A study of the immunoloregulation of double filtration plasmapheresis in maintenance hemodialysis patients with chronic hepatitis C

Abstract

Although a large number of drugs have been used to treat chronic hepatitis C (CHC), there still remains a great challenge to treat maintenance hemodialysis (MHD) patients with chronic hepatitis C. To clarify the immunnoloregulation of double filtration plasmapheresis (DFPP) in MHD patients with CHC, DFPP was performed in 20 MHD patients with CHC (HCV-antibody positive, serum HCV RNA >500 IU/ml more than 6 months and HCV genotype 1b). The clinical data was collected and peripheral blood mononuclear cells (PBMCs) were analyzed by flow cytometry at the time of hour 0, hour 3, day 3, day 7 and day 28 after the DFPP, respectively. Serum HCV particles could be removed partially by the DFPP. The titer of serum HCV RNA could remain in a lower level even 28 days after the treatment. Compared to MHD patients without HCV infection, the frequencies of innate immune cells were similar in MHD patients with CHC, while Th1/Th2 was elevated and the frequencies of regulatory T (Treg) cells were higher in those MHD patients with CHC. The frequencies of monocytes and natural killer (NK) cells remained after the DFPP in MHD patients with CHC. There were no significant changes of Th1, Th2 and Th1/Th2 in PBMC after DFPP. DFPP could reduce the frequencies of Th17 cells and Treg cells in PBMC from 7 days after DFPP in MHD patients with CHC. DFPP could partially remove the serum HCV particles mechanically. The titer of HCV RNA could remain in a lower level at least for 28 days probably due to the redistribution of the immunocytes in circulation.

Figure 1. Viral dynamics of HCV RNA during the DFPP in MHD patients with CHC.

A. The titers of HCV RNA before and after the DFPP. B. The titers of HCV RNA during 28 days after DFPP. The Y axis indicates the log HCV RNA. The X axis indicates the time course of the therapy. 0 h means before the DFPP, 3 h means after the DFPP, 28 d means 28 days after the DFPP.

Figure 2. The frequencies of monocytes in PBMC after a single DFPP.

A, B. Monocyte was expressed as CD14+ cells in PBMCs. C. The frequencies of monocytes in MHD patients with CHC compared to those without CHC. D. The frequencies of monocytes in MHD patients with CHC during the DFPP.

Figure 3. The percentages of NK cells in PBMC after the DFPP.

A, B. NK cell was expressed as CD3–CD16+CD56+ cells in PBMCs. C. The frequencies of NK cells in MHD patients with CHC compared to those without CHC. D. The frequencies of NK cells in MHD patients with CHC during the DFPP.

Figure 4. The tendencies of Th1 and Th2 cells in PBMC after the DFPP.

A-D. Th1 cells was expressed as IFN-γ+CD4+ cells; Th2 cells was expressed as IL-4+CD4+ cells. E, F The frequencies of Th1 cells in MHD patients with CHC during the DFPP. G, H The frequencies of Th2 cells in MHD patients with CHC during the DFPP. I, J The ratio of Th1 to Th2 cells in MHD patients with CHC.

Figure 5. The changes of Th17 cells in PBMC after the DFPP.

A-C. Th17 cell was expressed as CD17+CD4+ cells in PBMC. D. The frequency of Th17 cells in MHD patients with CHC compared to those without CHC. E. The frequencies of Th17 cells in MHD patients with CHC during the DFPP.

Figure 6. The tendencies of Treg cells in PBMC after a single DFPP.

A-D. Treg cell was expressed as CD4+CD25+ CD127^low/−cells in PBMC. E, F. The frequency of CD4+CD25+ Treg cells in MHD patients with CHC during the DFPP. G, H. The frequencies of CD4+CD25+ CD127^low/− Treg cells in MHD patients with CHC during the DFPP