End-stage renal disease (ESRD) with immune disorder involves complex interactions between the innate and adaptive immune responses. ESRD is associated with various alterations in immune function such as a reduction in polymorphonuclear leukocyte bactericidal activity, a suppression of lymphocyte proliferative response to stimuli, and a malfunction of cell-mediated immunity at the molecular level. ESRD also increases patients' propensity for infections and malignancies as well as causing a diminished response to vaccination. Several factors influence the immunodeficiency in patients with ESRD, including uremic toxins, malnutrition, chronic inflammation, and the therapeutic dialysis modality. The alteration of T-cell function in ESRD has been considered to be a major factor underlying the impaired adaptive cellular immunity in these patients. However, cumulative evidence has suggested that the immune defect in ESRD can be caused by an Ag-presenting dendritic cell (DC) dysfunction in addition to a T-cell defect. It has been reported that ESRD has a deleterious effect on DCs both in terms of their number and function, although the precise mechanism by which DC function becomes altered in these patients is unclear. In this review, we discuss the effects of ESRD on the number and function of DCs and propose a possible molecular mechanism for DC dysfunction. We also address therapeutic approaches to improve immune function by optimally activating DCs in patients with ESRD.

中文翻译：

---

终末期肾病患者的树突状细胞功能障碍

伴有免疫紊乱的终末期肾病 (ESRD) 涉及先天免疫反应和适应性免疫反应之间的复杂相互作用。ESRD 与免疫功能的各种改变有关，例如多形核白细胞杀菌活性的降低、淋巴细胞对刺激的增殖反应的抑制以及分子水平上细胞介导的免疫功能障碍。ESRD 还会增加患者感染和恶性肿瘤的倾向，并导致对疫苗接种的反应减弱。有几个因素会影响 ESRD 患者的免疫缺陷，包括尿毒症毒素、营养不良、慢性炎症和治疗性透析方式。ESRD 中 T 细胞功能的改变被认为是这些患者适应性细胞免疫受损的主要因素。然而，累积的证据表明，除了 T 细胞缺陷外，ESRD 的免疫缺陷还可能是由呈递抗原的树突状细胞 (DC) 功能障碍引起的。据报道，ESRD 在 DC 的数量和功能方面对 DC 有有害影响，尽管 DC 功能在这些患者中发生改变的确切机制尚不清楚。在这篇综述中，我们讨论了 ESRD 对 DC 数量和功能的影响，并提出了 DC 功能障碍的可能分子机制。我们还提出了通过优化激活 ESRD 患者的 DC 来改善免疫功能的治疗方法。据报道，ESRD 在 DC 的数量和功能方面对 DC 有有害影响，尽管 DC 功能在这些患者中发生改变的确切机制尚不清楚。在这篇综述中，我们讨论了 ESRD 对 DC 数量和功能的影响，并提出了 DC 功能障碍的可能分子机制。我们还提出了通过优化激活 ESRD 患者的 DC 来改善免疫功能的治疗方法。据报道，ESRD 在 DC 的数量和功能方面对 DC 有有害影响，尽管 DC 功能在这些患者中发生改变的确切机制尚不清楚。在这篇综述中，我们讨论了 ESRD 对 DC 数量和功能的影响，并提出了 DC 功能障碍的可能分子机制。我们还提出了通过优化激活 ESRD 患者的 DC 来改善免疫功能的治疗方法。