Chronic stress, glucocorticoid receptor resistance, inflammation, and disease risk

• Published in: Proceedings of the National Academy of Sciences - PNAS Vol. 109; no. 16; pp. 5995 - 5999
• Main Authors: Cohen, Sheldon, Janicki-Deverts, Denise, Doyle, William J, Miller, Gregory E, Frank, Ellen, Rabin, Bruce S, Turner, Ronald B
• Format: Journal Article
• Language: English
• Published: United States National Academy of Sciences 17.04.2012; National Acad Sciences
• Subjects: Adult; Biological Sciences; blood; Body mass index; Chronic Disease; chronic exposure; common cold; Common Cold - metabolism; Common Cold - psychology; Common Cold - virology; Cytokines; Cytokines - metabolism; Disease models; Disease risk; Disease Susceptibility; Disease Susceptibility - metabolism; Disease Susceptibility - psychology; Diseases; education; Enterovirus; Female; Health risks; Humans; Hydrocortisone; Hydrocortisone - blood; inflammation; Inflammation - metabolism; Inflammation - psychology; interleukin-1; interleukin-6; isolation & purification; Leukocyte Count; Leukocytes; Life events; Lymphocytes; Male; metabolism; methods; Middle Aged; Models, Psychological; Nasal Lavage Fluid; Nasal Lavage Fluid - virology; Neutrophils; nose; psychology; Quarantine; Quarantine - methods; Quarantines; Receptors, Glucocorticoid; Receptors, Glucocorticoid - metabolism; Rhinovirus; Rhinovirus - isolation & purification; risk; Risk Factors; Social Sciences; Stress; Stress, Psychological; Stress, Psychological - metabolism; Stress, Psychological - psychology; T cell receptors; tumor necrosis factor-alpha; Virology; Viruses; volunteers; Young Adult
• ISSN: 0027-8424; 1091-6490; 1091-6490
• DOI: 10.1073/pnas.1118355109

We propose a model wherein chronic stress results in glucocorticoid receptor resistance (GCR) that, in turn, results in failure to down-regulate inflammatory response. Here we test the model in two viral-challenge studies. In study 1, we assessed stressful life events, GCR, and control variables including baseline antibody to the challenge virus, age, body mass index (BMI), season, race, sex, education, and virus type in 276 healthy adult volunteers. The volunteers were subsequently quarantined, exposed to one of two rhinoviruses, and followed for 5 d with nasal washes for viral isolation and assessment of signs/symptoms of a common cold. In study 2, we assessed the same control variables and GCR in 79 subjects who were subsequently exposed to a rhinovirus and monitored at baseline and for 5 d after viral challenge for the production of local (in nasal secretions) proinflammatory cytokines (IL-1β, TNF-α, and IL-6). Study 1: After covarying the control variables, those with recent exposure to a long-term threatening stressful experience demonstrated GCR; and those with GCR were at higher risk of subsequently developing a cold. Study 2: With the same controls used in study 1, greater GCR predicted the production of more local proinflammatory cytokines among infected subjects. These data provide support for a model suggesting that prolonged stressors result in GCR, which, in turn, interferes with appropriate regulation of inflammation. Because inflammation plays an important role in the onset and progression of a wide range of diseases, this model may have broad implications for understanding the role of stress in health.