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: 8118150
• 负责人: Carolyn Y. Fang
• 金额: $ 57.36万
• 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 2013-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8118150
• 关键词: Antigens; Anxiety; Area; Attention; Behavioral; Biological Process; Cancer Model; Cancer Patient; Cervical; Cervical dysplasia; Cervix Uteri; Clinical; Control Groups; Cytolysis; Data; Development; Diagnosis; Disease; Disease Progression; Distress; 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; Lead; Lesion; Life; Link; Malignant Neoplasms; Malignant neoplasm of cervix uteri; Mediating; Natural Killer Cells; Observational Study; Outcome; Pap smear; Participant; Pathway interactions; Patients; Peptides; Personal Satisfaction; Play; Population; Premalignant; Proteins; Psychological Stress; Psychosocial Assessment and Care; Psychosocial Factor; Quality of life; Randomized; Reporting; Research Personnel; Risk; Risk Factors; Role; Severities; Stress; Stressful Event; T cell response; T-Lymphocyte; Test Result; Time; Vaccines; Woman; biobehavior; cancer risk; cell mediated immune response; cytokine; follow-up; immune function; improved; intervention effect; malignant breast neoplasm; mindfulness-based stress reduction; post intervention; programs; psychologic; psychological distress; psychosocial; randomized trial; 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，感染本身并不会在所有情况下导致癌症。数据表明，免疫因素在控制宫颈疾病进展中起着核心作用。研究表明，对特定HPV 16肽的T细胞增殖反应受损与HPV感染和持续性宫颈疾病的解决失败有关。免疫功能和宫颈疾病之间的关系是特别相关的，考虑到以下一组观察：1）接受异常巴氏试验结果是一个压力事件，可导致增加的痛苦和破坏的主要生活领域;和2）心理反应的压力与免疫变化。在过去的几年里，我们一直在进行初步研究的心理和行为相关的T细胞反应的特定HPV 16肽的妇女宫颈发育不良。我们的研究结果表明，即使在控制了关键的行为风险因素之后，更高水平的压力也与T细胞对HPV的反应受损有关。然而，心理社会因素对HPV特异性免疫应答的任何因果影响仍有待证实。因此，在一项随机试验中，我们计划评估一个完善的，标准化的正念减压（MBSR）计划对宫颈发育不良妇女的生物行为影响。MBSR在不同的社会经济和文化群体中非常容易获得，并已证明对各种患者和健康人群的心理社会和情感健康具有有益影响。在这项拟议的研究中，300名宫颈发育不良的妇女将被随机分配到正念减压疗法项目或注意力控制条件。这项研究的主要目的是检查正念减压疗法对心理社会健康的影响（例如，感知的压力，生活质量）和HPV特异性免疫功能（例如，T细胞对HPV 16 E6、E7和L1肽的应答，HPV刺激的T细胞中的细胞内细胞因子表达）与干预后和随访时间点的对照条件相比。据推测，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HPV特异性免疫反应（即更大的增殖反应HPV 16和更多的Th 1细胞因子的表达）相比，对照组参与者在干预后和随后的随访时间点。第二个目的是检查心理社会健康的变化在多大程度上可能介导干预对HPV特异性免疫应答的任何影响。相关性：拟议的项目将是第一批研究心理社会因素是否可以直接影响负责控制宫颈疾病的生物过程的项目之一。这些发现将对管理有宫颈癌风险的妇女具有临床意义。