Agnieszka Grzebalska

Assessment of cytokine release after in vitro stimulation of whole blood with legionella pneumophila in immunocompromised patients.

This study we examined ex vivo potential of the immune response after stimulation of whole blood with L. pneumophila SG 1, SG 2-14 and L. pneumophila standard strain ATCC 33152 in immunocompromised patients, such as: hemodialysis patients and patients after renal transplantation. The levels of TNF-α and IFN-γ in supernatants were measured with the use of commercial ELISA kits. The synthesis of TNF-α and IFN-γ after stimulation with L. pneumophila were analyzed in two aspects: differentiated stimulatory activity in relation to SG 1, SG 2-14 and ATCC 33152 L. pneumophila and differentiated response of the hemodialysis patients and patients after renal transplantation in relation to the control group. The positive and negative results of anti-L. pneumophila antibodies of two groups of our patients were found for the analysis of the stimulatory activity of L.pneumophila as a primary or secondary response. In patients with immunosuppression the response in the secretion of cytokines (TNF-α and IFN-γ) was reduced after stimulation of L. pneumophila SG 1 but in varying degrees after stimulation of L. pneumophila SG 2-14, which indicates that the risk of the infection is varied.

Prevalence of Legionella antibodies in immunocompromised patients

IntroductionDialysis patients and patients post-renal transplantation can be predisposed to Legionella infections. The aim of this work was to investigate the prevalence of L. pneumophila serogroups 1–7 (SG 1–7) antibodies in dialysis patients and in patients following renal transplantation, in order to analyse the potential risk factors for infections.Material and MethodsCommercial ELISA kits were used for detection of serum IgG (SG 1–7, SG 1) and IgM (SG 1–7) present in patients and the control group. Results: In the studied group of patients, positive results (IgM and/or IgG SG 1–7) were obtained in 20 patients (7.12%). One patient only had two classes of antibodies. From the total study group, the antibodies against L. pneumophila SG 1 were detected in only one patient on dialysis. Patients with L. pneumophila antibodies who are on dialysis or post-renal transplantation did not differ significantly in any of the usually evaluated risk factors of clinical infection.ConclusionsThe reported outbreaks of Legionnaires’ disease in chronic dialysis patients and those with renal transplants, as well as our results of IgG and IgM antibodies, merit further identification of the sources of this infection but also the ways in which cellular immune system can be managed in the immunocompromised patients with Legionella infection.

Long-time survival of a female with primary amyloidosis treated by peritoneal dialysis

Introduction. Amyloidosis, both primary and secondary, is a systemic disease characterized by extracellular deposition of fibrillar protein in vital organs, leading to their injury and even insufficiency. It results in a poor diagnosis, especially for patients with primary amyloidosis. Kidney involvement is typical and usually manifests by proteinuria, mainly nephrotic range, leading to end-stage renal disease (ESRD). Patients with ESRD need renal replacement therapy (RRT). Some data claim that better results and longer patient, survival are observed in peritoneal dialysed rather than in haemodialysed patients. Case report. The case is described of 19-year-old Caucasian woman with primary amyloidosis. Inherited primary amyloidosis with abnormal apolipoprotein A-I was established. The patient was successfully treated with peritoneal dialysis for 87 months. After this period, she was transferred for haemodialysis. Such a long survival time on peritoneal dialysis (PD) in a patient with primary amyloidosis has not been found. It is believed that the lowering of immunoglobulin levels in blood and normalization of total protein in serum effectively removed, through dialysate, the pathological polyclonal proteins. This effect probably also sustained cardio-circulatory sufficiency of the patient and significantly prolonged her survival. Conclusion. Peritoneal dialysis is an effective and recommended method of treatment in patients suffering from primary amyloidosis. Peritoneal dialysis should be the first choice therapy in ESRD patient; contrary to haemodialysis, peritoneal dialysis removes pathological proteins and allows the avoidance of intra-dialytic hypotension.

Interleukin-18 gene polymorphism and risk of CVD in older patients with type 2 diabetes mellitus

OBJECTIVE Interleukin-18 (IL-18), a proinflammatory cytokine, plays a key role in the acute and chronic inflammatory processes. It is associated with risk of developing cardiovascular disease (CVD). The aim of this study was to evaluate association between G(-137)C polymorphism (rs187238) in the IL-18 gene and risk of diabetes and CVD in type 2 diabetes patients. METHODS We examined 1548 T2DM patients and 590 controls. All subjects were genotyped for the G(-137)C promoter region polymorphism by polymerase chain reaction (PCR-SSP). RESULTS Genotype distribution of the G(-137)C polymorphism showed no significant difference between T2DM patients and controls (p=0.115). An association with CVD was analyzed in two age groups: ⩾65 and <65years. In patients younger than 65years there was a tendency to association of CC genotype with CAD (OR 1.87, 95% CI 1.0-3, p=0.051). In contrast, in subjects aged 65 or older, the C allele and CC genotype showed the significant association with the presence of CVD, with the OR 1.99, p=0.001 and OR 5.31, p=0.006, respectively. The C allele carriers showed the higher prevalence of CVD compared to non-carriers (61% vs. 39%, p<0.0001). CONCLUSION Older T2DM patients carrying the C allele of IL-18 G(-137)C polymorphism have a significantly increased risk of CVD.

Cardiac sympathetic hyperactivity in chronic kidney disease--a comparison between haemodialysis and peritoneal dialysis patients.

BACKGROUND The effect of renal replacement therapy on cardiac sympathetic function in patients with chronic kidney disease has not yet been completely elucidated. The aim of this study was to evaluate the impact of renal replacement therapy on the activity of cardiac sympathetic nervous system. MATERIAL AND METHODS Thirty-four patients with chronic kidney disease were studied: 14 patients (6 men, mean age 48 ± 11 years) were receiving peritoneal dialysis (PD) and 20 patients (20 men, mean age 52 ± 10 years) were receiving haemodialysis (HD). Patients with diabetes and heart failure were excluded from the study. All patients underwent resting gated myocardial perfusion and ¹²³I-mIBG myocardial scintigraphy from which early and late heart to mediastinum ratios (HRM) and myocardial washout rate (WR) values were calculated. RESULTS PD and HD patients did not differ with respect to left ventricular ejection fraction (52 ± 9% vs. 57 ± 7%) and summed rest score (3.8 ± 2.4 vs. 3.5 ± 0.3). Similarly, early (1.89 ± 0.23 vs. 1.87 ± 0.27) and late (1.76 ± 0.47 vs. 1.74 ± 0.25) HMR, and washout rate (35.5 ± 15.8% vs. 31.3 ± 9.4%) were not significantly different between the two groups of patients. CONCLUSIONS These results suggest that the applied method of renal replacement therapy has no significant influence on global activity of cardiac sympathetic nervous system.