Chronic Cortisol Exposure Research Articles

Sleep, Health Outcomes and Body Weight (SHOW) study: a measurement burst design study on sleep and risk factors for obesity in black emerging adults in North Carolina, USA

IntroductionBlack emerging adults (18–28 years) have the highest risk of short sleep duration and obesity. This increased risk may be partly explained by greater stress levels, which may result from...

Radiation-induced DNA double-strand breaks in cortisol exposed fibroblasts as quantified with the novel foci-integrated damage complexity score (FIDCS)

Without the protective shielding of Earth’s atmosphere, astronauts face higher doses of ionizing radiation in space, causing serious health concerns. Highly charged and high energy (HZE) particles are particularly effective in causing complex and difficult-to-repair DNA double-strand breaks compared to low linear energy transfer. Additionally, chronic cortisol exposure during spaceflight raises further concerns, although its specific impact on DNA damage and repair remains unknown. This study explorers the effect of different radiation qualities (photons, protons, carbon, and iron ions) on the DNA damage and repair of cortisol-conditioned primary human dermal fibroblasts. Besides, we introduce a new measure, the Foci-Integrated Damage Complexity Score (FIDCS), to assess DNA damage complexity by analyzing focus area and fluorescent intensity. Our results show that the FIDCS captured the DNA damage induced by different radiation qualities better than counting the number of foci, as traditionally done. Besides, using this measure, we were able to identify differences in DNA damage between cortisol-exposed cells and controls. This suggests that, besides measuring the total number of foci, considering the complexity of the DNA damage by means of the FIDCS can provide additional and, in our case, improved information when comparing different radiation qualities.

Association between maltreatment, hair cortisol concentration, positive parent-child interaction, and psychosocial outcomes in Chinese preschool children.

Children now are facing an increasing risk of early life stress (ELS), which leads to detrimental psychosocial outcomes. Behavior studies suggested that positive parental interactions might moderate the negative impact of ELS, but the related biological alteration remains unclear. This study aims to investigate whether positive parent-child interactions moderate the association between maltreatment (as a severe form of ELS) and hair cortisol concentration (HCC), as well as between HCC and psychosocial outcomes in young children. Participants were 6-year-old Chinese children (N = 257, Mage = 6.2, 121 were male) selected by stratified cluster random sampling from a Shanghai population representative cohort. Proximal 3cm hair strands were analyzed using liquid chromatography coupled with tandem mass spectrometry for HCC. Children's psychosocial outcome was evaluated using the parental report Strengths and Difficulties Questionnaire (SDQ). Parents also reported the frequency of positive parent-child interactions using the Chinese Parent-Child Interaction Scale (CPCIS) as well as the history of maltreatment. Multi-level logistic regression models adjusting for individual, kindergarten, and district confounders were used to evaluate the associations between maltreatment, HCC, and psychosocial outcomes. Interactions terms tested whether more frequent positive parent-child interactions moderates the association between maltreatment and HCC, as well as between HCC and psychosocial outcomes. Maltreated children exhibited higher levels of HCC (B = 1.20, 95% CI: 0.38,2.02; p = 0.004), and children with higher HCC exhibited poorer psychosocial outcomes (B = 0.34, 95% CI: 0.18,0.51; p < 0.001). Positive parent-child interactions did not have a moderating effect on the association between maltreatment and HCC, but they demonstrated a moderating effect on the association between increased HCC and psychosocial outcomes (interaction term: B = -0.42, 95% CI: -0.75,-0.10; p = 0.01). These findings provide evidence that positive parental interaction may serve as a moderator between chronic cortisol exposure and psychosocial problems. It highlights the importance of frequent parent-child interactions, especially among children under a high risk of ELS.

