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Kanjanabuch T, Siribamrungwong M, Khunprakant R, Kanjanabuch S, Jeungsmarn P, Achavanuntakul B, Pongpirul K, Park MS, Tungsanga K, Eiam-Ong S. Overnight Mesothelial Cell Exfoliation: A Magic Tool for Predicting Future Ultrafiltration Failure in Patients on Continuous Ambulatory Peritoneal Dialysis. Perit Dial Int 2020. [DOI: 10.1177/089686080802803s21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
⋄ Background Continuous exposure of the peritoneal membrane to dialysis solutions during long-term dialysis results in mesothelial cell loss, peritoneal membrane damage, and thereby, ultrafiltration (UF) failure, a major determinant of mortality in patients on continuous ambulatory peritoneal dialysis (CAPD). Unfortunately, none of tests available today can predict long-term UF decline. Here, we propose a new tool to predict such a change. ⋄ Mesothelial cells from 8-hour overnight effluents (1.36% glucose dialysis solution) were harvested, co-stained with cytokeratin (a mesothelial marker) and TUNEL (an apoptotic marker), and were counted using flow cytometry in 48 patients recently started on CAPD. Adequacy of dialysis, UF, nutrition status, dialysate cancer antigen 125 (CA125), and a peritoneal equilibration test (3.86% glucose peritoneal dialysis solution) were simultaneously assessed and were reevaluated 1 year later. ⋄ Results The numbers of total and apoptotic mesothelial cells were 0.19 ± 0.19 million and 0.08 ± 0.12 million cells per bag, respectively. Both numbers correlated well with the levels of end dialysate–to–initial dialysate (D/D0) glucose, dialysate-to-plasma (D/P) creatinine, and sodium dipping. Notably, the counts of cells of both types in patients with diabetes or with high or high-average transport were significantly greater than the equivalent counts in nondiabetic patients or those with low or low-average transport. A cutoff of 0.06 million total mesothelial cells per bag had sensitivity of 1 and a specificity of 0.75 in predicting a further decline in D/D0 glucose and a sensitivity of 0.86 and a specificity of 0.63 to predict a further decline in UF over a 1-year period. In contrast, dialysate CA125 and other measured parameters had low predictive values. ⋄ Conclusions The greater the loss of exfoliated cells, the worse the expected decline in UF. The ability of a count of mesothelial cells to predict a future decline in UF warrants further investigation in clinical practice.
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Affiliation(s)
- Talerngsak Kanjanabuch
- Division of Nephrology, Department of Medicine, Kidney, Bangkok
- Urinary Bladder and Metabolic Syndrome Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok
| | | | | | | | | | - Bunlusak Achavanuntakul
- Renal Unit, Internal Medicine Department, Sappasitthiprasong Hospital, Ubon Ratchathani, Thailand
| | - Krit Pongpirul
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Seoul, Korea
| | - Min-Sun Park
- Renal Asia, Regional Medical Affairs, Seoul, Korea
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Rashid G, Luzon AA, Korzets Z, Klein O, Zeltzer E, Bernheim J. The Effect of Advanced Glycation End-Products and Aminoguanidine on Tnfα Production by Rat Peritoneal Macrophages. Perit Dial Int 2020. [DOI: 10.1177/089686080102100203] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
ObjectiveTo evaluate the effect of advanced glycation end-products (AGEs) and the inhibitor of their formation, aminoguanidine, on tumor necrosis factor-α (TNFα) production (as a functional marker) by rat peritoneal macrophages (PMΦ).DesignCharles River rats underwent a daily intraperitoneal injection of peritoneal dialysis solution [(PDS), 4.25 g/dL dextrose; Dialine, Travenol, Ashdod, Israel] for a 2-month period (group E). Another group of rats was subjected to the same protocol with the addition of 25 mg/kg aminoguanidine (group A). Three control groups were utilized: ( 1 ) rats that were injected daily with aminoguanidine only (group AO), ( 2 ) rats that were injected with Dulbecco's phosphate-buffered saline (group D), and ( 3 ) rats in which no intervention was carried out (group C). After 2 months, PMΦ were isolated from rat peritoneal effluent and their TNFα production measured by ELISA in cell-free culture supernatants, in both the basal state and after 24-hour stimulation with lipopolysaccharide (LPS). The concentrations of AGEs in peritoneal effluent were assayed and correlated to TNFα levels. PMΦ obtained from normal rats were then incubated for 24 hours with ( 1 ) the peritoneal effluent of each of the above respective groups, with or without LPS; ( 2 ) increasing concentrations of AGEs (0 - 250 μg/mL); and ( 3 ) increasing concentrations of aminoguanidine (0 - 7.5 mg/mL), and TNFα secretion again determined.ResultsAfter 2 months of daily intraperitoneal injection of PDS, in the basal state, TNFα production was significantly higher in PMΦ isolated from the peritoneal effluent groups (groups E, A, and AO) compared to controls (group C). Following LPS stimulation, a further increase in TNFα secretion was seen, with a significantly greater response in group AO versus groups E, A, and D. Effluent AGEs were markedly elevated only in group E. No correlation was found between TNFα secretion by these PMΦ and the concentration of AGEs. On incubation with the respective peritoneal effluents (groups E, A, and AO), in both the basal and stimulated state, TNFα production by PMΦ from normal rats was significantly enhanced compared to group C. Incubation with increasing concentrations of AGEs or aminoguanidine resulted in an increase of TNFα secretion by these PMΦ.ConclusionsFollowing intermittent intraperitoneal administration of glucose-based PDS, rat PMΦ are chronically activated, as evidenced by increased basal TNFα secretion. The peritoneal effluent of such treated animals is capable of stimulating TNFα production by normal rat PMΦ. These data suggest that glucose-based PDS acts as a primer of PMΦ, which retain their ability to further stimulation by LPS. Although, in vitro, AGEs promote TNFα secretion by normal rat PMΦ, in vivo, their influence is probably modulated by other factors. Aminoguanidine has a specific inducing effect on rat PMΦ, independent of glucose-based PDS.
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Affiliation(s)
- Gloria Rashid
- Department of Nephrology and Hypertension, Sapir Medical Center, Kfar-Saba, and The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ami-Ad Luzon
- Department of Nephrology and Hypertension, Sapir Medical Center, Kfar-Saba, and The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ze'ev Korzets
- Department of Nephrology and Hypertension, Sapir Medical Center, Kfar-Saba, and The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Osnat Klein
- Department of Nephrology and Hypertension, Sapir Medical Center, Kfar-Saba, and The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ella Zeltzer
- Department of Nephrology and Hypertension, Sapir Medical Center, Kfar-Saba, and The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jacques Bernheim
- Department of Nephrology and Hypertension, Sapir Medical Center, Kfar-Saba, and The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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3
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Affiliation(s)
- Tao Wang
- Divisions of Baxter Novum and Renal Medicine, Department of Clinical Science, Karolinska Institute, Huddinge University Hospital, Stockholm, Sweden
| | - Bengt Lindholm
- Divisions of Baxter Novum and Renal Medicine, Department of Clinical Science, Karolinska Institute, Huddinge University Hospital, Stockholm, Sweden
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Pannekeet MM, Zemel D, Koomen GC, Struijk DG, Krediet RT. Dialysate Markers of Peritoneal Tissue during Peritonitis and in Stable Capd. Perit Dial Int 2020. [DOI: 10.1177/089686089501506s01] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective To investigate whether dialysateconcentrations of substances that are locally produced within the peritoneal cavity can be used to study the effects of inflammation on peritoneal tissue. Design We followed the appearance rates (AR) of concentrations of cancer antigen (CA) 125, phospholipids (PHL), hyaluronan (HA), and the procollagen peptides PICP (procollagen 1 C-terminal) and PIIINP (procollagen 3 N-terminal) in dialysate during peritonitis (8 consecutive days) and after recovery. Data were compared with the stable situation. Setting CAPD (continuous ambulatory peritoneal dialysis) unit in the Academic Medical Center in Amsterdam. Patients Twelve CAPD patients with a total of 16 episodes of peritonitis and 10 clinically stable CAPD patients were studied. Results All substances showed temporal increments in dialysate during peritonitis compared to control. No difference was found between the control day of peritonitis and the stable patients. Maximum AR were reached in the acute phase of peritonitis for CA 125, PHL, and HA and on day 4 for both PICP and P111NP. A second increment in CA125 occurred on days 4 to 6. These findings indicate acute damage to the mesothelium (CA 125) and other cells (PHL) by the infection. HA may reflect stromal changes. Subsequently, peritoneal healing (PICP, PIIINP) and remesothelialization (second peak CA125) are likely to occur. Conclusions Dialysate concentrations of these substances can be used as markers for the effects of peritonitis on the peritoneum of CAPD patients in vivo. The similarity between the marker concentrations in the effluent after recovery from peritonitis and those in stable CAPD patients implies that complete peritoneal healing is likely to occur after uncomplicated peritonitis.
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Affiliation(s)
- Marja M. Pannekeet
- Academic Medical Center, Renal Unit, Department of Medicine, Amsterdam, Utrecht, The Netherlands
| | - Désirée Zemel
- Academic Medical Center, Renal Unit, Department of Medicine, Amsterdam, Utrecht, The Netherlands
| | - Ger C.M. Koomen
- Academic Medical Center, Renal Unit, Department of Medicine, Amsterdam, Utrecht, The Netherlands
| | - Dick G. Struijk
- Academic Medical Center, Renal Unit, Department of Medicine, Amsterdam, Utrecht, The Netherlands
- Foundation for Home Dialysis Midden-West Nederland, Utrecht, The Netherlands
| | - Raymond T. Krediet
- Academic Medical Center, Renal Unit, Department of Medicine, Amsterdam, Utrecht, The Netherlands
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5
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Dobbie JW. The Role of Peritoneal Biopsy in Clinical and Experimental Peritoneal Dialysis. Perit Dial Int 2020. [DOI: 10.1177/089686089301302s04] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Mateijsen MA, Van Der Wal AC, Hendriks PM, Zweers MM, Mulder J, Struijk DG, Krediet RT. Vascular and Interstitial Changes in the Peritoneum of Capd Patients with Peritoneal Sclerosis. Perit Dial Int 2020. [DOI: 10.1177/089686089901900605] [Citation(s) in RCA: 238] [Impact Index Per Article: 59.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective To analyze morphological changes in the peritoneum of peritoneal sclerosis (PS) patients. Emphasis was put on vascular abnormalities, because the continuous exposure to glucose-based dialysis solutions could cause diabetiform changes and because longitudinal transport studies suggested the development of a large peritoneal vascular surface area. Design Peritoneal biopsies from continuous ambulatory peritoneal dialysis (CAPD) patients were investigated in two studies. Diabetic patients were excluded. In study 1, 11 PS biopsies were compared to three control groups varying in duration of CAPD treatment: 0 months ( n = 15), 2 – 25 months ( n = 7), and > 25 months CAPD ( n = 7). The second study was a case-control study, comparing six biopsies from the long-term control group to six PS biopsies, matched for age and duration of CAPD. All biopsies were scored for presence and type of fibrosis [Picro Sirius red, type IV collagen, α-smooth muscle actin (αSMA)] and for neoangiogenesis (factor VIII). Thickening of vascular walls by type IV collagen and vasodilation of capillaries were measured by computer-aided planimetry. Results In study 1 the presence of sclerosing fibrosis, deposition of interstitial type IV collagen, and the number of myofibroblasts (αSMA-positive cells) was greater in the PS biopsies than biopsies from all control groups ( p < 0.002). Moreover, the number of vessels per field was higher in PS biopsies ( p < 0.01). Vascular wall thickening of small arteries ( p < 0.008) and vasodilation of capillaries were found in PS biopsies compared to all control groups ( p < 0.007). The second study revealed differences in the presence of sclerosis but not in the extent of fibrosis between PS biopsies and their controls. The number of vessels per field in PS biopsies was higher compared to controls ( p = 0.04). Also, thickening of the vascular wall was more marked in PS biopsies ( p = 0.03). Vasodilation of capillaries was greater in PS biopsies than in controls ( p = 0.07). Conclusion Fibrosis of the peritoneum may precede peritoneal sclerosis. The deposition of type IV collagen and the presence of myofibroblasts in the interstitial layer could be part of a pathologic process similar to the scarring in diabetic nephropathy. Neoangiogenesis and thickening of the vascular wall by type IV collagen are consistent with glucose-induced microangiopathy. These abnormalities and the vasodilation of the capillaries can explain the high dialysate-to-plasma ratios or mass transfer area coefficients of low molecular weight solutes that can be found in long-term CAPD patients.
