The role of tumor necrosis factor-α in the pathogenesis of anorexia and bulimia nervosa, cancer cachexia and obesity

doi:10.1016/S0306-9877(96)90153-X

Medical Hypotheses

Volume 47, Issue 6, December 1996, Pages 423-438

https://doi.org/10.1016/S0306-9877(96)90153-X Get rights and content

Abstract

In this paper a new immunological model of anorexia and bulimia nervosa will be presented in which the inflammatory cytokines are conceived as the fundamental regulators of body metabolism. This conception differs from the conventional view in which the inflammatory cytokines are perceived primarily as peptide molecules utilized by the immune system to control infection, inflammation and tissue or neuronal damage. Given that the inflammatory cytokines are also fundamental regulators of body metabolism, when they become dysregulated they create physiological chaos which results in the development of a number of autoimmune, metabolic and psychiatric disorders.

In this proposed immunological model of anorexia and bulimia nervosa, elevated tumor necrosis factor-α features as the primary cause of these conditions. Pathophysiological parallels are drawn between anorexia nervosa and cancer cachexia in terms of the causal role the cytokines, neuropeptides and neurotransmitters play in the manifestation of shared symptoms. These shared symptoms include elevated tumour necrosis factor-α, down-regulated interleukin-2 and interleukin-4 and depletion of lean body mass. Furthermore, the following neuropeptides are dysregulated in both anorexia nervosa and cancer cachexia: vasoactive intestinal peptide, cholecystokinin, corticotropin-releasing factor, neuropeptide Y, peptide YY and β-endorphin. In addition, in anorexia and bulimia nervosa, secretion of the neurotransmitter serotonin is inhibited while norepinephrine is enhanced.

Itnwill be argued that the causal interplay between the cytokines, neuropeptides and neurotransmitters initiates a cascade of biochemical events which may result in either anorexia or bulimia nervosa, or cancer cachexia. The extent to which these inflammatory cytokines, neuropeptides and neurotransmitters are causally efficacious in the pathogenesis of other autoimmune disorders, such as diabetes mellitus and rheumatoid arthritis, will also be addressed.

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The role of tumor necrosis factor-α in the pathogenesis of anorexia and bulimia nervosa, cancer cachexia and obesity

Abstract

Compr Psychiatry

J Nutr

Med Hypotheses

Recent Prog Horm Res

Life Sci

Cell Inmunol

Metabolism

Diabetes

Cytokine

PSEBM

N Engl J Med

J Immunol

Brain Res Bull

Psychiatry Res

Acta Psychiatr Scand

Chin Med J Engl

Endocrinology

J Neuroimmunol

J Neuroimmunol

J Immunol

Implications of historical evidence for the classification of eating disorders. A dimension overlooked in DSM-111-R and ICD-10

Br J Psychiatry

Merycism or rumination disorder. A historical investigation and current assessment

Br J Psychiatry

Self-mutilation in four historical cases of bulimia

Br J Psychiatry

Anorexia nervosa and depression in a woman blind since the age of nine months

Can J Psychiatry

Borderline personality disorder and perceived family dysfunction in the eating disorders

J Nerv Ment Dis

Sexual abuse and eating disorders. Borderline personality disorder as a mediating factor?

Br J Psychiatry

Dissociative experiences and trauma in eating disorders

Int J Eat Disord

Comorbidity of DSM-III-R eating disorders and personality d1sorders

Int J Eat Disord

Alexithymia ratings in bulimia nervosa: clinical correlates

Psychosom Med

Clinical correlates of self-mutilation in borderline personality disorder

Am J Psychiatry

Impulsivity and eating disorders

Br J Psychiatry

Co-morbidity of eating disorders and substance abuse review of the literature

Int J Eat Disord

History of eating disorders in female patients with obsessive-compulsive disorder

Int J Eat Disord

Past history of anorexia nervosa in women with obsessivecompulsive disorder

Int J Eat Disord

Obsessive-compulsive disorder among patients with anorexia nervosa and bulimia nervosa

Am J Psychiatry

Impulsivity and dyscontrol in bulimia nervosa: is impulsivity an independent phenomenon or a marker of severity?

Acta Psychiatr Scand

Aberrant snacking patterns and eating disorders in patients with obsessive compulsive disorder

J Clin Psychiatry

Repeated binge/purge cycles in bulimia nervosa: role of glucose and insulin

Int J Eat Disord

Effect of meal composition on mood

Behav Neurosci

Alcohol and central serotonin metabolism in man

Arch Gen Psychiatry

Multiple serotonin receptors: clinical and experimental aspects

Ann Clin Psychiatry

Food and mood: relationship between food, serotonin and affective disorders

Acta Psychiatr Scand

Rational therapy of eating disorders

Drugs

Amenorrhea in anorexia nervosa. Neuroendocrine control of hypothalamic dysfunction

Int J Eat Disord

Gastrointestinal and nutritional aspects of eating disorders

J Am Coll Nutr

Osteoporosis and normal weight bulimia nervosa-which patients are at risk?

J Psychosom Res

Neurochemistry of bulimia nervosa

J Clin Psychiatry

Neuropeptides and anxiety: focus on cholecystokinin

Clin Chem

Fasting associated with decrease in hypothalamic β-endorphin

Science