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• W2894843133 abstract "Information for Category 1 CME CreditCredit can now be obtained, free for a limited time, by reading the review articles in this issue. Please note the following instructions.Method of Physician Participation in Learning Process: The core material for these activities can be read in this issue of the Journal or online at the JACI Web site: www.jacionline.org. The accompanying tests may only be submitted online at www.jacionline.org. Fax or other copies will not be accepted.Date of Original Release: October 2018. Credit may be obtained for these courses until September 30, 2019.Copyright Statement: Copyright © 2018-2019. All rights reserved.Overall Purpose/Goal: To provide excellent reviews on key aspects of allergic disease to those who research, treat, or manage allergic disease.Target Audience: Physicians and researchers within the field of allergic disease.Accreditation/Provider Statements and Credit Designation: The American Academy of Allergy, Asthma & Immunology (AAAAI) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. The AAAAI designates this journal-based CME activity for a maximum of 1.00 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.List of Design Committee Members: Atsuhito Nakao, MD, PhD (author); Zuhair K. Ballas, MD (editor)Disclosure of Significant Relationships with Relevant Commercial Companies/Organizations: The author declares no relevant conflicts of interest. Z. K. Ballas (editor) disclosed no relevant financial relationships.Activity Objectives:1.To explain how the circadian clock is regulated.2.To identify allergic processes that vary according to circadian rhythms.3.To explain the mechanisms that regulate circadian rhythms in allergic cells.Recognition of Commercial Support: This CME activity has not received external commercial support.List of CME Exam Authors: Amanda Agyemang, MD, Mary Grace Baker, MD, Hsi-en Ho, MD, Michele Pham, MD, Travis Sifers, MD, Tamar Weinberger, MD, and Shradha Agarwal, MD, FAAAAIDisclosure of Significant Relationships with Relevant CommercialCompanies/Organizations: The exam authors disclosed no relevant financial relationships.Allergic disease is characterized by marked day-night changes in the clinical symptoms and laboratory parameters of allergy. Recent reports suggest that the circadian clock, which drives a biological rhythm with a periodicity of approximately 24 hours in behavior and physiology, underpins a time of day–dependent variation in allergic reactions. New studies also suggest that disruption of clock activity not only influences temporal variation but can also enhance the severity of allergic reactions and even increase susceptibility to allergic disease. These findings suggest that the circadian clock is a potent regulator of allergic reactions that plays more than a simple circadian timekeeping role in allergy. A better understanding of these processes will provide new insight into previously unknown aspects of the biology of allergies and can lead to the application of clock modifiers to treat allergic disease. Finally, this area of research provides a novel opportunity to consider how modern lifestyles in the developed world are changing the clinical manifestations of allergy as our society quickly transforms into a circadian rhythm–disrupted society in which sleeping, working, and eating habits are out of sync with endogenous circadian rhythmicity. Such findings might reveal lifestyle interventions that enable us to better control allergic disease. Information for Category 1 CME CreditCredit can now be obtained, free for a limited time, by reading the review articles in this issue. Please note the following instructions.Method of Physician Participation in Learning Process: The core material for these activities can be read in this issue of the Journal or online at the JACI Web site: www.jacionline.org. The accompanying tests may only be submitted online at www.jacionline.org. Fax or other copies will not be accepted.Date of Original Release: October 2018. Credit may be obtained for these courses until September 30, 2019.Copyright Statement: Copyright © 2018-2019. All rights reserved.Overall Purpose/Goal: To provide excellent