Influenza subtype-specific immunoglobulin A and G responses after booster versus one double-dose vaccination in hemodialysis patients

Rautenberg, Peter; Proppe, Dietfrid; Schütte, Andreas; Ullmann, U.

doi:10.1007/bf01963779

Cited by 24 publications

(18 citation statements)

References 12 publications

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“…Previous influenza vaccination studies with dialysis patients have shown that their responses are weaker than those of subjects with a normal kidney function [2, 14, 15]. With enhanced vaccination protocols, it has, however, been possible to induce better responses than with conventional vaccination schedules [16], indicating quantitative rather than qualitative immune abnormalities.…”

Section: Discussionmentioning

confidence: 99%

Adequate Seroresponse to Influenza Vaccination in Dialysis Patients

Antonen

Hannula

Pyhälä

et al. 2000

Nephron

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Background: Hemodialysis (HD) patients are immunocompromised, and they have been shown to react suboptimally to recommended vaccinations. Advances in dialysis therapy and other supportive measures may theoretically result in better immune system functions. Clinical evidence supporting this theory has, however, not been presented. With influenza vaccination response, we tried to address this question. Methods: 42 HD and 15 continuous ambulatory peritoneal dialysis (CAPD) patients were vaccinated with a trivalent influenza vaccine, and the seroresponses at 5 weeks were measured. The results were compared with those of similarly vaccinated 20 nephrology outpatient clinic patients with varying degrees of renal insufficiency and those of 31 cardiac patients with normal renal function. Results: The dialysis patients had higher prevaccination titers of hemagglutination-inhibiting (HI) antibodies to all three vaccine virus antigens than the other groups due to more frequent previous vaccinations. The dialysis patients exhibited lower antibody increases, but an almost comparable proportion of them reached a protective antibody level (HI titers ≧40) 5 weeks after vaccination [A/H3N2: 61% (cardiac patients), 35% (nephrology outpatient clinic patients), 67% (CAPD), and 36% (HD); A/H1N1: 71, 70, 80 and 60; B: 97, 90, 80, and 76%, respectively]. Among the HD group, all patients receiving parenteral calcitriol except 1 (83%), but only 50% of the other HD patients produced protective antibody titers at least to two out of three vaccine virus antigens. No other patient- or HD treatment-associated parameter was significantly related to the vaccination-induced antibody response. Conclusions: We conclude that influenza vaccination of dialysis patients according to current recommendations may be effective. Additionally, our results suggest that parenteral calcitriol treatment may augment the immune response of HD patients even in a clinically relevant way, an effect so far shown only in in vitro studies.

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Section: Discussionmentioning

confidence: 99%

Adequate Seroresponse to Influenza Vaccination in Dialysis Patients

Antonen

Hannula

Pyhälä

et al. 2000

Nephron

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“…The incidence of tuberculosis is increased by up to 10-to 12-fold (Andrew et al 1980;Rutsky & Rostana 1980). There is also a significantly increased incidence of fungal and viral infections (Broyer & Boudouillez 1985;Eickhoff et al 1961;Fe1dhoff et al 1981;Onorato et al 1979;Plotkin et al 1990;Rautenberg et al 1989;Sipilsa et al 1990). …”

Section: Cell-mediated Immunitymentioning

confidence: 99%

The Use of Vaccines in Renal Failure

Johnson

Fleming

1992

Clinical Pharmacokinetics

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Renal insufficiency is characterised by impaired host defences, which are compromised further by each of the 3 modes of renal replacement--haemodialysis, continuous ambulatory peritoneal dialysis (CAPD) and renal transplantation. Reduced renal clearance of unknown toxins, possible development of nutritional deficiencies and administration of immunosuppressive medications lead to aberrant immune regulation early in the course of renal failure. This results subsequently in increased frequency and severity of infection. Vaccination plays an important role in attenuating this infection risk, but impaired cell-mediated and humoral immunity contraindicates the use of live vaccines and engenders suboptimal and short-lived antibody responses to inactivated vaccines. Reinforced vaccination schedules, increased vaccine dosage and concomitantly administered adjuvant immunomodulators have variably improved the defective antibody responses to certain vaccines. Immunisation against hepatitis B virus has resulted in a significant decrease in prevalence and incidence of this infection in haemodialysis units. Similarly, the inoculation of influenza vaccine in patients with uraemia and of polyvalent pneumococcal vaccine in special risk circumstances has been recommended because of perceived reductions in morbidity and mortality from infection with these agents. Cytomegalovirus (CMV) vaccine may attenuate CMV disease severity in recipients of renal allografts. Staphylococcus aureus vaccine, on the other hand, is ineffective in preventing peritonitis or exit site infections in patients receiving CAPD. Other killed vaccines have not been comprehensively studied, but generally have the same indications for use as in normal individuals. However, the protection that these vaccines afford may be either inadequate or transient, so that other infection control strategies should be simultaneously implemented.

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“…ESKD patients awaiting transplantation are immunologically unique in showing features of both immunodeficiency (22)(23)(24) and chronic inflammation/immune dysregulation (25)(26)(27). ESKD patients have reduced peripheral blood Tregs (28) and naïve T cells (29), implying a deficiency of naïve Tregs, the population most resistant to Th17 conversion in vitro (14).…”

Section: Introductionmentioning

confidence: 99%

Comparison of Regulatory T Cells in Hemodialysis Patients and Healthy Controls

Afzali

Edozie

Fazekasova

et al. 2013

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Cell-based therapy with natural (CD4 + CD25 hi CD127 lo ) regulatory T cells to induce transplant tolerance is now technically feasible. However, regulatory T cells from hemodialysis patients awaiting transplantation may be functionally/numerically defective. Human regulatory T cells are also heterogeneous, and some are able to convert to proinflammatory Th17 cells. This study addresses the suitability of regulatory T cells from hemodialysis patients for cell-based therapy in preparation for the first clinical trials in renal transplant recipients (the ONE Study).Design, setting, participants, & measurements Healthy controls and age-and sex-matched hemodialysis patients without recent illness/autoimmune disease on established, complication-free hemodialysis for a minimum of 6 months were recruited. Circulating regulatory T cells were studied by flow cytometry to compare the regulatory T cell subpopulations. Regulatory T cells from members of each group were compared for suppressive function and plasticity (IL-17-producing capacity) before and after in vitro expansion with and without Rapamycin, using standard assays.Results Both groups had similar total regulatory T cells and subpopulations I and III. In each subpopulation, regulatory T cells expressed similar levels of the function-associated markers CD27, CD39, HLA-DR, and FOXP3. Hemodialysis regulatory T cells were less suppressive, expanded poorly compared with healthy control regulatory T cells, and produced IL-17 in the absence of Rapamycin. However, Rapamycin efficiently expanded hemodialysis regulatory T cells to a functional and stable cell product.Conclusions Rapamycin-based expansion protocols should enable clinical trials of cell-based immunotherapy for the induction of tolerance to renal allografts using hemodialysis regulatory T cells.

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Influenza subtype-specific immunoglobulin A and G responses after booster versus one double-dose vaccination in hemodialysis patients

Cited by 24 publications

References 12 publications

Adequate Seroresponse to Influenza Vaccination in Dialysis Patients

Adequate Seroresponse to Influenza Vaccination in Dialysis Patients

The Use of Vaccines in Renal Failure

Comparison of Regulatory T Cells in Hemodialysis Patients and Healthy Controls

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