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Affiliation(s)
| | | | | | - Machteld M. Zweers
- Department of Nephrology, Academic Medical Center Amsterdam, The Netherlands
| | - Jos Mulder
- Department of Pathology, Academic Medical Center Amsterdam, The Netherlands
| | - Dirk G. Struijk
- Department of Nephrology, Academic Medical Center Amsterdam, The Netherlands
| | - Raymond T. Krediet
- Department of Nephrology, Academic Medical Center Amsterdam, The Netherlands
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7
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Burkart JM. Ysis Prescription and Peritoneal Membrane Transport Characteristics on Nutritional Status. Perit Dial Int 2020. [DOI: 10.1177/089686089501505s03] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
These data suggest that dialysis dose is one of the major determinants of protein and energy intake in PD patients and that higher doses of dialysis tend to improve outcome. The data also suggest that with a long time on PD the peritoneal membrane probably has some underlying histological changes that preclude it from optimally responding to injury and may predispose it to irreversible damage. A possible early finding in this case is an increase in peritoneal transport in patients whose transport was initially stable. Peritoneal membrane transport properties are an important determinant of not only dialysis dose, but also nutritional status via both direct and indirect means. It is therefore important to identify the individual patient's peritoneal membrane transport characteristics. These transport characteristics may change over time. High transporters on CAPD represent a unique challenge. They have ultrafiltration problems and a tendency toward protein malnutrition presumably due to increased dialysate protein losses while on CAPD. One must consider that malnutrition in a rapid transporter may be due to the fact that the patient is on the wrong PD therapy. A change to NIPD may rectify some of the biochemical parameters, but these patients may not always improve. Reasons for this occasional lack of improvement are multifactorial, but emphasize our need to look at each patient as an individual and not focus only on laboratory parameters.
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Affiliation(s)
- John M. Burkart
- Bowman Gray School of Medicine, Winston-Salem, North Carolina, U.S.A
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Spaia S, Christidou F, Pangidis P, Tsoulkas T, Pazarloglou M, Pappa A, Vayonas G. Variability of Peritoneal Protein Loss in Diabetic and Nondiabetic Patients on Continuous Ambulatory Peritoneal Dialysis. Perit Dial Int 2020. [DOI: 10.1177/089686089301302s60] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In order to evaluate the Influence of diabetes mellitus on peritoneal membrane permeability, we studied the peritoneal protein loss In two groups of patients. Group A consisted of 16 patients (9 nondlabetics and 7 diabetics) who were In the first month of treatment on continuous ambulatory peritoneal dialysis (CAPO). Group B consisted of 13 patients (7 nondlabetics and 6 diabetics) who had been on CAPO for approximately 15 months. In both groups we measured the body weight, serum total protein, albumin, and total protein, urea, and glucose In the peritoneal fluid. We did not find any difference In groups A and B between diabetics and nondlabetics as far as the estimated parameters were concerned. Age, body weight, serum biochemistry, and protein and urea content In peritoneal fluid were similar, when group A was compared to group B. Patients of group B hed on average higher protein losses than those who had been on the method for a short period (mean 7.9 g/dL, vs 6.09 g/dL). Six patients were followed for over 15 months and were found to have significantly Increased protein losses (p=0.02). Glucose levels In peritoneal fluid were significantly lower In patients In group B, p<0.05 (mean 51.8 g/dL vs 37.1 g/dL). Peritoneal protein loss does not seem to differ between diabetic and nondiabetic patients with end-stage renal disease treated with CAPO, at any given time of the treatment. We observed an Increase In protein loss In some patients and a tendency to Increase the protein loss In others. This, along with the fall In glucose levels, might reflect progressive alterations In structure and permeability of the elements Involved In peritoneal transport, and It should receive further evaluation.
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Affiliation(s)
- Sophia Spaia
- Renal Unit, 2nd Hospital of lKA, Thessalomki, Greece
| | | | | | | | | | - Anna Pappa
- Renal Unit, 2nd Hospital of lKA, Thessalomki, Greece
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9
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Affiliation(s)
- James W. Dobbie
- Lister Surgical Research Laboratories, University Department of Surgery, Edinburgh Royal Infirmary, Scotland
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10
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De Fijter CW, Oe PL, Donker AJ, Verhoef J, Verbrugh HA. Compatibility of Peritoneal Dialysis Fluids Containing Alternative Osmotic Agents with Cells Present in the Peritoneal Cavity. Perit Dial Int 2020. [DOI: 10.1177/089686089401402s05] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The success of continuous ambulatory peritoneal dialysis (CAPD) lies in preserving the peritoneum as a dialyzing membrane. Repeated infusions of nonphysiological fluids are potentially detrimental to the peritoneal membrane and its host defense. The disadvantages of the currently used peritoneal dialysis fluids (PDPs) containing glucose as an osmotic agent (short ultrafiltration profile, systemic carbohydrate load, nonphysiological composition) have stimulated the search for alternative, less toxic osmotic agents devoid of metabolic side effects and capable of sustaining ultrafiltration. PDFs containing glycerol, amino acids, or glucose polymers have had clinical usage in CAPD patients and were reviewed with regard to their compatibility with cells present in the peritoneal cavity. Overall, glycerol appears to have no advantage over glucose-based PDFs, although it is less inhibitory for mesothelial cell proliferationin vitro. The optimum formulation of amino acid-based PDFs has not yet been established; its lactate and specific amino acid content may limit their biocompatibility. The virtually iso-osmolar glucose polymer (icodextrin)-containing PDFs were associated with improved biocompatibility compared to glucose monomer-based solutions. Modifications of PDFs towards a more balanced salt solution with a neutral pH may further increase their compatibility with peritoneal host defense as well as with the integrity of the mesothelial membrane. Such improvement in PDF biocompatibility may result in clinical benefit, that is, enhanced resistance to infection and preservation of peritoneal ultrafiltration capacity.
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Affiliation(s)
| | - P. Liem Oe
- Department of Internal Medicine, Free University Hospital, Amsterdam
| | - Ab J.M. Donker
- Department of Internal Medicine, Free University Hospital, Amsterdam
| | - Jan Verhoef
- Department of Microbiology, State University of Utrecht, The Netherlands
| | - Henri A. Verbrugh
- Department of Microbiology, State University of Utrecht, The Netherlands
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11
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Hjelle JT, Steidley KR, Pavlina TM, Dobbie JW. Choline Incorporation into Phospholipids in Mesothelial Cells in Vitro. Perit Dial Int 2020. [DOI: 10.1177/089686089301300405] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
ObjectiveTo determine the effect of extracellular choline concentration on phospholipid production and handling by peritoneal mesothelial cells in vitro.Design and MeasurementsRadiolabeled choline was used to monitor the formation of phosphatidylcholine {PC), sphingomyelin (SPH), and Iysophosphatidylcholine (LPC) by rat and rabbit mesothelial cells as a function of concentration and time of exposure to choline. The subcellular location of the newly formed phospholipids was examined by ultracentrifugation in Percoll-sucrose gradients using analytical cell fractionation techniques. The fatty acid composition of the PC formed was determined by thin-layer chromatography (TLC) and gas chromatography.ResultsCholine incorporation into PC, SPH, and LPC increased with extracellular choline levels up to 640 μmol/L, which is 100 times greater than physiological levels of choline in plasma and 20 times higher than choline levels measured in peritoneal dialysis effluent. The newly formed, radiolabeled phospholipids were primarily found in a single subcellular compartment that exhibited a buoyant density of 1.05 g/mL in Percollsucrose gradients. Analysis of the fatty acyl groups of PC obtained from the mesothelial cells showed enrichment in palmitic [16:0], oleic [18:1], and linoleic [18:2] acids.ConclusionThe rate of phospholipid formation by mesothelial cells in vitro can be manipulated, in part, by choline concentration.
