According to the Fostamatinib manufacturer’s instructions, 15 μL was electrophoresed on NuPAGE 12% Bis-Tris gels using MES SDS running buffer (Invitrogen NP0349BOX, NP0002). For albumin digestion reactions, haemoglobin was replaced with ovine albumin (Sigma A3264). This was carried out as described earlier in 0·1 m sodium acetate pH 5·0, with haemoglobin ranging from 2·2 mg/mL to 25 μg/mL. The combined volume of dH2O and haemoglobin was the same for all solutions. Absorbance values obtained for 24-h digestion were assumed to be equivalent

to the total concentration of haemoglobin in the reaction. These values were used to estimate the concentration of haemoglobin in samples from all time points. The concentration estimates were then plotted against time in seconds to obtain a gradient corresponding to a rate per second (v) and this rate was plotted against the total concentration of haemoglobin in the reaction to produce the Michaelis–Menton curve. For experiments with pre-incubation at pH 5·0 followed by reaction at pH 5·0, H-gal-GP (30 μg/mL) was pre-incubated selleck inhibitor with pIgG (320 μg/mL or 1·6 mg/mL), cIgG (320 μg/mL or 1·6 mg/mL), npIgG (1·6 mg/mL) or pA (113 μg/mL) [Table 1] for

1 h in 0·1m sodium acetate pH 5·0 reaction buffer at 37°C. Control reactions substituting H-gal-GP with dH2O or IgG with 10 mm Tris–HCl pH 8·0 were always included. Haemoglobin (to a final concentration of 3·6 mg/mL) was then added to the pre-incubated solutions and samples for gel and ninhydrin extraction were taken and assayed as described earlier. For experiments with pre-incubation at pH 7·4 followed by reaction at pH 5·0, the pre-incubation solution included the H-gal-GP (or dH2O for enzyme-free controls) and IgG already in 10 mm Tris–HCl pH 7·4 incubation buffer (or incubation buffer only for control reactions). The 0·1 m sodium acetate pH 5·0 reaction Baricitinib buffer was added post-incubation followed by substrate. For experiments with pre-incubation at pH 4·0 followed by reaction at pH 4·0, the reaction buffer was replaced with 0·1 m sodium acetate pH 4·0 in the method. All concentrations were estimated by the

bicinchoninic acid protein assay kit (Pierce 23225, Thermo Fisher Scientific, Cramlington, UK) according to instructions. To convert mg/mL of haemoglobin to molarity the molecular weight of 64 kDa was used. Arithmetic group means are shown with standard deviations. Following SDS PAGE, the sheep red cell lysate yielded the 16 kDa α and β subunits characteristic of haemoglobin (Figure 1) (14,15). Similarly, all the IgG preparations resolved as typical ∼60- and 23-kDa heavy and light chain bands, whilst the H-gal-GP band patterns were the same as observed before (Figure 1) (7,16). The name, source and method of preparation of the different IgGs tested for inhibition of H-gal-GP haemoglobinase activity are given in Table 1.

Indeed, clinical trials with activated γδ T cells have shown promising results for the

treatment of solid tumors [57], lymphoma [54], INCB024360 ic50 renal carcinoma [58], and lung cancer [55]. Humans have a less varied repertoire of γδ T cells as compared with mice; indeed, the majority of human γδ T cells are of either the Vδ1+ or Vδ2+ subclasses of γδ T cells. The majority of human peripheral blood γδ T cells are of the Vδ2+ subset, while the Vδ1+ cells account for the bulk of γδ T cells found at the epithelium. Similar to the murine γδ TCR, the human γδ TCR has been shown to be activated in an MHC-independent manner. Vγ9Vδ2+ T cells are rapidly activated by (E)-4-hydroxy-3-methyl-but-2-enyl pyrophosphate (HMB-PP) and to a lesser extent by isopentenyl pyrophosphate (IPP), both metabolites of the isoprenoid biosynthesis pathway in bacteria and protozoa [59-62]. Furthermore, neonatal Vγ9Vδ2+ T cells produce IL-17, but not IFN-γ, following stimulation with IL-23 and the aminobisphosphonate zoledronate [60]. In addition, it Selleck STA-9090 has

