[Immune factors or depression? Fatigue correlates in Parkinson's disease]. / Factores inmunes o depresión? La fatiga relacionada con la enfermedad de Parkinson.

INTRODUCTION: Fatigue is a frequent symptom in Parkinson disease (PD), but its pathogenesis remains obscure. Fatigue may be influenced by depression and motor disability, but immunological factors have been also implicated. The purpose of the study was to assess fatigue in PD patients in relation to depression and various immunological factors. SUBJECTS AND METHODS: Forty PD patients and 26 normal matched controls were studied. Fatigue was assessed by the Fatigue Severity Scale (FSS). The Beck Depression Inventory (BDI) was employed for depression screening. The following immunological factors were estimated: a) T- and B-lymphocytes, T-lymphocyte subsets (helper/suppressor cells) as well as natural killer cells (NK); b) circulating levels of interleukins IL-1alpha, IL-1beta, IL-6, IL-1 receptor antagonist (IL-1Ra) and tumor necrosis factor-alpha. RESULTS: FSS mean score was higher in PD patients compared to controls (p < 0.01). Significant differences between patients and controls were found in the following immunological parameters. In PD patients: a) mean percentage of NK cells was higher, p < 0.01); b) IL-1beta levels were significantly increased (p < 0.01) and IL-1Ra levels were decreased (p < 0.001). FSS correlated significantly to BDI (p < 0.008). Circulating Il-1Ra levels correlated to fatigue severity (p < 0.01), but after exclusion of depressed PD subjects this correlation significance level dropped to p = 0.055. CONCLUSIONS: Our results indicate that fatigue is a common non motor symptom in PD. Immunological differences between PD patients and controls were observed in percentages of NK cells, IL-1beta and IL-1Ra blood levels. Fatigue correlated to depression and IL-Ra levels. However after exclusion of depressed subjects IL-1Ra levels showed only a tendency to significance, leaving depression as the principle correlate of fatigue.

¿Factores inmunes o depresión? La fatiga relacionada con la enfermedad de Parkinson / Immune factors or depression? Fatigue correlates in parkinson’s disease

La fatiga es un síntoma frecuente en la enfermedad de Parkinson (EP), pero su patogénesis permanecesin aclarar. El propósito de este estudio fue evaluar la fatiga de pacientes con EP en relación con los factores inmunológicos.Sujetos y métodos. Se estudiaron 40 pacientes con EP y 26 sujetos control. La fatiga se evaluó con la Fatigue SeverityScale (FSS). Se empleó el Beck Depression Inventory (BDI) para examinar la depresión. Como factores inmunológicos se estudiaron los linfocitos T y B, subclases de linfocitos T (helper y supressor), así como las células natural killer (NK), y los nivelessanguíneos de interleucinas IL-1alfa, IL-1beta, IL-6, el antagonista del receptor de IL-1 (IL-1Ra) y el factor de necrosis tumoral alfa. Resultados. Se encontró significación estadística (p < 0,01) entre los niveles sanguíneos de IL-1Ra y la gravedad de la fatiga, pero tras excluir los pacientes con depresión y EP, el nivel de significación disminuyó a p = 0,055. Conclusiones.Se hallaron diferencias inmunológicas en los niveles sanguíneos de pacientes con EP y sujetos control en los porcentajes de células NK, IL-1beta e IL-1Ra. La fatiga correlacionaba con la depresión y los niveles de IL-1Ra. Sin embargo, tras la exclusión de los pacientes con depresión, los niveles de IL-1Ra mostraron sólo una tendencia hacia la significación, y situarona la depresión como el principal factor correlacionado con la fatiga

