Child care setting affects salivary cortisol and antibody secretion in young children

Cortisol patterns at home and child care: Afternoon differences and evening recovery in children attending very high quality full-day center-based child care

Serum IgG, IgA and IgM antibody and salivary IgA antibody concentrations to non-capsular Haemophilus influenzae antigens were measured in 13 children with H. influenzae type b meningitis and in 15 children with epiglottitis. Most had detectable serum IgG and IgM antibody at presentation but significantly fewer patients with meningitis had serum IgA antibody at presentation (P less than 0.05). Serum antibody concentrations had risen significantly by 3 weeks after presentation in patients with epiglottitis only. Convalescent serum IgG antibody concentrations against these antigens were higher in younger children with epiglottitis. Salivary IgA antibody to H. influenzae was detectable at presentation in all children with epiglottitis and in 12 of 13 with meningitis. Salivary antibody concentrations did not differ significantly between the two patient groups at presentation, although patients with meningitis had higher salivary IgA antibody concentrations than 10 children of similar age with bronchiolitis (P less than 0.02). There was no association between the presence of salivary antibody and low concentrations of convalescent serum antibody. The rise in convalescent serum antibody concentrations to non-capsular H. influenzae antigens only in children with epiglottitis is similar to findings for antibody to capsular polysaccharide. However, this rise was greater for IgG in younger patients, and the low titre of convalescent serum antibody in patients with meningitis was not associated with higher titres of IgA antibody in secretions as described by others for polysaccharide antibody. These findings suggest that the poor serum antibody response to these antigens in patients with meningitis is independent of age and is not due to mucosal induction of systemic tolerance.(ABSTRACT TRUNCATED AT 250 WORDS)

The effect of systemic priming with soluble or particulate antigen or the carriers on the locally induced salivary antibody response in the rat was examined. DNP-BGG and DNP-BGG- S. mutans represented the soluble and particulate antigens, respectively. Footpad (FP) injection of the soluble or the particulate antigen or of the soluble or particulate carriers was followed 10 days later by a salivary gland vicinity (SGV) injection of the homologous intact antigen. IgA and IgG salivary antibody and IgG serum antibody concentrations were determined by an ELISA technique. The results were compared with injection of antigen at either the FP or SGV alone. FP injection of soluble antigen resulted in greatly increased levels (1300 ± 360 ng/ml) of salivary IgA antibody upon local SGV injection of the same antigen. Although FP injection of the particulate antigen was also able to increase the IgA response (450 ± 235 ng/ml), the increase was not nearly so great. The salivary IgG antibody response, however, was approximately equally primed by FP injection of either the soluble or the particulate antigens (210 ± 155 vs 145 ± 105 ng/ml). The serum IgG response, like the IgA response in saliva, demonstrated that the soluble antigen had led to a greater degree of priming than the particulate antigen (912 ±96 vs 513 ± 35 µg/ ml). FP injection of the soluble carrier (BGG) did not prime the salivary IgA or IgG or the serum IgG responses to local (SGV) injection of soluble antigen. However, FP injection of particulate carriers before SGV injection of particulate antigen (BGG-S. mutans, S. mutans) led to a significant reduction (80%) in serum IgG antibody but did not affect salivary antibody levels. Systemic injection of a soluble antigen can effectively prime for an increased secretory IgA response in saliva. The lack of carrier priming and reduction in serum antibody by carrier injection indicates that T cells may not be involved in the increased response observed after priming. Instead, injection of carrier may have an effect on suppressor cells regulating the serum antibody response separately from the secretory antibody response.