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Affiliation(s)
- J. Thomas Hjelle
- Basic Sciences, University of Illinois College of Medicine at Peoria
| | - Kevin R. Steidley
- Basic Sciences, University of Illinois College of Medicine at Peoria
| | - Thomas M. Pavlina
- Applied Sciences, Baxter Healthcare Corporation, Round Lake, Illinois, U.S.A.
| | - James W. Dobbie
- Baxter Research and Development Europe, Baxter Healthcare Corporation, Nivelles, Belgium
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12
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Haslinger B, Mandl–Weber S, Sitter T. Thrombin Suppresses Matrix Metalloproteinase 2 Activity and Increases Tissue Inhibitor of Metalloproteinase 1 Synthesis in Cultured Human Peritoneal Mesothelial Cells. Perit Dial Int 2020. [DOI: 10.1177/089686080002000632] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
ObjectiveRecently, high levels of intraperitoneally generated thrombin were found in the effluent of patients treated with continuous ambulatory peritoneal dialysis (CAPD). The aim of the present study was to investigate in human peritoneal mesothelial cells (HMCs) the effect of thrombin on the activity and synthesis of matrix metalloproteinases (MMPs), which regulate the degradation of basement membrane collagen.MethodsCultured HMCs were isolated from omental tissue and used at confluence for the experiments. Conditioned media were obtained by incubating cells with serum-free M199 containing the relevant doses of thrombin. Activity of MMP-2 and MMP-9 were determined by an activity assay system. The antigen levels of MMPs and of the specific tissue inhibitor of metalloproteinases 1 (TIMP-1) were measured by ELISA. Northern blot analysis was applied to analyze mRNA expression of MMP-2 and TIMP-1.ResultsIncubation of HMCs with increasing doses of thrombin resulted in a concentration- and time-dependent suppression of MMP-2 activity. No changes in MMP-9 activity were seen. After a 48-hour stimulation period with thrombin (5 U/mL), MMP-2 activity decreased to 53% of that seen in control conditions. Antigen measurements revealed that this decrease was paralleled by a slight reduction in MMP-2 levels, which became significant at a thrombin dose of 5 U/mL [50.65 ± 7.5 ng/105cells (48 hours, 5 U/mL) vs 64.6 ± 10.1 ng/105cells (control)]. Under the same conditions, TIMP-1 levels were considerably increased [3.9 ± 0.46 μg/105cells (48 hours, 5 U/mL) vs 1.2 ± 0.14 μg/105cells (control)]. Hirudin (10 U/mL) completely inhibited the thrombin-induced effects on MMP-2 and TIMP-1 synthesis. These results were also reflected by Northern blot hybridization, where a slight decrease in MMP-2 and an increase in TIMP-1 mRNA expression were observed in response to thrombin.ConclusionsOur results suggest that high thrombin levels suppress MMP-2 activity through decreased MMP-2 and increased TIMP-1 synthesis. Thus, thrombin may promote the accumulation of basement membrane collagen. In addition to fibrin formation, this mechanism may represent a further contribution by thrombin to peritoneal thickening during CAPD.
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Affiliation(s)
- Bettina Haslinger
- Medizinische Klinik, Klinikum Innenstadt, Ludwig-Maximilians-Universität, Munich, Germany
| | - Sonja Mandl–Weber
- Medizinische Klinik, Klinikum Innenstadt, Ludwig-Maximilians-Universität, Munich, Germany
| | - Thomas Sitter
- Medizinische Klinik, Klinikum Innenstadt, Ludwig-Maximilians-Universität, Munich, Germany
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13
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Ateshkadi A, Johnson CA, Founds HW, Zimmerman SW. Serum Advanced Glycosylation End-Products in Patients on Hemodialysis and CAPD. Perit Dial Int 2020. [DOI: 10.1177/089686089501500207] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
ObjectivesPart I: To evaluate the long-term effects of daily glucose absorption from the peritoneal dialysis fluid on the formation of low-molecular-weight advanced glycosylation end products (AGE-peptides) in nondiabetic continuous ambulatory peritoneal dialysis (CAPD) patients. Part II: To determine the acute effect of CAPD on serum AGE-peptide concentrations.DesignPart I: Noninterventional, parallel, cross-sectional clinical trial. Part II: Crossover clinical trial.SettingA university-based hospital, and clinics.PatientsPart I: Sixty nondiabetic subjects recruited into three age-matched (:1:5 years) groups, as follows: 20 healthy volunteers (controls); 20 hemodialysis patients; and 20 CAPD patients. Part II: Eight patients with diabetes mellitus (type lor II) and chronic renal failure who were about to undergo CAPD.InterventionPart I: None. Part II: Uninterrupted CAPD, as medically required.MeasurementsPart I: To determine serum AGEpeptide concentrations blood samples were obtained randomly from controls and CAPD patients, and predialysis from hemodialysis patients. Hemoglobin A1c was also measured in all subjects. Part II: To determine serum AGE-peptide concentrations, blood samples were collected within one month prior to initiation of CAPD (predialysis) and, again, one week after initiation of uninterrupted CAPD (postdialysis). Hemoglobin A1c was measured predialysis.ResultsPart I: Mean hemoglobin A1c values for all groups were within the normal range; however, the mean value for CAPD patients was significantly higher than for both hemodialysis patients and healthy controls (controls, 5.21%:1:0.6%; hemodialysis, 5.12%:1:0.5%; CAPD, 5.78%:1:0.6%; p < 0.01). The dialysis patients had a significantly higher mean serum AGE-peptide concentration than the control subjects (controls, 7.02:1:3.4 units/mL; hemodialysis, 11.9:1:3.6 units/mL; CAPD, 11.1:1:4.5 units/mL; p < 0.01). There was no difference in the mean serum AGE-peptide concentration of patients in the hemodialysis and CAPD groups. Part II: The mean hemoglobin A1c value in the diabetic predialysis patients was 9.2%:1:1.9%. There was no difference between the predialysis and postdialysis serum AGE-peptide concentrations (predialysis, 16.9:1:9.6 units/mL; postdialysis, 16.0:1:2.9 units/mL; p = 0.78).ConclusionsDespite the increased glucose load and the higher hemoglobin A1c values, indicating poor glycemic control, nondiabetic CAPD patients did not have higher serum AGEpeptide concentrations than the nondiabetic hemodialysis patients. In diabetic patients, CAPD did not further increase the serum concentrations of AGEpeptides.
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Affiliation(s)
- Arasb Ateshkadi
- Department of Pharmacy Practice, The University of Utah College of Pharmacy, Salt Lake City, Utah
| | - Curtis A. Johnson
- School of Pharmacy, University of Wisconsin-Madison, Madison, Wisconsin
| | | | - Stephen W. Zimmerman
- Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin, U.S.A
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14
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Park MS, Lee HB. Age Accumulation in Peritoneal Membrane and Cavity during Peritoneal Dialysis and Its Effect on Peritoneal Structure and Function. Perit Dial Int 2020. [DOI: 10.1177/089686089901902s09] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Min Sun Park
- Hyonam Kidney Laboratory; Soon Chun Hyang University; Seoul, Korea
| | - Hi Bahl Lee
- Hyonam Kidney Laboratory; Soon Chun Hyang University; Seoul, Korea
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15
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Dobbie JW. The Biopsy Registry as a Quality Control Mechanism in the Development of Continuous Ambulatory Peritoneal Dialysis. Perit Dial Int 2020. [DOI: 10.1177/089686089301302s144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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16
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Bird SD, Legge M, Walker RJ. L-Cysteine Improves Growth of Human Peritoneal Mesothelial CellsIn Vitro. Perit Dial Int 2020. [DOI: 10.1177/089686089601600609] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
ObjectiveTo improve the growth characteristics of human peritoneal mesothelial cells (HPMC).DesignThe effect of commonly used agents, L-cysteine and epidermal growth factor (EGF), added individually (“single”) or mixed with hydrocortisone and apo-transferrin (“admixture”) in the culture medium (M199) on cultured HPMC, was investigated. Methods: Growth agents were added to M199 medium along with 2% fetal bovine serum and L-glutamine. Growth was determined by the analysis of thymidine ([methyl-3H] thymidine) incorporation into deoxyribonucleic acid, total cell protein, and by cell counts. Morphology was assessed by phase contrast light microscopy and scanning electron microscopy.ResultsHPMC exposed to L-cysteine 0.25 x 10–3 mol/L (30 μg/mL) exhibited significantly improved attachment and growth. Attached cells appeared flat and well spread out shortly after seeding, and produced a tight polygonal monolayer in 14 days, in contrast to the growth of HPMC in control M199 medium, which failed to reach confluence. After an initial lag period in cell growth, EGF (0.01 μg/mL) produced a greater increase in cell growth than L-cysteine did; however, this was associated with changes in HPMC morphology. During the growth period (14 days), EGF-stimulated HPMC appeared distorted and irregular compared to L-cysteine-treated cells, which had the characteristic tight “cobblestone” appearance.ConclusionL-cysteine improved cell attachment with preservation of the characteristic morphology of HPMC. Epidermal growth factor improved cell growth but produced changes in morphology. The addition of L-cysteine to the culture medium has an important cell growth enhancement role due to the improved cell attachment and cell viability.
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Affiliation(s)
- Stephen D. Bird
- Department of Medicine, Faculty of Medicine, University of Otago, Dunedin, New Zealand
| | - Michael Legge
- Department of Biochemistry, Faculty of Medicine, University of Otago, Dunedin, New Zealand
| | - Robert J. Walker
- Department of Medicine, Faculty of Medicine, University of Otago, Dunedin, New Zealand
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Monquil MC, Imholz AL, Struijk DG, Krediet RT. Does Impaired Transcellular Water Transport Contribute to Net Ultrafiltration Failure during CAPD? Perit Dial Int 2020. [DOI: 10.1177/089686089501500109] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objectives To assess the contribution of transcellular water transport in net ultrafiltration failure during continuous ambulatory peritoneal dialysis (CAPD). Design Retrospective. Setting Renal Unit, Academic Medical Center, Amsterdam. Patients One group of 6 patients with clinical severe ultrafiltration loss and a group of 10 stable CAPD patients without ultrafiltration problems. Intervention In all patients, two peritoneal permeability tests were done within one week, using glucose 1.36% dialysate on one day and glucose 3.86% on the other day. Dextran 70 was used as a volume marker. Results The difference in net ultrafiltration between 3.86% glucose and 1.36% glucose dialysate was 569±51 mL (control) and 153±1 03 mL (poor ultrafiltration group; p < 0.005). The dialysatelplasma (DIP) concentration ratios increased in both groups with glucose 1.36%. When using 3.86% glucose, the DIP ratio decreased in the control group with a median minimum value one hour after completion of inflow. It is possible that sieving of sodium was due to transcellular water transport by crystalloid osmosis during the hypertonic dwell, as a dissociation between the transport of water and sodium is unlikely to occur in transport through the much larger intercellular pores. The DIP sodium ratio after one hour was related to the mass transfer area coefficient (MTC) of creatinine and the percentage of glucose absorption in the control group. No decrease in DIP ratio was found in the poor ultrafiltration group. This suggests impairment of transcellular water transport. No significant differences were present between both groups with regard to MTC creatinine (10.2 and 14.0 mL/min), glucose absorption (71% and 71%), effective lymphatic absorption rate (1.34 and 1.01 mL/min), and residual volume (248 and 178 mL). Only 1 patient in the ultrafiltration loss group continued with CAPD. The others had to be transferred to hemodialysis; 1 of them developed sclerosing peritonitis. Conclusion The sieving of sodium during CAPD may be caused by transcellular water transport. Deficient sieving as assessed by the absence of a decreased DIP ratio after one hour of a hypertonic dwell suggests impairment of transcellular water transport. This is asso ciated with severe ultrafiltration failure. It indicates that failure of transcellular water transport, possibly by glycosylation of specific proteins on the cell membrane, may be considered one of the causes of ultrafiltration failure during CAPD.