Glucocorticoid receptor activation reduces food intake independent of hyperglycemia in zebrafish

Chronic cortisol exposure suppresses food intake in fish, but the central mechanism(s) involved in appetite regulation are unclear. Stress and the associated increase in cortisol levels increase hepatic gluconeogenesis, leading to hyperglycemia. As hyperglycemia causes a reduction in food intake, we tested the hypothesis that cortisol-induced hyperglycemia suppresses feeding in zebrafish (Danio rerio). We first established that stress-independent hyperglycemia suppressed food intake, and this corresponded with a reduction in the phosphorylation of the nutrient sensor, AMP-activated protein kinase (AMPK) in the brain. Chronic cortisol exposure also led to hyperglycemia and reduced food intake, but the mechanisms were distinct. In cortisol-exposed fish, there were no changes in brain glucose uptake or AMPK phosphorylation. Also, the phosphorylation of Akt and mTOR was reduced along with an increase in redd1, suggesting an enhanced capacity for proteolysis. Loss of the glucocorticoid receptor did not rescue cortisol-mediated feeding suppression but did increase glucose uptake and abolished the changes seen in mTOR phosphorylation and redd1 transcript abundance. Taken together, our results indicate that GR activation enhances brain proteolysis, and the associated amino acids levels, and not hyperglycemia, maybe a key mediator of the feeding suppression in response to chronic cortisol stimulation in zebrafish.

Cortisol changes in healthy children and adolescents during the COVID-19 pandemic

The Coronavirus Disease 2019 (COVID-19) pandemic has caused massive disruptions to daily life in the United States, closing schools and businesses and increasing physical and social isolation, leading to deteriorations in mental health and well-being in people of all ages. Many studies have linked chronic stress with long-term changes in cortisol secretion, which has been implicated in many stress-related physical and mental health problems that commonly emerge in adolescence. However, the physiological consequences of the pandemic in youth remain understudied. Using hair cortisol concentrations (HCC), we quantified average longitudinal changes in cortisol secretion across a four-month period capturing before, during, and after the transition to pandemic-lockdown conditions in a sample of healthy youth (n = 49). Longitudinal changes in HCC were analyzed using linear mixed-effects models. Perceived levels of pandemic-related stress were measured and compared to the physiological changes in HCC. In children and adolescents, cortisol levels significantly increased across the course of the pandemic. These youth reported a multitude of stressors during this time, although changes in HCC were not associated with self-reported levels of COVID-19-related distress. We provide evidence that youth are experiencing significant physiological changes in cortisol activity across the COVID-19 pandemic, yet these biological responses are not associated with perceived stress levels. Youth may be especially vulnerable to the deleterious impacts of chronic cortisol exposure due to their current status in the sensitive periods for development, and the incongruency between biological and psychological stress responses may further complicate these developmental problems.

Avocado oil (Persea americana) protects SH-SY5Y cells against cytotoxicity triggered by cortisol by the modulation of BDNF, oxidative stress, and apoptosis molecules.

Chronic psycho-environmental stress can induce neurological dysfunction due to an increase in cortisol levels. It is possible that some food supplements could attenuate its negative impact, such as avocado oil (AO), which is rich in fatty acids with beneficial effects on the brain. This hypothesis was tested by an in vitro model using undifferentiated neuroblastoma cells (SH-SY5Y) exposed to hydrocortisone (HC), an active cortisol molecule with and without AO-supplementation. Cortisol can induce oxidative stress, apoptosis events, and a lowering effect on brain-derived neurotrophic factor (BDNF), a neurogenic molecule. As AO protective effects on HC-exposed cells could involve these routes, some markers of these routes were compared among neuroblastoma cultures. In the first assay, the range concentrations of HC exposure that trigger cell mortality and range AO-concentrations that could revert the HC effect. AO at all concentrations tested (2-30µg/ml) did not present a cytotoxic effect on SH-SY5Y cells, whereas HC at 0.3-10ng/ml had a dose-dependent cytotoxic effect on these cells. From these results, HC at 10ng/ml and AO at 5µg/ml were chosen for mechanistic analysis. AO was able to decrease the oxidative molecules; however, both AO- and HC-induced differential and varied gene expression modulation of these enzymes. AO partially reverted the protein and gene expression of apoptotic markers that were higher in HC-exposed cells. AO also increases the BDNF levels, which are lower HC-exposed cultures. The results indicate that AO could be a beneficial supplement in situations where cortisol levels are elevated, including chronic psycho-environmental stress. PRACTICAL APPLICATIONS: Psychological chronic stress that induces high cortisol exposure has been linked to premature aging and decreased healthy life expectancy. Neurobiological models involving cortisol have suggested a neurotoxic effect of this molecule, increasing the risk of psychiatric and other CNTDs. This effect can have a high impact mainly in infants and elderly people. In child abuse situations, chronic cortisol exposure could induce extensive apoptosis events, causing impairment in synaptogenesis. In both age groups, chronic cortisol exposure increased the risk of psychiatric conditions, especially anxiety and major depression. However, it is possible that the negative effects associated with chronic cortisol exposure could be attenuated by some food supplements. This is the case for molecules acquired through diet, such as polyunsaturated fatty acids (PUFAs), including omega-3. As inadequate omega-3 levels in the brain can increase the risk factor for neuropsychiatric disorders, it is possible to infer that some from food supplements, such as avocado oil, could attenuate the neurotoxic effects of chronic cortisol exposure. This hypothesis was tested using an exploratory in vitro protocol, and the results suggested that avocado oil could be used as a cytoprotective food supplement by decreasing the oxidative stress and apoptotic events induced by cortisol.

