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THE ROLE OF POLYMETHYLMETHACRYLATE MEMBRANE AND APO-A1 OF HDL CHOLESTEROL IN RESPONSE TO HBV VACCINATION IN A COHORT OF PATIENTS ON LONG-TERM HAEMODIALYSIS

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Razionale

Hepatitis B Virus(HBV)-vaccine response rate in haemodialysis(HD) population is only40-70% than90% in general population, because of inflammatory immune-paralysis.

HD with polymethylmethacrylate(PMMA) membrane improved HBV-vaccine response in not responders patients previously vaccinated during conventional HD-filters use.

We wanted to evaluate if PMMA was better than traditional polysulfone in achieving HBV-seroconversion with a prospective randomized controlled trial, confirming previous literature data[Contine,Immunology2003; Duranti,MinervaMed2011]. Moreover, we tried to find other HBV-vaccine-response predictive factors, focusing on HDL cholesterol(HDL-C), which is known to have a pivotal role as modulator of adaptive immune response.

Casistica e Metodi

53patients were included in 2011HBV-vaccination campaign. In 2014 37patients were blindly randomized to PMMA(n=19), or polysulfone(n=18). They used the new filter for 3months before receiving 1°HBV-vaccination dose. Full course consists of three 40μg doses: 2°dose at1°month, 3°dose at6°month, HBsAb test at8°month.

Risultati

2011campaign:

23responders(HBsAb ≥10IU/L), 30NotResponders. Responders(R) had higher HDL-Cs than NotResponders(NR)(R43.6±13.4mg/dl,IC95%:37.1-50.1mg/dl;NR34.6±7.6mg/dl,IC95%:31.9-37.4mg/dl;p=0.0018).


2014campaign:

7responders(37%) in PMMA, 11responders(61%) in polysulfone. Considering twelve2011NR included in 2014: 3responders in PMMA(3of8) and only one in polysulfone(1of4). HDL-C was not independently associated with response, but basal ApoA1, a main HDL-apolipoprotein(odd ratio1.28,z2.01,P>z0.044,IC95%:1.006-1.620;loglikelihoodchisquare20.17,Prob>Chi2=0.052).

HDL-Cs increased in PMMA group(mean-basal-HDL-C45.53±25.95mg/dl,mean-final52.68±33.07 mg/dl;p=0.0018) but not in polysulfone group(mean-basal-HDL34.22±11.05mg/dl,mean-final36.39±7.92mg/dl;p=0.13)(Figure1B). Considering 2011NRpatients, PMMA-driven-HDL-Cs-increase was even more impressing(mean-basal-HDL-Cs47.5±29.36mg/dl,mean-final60.12±38.2mg/dl;p=0.02), whereas polysulfone didn’t change HDL-Cs.

 

Campaigns joined together:

Responders had higher HDL-Cs than NotResponders(R45.04±22.87mg/dl,IC95%37.30-52.78mg/dl;NR36.03±10.29mg/dl;32.98-39.09mg/dl;p=0.0098)(Figure1A). Patients’age(odd ratio0.925,z-2.83,P>z0.005,IC95%:0.877-0.976) and basal-mean-HDL-Cs(odd ratio1.057,z2.08,P>z0.037,IC95%:1.003-1.114) were significantly and independently associated with HBsAb-response(log-likelihood-chi-square17.94,Prob>Chi2=0.0122).

Conclusioni

Mean-HDL-Cs and basal ApoA1 are positive independent  HBsAb-response predictors.

PMMA surprisingly increases HDL-Cs, in confront with polysulfone, probably improving inflammation.

PMMA is not usefull in naive patients, while in not responders subjects it could be used with positive results. Further controlled trials with a lager patients sample size are needed to confirm these observations.

Rastelli F.(1), Buzzi L.(1), Baragetti I.(1), Olteanu M.(1), Krefka A.(1), Amendola A.(1), De Simone I.(1), Ferrario F.(1), Furiani S.(1), Santagostino G.(1), Corghi E.(1), Alberghini E.(1), Garlaschelli K.(3), Baragetti A.(32), Norata GD.(32), Catapano AL.(4), Pozzi C.(1,2)
((1)Nephrology and Dialysis Unit, Bassini Hospital, Cinisello Balsamo, Milan, Italy; (2)Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Milan, Italy; (3)Center for the Study of Atherosclerosis, Italian Society for the Study of Atherosclerosis (SISA) Lombardia Chapter, Bassini Hospital, Cinisello Balsamo, Milan, Italy; (4)Multimedica IRCCS, Milan, Italy; )
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