Skip to main content
SpringerLink
Log in

Sekundärer Immundefekt bei Niereninsuffizienz am Beispiel der Hepatitis B-Impfung

Hepatitis B-vaccination and secondary immune deficiency

  • Published:
Klinische Wochenschrift Aims and scope Submit manuscript

Summary

In dialysis patients the immune response to hepatitis B-vaccination is greatly impaired. In vitro the non-responders show a failure of the monocytes to support the process of primary T-cell activation. This defect results in a lack of interleukin 2-production and an enhanced sensitivity of the interleukin-2 receptor system. Addition of low doses of interleukin-2 fully reconstitutes the deficient immune response in vitro. Furthermore, the local application of low dose interleukin-2 during a standard vaccination with 40 µg hepatitis B-vaccine normalizes the non-responder state in vivo.

Zusammenfassung

Die aktive Hepatitis-B-Impfung führt bei Gesunden in über 95%, bei Dialysepatienten nur in ca. 60% zur Bildung protektiver anti-HBs-Antikörper. In vitro geht der Non-Responder-Status mit einer gestörten Monozytenfunktion einher, die eine mangelhafte Interleukin-2-Produktion nach sich zieht. Gleichzeitig findet sich eine vermehrte Expression funktioneller Interleukin-2-Rezeptoren. Exogen zugeführtes Interleukin-2 normalisiert daher bereits in niedriger Dosierung die vorher verminderte proliferative Antwort von Non-Responder-Lymphozyten in vitro. Außerdem läßt sich der Non-Responder-Status von Dialysepatienten in vivo beheben, wenn zur Standard-Impfung mit 40 µg Hepatitis B-Vakzine zusätzlich eine niedrige Interleukin-2-Dosis (2,5 × 105 Einheiten) lokal appliziert wird.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Literatur

  1. Bender SB, Curtis JL, Nagel JE, Chrest FJ, Kraus ES, Briefel GR, Adler WH (1984) Analysis of immune status of hemodialyzed adults: Association with prior transfusion. Kidney Intern 26:436–443

    Google Scholar 

  2. Craven DE, Awden ZL, Kunches LM, Yunis EJ, Dienstag JL, Werner BG, Polk BF, Snydman DR, Platt R, Crumpacker CS, Grady GF, Alper CA (1986) Nonresponsiveness to hepatitis B vaccine in health care workers. Ann Intern Med 105:356–360

    Google Scholar 

  3. Crosnier J, Jungers P, Courouće AM, Laplanche A, Benhamou E, Degos F, Lacour B (1981) Randomised placebocontrolled trial of hepatitis B surface antigen vaccine in french haemodialysis units: II, haemodialysis patients. Lancet I:797–800

    Google Scholar 

  4. Desmyter J, Colaert J, de Groote G, Reynders M, Reering-Brongers EE, Dees PJ, Lelie PN, Reesink HW (1983) Efficacy of heat-inactivated hepatitis B vaccine in haemodialysis patients and staff. Lancet II:1323–1327

    Google Scholar 

  5. Gahl GM, Hess G, Arnold W, Grams G (1979) Hepatitis B virus markers in 97 long-term hemodialysis patients. Nephron 24:58–63

    Google Scholar 

  6. Grob PJ, Binswanger U, Blumberg A, Gloor HJ, Hany A, Herwig W, Iselin H, Zàruba K, Bolla K (1985) Thymopentin as adjuvant to Hepatitis B vaccination. Surv immunol res 4 (Suppl 1):107–115

    Google Scholar 

  7. Kaye WA, Adri MNS, Stuart-Soeldner J, Rabinowe SL, Kaldany A, Kahn CR, Bestrian B, Srikanta S, Ganda OmP, Eisenbarth, GS (1986) Acquired defect in interleukin-2 production in patients with type I diabetes mellitus. N Engl J Med 315:920–924

    Google Scholar 

  8. Köhler H, Arnold W, Renschin G, Dormeyer HH, Meyer zum Büschenfelde KH (1984) Active hepatitis B vaccination of dialysis patients and medical staff. Kidney Intern 25:124–128