Klf9 is a key feedforward regulator of the transcriptomic response to glucocorticoid receptor activity

The zebrafish has recently emerged as a model system for investigating the developmental roles of glucocorticoid signaling and the mechanisms underlying glucocorticoid-induced developmental programming. To assess the role of the Glucocorticoid Receptor (GR) in such programming, we used CRISPR-Cas9 to produce a new frameshift mutation, GR369-, which eliminates all potential in-frame initiation codons upstream of the DNA binding domain. Using RNA-seq to ask how this mutation affects the larval transcriptome under both normal conditions and with chronic cortisol treatment, we find that GR mediates most of the effects of the treatment, and paradoxically, that the transcriptome of cortisol-treated larvae is more like that of larvae lacking a GR than that of larvae with a GR, suggesting that the cortisol-treated larvae develop GR resistance. The one transcriptional regulator that was both underexpressed in GR369- larvae and consistently overexpressed in cortisol-treated larvae was klf9. We therefore used CRISPR-Cas9-mediated mutation of klf9 and RNA-seq to assess Klf9-dependent gene expression in both normal and cortisol-treated larvae. Our results indicate that Klf9 contributes significantly to the transcriptomic response to chronic cortisol exposure, mediating the upregulation of proinflammatory genes that we reported previously.

DNA methylation and sex-specific expression of FKBP5 as correlates of one-month bedtime cortisol levels in healthy individuals

Chronic exposure to cortisol is associated with cardiovascular, metabolic, and psychiatric disorders. Although cortisol can be readily measured from peripheral sources such as blood, urine, or saliva, multiple samplings spanning several days to weeks are necessary to reliably assess chronic cortisol exposure levels (referred to as cortisol load). Although cortisol levels in hair have been proposed as a measure of cortisol load, measurement is cumbersome and many people are not candidates due to short hair length and use of hair dyes. To date, there are no blood biomarkers that capture cortisol load.To identify a blood biomarker capable of integrating one-month cortisol exposure levels, 75 healthy participants provided 30+ days of awakening and bedtime saliva cortisol and completed psychosocial measures of anxiety, depression, and stress. Mean daily awakening and bedtime cortisol levels were then compared to CpG methylation levels, gene expression, and genotypes of the stress response gene FKBP5 obtained from blood drawn on the last day of the study.We found a correlation between FKBP5 methylation levels and mean 30+day awakening and bedtime cortisol levels (|r|≥0.32, p ≤ 0.006). We also observed a sex-specific correlation between bedtime cortisol levels and FKBP5 mRNA expression in female participants (r = 0.42, p = 0.005). Dividing the 30-day sampling period into four weekly bins showed that the correlations for both methylation and expression were not being driven by cortisol levels in the week preceding the blood draw. We also identified a female-specific association between FKBP5 mRNA expression and scores on the Beck Anxiety Inventory (r = 0.37, p = 0.013) and Beck Depression Inventory-II (r = 0.32, p = 0.033). Finally, DNA was genotyped at four SNPs, and variation in rs4713902 was shown to have an effect on FKBP5 expression under a codominant model (f = 3.41, p = 0.048) for females only.Our results suggest that blood FKBP5 DNA methylation and mRNA expression levels may be a useful marker for determining general or sex-specific 30-day cortisol load and justifies genome-wide approaches that can potentially identify additional cortisol markers with broader clinical utility.

