Analysis of peripheral blood lymphocyte cell surface density of functional and activation associated markers in young and old hemodialysis patients

Tacrolimus/Mycophenolate Mofetil Improved Natural Killer Lymphocyte Reconstitution One Year After Kidney Transplant by Reference to Cyclosporine/Azathioprine

BACKGROUND

Recently introduced immunosuppressive drugs are more potent to control graft rejection, but current concerns are raised regarding their potential to increase long-term neoplastic and infectious complications. Considering the role of B, T, or natural killer (NK) lymphocyte in controlling alloreactive, anti-infectious, and antitumoral immune responses, we compared the impact of two immunosuppressive regimens on lymphocyte subsets one year following kidney transplant.

METHODS

Multivariate regression analysis of variables affecting lymphocyte subset counts was retrospectively performed on 91 kidney-transplanted patients, analyzed before graft, at day 15 and 1-year postgraft. These patients were included in a randomized prospective open trial comparing tacrolimus/mycophenolate mofetil (FK/MMF) versus cyclosporine/azathioprine (CSA/Aza), both used in association with rabbit antithymocyte globulines (rATG) induction and prednisone.

RESULTS

Fifteen days postgraft, severe T and NK lymphocyte depletion were observed in all patients, while B cell counts were selectively higher in the FK/MMF group as compared to before graft. One-year posttransplant, NK cell counts and NK cell cytotoxicity was significantly higher in patients receiving FK/MMF therapy, as compared to CSA/Aza. Cytomegalovirus (CMV) infection during the first year posttransplant was also associated to higher NK, CD8, and CD4CD8 T cell counts at month 12.

CONCLUSIONS

In addition to its higher potential in preventing graft rejection, we show that after one year of transplant, FK/MMF better preserves NK innate immune effector cells and their cytotoxic potential. These data prompt to further evaluate the role of NK cells in relation to antiviral and tumoral surveillance of transplanted patients, which are common complications of long-term immunosuppression.

Age-related increase of frequency of a new, phenotypically distinct subpopulation of human peripheral blood T cells expressing lowered levels of CD4

Aging is associated with modifications of T-cell phenotype and function, leading to impaired activation in response to both new and recall antigens. It is not known if T-cell activation results in elimination of a number of the CD4 molecules from the cell surface, as is the case with CD3/T-cell receptor complexes, or how aging influences the process. The T cells of young and elderly donors with reduced expression of CD4 were examined to see whether these cells exhibit other phenotypic features suggesting their active state. It was found that T lymphocytes expressing CD4 can be divided into 2 semidiscrete subpopulations: the major (CD4(+)) population, in which the level of expression of CD4 is constant and high, and a minor population (CD4(lo)), in which the expression of CD4 can be up to an order of magnitude lower than on the CD4(+) cells. The proportion of CD4(lo) cells is age dependent and highly variable in the apparently healthy human population, with the expression of CD4 ranging from around 10% of all peripheral blood lymphocytes in the young to more than 30% in the elderly. Lowered expression of CD4 is correlated with a reduced expression of CD3, as well as with a decreased amount of CD28 and CD95Fas. Activation of CD4(lo) cells is suggested by their expression of CD25 and increased amounts of HLA-DR. Phenotypic characteristics of the CD4(lo) T-cell subpopulation suggest that it might be formed by (perhaps chronically) activated, temporarily apoptosis-resistant cells, possibly accumulating in the elderly. (Blood. 2001;98:1100-1107)

Antigen phenotype and cytotoxic activity of natural killer cells in hemodialysis patients

The antigen phenotype and cytotoxic activity of peripheral blood natural killer (NK) cells have been studied in 35 patients on hemodialysis, evaluating the influence exerted by different types of dialysis membranes and diverse clinical and biologic features of end-stage renal disease. Two-color immunofluorescent analyses with different monoclonal antibodies and flow cytometry were performed to identify the NK cells. Functional cytotoxic assays were simultaneously performed in the same patients. The results show that hemodialysis elicits higher proportions of CD3-/CD56+ and CD3-/CD16+ NK cells and a decrease in their cytotoxic activity compared with the control group. This alteration is related to the use of cuprophan membranes; biocompatible membranes would not significantly affect NK cells. The cuprophan membranes were also found to induce a higher degree of NK cell activation, measured as the number of CD16+/HLA-DR+ cells. Age appeared to be associated with NK cell function. Regarding age, in patients older than 65 years the change from cuprophan to biocompatible membranes was associated with a recovery of NK cytotoxic activity to normal levels. In summary, hemodialysis with cuprophan membranes induces an increased proportion of both NK cells and activated NK cells associated with decreased NK cytolytic activity.