Yaacov Bar-Khayim

Effect of 1α-hydroxyvitamin D3 treatment on production of tumor necrosis factor-α by peripheral blood mononuclear cells and on serum concentrations of soluble tumor necrosis factor receptors in hemodialysis patients

The effect of 1,25-dihydroxyvitamin D3 [1,25-(OH)2D3] deficiency, as well as of replacement therapy with 1 alpha-hydroxyvitamin D3[1 alpha-(OH)D3], on the production of tumor necrosis factor-alpha (TNF-alpha) by peripheral blood mononuclear cells (PBMC) and on the serum levels of soluble TNF receptors (sTNFRs) in hemodialysis (HD) patients was investigated. PBMC from HD patients without prior therapy with hydroxylated vitamin D3 analogs and from normal controls produced similar amounts of TNF-alpha, either spontaneously or after stimulation with lipopolysaccharide (LPS). After oral administration of 1 alpha-(OH)D3, a precursor of 1,25-(OH)2D3, LPS-induced TNF-alpha production by PBMC of HD patients was significantly higher than that of HD patients prior to the treatment or of healthy controls. Such treatment did not, however, affect spontaneous TNF-alpha production by PBMC. Serum concentrations of both soluble TNF receptors [sTNFR-A(p75) and sTNFR-B(p55)] were significantly higher in HD patients than in controls. The ratio of sTNFR-A/sTNFR-B decreased significantly in HD patients following 1 alpha-(OH)D3 therapy. These results suggest that therapy with 1 alpha-hydroxylated vitamin D3 analogs normally given to HD patients for the management of renal osteodystrophy may also regulate the in vivo activity of TNF-alpha.

RECOMBINANT HUMAN ERYTHROPOIETIN FOR ANEMIA OF END-STAGE RENAL FAILURE IN BETA THALASSEMIA TRAIT

A. Kagan, MD, Division of Nephrology, Kaplan Hospital, Rehovot, 76100 (Israel) Dear Sir, Recently, Steinberg [1] reported the successful use of recombinant human erythropoietin in the treatment of 2 patients with sickle cell anemia and renal failure. We have used erythropoietin therapy for severe anemia in 2 siblings with ß thalassemia minor and end-stage renal failure, in whom a unique association of hereditary nephritis and ep-idermolysis bullosa was previously reported [2]. The hematological characteristics of the patients and their response to treatment are shown in figure 1. Blood transfusion requirements for 6 months prior to therapy were 14 blood units for R.Y., a 21-year-old male, and 12 blood units for I.Y., his 19-year-old sister. In the first 4 months following initiation of erythropoietin treatment, R.Y. required 7 units and I. Y. 5 units; thereafter, blood transfusions were not needed. No problems with vascular access or increase in blood pressure were observed. Maintenance doses of erythropoietin in 15 other adult patients on dialysis are shown in table 1. These doses in the 2 siblings were higher than those required in the other 6 patients with ß thalassemia trait, probably due to the differences in the ß globin synthesis. ß Thalassemia is characterized by a decreased amount of ß globin as well as typically

Delayed Decubitus Perforation of the Bowel by Long-Term Peritoneal Dialysis Catheter

Delayed perforation of the bowel is a rare complication of long-term peritoneal dialysis (LTPD), carrying high morbidity and mortality. We report a case of delayed perforation of the sigmoid colon by