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Affiliation(s)
| | | | - Dirk G. Struijk
- Department of Medicine, Academic Medical Center, Amsterdam
- Foundation of Home Dialysis Midden-West Nederland, Department of Medicine, Utrecht, the Netherlands
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Lameire N, Faict D. Peritoneal Dialysis Solutions Containing Glycerol and Amino Acids. Perit Dial Int 2020. [DOI: 10.1177/089686089401403s26] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- N. Lameire
- University Hospital, Renal Division, Gent
| | - D. Faict
- Baxter Renal R & D Europe, Nivelles, Belgium
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19
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Topley N, Mackenzie R, Jörres A, Goles GA, Davies M, Williams JD. Cytokine Networks in Continuous Ambulatory Peritoneal Dialysis: Interactions of Resident Cells during Inflammation in the Peritoneal Cavity. Perit Dial Int 2020. [DOI: 10.1177/089686089301302s71] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Nicholas Topley
- Universitätsklinikum Rudolf Virchow, Charlottenburg-Berlin, Germany
| | - Ruth Mackenzie
- Universitätsklinikum Rudolf Virchow, Charlottenburg-Berlin, Germany
| | - Achim Jörres
- Institute of Nephrology, University of Wales College of Medicine, Cardiff Royal Infirmary, Cardiff, U.K., and Abteilung for Innere Medizin mit Schwerpunkt Nephrologie, Germany
| | - Gerald A. Goles
- Universitätsklinikum Rudolf Virchow, Charlottenburg-Berlin, Germany
| | - Malcolm Davies
- Universitätsklinikum Rudolf Virchow, Charlottenburg-Berlin, Germany
| | - John D. Williams
- Universitätsklinikum Rudolf Virchow, Charlottenburg-Berlin, Germany
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20
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Lee EA, Oh JH, Lee HA, Kim SI, Park EW, Park KB, Park MS. Structural and Functional Alterations of the Peritoneum after Prolonged Exposure to Dialysis Solutions: Role of Aminoguanidine. Perit Dial Int 2020. [DOI: 10.1177/089686080102100304] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
ObjectiveThe effect of long-term use of high glucose dialysate on peritoneal structure and function, and its relation with accumulation of advanced glycosylation end-product (AGE) in the peritoneum was investigated in this study.MethodsDialysates with 4.25% glucose were injected into the peritoneal cavity of normal rats for 12 weeks without (PD, n = 7) and with (1 g/L, PD+AG, n = 7) aminoguanidine in their drinking water. Rats not having intraperitoneal (IP) injection served as control ( n = 9). After 12 weeks of IP injection, a 2-hour peritoneal equilibration test (PET) was performed using 30 mL 4.25% glucose dialysate. Intraperitoneal volume (IPV), dialysate-to-plasma urea ratio at 2 hours (D2/P2), the ratio of dialysate glucose at 2 hours to initial dialysate glucose (D2/D0), and the peritoneal fluid absorption rate (Qa) were evaluated. After the PET, samples of the parietal peritoneum were taken for hematoxylin and eosin (H&E) staining and immunohistochemical staining for AGE.ResultsThe IPV and D2/D0glucose were significantly lower and Qaand D2/P2urea significantly higher in the PD group than in the control group. Aminoguanidine reversed in part the changes in IPV and D2/P2urea in the PD group; it had no effect on Qaand D2/D0glucose. The H&E staining showed a linear mesothelial lining with negligible cells and capillaries in the narrow submesothelial space in the control group. Mesothelial denudation and submesothelial infiltration of monocytes and capillary formation were observed in the PD group. Mesothelial denudation was relatively intact in the PD+AG group compared with the PD group. Submesothelial monocyte infiltration and capillary formation in the PD+AG group were not as prominent as in the PD group. Positive AGE staining was found in the submesothelial space, vascular walls, and endomysium in the PD group, while it was markedly attenuated in PD+AG group and negligible in the control group.ConclusionLong-term use of high glucose solutions induced peritoneal AGE accumulation and mesothelial denudation, and increased peritoneal permeability and peritoneal fluid absorption rate. Inhibition of peritoneal AGE accumulation prevented those functional and structural damages to the peritoneum.
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Affiliation(s)
- Eun Ah Lee
- Hyonam Kidney Laboratory, Soon Chun Hyang University, Seoul
| | - Jong Hoon Oh
- Hyonam Kidney Laboratory, Soon Chun Hyang University, Seoul
| | - Hyun Ah Lee
- Hyonam Kidney Laboratory, Soon Chun Hyang University, Seoul
| | - Sung Il Kim
- Hyonam Kidney Laboratory, Soon Chun Hyang University, Seoul
| | - Eung Woo Park
- Korea Atomic Energy Research Institute, Daejeon, Korea
| | | | - Min Sun Park
- Hyonam Kidney Laboratory, Soon Chun Hyang University, Seoul
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Abstract
Evidence is reviewed that demonstrates how the mesothelial cell in the normal peritoneum and comparable serosal cavities secretes surface-active phospholipid (SAPL) as a means of protecting itself and the membrane it forms with its neighbors. It is shown how SAPL, if adsorbed (reversibly bound) to mesothelium, can impart excellent lubricity, antiwear and release (antistick) properties, while impeding surgical adhesion formation. More-speculative benefits include acting as a deterrent to fibrosis and as a barrier to both protein leakage and pathogen invasion by spanning cell junctions. Such spanning would also “pin down” cell corners, impeding peeling as the first step in exfoliation encountered in prolonged continuous ambulatory peritoneal dialysis (CAPD). The molecular mechanism underlying each of these possible functions is adsorption. Morphological and hydrophobicity studies are discussed as validation for such an adsorbed lining and how it can be fortified by administering exogenous SAPL.Any role for SAPL in ultrafiltration is much more controversial. However, a surfactant lining can explain the very high permeability of the membrane to lipid-soluble drugs, implying that it is a barrier to water-soluble solutes. The clinical and animal evidence is conflicting but would seem to be best explained by a role for the barrier in promoting semipermeability, and hence the osmotic driving force for water transmission. Thus, adsorption of exogenous SAPL in CAPD patients with low ultrafiltration seems to restore this barrier function. The future direction for surfactant in CAPD would seem to rest with the physical chemists in producing formulations that optimize adsorption, probably involving a compromise between water solubility and surface activity of the phospholipids selected. It might even warrant using the interdialytic interval for re-adsorbing SAPL without the problem of dilution by a large volume of dialysate.
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Affiliation(s)
- Brian A. Hills
- Paediatric Respiratory Research Centre, Mater Children's Hospital, and Department of Medicine, The University of Queensland, Brisbane, Australia
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22
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Gokal R, Mistry CD, Peers EM. Peritonitis Occurrence in a Multicenter Study of Icodextrin and Glucose in CAPD. Perit Dial Int 2020. [DOI: 10.1177/089686089501500309] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective To compare peritonitis occurrence and outcome in a large U.K. study Multicentre Investigation of Icodextrin in Ambulatory Dialysis (MIDAS). Design Prospective, randomized, controlled 6-month comparison of icodextrin with glucose for the long dwell in continuous ambulatory peritoneal dialysis (CAPD) patients. Setting Eleven CAPD units in U.K. teaching hospitals. Patients A total of 209 patients established on CAPD for at least 3 months (103 control, 106 icodextrin). Twentythree control (C) and 22 icodextrin (I) patients experienced peritonitis during the study. Intervention Patients who had peritonitis remained on treatment (unless CAPD was withdrawn, temporarily or permanently). Main Outcome Measures The main outcome measures were the rate of peritonitis and duration of CAPD treatment prestudy; the rate of peritonitis episodes and their outcome during study; the effect of peritonitis on laboratory variables, serum icodextrin metabolites, and ultrafiltration efficacy. Results Prestudy: Nine (39%) of C but 14 (64%) of I patients had suffered previous peritonitis episode(s), with overall rates of 0.58 and 0.78 episodes per patient year, respectively. During study There were 31 C episodes and 35 I episodes, with overall rates of 0.76 and 0.93 per patient year, respectively. The increase in the C and I groups was 31% and 19%, respectively. Serum osmolality and sodium levels were unaffected by peritonitis, and there was no increase in serum icodextrin metabolites during peritonitis. Overnight ultrafiltration volume during peritonitis (mean±SD) declined slightly from 218±354 mL to 185±299 mL (NS) in the control group, but increased in the icodextrin group from 570±146 mL to 723±218 mL (p < 0.01). Conclusions Using icodextrin for the long dwell in CAPD does not increase the rate of peritonitis, nor does it alter the outcome of peritonitis. Peritonitis does not affect uptake of icodextrin from the peritoneum.
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Affiliation(s)
- Ram Gokal
- Manchester Royal Infirmary, Cardiff Royal Infirmary, St. Albans, U.K
| | - Chandra D. Mistry
- Manchester Royal Infirmary, Cardiff Royal Infirmary, St. Albans, U.K
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23
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Dobbie JW. Pathogenesis of Peritoneal Fibrosing Syndromes (Sclerosing Peritonitis) in Peritoneal Dialysis. Perit Dial Int 2020. [DOI: 10.1177/089686089201200105] [Citation(s) in RCA: 267] [Impact Index Per Article: 66.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Drawing from diverse sources including epidemiological and clinical data, surgical observations, histopathology, serosal healing responses to fibrin and fibrinolysis, tissue reaction to chronic exposure, and to exo and endotoxins, new information on mesothelial stem cells, autocrine and paracrine influences on their proliferation and collagen synthesis, and the effect of glucose on fibroconnective tissue, we have begun to piece together the pathogenetic jigsaw of fibrosis in continuous ambulatory peritoneal dialysis (CAPD). The reaction of peritoneal mesothelium and stroma to the stress of continual dialysis results in a spectrum of alterations ranging from opacification through a tanned peritoneum syndrome to sclerosing encapsulating peritonitis (SEP). Any agent that causes irritation of the mesothelial layer and induces serositis, or single severe or multiple episodes of peritonitis resulting in mesothelial loss, predisposes the peritoneum to fibroneogenesis. An accurate definition of the histopathological changes of peritoneal thickening is a prerequisite for defining pathogenesis. This paper is the first attempt to create such a framework. It is evident from many areas of study that fibrin deposition and fibrinolysis, hyalinization of the superficial stromal collagen possibly tanned through nonenzymatic glycosylation by dialysate glucose and the proliferative potential of mesothelial stem cells play an important and possibly interdependent role in excessive fibroneogenesis in certain patients on CAPD. Many of the pieces of the jigsaw are obviously still missing, and the picture is most surely incomplete. Nevertheless, the outline of the pathologic and etiologic landscape should now be discernible.
