Effects of Mindfulness-Based Stress Reduction (MBSR) on Immune Response to HPV

基于正念的减压 (MBSR) 对 HPV 免疫反应的影响

• 批准号: 7499004
• 负责人: Carolyn Y. Fang
• 金额: $ 58.13万
• 依托单位: FOX CHASE CANCER CENTER
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-09-21 至 2012-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7499004
• 关键词: Antigens; Anxiety; Area; Attention; Behavioral; Biological Process; Cancer Model; Cancer Patient; Cervical; Cervical dysplasia; Cervix Uteri; Clinical; Condition; Control Groups; Cytolysis; Data; Development; Diagnosis; Disease; Disease Progression; Disruption; Distress; Effectiveness of Interventions; Emotional; Expectancy; Failure; HPV-High Risk; Human Papillomavirus; Human papilloma virus infection; Human papillomavirus 16; Immune; Immune response; Immunologics; Immunosuppression; Individual; Infection; Informal Social Control; Intervention; Invasive; Lead; Lesion; Life; Link; Malignant Neoplasms; Malignant neoplasm of cervix uteri; Mediating; Natural Killer Cells; Observational Study; Outcome; Pap smear; Papillomavirus; Participant; Pathway interactions; Patients; Peptides; Personal Satisfaction; Play; Population; Premalignant; Proteins; Psychological Stress; Psychosocial Assessment and Care; Psychosocial Factor; Quality of life; Randomized; Randomized Controlled Clinical Trials; Reporting; Research Personnel; Risk; Risk Factors; Role; Severities; Stress; Stressful Event; T-Lymphocyte; Test Result; Therapeutic immunosuppression; Time; Vaccines; Week; Well in self; Woman; biobehavior; cancer risk; cell mediated immune response; cytokine; follow-up; immune function; improved; malignant breast neoplasm; mindfulness-based stress reduction; programs; psychologic; psychological distress; psychosocial; response; socioeconomics; stressor

DESCRIPTION (provided by applicant): Human papillomavirus (HPV) infection is a primary risk factor for cervical cancer. However, infection alone does not lead to cancer in all cases. Data suggest that immune factors play a central role in controlling cervical disease progression. Studies have shown that an impaired T-cell proliferative response to specific HPV16 peptides is associated with a failure to resolve HPV infection and persistent cervical disease. The relation between immune function and cervical disease is particularly relevant given the following set of observations: 1) Receipt of an abnormal Pap test result is a stressful event that can lead to increased distress and disruptions in major life areas; and 2) Psychological responses to stress are associated with immunologic changes. Over the past few years, we have been conducting preliminary studies of psychosocial and behavioral correlates of T-cell response to specific HPV16 peptides among women with cervical dysplasia. Our findings suggest that higher levels of stress are associated with an impaired T-cell response to HPV, even after controlling for key behavioral risk factors. However, any causal effects of psychosocial factors on HPV-specific immune response still remain to be demonstrated. Therefore, in a randomized trial, we plan to evaluate the biobehavioral effects of a well-established, standardized Mindfulness-Based Stress Reduction (MBSR) program in women with cervical dysplasia. MBSR is highly accessible across diverse socioeconomic and cultural groups and has demonstrated beneficial effects on psychosocial and emotional well-being in a variety of patient and healthy populations. In the proposed study, 300 women with cervical dysplasia will be randomly assigned to the MBSR program or an attention control condition. The primary aims of the study are to examine the effects of MBSR on psychosocial well-being (e.g., perceived stress, quality of life) and HPV-specific immune functioning (e.g., T-cell response to HPV16 E6, E7, and L1 peptides, intracellular cytokine expression in HPV-stimulated T cells) compared to the control condition at post-intervention and follow-up time points. It is hypothesized that MBSR participants will report lower levels of perceived stress, higher quality of life, and enhanced HPV-specific immune response (i.e. greater proliferative response to HPV16 and greater expression of Th1 cytokines) compared to control participants at post-intervention and subsequent follow-up time points. A secondary aim is to examine the extent to which changes in psychosocial well-being may mediate any effects of the intervention on HPV- specific immune response. RELEVANCE: The proposed project will be one of the first to examine whether psychosocial factors can directly influence the biological processes that are responsible for controlling cervical disease. Such findings would have clinical implications for the management of women at risk for cervical cancer.

描述（由申请人提供）：人乳头瘤病毒（HPV）感染是宫颈癌的主要危险因素。然而，仅感染并不在所有情况下都会导致癌症。数据表明，免疫因素在控制宫颈疾病进展中发挥着核心作用。研究表明，T 细胞对特定 HPV16 肽的增殖反应受损与未能解决 HPV 感染和持续性宫颈疾病有关。鉴于以下一组观察结果，免疫功能与宫颈疾病之间的关系尤其相关：1）收到异常的巴氏试验结果是一种压力事件，可能导致主要生活领域的痛苦增加和破坏； 2) 对压力的心理反应与免疫变化有关。在过去的几年里，我们一直在对患有宫颈发育不良的女性中 T 细胞对特定 HPV16 肽的反应的心理社会和行为相关性进行初步研究。我们的研究结果表明，即使在控制了关键行为风险因素之后，较高的压力水平也与 T 细胞对 HPV 的反应受损有关。然而，心理社会因素对 HPV 特异性免疫反应的因果影响仍有待证明。因此，在一项随机试验中，我们计划评估一项完善的标准化正念减压（MBSR）计划对宫颈发育不良女性的生物行为影响。 MBSR 在不同的社会经济和文化群体中很容易获得，并且已证明对各种患者和健康人群的心理社会和情感健康有有益的影响。在拟议的研究中，300 名患有宫颈发育不良的女性将被随机分配到 MBSR 计划或注意力控制条件组。该研究的主要目的是检查与干预后和随访时间点的对照条件相比，MBSR 对社会心理健康（例如，感知压力、生活质量）和 HPV 特异性免疫功能（例如，T 细胞对 HPV16 E6、E7 和 L1 肽的反应，HPV 刺激的 T 细胞中细胞内细胞因子表达）的影响。据推测，与对照组参与者相比，在干预后和随后的随访时间点，MBSR 参与者将报告较低水平的感知压力、更高的生活质量和增强的 HPV 特异性免疫反应（即对 HPV16 的增殖反应更强，Th1 细胞因子的表达更高）。第二个目的是检查社会心理健康的变化在多大程度上可能介导干预措施对 HPV 特异性免疫反应的影响。相关性：拟议的项目将是第一个研究心理社会因素是否可以直接影响控制宫颈疾病的生物过程的项目之一。这些发现将对有宫颈癌风险的女性的管理具有临床意义。