Cited by 339Stress Responses and CortisolTryptophan and brain disordersTreatment of Major Depression

The DOI matches its Crossref record, with a small difference in title or year; 127 of the 127 references it cites were found in a registry or an index; 43 of the 164 sources its claims cite were checked for support.

Cytokines and Glucocorticoid Receptor Signaling

Open access
Pace, Thaddeus W. W., Miller, Andrew H.·2009·Annals of the New York Academy of Sciences

Abstract

Data suggest that the activation of immune responses and the release of inflammatory cytokines may play a role in the pathophysiology of major depression. One mechanism by which cytokines may contribute to depression is through their effects on the glucocorticoid receptor (GR). Altered GR function in depression has been demonstrated by neuroendocrine challenge tests that reliably reveal reduced GR sensitivity as manifested by nonsuppression of cortisol following dexamethasone administration in vivo and lack of immune suppression following administration of glucocorticoids in vitro. Relevant to the GR, cytokines have been shown to decrease GR expression, block translocation of the GR from cytoplasm to nucleus, and disrupt GR‐DNA binding through nuclear protein‐protein interactions. In addition, cytokines have been shown to increase the expression of the relatively inert GR beta isoform. Specific cytokine signaling molecules that have been shown to be involved in the disruption of GR activity include p38 mitogen‐activated protein kinase, which is associated with reduced GR translocation, and signal transducer and activator of transcription (STAT)5, which binds to GR in the nucleus. Nuclear factor‐κB (NF‐κB) also has been shown to lead to GR suppression through mutually inhibitory GR‐NF‐κB nuclear interactions. Interestingly, several antidepressants have been shown to enhance GR function, as has activation of protein kinase A (PKA). Antidepressants and PKA activation have also been found to inhibit inflammatory cytokines and their signaling pathways, suggesting that drugs that target both inflammatory responses and the GR may have special efficacy in the treatment of depression.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

This review proposes that innate immune cytokines contribute to glucocorticoid resistance in major depression by disrupting glucocorticoid receptor (GR) signaling at multiple levels, including GR translocation, DNA binding, and isoform expression. It further suggests that treatments enhancing GR function while inhibiting inflammatory pathways may have special efficacy in depression.

Key findings

  • Cytokines reduce GR function through p38 MAPK, JNK, ERK, Jak-STAT5, and NF-κB signaling, affecting GR translocation, GR-DNA binding, protein-protein interactions, and GR isoform expression. In HeLaS3 and CEMC7 cells, TNF-α or IL-1 increased hGR-β expression two-fold while increasing hGR-α only 1.5-fold.
  • Major depression is associated with both increased inflammatory markers and glucocorticoid resistance; DEX nonsuppression rates in depressed patients range from 25% to 80% depending on age, sex, severity, and test type, with the DEX-CRF test believed more sensitive than the DST.
  • In an IFN-α model, 45% of patients receiving high-dose IFN-α for cancer met criteria for major depression, and one third dropped out due to behavioral toxicity; 12 weeks of IFN-α plus ribavirin flattened the cortisol curve, which correlated with depressive symptoms and fatigue.
  • Chronic caregiving stress was associated with increased monocyte expression of NF-κB promoter-containing genes and decreased GR promoter-containing genes, increased IL-1ra and CRP (mean >3 mg/L, high-risk category), with no group difference in salivary cortisol over 3 consecutive days.

Methods

  • Narrative review synthesizing published in vitro, animal, and human studies on cytokine effects on GR signaling and their relevance to major depression.
  • Evidence reviewed includes cell lines (e.g., mouse L929 fibroblasts, rat PC12 cells, human cells), animal stress models, and human studies of depression, IFN-α treatment, and chronic caregiving stress.
  • Main analysis is qualitative synthesis of cited literature, including mechanistic pathways and treatment implications; no primary experimental cohort or systematic search is described.

Limitations

  • Stated: a role for hGR-β in major depression has yet to be established; whether the reciprocal inflammatory-GR relationship occurs in depression remains to be established; future studies are needed to examine the relative balance of glucocorticoid and innate immune signaling and therapeutic strategies.
  • Stated: cross-sectional studies of inflammation and glucocorticoid resistance in major depression have yielded mixed results.
  • Evident: as a narrative review, it lacks a systematic search or meta-analysis, and causal direction in human depression is not established; many mechanistic findings derive from cell lines or animal models.

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Integrity signals

Registry

Crossref · 10.1111/j.1749-6632.2009.04984.x

Cites

127 of 127 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Verification

Claims the paper makes

90 No full text of the sources · 19 No basis given · 15 Supported · 15 Partly supported · 15 Own interpretation · 6 Couldn’t confirm · 3 Supported so far · 3 Not checked yet · 1 Sources not found · accuracy not yet measured

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Show all 126 claims

  • It may state two separate claims as one. 36
  • Probably not a substantial claim. 8
41 of 41
  • The paper relies on this without support.

    Cyclic AMP/PKA signal transduction pathways are reduced in postmortem brain tissue from depressed patients.

    “Cyclic AMP/PKA signal transduction pathways have also been shown to be reduced in postmortem brain tissue from depressed patients.”
  • The paper relies on this without support.

    IFN-α activates Jak-STAT and p38 MAPK signaling pathways.

    “IFN-α is well known to activate Jak-STAT as well as p38 MAPK signaling pathways”
  • The paper relies on this without support.

    Anisomycin activates both p38 and JNK signaling pathways.

    “Anisomycin activates both p38 and JNK signaling pathways.”
3 of 3

Self-check

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Each contradiction between two passages listed here was confirmed by an independent check.

1 of 1

Citations

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Metadata

Authors
Pace, T. W. W., & Miller, A. H.
Affiliations
Emory University (US)
Corresponding author
Miller, Andrew H.
Venue
Annals of the New York Academy of Sciences
Publisher
Wiley
Published
2009-10
Volume
1179
Issue
1
Pages
86-105
ISSN
  • 0077-8923 (ISSN-L)
  • 1749-6632
OpenAlex
W2066044455
Cited by
339
References
126
Citations by year
2026: 11 · 2025: 12 · 2024: 21 · 2023: 13 · 2022: 15 · 2021: 43 · 2020: 13 · 2019: 14 · 2018: 15 · 2017: 25 · 2016: 27 · 2015: 21 · 2014: 23 · 2013: 24 · 2012: 26
FWCI
1.11
Type
journal article
Language
en
Open access
Locations
  • Annals of the New York Academy of Sciences (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Heart, Lung, and Blood Institute (R01HL073921)
  • National Institute of Mental Health (R03MH079870, R01MH075102, K05MH069124)
  • National Center for Research Resources (M01-RR00039, UL1RR025008, M01RR000039)
  • National Center for Advancing Translational Sciences (UL1 TR000454)
Topics
  • Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
  • Life Sciences › Neuroscience › Biological Psychiatry › Tryptophan and brain disorders
  • Health Sciences › Medicine › Pharmacology (medical) › Treatment of Major Depression
Keywords
major depressive disorder, glucocorticoid receptor, inflammatory cytokines, glucocorticoid resistance, dexamethasone suppression test, p38 MAPK, STAT5, NF-κB, protein kinase A, antidepressants, neuroendocrine challenge
MeSH terms
Cross-Sectional Studies, Major Depressive Disorder, Depressive Disorder, Major, Glucocorticoids, Humans, Inflammation, Models, Biological, Receptors, Glucocorticoid, Signal Transduction, Cytokines, NF-kappa B, p38 Mitogen-Activated Protein Kinases

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