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RESEARCH PRODUCT

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

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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 months. Prior to the first injection IL-2 receptor expression of activated T cells was studied by an in vitro proliferation assay. Sixty-four healthy subjects served as controls. After completion of the third vaccination 55.0% of the patients acquired antibody titers > 10 U/liter. The seroconversion rate did not differ between patients with lower ( 3.5 mg/dl) creatinine levels. In nonresponders IL-2 receptor expression (stimulation index, SI = 10.09 ± 1.80) was elevated compared to healthy controls (SI = 4.62 ± 0.35, P > 0.002) or patients who responded with a high antibody titer (> 50 U/liter, SI = 3.12 ± 0.43, P < 0.001). Patients who produced low antibody titers (< 50 U/liter) also presented with enhanced IL-2 receptor expression. These data show that an impaired antibody production following hepatitis B vaccination and an enhanced IL-2 receptor expression of T cells may already be present in early stages of chronic renal failure.