Stress markers in saliva

1. REVIEW PAPER
BY
ABIRAMI VETRISELVAN
SPITTING OUT STRESS

2. • In medical context, stress is defined as “a state in which
homeostasis, as a dynamic balance of internal
conditions necessary for the proper functioning of
cells or the living organism as a whole, is affected
by the action of various stressors.”
• There are 3 types of stress according to American
Psychological Association – acute stress, episodic
acute stress, chronic stress.
• There is an urgent demand for developing rapid, highly
accurate and non-invasive tools for screening, early
detection, diagnostics, staging and prognostics.

3. STRESS
PHENOMENOLOGY
• Stress system activity is located in both central and peripheral nervous
systems. The system receives and concomitantly processes numerous
neurosensory impulses as well as signals through blood.
• Stress activation results in a series of temporally limited physiological
and behavioral reactions for the purpose of bodily adaptation to the
new circumstances the body is exposed to.
• Along with stress activation, there is always a mechanism of stress
inhibition.

4. CRH – Corticosteroid Releasing Hormone
AVP – Arginine vasopressin
ACTH - Adrenocorticotrophic Hormone

7. COMPLICATIONS
Gastrointestinal
disturbances

8. SALIVAOMICS
• In addition, saliva, as a "mirror of the body," can reflect the
physiological and pathological state of the body.
• Introduced in 2008, the term "Salivaomics" aimed to highlight the rapid
development of knowledge about various "omics" constituents of
saliva.
• Saliva as a multi-constituent oral fluid, extensively supplied by blood.
There are many advantages of using saliva as a biofluid. Its collection
is fast, easy, inexpensive, and non-invasive.
• It is the need of the hour in diagnosing various systemic diseases by
detecting the specific markers in saliva which is less invasive
compared to any other sample collection.

9. STRESS MARKERS
• Saliva is an elixir of blood with its constituents at a lower concentration. It is a
powerful tool for diagnosis.
• Common stress markers that are of interest are cortisol levels, Chromogranin
A, α-amylase and β-endorphin.
• Cortisol is the most often studied salivary biomarker, which is associated with
the activation of hypothalamic-pituitary-adrenal (HAP) axis.
• Stress also leads to immunosuppression of lymphocytes, monocytes and
macrophages, thereby decreasing the levels of secretory IgA and salivary
lysozyme, which can also be used as a biomarker.

10. CORTISOL
• Salivary cortisol is present in free, unbound form in the saliva, unlike blood
cortisol that is 65% in bound form.
• It is due to the low molecular weight and liposolubility, by ways of which it
passes through the basal membrane entering the saliva.
• Balance between blood and salivary cortisol is achieved within 5 minutes due
to which it is highly reliable, earliest detectable factor.
• It is easier to assess the concentration of cortisol in unbound form than the
bound form. Hence it is advantageous in quantifying the salivary cortisol than
blood.

11. IMMUNOGLOBULIN
• Secretory IgA is the most common antibody in the saliva.
 Daily secretion = 66mg/kg/day
 Half life – 3 to 6 days
 Peak levels – ½ an hour after awakening
• Psychological stressors increase the level of cortisol in the blood leading to
suppression of lymphocytes, macrophages and monocytes.
• Hence secretory IgA in saliva always has a negative correlation with the levels
of stress.

12. LYSOZYME
• Lysozyme is a low molecular mass cationic protein, widely present in the
tissues and tissue secretion.
• It is synthesized in monocytes and macrophages. It acts by hydrolyzing the
bond between N-acetylglucosamine and N-acetylmuramic acid in bacterial cell
wall.
• They correlate negatively to the level of stress similar to IgA.

13. CHROMOGRANIN A
• Chromogranin A is an acidic protein present in secretory granules of endocrine
and neuroendocrine cells.
• CgA is primarily stored in the cells of adrenal gland and is released along with
catecholamines. Immunohistochemistry has proved its presence in
submandibular gland also.
• Glampaolo et al have demonstrated a daily CgA rhythm in healthy subjects.
 Peak lavels – 23:00 hour
 Least levels – 8:00 hour
 Half life – 18.4 min
• CgA levels decrease with increase in stress.

14. α-AMYLASE
• Salivary glands excrete the enzyme α-amylase as a result of adrenergic
stimulation.
 Peak levels : Late afternoon
 Least levels :Morning hours
 Half life : 12-24 hrs
• The values of α-amylase increases in response to stress as the cortisol
levels raise on HPA stimulation.

15. CONCLUSION
• In a modern society, stress reactions have a decreasingly protective character
aimed at helping the body cope with situations.
• Stress reactions are continual interactions between physical, psychological
and social factors in health/disease. Hence there is a necessity for
multidisciplinary approach to evaluate and treat certain conditions.
• Studies conducted in the fields of stress reaction have certainly been upgraded
by the use of specific quantitative and qualitative salivary analyses.
• Salivary analyses are emerging trends of reliable and additional diagnostics
that can be clinically practiced on day to day basis.

16. REFERENCES
• Faculty of Medicine Foca, University of East Sarajevo, Republic of Srpska, Bosnia
and Herzegovina
• Glam Paolo B, Angelica M, Antonio S. Chromogranin A in normal subjects, essential
hypertensives and adrenalectomized patients.
• Schoofs D, Hartmann R, Wolf OT, Neuroendocrine stress responses to an oral
academic examination.
• www.content.sciendo.com
• www.ncbi.nlm.nih.gov