Department of Internal Medicine, Akdeniz University Medical School, Antalya, Turkey.
Department of Microbiology, Division of Immunology, Akdeniz University Medical School, Antalya, Turkey.
Int Urol Nephrol. 2020 Aug;52(8):1563-1570. doi: 10.1007/s11255-020-02475-1. Epub 2020 May 13.
In this study, we aimed to investigate the effect of paricalcitol and calcitriol usage on vitamin D receptor (VDR) contents of CD8+ , CD4+ lymphocytes and monocytes in stage 5d chronic kidney disease (CKD) patients.
Thirty-six hemodialysis patients older than 18 years of age and 19 healthy controls (group HC) without any known acute or chronic diseases were included in the study. The group of patients undergoing scheduled hemodialysis comprised three subgroups: group CL: patients on calcitriol (n: 10), group PC: patients on paricalcitol (n: 13), and group NT: patients not taking any vitamin D or VDR activating medications (n: 13). CD8+/VDR, CD4+/VDR and MONO/VDR values were representing the ratio of VDR representing cells among related cell group. On the other hand, values of CD8+/MFI, CD4+/MFI and MONO/MFI have shown the total amount of cellular VDR content per cell which has been given as of mean fluorescence intensity in the flow cytometric process. Main CKD mineral bone disorder parameters such as a hemogram, serum BUN, creatinine, albumin, Ca, iP, iPTH, 25(OH)D levels were also measured.
Average VDR contents in CD8+, CD4+ and monocytes were not different among three patient groups on hemodialysis. But in all hemodialysis subgroups, CD8+/VDR, CD4+/VDR, MONO/VDR, CD8+/MFI, CD4+/MFI and MONO/MFI levels were found to be higher compared with the healthy control subjects (p < 0.001). Among hemodialysis groups, no significant CD8+/VDR, CD4+/VDR, and MONO/VDR content differences were found with regard to the type of VDR activator agent used. There was no difference in serum levels of 25(OH)D and CRP among groups participating in the study.
There was no difference between CD8+/VDR, CD4+/VDR, and MONO/VDR levels in hemodialysis patients using calcitriol or paricalcitol, suggesting that both treatment agents may have a similar effect on VDR contents in lymphocytes and monocytes in that patient population. But in all hemodialysis subgroups, CD8+/VDR, CD4+/VDR, and MONO/VDR levels were found to be higher compared with the healthy control subjects, suggesting an overexpression of VDR through a non CRP and/or 25(OH)D dependent mechanism.
本研究旨在探讨帕立骨化醇和骨化三醇对 5d 期慢性肾脏病（CKD）患者 CD8+、CD4+淋巴细胞和单核细胞中维生素 D 受体（VDR）含量的影响。
本研究纳入了 36 名年龄大于 18 岁的血液透析患者和 19 名无任何已知急性或慢性疾病的健康对照者（HC 组）。接受常规血液透析的患者分为三组：CL 组：服用骨化三醇的患者（n=10）；PC 组：服用帕立骨化醇的患者（n=13）；NT 组：未服用任何维生素 D 或 VDR 激活药物的患者（n=13）。CD8+/VDR、CD4+/VDR 和 MONO/VDR 值代表相关细胞群中 VDR 代表细胞的比例。另一方面，CD8+/MFI、CD4+/MFI 和 MONO/MFI 值表示流式细胞术过程中每个细胞的细胞内 VDR 含量的总量，以平均荧光强度表示。还测量了主要 CKD 矿物质骨代谢紊乱参数，如全血细胞计数、血清 BUN、肌酐、白蛋白、Ca、iP、iPTH、25（OH）D 水平。
三组血液透析患者的 CD8+、CD4+和单核细胞中的 VDR 含量无差异。但在所有血液透析亚组中，CD8+/VDR、CD4+/VDR、MONO/VDR、CD8+/MFI、CD4+/MFI 和 MONO/MFI 水平均高于健康对照组（p<0.001）。在血液透析组中，使用 VDR 激活剂的类型与 CD8+/VDR、CD4+/VDR 和 MONO/VDR 含量无显著差异。参与研究的各组血清 25（OH）D 和 CRP 水平无差异。
使用骨化三醇或帕立骨化醇的血液透析患者的 CD8+/VDR、CD4+/VDR 和 MONO/VDR 水平无差异，表明两种治疗药物可能对该患者人群中淋巴细胞和单核细胞中的 VDR 含量具有相似的作用。但在所有血液透析亚组中，CD8+/VDR、CD4+/VDR 和 MONO/VDR 水平均高于健康对照组，提示通过非 CRP 和/或 25（OH）D 依赖机制过度表达 VDR。
