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Air Travel, Circadian Rhythms/Hormones, and Autoimmunity

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Abstract

Biological rhythms are fundamental for homeostasis and have recently been involved in the regulatory processes of various organs and systems. Circadian cycle proteins and hormones have a direct effect on the inflammatory response and have shown pro- or anti-inflammatory effects in animal models of autoimmune diseases. The cells of the immune system have their own circadian rhythm, and the light-dark cycle directly influences the inflammatory response. On the other hand, patients with autoimmune diseases characteristically have sleep disorders and fatigue, and in certain disease, such as rheumatoid arthritis (RA), a frank periodicity in the signs and symptoms is recognized. The joint symptoms predominate in the morning, and apparently, subjects with RA have relative adrenal insufficiency, with a cortisol peak unable to control the late night load of pro-inflammatory cytokines. Transatlantic flights represent a challenge in the adjustment of biological rhythms, since they imply sleep deprivation, time zone changes, and potential difficulties for drug administration. In patients with autoimmune diseases, the use of DMARDs and prednisone at night is probably best suited to lessen morning symptoms. It is also essential to sleep during the trip to improve adaptation to the new time zone and to avoid, as far as possible, works involving flexible or nocturnal shifts. The study of proteins and hormones related to biological rhythms will demonstrate new pathophysiological pathways of autoimmune diseases, which will emphasize the use of general measures for sleep respect and methods for drug administration at key daily times to optimize their anti-inflammatory and immune modulatory effects.

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References

  1. Curtis AM, Bellet MM, Sassone-Corsi P, O'Neill LA (2014) Circadian clock proteins and immunity. Immunity 40(2):178–186. doi:10.1016/j.immuni.2014.02.002

    Article  CAS  PubMed  Google Scholar 

  2. Schulz P, Steimer T (2009) Neurobiology of circadian systems. CNS Drugs 23(Suppl 2):3–13

    Article  CAS  PubMed  Google Scholar 

  3. Yoshida K, Hashimoto T, Sakai Y, Hashiramoto A (2014) Involvement of the circadian rhythm and inflammatory cytokines in the pathogenesis of rheumatoid arthritis. J Immunol Res 2014:282495. doi:10.1155/2014/282495

    Article  PubMed  PubMed Central  Google Scholar 

  4. Hand LE, Hopwood TW, Dickson SH, Walker AL, Loudon AS, Ray DW, Bechtold DA, Gibbs JE (2016) The circadian clock regulates inflammatory arthritis. FASEB J 30(11):3759–3770. doi:10.1096/fj.201600353R

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Yoshida K, Hashiramoto A, Okano T, Yamane T, Shibanuma N, Shiozawa S (2013) TNF-alpha modulates expression of the circadian clock gene Per2 in rheumatoid synovial cells. Scand J Rheumatol 42(4):276–280. doi:10.3109/03009742.2013.765031

    Article  CAS  PubMed  Google Scholar 

  6. Majde JA, Krueger JM (2005) Links between the innate immune system and sleep. J Allergy Clin Immunol 116(6):1188–1198. doi:10.1016/j.jaci.2005.08.005

    Article  CAS  PubMed  Google Scholar 

  7. Cutolo M, Seriolo B, Craviotto C, Pizzorni C, Sulli A (2003) Circadian rhythms in RA. Ann Rheum Dis 62(7):593–596

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Lechner O, Dietrich H, Oliveira dos Santos A, Wiegers GJ, Schwarz S, Harbutz M, Herold M, Wick G (2000) Altered circadian rhythms of the stress hormone and melatonin response in lupus-prone MRL/MP-fas(Ipr) mice. J Autoimmun 14(4):325–333. doi:10.1006/jaut.2000.0375

    Article  CAS  PubMed  Google Scholar 

  9. Cutolo M, Sulli A, Pizzorni C, Secchi ME, Soldano S, Seriolo B, Straub RH, Otsa K, Maestroni GJ (2006) Circadian rhythms: glucocorticoids and arthritis. Ann N Y Acad Sci 1069:289–299. doi:10.1196/annals.1351.027

