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Hypothalamic-pituitary-adrenal axis
(section)
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== Immune system == There is bi-directional communication and feedback between the HPA axis and immune system<ref name="MD2">{{cite journal | last1 = Marques-Deak | first1 = A | last2 = Cizza | first2 = G | last3 = Sternberg | first3 = E | date = February 2005 | title = Brain-immune interactions and disease susceptibility | url = http://www.nature.com/mp/journal/v10/n3/pdf/4001643a.pdf | journal=Molecular Psychiatry|volume=10 | pages = 239β250|doi=10.1038/sj.mp.4001643|access-date = 13 February 2016}}</ref><ref name="Otmishi2">{{cite journal | last1 = Otmishi | first1 = Peyman | last2 = Gordon | first2 = Josiah | last3 = El-Oshar | first3 = Seraj | last4 = Li | first4 = Huafeng | last5 = Guardiola | first5 = Juan | last6 = Saad | first6 = Mohamed | last7 = Proctor | first7 = Mary | last8 = Yu | first8 = Jerry | date = 2008 | title = Neuroimmune Interaction in Inflammatory Diseases | url = https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2990232/pdf/ccrpm-2008-035.pdf | journal=Clinical Medicine: Circulatory, Respiratory, and Pulmonary Medicine|volume=2 | pages = 35β44|pmid=21157520|access-date = 14 February 2016}}</ref>. A number of [[cytokines]], such as [[interleukin 1|IL-1]], [[interleukin 6|IL-6]], [[interleukin 10|IL-10]] and [[TNF-alpha]] can activate the HPA axis, although IL-1 is the most potent. The HPA axis in turn modulates the immune response: high levels of cortisol suppress immune and inflammatory reactions and trigger immune cells such as [[Monocyte|monocytes]] and [[Neutrophil|neutrophils]] to release anti-inflammatory cytokines (e.g. [[interleukin 4|IL-4]], [[interleukin 10|IL-10]], and [[Interleukin 13|IL-13]]). <ref name="Otmishi2" /><ref name="Tian2">{{cite journal | last1 = Tian | first1 = Rui | last2 = Hou | first2 = Gonglin | last3 = Li | first3 = Dan | last4 = Yuan | first4 = Ti-Fei | date = June 2014 | title = A Possible Change Process of Inflammatory Cytokines in the prolonged Chronic Stress and its Ultimate Implications for Health | url = https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4065693/pdf/TSWJ2014-780616.pdf | journal=The Scientific World Journal|volume=|pages=1β8|doi=10.1155/2014/780616|pmid=24995360|access-date = 13 February 2016}}</ref><ref name="Bellavance2">{{cite journal | last1 = Bellavance | first1 = Marc-Andre | last2 = Rivest | first2 = Serge | date = March 2014 | title = The HPA-immune axis and the immunomodulatory actions of glucocorticoids in the brain | url =https://www.researchgate.net/profile/Marc_Andre_Bellavance/publication/261764460_Bellavance_MA_Rivest_S._The_HPA_-_Immune_Axis_and_the_Immunomodulatory_Actions_of_Glucocorticoids_in_the_Brain._Front_Immunol_5_136/links/55c2286108aeb975673e3b9f.pdf | journal=Frontiers in Immunology|volume=5|pages=1β13|doi=10.3389/fimmu.2014.00136|access-date = 11 February 2016}}</ref><ref name="Padgett2">{{cite journal | last1 = Padgett | first1 = David | last2 = Glaser | first2 = Ronald | date = August 2003 | title = How stress influences the immune response | url = http://www.direct-ms.org/pdf/ImmunologyGeneral/Stress%20and%20immunity.pdf | journal=Trends in Immunology|volume=24|issue=8 | pages = 444β448|doi=10.1016/S1471-4906(03)00173-X|pmid=12909458|access-date = Feb 12, 2016}}</ref> This helps to protect the organism from a potentially lethal overactivation of the immune system, and minimizes tissue damage from inflammation.<ref name="isbn_97804445304003">{{cite book | title = The hypothalamus-pituitary-adrenal axis | last1 = Besedovsky | first1 = Hugo | last2 = Chrousos | first2 = George | last3 = Rey | first3 = Adriana Del | date = 2008|publisher=Academic|isbn=9780444530400|edition=1st|location=Amsterdam}}</ref>
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