Immunomodulatory Device Promotes a Shift of Circulating Monocytes to a Less Inflammatory Phenotype in Chronic Hemodialysis Patients.
Patients with end-stage renal disease (ESRD) on chronic hemodialysis (HD) suffer accelerated morbidity and mortality rates caused by cardiovascular disease and infections. Chronic inflammation plays a critical role in these poor outcomes. The activated monocyte (MO) has become a prime therapeutic target to modulate this inflammatory process. A selective cytopheretic device (SCD) was evaluated to assess its effects on the circulating MO pool. A pilot trial was undertaken in 15 ESRD patients on HD with C-reactive protein (CRP) levels greater than 5 mg/dl. An excellent safety profile was observed with no decline in leukocyte (LE) or platelet counts. The effect of SCD therapy on MO phenotypes in these patients was determined on peripheral blood MO utilizing flow cytometry. SCD therapy promoted a shift in MO phenotype from predominantly CD14 expressing MO at baseline/pre-SCD therapy to CD14 expressing MO post-SCD therapy. A significant shift in MO population phenotype afforded by a single SCD therapy session was observed (p < 0.013). In a subset of patients (n = 7) presenting with type 2 diabetes mellitus (T2D), this persistent decline in MO CD14 expression was sustained as long as 2 weeks posttherapy. These results demonstrate that the SCD therapy has the potential to modulate the chronic proinflammatory state in ESRD patients.
From the *Department of Internal Medicine, University of Michigan Medical School, 4520C MSRB I, SPC 5651, Ann Arbor, Michigan; †Innovative BioTherapies, Inc., Ann Arbor, Michigan; ‡CytoPherx, Inc., Ann Arbor, Michigan; and §Henry Ford Health System, Detroit, Michigan.
Balazs
B
Szamosfalvi
Angela
A
Westover
Deborah
D
Buffington
Alexander
A
Yevzlin
H David
HD
Humes
D005260:Female; D005434:Flow Cytometry / Q000379:methods*; D006801:Humans; D007249:Inflammation / Q000209:etiology* / Q000628:therapy; D007676:Kidney Failure, Chronic / Q000628:therapy; D008297:Male; D008567:Membranes, Artificial; D009000:Monocytes / Q000276:immunology* / Q000378:metabolism; D010641:Phenotype; D006435:Renal Dialysis / Q000009:adverse effects*
D008567:Membranes, Artificial