title: Changes of cytolytic cells and perforin expression in patients with posttraumatic stress disorder.
abstract: OBJECTIVE
  To define phenotypic characteristics of cytotoxic T lymphocytes (CTL) and natural killer cells (NK) in peripheral blood, frequency of somatic symptoms, and level of anxiety and depression in 25 patients clinically diagnosed with chronic post-traumatic stress disorder (PTSD).
  
  
  METHODS
  Patients were divided into two sub-groups according to the stressor: 18 PTSD patients with the battlefield experience and 7 PTSD patients with battlefield experience who were tortured as the prisoners of war (POW) in Bosnian-Serbian camps. The control group consisted of 15 healthy volunteers matched to the patients by sex and age. We tested all patients using Becks depression inventory, Spielberger anxiety test, and somatic disturbance list, and analyzed their peripheral blood lymphocytes using flow cytometry with the double fluorescence staining of cell surface antigens (CD3, CD4, CD8, CD16, and CD56) and intracellular cytolytic molecule perforin (P), a mediator of cytolytic action at the molecular level.
  
  
  RESULTS
  All PTSD patients showed a significant level of anxiety, depression, and numerous somatic symptoms. The only significant difference between PTSD patients with and without POW experience was in the anxiety level (median, 71; range 61-79; vs median, 65; range, 49-77). PTSD patients with POW experience had significantly higher levels of CD16+ cells (median, 37%; range, 16-55%) than those without it (median, 12%; range, 5-37%). Double labeling for intracellular P antigen and cell surface antigens showed the highest levels of CD16+P+ (median, 33%; range, 15-40%; vs median, 10%; range, 3-29%) and CD56+P+ (median, 21%; range, 11-40%; vs median 8%; range, 1-30%) cells in PTSD-POW patients.
  
  
  CONCLUSIONS
  Chronic PTSD patients who survived concentration camps show the most numerous alterations in PBL phenotype, the highest number of perforin-containing cells, and a significantly higher level of anxiety.
authors.affiliation: Department of Psychiatry, Rijeka University School of Medicine, B. Branchetta 20, 51000 Rijeka, Croatia.
authors.forename: I
authors.initials: I
authors.lastname: Skarpa
authors.forename: G
authors.initials: G
authors.lastname: Rubesa
authors.forename: L
authors.initials: L
authors.lastname: Moro
authors.forename: D
authors.initials: D
authors.lastname: Manestar
authors.forename: M
authors.initials: M
authors.lastname: Petrovecki
authors.forename: D
authors.initials: D
authors.lastname: Rukavina
mesh_terms: D000328:Adult; D001007:Anxiety / Q000209:etiology; D016022:Case-Control Studies; D017523:Croatia; D003863:Depression / Q000209:etiology; D006801:Humans; D016130:Immunophenotyping; D007694:Killer Cells, Natural / Q000276:immunology*; D008297:Male; D008562:Membrane Glycoproteins / Q000378:metabolism; D054353:Perforin; D052899:Pore Forming Cytotoxic Proteins; D013313:Stress Disorders, Post-Traumatic / Q000276:immunology* / Q000523:psychology; D013602:T-Lymphocytes, Cytotoxic / Q000276:immunology*; D014104:Torture / Q000523:psychology; D014857:Warfare
chemical_list: D008562:Membrane Glycoproteins; D052899:Pore Forming Cytotoxic Proteins; D054353:Perforin