin…has been linked with prevention of hyperlipidemia, hypertension, and carcinogenesis through an unknown mechanism. Because the transcription factor NF-κB has been associated with inflammation, carcinogenesis, tumor cell survival, proliferation, invasion, and angiogenesis of cancer, we postulated that sesamin might mediate its effect through the modulation of the NF-κB pathway.”

They found in fact that sesamin packs quite a punch:

“…sesamin inhibited the proliferation of a wide variety of tumor cells including leukemia, multiple myeloma, and cancers of the colon, prostate, breast, pancreas, and lung. Sesamin also potentiated tumor necrosis factor-α–induced apoptosis and this correlated with the suppression of gene products linked to cell survival, proliferation, inflammation (e.g., cyclooxygenase-2), invasion (e.g., matrix metalloproteinase-9, intercellular adhesion molecule 1), and angiogenesis (e.g., vascular endothelial growth factor). Sesamin downregulated constitutive and inducible NF-κB activation induced by various inflammatory stimuli and carcinogens…”

Those of you who may be pursuing immunopheresis for cancer (filtering TNF-α soluble receptors that barricade tumors from the immune system’s attack) may very well wish to include sesamin in your protocol since it enhances cytotoxic TNF-α activity. Interestingly, sesamin is included in some of our omega-3 fatty acid formulae for brain support as an evidence-based agent for reducing brain inflammation. So the authors’ conclusion is a welcome one:

“Overall, our results showed that sesamin may have potential against cancer and other chronic diseases through the suppression of a pathway linked to the NF-κB signaling.”

Laser therapy reduces inflammatory cytokines

Posted on June 14, 2010 by Dr. Jonathan

Photomedicine and Laser Surgery The therapeutic use of non-invasive, low level (cold) laser and and infrared has not crossed the gap into clinical practice to the degree that the rich body of scientific research justifies. The laser and infrared therapies we use here appear to help even though you can’t feel them (at the time of application); but what evidence is there that they really do anything? And by what mechanisms? Consider this study published in the journal Photomedicine and Laser Surgery a few years ago that documents the effect of visible and infrared light on inflammatory cytokines (immune system messenger molecules). The authors state:

“The aim of this randomized, placebo-controlled, double-blind trial was to investigate changes in the content of 10 cytokines in the human peripheral blood after transcutaneous [through the skin] and in vitro [to blood removed from the body] irradiation with polychromatic visible and infrared (IR) polarized light…”

The magnitude of the effect that they observed by just applying the light to the sacral area of the study subjects is surprising:

“A dramatic decrease in the level of pro-inflammatory cytokines TNF-α, IL-6, and IFN-γ was revealed: at 0.5 h after exposure of volunteers (with the initial parameters exceeding the norm), the cytokine contents fell, on average, 34, 12, and 1.5 times. The reduced concentrations of TNF-α and IL-6 were preserved after four daily exposures, whereas levels of IFN-γ and IL-12 decreased five and 15 times. At 0.5 h and at later times, the amount of anti-inflammatory cytokines was found to rise: that of IL-10 rose 2.7–3.5 times (in subjects with normal initial parameters) and of TGF-β1 1.4–1.5 times.”

But if you expose just the area over the sacrum, what happens when that blood mixes with the rest of the circulation?

“Similar regularities of the light effects were recorded after in vitro irradiation of blood, as well as on mixing the irradiated and non-irradiated autologous blood at a volume ratio 1:10 (i.e., at modeling the events in a vascular bed of the exposed person when a small amount of the transcutaneously photomodified blood contacts its main circulating volume).”

In other words, a small limited application causes system-wide effects. Considering how much we need therapies that physiologically modulate the inflammatory response without side effects, the authors’ conclusion is extremely compelling:

“Exposure of a small area of the human body to light leads to a fast decrease in the elevated pro-inflammatory cytokine plasma content and to an increase in the the anti-inflammatory factor concentration, which may be an important mechanism of the anti-inflammatory effect of phototherapy. These changes result from transcutaneous photomodification of a small volume of blood and a fast transfer of the light-induced changes to the entire pool of circulating blood [!].”

