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The effects of the dialysis membrane on cytokine release
Insights
Dialysis membranes impact immune cell function. Cuprophane membranes reduce cytokine production in hemodialysis patients, while biocompatible membranes restore it, potentially explaining varied patient cytokine levels.
Area of Science:
- Immunology
- Nephrology
- Biomaterials Science
Background:
- Cytokines like IL-1, TNF, and IL-2 are crucial for immune responses.
- Hemodialysis patients often exhibit altered immune function.
- Dialysis membranes may influence cytokine production.
Purpose of the Study:
- To investigate the effect of different dialysis membranes on cytokine elaboration by peripheral blood mononuclear cells (PBMNC) in hemodialysis patients.
- To compare the impact of cuprophane and biocompatible membranes on immune cell responses.
Main Methods:
- Prospective crossover study involving eight hemodialysis patients.
- Sequential dialysis periods: 2 weeks cuprophane, 2 weeks biocompatible, 2 weeks cuprophane.
- Measurement of IL-1 beta, TNF-alpha, IL-2, and soluble IL-2 receptors in PBMNC stimulated with phytohemagglutinin.
Main Results:
- Cuprophane membrane exposure significantly reduced PBMNC elaboration of IL-1 beta, TNF-alpha, and IL-2.
- Biocompatible membrane dialysis increased these cytokine levels.
- PBMNC response to phytohemagglutinin with biocompatible membranes approached levels seen in normal controls.
Conclusions:
- Dialysis membrane material significantly affects cytokine production in hemodialysis patients.
- Cuprophane membranes suppress immune cell elaboration of key cytokines.
- Findings may clarify discrepancies in cytokine level measurements and have clinical relevance for hemodialysis patient management.
Abstract:
The immune response requires the coordinated release of a network of cytokines including interleukin-1 (IL-1), tumor necrosis factor (TNF), and IL-2. The potential role of the dialysis membrane on the elaboration of these cytokines by peripheral blood mononuclear cells (PBMNC) harvested from hemodialysis patients was investigated in a prospective crossover study. Eight hemodialysis patients, chronically dialyzed with a biocompatible membrane, were sequentially dialyzed for 2 wk with new cuprophane membranes (Phase I), 2 wk with a low-flux, low-complement-activating membrane (Phase II), and then switched back for a further 2 wk of dialysis with a cuprophane membrane (Phase III). At the end of 2 wk of exposure to the cuprophane membrane, during both Phase I and Phase III, the ability of PBMNC to elaborate IL-1 beta, tumor necrosis factor-alpha, and IL-2, as well as soluble IL-2 receptors, in response to phytohemagglutinin was significantly reduced compared with their respective levels at the beginning of the phase; dialysis with a biocompatible membrane increased these levels, and at the end of 2 wk, the response of the PBMNC to phytohemagglutinin was close to that in normal controls. These findings may explain some of the conflicting results in the measurement of cytokine levels in hemodialysis patients and may have clinical implications.
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