Indoleamine 2,3-dioxygenase is increased in hemodialysis patients and affects immune response to hepatitis B vaccination

February 12, 2011

Vaccine. 2011 Feb 1. [Epub ahead of print]

Indoleamine 2,3-dioxygenase is increased in hemodialysis patients and affects

immune response to hepatitis B vaccination.

Eleftheriadis T, Liakopoulos V, Antoniadi G, Stefanidis I, Galaktidou G.

Department of Nephrology, Medical School, University of Thessaly, Larissa,

Greece; Research Institute, Theagenion Anticancer Hospital, Thessaloniki,

Greece.

Abstract

BACKGROUND: Acquired immunity is impaired in hemodialysis (HD) patients.

Indoleamine 2,3-dioxygenase (IDO) is inducible by inflammation and through

tryptophan depletion and generation of kynurenine pathway products suppresses

adaptive immune response. In the present study plasma IDO levels were assessed

in HD patients. Its effect on response to HBV vaccination program was evaluated.

PATIENTS AND METHODS: Sixty-six HD patients and twenty-four healthy volunteers

enrolled into the study. All the HD patients were initially vaccinated with four

double doses of recombinant HBV vaccine. All doses were repeated in patients who

had not responded after complete first vaccination series. Only one boost dose

was being administered in patients with initial adequate antibody levels against

the HBV surface antigen (anti-HBs>10IU/L) who then presented with reduced

anti-HBs levels. IDO, CRP, IL-6 and TNF-á were measured by means of ELISA.

RESULTS: Compared to healthy volunteers, IDO levels were twice higher in HD

patients. CRP, IL-6 and TNF-á were also much higher in HD patients. IDO levels

were almost twice higher in HD patients with inadequate response to HBV

vaccination, than in those with adequate immune response. CRP, IL-6 and TNF-á

did not differ between the two patients' groups. IDO was negatively correlated

with all markers of inflammation in HD patients.

CONCLUSION: IDO is increased in HD patients. It is possible that after its

initial upregulation due to chronic inflammation, IDO curtails its own provoking

agent, i.e., inflammation. Increased IDO suppresses adaptive immunity in HD

patients, as it is assessed by the response to HBV vaccination.

PMID: 21292009 [PubMed - as supplied by publisher]

February 12, 2011