Review Article the Bidirectional Relationship Between Sleep and Immunity Against Infections
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Hindawi Publishing Corporation Journal of Immunology Research Volume 2015, Article ID 678164, 14 pages http://dx.doi.org/10.1155/2015/678164 Review Article The Bidirectional Relationship between Sleep and Immunity against Infections Elizabeth G. Ibarra-Coronado,1 Ana Ma. Pantaleón-Martínez,1 Javier Velazquéz-Moctezuma,2 Oscar Prospéro-García,3 Mónica Méndez-Díaz,3 Mayra Pérez-Tapia,4,5 Lenin Pavón,6 and Jorge Morales-Montor1 1 Departamento de Inmunolog´ıa, Instituto de Investigaciones Biomedicas,´ Universidad Nacional Autonoma´ de Mexico,´ AP 70228, 04510 Mexico,´ DF, Mexico 2Area de Neurociencias, Departmento de Biolog´ıa de la Reproduccion, CBS, Universidad Autonoma Metropolitana-Iztapalapa, Avenida San Rafael Atlixco No. 186, Col Vicentina, Iztapalapa, 09340 Mexico City, DF, Mexico 3Grupo de Neurociencias, Laboratorio de Canabinoides, Departamento de Fisiolog´ıa, Facultad de Medicina, Universidad Nacional Autonoma´ de Mexico,´ Mexico,´ DF, Mexico 4Departamento de Inmunolog´ıa, Escuela Nacional de Ciencias Biologicas,´ IPN Prolongacion´ de Carpio y Plan de Ayala s/n, Col. Sto. Tomas,´ 11340 Mexico,´ DF, Mexico 5Unidad de Desarrollo e Investigacion´ en Bioprocesos (UDIBI), Escuela Nacional de Ciencias Biologicas,´ IPN Prolongacion´ de Carpio y Plan de Ayala s/n, Col. Sto. Tomas,´ 11340 Mexico,´ DF, Mexico 6Laboratorio de Psicoinmunolog´ıa, Direccion´ de Investigaciones en Neurociencias, Instituto Nacional de Psiquiatr´ıa Ramon´ de la Fuente, 14370 Mexico,´ DF, Mexico Correspondence should be addressed to Jorge Morales-Montor; [email protected] Received 3 October 2014; Accepted 24 December 2014 Academic Editor: Muhammad Atif Zahoor Copyright © 2015 Elizabeth G. Ibarra-Coronado et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Sleep is considered an important modulator of the immune response. Thus, a lack of sleep can weaken immunity, increasing organism susceptibility to infection. For instance, shorter sleep durations are associated with a rise in suffering from the common cold. The function of sleep in altering immune responses must be determined to understand how sleep deprivation increases the susceptibility to viral, bacterial, and parasitic infections. There are several explanations for greater susceptibility to infections after reduced sleep, such as impaired mitogenic proliferation of lymphocytes, decreased HLA-DR expression, the upregulation of CD14+,andvariationsinCD4+andCD8+Tlymphocytes,whichhavebeenobservedduringpartialsleepdeprivation.Also,steroid hormones, in addition to regulating sexual behavior, influence sleep. Thus, we hypothesize that sleep and the immune-endocrine system have a bidirectional relationship in governing various physiological processes, including immunity to infections. This review discusses the evidence on the bidirectional effects of the immune response against viral, bacterial, and parasitic infections on sleep patterns and how the lack of sleep affects the immune response against such agents. Because sleep is essential in the maintenance of homeostasis, these situations must be adapted to elicit changes in sleep patterns and other physiological parameters during the immune response to infections to which the organism is continuously exposed. 1. Introduction influence on the immune system. Many studies have demon- strated that total sleep deprivation and rapid eye movement Sleep is a physiological process that has been proposed to (REM) sleep deprivation modify various components of the have restorative and regulatory properties [1, 2]. Although immune system, such as the percentage of cell subpopulations it remains unknown what its exact function is, sleep has (e.g., CD4+, CD8+, and NK) and cytokine levels (e.g., IFN-g, garnered particular interest in recent years due to its potential TNF-a, and IL-1) [3–5]. Also, conversely, sleep patterns are 2 Journal of Immunology Research altered during the immune response, suggesting that sleep molecular patterns (PAMPs) [17]. PMAPs are generally com- and the immune response are linked through bidirectional ponents of the bacterial cell wall, such as lipopolysaccharide communication. (LPS) and peptidoglycan. Other important PAMPs include Sleepcanbedefinedasastateofimmobility,resulting -glucan (a cell wall component of fungi) and viral nucleic from the decreased ability to respond to external stimuli, acids (DNA and RNA), all of which have specific structural andisdistinguishedfromcomaandanalgesia,becauseit characteristics [18]. is rapidly reversible. Further, when deprived of sleep, the There are various receptors that recognize PAMPs, the organism tends to recover, depending