2011 effects of restraint stress on nalt structure and nasal ig a levels
This article appeared in a journal published by Elsevier. The attachedcopy is furnished to the author for internal non-commercial researchand education use, including for instruction at the authors institution and sharing with colleagues. Other uses, including reproduction and distribution, or selling or licensing copies, or posting to personal, institutional or third party websites are prohibited. In most cases authors are permitted to post their version of the article (e.g. in Word or Tex form) to their personal website or institutional repository. Authors requiring further information regarding Elsevier’s archiving and manuscript policies are encouraged to visit: http://www.elsevier.com/copyright
Authors personal copy R. Oros-Pantoja et al. / Immunology Letters 135 (2011) 78–87 79nodes, cells which play a critical role in the induction of immune with 2 ml sterile saline solution, which was collected in Eppendorffresponses to antigens in the eye, upper respiratory tract and oral tubes. The tubes were stored at −70 ◦ C until the analysis was donemucosa [24,25]. of secretory IgA (sIgA) by paired ELISA. Protein concentration and The NALT is deﬁned as the oropharyngeal lymphoid tissue of quantiﬁcation curves were constructed by the Bradford method.the upper respiratory airways of rodents, considered analogous After the nasal wash procedure, the skin of the head wasto Waldeyer’s ring in humans [26–28]. It consists of paired lym- removed, as were the inferior jawbone and soft tissue, accord-phoid structures situated above the soft palate at the entrance to ing to the method described by Asanuma et al. and Heritagethe bifurcated pharyngeal duct, which are composed in part of sec- et al. [30–32]. The extracted palate was placed upside down inondary lymphoid aggregates characterized by follicular B-cell areas 1 cm3 aluminum containers embedded in tissue inclusion mediumand parafollicular T-cell areas , as well as the many lympho- (Tissue-tek, Sakura, 4583). The containers were frozen and storedcytes found in and underneath the epithelial lining of the nasal at −70 ◦ C until the embedded tissue was cut in a cryostate. Aftermucosa . The NALT is covered by an epithelium or follicle- removing the NALT, the skulls were ﬁxed by immersion in 4%associated epithelium (FAE), which consists of ciliated columnar paraformaldehyde for 24 h, washed, and decalciﬁed with 8% EDTAcells, M cells (alone or in clusters), intraepithelial lymphocytes (Baker analyzed) at pH 7.6. The solution was changed and this cycleand a few goblet cells. Antigen-presenting cells, including dendritic was repeated daily for 8 d. The skulls were then included in parafﬁn.cells and macrophages, are also found in the NALT. Therefore, thisorgan must have an important role in the induction and regulation 2.4. Processingof mucosal immune responses to antigens in the upper respiratorytract [27–29]. From the samples of frozen NALT, 7 m thick cuts were made To the best of our knowledge there have not yet been any reports on the crown portion, and then placed on slides previously treatedon the effects of stress on the structure and function of the NALT. with 1% gel. Some slides were ﬁxed in acetone for 20 min and othersThus, the aim of the present study was to determine whether or not in 4% formaldehyde for the same time. Those cuts ﬁxed in formalde-repeated restraint stress induces a change in the levels of plasmatic hyde and the cuts from the samples processed in wax were stainedglucocorticoids and catecholamines, and/or in the distribution of with haematoxylin and eosin for a general morphological analysis.lymphocytes in the nasal mucosa, and if so, whether such changeshave any correlation with nasal IgA levels in mice. The results show 2.5. Immunohistochemistrythat repeated restraint stress selectively affects individual compo-nents of the immune system of the nasal mucosa of mice and the Cells were quantiﬁed by utilizing immunohistochemical meth-basal production of IgA. ods. 7 m crown sections of NALT were ﬁxed in acetone for 20 min. Later, the slides were hydrated with PBS and the endogenous per-2. Materials and methods oxidase was blocked by incubation with 3% H2 O2 and 0.1% NaN3 in PBS for 10 min. The samples were washed, incubated with 5%2.1. Animals bovine serum for 30 min, and washed again with 0.05% Tween-20 in PBS. Plasmatic cells producing IgA were determined by a direct Ten week old male Balb/c mice (Harlan, Mexico) were ran- immunohistochemical technique, utilizing goat anti-mouse IgAdomly placed in three groups (n = 7): two experimental groups that peroxidase conjugate polyclonal antibodies (HRP-Serotec). Addi-underwent restraint stress and a non-stressed control group. Of the tionally, monoclonal biotin conjugate mouse antibodies were usedexperimental groups, one underwent restraint stress during 4 d and for an indirect immunohistochemical technique. The followingthe other during 8 d. Animals were handled and treated according lymphocytes were detected: CD3+ (BD Pharmingen, 553323), CD4+to a protocol approved by the Ethics and Institutional Animal Care (BD Pharmingen, 553728), CD8+ (BD Pharmingen, 553029) andand Use Committees. CD45-R (B220 BD Pharmingen, 553085). Estreptavidine peroxidase conjugate (Jackson Immuno Research) was later applied.2.2. Restraint stress protocol The primary antibodies were incubated for 2 h and estreptavi- dine for 1 h, both at RT in a humidiﬁed chamber. Gentle washes The experimental groups were submitted to 3 h restraint stress were carried out with PBS at the end of each incubation period.sessions daily, always from 8:00 to 11:00 am. Restraint stress was The peroxidase reaction was revealed according to the Karnovskycarried out by placing the mice in cylindrical plastic containers 6 cm method with DAB (Pierce, 34065). The samples were counter-long, 3 cm high and 3.5 cm wide, with many ventilation holes to stained with one part of Harris’ haematoxylin diluted in 3 partsprevent hyperthermia. At the time of restraint stress for the exper- of water, then dehydrated and covered with synthetic resin. Withimental groups, non-restrained mice were left undisturbed in their the control samples for each antibody, stains were conducted by thehome cages, but without access to food or water. Apart from the same method except that the ﬁrst antibody primer was substitutedrestraint stress schedule, the experimental animals were kept in by PBS. Other control samples were incubated with a peroxidatedcages and all three groups were provided with food and water ad antibody before staining for anti-mouse IgA antibodies.libitum. To avoid adaptation during the 3 h restraint stress sessions, the 2.6. Microscopic analysis and cell quantiﬁcationmice received various stimuli in 30 min cycles, the ﬁrst cycle con-sisting of (i) the agitation of the containers for 10 s after 10 min, and The total area of NALT was measured in m2 in the cuts stained(ii) the rotation of the containers for 10 s after 20 min, followed by with H–E by using Imagen Pro Plus software, calibrated at 200×another 30 min cycle that began in the same way and included the magniﬁcation. With the same software, using constant areas ofimmersion of the mouse tails in cold water for 10 s after 30 min. 2500 m2 from images magniﬁed 400× (see Fig. 4A), the number of T CD3+ , CD4+ , CD8+ , B IgA+ and CD45+ lymphocytes were quan-2.3. Obtaining and processing biological material tiﬁed in the follicular and parafollicular zones. The software tools employed in the count were: adjustment of the minimum and max- Control and experimental mice were anaesthetized with ether, imum range of the area of cells to be counted, manual selection ofbled by direct cardiac puncture, and sacriﬁced by decapitation. The the color of cells to be counted, and Watershed-split and Autosplitnasal wash was done by retrograde infusion through the trachea to separate cells that were very close together. In the lamina propria
Authors personal copy80 R. Oros-Pantoja et al. / Immunology Letters 135 (2011) 78–87the IgA+ cells were counted in the same way. In the quantiﬁcation of 12000 250CD4+ and CD8+ intraepithelial lymphocytes, the average longitude P < 0.001 Controlof the respiratory epithelium in the crown cuts of the NALT, which 10000 Stress 4 d * * Stress 8 d 200turned out to be 800 linear m, was used as a reference. Finally, the *volume of the NALT was calculated by measuring the total area of 8000this tissue from each cut, averaging the various cuts made on each 150 ng / ml pg / mlanimal, then averaging this value for all the animals in each group. 6000Each count was made in duplicate. 100 40002.7. Flow cytometry 2000 50 * Nasal-associated lymphoid tissue (NALT) cell suspensions and 0 0the nasal passage (non-NALT) lymphocytes, which were prepared Corticosterone Epinephrinefrom the portion of the nasal cavity remaining after isolation ofNALT, were obtained according to procedures previously described Fig. 1. Effect of restraint stress on serum corticosterone and epinephrine levels.[30,32]. For cell immunophenotyping, directly labeled antibodies Mice were subjected to restraint stress during 3 h for 4 or 8 consecutive days. Later,were used: anti-CD19-PE, IgA-FITC, CD138-APC, CD3-FITC, CD4-PE peripheral blood was collected and subjected to corticosterone and norepinephrine radioimmunoassay. Data are expressed as the mean ± SD (n = 5–8). Corticosteroneand CD8-APC (all from BD Biosciences, San Jose, CA, USA). Cells were levels were signiﬁcantly lower in mice restrained for 4 d than in the other twoharvested, washed twice with PBS and 0.5% BSA and then stained groups: the 8 d restrained group and the unrestrained control (P < 0.001, Bonfer-for T cell phenotype with a cocktail of anti-CD3, -CD4 and -CD8 roni t-test). Norepinephrine levels were signiﬁcantly higher in mice restrained formAb, for 30 min at room temperature in the dark. The cells were 4 and 8 d than in the unrestrained control (P < 0.001, Bonferroni t-test).then washed with PBS and ﬁxed in 2% formaldehyde in PBS. B cellswere ﬁxed, permeabilized and stained according to BD Biosciences’protocol for intracellular staining. Stained cells were acquired with 3. Resultsa FACSCalibur ﬂow cytometer (BD Biosciences). Data were analyzedusing the Flow-jo software v7.5 (Tree Star, Inc.). 3.1. Effect of restraint stress on serum corticosterone and norepinephrine2.8. Enzyme-linked immunosorbent assay (ELISA) for IgA in the Given that the changes in the immune response induced bynasal wash stress are mediated principally through the release of glucocor- ticoids and catecholamines, we determined plasma corticosterone Rabbit anti-mouse IgA immunoglobin (20 g/ml) was placed and norepinephrine concentrations in restrained and unrestrainedin each well, which was incubated for 18 h at 4 ◦ C. After wash- mice (Fig. 1). Compared to control animals, restraint stress signif-ing 3 times with a phosphate-Tween 20 (PBS-T) buffer at pH 7.2, icantly modiﬁed serum levels of corticosterone (one-way ANOVA;the samples were directly applied and incubated for 2 h at 37 ◦ C. F(2,15) = 80; P < 0.001) and norepinephrine (F(2,15) = 32; P < 0.001).The plates were then washed 5 times with PBS-T and 5 times Corticosterone levels were signiﬁcantly lower in mice at 4 d ofwith PBS, then incubated for 2 h at 37 ◦ C with goat anti-mouse restraint stress than in the other two groups; at 8 d restraint stressIgA conjugate (BD Pharmingen, 55549) diluted 1:3000 in PBS-T. or in control animals (P < 0.001, Bonferroni t-test). On the contrary,Finally, the plates were washed 3 times with PBS-T and 3 times the norepinephrine concentrations in both groups of restrainedwith PBS before the substrate (Ortophenylendiamina, Sigma-OPD) mice (4 and 8 d) were signiﬁcantly higher than in control micewas added at RT. After 15 min the reaction was stopped with 2.5 M (P < 0.001, Bonferroni t-test).sulfuric acid and the absorbance was determined at a wave lengthof 490 nm. A standard curve was made utilizing puriﬁed mouse IgA 3.2. Effect of restraint stress on the microscopic structure andfrom myeloma (MP-Biomedicals, 64334) at a concentration range volume of the NALTof 50 g to 150 ng. We analyzed the morphology of the NALT after staining this tissue with H&E. In unstressed mice we observed one area with2.9. Determination of plasma corticosterone and epinephrine two ovoid masses, one on each side of the midline of the nasal face of the palate next to the sidewall of the nose (Fig. 2A). In the A determination of plasma corticosterone was made by a com- structure of the NALT it was difﬁcult to identify typical lymphoidmercial kit of ELISA (Cayman Chemical Company, 500651), and that nodules. Regarding irrigation, both conventional and high endothe-of plasma epinephrine by a commercial kit of radioimmunoassay lial venules (HEV) and arterioles were identiﬁed in the NALT.