reviews on key aspects of allergic disease to those who research, treat, or manage allergic disease.Target Audience: Physicians and researchers within the field of allergic disease.Accreditation/Provider Statements and Credit Designation: The American Academy of Allergy, Asthma & Immunology (AAAAI) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. The AAAAI designates this journal-based CME activity for a maximum of 1.00 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.List of Design Committee Members: Atsuhito Nakao, MD, PhD (author); Zuhair K. Ballas, MD (editor)Disclosure of Significant Relationships with Relevant Commercial Companies/Organizations: The author declares no relevant conflicts of interest. Z. K. Ballas (editor) disclosed no relevant financial relationships.Activity Objectives:1.To explain how the circadian clock is regulated.2.To identify allergic processes that vary according to circadian rhythms.3.To explain the mechanisms that regulate circadian rhythms in allergic cells.Recognition of Commercial Support: This CME activity has not received external commercial support.List of CME Exam Authors: Amanda Agyemang, MD, Mary Grace Baker, MD, Hsi-en Ho, MD, Michele Pham, MD, Travis Sifers, MD, Tamar Weinberger, MD, and Shradha Agarwal, MD, FAAAAIDisclosure of Significant Relationships with Relevant CommercialCompanies/Organizations: The exam authors disclosed no relevant financial relationships.Allergic disease is characterized by marked day-night changes in the clinical symptoms and laboratory parameters of allergy. Recent reports suggest that the circadian clock, which drives a biological rhythm with a periodicity of approximately 24 hours in behavior and physiology, underpins a time of day–dependent variation in allergic reactions. New studies also suggest that disruption of clock activity not only influences temporal variation but can also enhance the severity of allergic reactions and even increase susceptibility to allergic disease. These findings suggest that the circadian clock is a potent regulator of allergic reactions that plays more than a simple circadian timekeeping role in allergy. A better understanding of these processes will provide new insight into previously unknown aspects of the biology of allergies and can lead to the application of clock modifiers to treat allergic disease. Finally, this area of research provides a novel opportunity to consider how modern lifestyles in the developed world are changing the clinical manifestations of allergy as our society quickly transforms into a circadian rhythm–disrupted society in which sleeping, working, and eating habits are out of sync with endogenous circadian rhythmicity. Such findings might reveal lifestyle interventions that enable us to better control allergic disease. Credit can now be obtained, free for a limited time, by reading the review articles in this issue. Please note the following instructions. Method of Physician Participation in Learning Process: The core material for these activities can be read in this issue of the Journal or online at the JACI Web site: www.jacionline.org. The accompanying tests may only be submitted online at www.jacionline.org. Fax or other copies will not be accepted. Date of Original Release: October 2018. Credit may be obtained for these courses until September 30, 2019. Copyright Statement: Copyright © 2018-2019. All rights reserved. Overall Purpose/Goal: To provide excellent reviews on key aspects of allergic disease to those who research, treat, or manage allergic disease. Target Audience: Physicians and researchers within the field of allergic disease. Accreditation/Provider Statements and Credit Designation: The American Academy of Allergy, Asthma & Immunology (AAAAI) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. The AAAAI designates this journal-based CME activity for a maximum of 1.00 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. List of Design Committee Members: Atsuhito Nakao, MD, PhD (author); Zuhair K. Ballas, MD (editor) Disclosure of Significant Relationships with Relevant Commercial Companies/Organizations: The author declares no relevant conflicts of interest. Z. K. Ballas (editor) disclosed no relevant financial relationships. Activity