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. 2013 Jun 21;4(1):17.
doi: 10.1186/1878-5085-4-17. eCollection 2013.

Altered molecular repertoire of immune system by renal dysfunction in the elderly: is prediction and targeted prevention in the horizon?

Cheng-Lin Lang  1 , Min-Hui Wang  2 , Kuan-Yu Hung  3 , Chih-Kang Chiang  3 , Kuo-Cheng Lu  2
Affiliations

Altered molecular repertoire of immune system by renal dysfunction in the elderly: is prediction and targeted prevention in the horizon?

Cheng-Lin Lang et al. EPMA J. .

Abstract

Background: Patients on chronic hemodialysis (HD) have impaired cellular and humoral immunity. The percentage of elderly people among the total population in Taiwan is increasing dramatically, and HD is the primary alternative for renal replacement therapy when renal function declines. Activated vitamin D is widely used in HD patients with secondary hyperparathyroidism (SHPT) and is a well-known immunomodulatory agent. Personalized medicine and integrative medical approach has been a trend in current clinical practice. Can we improve their immune function using vitamin D in spite of the mineral aspect? Here, we investigated the relationship between serum 25-hydroxyvitamin D (25(OH)D) level and T cell differentiation in chronic HD patients.

Methods: Forty patients with chronic HD were enrolled. HD patients with SHPT had been treated with activated vitamin D for 3 months. Peripheral blood mononuclear cells obtained from the patients were cultured and stimulated by mitogens, and T cells were analyzed by flow cytometry. Serum 25(OH)D levels were detected by enzyme-linked immunosorbent assay.

Results: The incidence of T cell differentiation to the T helper cell (Th)2 subtype was more prevalent in the elderly group than in the controls (p = 0.001). Th2 differentiation was also correlated with age (p = 0.004) and serum 25(OH)D levels (p < 0.05). After treated with activated vitamin D, the level of Th1 cytokines decreased while the Th2 cytokine level increased in the sera (p < 0.05). The T cell differentiation tended toward the Th2 subtype (p = 0.027) after treatment of activated vitamin D in SHPT patients.

Conclusions: These results demonstrated that Th2 differentiation is correlated with age and the serum 25(OH)D level of patients. Treatment with activated vitamin D influenced T cell differentiation and cytokine expression in SHPT patients. Taking vitamin D is the possible prediction and targeted treatment in the immune dysfunction in chronic HD patients.

Keywords: Age; Hemodialysis; Immunosenescence; Integrative medical approach; T cell differentiation; Target prevention; Vitamin D.

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Figures

Figure 1
Figure 1
PBMCs from patients after culture with stimulation mitogen were then triple-stained for surface and intracellular cytokine antibodies. A total 10,000 events were acquired. (a) Lymphocyte selection, (b) chose the PE-Cy5-labelled positive cells as Th cell, (c) results were expressed as percentage of cells stained in total events.
Figure 2
Figure 2
T cell differentiation correlated with serum 25(OH)D level.
Figure 3
Figure 3
T cell differentiation correlated with the age.
Figure 4
Figure 4
T cell differentiation change before and after treatment with activated vitamin D in the hemodialysis patient with secondary hyperparathyroidism.
See this image and copyright information in PMC

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