Identification of T helper cell subsets in continuous ambulatory peritoneal dialysis patients

End-stage renal failure induces a clinical state of immunodeficiency with a higher incidence of infections and a higher mortality due to infectious complications as compared with the normal population. A crucial element in this immune response is the development of a network of cytokines. CD4-positive T helper (Th) cells differentiate into either Th1 or Th2 cells in response to various stimuli. It is important to examine whether the impaired immune responses in patients with end-stage renal disease are due to an enhanced Th1 response or a reduced number of Th2 cells.

Using a newly developed immunofluorescence staining of intracellular cytokines for flow cytometric analysis, we studied Th subsets in 24 patients on continuous ambulatory peritoneal dialysis (CAPD).

The proportions of Th1 cells did not differ between CAPD patients (18.7 +/- 1.8%) and controls (19.6 +/- 1.5%). Unlike Th1 cells, a significantly higher proportion of CD4 cells in CAPD patients is characterized by a Th2-type cytokine secretion pattern as compared with healthy controls: 2.9 +/- 0.8% versus 1.7 +/- 0.4%.

These data demonstrate that Th cells from CAPD patients manifest a dysregulated differentiation profile characterized by a major increase in the percentage of Th2 cells and by a normal percentage of Th1 cells.