Toxic stress refers to the situation where there is unsuccessful coping due to lack of adequate internal capacities as well as poor external support that may also be based upon inadequate neural architecture to handle the stressors, LY2157299 in vitro and “allostatic overload” applies to those toxic stress situations where physiological dysregulation is likely to accelerate development of disease (McEwen and Wingfield, 2003). In the healthy brain, structural remodeling occurs after both acute and chronic stress. The discovery of receptors for glucocorticoids in the hippocampus has led to many investigations in animal models and translation to the human brain using modern imaging methods. The most striking

findings from animal models have identified structural plasticity in the hippocampus, consisting of ongoing neurogenesis in the dentate gyrus (Cameron and Gould, 1996) and remodeling of dendrites and synapses in the major neurons of Ammon’s horn (McEwen, 1999). Indeed, neurogenesis in the adult mammalian brain was initially

described (Altman and Das, 1965 and Kaplan BIBW2992 cost and Bell, 1983) and then suppressed (Kaplan, 2001), only to be rediscovered in the dentate gyrus of the hippocampus (Cameron and Gould, 1994 and Gould and McEwen, 1993) in the context of studies of neuron cell death and actions of adrenal steroids and excitatory amino acids in relation to stress. This was further developed to call attention to the generality of neurogenesis across vertebrates (Alvarez-Buylla and Lois, 1995), with recent evidence making it clear that the human hippocampus shows significant neurogenesis in adult life (Spalding et al., 2013). See Astemizole also Box 1. The mediators of brain structural plasticity include excitatory amino acids and glucocorticoids, along with a growing list of other mediators such as oxytocin,

corticotrophin releasing factor, brain derived neurotrophic factor (BDNF), lipocalin-2 and tissue plasminogen activator (tPA) (McEwen, 2010). Moreover, glucocorticoid actions involve both genomic and non-genomic mechanisms that implicate mineralocorticoid, as well as glucocorticoid receptors and their translocation to mitochondria as well as cell nuclei; and, an as-yet unidentified G-protein coupled membrane receptor related to endocannabinoid production (Du et al., 2009, Hill and McEwen, 2010 and Popoli et al., 2012). Box 1 Studies of the human hippocampus have demonstrated shrinkage of the hippocampus not only in mild cognitive impairment and Alzheimer’s disease (de Leon et al., 1997), but also in Type 2 diabetes (Gold et al., 2007), prolonged major depression (Sheline, 2003), Cushing’s disease (Starkman et al., 1999) and post-traumatic stress disorder (PTSD) (Gurvits et al., 1996). Moreover, in non-disease conditions, such as chronic stress (Gianaros et al., 2007b), chronic inflammation (Marsland et al., 2008), lack of physical activity (Erickson et al.