The Physiological Role of Tumor Necrosis Factor in Human Immunity and Its Potential
Implications in Spinal Manipulative Therapy: A Narrative Literature Review
Liang Zhang, MD, PhD, Chao Hua Yao, MD
Palmer College of Chiropractic,
Florida Campus, Port Orange, FL;
Palmer Laboratory of Cell & Molecular Biology,
Palmer Center for Chiropractic Research,
Port Orange, FL.
OBJECTIVE: Although tumor necrosis factor (TNF) is a well-known inflammatory cytokine in the pathological development of various human diseases, its physiological roles are not widely understood nor appreciated. The molecular mechanisms underlying spinal manipulation therapy (SMT) remain elusive. The relationship between TNF and SMT is unclear. Thus, we performed this literature review to better understand TNF physiology and its potential relationship with SMT, and we propose a novel mechanism by which SMT may achieve clinical benefits by using certain beneficial features of TNF.
METHODS: We searched several databases for relevant articles published between 1975 and 2015 and then reexamined the studies from current immunophysiological perspectives.
RESULTS: The history and recent progresses in TNF physiology research were explored. Conflicting reports on the relationship between TNF and SMT were identified. Based on the newly discovered interaction between TNF and regulatory T cells, we proposed a putative biphasic TNF response to SMT, which may resolve the conflicts in the reported observations and interpretations.
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CONCLUSION: The current literature about TNF informed our discussion of new physiological roles for TNF, which may help to better understand the physiological effects of SMT.
KEYWORDS: Manipulation spinal; T-lymphocytes regulatory; Tumor necrosis factor
From the Full-Text Article:
Tumor necrosis factor (TNF), also known as TNFα, cachexin, or cachectin, is an inflammatory cytokine involved in the pathology of numerous diseases. A recent article reported serious adverse effects during long-term anti-TNF therapy,  which may indicate its beneficial functions at normal physiological levels. These beneficial physiological functions are unfamiliar to us in the complementary and alternative medicine (CAM) field. We are wondering whether this is an isolated report or an important issue widely underappreciated. Thus, a better understanding of TNF physiology and its current research progresses is warranted.
Spinal manipulative therapy (SMT) is a clinical approach widely used by CAM practitioners, such as doctors of chiropractic, osteopathic physicians, physical therapists, and some traditional Chinese medicine specialists, for maintaining general muscular skeleton health or/and alleviating pain. [2-6] Current SMT theories are based on an earlier understanding of spine anatomy and neurophysiology. [7, 8] The human body functions through various specialized cells working in concert. These cellular activities are controlled and coordinated at a variety of biological levels that include molecules acting as mediators. The current research has not examined the manner in which SMT may affect molecular controlling mechanisms.