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Affiliation(s)
- James w. Dobbie
- Baxter R & D Europe, Advanced Scientific Development, Nivelles, Belgium
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24
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Abstract
The osmotic effectiveness of glucose polymer is now well established. The relative inertness of this macromolecular compound has been the key factor in its success as the first “colloid” osmotic agent in clinical use. In its present form, it produces sustained ultrafiltration for up to 12 hours, and a daily overnight use would obviate the need for hypertonic exchanges, especially 3.86% glucose. In addition, it could be used in automated peritoneal dialysis regimes to enhance ultrafiltration and solute clearance during the daytime. Preliminary reports also indicate that it is beneficial in diabetic patients and in some patients who have lost ultrafiltration. The new “bimodal” formulations look promising, with the potential to replace all the currently used hyperosmolar exchanges with physiological solutions. Although systemic accumulation of glucose polymer breakdown products occurs, it reaches steadystate levels quickly (within two weeks) and remains stable throughout the duration of polymer use. In the long-term study, these levels of maltose and oligosaccharides over three-and-a-half years represent the longest exposure of these substances in uremic patients without any clinical or metabolic adverse effects and provide an important evidence of safety. Future work based on studies that are ongoing suggest that a family of physiological solutions (“bimodal” preparations in iso-osmolar combination) could be available, and the individual's dialysis prescription could be tailored to take into account the ultrafiltration, metabolic needs, as well as the longterm viability of the membrane. Glucose polymer will be a key component of such solutions.
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Affiliation(s)
- Chandra D. Mistry
- Peterborough District Hospital, Peterborough and Manchester RoyalInfirmary, Peterborough, U.K
| | - Ram Gokal
- Peterborough District Hospital, Peterborough and Manchester RoyalInfirmary, Peterborough, U.K
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25
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Abstract
Objective To review all clinical studies and experience gained with icodextrin to date; primarily its use in peritoneal dialysis in patients with end-stage renal failure, but also its use as an intraperitoneal vehicle. Data sources Peer-reviewed original research articles in the literature; abstracts from international scientific meetings; data generated from the compassionate use programme. Study selection All published studies to date are included, some 10–20 studies being included in this review. Data extraction Data have not been specifically extracted from studies; results have been described in the context of overall experience. Results Over ten years of clinical experience with icodextrin have now been accumulated, in both continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD). A small number of patients have received icodextrin for over five years, with no loss of effect. Icodextrin produces sustained ultrafiltration over long dwells while being iso-osmolar, by the process of colloid osmosis. Conclusion Icodextrin represents the first viable alternative osmotic agent to glucose, for use in solutions for peritoneal dialysis. It also has a potential use as a vehicle solution for intraperitoneal drug delivery.
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Affiliation(s)
- Elizabeth Peers
- ML Laboratories pIc, St. Albans, and Manchester RoyalInfirmary, Manchester, England
| | - Ram Gokal
- ML Laboratories pIc, St. Albans, and Manchester RoyalInfirmary, Manchester, England
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26
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Pannekeet MM, Zemel D, Koomen GC, Struijk DG, Krediet RT. Dialysate Markers of Peritoneal Tissue during Peritonitis and in Stable CAPD. Perit Dial Int 2020. [DOI: 10.1177/089686089501500308] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective To investigate whether dialysate concentrations of substances that are locally produced within the peritoneal cavity can be used to study the effects of inflammation on peritoneal tissue. Design We followed the appearance rates (AR) of concentrations of cancer antigen (CA) 125, phospholipids (PHL), hyaluronan (HA), and the procollagen peptides PICP (procollagen 1 C-terminal) and PIIINP (procollagen 3 N-terminal) in dialysate during peritonitis (8 consecutive days) and after recovery. Data were compared with the stable situation. Setting CAPD (continuous ambulatory peritoneal dialysis) unit in the Academic Medical Center in Amsterdam. Patients Twelve CAPD patients with a total of 16 episodes of peritonitis and 10 clinically stable CAPD patients were studied. Results All substances showed temporal increments in dialysate during peritonitis compared to control. No difference was found between the control day of peritonitis and the stable patients. Maximum AR were reached in the acute phase of peritonitis for CA 125, PHL, and HA and on day 4 for both PICP and P111NP. A second increment in CA125 occurred on days 4 to 6. These findings indicate acute damage to the mesothelium (CA 125) and other cells (PHL) by the infection. HA may reflect stromal changes. Subsequently, peritoneal healing (PICP, PIIINP) and remesothelialization (second peak CA125) are likely to occur. Conclusions Dialysate concentrations of these substances can be used as markers for the effects of peritonitis on the peritoneum of CAPD patients in vivo. The similarity between the marker concentrations in the effluent after recovery from peritonitis and those in stable CAPD patients implies that complete peritoneal healing is likely to occur after uncomplicated peritonitis.
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Affiliation(s)
| | - Désirée Zemel
- Academic Medical Center, Renal Unit, Department of Medicine, Amsterdam
| | - Ger C.M. Koomen
- Academic Medical Center, Renal Unit, Department of Medicine, Amsterdam
| | - Dick G. Struijk
- Academic Medical Center, Renal Unit, Department of Medicine, Amsterdam
- Foundation for Home Dialysis Midden-West Nederland, Utrecht, The Netherlands
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27
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Affiliation(s)
- Anne Dawnay
- Renal Research Laboratory, Department of Chemical Pathology, St. Bartholomew's Hospital, London, England
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28
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Hjelle JT, Golinska BT, Waters DC, Steidley KR, Miller MA, McCarrol DR, Dobbie JW. Lectin Staining of Peritoneal Mesothelial Cells in Vitro. Perit Dial Int 2020. [DOI: 10.1177/089686089101100403] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A survey of lectin-binding specificities present on rodent and human mesothelial cells propagated and maintained in tissue culture was made using fluorescein isothiocynate conjugated (FITC) lectins. Rodent and human cells exhibited cell-associated fluorescence following exposure to the FITC-Iectins from C. ensiformis, T. vulgaris, A. hypogaea, E. cristagalli and B. simplicifolia, but not with lectins from G. max and D. biflorus. Rodent cells were also positive for FITC-M. pomifera lectin binding. Human, but not rodent, cells were positive for FITC T. purpureas lectin binding. Exposure of rabbit mesothelial cells in vitro to FITC-Iectins that bound to the cell surface resulted in the appearance of discrete loci of putatively intracellular fluorescence. Exposure of cells to ferritin-Iabelled T. vulgaris lectin at 37°C for as little as 7.5 minutes resulted in the appearance of ferritin-size particles in intracellular vesicles. These results demonstrate 1. the presence of lectinbinding sites in and on peritoneal mesothelial cells from rodents and humans and 2. a possible role of such sites in mediating the entry of lectin-Iike endogenous molecules into the vacuolar apparatus of these cells.
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Affiliation(s)
- J. Thomas Hjelle
- Basic Sciences and Pediatrics, University of Illinois College of Medicine at Peoria
| | - Barbara T. Golinska
- Basic Sciences and Pediatrics, University of Illinois College of Medicine at Peoria
| | - Diane C. Waters
- Basic Sciences and Pediatrics, University of Illinois College of Medicine at Peoria
| | - Kevin R. Steidley
- Basic Sciences and Pediatrics, University of Illinois College of Medicine at Peoria
| | - Marcia A. Miller
- Basic Sciences and Pediatrics, University of Illinois College of Medicine at Peoria
| | - David R. McCarrol
- Basic Sciences and Pediatrics, University of Illinois College of Medicine at Peoria
- Research Department, HOIR-American Red Cross, Peoria, Illinois
| | - James W. Dobbie
- Baxter R & D Europe, Baxter Healthcare Corporation, Nivelles, Belgium
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Dobbie JW. Serositis: Comparative Analysis of Histological Findings and Pathogenetic Mechanisms in Nonbacterial Serosal Inflammation. Perit Dial Int 2020. [DOI: 10.1177/089686089301300402] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Peritonitis is the established term for infective inflammation of the peritoneum, while serositis generally refers to nonorganismal inflammation in any serous cavity, including the peritoneum. In continuous ambulatory peritoneal dialysis (CAPD) literature, however, culture-negative peritoneal inflammation is referred to as “sterile” or “chemical” peritonitis. These terms not only imply unwarranted etiologic assumptions, but may also deflect attention from the existence of medical conditions to which the peritoneum is subject. This is evident in CAPD literature where there is little recognition that the peritoneum, as a member of the serosa and a secretor of lamellar bodies, is prey to a wide range of disorders. Thus before, during, and after CAPD, the membrane is liable to fall victim to disease states unconnected with the process of dialysis. Significant peritoneal pathology occurs as part of a pan-serositis, which may be metabolic (uremia, cholesterolosis), autoimmune (systemic lupus erythematosus, rheumatoid disease, acute rheumatism, endocrinopathies), genetic (recurrent hereditary polyserositis), allergic (eosinophilic serositis), and granulomatous in nature. This paper presents a comparative analysis of histopathological presentation and pathogenetic mechanisms involved in all forms of peritoneal serositis. It incorporates recent advances in molecular biology of the membrane into a holistic reappraisal of peritoneal pathology, revealing hitherto unrecognized homologies in peritoneal reaction to diverse disorders.
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30
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Mistry CD, Gokal R. The Use of Glucose Polymer (Icodextrin) in Peritoneal Dialysis: An Overview. Perit Dial Int 2020. [DOI: 10.1177/089686089401403s28] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | - Ram Gokal
- Manchester Royal In firmary, United Kingdom
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31
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Abstract
Over the past decade we have explored the potential of a starch-derived glucose polymer (icodextrin) as a “colloid” osmotic agent and clinically adapted it to produce sustained ultrafiltration over long dwell exchanges. An optimal osmotic profile was defined using a series of glucose polymer formulations of varying molecular distribution. Initially, a readily available dextrin formulation (Caloreen) with a bimodal molecular weight profile was used. Five and 10% solutions containing this formulation [weight average MW (Mw) of 7000 dalton and number average MW (Mn) of 960 dalton were nearly twice as effective as 1.36% and 3.86% glucose solutions, but their effectiveness was limited by rapid absorption of fractions less than 12 glucose units. Further modification isolated a purified “high” MW fraction containing chain length greater than 12 glucose units with Mw of 16 823 dalton and Mn of 5304 dalton. A 5% solution containing this fraction, iso-osmolar to uremic plasma, provided calorie load half that of a 1.36% glucose, yet produced increased and sustained ultrafiltration for up to 12 hours by a mechanism resembling “colloid” osmosis. Only a fraction of glucose polymer load was absorbed via the lymphatic pathway, but its metabolism was incomplete, resulting in the accumulation of maltose. Although it was devoid of any detectable adverse effect in the short term, long-term concerns remained. In studies using a single daily overnight exchange of glucose polymer combined with three daytime exchanges of glucose over 5 days, 10 days, and 3 months, we have shown that a constant peritoneal clearance (3 mL/minute) ensures a steady-state level of maltose in the serum within 10 days, and this remains stable for up to 3 months without any adverse effects. The relative inertness of icodextrin has been the key factor in its success as the first “colloid” osmotic agent in clinical use. It is safe and effective, and the demonstration of steady-state levels of accumulated maltose and oligosaccharides without any adverse effects has been encouraging and provided further impetus to proceed with longer-term studies.
