Nephrol Dial Transplant (2002) 17: 1790-1794
© 2002 European Renal Association-European Dialysis and Transplant Association
A shift in the Th1/Th2 ratio accompanies the clinical remission of systemic lupus erythematosus in patients with end-stage renal disease
1 Medical Department IV, Nephrology, University Homburg, Homburg and 2 Medical Department II, Nephrology, Städtisches Krankenhaus München-Harlaching, München, Germany
Background. Patients suffering from systemic lupus erythematosus (SLE) with renal involvement often show remission of systemic clinical activity after progression to end-stage renal disease (ESRD). SLE is characterized by predominantly humoral, T-helper (Th)2-mediated autoimmune responses. Since ESRD induces a state of immunodeficiency that affects the balance of Th cell subsets, we hypothesized that a Th1 shift induced by ESRD leads to clinical remission of SLE.
Methods. Using single-cell measurement of intracellular cytokines by flow cytometry after polyclonal stimulation with PMA/ionomycin, helper cell profiles were analysed in SLE patients with preserved renal function and in SLE patients with ESRD, from both isolated peripheral blood mononuclear cells (PBMC) and whole blood.
Results. Using the whole-blood assay, patients with SLE and preserved renal function showed a predominance of Th2 cells compared to healthy controls (patients, Th1/Th2 ratio 6.0±1.0 vs controls, 9.0±1.0; P<0.05). In contrast, SLE patients with ESRD have significantly more Th1 cells (36.8±5.0%) than those without ESRD (23.4±3.6%; P<0.05). This results in an enhancement of the Th1/Th2 ratio to 12.1±2.6, which is not significantly different from healthy controls. These data were confirmed using a PBMC-based assay.
Conclusions. SLE patients with preserved renal function show a bias in the differentiation of Th cells towards Th2. Once ESRD occurs, the Th1/Th2 ratio normalizes. This may contribute to the remission of Th2-mediated autoimmune diseases such as SLE.
Keywords: flow cytometry; haemodialysis; immunodeficiency; PBMC; systemic lupus erythematosus; Th1/Th2
Correspondence and offprint requests to: Hans Köhler, MD, Medical Department, Nephrology, Kirrberger Straße, University Homburg, D-66421 Homburg, Germany. Email: inhkoe{at}uniklinik\|[hyphen]\|saarland.de
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