    Article  CAS  PubMed  Google Scholar 

  10. Cutolo M, Maestroni GJ (2005) The melatonin-cytokine connection in rheumatoid arthritis. Ann Rheum Dis 64(8):1109–1111. doi:10.1136/ard.2005.038588

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Garcia-Mauriño S, Gonzalez-Haba M, Calvo JR, Rafii-El-Idrissi M, Sanchez-Margalet V, Goberna R, Guerrero JM (1997) Melatonin enhances IL-2, IL-6, and IFN-gamma production by human circulating CD4+ cells: a possible nuclear receptor-mediated mechanism involving T helper type 1 lymphocytes and monocytes. J Immunol 159(2):574–581

    PubMed  Google Scholar 

  12. Irwin MR (2015) Why sleep is important for health: a psychoneuroimmunology perspective. Annu Rev Psychol 66:143–172. doi:10.1146/annurev-psych-010213-115205

    Article  PubMed  Google Scholar 

  13. De Cata A, D'Agruma L, Tarquini R, Mazzoccoli G (2014) Rheumatoid arthritis and the biological clock. Expert Rev Clin Immunol 10(5):687–695

    Article  CAS  PubMed  Google Scholar 

  14. Cutolo M, Sulli A, Pincus T (2015) Circadian use of glucocorticoids in rheumatoid arthritis. Neuroimmunomodulation 22(1–2):33–39. doi:10.1159/000362733

    Article  CAS  PubMed  Google Scholar 

  15. Castanon-Cervantes O, Wu M, Ehlen JC, Paul K, Gamble KL, Johnson RL, Besing RC, Menaker M, Gewirtz AT, Davidson AJ (2010) Dysregulation of inflammatory responses by chronic circadian disruption. J Immunol 185(10):5796–5805. doi:10.4049/jimmunol.1001026

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Qin B, Deng Y (2015) Overexpression of circadian clock protein cryptochrome (CRY) 1 alleviates sleep deprivation-induced vascular inflammation in a mouse model. Immunol Lett 163(1):76–83. doi:10.1016/j.imlet.2014.11.014

    Article  CAS  PubMed  Google Scholar 

  17. Wright KP Jr, Drake AL, Frey DJ, Fleshner M, Desouza CA, Gronfier C, Czeisler CA (2015) Influence of sleep deprivation and circadian misalignment on cortisol, inflammatory markers, and cytokine balance. Brain Behav Immun 47:24–34. doi:10.1016/j.bbi.2015.01.004

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Hui L, Hua F, Diandong H, Hong Y (2007) Effects of sleep and sleep deprivation on immunoglobulins and complement in humans. Brain Behav Immun 21(3):308–310. doi:10.1016/j.bbi.2006.09.005

    Article  PubMed  Google Scholar 

  19. Frey DJ, Fleshner M, Wright KP Jr (2007) The effects of 40 hours of total sleep deprivation on inflammatory markers in healthy young adults. Brain Behav Immun 21(8):1050–1057. doi:10.1016/j.bbi.2007.04.003

    Article  CAS  PubMed  Google Scholar 

  20. Vgontzas AN, Zoumakis E, Bixler EO, Lin HM, Follett H, Kales A, Chrousos GP (2004) Adverse effects of modest sleep restriction on sleepiness, performance, and inflammatory cytokines. J Clin Endocrinol Metab 89(5):2119–2126. doi:10.1210/jc.2003-031562

    Article  CAS  PubMed  Google Scholar 

  21. Meier-Ewert HK, Ridker PM, Rifai N, Regan MM, Price NJ, Dinges DF, Mullington JM (2004) Effect of sleep loss on C-reactive protein, an inflammatory marker of cardiovascular risk. J Am Coll Cardiol 43(4):678–683

    Article  CAS  PubMed  Google Scholar 

  22. Haack M, Sanchez E, Mullington JM (2007) Elevated inflammatory markers in response to prolonged sleep restriction are associated with increased pain experience in healthy volunteers. Sleep 30(9):1145–1152

    Article  PubMed  PubMed Central  Google Scholar 

  23. Dinges DF, Douglas SD, Zaugg L, Campbell DE, McMann JM, Whitehouse WG, Orne EC, Kapoor SC, Icaza E, Orne MT (1994) Leukocytosis and natural killer cell function parallel neurobehavioral fatigue induced by 64 hours of sleep deprivation. J Clin Invest 93(5):1930–1939

