Number of thymus-derived lymphocytes in normales and patients maintained on long-term kaemodialysis. Eckstein, D., D., U. Mey, R. Fuchs u. L. Lachhein: Folia Haematol., 106 (1979), 517 - 522
There is no doubt cell-mediated immunity is impaired by uraemia. The evidence for this includes prolonged graft survival (3,11)reduced delayed cutaneous responses to various antigens (3), (1, 16,20), abnormal in vitro lymphocytes responsiveness to different forms of stimulation (5, 14, 18), lymphocytes transfer test (2) and lyphopenia (20)
However., the value of the indicated findings is not clear. This study was therefor designed to investigate if the number of thymus-derived lymphocytes in patients maintained on long therm haemodialysis is changed.
Comparison of the test (native preparation) with 1 h and 24 h incubation in normals (P > 0,01) as well as in patients (P > 0,05) indicated slightly different values. The total number of leucocytes, lymphocytes (Tab. 1) in haemodialysis pations was not different from normals (P > 0,01 in all cases).
Identification of T-lymphocytes by their capacity to form spontaneous rosettes is today widespread and several modifications of the test have been reported. Some variations of the test performed in this work revealed two phenomena: The time of incubation at 4 °C (1 h and 24 h) has only a slight influence on the capacity of T-cells to form spontaneous rosettes. Seiler et al. (15) reported similar findings. Better in vitro stabilization of spontaneous rosettes of lymphocytes and sheep red blood cells using glutendialdehyde as reported by Fuchs et al. (6) for normals, can also be performed in chronically uraemic patients. In accordance with the study of Korz, Naber and Essers (8) the present findings show a normal vitality of uraemic lymphocytes. These results are in contrast to studies of Daniels et al. (4) and Reis et al. (13). Elves et al. (5),however, reported evidence of reducing the survival of normal leucocytes in uraemic serum and that centrifuged uraemic cell show "a better survival" in comparison to non-zentrifuged cells, maybe by destroying the moribund and less robust cells. Thus, there is the influence of uraemic serum in the findings of Daniels et al. (4) and Reis et al. (13) and, in our study, the effect of centrifugation which must be taken into consideration. That is why methodical aspects in these findings about vitality in lymphocytes from uraemic patients seem to be important. Lyphopenia in uraemia was reported by Wilson et al. (20) and Boulton-Jones et al. (1). In contrast, like Reis et al. (14), we found a normal number of lymphocytes in uraemia. It is also of interest if the number of T-lymphocytes is decreased. Sengar et al. (17). Reddy et al. (12) and Tong et al. (19) reported in this respect, but unfortunately there was no sufficient information on th number of lymphocytes in total and study populations were small. Other authors informed on normal total and relative T-lymphocytes in chronic uraemic patients (7,9,10,14). Our findings in a larger study populations show that the number of T-lymphocytes is normal. Thus, in conclusion, impaired immune responses of patients maintained on long-term haemodialysis is not due to lymphopenia and T-lymphopenia in blood. That is why further investigations into lymphocyte function and lymphocyte vitality in uraemia would be desirable.
For 32 patients in a chronic haemodialysis programme the number of thymus dependent lymphocytes was counted. These patients were susceptible to infections, the cause of which was supposed to be a disturbance of the immune defence. 51 healthy persons were taken as a control group. Various modifications of the spontaneous rosette test were applied. The number of T-lymphocytes proved to be as normal as the number of the total lymphocytes in all test series. This proves that the immune defect in patients with a chronic renal failure is not caused by T-lymphocytes as assumed by several authors.
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