Department of Internal Medicine, Division of Nephrology and Transplantation, Erasmus Medical Centre, Rg5, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
Toxins (Basel). 2020 Apr 3;12(4):224. doi: 10.3390/toxins12040224.
Progressive loss of renal function is associated with a series of changes of the adaptive immune system which collectively constitute premature immunological ageing. This phenomenon contributes significantly to the mortality and morbidity of end-stage renal disease (ESRD) patients. In this review, the effect of ESRD on the T cell part of the adaptive immune system is highlighted. Naïve T cell lymphopenia, in combination with the expansion of highly differentiated memory T cells, are the hallmarks of immunological ageing. The decreased production of newly formed T cells by the thymus is critically involved. This affects both the CD4 and CD8 T cell compartment and may contribute to the expansion of memory T cells. The expanding populations of memory T cells have a pro-inflammatory phenotype, add to low-grade inflammation already present in ESRD patients and destabilize atherosclerotic plaques. The effect of loss of renal function on the thymus is not reversed after restoring renal function by kidney transplantation and constitutes a long-term mortality risk factor. Promising results from animal experiments have shown that rejuvenation of the thymus is a possibility, although not yet applicable in humans.
肾功能的进行性丧失与适应性免疫系统的一系列变化有关，这些变化共同构成了过早的免疫衰老。这种现象对终末期肾病（ESRD）患者的死亡率和发病率有重大影响。在这篇综述中，强调了 ESRD 对适应性免疫系统的 T 细胞部分的影响。幼稚 T 细胞减少，加上高度分化的记忆 T 细胞的扩增，是免疫衰老的标志。胸腺产生新形成的 T 细胞的减少是至关重要的。这既影响 CD4 和 CD8 T 细胞区室，也可能导致记忆 T 细胞的扩增。记忆 T 细胞的扩增群体具有促炎表型，增加了 ESRD 患者已经存在的低度炎症，并使动脉粥样硬化斑块不稳定。肾功能丧失对胸腺的影响在通过肾移植恢复肾功能后不能逆转，构成了长期死亡的风险因素。来自动物实验的有希望的结果表明，胸腺的年轻化是可能的，尽管在人类中尚未适用。