been demonstrated that combinations of IL-1, IL-23, IL-6, and TGF-β promote IL-17 production from RORγt+ Vγ9Vδ2+ T cells [25, 63-65]. Of note, mice do not appear to express a homologue of the Vγ9Vδ2 TCR. Other stimuli for human γδ T cells are zoldronate, IL-2, IL-18, and anti-γδ TCR antibodies [54-56, 66]. The anti-γδ TCR antibody GL3 appears

to induce more sustained proliferation of both Vδ2 and Vδ1 human γδ T cells than phosphoantigen-expanded human γδ T cells [54]. ILCs develop from hematopoietic precursors and have common phenotypic characteristics with T lymphocytes, yet they lack expression of specific antigen receptors (Fig. 2). All ILCs depend on IL-7 for their development. Evidence is emerging that these cells differentiate into subsets eltoprazine capable of producing effector cytokines similar to the different T helper cell subsets, except it appears that ILCs are able to respond more rapidly to inflammatory stimuli (as reviewed in [67]). ILCs are a heterogeneous population of cells, often increased in number at barrier surfaces, where they play a protective role in immune responses to infection [68]; however, there is emerging evidence that dysregulation of the IL-17-producing ILC subset drives intestinal inflammation, leading to colitis [3]. Id2 (inhibitor of DNA binding-2) is a helix-loop-helix transcription factor that lacks DNA-binding domains and heterodimerizes with E-box proteins to act as a critical regulator of gene transcription [69]. It is a key regulatory protein essential for a wide range of developmental and cellular processes and is essential for the development of all ILC subsets [70-72].

There are numerous pro- and anti-inflammatory factors involved in the pathophysiology of human atherosclerosis. LDL apheresis affects many of these factors including the complement cascade, the cytokine network and several other inflammatory mediators. Several studies demonstrate an apparently beneficiary profile regarding these factors during LDL apheresis, most likely due to adsorption of the mediators to the columns. This could potentially be of benefit for these patients with respect to progression LEE011 research buy of arteriosclerosis,

in addition to lowering their LDL cholesterol. However, most of the studies cited are small, have utilized different kinds of apheresis columns, have studied different patients groups and, most importantly, have a limited and partly diverse panel of mediators included. Although a net effect in certain apheresis systems might be anti-inflammatory, as evaluated by plasma measurements, a main goal for future improvement of apheresis columns will be to make them as biocompatible as possible, that is, being inert with respect to complement, cytokines and the remaining inflammatory network. There are definitely

more mediators generated by the artificial surface than we are measuring and, thus, proinflammatory mediators may contribute more than apparent from current studies. Therefore, to get more insight into the effects on inflammation induced by LDL apheresis, MK-2206 nmr larger studies should be performed, preferably comparing the effect of different LDL apheresis columns on the total inflammatory profile, by

including a broad spectrum of biomarkers. Furthermore, changes in pro- and anti-inflammatory biomarkers should ideally be correlated to clinical endpoints. Considering the fact that each centre performing LDL apheresis has Oxymatrine a relatively limited number of patients, multicentre trials would be required. Although the total number of patients available for clinical studies probably would preclude the use of hard endpoints like death or myocardial infarction, surrogate endpoints like carotid intimae media thickness or coronary calcium score evaluated by computerized tomography would undoubtedly add valuable information about the relationship between inflammatory biomarkers and the process of atherosclerosis. “
“Sepsis is characterized by a severe systemic inflammatory response to infection that is associated with high morbidity and mortality despite optimal care. Invariant natural killer T (iNK T) cells are potent regulatory lymphocytes that can produce pro- and/or anti-inflammatory cytokines, thus shaping the course and nature of immune responses; however, little is known about their role in sepsis. We demonstrate here that patients with sepsis/severe sepsis have significantly elevated proportions of iNK T cells in their peripheral blood (as a percentage of their circulating T cells) compared to non-septic patients.

com) (Fig. 2). In addition to the highly conserved exonic regions, two intronic regions (introns 2 and 7) of the WASP were found to have apparent high

evolutionary conservation. PCR-sequencing, however, did not detect any variants. We previously described the termination codon mutation in the WASP gene in a Thai family affected with classic WAS [13]. This study further reported the clinical manifestations and long-term follow-up of seven unrelated patients with molecular diagnosis of classic WAS. In addition to the previously reported mutation, four different recurrent mutations were identified, including two missense mutations, an insertion and a 4-bp deletion in intron 8. One novel nonsense (c.55C > T, p.Q19X) Compound Library mutation was also detected. No causative mutations in the coding, promoter and conserved intronic regions could be identified in case 2. The patient had classic Roxadustat molecular weight WAS with a score of 4, and no WASP expression could be detected in his cells by immunoblot analysis (courtesy of Dr. Hubert B. Gaspar and Dr. Kimberly C. Gilmour, UK). It remains possible that the mutation could be located in the noncoding parts of the gene including regulatory regions. Our patients with classic WAS