Disclosure: M. Jung: None. M. Kim: None. Y. Choi: None. H. Yoo: None. S. Lee: None. E. Yoo: None. Purpose: Measurement of salivary cortisol is non-invasive and the level correlates well with that of free cortisol, but data in children are insufficient. We measured salivary cortisol and cortisone levels in obese children and compared with those in non-obese healthy children. Methods: A Total of 84 (45 obese and 39 non-obese) children aged 6 to 12 years were recruited. Children with acute or chronic illness were excluded. Salivary samples were analyzed for cortisol and cortisone using liquid chromatography-tandem mass spectrometry. Serum cortisol levels were measured only in obese children. Results: There was no significant difference in salivary cortisol and cortisone levels between the non-obese and obese children. There was no gender difference in salivary cortisol and cortisone levels. Salivary cortisol correlated to serum cortisol levels in obese children (ρ = 0.428, P = 0.007). Salivary cortisone levels were related with salivary cortisol (ρ = 0.537, P <0.001), and inversely with sampling time range (ρ = -0.282, P= 0.009). There was no significant correlations between salivary cortisol or cortisone values and age or body mass index. Conclusions: There was no significant difference in salivary cortisol and cortisone levels between non-obese and obese children. Salivary cortisol correlated well with serum cortisol in obese children. Presentation: 6/1/2024

Differences in cortisol awakening response on work days and weekends in women and men from the Whitehall II cohort

Thirty-one children, aged 0.8–3.8 years, were studied with respect to dental caries, the presence of Streptococcus mutans in dental plaque, and the amount and avidity of specific antibodies against S. mutans serotype c in serum and saliva. Twelve of the children harbored S. mutans in plaque and all 4 children with carious lesions belonged to this group. Comparison of S. mutans-positive and -negative children revealed no significant differences in the concentrations of total immunoglobulins (isotypes A, G and M) in serum or saliva, nor did the amount of intact secretory IgA molecules in saliva differ between the groups. All children had developed serum antibodies against S. mutans, irrespective of the presence of this bacterium in their plaque samples. Significantly more specific serum antibodies of IgG type (p = 0.001) were detected in S. mutans-free children than in those whose dentition was infected with this bacterium. Specific salivary IgA antibodies to S. mutans were found in only 26% of all children (8/31) with no correlation to the presence of oral S. mutans. Our results could be explained by the observation that the oral exposure to antigens in early infancy results preferably in a systemic (serum) immune response, which may be due to the incomplete antigen exclusion in the intestinal epithelium of human neonatal infants. Furthermore our data indicate that the specific serum IgG antibodies may be protective against the colonization of primary teeth by S. mutans in early childhood.

Intranasally administered dental caries vaccines show significant promise for human application. Alternate mucosal routes may be required, however, to induce caries-protective salivary IgA antibody in children with respiratory diseases. Since rectal mucosa contains inductive lymphoid tissue, we hypothesized that the rectal route could be used to induce salivary immunity to mutans streptococcal glucosyltransferase (GTF), resulting in protective immunity to experimental dental caries. We first explored the ability of glucosyltransferase, incorporated into polylactide-co-glycolide (PLGA) microparticles (MP), and administered rectally together with mucosal adjuvant, to induce a salivary IgA antibody response. Groups of Sprague-Dawley rats (6/group) were immunized rectally on days 0, 7, 14 and 21 with a) GTF-MP alone, b) GTF-MP with cholera toxin, c) GTF-MP with detoxified mutant Escherichia coli toxin (dLT), or d) sham immunized with PLGA and cholera toxin. An additional group was immunized intranasally with GTF-MP alone. Saliva and nasal washes of all intranasally immunized rats contained IgA antibody to glucosyltransferase on day 28. Salivary IgA antibody was also detected in 7/12 rats rectally immunized with GTF-MP and cholera toxin or dLT, although responses were lower than those obtained by intranasal immunization. Most fecal extracts from rectally delivered GTF-MP plus cholera toxin or dLT rats contained IgA antibody to GTF-MP. Low levels of fecal IgA antibody were detected in 3/6 intranasally immunized rats and 2/6 rats rectally immunized with GTF-MP alone. We then examined the extent to which salivary IgA antibody induced by the rectal route could be protective. At 25, 31 and 38 days of age, two groups of female Sprague-Dawley rats (13/group) were rectally immunized with GTF-MP and cholera toxin or with empty microparticles and cholera toxin (sham group). A third group was intranasally immunized with GTF-MP alone. After demonstrating salivary IgA responses to GTF in most GTF-immunized rats, all animals were infected with streptomycin-resistant Streptococcus sobrinus and placed on diet 2000. After 79 days of infection, total caries on molar surfaces were lower in both rectally (7.9 +/- 1.0) and intranasally (7.1 +/- 0.9; P < 0.0.03) immunized groups compared with the sham-immunized group (11.9 +/- 1.6). Smooth surface caries were significantly lower (P < 0.05) in both rectally and intranasally immunized groups. These results support the interconnectedness of the mucosal immune system and indicate that rectal immunization with GTF-MP, together with adjuvant, or intranasal immunization with GTF-MP alone, can induce protective levels of salivary antibody in rats.