(RIA-LDN Labor Diagnostika Nord, BA-0100). Upon comparing the analysis of the NALT from stressed and unstressed animals, the morphology of the NALT was found to be similar. The total volume of the NALT was estimated by graph-2.10. Statistical analysis ing the volume of 35 serialized sections taken from the front to the back portion. When the points were joined, the organ showed Data are presented as the mean ± SD. The comparison of two a cylindrical shape with a greater volume in the central portiongroups was analyzed by using the Student’s unpaired two-tailed than at the extremes. This form was similar in control and stressedt-test. One-way ANOVA was performed to compare more than two groups (Fig. 2B). The mean volume was 2.95 ± 0.56 mm3 in thegroups, and if a signiﬁcant main effect or association was identi- control group, 2.68 ± 0.42 mm3 in the group stressed for 4 d, andﬁed (P < 0.05), the respective group means were compared using 3.27 ± 0.65 mm3 in the group stressed for 8 d. Analysis with one-the Bonferroni t-test. All analyses were performed using the statis- way ANOVA revealed that there were not any signiﬁcant differencestical program SigmaStat for Windows Version 2.03 software, and between the control and the experimental groups (F(2,15) = 1.4,graphed with Sigma Plot software (SPSS Inc.). P = 0.27), although there was a tendency towards the atrophy of
Authors personal copy R. Oros-Pantoja et al. / Immunology Letters 135 (2011) 78–87 81Fig. 2. Morphology and stress effect on NALT volume. (A) Two lymphoid nodes can be observed on the ﬂoor of the nose in the crown section of the middle NALT segment.In the portion photographed, these nodes are covered by respiratory epithelium (RE). Next to the middle portion is the epithelium of the sectioned nasal septum. The lateralface (LF) is followed by lateral walls, then by the basal face (BF), all forming part of the lamina propria (LP). The epithelial palate (EP) can be seen in the lower part. H&E. 4×.(B) In comparison to the control group, there was a decrease in the average total volume (measured in mm3 ) at 4 d of stress, but an increase at 8 d of stress. Statistical analysisdid not show any signiﬁcant differences between the three groups (F(2,15) = 1.44; P = 0.27).tissue in the 4 d stressed group and toward an increase in NALT In the follicular area (Fig. 3C), the ANOVA showed a statis-volume in the 8 d stressed group. tically signiﬁcant difference in CD3+ cells between the animal groups (F(2,15) = 24; P < 0.001). The number of such cells in the restrained groups (4 and 8 d) was signiﬁcantly lower than that in3.3. Effect of restraint stress on the distribution of NALT the control animals (P < 0.001, Bonferroni t-test). However, therelymphocytes was not any signiﬁcant difference between the 4 and 8 d stressed mice (P = 0.766). Hence, the stress protocol of the present study The immunohistochemical analysis of the NALT from control decreased the population of CD3+ lymphocytes in both the follicularanimals showed several patterns of cell distribution, which were and parafollicular areas.determined mainly by the organization of B and T lymphocytes.In the center of the NALT there were predominantly B lympho-cytes (IgA+ and CD45+ cells) forming a lymphoid follicle with no 3.4.2. CD4+ and CD8+ T cellsgerminative center, surrounded by a parafollicular area largely In the parafollicular area (Fig. 3B) a statistically signiﬁcantcomposed of T lymphocytes (CD3+ , CD4+ and CD8+ cells) (Fig. 3A). decrease was found in CD4+ T cells at 4 or 8 d of restraint stress com-However, there were no well-deﬁned boundaries between the pared to control mice (F(2,15) = 64; P < 0.001). Also, the number oftwo areas, as part of the parafollicular area was found mixed these cells was signiﬁcantly lower in the 8 d than 4 d restrainedwith follicular area. CD4+ T cells existed in both the follicular and group (P = 0.04). In the follicular area (Fig. 3C), there were notparafollicular areas, while CD8+ T cells showed a pattern of dis- any signiﬁcant differences between the three groups (F(2,15) = 23;tribution more circumscribed to the parafollicular area (Fig. 3A). P = 0.7). Therefore, the results show a progressive decrease in theThe immunohistochemical analysis of the NALT from stressed number of CD4+ cells in the parafollicular area with restraint stress.mice (both the 4-day and 8-day groups) did not show any alter- Regarding the CD8+ T cells in the parafollicular area, thereation in the distribution patterns of B or T lymphocytes or their were no statistically signiﬁcant differences between the groupssubpopulations. (F(2,15) = 0.09; P = 0.9; Fig. 3B). In the follicular area the CD8+ T cells were absent or very scarce in all groups (Fig. 3C). Therefore, this subpopulation was resistant to activation by the sympathetic ner-3.4. Effect of stress on the T cell subpopulations of the NALT vous system and hypothalamic–pituitary–adrenal axis during the restraint stress protocol of the present study.3.4.1. CD3+ T cells To determine if our stress protocol affected the number of CD3+cells, we compared the number of these cells in both the parafollicu- 3.5. Intraepithelial lymphocyteslar and follicular areas of the NALT for stressed and control animals.In the parafollicular area, the analysis with ANOVA showed a sta- There was a statistically signiﬁcant difference between thetistically signiﬁcant difference in CD3+ cells between the animal groups in the number of intraepithelial lymphocytes in the mid-groups (F(2,15) = 10; P = 0.002; Fig. 3B). Further analysis with Bon- dle part of the respiratory epithelium of the NALT (F(2,15) = 35;ferroni’s pairwise comparison procedure revealed that the number P < 0.001; Fig. 4). The number of CD4+ IEL cells (Fig. 4A) was signiﬁ-of CD3+ cells in mice at 8 d of stress (223 ± 10.6) was signiﬁcantly cantly lower at 4 d of restraint stress than in the other two groups:lower (P = 0.006) than that at 4 d of stress (249 ± 7.5) or in control the 8 d restrained group (P = 0.021, Bonferroni t-test) and controlanimals (237 ± 12.3). On the other hand, the number of CD3+ cells animals (P < 0.001, Fig. 4C). The number of these cells was also sig-was not statistically different between control animals and those niﬁcantly lower in the 8 d restrained group than in control animalsstressed for 4 d. (P < 0.05).
