Decreased antigen-specific T-cell proliferation by moDC among hepatitis B vaccine non-responders on haemodialysis

Abstract

Patients with end-stage kidney disease, whether or not on renal replacement therapy, have an impaired immune system. This is clinically manifested by a large percentage of patients unresponsive to the standard vaccination procedure for hepatitis B virus (HBV). In this study, the immune response to HBV vaccination is related to the in vitro function of monocyte-derived dendritic cells (moDC). We demonstrate that mature moDC from nonresponders to HBV vaccination have a less mature phenotype, compared to responders and healthy volunteers, although this did not affect their allostimulatory capacity. However, proliferation of autologous T cells in the presence of tetanus toxoid and candida antigen was decreased in non-responders. Also, HLA-matched CD4+ hsp65-specific human T-cell clones showed markedly decreased proliferation in the group of non-responders. Our results indicate that impairment of moDC to stimulate antigen-specific T cells provides an explanation for the clinical immunodeficiency of patients with end-stage kidney disease.

Meta-Analysis: The Impact of Nutritional Status on the Immune Response to Hepatitis B Virus Vaccine in Chronic Kidney Disease

“…In addition, the failure to complete a full course of vaccine towards HBV may cause a poor active immunization. The mechanism underlying the phenomenon of CKD-associated hepatitis B immune non-responsiveness is largely unknown, but a decreased antigen-specific T-cell proliferation by monocyte-derived dendritic cells (moDC) has recently been discovered [25].…”

“…The impact played by an inadequate nutritional status on the immunological sero-response to HB vaccine is biologically plausible as numerous changes in cellular and humoral responses have been described in non-uraemic patients with poor nutritional parameters. As an example, it has been recently suggested that poor nutritional status hampers the differentiation of monocyte-derived dendritic cells (moDC) by production of various cytokines such as interleukin-6 (IL-6) or TNF-alpha [25].…”

Modulation of the immune response to HBV vaccination by hemodialysis membranes

“…The cellular immune response to HBV vaccine is defective in HD patients possibly due to a reduction in CD4(?) T-cell and T-cell receptor numbers; decreased production of T-cell derived interleukins (IL-2 and IL-4) and interferon gamma; impaired functions of monocytes presenting antigen to T cells [11][12][13]. Uremia and HD are also associated with proinflammatory cytokines activation, which play an important role in the immune response to vaccination.…”

Comparing Humoral and Cellular Immune Response Against HBV Vaccine in Kidney Transplant Patients

“…During the phase of dialysis, diminished antigen-presenting cell (APC) function was reported to hamper mounting of HBV-specific humoral immunity (9), a process that might involve defective T helper cell generation (10).…”