Neuropeptides, which are stress responsive, (25> have multiple immunological effects(26) and have even been referred to as 'conductors of the immune orchestra'/2.7) b-Endorphin is a stimulant of NK cell activity. Substance P, co-released with noradrenaline (norepinephrine) at sympathetic nerve endings, may be particularly important in local immunity (and psychological influences thereon). Vasoactive intestinal peptide modulates immunoglobulin production. The sympathetic neurotransmitter noradrenaline (also a hormone) mobilizes NK cells into the circulation and is probably responsible for their increase during acute stress. Cerebral catecholamines and indolamines (e.g. serotonin) are released by immune activation and proinflammatory cytokines like interleukin 1 ( IL-1), which, in turn, probably influence neuroimmunomodulation.(24)

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