Abstract
The pathogenesis of an increasing number of chronic diseases is being attributed to effects of the immune system. However, its role in the development and maintenance of anorexia nervosa is seemingly under-appreciated. Yet, in examining the available research on the immune system and genetic studies in anorexia nervosa, one becomes increasingly suspicious of the immune system’s potential role in the pathophysiology of anorexia nervosa. Specifically, research is suggestive of increased levels of various pro-inflammatory cytokines as well as the spontaneous production of tumor necrosis factor in anorexia nervosa; genetic studies further support a dysregulated immune system in this disorder. Potential contributors to this dysregulated immune system are discussed including increased oxidative stress, chronic physiological/psychological stress, changes in the intestinal microbiota, and an abnormal bone marrow microenvironment, all of which are present in anorexia nervosa.
Highlights
The importance of the immune system in the pathogenesis of a large number of diseases is being increasingly accepted
Cell-mediated immunity is largely tested through delayed cutaneous hypersensitivity and lymphocyte proliferation
One is left to question how these bone marrow changes including a decreased amount of the bone marrow adipose tissue that is important for immune system regulation, impacts the immune system in anorexia nervosa, and, speculative, whether this is a significant contributor to the immune system changes present in anorexia nervosa compared to primary malnutrition, given that gelatinous marrow transformation (GMT) and low marrow adiposity is not noted in primary malnutrition
Summary
The importance of the immune system in the pathogenesis of a large number of diseases is being increasingly accepted. There is a case report of an individual with long-standing juvenile idiopathic arthritis and anorexia nervosa who exhibited improvement in body weight and appetite after treatment with infliximab (anti-TNF therapy) [8] There is another case report of an individual with a 12-year history of anorexia nervosa pre-dating by many years a diagnosis of Crohn’s disease, who experienced significant weight gain and no further relapse in psychopathology several months after beginning immunosuppressive therapy [9]. Another genetic finding approaching significance in anorexia nervosa involves a locus containing early B cell factor 1, which encodes a transcription factor important for immune system development, regulation of adipocyte/osteoblast differentiation and possible interaction with leptin signaling [10]. A brief review of the immune system is warranted [12,13]
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