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Affiliation(s)
- Chandra D. Mistry
- Department of Renal Medicine, Manchester RoyalInfirmary, Manchester, United Kingdom
| | - Ram Gokal
- Department of Renal Medicine, Manchester RoyalInfirmary, Manchester, United Kingdom
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32
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Kang DH, Hong YS, Lim HJ, Choi JH, Han DS, Yoon KI. High Glucose Solution and Spent Dialysate Stimulate the Synthesis of Transforming Growth Factor-β1of Human Peritoneal Mesothelial Cells: Effect of Cytokine Costimulation. Perit Dial Int 2020. [DOI: 10.1177/089686089901900307] [Citation(s) in RCA: 94] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
ObjectiveTo investigate the effect of high glucose and spent peritoneal dialysate on the transforming growth factor-β1(TGFβ1) synthesis of cultured human peritoneal mesothelial cells (HPMCs) and to examine the effect of costimulation with high glucose or spent dialysate, and cytokines, interleukin-1β (IL-1β), and tumor necrosis factor-α (TNFα) on TGFβ1synthesis of HPMCs.DesignHPMCs were exposed to different concentrations of glucose (30, 60, and 90 mmol/L) or spent peritoneal dialysate for 48 hours in the absence or presence of IL-1β (1 ng/mL) and TNFα (1 ng/mL). TGFβ1mRNA expression was assessed by Northern blot analysis and TGFβ1protein release by Western blot analysis and enzymelinked immunosorbent assay (ELISA).ResultsExposure of HPMCs to high glucose conditions (30, 60, and 90 mmol/L of D-glucose) induced 2.3-, 3.6-, and 4.0-fold increases in TGFβ1mRNA expression of HPMC with enhanced TGFβ1protein synthesis and secretion into the media, whereas there were no significant changes in TGFβ1synthesis with equimolar concentrations of D-mannitol. Incubation with spent dialysate also significantly increased TGFβ1mRNA expression and protein secretion compared to control media ( p < 0.05). Stimulation with IL-1β (1 ng/mL) or TNFα (1 ng/mL) resulted in a significant increase in TGFβ1mRNA expression after 48 hours: 2.7 and 2.1 times the control level, respectively. However, TNFα-induced increase in TGFβ1mRNA expression was not translated into TGFβ1protein secretion, while IL-1β stimulation induced a significant increase in TGFβ1protein secretion as well as TGFβ1mRNA expression. Combined stimulation by high glucose or spent dialysate, together with IL-1β or TNFα, showed a greater increase in TGFβ1mRNA expression and protein secretion compared to stimulation by high glucose or spent dialysate alone.ConclusionOur results clearly show that high glucose solution and spent dialysate themselves might be sufficient to stimulate the production of TGFβ1by peritoneal mesothelial cells. In peritoneal dialysis patients, this state of chronic induction of TGFβ1is further exacerbated in the presence of peritonitis because of the stimulatory effect of proinflammatory cytokines, resulting in augmented TGFβ1synthesis, thus promoting peritoneal fibrosis.
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Affiliation(s)
- Duk-Hee Kang
- Department of Internal Medicine, Yonsei University, Seoul, Korea
- Medical Research Center, College of Medicine, Ewha Women's University, Seoul, Korea
| | | | - Hyun Joung Lim
- Medical Research Center, Yonsei University, Seoul, Korea
| | - Jin-Hee Choi
- Medical Research Center, Yonsei University, Seoul, Korea
| | - Dae-Suk Han
- Medical Research Center, Yonsei University, Seoul, Korea
| | - Kyun-Il Yoon
- Department of Internal Medicine, Yonsei University, Seoul, Korea
- Medical Research Center, College of Medicine, Ewha Women's University, Seoul, Korea
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Park MS, Lee HA, Chu WS, Yang DH, Hwang SD. Peritoneal Accumulation of Age and Peritoneal Membrane Permeability. Perit Dial Int 2020. [DOI: 10.1177/089686080002000413] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BackgroundIn continuous ambulatory peritoneal dialysis (CAPD), the peritoneal membrane is continuously exposed to high-glucose-containing dialysis solutions. Abnormally high glucose concentration in the peritoneal cavity may enhance advanced glycosylation end-product (AGE) formation and accumulation in the peritoneum. Increased AGE accumulation in the peritoneum, decreased ultrafiltration volume, and increased peritoneal permeability in long-term dialysis patients have been reported.AimThe purpose of the study was to evaluate the relation between peritoneal membrane permeability and peritoneal accumulation of AGE.MethodsPeritoneal membrane permeability was evaluated by peritoneal equilibration test (PET) using dialysis solutions containing 4.25% glucose. Serum, dialysate, and peritoneal tissue levels of AGE were measured by ELISA method using polyclonal anti-AGE antibody. Peritoneal biopsy was performed during peritoneal catheter insertion [new group (group N), n = 18] and removal [long-term group (group LT), n = 10]. Peritoneal catheters were removed due to exit-site infection not extended into the internal cuff ( n = 6) and ultrafiltration failure ( n = 4) after 51.6 ± 31.5 months (13 – 101 months) of dialysis. PET data obtained within 3 months after the initiation of CAPD or before catheter removal were included in this study. Ten patients in group N and 4 patients in group LT were diabetic. Patients in group LT were significantly younger (46.5 ± 11.1 years vs 57.5 ± 1.3 years) and experienced more episodes of peritonitis (3.5 ± 2.1 vs 0.2 ± 0.7) than group N.ResultsPeritoneal tissue AGE level in group LT was significantly higher than in group N, in both nondiabetic (0.187 ± 0.108 U/mg vs 0.093 ± 0.08 U/mg of hydroxyproline, p < 0.03) and diabetic patients (0.384 ± 0.035 U/mg vs 0.152 ± 0.082 U/mg of hydroxyproline, p < 0.03), while serum and dialysate levels did not differ between the groups in both nondiabetic and diabetic patients. Drain volume (2600 ± 237 mL vs 2766 ± 222 mL, p = 0.07) and D4/D0glucose (0.229 ± 0.066 vs 0.298 ± 0.081, p < 0.009) were lower, and D4/P4creatinine (0.807 ± 0.100 vs 0.653 ± 0.144, p < 0.0001) and D1/P1sodium (0.886 ± 0.040 vs 0.822 ± 0.032, p < 0.0003) were significantly higher in group LT than in group N. On linear regression analysis, AGE level in the peritoneum was directly correlated with duration of CAPD ( r = 0.476, p = 0.012), number of peritonitis episodes ( r = 0.433, p = 0.0215), D4/P4creatinine ( r = 0.546, p < 0.027), and D1/P1sodium ( r = 0.422, p = 0.0254), and inversely correlated with drain volume ( r = 0.432, p = 0.022) and D4/D0glucose ( r = 0.552, p < 0.0023). AGE level in the peritoneal tissue and dialysate were significantly higher in diabetics than in nondiabetics in group LT, while these differences were not found in group N. Serum AGE level did not differ between nondiabetics and diabetics in either group N or group LT. Drain volume and D4/D0glucose were lower and D4/P4creatinine and D1/P1sodium higher in diabetics than in nondiabetics in both groups.ConclusionPeritoneal accumulation of AGE increased with time on CAPD and number of peritonitis episodes, and was directly related with peritoneal permeability. Peritoneal AGE accumulation and peritoneal permeability in diabetic patients were higher than in nondiabetic patients from the beginning of CAPD.
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Affiliation(s)
- Min Sun Park
- Hyonam Kidney Laboratory, Soon Chun Hyang University, Seoul, Korea
| | - Hyon Ah Lee
- Hyonam Kidney Laboratory, Soon Chun Hyang University, Seoul, Korea
| | - Won Suk Chu
- Hyonam Kidney Laboratory, Soon Chun Hyang University, Seoul, Korea
| | - Dong Ho Yang
- Hyonam Kidney Laboratory, Soon Chun Hyang University, Seoul, Korea
| | - Seung Duk Hwang
- Hyonam Kidney Laboratory, Soon Chun Hyang University, Seoul, Korea
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Mizusawa Y, Thomas K, Hills BA, Burke JR, Mizushima W, Rigby RJ, Crawford C, Freeman J. Proteolipid in Peritoneal Effluent of Capd Patients. Perit Dial Int 2020. [DOI: 10.1177/089686089801800213] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
| | - Kristen Thomas
- Princess Alexandra Hospital Paediatric Respiratory Unit Research Centre
| | - Brian A. Hills
- Princess Alexandra Hospital Paediatric Respiratory Unit Research Centre
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Hjelle JT, Miller-Hjelle MA, Dobbie JW. The Biology of the Mesothelium during Peritoneal Dialysis. Perit Dial Int 2020. [DOI: 10.1177/089686089501507s03] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Substantial derangements of mesothelial biology are observed during experimental simulations of dialysis conditions, inferred from the content of human dialysis effluent and visualized by microscopy of human mesothelial biopsies. Canosmotically active solutions be made biocompatible with the osmoregulatory system of the mesothelium? Can the contributions of the mesothelium to host defenses against inflammation and/or infection be supported during CAPD? Do underlying metabolic derangements present in various kidney diseases and end-stage renal disease, regardless of cause, require customized CAPD protocols and solutions? Use of dialysis solutions less directly toxic to the mesothelium is a necessary step toward some day manipulating peritoneal biology by pharmacological and therapeutic modalities.
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Affiliation(s)
- J. Thomas Hjelle
- Basic Sciences, University of Illinois College of Medicine at Peoria, Peoria, Illinois, U.S.A
| | - Marcia A. Miller-Hjelle
- Basic Sciences, University of Illinois College of Medicine at Peoria, Peoria, Illinois, U.S.A
| | - James W. Dobbie
- The Royal Infirmary, The University of Edinburgh, Edinburgh, Scotland
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Krediet RT. Dialysate Cancer Antigen 125 Concentration as Marker of Peritoneal Membrane Status in Patients Treated with Chronic Peritoneal Dialysis. Perit Dial Int 2020. [DOI: 10.1177/089686080102100605] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
ObjectiveThis study reviews publications on the history of cancer antigen 125 (CA125), the background of its use as a marker of mesothelial cell mass, determination in peritoneal effluent, and its practical use in both the follow-up of peritoneal dialysis (PD) patients and as a marker of in vivo biocompatibility of dialysis solutions.DesignReview article.ResultsCA125 is a high molecular weight glycoprotein. Previous studies in ascites suggested its release by mesothelial cells. In vitro studies with cultured mesothelial cells showed constitutive production, the majority of which was dependent on mesothelial cell mass. Serum CA125 is normal in PD patients, but its concentration in peritoneal dialysate suggests local release, probably from mesothelial cells. Effluent CA125 can be considered a marker of mesothelial cell mass in stable PD patients, but large amounts are found during peritonitis, due probably to necrosis of mesothelial cells. The majority of studies found no relationship between dialysate CA125 and peritoneal transport parameters. Some cross-sectional studies reported a relationship with duration of PD, but others were unable to confirm this, due probably to the large interindividual variability. Longitudinal follow-up has shown a decrease in dialysate CA125, indicating loss of mesothelial cell mass. Application of theoretically morebiocompatible PD solutions causes an increase in dialysate CA125.ConclusionsDialysate CA125 is a mesothelial cell mass marker. The concentration of CA125 should be determined after a standardized dwell. A single low value is not informative. A decrease with time on PD suggests loss of mesothelial cell mass. Dialysate CA125 is a marker of in vivo biocompatibility of (new) dialysis solutions. More research is necessary on the best methodology for measuring low concentrations and establishing normal values and a significant change.