had the age of onset ranging from 6 days to 8 months. Of these seven cases, two developed AIHA, which included the previously reported patient (case 1) with the c.1507T > A (p.X503R) mutation (Table 1). As there are no available HLA-matched donors, this patient has been given monthly IVIG and sulfamethoxazole-trimethoprim prophylaxis. Methisazone The missense mutations (p.R86N) at position 86, one of the common hot spot mutations found in the WASP gene, were identified in two unrelated patients. One with a WAS score of 4 carried

the c.256C > T (p.R86C) mutation. The other with a WAS score of 5 harboured the c.257G > A (p.R86H) mutation. The missense mutations at position 86 (p.R86N) have been found to be commonly associated with the XLT phenotype. However, some patients with these particular mutations can have a more severe phenotype with a score of 3–5 [10, 12, 17]. The previously reported c.1272insG (p.G424GfsX494) and IVS8 + 3 to 6del GAGT mutations in patients with classic WAS were also detected in the Thai population. The novel nonsense (c.55C > T, p.Q19X) mutation expected to result in the formation of a truncated protein lacking most of the functional domains was identified in one patient with severe WAS. He developed pneumonia with hepatosplenomegaly at 2 months of age caused by CMV. As microcephaly was observed at birth, congenital CMV infection cannot be excluded. Previous studies described CMV infection in patients with WAS both prior to and following HSCT [10, 18-20], and it resulted in a fatal outcome in the majority of cases. The treatment guideline for CMV infection in patients with WAS, however, has not been well established.

Lysosomal storage disorders result from inherited defects in lysosomal proteins [10]. These disorders can be caused either by a primary defect in a catabolic https://www.selleckchem.com/products/sotrastaurin-aeb071.html enzyme (e.g. Tay-Sachs and Sandhoff disease) or a defect in a transporter, channel or regulatory protein (e.g. Niemann-Pick type C (NPC1) disease). Lysosomal storage caused by a deficient lysosomal enzyme has been shown to lead to reduced iNKT cells in murine models of Sandhoff disease [11, 12], Tay-Sachs disease [11], GM1 gangliosidosis

[11-13] and Fabry disease [14, 15]. In the NPC1 mouse the numbers of iNKT cells also are greatly reduced but this is associated with impaired late-endosome/lysosome fusion in addition to the lysosomal lipid storage [11, 16]. NPC disease can be caused by mutations in one of two genes NPC1 or NPC2 [17]. Dysfunction of the NPC1 protein leads to decreased lysosomal calcium content which accounts for the failure of endocytic vesicle fusion and the complex pattern of lipid storage observed [18]. With the differential trafficking of murine and human CD1d for iNKT-cell

ligand Selleckchem PF2341066 presentation ex vivo and the requirement of normal lysosomal CD1d trafficking/function for murine iNKT-cell development in vivo, we reasoned that examining iNKT cells in NPC patients would reveal whether the findings in the murine model extends to humans. It has been reported that iNKT cells are present at normal frequencies in the peripheral blood of Fabry disease patients [19] and are slightly increased in Gaucher disease patients [20]. Here, we have studied iNKT-cell frequencies and functional responses

in NPC1 disease patients and the ability of patient-derived EBV-B-cell lines to stimulate iNKT cells. In contrast to the murine model of NPC1, we found unchanged iNKT-cell frequencies in NPC1 patients. In addition, the functional response of NPC1 iNKT cells to stimulation was normal, as was the ability of NPC1 antigen presenting cells to present a variety of iNKT cells ligands to control iNKT cells. We analysed the frequency of iNKT Immune system cells in the peripheral blood of controls, NPC1 patients and NPC1 heterozygote carriers by flow cytometry (gating strategy, Supporting Information Fig. 1). As previously reported [21], the frequencies of iNKT cells are very low in normal human peripheral blood, typically in the range of 0.1–1% of total T cells (Fig. 1A). In contrast to the NPC1 mouse where iNKT cells are undetectable, iNKT cells could be identified and were present at normal frequencies in the peripheral blood of NPC1 patients and heterozygotes (Fig. 1A). This indicates that fusion of late endosomes and lysosomes is not required for the generation, delivery or loading of iNKT-cell selecting ligand(s) in the thymus or for their maintenance in the periphery.