In the present study, the impact of mirtazapine treatment on salivary cortisol secretion was investigated in 12 patients (4 men, 8 women) suffering from major depression according to DSM-IV criteria. Patients were treated with mirtazapine for 3 weeks receiving 15mg mirtazapine on day 0; 30mg mirtazapine on day 1; and 45mg mirtazapine per day from day 2 up to the end of the study (day 21). Response to mirtazapine treatment was defined by a reduction of at least 50% in the Hamilton Rating Scale for Depression after 3 weeks of therapy. Salivary cortisol concentrations were measured before treatment (day -1), at the beginning of treatment (day 0), after 1 week (day 7) and after 3 weeks (day 21) of treatment with mirtazapine. Saliva samples were collected hourly from 0800 a.m. up to 0800 p.m. There was a significant reduction of cortisol concentrations already after one day of mirtazapine treatment which was comparable in responders and non-responders. In addition to new pharmacological approaches such as CRH1 receptor antagonists, mirtazapine therefore appears to be an effective strategy to decrease hypercortisolism and restore HPA system dysregulation in depression.

Social inequalities in childhood dental caries: The convergent roles of stress, bacteria and disadvantage

The prevalence of mucosally derived infections appears to increase with age, suggesting dysfunction at the mucosal surfaces. The present investigation was undertaken to examine any age-related changes in secretion rates and concentrations of secretory antibodies in whole and parotid saliva in a healthy adult population. A total of 116 subjects were subdivided into the following age groups: 20-39 years, 40-59 years, 60-79 years and 80 years and over. Specific immunoglobulin A (IgA), IgG and IgM antibodies in whole and parotid saliva to Streptococcus mutans (serotype c), Actinomyces viscosus NCTC 10951, and Escherichia coli NCTC 10418 were quantified by enzyme-linked immunosorbent assay. IgA antibodies to all three organisms examined increased with age in both whole and parotid saliva, whereas IgG antibody levels to S. mutans in whole saliva were significantly decreased with age. IgG antibodies to E. coli in parotid saliva were reduced in older age groups. IgM antibody levels to S. mutans were reduced with age in both secretions, whereas IgM antibodies to A. viscosus were greatest in the oldest age groups. No significant changes with age were observed in salivary IgM antibody levels to E. coli. No significant reduction in the secretion rates of IgA antibodies were observed in parotid or whole saliva, whereas IgG and IgM antibody secretion rates to all three microorganisms were reduced in most age groups in both whole and parotid saliva. The results of this investigation have demonstrated age-related changes with salivary antibodies, but, whereas salivary IgG and IgM antibodies showed decreases, salivary IgA levels generally increased with age. This suggests that the ability to form IgA antibody responses is not impaired with increased age, and that secretion rates and functional properties of antibodies may be as important as concentrations in protection against mucosal infective diseases.

