Association between malnutrition, integrin expression and impaired granulocyte adhesion in chronically hemodialyzed...

The relationship between malnutrition in hemodialysis (HD) patients with a chronic inflammatory condition and the expression levels of leukocyte integrins and their adhesiveness to fibronectin was investigated.

Subjective global assessment, albumin and body mass index were used as nutritional markers to group malnourished (MP) and eutrophic (EP) patients. C-reactive protein was used as an inflammation marker. LFA-1, VLA-4 and VLA-5 expression levels on circulating leukocytes before and after HD were flow cytometrically measured; and their adhesiveness, through immobilized fibronectin.

MPs showed significantly higher VLA-5 expression on granulocytes, when compared with healthy individuals (HPs) as controls (13.7% +/- 2.3% vs. 5.0% +/- 1.1%; p=0.005), particularly after HD (25.8% +/- 4.1%; p<0.001). They also presented a significantly lower ability to adhere to fibronectin when compared with EPs, before HD (48.8% +/- 1.5% vs. 62.3% +/- 0.7%; p<0.001) and after HD (50.6% +/- 1.2% vs. 65.7% +/- 1.4%; p<0.0001). Increased numbers of circulating immature neutrophils were observed only in MPs.

Although presenting higher VLA-5 expression, malnutrition in HD patients is associated with impairment of the adhesive capacity of circulating leukocytes, particularly younger neutrophils, which may contribute to the chronic inflammatory status of these patients.