The importance of IL-10 in controlling the degree and duration of the inflammatory reaction is illustrated by the observations that several chronic inflammatory and autoimmune pathologies develop as a consequence of the impaired execution of the anti-inflammatory pathways. In this regard,

the discovery that IL-10 not only modulates cytokine production by monocytes/macrophages, but also by neutrophils, has represented an important advance in our understanding of how IL-10 regulates the inflammatory response. Furthermore, some of the molecular bases specific to the IL-10/neutrophil network have been unveiled, although a complete picture of the signaling intermediates Smoothened Agonist mw regulating neutrophil responsiveness to IL-10 still requires additional research. Such investigations will be particularly relevant for a full understanding of the mechanisms underlying the IL-10-dependent AIR, which we know to be conditioned by complex regulatory circuits operating at different levels, be they BGB324 chemical structure environmental or as outlined in this review cell specific. This work was supported by grants from: Ministero dell’Istruzione,

dell’Università e della Ricerca (PRIN 2007H9AWXY and 2006064751), University of Verona (Joint Project grant), Fondazione Cariverona, Associazione Italiana per la Ricerca sul Cancro (AIRC, IG5839). N. T. and M. R. hold AIRC fellowships. The authors thank P. P. McDonald and Claudio Costantini for critical reading and editing. Conflict of interest: The authors declare no financial or commercial conflict of interest. “
“Previous studies on

the role of the tetraspanin CD37 in cellular immunity PI-1840 appear contradictory. In vitro approaches indicate a negative regulatory role, whereas in vivo studies suggest that CD37 is necessary for optimal cellular responses. To resolve this discrepancy, we studied the adaptive cellular immune responses of CD37−/− mice to intradermal challenge with either tumors or model antigens and found that CD37 is essential for optimal cell-mediated immunity. We provide evidence that an increased susceptibility to tumors observed in CD37−/− mice coincides with a striking failure to induce antigen-specific IFN-γ-secreting T cells. We also show that CD37 ablation impairs several aspects of DC function including: in vivo migration from skin to draining lymph nodes; chemo-tactic migration; integrin-mediated adhesion under flow; the ability to spread and form actin protrusions and in vivo priming of adoptively transferred naïve T cells. In addition, multiphoton microscopy-based assessment of dermal DC migration demonstrated a reduced rate of migration and increased randomness of DC migration in CD37−/− mice.

Alternatively OTX015 spliced transcripts of human IL-7Rα were reported in leukaemic cells from children with acute lymphoblastic leukaemia (ALL) [21]. Another study observed increased production of the soluble form of the IL-7Rα protein due to a twofold increase in alternatively spliced transcripts that eliminated exon 6 [19]. Moreover, serum levels of sIL-7Rα have been associated with the Hap2 haplotype (counting rs6897932T), also associated with

autoimmune disease [22]. Investigation of health controls demonstrate that an increase in sIL-7Rα is associated with the rs6897932 SNP, also found to be related to relapse in the present study with an approximately threefold increase in the median levels between the TT and CC genotype and intermediate levels for the CT genotype [23]. The functional impact of sIL-7Rα on IL-7 activity

is not known in vivo, but it was recently shown that in vitro, the native sIL-7R does interfere in optimal IL-7/IL-7Rα-signalling by significant inhibition of STAT5 and Bcl-2 phosphorylation [24]. It is likely that increased levels of sIL-7Rα may be associated with reduced IL-7 activity due to diminished expression of IL-7Rα on the cell surface. In addition, the soluble form of IL-7Rα may bind IL-7 in solution and may therefore act as a decoy receptor [25]. This may affect the IL-7-dependent thymic production of T cells, including the rate of regulatory T cell production Apoptosis Compound Library that has been associated with T cell alloreactivity in HCT [26]. The biological significance of this in relation to HCT, however, deserves further investigation because IL-7 levels have been shown to be considerably elevated during the Obeticholic Acid early phase after HCT [27]. Recently, it was demonstrated that IL-7Rα Hap 2 (counting rs6897932T) is associated with faster CD4+ T cell reconstitution following antiretroviral therapy (ART) for HIV infection and that these individuals have lower circulating soluble IL7Rα [28]. Furthermore, the potential of sIL-7Rα to influence TSLP signalling should be explored in

