The Somatic Connection  |   October 2014
Osteopathic Manipulative Treatment Induces Enhanced Intracellular Immune Response
Author Affiliations
  • Janice Blumer, DO
    Department of Neuromusculoskeletal Medicine/Osteopathic Manipulative Medicine, Western University of Health Sciences College of Osteopathic Medicine of the Pacific-Northwest, Lebanon, Oregon
Article Information
The Somatic Connection   |   October 2014
Osteopathic Manipulative Treatment Induces Enhanced Intracellular Immune Response
The Journal of the American Osteopathic Association, October 2014, Vol. 114, 813-814. doi:10.7556/jaoa.2014.161
The Journal of the American Osteopathic Association, October 2014, Vol. 114, 813-814. doi:10.7556/jaoa.2014.161
Walkowski S, Singh M, Puertas J, Pate M, Goodrum K, Benencia F. Osteopathic manipulative therapy induces early plasma cytokine release and mobilization of a population of blood dendritic cells. PLoS One. 2014;9(3):e90132. doi:10.1371/journal.pone.0090132.  
Osteopathic lymphatic techniques have long been associated with an improved healing response in the cellular tissues and improved immune response, but research has lagged in the cytokine, chemokine, and growth factor analysis of these effects.1 Lymphatic techniques may enhance treatment by increasing lymphatic flow and fluid removal and enhancing filtration and removal of inflammatory mediators and waste products from the interstitium.2 Researchers at the Ohio University Heritage College of Osteopathic Medicine investigated the impact of lymphatic techniques. 
In the first series, 21 healthy volunteers were recruited with 2 lost to attrition; in the second series, 36 were recruited and 3 were lost to attrition. In these 2 series, the groups were randomly assigned to an osteopathic manipulative treatment (OMT) group receiving 7 minutes of combined lymphatic techniques or a control group receiving light touch (sham therapy). Blood was drawn from each participant at baseline, 5 minutes, and 30 minutes in the first series and baseline, 30 minutes, and 60 minutes in the second series. 
The phenotype and presence of circulating leukocytes was analyzed in the OMT and sham groups, as well as the presence of cytokines and chemokines (eotaxin, granulocyte-colony stimulating factor [G-CSF], interleukin-1α (IL)-1α, IL-1β, granulocyte-macrophage colony-stimulating factor [GM-CSF], IL-2, IL-8, IL-4, IL-6, IL-10, monocyte chemoattractant protein-1 [MCP-1], and macrophage inflammatory protein-1α [MIP-1α]), and growth factors. In addition, nitric oxide and C-reactive protein (CRP) levels were measured. 
Results demonstrated no statistically significant differences in CRP at 5 and 30 minutes and no differences in leukocyte populations immediately after OMT; however, levels of 4 inflammatory cytokines (eotaxin, eotaxin-2, IL-10, IL-16) in the 30-minute samples were elevated only in the OMT group. In addition, multiple other cytokines were elevated in the OMT group but not in the control group. A small but statistically significant increase in nitric oxide was observed only in the OMT group. 
In the peripheral blood mononuclear cells (PBMC) fraction there were statistically significant increases in B cells and a decrease in the monocytes in both the OMT and sham groups, but more so in the OMT group. The investigators also looked at the antigen-presenting cell within the PBMC fraction 60 minutes after treatment in the sham and intervention groups and found that subpopulations of dendritic cells were significantly decreased in the PBMC fraction at 60 minutes compared with the whole blood analysis at 60 minutes in the group receiving OMT. The results demonstrated an increase in the overall dendritic cell population in whole blood in the OMT group at 60 minutes. This finding is particularly important given that dendritic cells have the ability to stimulate T-cell response and are responsible for the success of vaccinations. 
In the second series at 60 minutes, plasma levels of MIP-1α, G-CSF, and IL-8 were significantly increased in the OMT group compared with baseline levels. Granulocyte-colony stimulating factor, which induces monocyte production in the bone marrow, was up-regulated in the OMT groups at 30 and 60 minutes. 
One limitation of this study is that only a homogeneous healthy population was used for sample analysis. Future studies should explore patient samples with substantial somatic dysfunction and infectious disease. 
In conclusion, this study shows that OMT can modify the distribution of blood dendritic cells and thus can help patients fight infections or even increase vaccine efficacy. Further study is needed to demonstrate the duration of these modifications. This study shows promising data, which could potentially impact hospital length of stay and efficacy of treatment and ultimately decrease health care costs. 
   Editor's Note: This review is 1 of 4 pertaining to the unique contribution osteopathic medicine has to make in the evaluation and treatment of pediatric conditions. Part 1 appeared in the October 2011 issue and parts 2 and 3 in the January 2012 issue of The Journal of the American Osteopathic Association.
Bockenhauer SE, Juliard KN, Lo KS, Huang E, Sheth AM. Quantifiable effects of osteopathic manipulative techniques on patients with chronic asthma. J Am Osteopath Assoc. 2002;102(7):371-375. [PubMed]
Knott EM, Tune JD, Stoll ST, Downey HF. Increased lymphatic flow in the thoracic duct during manipulative intervention. J Am Osteopath Assoc. 2005;105(10): 447-456. [PubMed]