Here’s a little more from the large body of research published in the same journal:

By the way, this is interesting in connection with the earlier post on the infrared treatment of depression.

OCD: an autoimmune disease

Posted on May 30, 2010 by Dr. Jonathan

Cell An interesting study just published in the journal Cell demonstrates one mechanism by which immunological dysfunction causes obsessive-compulsive disorder (OCD). The authors show that microglia (the immune cells in the brain) when abnormal can cause compulsive behaviors in mice that correspond to OCD in humans:

“Mouse Hoxb8 mutants (with faulty microglia) show unexpected behavior manifested by compulsive grooming and hair removal, similar to behavior in humans with the obsessive-compulsive disorder spectrum disorder trichotillomania.”

They then showed that transplanting normal microglia eliminated their pathological OCD behavior.

“Immunological dysfunctions have been associated with neuropsychiatric disorders…In this mouse, a distinct compulsive behavioral disorder is associated with mutant microglia.”

The author of a report on this study published in Science Now comments:

“Previous studies have implied a link between the immune system and obsessive-compulsive disorder and other neuropsychiatric conditions, Capecchi says. “Here, we say there is a direct connection.”…The results raise the possibility of treating obsessive-compulsive disorder by targeting the immune system rather than the brain.”

What other evidence might there be that OCD in humans is an autoimmune disease? A paper published a year and a half ago in Neuroscience Letters shows how an immune cytokine abnormality also contributes to OCD. The authors begin by observing:

“Several lines of evidence support an immunologic involvement in obsessive-compulsive disorder (OCD): the increased prevalence of OCD in patients with rheumatic fever (RF), and the aggregation of obsessive-compulsive spectrum disorders among relatives of RF probands [affected persons studied in a genetic investigation]. Tumor necrosis factor alpha is a proinflammatory cytokine involved in RF and other autoimmune diseases…the goal of the present study was to investigate a possible association between polymorphisms within the promoter region of TNFA and OCD.”

They studied two polymorphisms of the genes for TNF-alpha and found that:

“Significant associations were observed between both polymorphisms and OCD.”

The theme is carried forward in a paper more recently published in the journal Neuropsychopharmacology that reports the presence of anti-brain autoantibodies that derange excitatory neurotransmitters with OCD. The authors begin by observing:

“…serum autoantibodies directed against basal ganglia (BG) implicate autoimmunity in the pathogenesis of obsessive–compulsive disorder (OCD),…We examined this by investigating the presence of autoantibodies directed against the BG or thalamus in the serum as well as CSF of 23 OCD patients compared with 23 matched psychiatrically normal controls.”

They also measured several neurotransmitters including the most abundant excitatory neurotransmitter glutamate. What did their data show?

“There was evidence of significantly more binding of CSF autoantibodies to homogenate of BG as well as to homogenate of thalamus among OCD patients compared with controls. …CSF glutamate and glycine levels were also significantly higher in OCD patients compared with controls…”

Thus their conclusion:

“The results of our study implicate autoimmune mechanisms in the pathogenesis of OCD and also provide preliminary evidence that autoantibodies against BG and thalamus may cause OCD by modulating excitatory neurotransmission.”

This post would not be complete without including the recognized association of OCD with Tourette’s disorder (TD). The authors of this clinically useful study published not long ago in the journal Progress in Neuro-Psychopharmacology and Biological Psychiatry linked TD and OCD in their investigation of the cytokines promoting the autoimmune attack on brain tissue:

“This study examined the potential role of cytokines, modulators of the immune system. We hypothesized that children with TD would have increased levels of tumor necrosis factor (TNF)-α, interleukin (IL)-12, IL-1β and IL-6, and decreased IL-2. We also explored whether comorbid [happening together] obsessive compulsive disorder (OCD) had an effect on the cytokine profile of TD patients.”