Type 2 diabetes and cardiometabolic risk may be associated with increase in DNA methylation of FKBP5

BackgroundSubclinical hypercortisolism and hypothalamic-pituitary-adrenal (HPA) axis dysfunction are associated with type 2 diabetes (T2DM), cardiovascular disease, and metabolic dysfunction. Intronic methylation of FKBP5 has been implicated as a potential indicator of chronic cortisol exposure. Our overall objective in this study was to determine the association of chronic cortisol exposure, measured via percent methylation of FKBP5 at intron 2, with percent glycosylated hemoglobin (HbA1c), low-density lipoprotein cholesterol (LDL-cholesterol), waist circumference (WC), and body mass index (BMI), in a clinic-based sample of 43 individuals with T2DM.ResultsGreater percent methylation of the FKBP5 intron 2 at one CpG-dinucleotide region was significantly associated with higher HbA1c (β = 0.535, p = 0.003) and LDL cholesterol (β = 0.344, p = 0.037) and a second CpG-dinucleotide region was significantly associated with higher BMI and WC (β = 0.516, p = 0.001; β = 0.403, p = 0.006, respectively).ConclusionsFKBP5 methylation may be a marker of higher metabolic risk in T2DM, possibly secondary to higher exposure to cortisol. Further work should aim to assess the longitudinal association of FKBP5 with cardiovascular disease and glycemic outcomes in T2DM as a first step in understanding potential preventive and treatment-related interventions targeting the HPA axis.

Mapping Hair Cortisol Concentrations Across Body Sites to Study Health Disparities

Perceived discrimination, poverty, and environmental stress stimulates the release of cortisol, the primary stress hormone, through the hypothalamic–pituitary–adrenal (HPA) axis. Chronic stress, a long‐term form of stress, increases the risk of various diseases, including; diabetes, hypertension, and inflammatory and autoimmune disorders among all populations. Unfortunately, ethnic minorities experience higher levels of chronic stress, and bear the burden of health disparities. Hair cortisol is a retrospective biological marker for cortisol exposure and can be used as an integrated measure of long‐term HPA activity and chronic stress. However, studies that use hair from the scalp may face collection challenges due to the symbolic and spiritual meaning that is carried by locks of hair among populations particularly affected by health disparities. Therefore, identifying alternatives for the measurement of chronic cortisol exposure would enable inclusion of diverse population in health disparities research. The purpose of this study is to determine if hair across body sites can be used for cortisol analysis to investigate chronic stress among populations affected by health disparities. I hypothesized that hair from arms, legs, and pelvic area will be correlated to scalp hair cortisol levels, and could be used to assess chronic cortisol levels. In this study, participants were asked to provide hair samples from the following four regions of the body; the scalp, arms, legs, and pelvic region. Hair samples were processed, and cortisol was extracted using the established methanol method. Cortisol was quantified using an Enzyme‐Linked Immunosorbent Assay. A total of eight participants were recruited, five females and three males. Participants represented 4 different ethnic groups and were of recruited from a University. 25% of participants provided samples from all four hair sites, while 62.5% provided all but pubic hair. Average cortisol levels ranged from 236 pg/ml in the scalp to 1020 pg/ml in the legs. Linear correlation analysis was conducted to determine the relationship between hair cortisol concentration (HCC) from the scalp and other areas of the body. Our preliminary analysis shows trends suggesting that arm and leg hair may be culturally appropriate samples for hair cortisol analysis. In conclusion, this study revealed cortisol levels across body hair sites, and highlights the need to incorporate culturally acceptable biomarkers to address and eliminate health disparities.Support or Funding InformationCCSF/SMCCD/SFSU BRIDGES TO THE BACCALAUREATE PROGRAM: R25 GM050078SFSU SF BUILD: ENABLING STUDENTS TO REPRESENT IN SCIENCE‐ TL4 GM118986This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Predicting hair cortisol levels with hair pigmentation genes: a possible hair pigmentation bias