Authors personal copy82 R. Oros-Pantoja et al. / Immunology Letters 135 (2011) 78–87Fig. 3. Distribution of T lymphocytes in the NALT (A). Great amounts of lymphocytes can be observed in the parafollicular area (PA) and a lesser number in the follicular area(FA), marked with monoclonal anti-CD3 (a), anti-CD4 (b), and anti-CD8 (c) antibodies (100×). The scheme (S) shows their pattern of distribution. Effect of restraint stresson the parafollicular (B) and follicular areas (C). Mice restrained for 4 or 8 d, or unrestrained. Immediately after the last stress session, the mice were sacriﬁced and nasaltissue samples were obtained. The number of CD3+ , CD4+ and CD8+ T cells (analyzed as the number of cells per m2 ) was determined by immunohistochemistry. Data wereobtained from 7 mice/group and are presented as the mean ± SD. The statistical analysis was performed by using ANOVA, followed by the Bonferroni’s multiple comparisontest. In the parafollicular area (B), compared with the unrestrained control group, restraint stress of 8 d reduced the number of CD3+ T cells (**P < 0.05, Bonferroni t-test), andrestraint stress of 4 and 8 d reduced the number of CD4+ T cells (*P < 0.001), but did not affect CD8+ T cells (P < 0.05). In the follicular area (C), compared with the unrestrainedcontrol group, restraint stress reduced the number of CD3+ T cells (*P < 0.001), but the number of CD4+ and CD8+ T cells was not affected. Similar results were obtained intwo independent experiments. Although the number of CD8+ IEL cells was scarce (Fig. 4B), suggest that B cells were resistant to the hormonal response to thewe found a statistically signiﬁcant difference between the groups restraint stress protocol used.(F(2,15) = 48; P = 0.007; Fig. 4C). Like CD4+ IEL cells, the number ofCD8+ IEL cells was signiﬁcantly lower at 4 d of restraint stress thanin the other two groups: the 8 d restrained group (P < 0.001) and 3.7. Effect of stress on IgA+ cells in the NALT and non-NALTcontrol animals (P < 0.01). However, unlike CD4+ IEL cells, the num-ber of CD8+ IEL cells was signiﬁcantly higher in the 8 d restrained IgA+ cells were distributed throughout the NALT (Fig. 6A). Ingroup than in control animals (P < 0.001). the lamina propria (Fig. 6B), IgA+ cells were observed among the mucoserous acinus of the mucosa lining of the respiratory epithelium, predominantly at the cornets. These cells were scarce3.6. Effect of stress on the B cell subpopulations of the NALT in the mucosa of the septum and in the anterior region of the nose. In the NALT, there was a statistically signiﬁcant difference The number of cells that expressed the B220 marker (Fig. 5A) in the number of IgA+ cells between the groups (F(2,15) = 10;in the follicular area was not signiﬁcantly different in control and P = 0.013; Fig. 6C). The number of IgA+ cells was signiﬁcantly lowerexperimental groups (F(2,15) = 1.04; P = 0.4; Fig. 5B). Our results at 4 d of restraint stress than in the other two groups: the 8 d
Authors personal copy R. Oros-Pantoja et al. / Immunology Letters 135 (2011) 78–87 83Fig. 4. Effect of restraint stress on the nasal intraepithelial lymphocytes. Immunohistochemical staining of intraepithelial lymphocytes. There are few intraepithelial lym-phocytes (arrows) labeled with anti-CD4 (A, 400×) and anti CD8 (B, 200×). The number of IEL was determined by immunohistochemistry with monoclonal antibodies, andis expressed as the number of cells per linear epithelium (C). Compared with the unrestrained control group, restraint stress of 4 d reduced the number of CD4+ T cells(*P < 0.001). Restraint stress of 8 d also reduced the number of lymphocytes, but to a lesser extent (**P < 0.05). Whereas restraint stress of 4 d reduced the number of CD8+ Tcells (**P < 0.05), restraint stress of 8 d increased their number (*P < 0.001). Similar results were obtained in two independent experiments.restrained group (P = 0.002) and control animals (P = 0.013). There decrease followed by a recovery to the basal level. In contrast,was no signiﬁcant difference between the 8 d restrained group in the lamina propria there was not any signiﬁcant differenceand control animals (P = 0.15). Therefore, IgA+ cells located in the in the number of IgA+ cells between the groups (F(2,15) = 0.5;NALT were susceptible to the stress protocol used, showing a P > 0.6).Fig. 5. B Lymphocytes in the NALT. The scheme (S) shows the distribution pattern. (A) The B lymphocytes marked with monoclonal anti-CD45 (B220) antibodies (100×) canbe seen predominantly in the follicular area (FA), and in a lesser number in the parafollicular area (PA). (B) The graph compares the number of lymphocytes in a folliculararea in the three groups under study. According to the one way ANOVA, there were no signiﬁcant differences between the three groups (F(2,15) = 1.044; P = 0.4).
Authors personal copy84 R. Oros-Pantoja et al. / Immunology Letters 135 (2011) 78–87Fig. 6. Effect of restraint stress on nasal IgA cells. Distribution of IgA+ cells in the NALT and lamina propria (A and B). The scheme (s) shows the diffuse distribution pattern inthe follicular area as well parafollicular areas. In the follicular area (FA) of the NALT numerous IgA+ cell can be observed (A, 200×). IgA+ cells are scarce in the lamina propriaof the respiratory mucosa (arrow, panel B, 400×). Number of IgA+ cells (C). Compared to the unrestrained control group, the number of lymphocytes diminished signiﬁcantlyin the 4 d stress group (F(2,15) = 9.667; P = 0.013) and increased signiﬁcantly in the 8 d stress group (F(2,15) = 3.238; P = 0.002). The quantity of cells in the lamina propriashowed a similar tendency. However the stress protocol in this study did not affect the number of IgA+ cells (F(2,15) = 0.536; P > 0.596).3.8. Effects of stress on nasal IgA levels In terms of the IgA concentration in the nasal lumen, there was astatistically signiﬁcant difference between the groups (F(2,24) = 9;P < 0.01; Fig. 7). The nasal IgA concentration was signiﬁcantly lowerat 4 d of restraint stress than in the other two groups: the 8 drestrained group (P < 0.001) and control animals (P = 0.003). On theother hand, the IgA concentration was similar in the 8 d restrainedgroup and control animals (P = 0.451).3.9. Flow cytometric analysis T- and B-cell composition of the NALT. We determined the cellularcomposition by ﬂow cytometry of isolated lymphocytes from theNALT of non-stressed and stressed mice. The percentages of T cells(CD3+ , CD4+ , and CD8+ ) and B cells (B220+ ) were similar to thosereported by others in the same strain of mice [30–32]. B cells (56%)were more abundant than T cells (35%), the T-cell population con-tained about 3 times as many CD4+ T cells as CD8+ T cells (22% vs7%), and the ratio CD4+ /CD8+ T cells was three. The percentage of CD3+ T cells in the lymphocytes of the NALTwas signiﬁcantly lower in mice stressed for 4 d and 8 d comparedwith the non-stressed group (Fig. 8A, P < 0.001). Lymphocytes ofthe NALT include those of the parafollicular and follicular areas.This information corroborates our data obtained by immunohisto-chemistry, according to which a reduction occurred in the numberof CD3+ T cells in the parafollicular area of mice stressed for 8 d, andin the same cell population in the follicular area of mice stressedfor 4 and 8 d (Fig. 3). The percentage of CD4+ T cells was signiﬁcantly lower in mice Fig. 7. Effect of restraint stress on nasal IgA. Immediately after the last stress session,stressed for 4 d and 8 d compared with the non-stressed group mice were sacriﬁced and the nasal ﬂuid was obtained. The IgA concentration was(Fig. 8A, *P < 0.05). Logically, in the T cell rich parafollicular area, determined by ELISA and is expressed as mg/ml for each group. Data were obtainedthe number of CD4+ T cells detected by immunohistochemistry was from 10 mice/group and are presented as the mean ± SD. Restraint stress modiﬁedalso lower in mice stressed for 4 and 8 d (Fig. 3) compared to control the concentration of IgA (F(2,27) = 24.2; P < 0.001), which was signiﬁcantly lower inanimals. mice restrained for 4 d than in the other two groups: the 8 d restrained group and the unrestrained control animals (*P < 0.001, Bonferroni t-test). Similar results were There were not any differences in the percentage of B cells in the obtained in two independent experiments.NALT of stressed and non-stressed mice (Fig. 8A, P > 0.1), a resultthat conﬁrms the data obtained by immunohistochemistry.
