A critical assessment of the interactions between the immune system and the hypothalamo-pituitary-adrenal axis

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Abstract
Introduction Many publications in recent years have greatly enhanced our understanding of the interrelationship between the immune system and the hypothalamo-pituitary-adrenal axis (HPA). Previously, the primary interaction between the two systems was ascribed to the effects of glucocorticoids on the immune response (Fauci, 1979). Recent studies, however, have shown the presence of additional interactions between the immune system and the HPA axis, which have led some authors to postulate the existence of reciprocal circuits as summarized in Fig. 1. At this time several of the links are hypothetical, as many reports are contradictory, and await further research for confirmation. This review is an attempt to clarify this complex area and is a critical assessment of published data which has enabled such a diagram to be constructed. For Fig.1 to be an accurate reflection of the physiological state, three major criteria have to be proven. These are (1) the presence of both

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