Kim Ji Ung, Kim Miyeon, Kim Sinae, Nguyen Tam Thanh, Kim Eunhye, Lee Siyoung, Kim Soohyun, Kim Hyunwoo
Division of Nephrology, Department of Internal Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju 63241, Korea.
Laboratory of Cytokine Immunology, Department of Biomedical Science and Technology, Konkuk University, Seoul 05029, Korea.
Immune Netw. 2017 Jun;17(3):152-162. doi: 10.4110/in.2017.17.3.152. Epub 2017 Jun 20.
End-stage renal disease (ESRD) with immune disorder involves complex interactions between the innate and adaptive immune responses. ESRD is associated with various alterations in immune function such as a reduction in polymorphonuclear leukocyte bactericidal activity, a suppression of lymphocyte proliferative response to stimuli, and a malfunction of cell-mediated immunity at the molecular level. ESRD also increases patients' propensity for infections and malignancies as well as causing a diminished response to vaccination. Several factors influence the immunodeficiency in patients with ESRD, including uremic toxins, malnutrition, chronic inflammation, and the therapeutic dialysis modality. The alteration of T-cell function in ESRD has been considered to be a major factor underlying the impaired adaptive cellular immunity in these patients. However, cumulative evidence has suggested that the immune defect in ESRD can be caused by an Ag-presenting dendritic cell (DC) dysfunction in addition to a T-cell defect. It has been reported that ESRD has a deleterious effect on DCs both in terms of their number and function, although the precise mechanism by which DC function becomes altered in these patients is unclear. In this review, we discuss the effects of ESRD on the number and function of DCs and propose a possible molecular mechanism for DC dysfunction. We also address therapeutic approaches to improve immune function by optimally activating DCs in patients with ESRD.
伴有免疫紊乱的终末期肾病（ESRD）涉及先天性和适应性免疫反应之间的复杂相互作用。ESRD与免疫功能的各种改变有关，如多形核白细胞杀菌活性降低、淋巴细胞对刺激的增殖反应受到抑制以及细胞介导的免疫在分子水平上出现功能障碍。ESRD还增加了患者感染和患恶性肿瘤的倾向，并导致对疫苗接种的反应减弱。有几个因素会影响ESRD患者的免疫缺陷，包括尿毒症毒素、营养不良、慢性炎症和治疗性透析方式。ESRD中T细胞功能的改变被认为是这些患者适应性细胞免疫受损的主要因素。然而，越来越多的证据表明，ESRD中的免疫缺陷除了T细胞缺陷外，还可能由抗原呈递树突状细胞（DC）功能障碍引起。据报道，ESRD对DC的数量和功能均有有害影响，尽管尚不清楚这些患者中DC功能改变的确切机制。在这篇综述中，我们讨论了ESRD对DC数量和功能的影响，并提出了DC功能障碍可能的分子机制。我们还探讨了通过最佳激活ESRD患者的DC来改善免疫功能的治疗方法。