Cortisol concentrations in hair are used to create hormone profiles spanning months. This method allows assessment of chronic cortisol exposure, but might be biased by hair pigmentation: dark hair was previously related to higher concentrations. It is unclear whether this association arises from local effects, such as increased hormone extractability, or whether the association represents systemic differences arising from population stratification. We tested the hypothesis that hair pigmentation gene variants are associated with varying cortisol levels independent of genetic ancestry. Hormone concentrations and genotype were measured in 1674 children from the Generation R cohort at age 6. We computed a polygenic score of hair color based on 9 single nucleotide polymorphisms. This score was used to predict hair cortisol concentrations, adjusted for genetic ancestry, sex, age and corticosteroid use. A 1-standard deviation (SD) higher polygenic score (darker hair) was associated with 0.08 SD higher cortisol levels (SE = 0.03, p = 0.002). This suggests that variation in hair cortisol concentrations is partly explained by local hair effects. In multi-ancestry studies this hair pigmentation bias can reduce power and confound results. Researchers should therefore consider adjusting analyses by reported hair color, by polygenic scores, or by both.

Quality of life in patients with adrenal insufficiency correlates stronger with hydrocortisone dosage, than with long-term systemic cortisol levels

In patients with adrenal insufficiency (AI) a higher hydrocortisone intake has been associated with more impairment in quality of life (QoL). Irrespective of age, sex and severity of AI the dosage of hydrocortisone is titrated around 20mg/D in all patients with AI based on physical and mental signs and symptoms. However, until now it is unknown whether these QoL impairments are related to increased systemic cortisol exposure. Measurement of hair cortisol levels (CORThair) can be used to assess chronic systemic cortisol exposure. This study aimed to explore whether QoL in patients with AI is associated with CORThair and daily hydrocortisone intake. We performed a cross-sectional study in 120 patients with AI on stable hydrocortisone replacement, in whom hair samples and QoL data were collected. CORThair were measured with ELISA, and QoL was assessed with validated questionnaires (SF-36, EQ-5D, HADS, MFI-20). Patients reported impairments in 14 of 15 QoL subscales (p<0.001). More impairments in physical aspects of QoL correlated with higher CORThair and higher daily hydrocortisone intake (p<0.05), an effect that was more pronounced in female patients. Regression analyses including both CORThair and hydrocortisone intake revealed a significant negative contribution of higher hydrocortisone intake on physical aspects of QoL (p≤0.046), whereas no significant contribution was found for CORThair.The present study showed that patients with AI report several impairments in QoL which are associated with hydrocortisone intake, and to a lesser extent reflected by chronic systemic cortisol exposure as measured by hair cortisol. This suggests that QoL impairments in patients with AI are not per se the effect of prolonged exposure to elevated systemic cortisol levels.

Cortisol is not associated with telomere shortening or chromosomal instability in human lymphocytes cultured under low and high folate conditions.

Chronic psychological stress and nutritional deficiencies are factors that impact negatively on human health and disease risk. Chronic stress has been associated with accelerated leukocyte telomere shortening in numerous cohorts, however, a mechanistic link has proven elusive. This study tested the hypotheses that chronic exposure to the stress hormone, cortisol, causes telomere shortening and chromosome instability (CIN) in vitro, and that these effects would be further exacerbated by folate (vitamin B9) deficiency. Primary human lymphocytes were maintained in vitro for 12 days in medium containing either 25 nM folic acid (FA(low)) or 100 nM FA (FA(high)), together with either 0, 400, 1000 or 3500 nM cortisol. The interactive effects of cortisol and FA were examined by comparing telomere length (TL), biomarkers of DNA damage, and cytostasis. At day 12 TL was 5-17% longer in lymphocytes cultured in FA(low) conditions (mean ± SD;10.2% ± 1.6), compared with those in FA(high) medium (9.1% ± 1, p = 0.02). Refuting the hypothesis, TL was consistently greater in the presence of cortisol. The effect of FA deficiency on the frequency of DNA damage was significant for nucleoplasmic bridges, circular nuclei, micronuclei and nuclear buds, (p < 0.0001 – 0.001). The effect of cortisol, however, was negligible, only reaching statistical significance for the frequency of fused nuclei (p = 0.04). Cortisol was significantly associated with reduced cell division and growth and had an apparent protective effect on cell viability in the FA(low) conditions. Conclusions: Both chronic cortisol exposure, and folate deficiency, resulted in telomere elongation, however, the effect of cortisol was marginal relative to that of folate. Cortisol was not associated with increased chromosomal instability, but caused a significant reduction in cell division and growth. Together these results indicate that cortisol is not directly genotoxic and that the telomere shortening associated with increased psychological stress in vivo may not be explained by a direct effect of cortisol.

