Granulocyte Macrophage Colony Stimulating Factor Mediated Modulation of Polymorphonuclear Leukocyte Dysfunction in Chronic Kidney Disease and Hemodialysis Patients

Introductions: Protein factors accumulating in the sera of patients suffering from end stage renal disease interfere with nonspecific immune response by inhibiting essential functions of polymorphonuclear leukocytes (PMNLs). Aim: The study aimed to assess the neutrophil functions which may be responsible for bacterial infections encountered in chronic kidney disease (CKD) and hemodialysis (HD) patients. In addition to evaluation of the potential therapeutic impact of the survival factor GM-CSF on neutrophil functions in these patients. Methods: The study was conducted on 59 patients, 34 cases with CKD and 25 HD cases. In addition to 15 normal subjects served as a control group. Neutrophil function was evaluated (before and after culture, with and without GM-CSF), by flowcytometric study of β2 integrin (CD18) and unstimulated and GM-CSF stimulated Nitroblue Tetrazolium test (NBT). The chronic inflammatory state known to be present in CKD was evaluated by estimation of C-reactive protein (CRP) using latex agglutination and serum levels of soluble intercellular adhesion molecule-1 (sICAM-1) using ELISA technique. Results: Neutrophils CD18 expression was significantly higher in CKD and HD patients compared to controls. Also neutrophil NBT reduction was significantly increased in HD group compared to control subjects. GM-CSF resulted in a highly significant increase of surface CD18 expression in both HD and CKD groups compared to their corresponding culture levels without GM-CSF. Both HD and CKD groups showed a highly significant increase in GM-CSF stimulated NBT reduction. Conclusions: These data clarify the potential therapeutic benefit of GM-CSF in reducing the severity and course of superimposed bacterial infections in those immunocompromised patients. (Nariman zahran, Iman William, Azza Sayed, Manal Zahran, Omar Sabry and Manar Raafat. Granulocyte Macrophage Colony Stimulating Factor Mediated Modulation of Polymorphonuclear Leukocyte Dysfunction in Chronic Kidney Disease and Hemodialysis Patients. J Am Sci 2012;8(6):731-737). (ISSN: 1545-1003). http://www.americanscience.org . 91