Authors personal copy R. Oros-Pantoja et al. / Immunology Letters 135 (2011) 78–87 85 A 70 Control axis, and that with restraint stress for 8 d this axis was again nor- Stress 4 d mally activated. Several studies have reported habituation and Stress 8 d 60 adaptation of the corticosterone response to the same (homotypic) stressor, resulting in a decrease in corticosterone levels in the short 50 run followed by a recovery of the same in the long run [33–40]. Contrarily, other studies have reported the pattern of continu- ous suppression of the corticosterone response to repeated stress Cells (%) 40 [41–44]. In rats subjected to restraint stress for 3, 7 and 10 d, the 30 * * corticosterone response to a 10 min session considerably decreased after 3 d and moderately decreased after 7 and 10 d. It is possible ** ** 20 that the difference is related to the distinct stress protocols. The signiﬁcant increase in plasma levels of adrenaline with the 10 restraint stress in the present study is in agreement with other reports [12,45]. The combination of high levels of adrenaline and 0 corticosterone in mice restrained for 8 d, along with high levels of T cells CD4 CD8 B cells adrenaline and low levels of corticosterone in mice restrained for 4 d found in the current contribution is also in agreement with a 40 B Control previous study by our workgroup . Stress 4 d Restraint-stress for 4 or 8 d did not have any effect on the struc- 35 Stress 8 d P < 0.001 ture and volume of the NALT. Although there are no previous 30 reports of stress on these parameters of the NALT, other studies * have found a reduction in the size of primary lymphoid organs 25 (e.g., the thymus) and secondary nodes and spleen (e.g., the mesen- IgA+ cells (%) teric lymphoid) [46–50]. Therefore, it is possible that the NALT of 20 Balb/c mice is more resistant to the effects of stress (e.g., apoptosis) ** than other lymphoid organs, which are modiﬁed signiﬁcantly with 15 short-term and long-term restraint stress protocols [51,52]. 10 In control animals, the CD4+ T cells in the parafollicular area were three times more abundant per area of tissue than CD8+ T 5 cells, which is consistent with several studies [27,30,31]. Compared with the control animals, the number of CD4+ T cells was signiﬁ- 0 NALT Lamina propria cantly lower in the parafollicular area of 4 and 8 d stressed animals. This was not the case with CD8+ T cells, as no differences wereFig. 8. Flow cytometric analysis of the effect of stress on NALT and non-NALT popu- found between the groups. The ﬂow cytometric analysis revealedlations. The animals were stressed 3 h for 4 or 8 d (n = 7 in each case) or not stressed that repeated restraint stress (4 and 8 d) decreased the percentage(n = 7). The percentages of lymphocytes isolated from NALT and non-NALT (lam- of CD4+ and CD3+ T cells, without affecting the percentage of CD8+ina propria) were determined by ﬂow cytometry. Results are expressed as themean ± SD (*P < 0.001, **P < 0.05, vs control). (A) T-cell subsets and B cells in the T cells. These results suggest that there was greater susceptibilityNALT. (B) IgA + plasma cells in NALT and non-NALT (lamina propria). The data shown of CD4+ than CD8+ T cells to the effects of the stress protocol used.are representative of two experiments. Our results are in agreement with a previous study in which acute treadmill exercise decreased the number of CD4+ T cells in the sub- mandibular lymph nodes [24,25], and with still another study in IgA+ cells. The ﬂow cytometric analysis showed that, compared which acute restraint stress caused a decrease in the total numberwith the control animals, the percentage of IgA+ cells in NALT of circulating CD4+ , but caused no signiﬁcant effect on CD8+ T cellswas lower in the 4 d but higher in the 8 d stressed group (Fig. 8B, during either acute or chronic stress . In other studies acute*P < 0.001, **P < 0.05, respectively). However, the percentage of IgA+ restraint stress decreased the number of both CD4+ and CD8+ Tcells in lamina propria (non-NALT) was not modiﬁed by the stress cells in Peyer’s patches, thymus and spleen of mice [49,54–56]. Weprotocol used (P > 0.1). This data is in agreement with that obtained suppose that the 3 h restraint stress sessions in the present studyby immunohistochemistry. did not reach the threshold of acute stress that could affect CD8+ We were unable to get enough intraepithelial lymphocytes from cells.the nasal mucosa to perform a ﬂow cytometry analysis. In fact, Upon analyzing the amount of nasal intraepithelial lympho-there is not any report in the literature about the characterization cytes (nIEL) in the epithelium covering the middle part of theof intraepithelial lymphocytes from NALT by ﬂow cytometry. NALT, we found that they were less abundant than the intestinal intraepithelial lymphocytes (iIEL). Similarly, two studies reported4. Discussion less abundant nIEL in the respiratory epithelium than iIEL in the intestinal epithelium [57,58]. There are no reports regarding the effect in the nasal mucosa In the present study the ratio of CD4+ IEL to CD8+ IEL cellsof mice of restraint stress on the distribution and number of var- was nearly 2:1. Although one study in human nasal mucosa foundious immune cell populations, or on the basal production of IgA. that CD4+ T cells were the predominant IEL population , thereThe results of the present study clearly demonstrate that the stress are several other reports of a predominant CD8+ T cell populationprotocol used selectively affected individual components of the [60–63]. However, it is difﬁcult to compare our results to any ofimmune system of the mouse nasal mucosa. these studies because they were done in human nasal mucosa. Regarding corticosterone levels, compared to the control ani- In the present study, compared to the control group the num-mals there was a marked reduction at 4 d and a notable increase ber of intraepithelial CD4+ T cells in the nasal epithelium decreasedat 8 d of restraint stress. Contrarily, the plasma norepinephrine in the 4 d stressed group, but recovered (moderately but not com-response showed an increase at both 4 and 8 d of restraint stress. pletely) in the 8 d stressed group. The intraepithelial CD8+ T cells inOur results suggest that restraint stress for 4 d inhibited the HPA the nasal epithelium also decreased in the 4 d stressed group, but
