@article{ref1,
title="Linking the hemodynamic consequences of adverse childhood experiences to an altered  HPA axis and acute stress response",
journal="Brain, behavior, and immunity",
year="2020",
author="Dempster, Kylie S. and O'Leary, Deborah D. and MacNeil, Adam J. and Hodges, Gary J. and Wade, Terrance J.",
volume="ePub",
number="ePub",
pages="ePub-ePub",
abstract="Adverse childhood experiences (ACEs), such as maltreatment and severe household  dysfunction, represent a significant threat to public health as ACEs are associated  with increased prevalence of several chronic diseases. Biological embedding,  believed to be rooted in dysfunction of the hypothalamic-pituitary-adrenal (HPA)  axis, is the prevailing theory by which chronic diseases become imprinted in  individuals following childhood adversity. A shift towards HPA axis hypoactivity  occurs in response to ACEs exposure and is proposed to contribute towards altered  cortisol secretion, chronic low-grade inflammation, and dysregulated hemodynamic and  autonomic function. This shift in HPA axis activity may be a long-term effect of  glucocorticoid receptor methylation with downstream effects on hemodynamic and  autonomic function. Emerging evidence suggests syncopal tendencies are increased  among those with ACEs and coincides with altered neuroimmune function. Similarly,  chronic low-grade inflammation may contribute towards arterial baroreceptor  desensitization through increased arterial stiffness, negatively impacting autonomic  regulation following posture change and increasing rates of syncope in later life,  as has been previously highlighted in the literature. Although speculative,  baroreceptor desensitization may be secondary to increased arterial stiffness and  changes in expression of glucocorticoid receptors and arginine vasopressin, which  are chronically altered by ACEs. Several research gaps and opportunities exist in  this field and represent prospective areas for future investigation. Here, we  synthesize current findings in the areas of acute psychosocial stress reactivity  pertaining to HPA axis function, inflammation, and hemodynamic function while  suggesting ideas for future research emphasizing systemic interactions and postural  stress assessments among those with ACEs. This review aims to identify specific  pathways which may contribute towards orthostatic intolerance in populations with  history of childhood adversity.<p /> <p>Language: en</p>",
language="en",
issn="0889-1591",
doi="10.1016/j.bbi.2020.12.018",
url="http://dx.doi.org/10.1016/j.bbi.2020.12.018"
}