Patients with NIDDM have elevated [Ca2+]i levels in PMNLs. This abnormality is probably induced by hyperglycemia and is primarily responsible for the imparied phagocytosis seen in these patients.

Dialysis patients have increased susceptibility to infection and this is, in part, due to impaired phagocytic and bactericidal activities of polymorphonuclear leukocytes (PMNL). The mechanisms responsible for the reduced phagocytosis are not known. Dialysis patients have elevated blood levels of parathyroid hormone (PTH), and available data indicate that PMNL is a target cell for PTH. Chronic exposure to excess PTH may cause accumulation of calcium in PMNL which in turn could adversely affect cellular events leading to their dysfunction. We studied phagocytosis, resting levels of cytosolic calcium ([Ca²⁺]_i), ATP content and the rise in [Ca²⁺]_i in response to ligation of Fcγ RIII receptors with 3G8 monoclonal antibody in PMNL from 37 dialysis patients and 48 normal subjects. The PMNL from the dialysis patients displayed impaired phagocytosis, elevated resting levels of [Ca²⁺]_i, decreased ATP content and a smaller rise in [Ca²⁺]_i in response to various doses of 3G8 monoclonal antibody as compared to values obtained in PMNL of normal subjects. Our results suggest that derangements in cellular metabolism and possibly an abnormality in Fcγ RIII interaction with antibody and/or the consequences of such interaction are responsible, at least in part, for the impaired phagocytosis of PMNL of dialysis patients. Our data are consistent with the notion that excess PTH may play an important role in the processes leading to impaired phagocytosis.

Lymphocytes have receptors for PTH and patients with chronic renal failure have high blood levels of PTH and impaired lymphocyte function. It is possible, therefore, that PTH affects lymphocyte function. We studied the interaction between PTH and proliferation of human lymphocytes in vitro and examined potential mechanisms for such an interaction. 1-84 PTH stimulated in a dose dependent manner PHA-induced proliferation of T cells but had no effect on PWM-induced proliferation. The hormone did not alter CD4/CD8 ratio. Inactivation of PTH abolished its stimulatory effect. PTH augmented IL-2 production by PHA-activated T cells but did not increase expression of IL-2R. 1-34 PTH also stimulated PHA-induced T cell proliferation. TPA augmented PHA-induced T cell proliferation but the addition of PTH to the culture stimulated by PHA and TPA did not augment further the proliferation of T cells. Staurosporin reversed the stimulation by PTH of the PHA-induced lymphocyte proliferation. Both 1-34 and 1-84 PTH stimulated cyclic AMP production by lymphocytes. Forskolin did not affect PHA-induced T cell proliferation although it stimulated cyclic AMP generation. The results show that: 1) PTH acts on T cells; 2) acute exposure to PTH augments PHA-induced T cell proliferation and IL-2 production; 3) this action of PTH is related to its biological activity and is most likely due to the ability of PTH to enhance entry of calcium into cells and/or stimulation of protein kinase C but is independent of cyclic AMP generation.

Available data indicate that B cell proliferation is inhibited in chronic renal failure and this is due to excess blood levels of PTH. This defect may also affect immunoglobulin production. We examined production of IgG, IgM and IgA by B cells stimulated with Staphylococcus aureus Cowan I (SAC) or with pokeweed mitogen (PWM) after eight days of culture and evaluated the effect of PTH on this process in 34 hemodialysis patients and 44 normal subjects. IgG, IgM and IgA production by B cells from patients was lower (P less than 0.01) than by B cells from normal subjects. Both 1-34 and 1-84 PTH inhibited (P less than 0.01) immunoglobulin production by B cells from normal subjects and dialysis patients. However, this inhibitory effect was evident in dialysis patients only with the higher dose of PTH. The inhibition of immunoglobulin production by PTH occurred only when the hormone was added at the initiation of the B cell culture. Inactivation of PTH abolished its inhibitory effect on immunoglobulin production. Agents that stimulate cAMP production (forskolin, cholera toxin) and the cAMP analogue, 8-bromoadenosine 3',5' cyclic monophosphate inhibited immunoglobulin production by B cells from both normal and dialysis patients, and the degree of inhibition was not different between the two groups. The calcium inophore A23187 also inhibited IgG, IgA and IgM production by B cells from normal subjects and dialysis patients; there was no significant difference in the degree of inhibition between the two groups. The resting levels of cytosolic calcium in B cells of dialysis patients was significantly (P less than 0.01) higher than that of B cells from normal subjects. The data show that: (1) immunoglobulin production is impaired in dialysis patients; (2) B cells of dialysis patients have elevated resting levels of cytosolic calcium; (3) PTH inhibits IgG, IgA and IgM production and this effect is at least partly mediated by PTH-induced cAMP production and alterations in cytosolic calcium into B cells; (4) this inhibitory effect is mediated by events that affect initial stages of B cell proliferation and maturation; (5) the requirement for high dose of PTH for its inhibitory effect on B cells from dialysis patients is probably due to desensitization and/or down-regulation of PTH receptors on B cells. The results are consistent with the proposition that impaired immunoglobulin production by B cells from dialysis patients is at least partly due to the state of secondary hyperparathyroidism in these patients.

Previous studies in our laboratory showed that the T cell is a target for parathyroid hormone (PTH) action. It is theoretically possible, therefore, that chronic exposure of the T cells to high blood levels of PTH in patients with chronic renal failure may adversely affect T cell function. We examined in both normal subjects and dialysis patients several aspects of T cell function, including (1) T cell proliferation in response to phytohemagglu-tinin (PHA) mitogen with and without PTH and with and without exogenous interleukin 2 (IL-2); (2) the IL-2 production induced by PHA with and without PTH, and (3) resting levels of cytosolic calcium – [Ca²⁺]i – and the increment in [Ca²⁺]; in response to anti-CD3 antibody. Although PHA significantly (p < 0.01) stimulated proliferation of T cells from both normal subjects and dialysis patients, the magnitude of the stimulation was significantly (p < 0.01) smaller in the latter group. In both normal subjects and dialysis patients, exogenous IL-2 alone stimulated T cell proliferation, and the magnitude of the stimulation was similar to that produced by PHA. Also, IL-2 augmented PHA-induced proliferation of T cells from normal subjects, but failed to do so in T cells from dialysis patients. PHA did not augment IL-2 production by T cells from dialysis patients, and PTH did not correct this defect. The resting levels of [Ca²⁺]i in T cells from dialysis patients were significantly (p < 0.01) higher, and the increments in [Ca²⁺]i in response to anti-CD3 antibody were significantly (p < 0.01) lower than in T cells from normal subjects. The data demonstrate that the T cell function is impaired in dialysis patients. It is proposed that chronic exposure to high blood levels of PTH in the dialysis patients is associated with a rise in resting levels of [Ca²⁺]i and with a reduced calcium signal in response to anti-CD3 antibody, and these cellular derangements may interfere with the proper response of T cells to mitogens.