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Open Access Highly Accessed Research article

Correlation between depression, anxiety, and polymorphonuclear cells’ resilience in ulcerative colitis: the mediating role of heat shock protein 70

Ilias I Vlachos16*, Calypso Barbatis2, Maria Tsopanomichalou2, Lydia Abou-Assabeh2, Konstantinos Goumas3, Maria Ginieri-Coccossis4, Marina Economou4, George N Papadimitriou4, Efstratios Patsouris5 and Polyxeni Nicolopoulou-Stamati1

Author Affiliations

1 First Department of Pathology, Medical School, Athens University, Athens, Greece

2 Pathology Department, Hellenic Red Cross Hospital, Athens, Greece

3 Gastroenterology Department, Hellenic Red Cross Hospital, Athens, Greece

4 1st Department of Psychiatry, University of Athens, Eginition Hospital, Athens, Greeece

5 First Department of Pathology, Laiko Hospital, Athens University, Athens, Greece

6 Ilias Vlachos, 8 str Alkmanos, 11528 Athens, Greece

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BMC Gastroenterology 2014, 14:77  doi:10.1186/1471-230X-14-77

Published: 17 April 2014



To investigate whether anxiety and depression levels are associated with Heat Shock Protein 70 (HSP70) induction in the colon of patients with ulcerative colitis (UC).


The design was cross-sectional. Clinical activity was assessed by the Rachmilewitz Index (CAI). Three psychometric questionnaires were used: Zung Depression Rating Scale (ZDRS), Spielberg State-Trait Anxiety Inventory (STAI), Hospital Anxiety and Depression Scale (HADS). Colon biopsies were obtained from each affected anatomical site. Severity of inflammation was assessed by eosin/hematoxylin. Constitutive (HSP70c) and inducible (HSP70i) HSP70 expression were immunohistochemically studied.


29 UC patients were enrolled (69% men). Mean age was 46.5 years (SD: 19.5). Inflammation severity was moderate in 17 patients, severe in 6, and mild in 6. The mean number of years since diagnosis was 7.9 (SD: 6.5). The mean CAI was 6.4 (SD: 3.1). In active UC, there was downregulation of HSP70c in inflamed epithelium, without significant HSP70 induction. In 22/29 cases of active cryptitis, polymorphonuclear cells (PMN) clearly expressed HSP70i, with weak, focal positivity in the other 7 cases. Except for the hospital anxiety scale, scores in all psychometric tools were higher in patients with strong HSP70i immunoreactivity in the PMN. Logistic regression showed a strong positive relationship between HSP70i immunoreactivity in the PMN cells and scores in the trait anxiety, ZDRS, and hospital depression scales, (Odds ratios 1.3, 1.3, and 1.5; P = 0.018, 0.023, and 0.038; Wald test, 5.6, 5.2, and 4.3 respectively) and a weaker but significant positive correlation with the CAI (Odds ratio 1.654; P = 0.049; Wald test 3.858).


HSP70 is induced in PMN cells of UC patients and its induction correlates with depression and anxiety levels.

Ulcerative colitis; Polymorphonuclear cells; Heat shock protein 70; Anxiety; Depression; Psychoneuroimmunology