The effects of threatened social evaluation of the physique on cortisol activity

Social self preservation theory asserts that situations high in social-evaluative threat elicit increases in cortisol, a hormone released by the hypothalamic-pituitary-adrenal axis. Most tests of the theory have examined threats associated with social evaluation of a performance. Two experiments examined the effects of threatened social evaluation of one's physique. In Experiments 1 (n = 50) and 2 (n = 40), participants allocated to an experimental (threat) condition had significantly higher post-manipulation cortisol than participants in a control (no threat) condition. In Experiment 1, perceptions of social-evaluative threat were significantly correlated with post-manipulation cortisol levels. These results suggest that the threatened social evaluation of one's body can activate the cortisol response. Women who frequently experience such threats may be at increased risk for a variety of health conditions associated with chronic cortisol exposure.

Reliability of hypothalamic–pituitary–adrenal axis assessment methods for use in population-based studies

Population-based studies have been hampered in exploring hypothalamic-pituitary-adrenal axis (HPA) activity as a potential explanatory link between stress-related and metabolic disorders due to their lack of incorporation of reliable measures of chronic cortisol exposure. The purpose of this review is to summarize current literature on the reliability of HPA axis measures and to discuss the feasibility of performing them in population-based studies. We identified articles through PubMed using search terms related to cortisol, HPA axis, adrenal imaging, and reliability. The diurnal salivary cortisol curve (generated from multiple salivary samples from awakening to midnight) and 11 p.m. salivary cortisol had the highest between-visit reliabilities (r = 0.63-0.84 and 0.78, respectively). The cortisol awakening response and dexamethasone-suppressed cortisol had the next highest between-visit reliabilities (r = 0.33-0.67 and 0.42-0.66, respectively). Based on our own data, the inter-reader reliability (r(s)) of adrenal gland volume from non-contrast CT was 0.67-0.71 for the left and 0.47-0.70 for the right adrenal glands. While a single 8 a.m. salivary cortisol is one of the easiest measures to perform, it had the lowest between-visit reliability (R = 0.18-0.47). Based on the current literature, use of sampling multiple salivary cortisol measures across the diurnal curve (with awakening cortisol), dexamethasone-suppressed cortisol, and adrenal gland volume are measures of HPA axis tone with similar between-visit reliabilities which likely reflect chronic cortisol burden and are feasible to perform in population-based studies.

Can incidence of depression in women be linked to estrogen dependent secretion of various hormone binding proteins?

This paper describes a possible framework of hormones and their binding proteins (BPs) that might be responsible for the increased incidence of depression in women, including postnatal depression. It is based on three reported facts: Increased cortisol exposure reduces growth hormone (GH) secretion. Cortisol and GH show opposite effects on mood. Liver secretion of various hormone binding proteins is increased under estrogen exposure. If we accept that pure cortisol exposure leads to depressive mood, while simultaneous brain exposure to cortisol and an anabolic (growth hormone or somatomammotropin) is less mood affecting, the occurrence of depression an be more likely in persons: with altered sleep patterns and thus reduced GH secretion, in individuals with increased chronic cortisol exposure (any individual under repeated or sustained stress, older individuals with stressful memories, etc.). The proposed mechanism can be enhanced in women of reproductive age through increased transcortin and GH BP pools due to estrogen action on liver. A particularly vulnerable phase seems to be the early postnatal period, when sudden discontinuation of somatomammotropin anabolic actions might lead to postnatal depression that takes weeks or months to resolve, until the GH/cortisol circadian rhythm normalization.