Authors personal copy86 R. Oros-Pantoja et al. / Immunology Letters 135 (2011) 78–87increased beyond the basal level of the control animals in the 8 d in (at 4 d of stress) and recovery of (at 8 d of stress) the number ofstressed group. The causes of these differences are not known. IgA+ cells and the levels of IgA in the mouse NALT. Whereas there was no signiﬁcant change in the percentage andnumber of IgA+ cells in the lamina propria of non-NALT areas, the Conﬂict of interestpercentage and number of IgA+ cells in the NALT and the level ofnasal IgA were lower at 4 d of restraint stress than in the other two None of the authors has any conﬂict of interest in relation to thegroups: the 8 d restrained group and control animals. The reports techniques used or the subjects mentioned in this manuscript.in the literature about stress and the number of IgA+ cells are all inrelation to intestinal and respiratory mucosa. One report showed Acknowledgementsthat restraint stress does not reduce the number of IgA-producingcells in intestinal lamina propria of mice . The other studies We thank Bruce Allan Larsen for reviewing the use of English incomparing the number of IgA+ cells in intestinal and respiratory this manuscript. This work was supported by SIP-IPN, COFAA-IPN,mucosa used stress protocols related to exercise or sickness, and are and CONACYT (Grant 33993).therefore difﬁcult to compare to the current contribution [64,65]. The mechanism of reduction of IgA+ cells is unknown. However, Referencesin the present study this mechanism could not have been relatedto B cell population changes, since no signiﬁcant differences were  Mayer EA. Psychological stress and colitis. Gut 2000;46:595–6.noted in either absolute numbers or in the percentage of B220+  Mayer EA. The neurobiology of stress and gastrointestinal disease. Gutcells in the NALT between stressed and non-stressed mice. Because 2000;47:861–9.  Mayer EA, Naliboff BD, Chang L, Coutinho SVV. Stress and irritable bowel syn-the level of corticosterone was lower and that of adrenaline was drome. Am J Physiol Gastrointest Liver Physiol 2001;280:G519–524.higher in mice stressed for 4 d, it is possible that the lack of signiﬁ-  Collins SM. Stress and the gastrointestinal tract IV. Modulation of intestinalcant change in the population of B cells owes itself to the effects of inﬂammation by stress: basic mechanisms and clinical relevance. Am J Physiol Gastrointest Liver Physiol 2001;280:G315–8.catecholamines, or to the ratio between catecholamines and gluco-  Mawdsley JE, Rampton DS. Psychological stress in IBD: new insights intocorticoids, on the maturation and differentiation of B cells. pathogenic and therapeutic implications. Gut 2005;54:1481–91. Adrenaline modulates B-cell function directly and indirectly  Pedersen BK, Hoffman-Goetz L. Exercise and the immune system: regulation, integration, and adaptation. Physiol Rev 2000;80:1055–81.via changes in Th1-cell cytokine production [66–68]. Although  Gleeson M, Bishop NC. Special feature for the Olympics: effects of exerciseconﬂicting ﬁndings exist about the role of adrenaline in the pro- on the immune system: modiﬁcation of immune responses to exercise byliferation and maturation of B cells into IgA-secreting cells [69,70], carbohydrate, glutamine and anti-oxidant supplements. Immunol Cell Biol 2000;78:554–61.it is possible that this hormone inhibits the number of IgA-secreting  Gleeson M, Pyne DB. Special feature for the Olympics: effects of exercise oncells, as well as the IgA produced per cell, by acting on plasmablast the immune system: exercise effects on mucosal immunity. Immunol Cell Bioland plasma cells in the lamina propria [67,68]. Catecholamines also 2000;78:536–44.may cause apoptosis of B cells [71,72], and/or modulate lymphocyte  Pyne DB, McDonald WA, Gleeson M, Flanagan A, Clancy RL, Fricker PA. Mucosal immunity, respiratory illness, and competitive performance in elite swimmers.distribution [73–75]. Med Sci Sports Exerc 2001;33:348–53. In the present study the level of total IgA in the nasal lumen  Bosch JA, Ring C, de Geus EJ, Veerman EC, Amerongen AV. Stress and secretoryof mice was lower at 4 d of restraint stress than in the other two immunity. Int Rev Neurobiol 2002;52:213–53.  Teeuw W, Bosch JA, Veerman EC, Amerongen AV. Neuroendocrine regulationgroups: the 8 d restrained group and control animals. Similarly, but of salivary IgA synthesis and secretion: implications for oral health. Biol Chemin mouse intestine, we reported that repeated restraint stress (4 h 2004;385:1137–46.for 4 d) reduces IgA levels . We suppose that in the current study  Jarillo-Luna A, Rivera-Aguilar V, Garﬁas HR, Lara-Padilla E, Kormanovsky A, Campos-Rodriguez R. Effect of repeated restraint stress on the levels of intesti-the high levels of norepinephrine greatly inﬂuenced the reduction nal IgA in mice. Psychoneuroendocrinology 2007;32:681–92.of nasal IgA concentration at 4 d of restraint stress, reﬂecting the  Jarillo-Luna A, Rivera-Aguilar V, Martinez-Carrillo BE, Barbosa-Cabrera E,hormonal effects on the number of cells producing IgA as well as the Garﬁas HR, Campos-Rodriguez R. Effect of restraint stress on the popula- tion of intestinal intraepithelial lymphocytes in mice. Brain Behav Immunamount of IgA secreted per cell. Catecholamines can have at least 2007.three effects related to IgA levels: (i) a reduction in the population  Cohen S, Tyrrell DA, Smith AP. Psychological stress and susceptibility to theof IgA producing cells, (ii) a possible inhibition of the production of common cold. N Engl J Med 1991;325:606–12.  