of the extent and most extensively studied of which are Toll-like receptors duration of sleep loss. The existence of this “rebound” after (TLRs), comprising 13 types that recognize a wide range of sleep deprivation suggests that sleep is not simply a period in PAMPs. TLRs bind to molecules, such as large lipopeptides which activity and alertness decline [6, 7]—it is a vital process in bacteria and mycoplasma [19]. NLRs form another group that modulates various physiological functions. of TLRs that act as intracellular sensors that detect viral DNA In mammals and birds, sleep has specific electroen- and RNA [20]. cephalographic (EEG) patterns, which divide the sleep The activation of TLRs by their bacterial ligands induces process into several stages. In addition, electromyograms an inflammatory response that stimulates macrophages, which produce proinflammatory cytokines, such as tumor (EMGs) and electrooculograms (EOGs) are used to dif- necrosis factor alpha (TNF-), interleukin-1 (IL-1), ferentiate the phases of sleep. Based on these parameters, interferon-gamma (IFN-), and interleukin-6 (IL-6), which several stages of sleep have been proposed: wakefulness, light coordinate local and systemic inflammatory immune sleep (2 stages), slow-wave sleep, and rapid eye movement responses. TNF- and IL-1 trigger the local endothelium (REM) sleep, each of which has specific electrical patterns to induce vasodilation and increase permeability of blood [8]. Based on the classification of sleep stages, a hypnogram vessels, promoting the recruitment of serum proteins and can be constructed, describing the number of episodes, leukocytes to the site of infection. IL-1 and IL-6 together, duration, rhythmicity, and latency of overnight sleep. Sleep interacting to hepatocytes, activate them to produce acute patterns differ between species and during ontogeny and are phase proteins which activate complement and opsonize altered in sleeping disorders (dyssomnia) or when a medical, pathogens, to be phagocytosed by neutrophils and macro- psychiatric, or neurological disease develops [9]. phages. During sleep, important processes occur with regard to TLRs are expressed in other effector cells of the innate endocrine function in mammals, such as rises in the levels of immune system, such as neutrophils, monocytes, NK cells, hormones, such as prolactin and growth hormone [10]. On and Tcells[18], which can coexpress more than 1 type of the contrary, cortisol levels decline, peaking before one wakes TLR. Phagocytic leukocytes, such as eosinophils, basophils, up [10, 11] which demonstrates the existence of a connection and mast cells, are the principal effectors of innate immunity, between sleep and other physiological events. the main function of which is to ingest and kill pathogens. Studies on total sleep deprivation and REM sleep depri- Other types of phagocytes participate in these processes, vation suggest that sleep has an important function in acting as antigen-presenting cells (APCs) and generating memory consolidation, learning, and neuronal plasticity [12– antigenic peptides that activate specific immune responses— 14],althoughithasalsobeenproposedtobeamechanism particularly foreign antigens that are partially degraded by T to conserve and recover energy [1, 15]. Another theory lymphocytes [21]. claimsthatsleepisaprocessinwhichfunctionsandcellular Recognition of antigens by the adaptive immune system components [2, 16] are restored, but some of these studies is mediated by specific receptors. These receptors are also are controversial; thus, the exact function of sleep remains encoded in the germline, and through somatic recombina- unknown. tion, random combinations of segments of these genes can The primary function of the immune system is to generate a large and diverse repertoire of receptors with defend the body from infections due to pathogens or self- high specificity22 [ ]. The resulting products are clonally transformed cells through early innate immunity and subse- distributed in antigen-specific T and B lymphocytes, which quent adaptive responses. express receptors that are specific for 1 antigen, and spe- Innate immunity is the first line of defense. Its two pri- cific populations are selected to expand in response to the mary functions are to isolate and destroy invading pathogens pathogen [23]. through inflammatory processes and to recognize and pro- T cells recognize peptides through the T-cell receptor cess antigens to affect acquired immunity. Both types of (TCR), which affects disparate mechanisms, depending on immunity include cellular and biochemical mechanisms that thetypeofTlymphocyteresponse.Thereare2chiefgroups aredesignedtorespondquicklytoinfectionsandaccurately of conventional T cells: