Influence of Thymopentin on Antibody Response, and Monocyte and T Cell Function in Hemodialysis Patients Who Fail to Respond to Hepatitis B Vaccination

We investigated the influence of thymopentin as an adjuvant for hepatitis B vaccination on in vitro monocyte and T cell function and in vivo antibody response in a prospective, placebo-controlled double-blind trial in 20 low- and nonresponders to hepatitis B vaccination on chronic hemodialysis. 50 mg thymopentin was given subcutaneously twice per week for 3 weeks, followed by 1 intramuscular injection of 40 micrograms HB-Vax and 3 subsequent injections of thymopentin. After 1 month, the patients were boostered with 40 micrograms HB-Vax. There was no significant difference in T cell and monocyte function after administration of thymopentin, as determined in vitro. After 3 months, 3 patients …

Hepatitis-B-Impfung bei Dialysepatienten*

Sekundärer Immundefekt bei Niereninsuffizienz am Beispiel der Hepatitis B-Impfung

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.

LOW-DOSE INTERLEUKIN-2 INDUCES SYSTEMIC IMMUNE RESPONSES AGAINST HBsAg IN IMMUNODEFICIENT NON-RESPONDERS TO HEPATITIS B VACCINATION

Abstract A metabolic monocyte defect appears to correlate with non-responsiveness to hepatitis B vaccine in many patients on haemodialysis. This defect prevents production of interleukin-2 during T-cell activation after antigen contact. Receptors for interleukin-2 are, however, expressed in greater numbers than in healthy subjects or uraemic responders to hepatitis B vaccination. In this study, ten uraemic patients, previous non-responders to vaccination against hepatitis B, were revaccinated with the same vaccine combined with one intramuscular injection (2·5 × 10 5 U) of natural human interleukin-2. Systemic production of antibodies against hepatitis B surface antigen was initiated in tho…

Uremic serum inhibits monocyte-dependent, but not interleukin-2-dependent steps of T cell proliferation.

We examined the influence of uremic serum on antigen receptor triggered T cell proliferation in dialysis patients with impaired immune function, i.e., 12 nonresponders to hepatitis B vaccination. The dialysis patients showed a monocyte dysfunction and an increased responsiveness to interleukin 2 (IL-2) according to our previous findings. In vitro the addition of IL-2 completely reconstituted the defect. Uremic serum inhibited monocyte-dependent T cell proliferation of patients and of healthy controls. Contrary, monocyte-independent steps of T cell proliferation were not impaired by uremic serum. When IL-2 was added to cultures, the T cell proliferation in the presence of uremic serum was ev…

Hepatitis B vaccination and interleukin 2 receptor expression in chronic renal failure

Hepatitis B vaccination and interleukin-2 receptor expression in chronic renal failure. Only 50 to 60% of dialysis patients develop anti-HBs antibodies following hepatitis b vaccination. The nonre-sponder state correlates with impaired monocyte function, decreased interleukin-2 (IL-2) production of T cells, and an upregulation of the IL-2 receptor system. In the present study we examined anti-HBs production after hepatitis B vaccination and the in vitro expression of IL-2 receptors in nondialyzed patients with various degrees of chronic renal failure. Forty-four patients with impaired renal function were immunized with 20 µg recombinant hepatitis B vaccine and boostered after one and six mo…