The response to vaccination with recombinant hepatitis B virus (HBV) vaccine is poor in haemodialysis patients. A defect in the antigen-presenting cells may be responsible for this hyporesponsiveness. To overcome this and to improve the response to HBV vaccine in dialysis patients, we used granulocyte-macrophage colony-stimulating factor (GM-CSF) as a vaccine adjuvant. Fifteen consecutive patients with chronic renal failure (CRF), commenced on dialysis, were stratified to receive either 40microg HBV vaccine (Engerix-B) at 0, 1, 2 and 6 months (group A, n=9) or 3microg kg-1 GM-CSF (Leucomax) on day 1 followed by the vaccination schedule described above (group B, n=6). All patients were negative for hepatitis B surface antigen (HBsAg), antibodies to hepatitis C virus (anti-HCV) and human immunodeficiency virus (HIV) serology. Titres of antibody to HBsAg (HBsAb) were quantitatively assayed, using enzyme-linked immunosorbent assay (ELISA), at 1, 2, 6 and 7 months from the first dose of vaccination. Only 44% of the patients in group A developed protective antibody levels (mean HBsAb: 22 IU l-1) Fifty per cent of responders developed protective antibody levels (HBsAb >10 IU l-1) only after the fourth dose of vaccination. In contrast, all six patients (100%) in group B developed protective levels of HBsAb (mean HBsAb: 70 IU l-1) (P<0.02). Sixty-seven per cent of the responders were protected after only the second dose of vaccination (P=0.046). No serious adverse effects of GM-CSF were observed in group B. Hence, haemodialysis patients respond poorly to HBV vaccine. GM-CSF is a safe vaccine adjuvant capable of stimulating an earlier and a stronger antibody response to HBV vaccine in haemodialysis patients.
disease and portal hypertension. Likewise, patients with alcoholic pancreatitis had severe damage, with presence of dilated pancreatic ducts. A detailed assessment was made in each patient with respect to the amount and duration of alcohol consumption, signs of hepatic decompensation, and grading of premorbid hair distribution as described previously. 3 Briefly, grade 0 indicated a lack of hair over the trunk; grade 1, hair limited to nipple areas; grade 2, hair around nipples and middle of chest; grade 3, sparse hair over the trunk; grade 4, thick hair over the trunk; and grade 5, thick hair over the trunk and back.Eighty-six male subjects comprising 44 with ALD and 42 with alcoholic pancreatitis were investigated. The results are shown in Table 1.The duration of illness prior to presentation was shorter in patients with ALD compared with alcoholic pancreatitis. An assessment of hair distribution showed that patients with ALD had significantly less hair growth compared to patients with alcoholic pancreatitis. As expected, laboratory tests for liver disease showed greater derangement in alcoholic liver disease compared to alcoholic pancreatitis.Abstract The present study shows that scanty hair distribution over the trunk is a specific finding in patients with alcoholic liver disease (ALD), and is not seen in alcoholic pancreatitis. This observation not only provides a useful clinical marker of individuals at increased risk of developing alcohol-related liver disease, but from the pathogenetic viewpoint, it suggests that at the tissue level, the male sex hormones protect the liver against ethanol-related damage.
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