They found that both TD and OCD had abnormal elevations of cytokines associated with their immune dysfunction, only those who had OCD comorbid with TD had significantly elevated IL-12.

“Findings suggest a role for IL-12 and IL-2 in TD, and that the TD+OCD subgroup may involve different neuroimmunological functions than the TD−OCD subgroup.”

Their conclusion confirms both the autoimmune etiology and that each patient must be precisely evaluated and treated as in individual for their autoimmune disorder.

Nervous system regulation of inflammation, cytokines, and heart rate variability

Posted on May 27, 2010 by Dr. Jonathan

As readers here know, inflammation is a fundamental factor in chronic disease and accelerated aging (neurodegeneration). A functional approach to treatment requires an objective understanding of how this system is working for each patient. Here are several of the many studies that illustrate how nervous system function and inflammation can be evaluated with heart rate variability (HRV) analysis and cytokine (‘messenger molecules’ of inflammation) levels.

Shock The practical focus is on restoring parasympathetic nervous system (PNS) activity which inhibits inflammation. (PNS resources decline with disease, stress and age resulting in a state of ‘sympathetic nervous system dominance’.) This paper just published in the journal Shock shows how autonomic nervous system activity (sympathetic and parasympathetic) as measured by HRV corresponds to inflammatory cytokine activity, in this case when stimulated by endotoxins (poisons produced by bacterial infections):

“Autonomic inputs from the sympathetic and parasympathetic nervous systems, as measured by heart rate variability (HRV), have been reported to correlate to the… responses to infectious challenge… In addition, parasympathetic/vagal activity has been shown experimentally to exert anti-inflammatory effects via attenuation of splanchnic tissue TNF-α [cytokine] production. We sought… to determine if baseline HRV parameters correlated with endotoxin-mediated circulating cytokine responses.”

They documented a strong correspondence regardless of gender, body mass index and resting heart rate:

“…we found a significant correlation of several baseline HRV parameters…on TNF-α release after endotoxin exposure.”

This is not a new observation. An interesting study published a few years ago in the journal Psychosomatic Medicine documents the HRV expression of autonomic activity in response to an inflammatory challenge and its correspondence to cytokine production. They begin by noting that:

“…the autonomic nervous system plays a key role in regulating the magnitude of immune responses to inflammatory stimuli. Signaling by the parasympathetic system inhibits the production of proinflammatory cytokines by activated monocytes/macrophages and thus decreases local and systemic inflammation.”

They examined the relationship of HRV to lipopolysaccharide-induced production of the inflammatory cytokines interleukin (IL)-1ß, IL-6, tumor necrosis factor (TNF)-{alpha}, and IL-10. What did the data show?

“Consistent with animal findings, higher derived estimates of vagal activity measured during paced respiration* were associated with lower production of the proinflammatory cytokines TNF-{alpha} and IL-6…These associations persisted after controlling for demographic and health characteristics, including age, gender, race, years of education, smoking, hypertension, and white blood cell count.”

Their conclusion has profound implications for the biological mechanism by which stress causes inflammation:

“These data provide initial human evidence that vagal activity is inversely related to inflammatory competence, raising the possibility that vagal regulation of immune reactivity may represent a pathway linking psychosocial factors to risk for inflammatory disease.”

How might this show up in heart disease? This paper published not long ago in the journal Brain, Behavior, and Immunity investigates the links between HRV, inflammatory cytokines, coronary heart disease and depression:

“Studies show negative correlations between heart rate variability (HRV) and inflammatory markers [less variability = more inflammation]…We investigated links between short-term HRV and inflammatory markers in relation to depression in acute coronary syndrome (ACS) patients.”

They measured C-reactive protein (CRP), interleukin-6 (IL-6, a cytokine), depression symptoms and heart rate variability determinants of autonomic function. What did their data show?