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Affiliation(s)
- Raymond T. Krediet
- Division of Nephrology, Department of Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Gokal R, Mistry CD, Peers E, Brown C, Smith S, Edwards D, Junor B, Gordon A, McMillan M, Robertson M, Michael J, McKain J, Raftery M, Peters J, Clutterbuck E, Clemenger M, Walls J, Orton C, Goodship T, Grieves J, Dharmasena D, Hourhane G, Howarth D, Boyes R, Clisby L, Beran Y. A United Kingdom Multicenter Study of Icodextrin in Continuous Ambulatory Peritoneal Dialysis. Perit Dial Int 2020. [DOI: 10.1177/089686089401402s03] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
While glucose remains the only osmotic agent used universally for peritoneal dialysis, its various shortcomings for the long dwell equilibration continuous ambulatory peritoneal dialysis (CAPD) has led to a search for alternative agents. The large molecular weight group has been of interest, because these agents theoretically would lead to greater ultrafiltration and a better metabolic profile. Mostsubstances (dextrans, charged macromolecules) have been found unsuitable for reasons of insolubility, allergenicity, and peritoneal toxicity. Short-chain polypeptides have been studied in humans, but the experience is limited, and there is the potential for allergenicity with long-term use. The only large molecular weight agent that has been studied in some detail but hitherto in one center only and in a limited number of patients is glucose polymer (generic name, icodextrin). Because of the promise shown by these initial studies, a randomized controlled multicenter investigation of icodextrin in CAPD (MIDAS Study Group) was undertaken to evaluate the long-term safety and efficacy by comparing daily overnight (8 12 hours) use of a slightly hypo-osmolar solution (282 mOsm/ kg) with 1.36% (346 mOsm/kg) and 3.86% (484 mOsm/kg) glucose exchanges. Over a 6-month period 209 patients from 11 centers in the United Kingdom were randomized, with 106 allocated to receive icodextrin (study group) and 103 to remain on glucose (control group). One hundred and thirty-eight patients completed the 6-month study (71 control, 67 study). The mean net ultrafiltration overnight with icodextrin was 3.5 times greater than 1.36% at 8 hours and 5.5 times greater at 12 hours (p<0.0001), but no different from that of 3.86% glucose at 8 and 12 hours (although for the latter dwell the net mean ultrafiltration volume was greater by about 140 mL). Biochemical profiles were no different except for a small fall in serum sodium and chloride in the icodextrin group. The mean serum maltose rose to a steady-state level of 1.2 g/L within 2 weeks and remained stable. The mean carbohydrate absorbed for icodextrin (29±5 g) was lower than with 3.86% glucose (62±5 g). The use of icodextrin did not increase the incidence of peritonitis, nor did it alter its outcome, affect uptake of icodextrin from the peritoneum, alter serum osmolality or sodium levels. There were no adverse effects associated with the use of icodextrin, and the overall CAPD-related symptom score was significantly better for icodextrin than control subjects. This study and subsequent extensive use and clinical experience has demonstrated that the daily use of an iso-osmolar icodextrin solution is generally well tolerated, effective, and could replace the overnight use of hyperosmotic glucose solution. Its use was of equal efficacy in peritonitis and in diabetic patients. The elevated levels of maltose did not appear to have any clinical side effects.
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Affiliation(s)
- Ram Gokal
- Manchester RoyalInfirmary, Manchester
| | | | | | | | - S. Smith
- (Northern General Hospital, Sheffield)
| | | | | | | | | | | | | | - J. McKain
- (Queen Elizabeth Hospital, Birmingham)
| | | | | | | | | | - J. Walls
- (Leicester General Hospital, Leicester)
| | - C. Orton
- (Leicester General Hospital, Leicester)
| | | | - J. Grieves
- (Royal Victoria Hospital, NewcastleUpon-Tyne)
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Krediet RT, Imholz AL, Lameire N, Faict D, Koomen GC, Martis L. The Use of Peptides in Peritoneal Dialysis Fluids. Perit Dial Int 2020. [DOI: 10.1177/089686089401403s27] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Raymond T. Krediet
- Department of Medicine, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Alexander L.T. Imholz
- Department of Medicine, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Norbert Lameire
- Department of Medicine, University Hospital, University of Gent, Nivelles, Belgium
| | - Dirk Faict
- Baxter R and D Europe, Nivelles, Belgium
| | - Gerardus C.M. Koomen
- Department of Medicine, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Leo Martis
- Baxter R and D Europe, Nivelles, Belgium
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Gokal R, Mistry CD, Peers EM, Brown C, Smith S, Edwards D, Junor B, Gordon A, McMillan M, Robertson M, Michael J, McKain J, Raftery M, Peters J, Clutterbuck E, Clemenger M, Walls J, Orton C, Goodship T, Grieves J, Olubodun J, Jackson F, Dharmasena D, Hourahane G, Howarth D, Boyes R, Clisby L, Beran Y. Peritonitis Occurrence in a Multicenter Study of Icodextrin and Glucose in Capd. Perit Dial Int 2020. [DOI: 10.1177/089686089501506s07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective To compare peritonitis occurrence and outcome in a large U.K. study Multicentre Investigation of Icodextrin in Ambulatory Dialysis (MIDAS). Design Prospective, randomized, controlled 6-month comparison of icodextrin with glucose for the long dwell in continuous ambulatory peritoneal dialysis (CAPD) patients. Setting Eleven CAPD units in U.K. teaching hospitals. Patients A total of 209 patients established on CAPD for at least 3 months (103 control, 106 icodextrin). Twentythree control (C) and 22 icodextrin (I) patients experienced peritonitis during the study. Intervention Patients who had peritonitis remained on treatment (unless CAPD was withdrawn, temporarily or permanently). Main Outcome Measures The main outcome measures were the rate of peritonitis and duration of CAPD treatment prestudy; the rate of peritonitis episodes and their outcome during study; the effect of peritonitis on laboratory variables, serum icodextrin metabolites, and ultrafiltration efficacy. Results Prestudy: Nine (39%) of C but 14 (64%) of I patients had suffered previous peritonitis episode(s), with overall rates of 0.58 and 0.78 episodes per patientyear, respectively. During study There were 31 C episodes and 35 I episodes, with overall rates of 0.76 and 0.93 per patientyear, respectively. The increase in the C and I groups was 31% and 19%, respectively. Serum osmolality and sodium levels were unaffected by peritonitis, and there was no increase in serum icodextrin metabolites during peritonitis. Overnight ultrafiltration volume during peritonitis (mean±SD) declined slightly from 218±354 mL to 185±299 mL (NS) in the control group, but increased in the icodextrin group from 570±146 mL to 723±218 mL (p < 0.01). Conclusions Using icodextrin for the long dwell in CAPD does not increase the rate of peritonitis, nor does it alter the outcome of peritonitis. Peritonitis does not affect uptake of icodextrin from the peritoneum.
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Affiliation(s)
| | - Ram Gokal
- Manchester Royal Infirmary, Cardiff Royal Infirmaryl and ML Laboratories2 plc, St. Albans, U.K
| | - Chandra D. Mistry
- Manchester Royal Infirmary, Cardiff Royal Infirmaryl and ML Laboratories2 plc, St. Albans, U.K
| | - Elizabeth M. Peers
- Manchester Royal Infirmary, Cardiff Royal Infirmaryl and ML Laboratories2 plc, St. Albans, U.K
| | | | - S. Smith
- Northern General Hospital, Sheffield
| | | | | | | | | | | | | | - J. McKain
- Queen Elizabeth Hospital, Birmingham
| | | | | | | | | | - J. Walls
- Leicester General Hospital, Leicester
| | - C. Orton
- Leicester General Hospital, Leicester
| | | | - J. Grieves
- Royal Victoria Hospital, Newcastle-upon Tyne
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Seo MJ, Oh SJ, Kim SI, Cho KW, Jo I, Schaub T, Schilling H, Passlick–Deetjen J, Han DC. High Glucose Dialysis Solutions Increase Synthesis of Vascular Endothelial Growth Factors by Peritoneal Vascular Endothelial Cells. Perit Dial Int 2020. [DOI: 10.1177/089686080102103s06] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
♦ Objective Increased peritoneal vasculature has been reported in long-term peritoneal dialysis (PD), and vascular endothelial growth factors (VEGFs) have been found in dialysate. High concentrations of glucose or lactate, glucose degradation products (GDPs), and low pH of dialysis solutions are all possible factors in increased peritoneal VEGF synthesis. In this study, we investigated the effects of high glucose dialysis solutions on VEGF synthesis by peritoneal vascular endothelial cells (PVECs). ♦ Methods The PVECs were isolated from rat omentum and were incubated for 4 hours in three different culture media [M199 media (control), conventional dialysis solutions containing 4.25% glucose diluted with an equal volume of M199 media (HGD), and M199 media containing 118 mmol/L mannitol as an osmolar control (mannitol)]. Levels of VEGF protein in the culture supernatant were measured by ELISA, and mRNA expression was determined by Northern blot analysis. Data are presented as percent of control. ♦ Results After incubation for 4 hours, the number of cells did not differ between the 3 groups. Levels of VEGF in culture supernatant were significantly higher in the HGD group (124% ± 19%, p = 0.006) as compared with the control and mannitol (85% ± 10%) groups. The mRNA expression of VEGF appeared to be higher in the HGD group (128% ± 49%) than in the control and mannitol (94% ± 18%) groups. ♦ Conclusion High glucose dialysis solutions increased VEGF synthesis by PVECs. The relationship between VEGF synthesis by PVECs and neovascularization of the peritoneum observed in long-term peritoneal dialysis patients has to be studied further.
