Adsorptive Hemodialysis by Polymethylmethacrylate (PMMA): an update on Hepatitis B Vaccination Immunoresponce
نویسندگان
چکیده
Patients with end stage renal disease (ESRD), undergoing hemodialysis, present with an alteration in immune response to anti-HBV vaccination [1]. Immunodeficiency in ESRD patients is caused by a dysregulation of various types of immune cells. The receptor CD40, which is expressed on the surface of B-cells, interacts with CD40 ligand (CD40L), which is expressed on T cells, NK cells and basophils [2]. The CD40/CD40L complex modulates the proliferation of B-cells, expression of IL-12 and activation of T-cells [2]. The soluble form of CD40, sCD40, serves to regulate the interaction between CD40 and CD40L and thereby causing a reduction in lymphocyte activation and Ig production. Up to 50% of patients with end-stage renal disease (ESRD) undergoing dialysis therapy present with a reduced response to anti-hepatitis B virus (anti-HBV) vaccination [1]. Patients on hemodialysis have been shown to have higher levels of soluble CD40 (sCD40), compared to healthy subjects [9,3]. Soluble CD40 is produced by B-cells by alternative splicing of the CD40 gene and by proteolytic cleavage of membrane-bound CD40 [4]. It has been shown experimentally that sCD40 reduces immunoglobulin (Ig) production and T cell activation and this molecule has therefore been hypothesized to have an immunodepressant effect [5]. Soluble CD40 is a glycoprotein and exists as dimeric and higher oligomeric forms of 50 and 150 kDa [6]. Due to its high molecular weight, sCD40 cannot be removed effectively by standard diffusive or convective dialysis therapy.
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