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Irwin M, Thompson J, Miller C, Gillin JC, Ziegler M (1999) Effects of sleep and sleep deprivation on catecholamine and interleukin-2 levels in humans: clinical implications. J Clin Endocrinol Metab 84(6):1979–1985

    CAS  PubMed  Google Scholar 

  25. Lange T, Dimitrov S, Fehm HL, Westermann J, Born J (2006) Shift of monocyte function toward cellular immunity during sleep. Arch Intern Med 166(16):1695–1700

    Article  CAS  PubMed  Google Scholar 

  26. Savard JLL, Simard S, Ivers H, Morin CM (2003) Chronic insomnia and immune functioning. Psychosom Med 65(2):211–221

    Article  PubMed  Google Scholar 

  27. Vgontzas AN, Zoumakis E, Bixler EO, Lin HM, Follett H, Kales A, Chrousos GP (2004) Adverse effects of modest sleep restriction on sleepiness, performance, and inflammatory cytokines. J Clin Endocrinol Metab 89(5):2119–2126

    Article  CAS  PubMed  Google Scholar 

  28. van Leeuwen WMLM, Karisola P, Lindholm H, Luukkonen R, Sallinen M, Härmä M, Porkka-Heiskanen T, Alenius H (2009) Sleep restriction increases the risk of developing cardiovascular diseases by augmenting proinflammatory responses through IL-17 and CRP. PLoS One 4(2):e4589

    Article  PubMed  PubMed Central  Google Scholar 

  29. Irwin M, McClintick J, Costlow C, Fortner M, White J, Gillin JC (1996) Partial night sleep deprivation reduces natural killer and cellular immune responses in humans. FASEB J 10(5):643–653

    CAS  PubMed  Google Scholar 

  30. Lange T, Perras B, Fehm HL, Born J (2003) Sleep enhances the human antibody response to hepatitis a vaccination. Psychosom Med 2003(65):5

    Google Scholar 

  31. Spiegel K, Sherdan JF, Van Cauter E (2002) Effect of sleep deprivation on response to immunization. JAMA 288(12):1471–1472

    Article  PubMed  Google Scholar 

  32. O'Sullivan D (2007) Exposure to galactic cosmic radiation and solar energetic particles. Radiat Prot Dosim 125(1–4):407–411. doi:10.1093/rpd/ncm317

    Google Scholar 

  33. Grajewski B, Waters MA, Yong LC, Tseng CY, Zivkovich Z, Cassinelli RT 2nd (2011) Airline pilot cosmic radiation and circadian disruption exposure assessment from logbooks and company records. Ann Occup Hyg 55(5):465–475. doi:10.1093/annhyg/mer024

    PubMed  PubMed Central  Google Scholar 

  34. Parihar VK, Allen BD, Caressi C, Kwok S, Chu E, Tran KK, Chmielewski NN, Giedzinski E, Acharya MM, Britten RA, Baulch JE, Limoli CL (2016) Cosmic radiation exposure and persistent cognitive dysfunction. Sci Rep 6:34774. doi:10.1038/srep34774

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Imeri L, Opp MR (2009) How (and why) the immune system makes us sleep. Nat Rev Neurosci 10(3):199–210. doi:10.1038/nrn2576

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Zee PC, Goldstein CA (2010) Treatment of shift work disorder and jet lag. Curr Treat Options Neurol 12(5):396–411. doi:10.1007/s11940-010-0090-9

    Article  PubMed  Google Scholar 

  37. Smolensky MH, Portaluppi F, Manfredini R, Hermida RC, Tiseo R, Sackett-Lundeen LL, Haus EL (2015) Diurnal and twenty-four hour patterning of human diseases: acute and chronic common and uncommon medical conditions. Sleep Med Rev 21:12–22. doi:10.1016/j.smrv.2014.06.005

    Article  PubMed  Google Scholar 

  38. Nicholson AN (2006) Sleep and intercontinental flights. Travel Med Infect Dis 4(6):336–339. doi:10.1016/j.tmaid.2006.01.009