future studies. TSLP is important for the development of regulatory T cells. A reduction in TSLP signalling could lead to reduced production of Tregs and thereby increased GvHD and TRM. In conclusion, there is accumulating evidence for an association between various IL-7Rα SNPs and adverse outcome in HCT. In this study, we show for the first time that the donor type of IL-7Rα rs6897932 may be associated with the risk of relapse in patients undergoing HCT for haematological malignancies. In addition, the functional impact we know of rs6897932 on the release of sIL-7Rα in health controls and a potential biological mechanism for the immune-modulating function of the SNP. These data provide further evidence of a role of the IL-7 pathway in outcome of HCT and impact of non-synonymous SNPs on IL-7Rα function. Marianne B.

14,15 Yet, whereas all of these studies clearly confer on CD8+ T cells an important role in intestinal inflammation, none of these studies has been focused on the induction of truly CD8+ regulatory

T cells that express forkhead box P3 (Foxp3). In a previous study we demonstrated that the intestinal expression of a self-antigen leads to the induction of antigen-specific CD8+ Foxp3+ T cells in vivo.16 Furthermore, we have demonstrated that in vitro stimulation of antigen-specific CD8+ T cells in the presence of transforming growth factor-β (TGF-β) and retinoic acid (RA) induced a robust population of CD8+ Foxp3+ regulatory T cells.17 As the intestine is characterized by abundant production of TGF-β and RA it might therefore be prone to the LY2109761 solubility dmso induction of Foxp3+ regulatory T cells. As these cells might play an as yet underestimated role in the maintenance of intestinal homeostasis, we have investigated CD8+ Foxp3+ T cells generated by TGF-β and RA by analysing the function and phenotype in humans and mice. Our study shows that TGF-β/RA-converted CD8+ Foxp3+ T cells share all the major features of conventional CD4+

regulatory T cells, i.e. suppressive function in vitro. Furthermore, these subsets of regulatory T cells also resemble each other at the molecular level as determined by gene expression studies. The fact that this conversion by TGF-β and RA also works with human CD8+ T cells FDA-approved Drug Library mouse is of particular interest because we demonstrate in this study that the frequency of CD8+ Foxp3+ T cells is reduced in the peripheral blood of patients with intestinal inflammation. Hence, our study illustrates a previously unappreciated critical role of CD8+ Foxp3+ T cells in controlling potentially dangerous T cells. Foxp3/GFP mice express both the Foxp3 and green fluorescent protein (GFP) under the endogenous regulatory sequence of the Foxp3 locus and were obtained from the Charles River Laboratories (Sulzfeld,

Germany). BALB/c mice and C57BL/6 mice were obtained from Harlan Laboratories (Harlan Winkelmann GmbH, Borchen, Germany). Granzyme B (GzmB) -deficient C57BL/6 mice were kindly provided by Prof. Dr U. Dittmer (Department of Virology, University Duisburg-Essen). Blood samples http://www.selleck.co.jp/products/Gefitinib.html were obtained from 12 patients (five men, seven women; age range, 32–72 years) with active ulcerative colitis (UC) and from 18 healthy blood donors (eight men, ten women; age range, 22–87 years), who were used as control group. To assess disease activity, the clinical activity index (CAI) according to Rachmilewitz’s criteria and the ulcerative colitis disease activity index (UCDAI) according to Sutherland’s criteria, including a grading of clinical and endoscopic signs, were determined. Patients were classified as having acute UC with a CAI > 4. Peripheral blood mononuclear cells were isolated from heparin-treated blood by Bicoll density gradient centrifugation (Biochrom AG, Berlin, Germany).

