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Cholinergic anti-inflammatory pathway activity in dialysis patients: a role for neuroimmunomodulation?

Hilderman M, Qureshi AR, Al-Abed Y, Abtahi F, Lindecrantz K, Anderstam B, Bruchfeld A - Clin Kidney J (2015)

Bottom Line: CRP, TNF, IL-1 and IL-6 were significantly higher, whereas IL-10 was significantly lower at baseline in patients compared with controls.IL-6 attenuation was comparable with TNF and the IL-1b pattern was similar but remained significantly higher in patients.Results in HD and PD patients did not differ.

View Article: PubMed Central - PubMed

Affiliation: Renal Medicine and Baxter Novum , CLINTEC, Karolinska Institutet , Stockholm , Sweden.

ABSTRACT

Background: The cholinergic anti-inflammatory pathway (CAP) modulates inflammatory responses through the vagus nerve and the α-7-nicotinic acetylcholine receptor (α7nAChR) on macrophages and immune cells. Sympathetic/parasympathetic imbalance and chronic inflammation are both linked to poor outcome in dialysis patients. The aim of this study was to investigate CAP activity in these patients.

Methods: Twenty dialysis patients, 12 hemodialysis (HD) and 8 peritoneal dialysis (PD) patients (12 male, 8 female; age range 47-83 years) and 8 controls (5 male, 3 female; age range 31-52 years) were analyzed for C-reactive protein (CRP), tumor necrosis factor (TNF), interleukin-1b (IL-1b), IL-6 and IL-10 at baseline. The cytokines were then assessed after whole blood stimulation ex vivo with lipopolysaccharide (LPS) (10 and 100 ng/mL) and again in the presence of 45 and 90 μmol/L GTS-21, a cholinergic α7nAChR agonist.

Results: CRP, TNF, IL-1 and IL-6 were significantly higher, whereas IL-10 was significantly lower at baseline in patients compared with controls. After LPS stimulation, TNF increased significantly more in patients than in controls but decreased to similar levels in both groups after addition of GTS-21. IL-6 attenuation was comparable with TNF and the IL-1b pattern was similar but remained significantly higher in patients. Interestingly, IL-10 increased after GTS-21 in a dose-dependent manner, but only in patients. Results in HD and PD patients did not differ.

Conclusions: The response of immune cells after LPS exposure and cholinergic stimulation suggests a functional CAP in dialysis patients. It may thus be possible to target the α7nAChR control of cytokine release as an anti-inflammatory strategy and thereby improve outcome in these patients.

No MeSH data available.


Related in: MedlinePlus

(A) High-frequency (HF) power in patients and controls. (B) LF power in patients and controls. (C) Relationship of HF and LF powers of HRV for controls and patients HF (y-axis) versus LF (x-axis) with logarithmic scale.
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SFV074F1: (A) High-frequency (HF) power in patients and controls. (B) LF power in patients and controls. (C) Relationship of HF and LF powers of HRV for controls and patients HF (y-axis) versus LF (x-axis) with logarithmic scale.

Mentions: There were no significant differences for HRV in the HD and PD groups (data not shown), and hence the results of all dialysis patients were compared with controls. The result of HRV analysis confirmed significant autonomic dysfunction in patients when compared with controls with regard to the time domain parameter SDNN as well as the frequency domain parameters HF and LF (Table 2 and Figure 1A–C). Respiration rate and heart rate did not differ between groups. However, one HD patient with high heart and respiratory rates was excluded from the analysis as an outlier.Table 2.


Cholinergic anti-inflammatory pathway activity in dialysis patients: a role for neuroimmunomodulation?

Hilderman M, Qureshi AR, Al-Abed Y, Abtahi F, Lindecrantz K, Anderstam B, Bruchfeld A - Clin Kidney J (2015)

(A) High-frequency (HF) power in patients and controls. (B) LF power in patients and controls. (C) Relationship of HF and LF powers of HRV for controls and patients HF (y-axis) versus LF (x-axis) with logarithmic scale.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4581391&req=5

SFV074F1: (A) High-frequency (HF) power in patients and controls. (B) LF power in patients and controls. (C) Relationship of HF and LF powers of HRV for controls and patients HF (y-axis) versus LF (x-axis) with logarithmic scale.
Mentions: There were no significant differences for HRV in the HD and PD groups (data not shown), and hence the results of all dialysis patients were compared with controls. The result of HRV analysis confirmed significant autonomic dysfunction in patients when compared with controls with regard to the time domain parameter SDNN as well as the frequency domain parameters HF and LF (Table 2 and Figure 1A–C). Respiration rate and heart rate did not differ between groups. However, one HD patient with high heart and respiratory rates was excluded from the analysis as an outlier.Table 2.

Bottom Line: CRP, TNF, IL-1 and IL-6 were significantly higher, whereas IL-10 was significantly lower at baseline in patients compared with controls.IL-6 attenuation was comparable with TNF and the IL-1b pattern was similar but remained significantly higher in patients.Results in HD and PD patients did not differ.

View Article: PubMed Central - PubMed

Affiliation: Renal Medicine and Baxter Novum , CLINTEC, Karolinska Institutet , Stockholm , Sweden.

ABSTRACT

Background: The cholinergic anti-inflammatory pathway (CAP) modulates inflammatory responses through the vagus nerve and the α-7-nicotinic acetylcholine receptor (α7nAChR) on macrophages and immune cells. Sympathetic/parasympathetic imbalance and chronic inflammation are both linked to poor outcome in dialysis patients. The aim of this study was to investigate CAP activity in these patients.

Methods: Twenty dialysis patients, 12 hemodialysis (HD) and 8 peritoneal dialysis (PD) patients (12 male, 8 female; age range 47-83 years) and 8 controls (5 male, 3 female; age range 31-52 years) were analyzed for C-reactive protein (CRP), tumor necrosis factor (TNF), interleukin-1b (IL-1b), IL-6 and IL-10 at baseline. The cytokines were then assessed after whole blood stimulation ex vivo with lipopolysaccharide (LPS) (10 and 100 ng/mL) and again in the presence of 45 and 90 μmol/L GTS-21, a cholinergic α7nAChR agonist.

Results: CRP, TNF, IL-1 and IL-6 were significantly higher, whereas IL-10 was significantly lower at baseline in patients compared with controls. After LPS stimulation, TNF increased significantly more in patients than in controls but decreased to similar levels in both groups after addition of GTS-21. IL-6 attenuation was comparable with TNF and the IL-1b pattern was similar but remained significantly higher in patients. Interestingly, IL-10 increased after GTS-21 in a dose-dependent manner, but only in patients. Results in HD and PD patients did not differ.

Conclusions: The response of immune cells after LPS exposure and cholinergic stimulation suggests a functional CAP in dialysis patients. It may thus be possible to target the α7nAChR control of cytokine release as an anti-inflammatory strategy and thereby improve outcome in these patients.

No MeSH data available.


Related in: MedlinePlus