    Article  PubMed  Google Scholar 

  39. Uchibayashi M (2001) Forgotten episodes of the birth of cortisone. Yakushigaku Zasshi 36(1):70–75

    CAS  PubMed  Google Scholar 

  40. Kendall ECKA (1956) The centenary of Addison's disease; discussion. Bull N Y Acad Med 32(11):837–843

    CAS  PubMed  PubMed Central  Google Scholar 

  41. Puttonen S, Oksanen T, Vahtera J, Pentti J, Virtanen M, Salo P, Kivimaki M (2010) Is shift work a risk factor for rheumatoid arthritis? The Finnish public sector study. Ann Rheum Dis 69(4):779–780. doi:10.1136/ard.2008.099184

    Article  PubMed  Google Scholar 

  42. Cutolo M, Masi AT (2005) Circadian rhythms and arthritis. Rheum Dis Clin N Am 31(1):115–129 . doi:10.1016/j.rdc.2004.09.005ix-x

    Article  Google Scholar 

  43. Spies CM, Straub RH, Cutolo M, Buttgereit F (2014) Circadian rhythms in rheumatology--a glucocorticoid perspective. Arthritis Res Ther 16(Suppl 2):S3

    Article  PubMed  PubMed Central  Google Scholar 

  44. Cutolo M (2016) Glucocorticoids and chronotherapy in rheumatoid arthritis. RMD Open 2(1):e000203

    Article  PubMed  PubMed Central  Google Scholar 

  45. Kirwan JR, Clarke L, Hunt LP, Perry MG, Straub RH, Jessop DS (2010) Effect of novel therapeutic glucocorticoids on circadian rhythms of hormones and cytokines in rheumatoid arthritis. Ann N Y Acad Sci 1193:127–133. doi:10.1111/j.1749-6632.2009.05289.x

    Article  CAS  PubMed  Google Scholar 

  46. Cutolo M (2012) Why and how to optimize glucocorticoid treatment in rheumatoid arthritis. Arthritis Res Ther 14(Suppl 2):A19

    Article  PubMed Central  Google Scholar 

  47. Haas S, Straub RH (2012) Disruption of rhythms of molecular clocks in primary synovial fibroblasts of patients with osteoarthritis and rheumatoid arthritis, role of IL-1beta/TNF. Arthritis Res Ther 14(3):R122. doi:10.1186/ar3852

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Kouri VP, Olkkonen J, Kaivosoja E, Ainola M, Juhila J, Hovatta I, Konttinen YT, Mandelin J (2013) Circadian timekeeping is disturbed in rheumatoid arthritis at molecular level. PLoS One 8(1):e54049. doi:10.1371/journal.pone.0054049

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. Bang J, Chang HW, Jung HR, Cho CH, Hur JA, Lee SI, Choi TH, Kim SH, Ha E (2012) Melatonin attenuates clock gene cryptochrome1, which may aggravate mouse anti-type II collagen antibody-induced arthritis. Rheumatol Int 32(2):379–385. doi:10.1007/s00296-010-1641-9

    Article  CAS  PubMed  Google Scholar 

  50. Forrest CM, Mackay G, Stoy N, Stone TW, Darlington LG (2007) Inflammatory status and kynurenine metabolism in rheumatoid arthritis treated with melatonin. Br J Clin Pharmacol 64(4):517–526

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  51. Miller SC, Pandi-Perumai S, Esquifino AI, Cardinali DP, Maestroni GJ (2006) The role of melatonin in immuno-enhancement: potential application in cancer. Int J Exp Pathol 87(2):81–87

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  52. Maestroni GJ, Sulli A, Pizzorni C, Villaggio B, Cutolo M (2002) Melatonin in rheumatoid arthritis: a disease-promoting and modulating hormone? Clin Exp Rheumatol 20(6):872–873

    CAS  PubMed  Google Scholar 

  53. Hansson I, Holmdahl R, Mattsson R (1992) The pineal hormone melatonin exaggerates development of collagen-induced arthritis in mice. J Neuroimmunol 39(1–2):23–30

    Article  CAS  PubMed  Google Scholar 

  54. Maestroni GJ, Otsa K, Cutolo M (2008) Melatonin treatment does not improve rheumatoid arthritis. Br J Clin Pharmacol 65(5):797–798

