title: Raised cortisol:DHEAS ratios in the elderly after injury: potential impact upon neutrophil function and immunity.
abstract: The detrimental effect of stress on the immune response increases with age, though the mechanisms responsible are not fully understood. The physiological response to stress is regulated in part by the adrenocortical system. Adrenal hormones dehydroepiandrosterone sulphate (DHEAS) and cortisol have opposing effects on the innate immune system, DHEAS enhances while cortisol suppresses immunity and the molar ratio of cortisol to DHEAS increases with age. We found that elderly hip fracture patients produced a robust neutrophilia after injury, but circulating neutrophils showed an impaired antibacterial response. We therefore proposed that adrenocortical hormones mediate the heightened immunosuppression seen in the elderly after injury. We examined neutrophil function and adrenocortical hormone levels in elderly (> 65 years) hip fracture patients and age-matched healthy controls. Thirteen out of 35 elderly patients acquired infections following hip fracture. Neutrophil superoxide production was lower in elderly hip fracture patients compared with controls (P < 0.005) and lower in patients who acquired infection following injury compared with those who did not (P < 0.05). Serum cortisol:DHEAS ratio was higher in elderly hip fracture patients (0.56 +/- 0.38) compared with either age-matched controls (0.36 +/- 0.21; P < 0.05) or young fracture patients (0.087 +/- 0.033; P < 0.0001). Moreover, cortisol: DHEAS was increased in elderly patients who succumbed to infection compared with those who did not (0.803 +/- 0.42 vs. 0.467 +/- 0.28; P < 0.02). In vitro cortisol significantly decreased neutrophil superoxide generation (P < 0.05) and this was prevented by coincubation with DHEAS. We propose that increased cortisol:DHEAS ratios may contribute to reduced immunity following physical stress in the elderly.
authors.affiliation: MRC Centre for Immune Regulation, Birmingham University Medical School, UK.
authors.forename: Stephen K
authors.initials: SK
authors.lastname: Butcher
authors.forename: Vijay
authors.initials: V
authors.lastname: Killampalli
authors.forename: David
authors.initials: D
authors.lastname: Lascelles
authors.forename: Keqing
authors.initials: K
authors.lastname: Wang
authors.forename: E Kaya
authors.initials: EK
authors.lastname: Alpar
authors.forename: Janet M
authors.initials: JM
authors.lastname: Lord
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D019314:Dehydroepiandrosterone Sulfate / Q000097:blood*; D005260:Female; D006620:Hip Fractures / Q000097:blood* / Q000276:immunology; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D007239:Infections / Q000209:etiology / Q000276:immunology; D007958:Leukocyte Count; D008297:Male; D009504:Neutrophils / Q000502:physiology*; D011446:Prospective Studies; D013481:Superoxides / Q000378:metabolism
chemical_list: D013481:Superoxides; D019314:Dehydroepiandrosterone Sulfate; D006854:Hydrocortisone