La faible libération d’une hormone en réponse à un stress pourrait expliquer pourquoi certaines personnes seulement développent un trouble de stress post-traumatique.

Un même événement traumatisant peut affecter plusieurs personnes à la fois. Alors que certaines d’entre elles surmonteront le choc, 25% à 35% d’entre elles développeront un trouble de stress post-traumatique (TSPT). Pourquoi une telle différence ? Une étude pilotée par l’Ecole polytechnique fédérale de Lausanne (EPFL), en Suisse, et conduite sur le rat, met en lumière le rôle des glucocorticoïdes.

Un événement extrêmement traumatisant en cause
Les troubles du stress post-traumatique se manifestent par la reviviscence régulière d’un événement extrêmement traumatisant – par exemple, une menace de mort imminente – accompagnée de manifestations physiques liées à l’émotion extrême ressentie, selon l’Institut national de la santé et de la recherche médicale (Inserm).

Les personnes touchées ont pour point commun de s’être senties impuissantes face à la menace.

« Aussi, les individus souffrant de TSPT peuvent être tout autant des personnes qui ont participé à des combats militaires, été victimes d’une agression physique ou sexuelle, d’une catastrophe naturelle, ou d’une prise d’otage, que des professionnels qui sont intervenus sur des terrains de catastrophes, des parents qui ont perdu un enfant ou encore des témoins d’un accident, d’un attentat ou d’une catastrophe naturelle », poursuit l’Inserm.

Un faible taux de glucocorticoïdes
La recherche tente toujours de mieux comprendre ce phénomène afin de prendre en charge plus efficacement les personnes touchées. Selon l’étude suisse publiée le 22 septembre 2023 dans la revue Biological Psychiatry, le développement d’un TSPT serait influencé par des hormones particulières, les glucocorticoïdes, que le corps libère normalement après une situation stressante.

« Il existe des différences individuelles considérables dans les taux de glucocorticoïdes présents dans la circulation sanguine lors d’un stress, remarque dans un communiqué la Pr Carmen Sandi, co-auteure de l’étude.

De faibles taux de glucocorticoïdes sont fréquemment observés chez les patientes et patients souffrant d’un TSPT après un traumatisme, et ont été initialement suspectés d’être une conséquence de l’exposition à un traumatisme. » Mais s’agissait-il, en réalité, plutôt d’un élément préexistant ? Ces taux ne seraient non plus un symptôme – ou plus seulement -, mais un facteur de risque.

« Liens manquants »
En réalisant plusieurs mesures sur des rats, les chercheurs ont découvert qu’un taux bas de glucocorticoïdes après un stress entraînait notamment une altération de l’extinction de la peur (un symptôme du TSPT), un processus permettant normalement de diminuer une peur avec le temps.

« En effet, un bon taux de glucocorticoïdes lors de la consolidation des souvenirs est lié à l’extinction de la peur conditionnée », explique à Sciences et Avenir la Pr Sandi. Les individus privés de tels taux auraient donc plus de difficultés à bénéficier de cette « extinction », subissant alors anormalement longtemps le souvenir de l’événement traumatisant.

Cependant, ce phénomène a ici été observé uniquement chez les mâles rats. Une différence qui pourrait s’expliquer par le fait que « le type de traumatisme et l’âge au moment de l’événement traumatique affectent le développement du TSPT de manière dépendante du sexe », détaille l’étude.

Les chercheurs ont aussi relevé, toujours dans le cas d’une faible réponse hormonale à un stress, une réduction du volume de l’hippocampe et des troubles du sommeil paradoxal.

« Le sommeil paradoxal est essentiel à la consolidation de la mémoire, et les troubles de ce type de sommeil sont depuis longtemps associés au TSPT », souligne l’EPFL dans un communiqué. Ainsi, en choisissant des rats génétiquement sélectionnés pour leur faible réactivité aux glucocorticoïdes, les chercheurs ont finalement obtenu des animaux dont le « phénotype distinct englobe plusieurs traits essentiels de vulnérabilité au TSPT, notamment une altération de l’extinction de la peur, un petit volume de l’hippocampe et des perturbations du sommeil paradoxal, révélant ainsi que ces traits sont biologiquement interconnectés », est-il noté dans l’étude.

« Nos résultats mettent en évidence qu’un faible taux de glucocorticoïdes est associé à d’autres facteurs de risque et symptômes qui, jusqu’à présent n’étaient liés au TSPT que de manière indépendante », confirme Carmen Sandi dans le communiqué.

Les chercheurs démontrent ainsi que tout semble, au moins en partie, connecté. « En résumé, nous avons mis en évidence les liens, jusqu’ici manquants, selon lesquels un faible taux de glucocorticoïdes, tels que le cortisol chez l’être humain, prédispose les individus à présenter tous les facteurs de vulnérabilité au TSPT », conclut Silvia Monari, auteure principale de l’étude.

De quoi faciliter le traitement des patients ? Déjà, en administrant aux rats une thérapie cognitive et comportementale humaine et de la corticostérone, les chercheurs ont réussi à diminuer leur peur et leurs troubles du sommeil.

On peut alors imaginer que l’administration de glucocorticoïdes pourrait permettre de réguler la structure de l’hippocampe, de favoriser la consolidation de la mémoire et le sommeil des personnes à risque ou déjà touchées par un TSPT.

sciencesetavenir

Part.

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