Objectives:1.To explain how the circadian clock is regulated.2.To identify allergic processes that vary according to circadian rhythms.3.To explain the mechanisms that regulate circadian rhythms in allergic cells. Recognition of Commercial Support: This CME activity has not received external commercial support. List of CME Exam Authors: Amanda Agyemang, MD, Mary Grace Baker, MD, Hsi-en Ho, MD, Michele Pham, MD, Travis Sifers, MD, Tamar Weinberger, MD, and Shradha Agarwal, MD, FAAAAI Disclosure of Significant Relationships with Relevant Commercial Companies/Organizations: The exam authors disclosed no relevant financial relationships. The circadian rhythm is a biological rhythm with a periodicity of approximately 24 hours and is observed in the behavior and physiology of virtually all living organisms. The word circadian is derived from the Latin circā (“about”) and diēs (“a day”), meaning about a day. Circadian clocks are the endogenous time-keeping mechanisms that drive circadian rhythms.1Turek F.W. Circadian clocks: not your grandfather's clock.Science. 2016; 354: 992-993Crossref PubMed Scopus (55) Google Scholar, 2Mohawk J.A. Green C.B. Takahashi J.S. Central and peripheral circadian clocks in mammals.Annu Rev Neurosci. 2012; 35: 445-462Crossref PubMed Scopus (1373) Google Scholar, 3Dibner C. Schibler U. Albrecht U. The mammalian circadian timing system: organization and coordination of central and peripheral clocks.Annu Rev Physiol. 2010; 72: 517-549Crossref PubMed Scopus (1648) Google Scholar Circadian clocks generate robust approximately 24-hour rhythms, even in the absence of external inputs, but can adjust their timing in response to environmental cues, such as light, meal timing, exercise, and strong social interactions. It is well documented that allergic diseases exhibit a circadian oscillation. Many symptoms and laboratory parameters in patients with allergic diseases show marked day-night changes.4Smolensky M.H. Lemmer B. Reinberg A.E. Chronobiology and chronotherapy of allergic rhinitis and bronchial asthma.Adv Drug Deliv Rev. 2007; 59: 852-882Crossref PubMed Scopus (170) Google Scholar, 5Fishbein A.B. Vitaterna O. Haugh I.M. Bavishi A.A. Zee P.C. Turek F.W. et al.Nocturnal eczema: review of sleep and circadian rhythms in children with atopic dermatitis and future research directions.J Allergy Clin Immunol. 2015; 136: 1170-1177Abstract Full Text Full Text PDF PubMed Scopus (89) Google Scholar For instance, in most patients with allergic rhinitis, symptoms worsen overnight or early in the morning (“morning attack”), thereby compromising nighttime sleep and resulting in poor daytime quality of life.4Smolensky M.H. Lemmer B. Reinberg A.E. Chronobiology and chronotherapy of allergic rhinitis and bronchial asthma.Adv Drug Deliv Rev. 2007; 59: 852-882Crossref PubMed Scopus (170) Google Scholar However, until recently, the precise mechanisms underlying these observations have remained enigmatic. New studies reveal that the immune system is fundamentally connected to the circadian clock system.6Arjona A. Silver A.C. Walker W.E. Fikrig E. Immunity's fourth dimension: approaching the circadian-immune connection.Trends Immunol. 2012; 33: 607-612Abstract Full Text Full Text PDF PubMed Scopus (72) Google Scholar, 7Cermakian N. Lange T. Golombek D. Sarkar D. Nakao A. Shibata S. et al.Crosstalk between the circadian clock circuitry and the immune system.Chronobiol Int. 2013; 30: 870-888Crossref PubMed Scopus (163) Google Scholar, 8Curtis A.M. Bellet M.M. Sassone-Corsi P. O'Neill L.A. Circadian clock proteins and immunity.Immunity. 2014; 40: 178-186Abstract Full Text Full Text PDF PubMed Scopus (366) Google Scholar, 9Man K. Loudon A. Chawla A. Immunity around the clock.Science. 2016; 354: 999-1003Crossref PubMed Scopus (160) Google Scholar, 10Scheiermann C. Gibbs J. Ince L. Loudon A. Clocking in to immunity.Nat Rev Immunol. 2018; 18: 423-437Crossref PubMed Scopus (248) Google Scholar As a type of immune response, an allergic reaction is also intrinsically under the control of the circadian clock.11Nakao A. Nakamura Y. Shibata S. The circadian clock functions as a potent regulator of allergic reaction.Allergy. 2015; 70: 467-473Crossref PubMed Scopus (41) Google Scholar, 12Durrington H.J. Farrow S.N. Loudon A.S. Ray D.W. The circadian clock and asthma.Thorax. 