Microarray analysis of cultured human brain aggregates following cortisol exposure: Implications for cellular functions relevant to mood disorders

Increased cortisol levels in humans are often observed in patients suffering from mood disorders. In this study human fetal brain aggregates were exposed to cortisol at 500 nM for 3 weeks, as an in-vitro model of chronic cortisol exposure. Microarray analysis on extracted mRNA using the Affymetrix U133A platform was then performed. Our results demonstrated a significant effect of cortisol on 1648 transcripts; 736 up-regulated and 912 down-regulated genes. The most differentially regulated biological categories were: RNA processing, protein metabolism, and cell growth. Within these categories we observed a down-regulation of fibroblast growth factor 2 (FGF2) (-1.5-fold) and aquaporin4 (AQP4) (-1.7-fold), alongside an up-regulation of fibroblast growth factor 9 (FGF9) (+1.7-fold) and vesicle associated membrane protein2 (VAMP2) (+1.7-fold). FGF2, FGF9, AQP4 and VAMP2 changes were confirmed at the protein level by immunohistochemistry. Alterations in FGF transcripts are in keeping with recent literature demonstrating such effects in patients with mood disorders.

Comment on: Reduced plasma levels of NGF and BDNF in patients with acute coronary syndromes

We appreciate the comment by Mackin and Gallagher relative to our article about reduced plasma levels of NGF and BDNF in patients with acute coronary syndromes (ACS) [2]. Mackin and Gallagher suggested that the results may be explained by the stress. Indeed, ACS is a highly dynamic phenomenon associated with neuroendocrine and proinflammatory activation ([3], also see Mackin and Gallagher’s refs. [3,4]), and, note, including adrenal insufficiency [4]. We may argue that reduced NGF/BDNF plasma levels in ACS are not due to stress-induced elevated cortisol presence in ACS. Our previous results demonstrated that various stressful events upregulated NGF ([5], reviewed in [6]). These data also revealed that the increased NGF level preceded the increased plasma cortisol and adrenocorticotropic hormone levels. Further, stress-induced increase in hypothalamic BDNF expression [7], as well as the increase in hippocampal BDNF presence in response to chronic cortisol exposure [8], were recently reported. This appears not to be consistent with the downregulation of NGF and BDNF as pointed by Mackin and Gallagher. On that background, why ‘‘cardiovascular’’ stressors such as ACS [2], (our present study), heart failure ([2], their ref. [9]), and metabolic syndrome ([2], their refs. [6,8]) are featured by decreased plasma and tissue levels of these neurotrophins is at present unclear. We wonder whether a link between testosterone [9], neurotrophin deficiency and the development of atherosclerotic cardiovascular disease could exist. From pioneering studies of Rita Levi-Montalcini it is known that there is a positive correlation between NGF and testosterone levels [10].

Chronic cortisol exposure promotes the development of a GABAergic phenotype in the primate hippocampus

Glucocorticoids regulate plasticity and survival of hippocampal neurons. Aberrant exposure to this steroid hormone can result in neurodegeneration, perhaps secondary to disruption of calcium homeostasis. Calbindin, a calcium-binding protein that buffers excess calcium, may protect against neurodegeneration resulting from overabundance of intracellular calcium. In this study, we examined whether chronic treatment (1 year) with cortisol enhances hippocampal calbindin expression in primates. Calbindin is a marker for inhibitory neurons and the dentate gyrus is known to adopt an inhibitory phenotype in response to extreme conditions such as seizures. Thus, we hypothesized that chronic cortisol exposure may also promote a GABAergic phenotype. Therefore, we examined the expression of the GABA-synthesizing enzyme glutamic acid decarboxylase. The expression of brain-derived neurotrophic factor, which is responsive to glucocorticoids, was also examined. Our results demonstrate significant increases in calbindin, glutamic acid decarboxylase and brain-derived neurotrophic factor in several regions of the primate hippocampus, including the dentate gyrus and CA3, in response to chronic cortisol exposure. These results suggest that chronic cortisol exposure may shift the balance towards a GABAergic phenotype, perhaps as part of a compensatory feedback mechanism to dampen the initial excitatory effects of glucocorticoids in the hippocampus.