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Affiliation(s)
| | | | | | - Kye Won Cho
- Divisions of Cardiovascular and Degenerative Disease Research (Division of Cardiovascular Research) Department of Biomedical Sciences, National Institute of Health, Seoul, Korea
| | - Inho Jo
- Divisions of Cardiovascular and Degenerative Disease Research (Division of Cardiovascular Research) Department of Biomedical Sciences, National Institute of Health, Seoul, Korea
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Anne B, Dawnayand SJ, Millar DJ. Glycation and Advanced Glycation End-Product Formation with Icodextrin and Dextrose. Perit Dial Int 2020. [DOI: 10.1177/089686089701700112] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
ObjectiveTo review protein glycation and advanced glycation end-product formation with particular reference to its occurrence in the peritoneum following exposure to peritoneal dialysis fluid.Data sourcesArticles identified through searches on MEDLINE and BIDS and references cited therein.Study selectionStudies on the interaction of amino groups with glucose, maltose and glucose polymers. Studies containing evidence of peritoneal advanced glycation end-product formation.Data extractionStudies evaluated as to whether they are in vivo, ex vivo or in vitro under non-physiological or physiological conditions.ResultsProtein glycation is slower with maltose and glucose polymers than with equimolar glucose. Advanced glycation end-product formation occurs with all three sugars, but to a greater extent after standard heat sterilization of dialysis fluid and to a lesser extent in heat sterilized fluids containing icodextrin rather than glucose. Glucose degradation products significantly contribute to protein-linked advanced glycation end-productlike fluorescence. Histology and immunohistochemistry demonstrate diabetiform changes and advanced glycation end-products in the peritoneal membrane following exposure to glucose-containing peritoneal dialysis fluids. Their presence is likely to be detrimental to peritoneal function and may contribute to loss of ultrafiltration.ConclusionsAdvanced glycation end-product formation is lower but still significant with heat sterilized peritoneal dialysis fluid containing icodextrin than with glucose. More research is needed to investigate the interaction of glucose degradation products and glucose polymers with proteins and the possible consequences of advanced glycation end-product formation on peritoneal function.
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Affiliation(s)
- B. Anne
- Renal Research Laboratory, Department of Clinical Biochemistry, St. Bartholomew's Hospital, London, England
| | - St. J. Dawnayand
- Renal Research Laboratory, Department of Clinical Biochemistry, St. Bartholomew's Hospital, London, England
| | - David J. Millar
- Renal Research Laboratory, Department of Clinical Biochemistry, St. Bartholomew's Hospital, London, England
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Devuyst O. Molecular Mechanisms of Peritoneal Permeability— Research in Growth Factors. Perit Dial Int 2020. [DOI: 10.1177/089686080102103s03] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Olivier Devuyst
- Division of Nephrology, Université catholique de Louvain Medical School, Brussels, Belgium
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Dobbie JW. Peritoneal Ultrastructure and Changes with Continuous Ambulatory Peritoneal Dialysis. Perit Dial Int 2020. [DOI: 10.1177/089686089301302s145] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Production and Regulation of Matrix Metalloproteinases and Their Inhibitors by Human Peritoneal Mesothelial Cells. Perit Dial Int 2020. [DOI: 10.1177/089686080002000507] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
ObjectiveHuman peritoneal mesothelial cells (HPMC) are likely to be involved in maintenance of the peritoneal membrane. We determined whether these cells were able to synthesize the matrix degrading enzymes, matrix metalloproteinases (MMPs), likely to be responsible for the breakdown of this membrane, and whether this secretion could be modulated by cytokines involved in the inflammatory response.DesignMMP activity in conditioned medium of growth-arrested HPMC was measured by zymography. Cultures were incubated in the presence and absence of the cytokines transforming growth factor-beta (TGFβ) and interleukin (IL)-1β in order to determine the effects of these cytokines on this process. The mRNA for these MMPs, together with that of their specific inhibitors, tissue inhibitors of metalloproteinases (TIMPs), was also examined by reverse transcriptase polymerase chain reaction (RT-PCR).ResultsHPMC were shown to constitutively secrete the metalloproteinases MMP-2 and MMP-3 in vitro. In response to the proinflammatory cytokine IL-1β, the protein and mRNA for MMP-9 was induced, while secretion of MMP-2 was unaltered. Similarly, the mRNA for MMP-3 was also increased relative to actin following the addition of IL-1β. TGFβ was shown to slightly induce the secretion of MMP-2 together with the mRNA for TIMP I, TIMP II, and, to a greater extent, TIMP III. Used peritoneal dialysate was also shown to induce MMP-9 secretion, and this effect was blocked by the co-incubation of IL-1 receptor antagonist. The secretion of enzyme activity was shown to be from the apical surface of the cells.ConclusionHPMC have the ability to control the accumulation of extracellular matrix by secreting the matrix degrading molecules MMP-2, MMP-3, and MMP-9. In addition, the secretion of these enzymes, together with that of their inhibitors (TIMPs) is regulated by the cytokines IL-1β and TGFβ. This process is likely to be important in both the normal maintenance of the integrity of the peritoneal membrane and in the changes that occur following prolonged peritoneal dialysis.
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Dobbie JW. Nature and Disposition of Intracavity and Intramembranous Phospholipid Surface-Active Material and Its Role in Peritoneal Dialysis. Perit Dial Int 2020. [DOI: 10.1177/089686089801800201] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- James W. Dobbie
- Mesothelial and Peritoneal Research Centre Lister Research Laboratories University Department of Surgery Edinburgh Royal Infirmary Edinburgh, Scotland
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Abstract
Recent advances in the field of glycobiology have exposed a multitude of biological processes that are controlled or influenced by proteoglycans, in both physiological and pathological conditions ranging from early embryonic development, inflammation, and fibrosis to tumor invasion and metastasis. The first part of this article reviews the biosynthesis of proteoglycans and their multifunctional roles in health and disease; the second part of this review focuses on their putative roles in peritoneal homeostasis and peritoneal inflammation and fibrosis in the context of chronic peritoneal dialysis and peritonitis.
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Affiliation(s)
- Susan Yung
- Department of Medicine, University of Hong Kong, Hong Kong
| | - Tak Mao Chan
- Department of Medicine, University of Hong Kong, Hong Kong
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47
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Kastelein AW, Vos LM, de Jong KH, van Baal JO, Nieuwland R, van Noorden CJ, Roovers JPW, Lok CA. Embryology, anatomy, physiology and pathophysiology of the peritoneum and the peritoneal vasculature. Semin Cell Dev Biol 2019; 92:27-36. [DOI: 10.1016/j.semcdb.2018.09.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 08/29/2018] [Accepted: 09/18/2018] [Indexed: 01/25/2023]
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48
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Glycerol Toxicity for Human Peritoneal Mesothelial Cells in Culture: Comparison with Glucose. Int J Artif Organs 2018. [DOI: 10.1177/039139889401700502] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Glycerol has been proposed as a substitute osmotic agent for glucose in peritoneal dialysis fluids. We have compared the effect of glycerol and glucose on the function of human peritoneal mesothelial cells (HPMC) in vitro. The viability of HPMC was not affected by glycerol (up to 250 mM), whereas it was reduced by glucose in a time- and dose-dependent manner, as assessed by the LDH release. Although the incubation of HPMC with glycerol induced a dose-dependent decrease in HPMC proliferation, the effect was significantly less inhibitory than that produced by glucose. In HPMC treated with 90 mM of glycerol or glucose the incorporation of [3H]-thymidine had reached 79.0±19.3% and 55.3+4.0% of the control (p<0.05 and p<0.01), respectively. As measured by the [methyl-14C]-choline incorporation, the intracellular amount of newly synthesized phospholipids was reduced from (cpm/μg cellular protein) 147±58 in control HPMC to 59+15 in cells exposed to 90 mM of glucose (p<0.01), but not affected by glycerol (163±65). On the other hand, both glycerol and glucose (90 mM) decreased the synthesis of proteins (as assessed by the [3H]-proline incorporation) and interfered with potassium (86Rb) transport mechanisms in HPMC. Our data suggest that there exist some possibly advantageous aspects of glycerol as far as mesothelial cell biocompatibility profile is concerned.
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Bird SD. Calcium mediates cell shape change in human peritoneal mesothelial cells. Cell Calcium 2018; 72:116-126. [PMID: 29730478 DOI: 10.1016/j.ceca.2018.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 01/15/2018] [Accepted: 02/15/2018] [Indexed: 12/13/2022]
Abstract
Mast cells in the peritoneal membrane (PM) may degranulate to release preformed inflammatory mediators including histamine which is capable of diffusing into the surrounding interstitium, modulating cells in their vicinity including, human peritoneal mesothelial cells (hPMC). The present study aimed to investigate the quorum intracellular calcium ([Ca2+i]) response to histamine compared to the membrane soluble ionophore, A23187, in adherent cultured hPMC. To examine [Ca2+i] handling, Fura - 2 loaded cells were exposed to histamine and A23187. Agonist induced transient [Ca2+i] event(s) (TCE) were defined and compared including, resting calcium, peak height, recovery and transient kinetics. Changes in cell shape were examined with immunocytochemistry of the cortical actin (CA) and microtubule (MT) cytoskeleton. To investigate whether histamine induced changes in cell shape were mediated by [Ca2+i], mobilization of [Ca2+i] was prevented with 20 μmol/l of the calcium chelator 1,2-bis-(2-aminophenoxy) ethane-N,N,N',N'-tetraacetic acid (BAPTA-AM). Histamine produced a dose dependent increase of [Ca2+i], maximal at 1.0 mmol/l which recovered to the pre-challenge resting value. Transient multiplicity with repeated challenge was evident below a histamine threshold of 10-2 mmol/l. Morphometric analysis of MTs and CA showed significant cell elongation plus histamine and A23187. The histamine induced cell elongation was eliminated with [Ca2+i] clamping. This data indicated that increased [Ca2+i] was essential for cell elongation and the formation of stress fibres and therefore has a pivotal role in the regulation of the PM barrier.
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Affiliation(s)
- Stephen D Bird
- Department of Obstetrics and Gynaecology, The University of Melbourne, Victoria, Australia; Department of Medicine, Dunedin School of Medicine, The University of Otago, Dunedin, New Zealand.
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Gotloib L, Gotloib LC, Khrizman V. The use of Peritoneal Mesothelium as a Potential Source of Adult Stem Cells. Int J Artif Organs 2018; 30:501-12. [PMID: 17628851 DOI: 10.1177/039139880703000608] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
At the dawn of the 21st century, classical curative medicine is being challenged by the fact that efforts to fight and prevent not a few diseases, are in many circumstances, beyond the power of the pharmacological armamentarium of the medical profession. On the other hand, replacement of lost function by mechanical or biophysical devices, or even by organ transplantation, prolongs life but generally derives in new and, at times, unsolvable problems. Regenerative therapy using stem cells began a revolutionary trend that may well change both the therapeutic approach to not a few of the diseases resulting from failing organs, as well as the fate and quality of life of millions of patients. The presence of pluripotent mesenchymal cells in the mesothelial monolayer as well as in the submesothelial connective tissue raises the possibility of using the peritoneal mesothelium in regenerative therapies. This perception of the problem is also based on observations made in humans as well as in laboratory animals showing bone, bone marrow, cartilaginous tissue, glomerular-like structures and creation of blood conducts, pathological situations (mesothelioma, sclerosing peritonitis), or after in vivo or ex vivo experimental interventions. The main concept emerging from this information is that peritoneal mesothelial cells are endowed with such a degree of plasticity that, if placed in the appropriate micro-environment, they have a remarkable potential to generate other mesenchymal-derived cell lines. Intensive research is required to define the best environmental conditions to take advantage of this plasticity and make the peritoneal mesothelium an actual option to be applied in regenerative medicine.
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Affiliation(s)
- L Gotloib
- Laboratory for Experimental Nephrology, Ha'Emek Medical Center, Afula 18101, Israel.
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