2014; 69: 90-92Crossref PubMed Scopus (83) Google Scholar, 13Paganelli R. Petrarca C. Di Gioacchino M. Biological clocks: their relevance to immune-allergic diseases.Clin Mol Allergy. 2018; 16: 1Crossref PubMed Scopus (27) Google Scholar This review summarizes recent advances in our understanding of clock-controlled allergic reactions, the effect of circadian disruption on allergy, and the potential application of clock modifiers to control allergic disease. Virtually all living organisms are subjected to 24-hour periodic changes in their external environment driven by the rotation of the earth. These environmental changes include a light/dark cycle, changes in temperature and food availability, and risk of predator attack. Consequently, organisms have evolved internal timers referred to as circadian clocks that drive daily rhythms in behavior and physiology, enabling them to anticipate and adapt to daily alterations in the environment.1Turek F.W. Circadian clocks: not your grandfather's clock.Science. 2016; 354: 992-993Crossref PubMed Scopus (55) Google Scholar, 2Mohawk J.A. Green C.B. Takahashi J.S. Central and peripheral circadian clocks in mammals.Annu Rev Neurosci. 2012; 35: 445-462Crossref PubMed Scopus (1373) Google Scholar, 3Dibner C. Schibler U. Albrecht U. The mammalian circadian timing system: organization and coordination of central and peripheral clocks.Annu Rev Physiol. 2010; 72: 517-549Crossref PubMed Scopus (1648) Google Scholar In mammals circadian rhythms are generated from cyclic gene expression controlled by cell-autonomous and self-sustained molecular clocks within each cell.2Mohawk J.A. Green C.B. Takahashi J.S. Central and peripheral circadian clocks in mammals.Annu Rev Neurosci. 2012; 35: 445-462Crossref PubMed Scopus (1373) Google Scholar, 3Dibner C. Schibler U. Albrecht U. The mammalian circadian timing system: organization and coordination of central and peripheral clocks.Annu Rev Physiol. 2010; 72: 517-549Crossref PubMed Scopus (1648) Google Scholar These molecular clocks consist of interlocked transcriptional-translational feedback loops centered on the transcription factors brain and muscle aryl hydrocarbon receptor nuclear translocator-like 1 (BMAL1) and circadian locomoter output cycles kaput (CLOCK) (Fig 1). BMAL1, which heterodimerizes with CLOCK, binds to E-box motifs throughout the genome and drives transcription of target genes, including their own repressors period 1 (Per1), Per2, and Per3 and cryptochrome 1 (Cry1) and Cry2. PER and CRY proteins form oligomers and enter the nucleus, where they inhibit BMAL1/CLOCK activity. This negative-feedback loop, in conjunction with multiple layers of posttranscriptional regulation, takes approximately 24 hours to be completed, which acts as a molecular oscillator controlling periodic expression of thousands of clock-controlled genes (CCGs) with E-box motifs in the promoter/enhancer regions. Most of the CCGs encode key regulators of various cellular pathways in metabolism and hormonal, neural, and immune functions. Indeed, Bmal1-deficient mice lack a functional molecular clock, leading to a loss of CCGs oscillation in most tissues and resulting in behavioral and physiologic arrhythmicity.14Bunger M.K. Wilsbacher L.D. Moran S.M. Clendenin C. Radcliffe L.A. Hogenesch J.B. et al.Mop3 is an essential component of the master circadian pacemaker in mammals.Cell. 2000; 103: 1009-1017Abstract Full Text Full Text PDF PubMed Scopus (1179) Google Scholar In addition to this core loop, there is a stabilizing loop that regulates the timing and amplitude of Bmal1. This stabilizing loop is provided by the nuclear receptors retinoic acid–related orphan receptor (ROR) α and REV-ERBα (Nr1d1). The BMAL1/CLOCK heterodimer activates transcription of RORα and REV-ERBα, which activates or represses BMAL1 transcription, respectively. Details of transcriptional regulation by the mammalian circadian clock, including dynamic control of chromatin remodeling on a daily basis, have been reviewed elsewhere.15Takahashi J.S. Transcriptional architecture of the mammalian circadian clock.Nat Rev Genet. 