Bermon S. Airway inﬂammation and upper respiratory tract infection in ath-IgA per cell, and (iii) a reduction of blood ﬂow, which has the effect letes: is there a link? Exerc Immunol Rev 2007;13:6–14.of inhibiting IgA production [66,76,77]. In the present study, with  Gleeson M. Mucosal immunity and respiratory illness in elite athletes. Int Ja high level of catecholamines and a low level of glucocorticoids Sports Med 2000;21(Suppl. 1):S33–43.(at 4 d of restraint stress), it is possible that the former acted to  Gleeson M. Mucosal immune responses and risk of respiratory illness in elite athletes. Exerc Immunol Rev 2000;6:5–42.inhibit IgA production and the population of IgA+ cells. On the other  Nieman DC. Exercise, infection, and immunity. Int J Sports Med 1994;15(Suppl.hand, when the levels of catecholamines and glucocorticoids were 3):S131–41.both high (at 8 d of restraint stress), perhaps the high levels of the  Gleeson M, McDonald WA, Pyne DB, Cripps AW, Francis JL, Fricker PA, et al. Salivary IgA levels and infection risk in elite swimmers. Med Sci Sports Exerclatter blocked the inﬂuence of the former on the production and/or 1999;31:67–73.secretion of IgA.  Gleeson M, McDonald WA, Pyne DB, Clancy RL, Cripps AW, Francis JL, et al. In summary, repeated restraint stress altered the distribution Immune status and respiratory illness for elite swimmers during a 12-week training cycle. Int J Sports Med 2000;21:302–7.and number of lymphocytes and IgA+ cells in nasal mucosa. We  Mackinnon L. Advances in Exercise Immunology. Human Kinetics 1999.detected signiﬁcant effects on the mouse NALT with the restraint  Sheridan JF, Dobbs C, Jung J, Chu X, Konstantinos A, Padgett D, et al. Stress-stress protocol employed, such as the susceptibility of CD4+ , CD8+ induced neuroendocrine modulation of viral pathogenesis and immunity. Ann N Y Acad Sci 1998;840:803–8.T cells, and IgA+ cells. Also notable was the lack of susceptibility  Nishioka K, Okano M, Ichihara Y, Ichihara N, Nishizaki K. Immunosuppressiveof B cells. Furthermore, the effects of restraint stress on CD4+ cells, effect of restraint stress on the initiation of allergic rhinitis in mice. Int ArchCD8+ T cells, IgA+ cells and IgA levels were signiﬁcantly different at Allergy Immunol 2005;136:142–7.  Boudreau J, Quadrilatero J, Hoffman-Goetz L. Voluntary training in mice and4 d and 8 d. The number of IELs (CD4+ and CD8+ T cells) was lower submandibular lymphocyte response to acute exercise. Med Sci Sports Exercat 4 d and higher at 8 d of stress compared to the control group. 2005;37:2038–45.Mice restrained for 4 d had high levels of adrenaline and low levels  Quadrilatero J, Boudreau J, Hoffman-Goetz L. Lymphocyte distribution in mouseof corticosterone, whereas mice restrained for 8 d had high levels submandibular lymph nodes in response to acute treadmill exercise. Can J Physiol Pharmacol 2003;81:972–8.of both adrenaline and corticosterone. The difference in the ratio  Csencsits KL, Jutila MA, Pascual DW. Nasal-associated lymphoid tissue: phe-of these two hormones was probably responsible for the decrease notypic and functional evidence for the primary role of peripheral node
Authors personal copy R. Oros-Pantoja et al. / Immunology Letters 135 (2011) 78–87 87 addressing in naive lymphocyte adhesion to high endothelial venules in a bacterial infections in chronically stressed mice. Brain Behav Immun 2006;20: mucosal site. J Immunol 1999;163:1382–9. 359–68. Bienenstock J, McDermott MR. Bronchus- and nasal-associated lymphoid tis-  Gonzales XF, Deshmukh A, Pulse M, Johnson K, Jones HP. Stress-induced differ- sues. Immunol Rev 2005;206:22–31. ences in primary and secondary resistance against bacterial sepsis corresponds Kraal G. Nasal-associated lymphoid tissue. In: Mestecky J, Lamm ME, Strober W, with diverse corticotropin releasing hormone receptor expression by pul- Bienenstock J, McGhee JR, Mayer L, editors. Mucosal immunology. Amsterdam: monary CD11c+ MHC II+ and CD11c− MHC II+ APCs. Brain Behav Immun Elsevier; 2005. p. 415–22. 2008;22:552–64. Kiyono H, Fukuyama S. NALT- versus Peyer’s-patch-mediated mucosal immu-  Bauer ME, Perks P, Lightman SL, Shanks N. Are adhesion molecules involved in nity. Nat Rev Immunol 2004;4:699–710. stress-induced changes in lymphocyte distribution? Life Sci 2001;69:1167–79. Asanuma H, Thompson AH, Iwasaki T, Sato Y, Inaba Y, Aizawa C, et al. Isolation  Sudo N, Yu XN, Sogawa H, Kubo C. Restraint stress causes tissue- and characterization of mouse nasal-associated lymphoid tissue. J Immunol speciﬁc changes in the immune cell distribution. Neuroimmunomodulation Methods 1997;202:123–31. 1997;4:113–9. Heritage PL, Underdown BJ, Arsenault AL, Snider DP, McDermott MR. Com-  Yin D, Tuthill D, Mufson RA, Shi Y. Chronic restraint stress promotes lymphocyte parison of murine nasal-associated lymphoid tissue and Peyer’s patches. Am J apoptosis by modulating CD95 expression. J Exp Med 2000;191:1423–8. Respir Crit Care Med 1997;156:1256–62.  Teshima H, Sogawa H, Kihara H, Nakagawa T. Inﬂuence of stress on the maturity Rodriguez-Monroy MA, Rojas-Hernandez S, Moreno-Fierros L. Phenotypic and of T-cells. Life Sci 1991;49:1571–81. functional differences between lymphocytes from NALT and nasal passages of  Sminia TKG. Nasal-associated lymphoid tissue. Mucosal Immunol mice. Scand J Immunol 2007;65:276–88. 1999:357–64. Dhabhar FS, McEwen BS, Spencer RL. Adaptation to prolonged or repeated  Cesta MF. Normal structure, function, and histology of mucosa-associated lym- stress—comparison between rat strains showing intrinsic differences in reac- phoid tissue. Toxicol Pathol 2006;34:599–608. tivity to acute stress. Neuroendocrinology 1997;65:360–8.  Winther B, Innes Jr DJ, Mills SE, Mygind N, Zito D, Hayden FG. Lymphocyte Strausbaugh HJ, Dallman MF, Levine JD. Repeated, but not acute, stress subsets in normal airway mucosa of the human nose. Arch Otolaryngol Head suppresses inﬂammatory plasma extravasation. Proc Natl Acad Sci U S A Neck Surg 1987;113:59–62. 1999;96:14629–34.  