1999 年 51 巻 2-4 号 p. 150-158
To clarify the pathophysiology of the uremia-related immunodeficiency, we measured the lymphocytes subsets and their activation in autologous mixed lymphocyte reaction (AMLR), and evaluated the effect of recombinant erythropoietin (Epo) treatment in patients with chronic renal failure on hemodialysis (HD). We also engrafted their peripheral blood mononuclear cells (PBMC) to severe combined immunodeficient (SCID) mice to investigate PBMC function independently of the uremic milieu. Patients with HD had normal percentages of CD3+, CD4+ and CD8+ lymphocytes populations, but CD19+ cells decreased in number. However, serum interleukin-6 (IL-6) concentrations and the percentage of helper Ti (Thl) subpopulation increased, and the activation of CD3+ and CD4+ cells to AMLR reduced. After the treatment of Epo, the reduced activation of CD3 + and CD4 + cells in the AMLR was normalized. In SCID mice to which human PBMC were engrafted, human immunoglobulin and IL-6 concentrations in serum were not different between those with PBMC from patients on HD and mice with PBMC from normal controls. These data suggest that (1) the number of B lymphocytes decreases and that of Thl cells increase in patients on HD, (2) their CD3+ and CD4 + cell activation in the AMLR is reduced and that (3) the immunological abnormality can be returned to normal in several weeks when anemia or the uremia-related milieu is improved.