2017; 18: 164-179Crossref PubMed Scopus (1124) Google Scholar, 16Weidemann B.J. Ramsey K.M. Bass J. A day in the life of chromatin: how enhancer-promoter loops shape daily behavior.Genes Dev. 2018; 32: 321-323Crossref PubMed Scopus (4) Google Scholar Molecular clocks regulate the timing of cellular activities by controlling a large proportion of CCGs in a cyclic manner. For instance, 1,403 (approximately 8.1%) genes out of a total of 17,308 genes expressed in mouse peritoneal macrophages oscillate in a circadian fashion.17Keller M. Mazuch J. Abraham U. Eom G.D. Herzog E.D. Volk H.D. et al.A circadian clock in macrophages controls inflammatory immune responses.Proc Natl Acad Sci U S A. 2009; 106: 21407-21412Crossref PubMed Scopus (559) Google Scholar These genes include many important regulators of pathogen recognition and cytokine secretion. This results in daily variation in the immune response to bacteria or viruses.6Arjona A. Silver A.C. Walker W.E. Fikrig E. Immunity's fourth dimension: approaching the circadian-immune connection.Trends Immunol. 2012; 33: 607-612Abstract Full Text Full Text PDF PubMed Scopus (72) Google Scholar, 7Cermakian N. Lange T. Golombek D. Sarkar D. Nakao A. Shibata S. et al.Crosstalk between the circadian clock circuitry and the immune system.Chronobiol Int. 2013; 30: 870-888Crossref PubMed Scopus (163) Google Scholar, 8Curtis A.M. Bellet M.M. Sassone-Corsi P. O'Neill L.A. Circadian clock proteins and immunity.Immunity. 2014; 40: 178-186Abstract Full Text Full Text PDF PubMed Scopus (366) Google Scholar, 9Man K. Loudon A. Chawla A. Immunity around the clock.Science. 2016; 354: 999-1003Crossref PubMed Scopus (160) Google Scholar, 10Scheiermann C. Gibbs J. Ince L. Loudon A. Clocking in to immunity.Nat Rev Immunol. 2018; 18: 423-437Crossref PubMed Scopus (248) Google Scholar Generally, cycling genes are expressed at high levels, and energy needed to synthesize and degrade mRNAs and protein levels of cyclic genes is as much as 2 times greater than that of noncyclic genes.18Wang G.Z. Hickey S.L. Shi L. Huang H.C. Nakashe P. Koike N. et al.Cycling transcriptional networks optimize energy utilization on a genome scale.Cell Rep. 2015; 13: 1868-1880Abstract Full Text Full Text PDF PubMed Scopus (34) Google Scholar Thus highly expressed genes might be selected to be downregulated in a cyclic manner for energy conservation, and rhythmic gene expression might optimize the metabolic cost of global gene expression.18Wang G.Z. Hickey S.L. Shi L. Huang H.C. Nakashe P. Koike N. et al.Cycling transcriptional networks optimize energy utilization on a genome scale.Cell Rep. 2015; 13: 1868-1880Abstract Full Text Full Text PDF PubMed Scopus (34) Google Scholar Under constant conditions, molecular clocks autonomously oscillate with a periodicity of around 24 hours (free run, about 23.5 hours in mice), so that the phase needs to be adjusted every day to match the periodic environmental signals. Each component of a molecular clock can be regulated by nonclock proteins, such as nuclear hormone receptors (eg, the glucocorticoid receptor).2Mohawk J.A. Green C.B. Takahashi J.S. Central and peripheral circadian clocks in mammals.Annu Rev Neurosci. 2012; 35: 445-462Crossref PubMed Scopus (1373) Google Scholar, 3Dibner C. Schibler U. Albrecht U. The mammalian circadian timing system: organization and coordination of central and peripheral clocks.Annu Rev Physiol. 2010; 72: 517-549Crossref PubMed Scopus (1648) Google Scholar These regulations result in adjustments to a molecular clock's phase, amplitude, and period in response to inputs from signaling associated with temporally relevant events, such as light and feeding, as discussed below. The human body consists of approximately 40 trillion cells, each having their own clock. How are the numerous cellular clocks coordinated within our body? In mammals the circadian clock system consists of the master oscillator, which is located in the suprachiasmatic nucleus (SCN) neurons of the hypothalamus (the central clock), and peripheral oscillators, which are present in virtually all cell types, including immune cells (peripheral clocks; Fig 2).2Mohawk J.A. Green C.B. Takahashi J.S. Central and peripheral circadian clocks in mammals.Annu Rev Neurosci. 