Antibodies to oxidation-specific epitopes characterize hemodialysis patients protected from cardiovascular events

Despite the high risk of cardiovascular disease (CVD) in patients on hemodialysis (HD), some appear protected from CVD-associated mortality and survive long-term on HD. The immune system can recognize oxidation-specific epitopes (OSEs) and create antibodies with pro- or antithrombotic properties. This study aimed to elucidate the role of natural antibodies against OSEs in patients on hemodialysis (HD) and their association with cardiovascular outcomes.

Serum levels of IgM and IgG autoantibodies to OSEs (including CuOx-LDL, MDA-LDL, and MAA-BSA) were measured using an ELISA assay in a prospective population-based cohort study of prevalent HD patients. The risk for the occurrence of the 3P-MACE outcome (myocardial infarction, ischemic stroke, and cardiovascular death) with the association of antibodies against OSEs was statistically analyzed in a competing risk framework.

In our study of 595 patients with ESKD (236 (37 %) women, median age: 67 (25th to 75th percentile 55-75) years); 54 patients were long-term survivors (>10 years on HD). There was no association between IgM and IgG antibodies to OSEs with the risk of 3P-MACE occurrence after adjusting for age, atrial fibrillation, stroke, and coronary heart disease. However, long-term survivors on HD, exhibited higher levels of antibodies to OSEs compared to other patients and lower risk of 3P-MACE (IgG MAA-BSA median 97,663.83 in long-term survivors versus 70,833.50 RLU rest of the cohort, p = 0.001).

Natural autoantibodies against OSEs were not associated with the overall risk of 3P-MACE in this cohort of HD patients. However, we found that long-term survivors had higher levels of natural autoantibodies against OSEs.