Fax +41 61 306 12 34 E-Mail karger@karger.ch www.karger.com Original Paper Neuroimmunomodulation 2011;18:37–44 DOI: 10.1159/000315529 The Relationship between Alexithymia and Circulating Cytokine Levels in Subjects Undergoing Upper Endoscopy Gabriele Mandarelli   a Lorenzo Tarsitani   a Flora Ippoliti   b Francesco Covotta   c Maria Paola Zerella   a Alessia Mirigliani   a Massimo Biondi   a   a  Department of Psychiatric Sciences and Psychological Medicine, b  Department of Experimental Medicine and Pathology, and c  Department of Surgical Sciences and Applied Medical Technologies, ‘Sapienza’ University of Rome, Rome, Italy tected significantly lower IL-4 and IL-6 concentrations in alexithymic than in non-alexithymic patients. According to multiple linear regression analysis, alexithymia predicted low IL-4 and IL-6 levels in the sample overall, independently of stress, anxiety, depression and other possible confound- ers. No between-group differences were found in serum lev- els of IFN- , IL-1 , and TNF- . Conclusion: These findings ar- gue against an isolated shift towards pro-inflammatory or anti-inflammatory mediators and suggest that circulating cytokine profiles differ in alexithymic and non-alexithymic subjects. Copyright © 2010 S. Karger AG, Basel Among the major psychological factors known to in- fluence the human immune system are depression [1, 2], anxiety [3, 4] and stress [5, 6]. Despite the well-known impact of personality on anxious and depressive respons- es to stressors [7], relatively few studies have directly in- vestigated the relationship between personality and the Key Words Alexithymia  Cytokines  Stress  Upper endoscopy Abstract Objective: Despite emerging evidence suggesting a link be- tween alexithymia and immune function, previous studies yielded contrasting results. The proposed link between alex- ithymia and immune function remains controversial as does the role, in this relationship, of anxiety, depression and sub- jective stress. The aim of the study is to investigate the pos- sible association between alexithymia and circulating levels of cytokines in subjects awaiting an upper endoscopy, a stressful procedure, controlling for anxiety levels, depres- sion and subjective stress. Methods: Participants were re- cruited from among consecutive patients referred for rou- tine diagnostic upper endoscopy. All participants completed the Toronto Alexithymia Scale (TAS-20), the Hospital Anxiety and Depression Scale, and the Stress-related Vulnerability Scale. Serum levels of IL-1 , IL-4, IL-6, IL-10, TNF-  and IFN-  were measured by ELISA. Results: Of the 90 subjects initially approached, 68 completed the study. The TAS-20 identified 22 alexithymic and 36 non-alexithymic patients. ELISA de- Received: November 25, 2009 Accepted after revision: April 30, 2010 Published online: July 9, 2010 Gabriele Mandarelli, MD Department of Psychiatric Sciences and Psychological Medicine ‘Sapienza’ University of Rome, Viale dell’Università 30 IT–00185 Rome (Italy) Tel. +39 06 49 694 258, Fax +39 06 44 362 895, E-Mail gabriele.mandarelli  @  uniroma1.it © 2010 S. Karger AG, Basel 1021–7401/11/0181–0037$38.00/0 Accessible online at: www.karger.com/nim G. Mandarelli and L. Tarsitani contributed equally to this work.