    Google Scholar 

  9. Kurz P, Köhler H, Hütteroth T, Weber M, Meyer zum Büschenfelde KH (1985) Immune defect in the early stage of chronic renal failure. Proc EDTA-ERA 22:941–945

    Google Scholar 

  10. Kurz P, Köhler H, Meuer S, Hütteroth T, Meyer zum Büschenfelde KH (1986) Impaired cellular immune responses in chronic renal failure: Evidence for a T cell defect. Kidney Intern 29:1209–1214

    Google Scholar 

  11. Langhoff E, Hofmann B, Odum N, Ladefoged J, Platz P, Ryder LP, Svejgaard A (1987) Kinetic analysis of interleukin 2 (IL-2) produktion and expression of IL-2 receptors by uraemic and normal lymphocytes. Scand J Immunol 25:29–36

    Google Scholar 

  12. Lelie PN, Reesink HW, de Jong-van Manen ST, Dees PJ, Reerink-Brongers EE (1985) Immune response to a heat inactivated hepatitis B vaccine in patients undergoing hemodialysis. Arch Intern Med 145:305–309

    Google Scholar 

  13. Meuer SC, Hauer M, Deusch K, Moebius U, Meyer zum Büschenfelde KH (1987) Two pathways of T cell activation. Behring Inst Mitt 81:15–30

    Google Scholar 

  14. Meuer S, Hauer M, Kurz P, Meyer zum Büschenfelde KH, Köhler H (1987) Selective blockade of the antigen-receptor-mediated pathway of T cell activation in patients with impaired primary immune responses. J Clin Invest 80:743–749

    Google Scholar 

  15. Meuer SC, Köhler H, Meyer zum Büschenfelde KH (1988) Monocyte defect in hemodialysis patients supports nonresponsiveness to hepatitis B vaccination and development of HBsAg carrier state. In: Liss AR (ed) Viral hepatitis and liver disease (im Druck)

  16. Miller TE (1984) Uraemia — Does it affect host resistance to infectious disease? Eur J Clin Microbiol:383–386

  17. Raskova J, Ghobrial I, Czerwinski DK, Shea SM, Eisinger RP, Raska K (1987) B-Cell activation and immunoregulation in endstage renal disease patients receiving hemodialysis. Arch Intern Med 147:89–93

    Google Scholar 

  18. Ribot S, Rothstein M, Goldblat M, Grasso M (1979) Duration of Hepatitis B surface antigenemia (HBsAg) in hemodialysis patients. Arch Intern Med 139:178–180

    Google Scholar 

  19. Stevens CE, Alter HJ, Taylor PE, Zang EA, Harley EJ, Szmuness W (1984) Hepatitis B vaccine in patients receiving hemodialysis. N Engl J Med 311:496–501

    Google Scholar 

  20. Zàruba K, Grob PJ, Bolla K (1985) Thymopentin as adjuvant therapy to Hepatitis B vaccination in formerly nonoder hyporesponding hemodialysis patients. Surv immunol res 4 (Suppl 1):102–106

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. I. Medizinische Klinik und Poliklinik der Johannes Gutenberg-Universität Mainz, Germany

    H. Köhler, H. Dumann & K. -H. Meyer zum Büschenfelde

  2. Abteilung Angewandte Immunologie, Institut für Radiologie und Pathophysiologie, Deutsches Krebsforschungszentrum Heidelberg, Germany

    S. Meuer

Authors
  1. H. Köhler
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. H. Dumann
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. K. -H. Meyer zum Büschenfelde
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. S. Meuer
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Köhler, H., Dumann, H., Meyer zum Büschenfelde, K.H. et al. Sekundärer Immundefekt bei Niereninsuffizienz am Beispiel der Hepatitis B-Impfung. Klin Wochenschr 66, 865–872 (1988). https://doi.org/10.1007/BF01728948

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01728948

Key words

Schlüsselwörter

Search

Navigation