2012; 35: 445-462Crossref PubMed Scopus (1373) Google Scholar, 3Dibner C. Schibler U. Albrecht U. The mammalian circadian timing system: organization and coordination of central and peripheral clocks.Annu Rev Physiol. 2010; 72: 517-549Crossref PubMed Scopus (1648) Google Scholar The SCN receives innervation from the retina, allowing it to be entrained by solar light/dark cycles. Actually, light signaling increases Per expression in the SCN neurons and induces phase shifts of the circadian rhythms. In turn, the central SCN clock transmits time-of-day information to peripheral clocks through the hypothalamus-pituitary-adrenal axis and the autonomic nervous system.19Albrecht U. Timing to perfection: the biology of central and peripheral circadian clocks.Neuron. 2012; 74: 246-260Abstract Full Text Full Text PDF PubMed Scopus (594) Google Scholar, 20Pezük P. Mohawk J.A. Wang L.A. Menaker M. Glucocorticoids as entraining signals for peripheral circadian oscillators.Endocrinology. 2012; 153: 4775-4783Crossref PubMed Scopus (140) Google Scholar Thus the main function of the SCN clock is to organize stable phase relationships in the peripheral oscillators. This hierarchically organized system keeps the central and peripheral clocks in phase with each other and synchronizes temporal programs of physiology across many tissues. Indeed, ablation of the SCN in mice leads to a loss of coherence of circadian rhythms in most tissues and results in behavioral and physiologic arrhythmicity. It is not fully understood how an extremely large number of immune cells are synchronized with systemic timing signals emitted from the SCN in vivo. However, humoral factors likely play an important role in synchronizing the immune cell clockwork. For instance, in vivo imaging analysis in mice shows that PER2 expression in mast cells exhibits circadian rhythmicity, with a peak during the active phase and a trough during the resting phase.21Nakamura Y. Nakano N. Ishimaru K. Hara M. Ikegami T. Tahara Y. et al.Circadian regulation of allergic reactions by the mast cell clock in mice.J Allergy Clin Immunol. 2014; 133: 568-575Abstract Full Text Full Text PDF PubMed Scopus (59) Google Scholar This circadian rhythmicity is lost after adrenalectomy (Fig 3, A).21Nakamura Y. Nakano N. Ishimaru K. Hara M. Ikegami T. Tahara Y. et al.Circadian regulation of allergic reactions by the mast cell clock in mice.J Allergy Clin Immunol. 2014; 133: 568-575Abstract Full Text Full Text PDF PubMed Scopus (59) Google Scholar, 22Nakamura Y. Nakano N. Ishimaru K. Ando N. Katoh R. Suzuki-Inoue K. et al.Inhibition of IgE-mediated allergic reactions by pharmacologically targeting the circadian clock.J Allergy Clin Immunol. 2016; 137: 1226-1235Abstract Full Text Full Text PDF PubMed Scopus (32) Google Scholar Additionally, the synthetic glucocorticoid dexamethasone synchronizes mast cell clocks both in vivo and in vitro in association with induction of Per expression (Fig 3, B),21Nakamura Y. Nakano N. Ishimaru K. Hara M. Ikegami T. Tahara Y. et al.Circadian regulation of allergic reactions by the mast cell clock in mice.J Allergy Clin Immunol. 2014; 133: 568-575Abstract Full Text Full Text PDF PubMed Scopus (59) Google Scholar suggesting that glucocorticoids play a role in synchronization of mast cell clockworks in vivo. Indeed, glucocorticoid-responsive elements to which the glucocorticoid receptor binds are present in the promoter region of Per1 and Per2.20Pezük P. Mohawk J.A. Wang L.A. Menaker M. Glucocorticoids as entraining signals for peripheral circadian oscillators.Endocrinology. 2012; 153: 4775-4783Crossref PubMed Scopus (140) Google Scholar Secretion of glucocorticoids (cortisol in human subjects and corticosterone in mice) from the adrenal gland exhibits circadian rhythms driven by the SCN and adrenal clocks, with a strong peak before onset of the active phase.23Son G.H. Cha H.K. Chung S. Kim K. Multimodal regulation of circadian glucocorticoid rhythm by central and adrenal clocks.J Endocr Soc. 2018; 2: 444-459Crossref PubMed Scopus (32) Google Scholar Therefore a glucocorticoid surge directed by the SCN can synchronize mast cell clocks at the population level once a day. Sympathetic nerve activity can mediate numerous effects on immune cells either directly through adrenergic receptors on immune cells or indirectly through