    Article  PubMed  PubMed Central  Google Scholar 

  55. Palma BD, Tufik S (2010) Increased disease activity is associated with altered sleep architecture in an experimental model of systemic lupus erythematosus. Sleep 33(9):1244–1248

    Article  PubMed  PubMed Central  Google Scholar 

  56. Loheswaran G, Kapadia M, Gladman M, Pulapaka S, Xu L, Stanojcic M, Sakic B (2013) Altered neuroendocrine status at the onset of CNS lupus-like disease. Brain Behav Immun 32:86–93. doi:10.1016/j.bbi.2013.02.006

    Article  CAS  PubMed  Google Scholar 

  57. Yoshimatsu H, Okazaki F, Ieiri I, To H (2014) Mechanism of the 24-hour rhythm of tumor necrosis factor-alpha formed by onset of rheumatoid arthritis. Chronobiol Int 31(4):564–571. doi:10.3109/07420528.2013.878350

    Article  CAS  PubMed  Google Scholar 

  58. van der Goes MC, Bossema E, Hartkamp A, Godaert GL, Jacobs JW, Kruize AA, Derksen RH, Bijlsma JW, Geenen R (2011) Cortisol during the day in patients with systemic lupus erythematosus or primary Sjogren’s syndrome. J Rheumatol 38(2):285–288. doi:10.3899/jrheum.100572

    Article  PubMed  Google Scholar 

  59. Botte DA, Noronha IL, Malheiros DM, Peixoto TV, de Mello SB (2014) Alpha-melanocyte stimulating hormone ameliorates disease activity in an induced murine lupus-like model. Clin Exp Immunol 177(2):381–390. doi:10.1111/cei.12336

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  60. Zhou LL, Wei W, Si JF, Yuan DP (2010) Regulatory effect of melatonin on cytokine disturbances in the pristane-induced lupus mice. Mediat Inflamm 2010. doi:10.1155/2010/951210

  61. Seriolo B FV, Sulli A, Fasciolo D, Cutolo M (2002) Serum prolactin concentrations in male patients with rheumatoid arthritis. Ann N Y Acad Sci 966 (258–62)

  62. Wang P, Lv TT, Guan SY, Li HM, Leng RX, Zou YF, Pan HF (2017) Increased plasma/serum levels of prolactin in systemic lupus erythematosus: a systematic review and meta-analysis. Postgrad Med 129(1):126–132

    Article  PubMed  Google Scholar 

  63. Donga E, van Dijk M, van Dijk JG, Biermasz NR, Lammers GJ, van Kralingen K, Hoogma RP, Corssmit EP, Romijn JA (2010) Partial sleep restriction decreases insulin sensitivity in type 1 diabetes. Diabetes Care 33(7):1573–1577. doi:10.2337/dc09-2317

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  64. Estrada CL, Danielson KK, Drum ML, Lipton RB (2012) Insufficient sleep in young patients with diabetes and their families. Biol Res Nurs 14(1):48–54. doi:10.1177/1099800410395569

    Article  PubMed  Google Scholar 

  65. Peschke E, Bähr I, Mühlbauer E (2015) Experimental and clinical aspects of melatonin and clock genes in diabetes. J Pineal Res 59(1):1–23

    Article  CAS  PubMed  Google Scholar 

  66. Ruiz FS, Andersen ML, Zager A, Martins RC, Tufik S (2007) Sleep deprivation reduces the lymphocyte count in a non-obese mouse model of type 1 diabetes mellitus. Braz J Med Biol Res 40(5):633–637

    Article  CAS  PubMed  Google Scholar 

  67. Lebailly B, Boitard C, Rogner UC (2015) Circadian rhythm-related genes: implication in autoimmunity and type 1 diabetes. Diabetes Obes Metab 17(Suppl 1):134–138. doi:10.1111/dom.12525

    Article  CAS  PubMed  Google Scholar 

  68. He CX, Prevot N, Boitard C, Avner P, Rogner UC (2010) Inhibition of type 1 diabetes by upregulation of the circadian rhythm-related aryl hydrocarbon receptor nuclear translocator-like 2. Immunogenetics 62(9):585–592. doi:10.1007/s00251-010-0467-7)