Fatigue is a frequent symptom in Parkinson disease (PD), but its pathogenesis remains obscure.Fatigue may be influenced by depression and motor disability, but immunological factors have been also implicated. The purpose of the study was to assess fatigue in PD patients in relation to depression and various immunological factors.Subjects and methods. Forty PD patients and 26 normal matched controls were studied. Fatigue was assessed by the Fatigue Severity Scale (FSS). The Beck Depression Inventory (BDI) was employed for depression screening. The following immunological factors were estimated: a) T-and B-lymphocytes, T-lymphocyte subset(helper/suppressor cells) as well as natural killer cells (NK); b) circulating levels of interleukins IL-1alpha, IL-1beta, IL-6, IL-1 receptor antagonist (IL-1Ra) andtumor necrosis factor-alpha. Results. FSS mean score was higher in PD patients compared to controls (p < 0.01). Significant differences between patients and controls were found in the following immunological parameters. In PD patients: a) mean percentage of NK cells was higher, p < 0.01); b) IL-1beta levels were significantly increased (p < 0.01) and IL-1Ra levels weredecreased (p < 0.001). FSS correlated significantly to BDI (p < 0.008). Circulating Il-1Ra levels correlated to fatigue severity (p < 0.01), but after exclusion of depressed PD subjects this correlation significance level dropped to p = 0.055. Conclusions.Our results indicate that fatigue is a common non motor symptom in PD. Immunological differences between PD patients and controls were observed in percentages of NK cells, IL-1beta and IL-1Ra blood levels. Fatigue correlated to depression and IL-Ra levels. However after exclusion of depressed subjects IL-1Ra levels showed only a tendency to significance, leaving depression as the principle correlate of fatigue

Tumor necrosis factor-alpha serum levels, weight loss and tissue oxygenation in chronic obstructive pulmonary disease.

Weight loss has been recognized as a feature of advanced emphysema and a factor of poor prognosis, but its mechanisms remain obscure. Studies have demonstrated high serum concentrations of TNF-a (cachexin) in chronic obstructive pulmonary disease (COPD) patients with emphysema. Pink puffers (PP) COPD patients have worse tissue oxygenation when compared with blue bloaters (BB) COPD patients. Consequently, PP patients would become cachectic, whereas BB patients with better tissue oxygenation would not. The aim of this study is to test the hypothesis that malnutrition in emphysema is a cytokine-mediated marker of chronic progressive tissue hypoxia. Thirty male COPD patients, without clinical or laboratory evidence of infection and severe air way obstruction (FEV1 < 1.5 l) were allocated: 16 as pink puffers (PP) and 14 as blue bloaters (BB). Lung function measurements included FEV1, FVC, RV, TLC, DLCO and arterial blood gases on room air. TNF-a serum levels were measured by immunoenzymic method (ELISA). Tissue oxygenation was assessed from oxygen delivery (DO2), PvO2 and oxygen extraction ratio (O2ER) obtained after right heart catheterization with Swan Ganz catheter. PP patients demonstrated lower DLCO and higher TLC, FRC and PaO2 from BB. We found that oxygen delivery was better in our BB than in PP patients (CI 2.9 +/- 0.2 vs 2.5 +/- 0.4 l/min/m2--P < 0.01, DO2 16.1 +/- 2.1 vs 13.1 +/- 0.2 ml/min/kg--P < 0.001) and the same was found for tissue oxygenation (PvO2 34.6 +/- 2.9 vs 31.2 +/- 3.8 mmHg--P < 0.01, O2ER 0.27 +/- 0.02 vs 0.34 +/- 0.06%--P < 0.001). The TNF-a values were higher in PP (31.3 +/- 26 pg/ml vs 15.2 +/- 9.9 pg/ml--P < 0.05) and their percent fat-free mass (%FFM) was 49.6 +/- 11.5 vs 42 +/- 8%--P < 0.001. We found that COPD patients with lower DO2 had increased TNF-a levels; but the correlations between TNF-a serum levels and PvO2 or O2ER were not statistically significant. TNF-a levels were elevated in PP patients with tissue hypoxia and may be a factor contributing to the weight loss of these patients.

Immunological parameters in patients with epilepsy.

Various immunological parameters (IgA, IgG, IgM serum levels, C3 and C4 complement components and T and B lymphocytes and T-lymphocyte subsets) were determined in 50 patients with epilepsy (20 without medication, 15 on carbamazepine and 15 on valproate) and in 20 controls. The epileptic group had fewer CD4 and more CD8 lymphocytes, while the CD4/CD8 ratio was lower; the levels of IgG and IgM were increased and C4 complement component was also decreased. Patients without medication showed all the above mentioned abnormalities. Patients on carbamazepine had a lower CD4/CD8 ratio, increased IgG and IgM levels and decreased C4 complement component while patients on valproate had more CD8 lymphocytes, a lower CD4/CD8 ratio, increased levels of IgM and decreased C4 complement component. Our results indicate that there is a defective immune mechanism in epileptic patients modified by treatment.