regulating blood or lymph flow, modulating the release of neuropeptides, such as substance P, from sensory nerve endings or regulating leukocyte distribution.24Pongratz G. Straub R.H. The sympathetic nervous response in inflammation.Arthritis Res Ther. 2014; 16: 504-515Crossref PubMed Scopus (206) Google Scholar Interestingly, recent studies in mice suggest that norepinephrine released from sympathetic nerve endings can control lymphocyte trafficking to lymph nodes in a circadian manner by synchronizing lymphocyte clocks and maintaining rhythmic expression of promigratory factors on lymphocytes in phase at the population level.25Suzuki K. Hayano Y. Nakai A. Furuta F. Noda M. Adrenergic control of the adaptive immune response by diurnal lymphocyte recirculation through lymph nodes.J Exp Med. 2016; 213: 2567-2574Crossref PubMed Scopus (121) Google Scholar, 26Druzd D. Matveeva O. Ince L. Harrison U. He W. Schmal C. et al.Lymphocyte circadian clocks control lymph node trafficking and adaptive immune responses.Immunity. 2017; 46: 120-132Abstract Full Text Full Text PDF PubMed Scopus (225) Google Scholar Thus the sympathetic nerve activity, under strong control of the SCN, might also act as a timing cue to immune cell clocks through norepinephrine. Entrainment is the process by which circadian clock activity becomes synchronized to a 24-hour periodic environmental cue called “zeitgeber” (German for “timegiver”). As discussed above, light, especially blue-wavelength light, is a strong zeitgeber to which the central SCN clock is entrained and readjusts its timing (phase and period). Recent studies reveal that peripheral clocks can be entrained by several nonphotic zeitgebers, such as food timing, temperature, exercise, and stress, independently of the SCN.27Zarrinpar A. Chaix A. Panda S. Daily eating patterns and their impact on health and disease.Trends Endocrinol Metab. 2016; 27: 69-83Abstract Full Text Full Text PDF PubMed Scopus (162) Google Scholar, 28Tahara Y. Aoyama S. Shibata S. The mammalian circadian clock and its entrainment by stress and exercise.J Physiol Sci. 2017; 67: 1-10Crossref PubMed Scopus (118) Google Scholar For example, livers of mice fed exclusively during the night (their active phase) or ad libitum show a similar phase angle of cyclic liver gene expression. In contrast, feeding during the day almost entirely inverts the phase of liver oscillatory gene expression.29Damiola F. Le Minh N. Preitner N. Kornmann B. Fleury-Olela F. Schibler U. Restricted feeding uncouples circadian oscillators in peripheral tissues from the central pacemaker in the suprachiasmatic nucleus.Genes Dev. 2000; 14: 2950-2961Crossref PubMed Scopus (1744) Google Scholar, 30Stokkan K.A. Yamazaki S. Tei H. Sakaki Y. Menaker M. Entrainment of the circadian clock in the liver by feeding.Science. 2001; 291: 490-493Crossref PubMed Scopus (1365) Google Scholar This suggests that food intake in opposition to an established circadian rhythm can decouple peripheral clocks from the light-sensitive SCN. The precise mechanisms underlying the entrainment of peripheral clocks by nonphotic cues remain to be determined. Importantly, such a misalignment of peripheral clocks across the body to the SCN rhythm (internal desynchrony) can undermine physiologic circadian rhythms, posing a threat to health.31West A.C. Bechtold D.A. The cost of circadian desynchrony: evidence, insights and open questions.Bioessays. 2015; 37: 777-788Crossref PubMed Scopus (76) Google Scholar Many epidemiologic studies show that chronic internal desynchrony, as induced by irregular eating times (eg, shift workers), increases the risk of metabolic diseases.27Zarrinpar A. Chaix A. Panda S. Daily eating patterns and their impact on health and disease.Trends Endocrinol Metab. 2016; 27: 69-83Abstract Full Text Full Text PDF PubMed Scopus (162) Google Scholar, 31West A.C. Bechtold D.A. The cost of circadian desynchrony:" @default.
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• W2894843133 title "Clockwork allergy: How the circadian clock underpins allergic reactions" @default.
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• W2894843133 doi "https://doi.org/10.1016/j.jaci.2018.08.007" @default.
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