    Article  CAS  PubMed  Google Scholar 

  69. He CX, Avner P, Boitard C, Rogner UC (2010) Downregulation of the circadian rhythm related gene Arntl2 suppresses diabetes protection in Idd6 NOD.C3H congenic mice. Clin Exp Pharmacol Physiol 37(12):1154–1158. doi:10.1111/j.1440-1681.2010.05451.x

    Article  CAS  PubMed  Google Scholar 

  70. Lebailly B, He C, Rogner UC (2014) Linking the circadian rhythm gene Arntl2 to interleukin 21 expression in type 1 diabetes. Diabetes 63(6):2148–2157. doi:10.2337/db13-1702/-/DC1

    Article  CAS  PubMed  Google Scholar 

  71. Peterson DC, Martin-Gill C, Guyette FX, Tobias AZ, McCarthy CE, Harrington ST, Delbridge TR, Yealy DM (2013) Outcomes of medical emergencies on commercial airline flights. N Engl J Med 368(22):2075–2083

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  72. Hedström AK, Åkerstedt T, Olsson T, Alfredsson L (2015) Shift work influences multiple sclerosis risk. Mult Scler 21(9):1195–1199. doi:10.1177/1352458514563592

    Article  PubMed  Google Scholar 

  73. Hedstrom AK, Akerstedt T, Hillert J, Olsson T, Alfredsson L (2011) Shift work at young age is associated with increased risk for multiple sclerosis. Ann Neurol 70(5):733–741. doi:10.1002/ana.22597

    Article  PubMed  Google Scholar 

  74. Buenafe AC (2012) Diurnal rhythms are altered in a mouse model of multiple sclerosis. J Neuroimmunol 243(1–2):12–17. doi:10.1016/j.jneuroim.2011.12.002

    Article  CAS  PubMed  Google Scholar 

  75. Melamud L, Golan D, Luboshitzky R, Lavi I, Miller A (2012) Melatonin dysregulation, sleep disturbances and fatigue in multiple sclerosis. J Neurol Sci 314(1–2):37–40. doi:10.1016/j.jns.2011.11.003

    Article  CAS  PubMed  Google Scholar 

  76. Kern S, Schultheiss T, Schneider H, Schrempf W, Reichmann H, Ziemssen T (2011) Circadian cortisol, depressive symptoms and neurological impairment in early multiple sclerosis. Psychoneuroendocrinology 36(10):1505–1512. doi:10.1016/j.psyneuen.2011.04.004

    Article  CAS  PubMed  Google Scholar 

  77. Porhomayon J, Zadeli G, Yarahamadi A, Nader ND (2013) A case of prolonged delayed postdural puncture headache in a patient with multiple sclerosis exacerbated by air travel. Case Rep Anesthesiol 2013:253218

    PubMed  PubMed Central  Google Scholar 

  78. Silver AC, Arjona A, Walker WE, Fikrig E (2012) The circadian clock controls toll-like receptor 9-mediated innate and adaptive immunity. Immunity 36(2):251–261

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  79. Narasimamurthy R, Hatori M, Nayak SK, Liu F, Panda S, Verma IM (2012) Circadian clock protein cryptochrome regulates the expression of proinflammatory cytokines. Proc Natl Acad Sci U S A 109(31):12662–12667

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico city, Mexico

    J. Torres-Ruiz

  2. Research Laboratories and Academic Division of Clinical Rheumatology, Director Postgraduate School on Rheumatology—Department of Internal Medicine, University of Genoa, Genoa, Italy

    A. Sulli & M. Cutolo

  3. IRCCS San Martino AOU, Genoa, Italy

    A. Sulli & M. Cutolo

  4. The Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, 5265601, Tel-Hashomer, Israel

    Y. Shoenfeld

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  1. J. Torres-Ruiz
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Correspondence to Y. Shoenfeld.

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Torres-Ruiz, J., Sulli, A., Cutolo, M. et al. Air Travel, Circadian Rhythms/Hormones, and Autoimmunity. Clinic Rev Allerg Immunol 53, 117–125 (2017). https://doi.org/10.1007/s12016-017-8599-2

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