A placebo-controlled trial to evaluate immunomodulatory effects of paricalcitol

Sharon M. Moe, Mindaugas Zekonis, Jaroslaw Harezlak, Walter T. Ambrosius, Christine M. Gassensmith, Cynthia L. Murphy, Regina R. Russell, Thomas D. Batiuk

Research output: Contribution to journalArticle

38 Scopus citations

Abstract

Calcitriol has shown a benefit in various small uncontrolled studies of ex vivo immune function. We hypothesized that paricalcitol, a new vitamin D derivative, will have a positive effect on the immune system with minimal adverse effects on calcium homeostasis. Thirty-one hemodialysis patients not administered vitamin D because of low intact parathyroid hormone (PTH) levels were randomized to placebo or 4 μg of paricalcitol intravenously with the hemodialysis session three times weekly for 12 weeks. Effects on in vivo and ex vivo assessments of immune function were evaluated. All patients achieved the target dose of paricalcitol. Twenty patients were anergic at the start of the study; 4 of 11 patients in the paricalcitol group and 0 of 9 patients in the placebo group converted to reactive (P=0.09). The in vivo response to standard hepatitis B booster vaccine and in vitro proliferation and release of interleukin-2 (IL-2), IL-6, tumor necrosis factor-α, and interferon-γ from stimulated lymphocytes were not different between the groups. In contrast to clinical immune effects, paricalcitol increased serum calcium levels and decreased PTH and bone alkaline phosphatase levels (all P<0.05). However, hypercalcemia was infrequent. In vitro experiments showed that paricalcitol led to greater dose-dependent thymidine uptake than calcitriol in lymphocytes isolated from either dialysis patients or control subjects. Paricalcitol has a tendency toward improving delayed hypersensitivity reactions, but did not have other proimmune effects. However, as expected, paricalcitol had significant effects on calcium homeostasis compared with placebo. Thus, patients with low PTH levels are unlikely to experience the proimmune effects of vitamin D therapy without more profound and potentially adverse oversuppression of PTH.

Original languageEnglish (US)
Pages (from-to)792-802
Number of pages11
JournalAmerican Journal of Kidney Diseases
Volume38
Issue number4
DOIs
StatePublished - Oct 2001

Keywords

  • Anergic
  • Calcitriol
  • Dialysis
  • Hemodialysis
  • Immune system
  • Paricalcitol

ASJC Scopus subject areas

  • Nephrology

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    Moe, S. M., Zekonis, M., Harezlak, J., Ambrosius, W. T., Gassensmith, C. M., Murphy, C. L., Russell, R. R., & Batiuk, T. D. (2001). A placebo-controlled trial to evaluate immunomodulatory effects of paricalcitol. American Journal of Kidney Diseases, 38(4), 792-802. https://doi.org/10.1053/ajkd.2001.27697