Immunodeficiency associated with anorexia nervosa is secondary and improves after refeeding

Abstract

SUMMARYSeveral studies have addressed the question of starvation effects on immune function by means of changes in lymphocyte subsets, cytokine induction or lymphocyte activation. Anorexia nervosa (AN ) patients are severely malnourished and contradictory results have been obtained regarding the accompanying immunodeficiency, including its assignation as a part of the primary nervous disorder. In the present work, an extensive immunological function examination was carried out on 40 AN patients who were compared with a control group of 14 healthy girls. The AN patients were also classified according to their nutritional status (by the Body Mass Index: BMI ), this being critical for a better understanding of these secondary immunodeficiency bases. Moreover, another immune system study was performed on five patients after refeeding. Lymphocyte subsets and function, cytokine induction and peripheral blood concentrations, and innate as well as humoral immunity were evaluated. Deregulation in the cytokine network, owing to the interaction of the central nervous (CNS ) and immune systems, seems to be the initial immune alteration in AN immunodeficiency but it has not been disproved that the immunodeficiency is a direct consequence of the original psychiatric perturbation. Spontaneous high levels of circulating interleukin-1b (IL-1b) and tumour necrosis factor-a (TNF-a) have been observed; this is probably one of the causes of the anomalies found in the T-cell subpopulations (mainly the naive CD4+CD45RA+ reduction and the cytotoxic CD8+ increase) and T-cell activation status (mainly the down-regulation of the CD2 and CD69 activation pathways). This finally leads to an impairment, not only in T-cell function but also in T-cell to B-cell co-operation. The AN specificity of these results is confirmed by the fact that these immune alterations improve after refeeding and when nutritional status becomes less critical, which also suggests that AN immunodeficiency is indeed secondary to malnutrition.

The effect of fermented milk on interferon production in malnourished children and in anorexia nervosa patients undergoing nutritional care

“…Also, different results should be expected if cytokine production is directly measured in plasma from the volunteers as compared with the in vitro production, which usually occurs under stimulation conditions of the isolated cells (SolisPereyra et al, 1997). Finally, it is important to take into account that adding different mitogens (Con A, PHA, LPS, etc) to the culture has been shown to induce different production of a particular cytokine (Allende et al, 1998).…”

Wybrane cytokiny prozapalne, metabolizm kostny, osteoprotegeryna i ligand receptora aktywatora czynnika jądrowego-kB u dziewcząt z jadłowstrętem psychicznym

“…The most significant differences were reported regarding the levels of circulating pro-inflammatory cytokines. Some researchers found an increase in circulating IL-1β, IL-6, or TNF-α in patients with AN compared to healthy individuals [9][10][11][12][13][14]. Others did not find significant differences in the concentrations of these cytokines between the study and control groups [15][16][17][18][19].…”

“…Istnienie powiązań między stężeniami IL-1β, IL-6, TNF-α a markerami kostnymi, OPG, jej liganden sRANKL i/lub wskaźnikiem OPG/sRANKL wskazuje na możliwy współudział wymienionych cytokin w mechanizmie prowadzącym do braku oczekiwanego wzrostu gęstości mineralnej kości u dziewcząt w okresie dorastania. Słowa kluczowe: jadłowstręt psychiczny; dziewczęta; cytokiny prozapalne; metabolizm kostny; OPG; sRANKL weight controls [9,10,20,21,24]. However, this finding was not confirmed by other investigators [3,16].…”

Malnutrition and Inflammation

“…Different results for cytokine production by peripheral blood mononuclear cells (PBMCs) have also been reported. For instance, a higher spontaneous production of IL-1 by PBMCs has been reported in AN patients in comparison with a control group (Allende et al, 1998), while no differences were observed under similar conditions in other studies (Bessler et al, 1993;Vaisman et al, 1996).…”