Vitamin E-Coated Dialyzer Membranes Downregulate Expression of Monocyte Adhesion and Co-Stimulatory Molecules

Abstract

Background: In patients on chronic hemodialysis leukocyte activation has been related to the impaired function of the immune system. In this study we investigated if the vitamin E-coated dialyzer membrane could reduce monocyte activation thereby improving cellular immunity. Methods: This hypothesis was tested in a prospective crossover trial in which 14 stable hemodialysis patients were switched from the baseline hemophane dialyzer to a vitamin E-coated and thereafter a polysulphone dialyzer membrane or vice versa. Results: Monocyte MHC class I, CD54 and ICAM-1 expression was significantly downregulated when a vitamin E-coated or polysulphone dialyzer was used. The use of a vitamin E membrane specifically decreased monocyte CD40 and CD86 expression. Lectin induced T cell proliferation increased with the use of the vitamin E-coated membrane as compared to polysulphone and hemophane dialyzers. Conclusion: Vitamin E-coated dialyzers induced a less-activated phenotype of monocytes and may improve cellular immunity.

Effects of ex vivo γ-Tocopherol on Airway Macrophage Function in Healthy and Mild Allergic Asthmatics

“…Our results show that ex-vivo GT treatment of sputum-derived airway macrophages caused decreases in certain phagocytic indices, down-regulated expression of specific cell surface proteins and that atopic status appears to be an important factor. These findings suggest that GT modulates macrophage activation and is consistent with findings in the earlier studies [28, 34, 36, 37]. …”

“…Consistent with our findings, Betjes et al [36] reported decreased expression of MHC-I and the co-stimulatory molecules CD86 and CD40 on blood monocytes associated with the use of vitamin E coated dialysis membranes in hemodialysis patients. We did not study the effects of GT on T-cell function or of antigen processing and presentation by sputum antigen presenting cells.…”

How can dialyzer designs improve solute clearances for hemodialysis patients?

“…Preliminary clinical studies observed that these heparin-bonded dialyzers permitted heparin-free dialysis, 31 although later studies reported a reduction in heparin requirements. 33 Initially, vitamin E was bonded to modified cellulosic membranes, and only recently has vitamin E been successfully bonded to polysulfone membranes, and as yet, there has been no convincing study that suggests a clinical benefit for hemodialysis patients. 33 Initially, vitamin E was bonded to modified cellulosic membranes, and only recently has vitamin E been successfully bonded to polysulfone membranes, and as yet, there has been no convincing study that suggests a clinical benefit for hemodialysis patients.…”

Vitamin E as a Functional and Biocompatibility Modifier of Synthetic Hemodialyzer Membranes: An Overview of the Literature on Vitamin E-Modified Hemodialyzer Membranes

“…Other reports demonstrated the positive effects related to (a) decreased oxidative stress [72,73,74,75,76,77,78,79,80,81]; (b) suppression of leukocyte activation [82,83,84,85,86,87,88]; (c) reduction of anticoagulant dosage [89]; (d) improved biocompatibility [90], and (e) decreased levels of advanced glycation end products [91]. Moreover, a recent study by Kirmizis et al [92] showed lowered levels of the inflammatory markers CRP, IL-6, and soluble intercellular adhesion molecule-1 in 35 patients when treated with Excebrane with respect to baseline treatments carried out with conventional low- or medium-flux dialyzers, while no change was observed in a matched control group of 25 patients who underwent treatment with these later unmodified dialyzers for the whole observation time.…”