“…all HRV measures were negatively and significantly associated with both inflammatory markers…HRV independently accounted for at least 4% of the variance in CRP in the depressed, more than any factor except BMI.”

Interestingly, they also noted that:

“Relationships between measures of inflammation and autonomic function are stronger among depressed than non-depressed cardiac patients. Interventions targeting regulation of both autonomic control and inflammation may be of particular importance.”

The research of another group published in the Journal of Critical Care used sepsis as their model.

“The aim of the study was to investigate possible associations between different heart rate variability (HRV) indices and various biomarkers of inflammation in 45 septic patients.”

They examined the correlation between HRV, C-reactive protein, and the cytokines interleukin 6 and interleukin 10:

“Our data suggest that low HRV and sympathovagal balance during septic shock are associated with both an increased hyperinflammatory and antiinflammatory response.”

The antiinflammatory response corresponds to high HRV and interleukin-10, the cytokine that is also increased by vitamin D.

Journal of Internal Medicine How can we reduce inflammation by increasing HRV and reducing inflammatory cytokines? There are numerous methods; one is to increase cholinergic activity in the nervous system (parasympathetic activity mediated by the neurotransmitter acetylcholine). We can increase this with natural precursor support for acetylcholine. This study published recently in the Journal of Internal Medicine shows the connection between vagal parasympathetic function (as shown by HRV), inflammatory cytokines, cholinergic activity and rheumatoid arthritis:

“The central nervous system regulates innate immunity in part via the cholinergic anti-inflammatory pathway, a neural circuit that transmits signals in the vagus nerve that suppress pro-inflammatory cytokine production…Vagus nerve activity is significantly suppressed in patients with autoimmune diseases, including rheumatoid arthritis (RA). It has been suggested that stimulating the cholinergic anti-inflammatory pathway may be beneficial to patients…”

They found that increasing cholinergic signaling in stimulated whole blood cultures suppressed cytokine production in rheumatoid arthritis patients whose vagal activity was deficient:

“These findings suggest that it is possible to pharmacologically target the α7nAChR dependent control of cytokine release in RA patients with suppressed vagus nerve activity.”

In a functional medicine practice, of course, we use natural acetylcholine precursors.

This is a drop in the bucket, but here’s one more fascinating paper published recently in the journal Brain, Behavior, and Immunity that shows how acetylcholine activity in the brain (the upper level of autonomic regulation) controls systemic cytokine levels through vagal function:

“The excessive release of cytokines by the immune system contributes importantly to the pathogenesis of inflammatory diseases. Recent advances in understanding the biology of cytokine toxicity led to the discovery of the “cholinergic anti-inflammatory pathway,” defined as neural signals transmitted via the vagus nerve that inhibit cytokine release…Vagus nerve regulation of peripheral functions is controlled by brain nuclei and neural networks…Here we report that brain acetylcholinesterase activity controls systemic and organ specific TNF [cytokine] production during endotoxemia.”

They demonstrated that inhibiting the breakdown of acetylcholine† markedly reduced proinflammatory serum TNF levels through the resulting increasing vagus nerve signaling which prevented inflammatory damage. What do they conclude from their research?

“These findings show that inhibition of brain acetylcholinesterase [that breaks down acetylcholine] suppresses systemic inflammation through a central…mediated and vagal…dependent mechanism. Our data also indicate that a clinically used centrally-acting acetylcholinesterase inhibitor† can be utilized to suppress abnormal inflammation to therapeutic advantage.”

* There are numerous therapies to reduce inflammation by increasing parasympathetic function. Breathing is a powerful stimulus to the autonomic nervous system. We train breathing with biofeedback while simultaneously monitoring for CO2 (capnography) and coherence in HRV to hit the physiological “sweet spot”.

† Agents that inhibit the breakdown of neurotransmitters including reuptake inhibitors do not restore the body’s ability to make its own. Precursor therapy provides the natural ingredients that have been depleted or are insufficient to meet genetic needs so neurotransmitters can be increased naturally.