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Intracellular acidification mediates the inhibitory effect of peritoneal dialysate on peritoneal macrophages

A Douvdevani1, J Rapoport, A Konforty

  • 1Department of Nephrology, Soroka Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.

Insights

Commercial peritoneal dialysis solution (CDS) lowers the pH within peritoneal macrophages (PM phi), impairing their ability to fight bacteria and produce cytokines. Restoring intracellular pH above 6.5 is crucial for normal macrophage function.

Area of Science:

  • Peritoneal dialysis
  • Immunology
  • Cellular physiology

Background:

  • Commercial peritoneal dialysis solutions (CDS) negatively impact peritoneal macrophage (PM phi) function, including bacterial killing and cytokine production.
  • The low pH of CDS is a primary contributor to its cytotoxic effects on PM phi.

Purpose of the Study:

  • To investigate the effect of CDS on the intracellular pH (pHi) of PM phi from continuous ambulatory peritoneal dialysis patients.
  • To determine the relationship between CDS-induced pHi changes and impaired PM phi functions.

Main Methods:

  • PM phi pHi was measured using a fluorometric method in various buffered solutions (HBSS and CDS) at different pH levels.
  • The impact of lactic acid influx on PM phi acidification was assessed.
  • Phagocytosis and tumor necrosis factor-alpha production were evaluated after pHi clamping using K+/nigericin.

Main Results:

  • PM phi exhibited a more acidic pHi in CDS compared to HBSS at equivalent external pH values.
  • Exposure to lactate-containing HBSS mimicked the cellular acidification caused by CDS, suggesting lactic acid influx.
  • Clamping pHi below 6.5 significantly reduced tumor necrosis factor-alpha production and phagocytosis, while pHi above 6.5 maintained normal function.

Conclusions:

  • The low pH of CDS leads to lactic acid influx into PM phi, causing cellular acidification.
  • This acidification below a pHi of 6.5 impairs critical macrophage functions like phagocytosis and cytokine production.
  • Maintaining an intracellular pH above 6.5 is essential for normal PM phi immune responses in patients undergoing peritoneal dialysis.

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