Graeme-Cook F, Bhan AK, Harris NL. Immunohistochemical characterization of Melia KR, Ryabinin AE, Schroeder R, Bloom FE, Wilson MC. Induction and habit- intraepithelial and subepithelial mononuclear cells of the upper airways. Am J uation of immediate early gene expression in rat brain by acute and repeated Pathol 1993;143:1416–22. restraint stress. J Neurosci 1994;14:5929–38.  Hameleers DM, Stoop AE, van der Ven I, Biewenga J, van der Baan S, Sminia Armario A, Hidalgo J, Giralt M. Evidence that the pituitary–adrenal axis does T. Intra-epithelial lymphocytes and non-lymphoid cells in the human nasal not cross-adapt to stressors: comparison to other physiological variables. Neu- mucosa. Int Arch Allergy Appl Immunol 1989;88:317–22. roendocrinology 1988;47:263–7.  Pawankar R, Okuda M. A comparative study of the characteristics of intraep- Hashimoto K, Suemaru S, Takao T, Sugawara M, Makino S, Ota Z. Corticotropin- ithelial and lamina propria lymphocytes of the human nasal mucosa. Allergy releasing hormone and pituitary–adrenocortical responses in chronically 1993;48:99–105. stressed rats. Regul Pept 1988;23:117–26.  Okuda M, Pawankar R. Flow cytometric analysis of intraepithelial lymphocytes Hauger RL, Lorang M, Irwin M, Aguilera G. CRF receptor regulation and sensi- in the human nasal mucosa. Allergy 1992;47:255–9. tization of ACTH responses to acute ether stress during chronic intermittent  Coutinho HB, Robalinho TI, Coutinho VB, Amorim AM, Furtado AF, Ferraz A, et al. immobilization stress. Brain Res 1990;532:34–40. Intra-abdominal sepsis: an immunocytochemical study of the small intestine Ma XM, Lightman SL. The arginine vasopressin and corticotrophin-releasing mucosa. J Clin Pathol 1997;50:294–8. hormone gene transcription responses to varied frequencies of repeated stress  Nilssen DE, Oktedalen O, Lygren I, Opstad PK, Brandtzaeg P. Intestinal IgA- and in rats. J Physiol 1998;510(Pt 2):605–14. IgM-producing cells are not decreased in marathon runners. Int J Sports Med Ma XM, Lightman SL, Aguilera G. Vasopressin and corticotropin-releasing hor- 1998;19:425–31. mone gene responses to novel stress in rats adapted to repeated restraint.  Elenkov IJ, Wilder RL, Chrousos GP, Vizi ES. The sympathetic nerve—an integra- Endocrinology 1999;140:3623–32. tive interface between two supersystems: the brain and the immune system. Andres R, Marti O, Armario A. Direct evidence of acute stress-induced Pharmacol Rev 2000;52:595–638. facilitation of ACTH response to subsequent stress in rats. Am J Physiol  Kohm AP, Sanders VM. Norepinephrine and beta 2-adrenergic receptor stimula- 1999;277:R863–8. tion regulate CD4+ T and B lymphocyte function in vitro and in vivo. Pharmacol Gadek-Michalska A, Bugajski J. Repeated handling, restraint, or chronic Rev 2001;53:487–525. crowding impair the hypothalamic–pituitary–adrenocortical response to acute  Sanders VM, Kohm AP. Sympathetic nervous system interaction with the restraint stress. J Physiol Pharmacol 2003;54:449–59. immune system. Int Rev Neurobiol 2002;52:17–41. Dallman MF, Akana SF, Strack AM, Scribner KS, Pecoraro N, La Fleur SE, et al.  Li YS, Kouassi E, Revillard JP. Differential regulation of mouse B-cell activation Chronic stress-induced effects of corticosterone on brain: direct and indirect. by beta-adrenoceptor stimulation depending on type of mitogens. Immunology Ann N Y Acad Sci 2004;1018:141–50. 1990;69:367–72. Rich EL, Romero LM. Exposure to chronic stress downregulates corticos-  Winzer A, Ring C, Carroll D, Willemsen G, Drayson M, Kendall M. Secretory terone responses to acute stressors. Am J Physiol Regul Integr Comp Physiol immunoglobulin A and cardiovascular reactions to mental arithmetic, cold 2005;288:R1628–36. pressor, and exercise: effects of beta-adrenergic blockade. Psychophysiology Uresin Y, Erbas B, Ozek M, Ozkok E, Gurol AO. Losartan may prevent the ele- 1999;36:591–601. vation of plasma glucose, corticosterone and catecholamine levels induced by  Bergquist J, Tarkowski A, Ewing A, Ekman R. Catecholaminergic suppression of chronic stress. J Renin Angiotensin Aldosterone Syst 2004;5:93–6. immunocompetent cells. Immunol Today 1998;19:562–7. Durnova GN, Kaplanskii AS, Glagoleva EV. Dynamics of morphological changes  Stevenson JR, Westermann J, Liebmann PM, Hortner M, Rinner I, Felsner P, et al. in the adrenal glands and lymphoid organs during immobilization stress in rats. Prolonged alpha-adrenergic stimulation causes changes in leukocyte distribu- Arkh Anat Gistol Embriol 1983;85:67–72. tion and lymphocyte apoptosis in the rat. J Neuroimmunol 2001;120:50–7. Grigorenko DE, Budushkina EE. Mesenteric lymph nodes in the rat after expo-  Benschop RJ, Rodriguez-Feuerhahn M, Schedlowski M. Catecholamine-induced sure to hydrocortisone. Arkh Anat Gistol Embriol 1985;89:58–62. leukocytosis: early observations, current research, and future directions. Brain Dominguez-Gerpe L, Rey-Mendez M. Time-course of the murine lym- Behav Immun 1996;10:77–91. phoid tissue involution during and following stressor exposure. Life Sci  Gader AM, Cash JD. The effect of adrenaline, noradrenaline, isoprenaline and 1997;61:1019–27. salbutamol on the resting levels of white blood cells in man. Scand J Haematol Sudo N, Oyama N, Yu XN, Kubo C. Restraint stress-induced elevation of endoge- 1975;14:5–10. nous glucocorticoids decreases Peyer’s patch cell numbers via mechanisms  Gonzalez-Ariki S, Husband AJ. The role of sympathetic innervation of the gut in that are either dependent or independent on apoptotic cell death. Neuroim- regulating mucosal immune responses. Brain Behav Immun 1998;12:53–63. munomodulation 2001;9:333–9.  Schmidt PT, Eriksen L, Loftager M, Rasmussen TN, Holst JJ. Fast acting ner- Roy MJ, Walsh TJ. Histopathologic and immunohistochemical changes in gut- vous regulation of immunoglobulin A secretion from isolated perfused porcine associated lymphoid tissues after treatment of rabbits with dexamethasone. ileum. Gut 1999;45:679–85. Lab Invest 1992;66:437–43.  Lundgren O. Sympathetic input into the enteric nervous system. Gut Kiank C, Holtfreter B, Starke A, Mundt A, Wilke C, Schutt C. Stress suscepti- 2000;47(Suppl. 4):iv33–35 [discussion iv36]. bility predicts the severity of immune depression and the failure to combat