54) after adjustment for age, gender, race, pre-existing coronary heart disease, mean arterial blood pressure, diabetes, glucose level, cholesterol level, smoking, body mass index, and geographic location within the study sites. In those with

no evidence of pre-existing heart disease, diabetes, or hypertension at enrollment to the study, the presence of retinopathy was associated with an almost threefold increased risk of future congestive heart failure (adjusted HR: 2.98; 1.50–5.94). Furthermore, the presence of retinopathy, in a nondiabetic cohort carries a similar mortality risk as diabetes itself after a cardiac event (HR: 2.28; 1.10–4.76), and over a sixfold increase in those with diabetes (HR: 6.69; 2.24–20.0) [38]. This may, in part, represent shared risk factors; however, the association remains only marginally reduced

after adjustment for known risk factors, suggesting that residual confounding is an unlikely explanation. However, selleck chemicals llc despite these data, individuals at high risk do not get routine retinal screening [6]. There is an established GW-572016 nmr co-linearity in the development and progression of microvascular and macrovascular disease [10,37,73]. This is the subject of considerable studies to establish whether there is a causal effect in either direction or simply represents shared risk factors, although it is most likely to be a complex combination of bidirectional interactions. A typical example of this would be the interplay between diabetic nephropathy, metabolic syndrome, and atherosclerosis. An elevated urinary albumin excretion rate was first described as a feature of glomerulosclerosis with a poor prognosis in 1936 by Clifford Wilson and

Paul Kimmelstiel [35]. Indeed, many textbooks still refer to diabetic nephropathy as “Kimmelstiel–Wilson” syndrome. At that time, it was thought to represent local pathology within the renal microcirculation; however, it has subsequently Alanine-glyoxylate transaminase been recognized as a predictor of future cardiovascular events and mortality in diabetes, renal failure hypertension, and the general population at large [16,18,26,73,76]. Furthermore, it predicts survival after myocardial infarction [36] and stroke [59]. As such, urinary albumin excretion rate or its proxy, albumin:creatinine ratio, has become an accepted surrogate for microcirculatory target organ damage in hypertension, renal disease, and type 2 diabetes. Currently, there remains little debate as to the importance of albuminuria as a prognostic indicator, although consensus has not been reached regarding the threshold of “abnormality”, given that the association persists down into levels that are currently considered normal and below the sensitivity of commercially available assays [7]. The lack of a clear mechanistic pathway to explain the association between microalbuminuria and adverse cardiovascular outcomes has led many clinicians to believe that it is solely a marker of blood pressure exposure.

34 The three most commonly used BVM devices, Crit-line, Haemoscan® and Fresenius® BVM, were compared with each other and to laboratory-derived BV changes (based on changes in haemoglobin).32 All three devices yielded values different from the laboratory-derived values and there was also significant variability between the three devices. This possibly reflects the different methods by which the changes in BV are acquired. Modulation of blood volume has been used to assess the different rates of UF on RBV. UF profiles and rates vary from constant, high at onset and isolated pulses. The highest rate of IDH was found in dialysis sessions where UF occurred in pulses or steps.35 Attempts

have been made to measure the changes in RBV over a

series of sessions and store this in the dialysis machine so that UF can be adjusted once the RBV reaches a patient-specific threshold. However, the selleckchem Caspase-independent apoptosis RBV adjusted for UF varies greatly between dialysis sessions reflecting different UF requirements.36 The more fluid overloaded a patient, the smaller the decrease in RBV per unit of UF volume.36,37 This technology has been expanded to create a preferred UF profile for an individual patient based on stored RBV measurements obtained from these patients. During HD the dialysis machine checks the RBV measurement against the stored profile and adjusts the UF rate and dialysate sodium concentration accordingly. This uses fuzzy logic principles, which aim to derive a definite conclusion from what is often imprecise or ambiguous data. This aims to mimic human decision making allowing a degree of flexibility not possible with mathematical modelling.38 After an initial successful single centre experience39 the biofeedback system technology Phospholipase D1 has been shown to reduce the incidence of IDH in several randomized trials.19,29,40 A recent study aimed to assess to utility of UF index (UF rates divided by post-dialysis weight), RBV slopes and volume

index (RBV slopes adjusted for UF rate and weight) in determining BV status in 150 difficult patients.41 While these were shown to be possible markers of volume status they did not predict the onset or frequency of IDH. The use of RBV slopes has been shown to be useful in the assessment of IBW in hypertensive HD patients.42 Various BVM technologies are now readily available; however, their utility in IDH remains unclear. BVM devices (especially with the addition of fuzzy logic systems) decrease the incidence of IDH in a at risk population; however, there is limited evidence that BVM can predict IDH in individual patients or that there is a long-term morbidity and mortality benefit, especially in the wider HD population. The technology is undergoing constant refinement, as is the interpretation and analysis of the RBV curves in relation to the other parameters such as weight, UF rate and sodium concentration.