Age-dependent deficiency in saliva and salivary antibodies secretion in Down's syndrome

Polygenic risk score of SERPINA6/SERPINA1 associates with diurnal and stress-induced HPA axis activity in children

To evaluate the efficacy of 'the perioperative dialogue (PD)' by analyzing salivary cortisol, in 5- to 11-year-old children undergoing day surgery. To deal with anxiety prior to investigations and/or procedures, children need to be confident and informed about what is going to happen. Therefore, intervention strategies should be initiated before admission to hospital. Children (n = 93), 79 boys and 14 girls, scheduled for elective day surgery requiring general anesthesia were randomly recruited into three groups: (i) standard perioperative care (n = 31), (ii) standard perioperative care including preoperative information (n = 31), and (iii) the PD (n = 31). Saliva was sampled for cortisol analysis at specific time points during the pre- and perioperative procedures. The children who received the PD had significantly lower (P = 0.003) salivary cortisol concentrations postoperatively. Moreover, it continuously decreased during the day of surgery compared with the other two groups (P < 0.01). Among the children who received analgesics, the PD group received significantly less morphine (P = 0.014) related to bodyweight: the mean dose was 0.1 mg·kg(-1) (n = 9) in the control group vs 0.04 mg·kg(-1) (n = 6) in the PD group. Irrespective of group, there was a positive correlation between the children's morphine consumption and salivary cortisol concentration (r = 0.56; P = 0.038). The W-B scale score was higher in the group that received morphine (median = 3 vs median=1; P = 0.001). The PD's caring, continuity, and on-going dialogues were associated with low concentrations of salivary cortisol postoperatively and reduced morphine consumption and thus appears to be a valuable complement to standard perioperative care in children undergoing day surgery.

Although the amount of television that young children watch at home is well-described, to date no study has examined how much television preschool children watch in day care settings. We performed a cross-sectional analysis using the Profile of Child Care Settings Study, examining predictors of television viewing in center (n = 2089) and home-based (n = 583) child care programs. On average, preschool-aged children were reported to watch more than four times as much television while at home-based programs than at center-based programs (1.39 hours per day vs 0.36 hours per day); with significant differences between groups in the type of television content viewed, and in the proportions of programs in which no television viewing occurred at all. The proportion of programs where preschool-aged children watched no television during the child care day was 65% in center-based programs and 11% in home-based programs. The hours a program was open each day was associated with increased television viewing in both settings; provision of after-school care to older children and being in a county with high family poverty rates were only significant factors in center-based programs. Factors associated with decreased television viewing included post-secondary education of staff members, as well as the average staff volume of the program. Preschool children in day care settings watch a considerable amount of television in addition to what is viewed at home. These results further highlight the urgent need to better understand the effects of viewing on young children.

Spontaneous aneurysmal subarachnoid haemorrhage (SAH) is a cause of stroke, which constitutes a severe trauma to the brain and may lead to serious long-term medical, psychosocial and endocrinological sequelae. Adrenocorticotrophic hormone deficiency, which is considered to occur in up to 20% of all survivors, is a possible consequence of bleeding. Moreover, preliminary data suggest that a poor psychosocial outcome in SAH survivors is linked to alterations in cortisol secretion. Despite these findings, investigation of diurnal cortisol profiles and the cortisol awakening response (CAR) in chronic SAH patients has not been done so far. In this study, basal serum cortisol and salivary cortisol concentration profiles were investigated in 31 SAH patients more than 1 year after the acute event and in 25 healthy controls. Additionally, low-dose dexamethasone (DEX) suppression tests were conducted, and sensitivity to stress was measured with a psychometric questionnaire (NeuropatternTM). Although significantly higher salivary cortisol concentrations were observed on waking in SAH patients (p = 0.013, ANOVA), without a CAR change, total serum cortisol concentrations were blunted, but only in patients with high levels of perceived stress (SAH high stress: 337 nmol/l, SAH low stress: 442 nmol/l, controls: 467 nmol/l; Controls vs. SAH high stress p = 0.018). DEX suppression of cortisol secretion was not significantly different between patients and controls. The results indicate that total (serum) and free (salivary) cortisol concentrations give different information about cortisol availability in patients after aneurysmal SAH. Enhanced free cortisol concentrations may reflect a meaningful biological coping mechanism in SAH patients.