title: IL-12, TNF-alpha, and hormonal changes during late pregnancy and early postpartum: implications for autoimmune disease activity during these times.
abstract: Clinical observations indicate that some autoimmune diseases, such as rheumatoid arthritis and multiple sclerosis, frequently remit during pregnancy but exacerbate, or have their onset, in the postpartum period. The immune basis for these phenomena is poorly understood. Recently, excessive production of IL-12 and TNF-alpha was causally linked to rheumatoid arthritis and multiple sclerosis. We studied 18 women with normal pregnancies in their third trimester and during the early postpartum period. We report that during the third trimester pregnancy, ex vivo monocytic IL-12 production was about 3-fold and TNF-alpha production was approximately 40% lower than postpartum values. At the same time, urinary cortisol and norepinephrine excretion and serum levels of 1,25-dihydroxyvitamin were 2- to 3-fold higher than postpartum values. As shown previously, these hormones can directly suppress IL-12 and TNF-alpha production by monocytes/macrophages in vitro. We suggest that a cortisol-, norepinephrine-, and 1,25-dihydroxyvitamin-induced inhibition and subsequent rebound of IL-12 and TNF-alpha production may represent a major mechanism by which pregnancy and postpartum alter the course of or susceptibility to various autoimmune disorders.
authors.affiliation: Arthritis and Rheumatism Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD 20892, USA. ije@gunet.georgetown.edu
authors.forename: I J
authors.initials: IJ
authors.lastname: Elenkov
authors.forename: R L
authors.initials: RL
authors.lastname: Wilder
authors.forename: V K
authors.initials: VK
authors.lastname: Bakalov
authors.forename: A A
authors.initials: AA
authors.lastname: Link
authors.forename: M A
authors.initials: MA
authors.lastname: Dimitrov
authors.forename: S
authors.initials: S
authors.lastname: Fisher
authors.forename: M
authors.initials: M
authors.lastname: Crane
authors.forename: K S
authors.initials: KS
authors.lastname: Kanik
authors.forename: G P
authors.initials: GP
authors.lastname: Chrousos
mesh_terms: D000328:Adult; D001327:Autoimmune Diseases / Q000209:etiology*; D001772:Blood Cell Count; D002112:Calcifediol / Q000097:blood; D004958:Estradiol / Q000097:blood; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000652:urine; D018664:Interleukin-12 / Q000096:biosynthesis*; D049590:Postpartum Period / Q000378:metabolism*; D011247:Pregnancy / Q000276:immunology* / Q000378:metabolism*; D011248:Pregnancy Complications / Q000209:etiology*; D011263:Pregnancy Trimester, Third; D011374:Progesterone / Q000097:blood; D011644:Puerperal Disorders / Q000209:etiology*; D014409:Tumor Necrosis Factor-alpha / Q000096:biosynthesis*
chemical_list: D014409:Tumor Necrosis Factor-alpha; D018664:Interleukin-12; D011374:Progesterone; D004958:Estradiol; D002112:Calcifediol; D006854:Hydrocortisone