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Krediet RT, Parikova A. Relative Contributions of Pseudohypoxia and Inflammation to Peritoneal Alterations with Long-Term Peritoneal Dialysis Patients. Clin J Am Soc Nephrol 2022; 17:1259-1266. [PMID: 35168992 PMCID: PMC9435980 DOI: 10.2215/cjn.15371121] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Long-term peritoneal dialysis (PD) is associated with alterations in peritoneal function, like the development of high small solute transfer rates and impaired ultrafiltration. Also morphologic changes can develop, the most prominent being loss of mesothelium, vasculopathy and interstitial fibrosis. Current research suggests peritoneal inflammation as the driving force for these alterations. In this review the available evidence for inflammation is examined and a new hypothesis is put forward consisting of high glucose-induced pseudohypoxia. Hypoxia of cells is characterized by a high NADH/NAD+ ratio in their cytosol. Pseudohypoxia is similar, but occurs when excessive amounts of glucose are metabolized, as is the case for peritoneal interstitial cells in PD. The glucose- induced high NADH/NAD+ ratio upregulates the hypoxia-inducible factor-1 gene, which stimulates not only the glucose transporter-1 gene, but also many profibrotic genes like TGFβ, VEGF, PAI-1 and CTGF, all known to be involved in the development of peritoneal fibrosis. This review discusses the causes and consequences of pseudohypoxia in PD and the available options for treatment and prevention. Reducing peritoneal exposure to the excessively high dialysate glucose load is the cornerstone to avoid the pseudohypoxia-induced alterations. This can partly be done by the use of icodextrin, or by combinations of low molecular weight osmotic agents, all in a low dose. The addition of alanyl-glutamine to the dialysis solution needs further clinical investigation.
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Affiliation(s)
- Raymond T. Krediet
- Division of Nephrology, Department of Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Alena Parikova
- Department of Nephrology, Transplant Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
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2
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Brulez HF, Verbrugh HA. First -Line Defense Mechanisms in the Peritoneal Cavity during Peritoneal Dialysis. Perit Dial Int 2020. [DOI: 10.1177/089686089501507s04] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Harald F.H. Brulez
- Department of Nephrology, Academic Hospital of the Academic Hospital Vrije Universiteit
| | - Henri A. Verbrugh
- Amsterdam,. Department of Clinical Microbiology, University Hospital “Dijkzigt,” Erasmus University of Rotterdam, The Netherlands
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3
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De Castro MF, Selgas R, Jimenez C, Baja MA, Martinez V, Romero JR, De Alvaro F, Vara F. Cell Populations Present in the Nocturnal Peritoneal Effluent of Patients on Continuous Ambulatory Peritoneal Dialysis and Their Relationship with Peritoneal Function and Incidence of Peritonitis. Perit Dial Int 2020. [DOI: 10.1177/089686089401400313] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective To study the relationship between peritoneal effluent cells and infection rate and to relate this population with functional characteristics. Design Prospective, longitudinal, and comparative study. Setting Outpatient continuous ambulatory peritoneal dialysis (CAPD) unit of a university medical center. Participants Seventy-one uninfected patients, treated for 0-156 months on CAPD, in stable condition were studied (33 female, 38 male). Interventions Nocturnal peritoneal effluent (NPE) was drained with EDT A (2.5 mmol/L) at 37°C and centrifuged at 2500 rpm for 9 minutes. Measurements Accumulated peritoneal inflammation days/year and ultrafiltration/diffusion (mass transfer coefficients (MTCs) for small molecules) capacities were recorded. Cellular count (cells/night) was performed using a Neubauer chamber. Macrophage function was assessed by cytochemical (lysosomal enzyme content: ANAE, beta-glucuronidase, acid phosphatase) and immunohistochemical procedures (expression of membrane antigens, CD4, 11b, 11c, 14,16,25,35, and 71). Results The macrophage is the most frequently appearing cell in the NPE. Cell count decreases over time on CAPD (from 20 x 106 to 5 x 106 after the first year). Intrapatient variability was low, but interpatient differences were marked. Mesothelial cell count remained stable over time (0.25 0.5 x 106). Four of our patients showed a “transforming” change in these cells. Previous incidence of peritonitis and values of functional measurements did not correlate with cell count or expressions of macrophage function (lysosome enzyme content and percentage of cells expressing different membrane antigens). Conclusion There is difficulty interpreting the results on peritoneal effluent cells and their relationship with the incidence of peritonitis and functional characteristics of the peritoneum. No definite conclusions can be drawn other than the great interpatient and intrapatient variability. The presence of abnormal peritoneal cells with undetermined origin and function suggests the need for periodic studies of peritoneal effluent cells on long-term CAPD patients.
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Affiliation(s)
| | - Rafael Selgas
- Hospital La Paz, Facultad de Medicina, Universidad Autonoma, Madrid, Spain
| | - Carlos Jimenez
- Hospital La Paz, Facultad de Medicina, Universidad Autonoma, Madrid, Spain
| | | | - Victoria Martinez
- Hospital La Paz, Facultad de Medicina, Universidad Autonoma, Madrid, Spain
| | - Jose Ramon Romero
- Hospital La Paz, Facultad de Medicina, Universidad Autonoma, Madrid, Spain
| | - Fernando De Alvaro
- Hospital La Paz, Facultad de Medicina, Universidad Autonoma, Madrid, Spain
| | - Francisco Vara
- Hospital La Paz, Facultad de Medicina, Universidad Autonoma, Madrid, Spain
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4
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Posthuma N, Ter Wee PM, Donker AJ, Dekker HAT, Oe PL, Verbrugh HA. Peritoneal Defense Using Icodextrin Or Glucose for Daytime Dwell in Ccpd Patients. Perit Dial Int 2020. [DOI: 10.1177/089686089901900409] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective To investigate peritoneal defense during icodextrin use in continuous cyclic peritoneal dialysis (CCPD). Design In an open, prospective, 2-year follow-up study, CCPD patients were randomized to either glucose (Glu) or icodextrin (Ico) for their long daytime dwell. Setting University hospital and teaching hospital. Patients Both established and patients new to CCPD were included. A life expectancy of more than 2 years, a stable clinical condition, and written informed consent were necessary before entry. Patients aged under 18 years, those who had peritonitis in the previous month, and women of childbearing potential, unless taking adequate contraceptive precautions, were excluded. Thirty-eight patients (19 Glu, 19 Ico) started the study. The median follow-up was 16 and 17 months for Glu and Ico respectively (range 0.5 – 25 months and 5 – 25 months, respectively). Outcome Measures Peritoneal defense characteristics and peritoneal dialysis-related infections were recorded every 3 months. Results Total peritoneal white cell count tended to decrease over time in both groups. After 1 year, absolute numbers and percentages of effluent peritoneal macrophages (PMΦs) were significantly higher in Ico than in Glu patients; this difference in the percentage persisted after 2 years. Percentage of mesothelial cells increased over time in Ico patients. The phagocytic capacity of PMΦs decreased over time, resulting in a borderline significant difference for coagulase-negative staphylococci ( p = 0.05) and a significant difference for Escherichia coli ( p < 0.05) phagocytosis in favor of Ico patients. PMΦ oxidative metabolism remained stable over time without a difference between the groups. PMΦ cytokine production and effluent opsonic capacity also remained stable over time. Finally, 16 peritonitis episodes in Glu and 14 in Ico patients occurred. Glucose patients had 37 and Ico patients 32 exit-site infections during the study. Conclusion CCPD patients using Ico did equally as well as Glu-treated patients with respect to clinical infections and most peritoneal defense characteristics. However, in a few peritoneal defense tests, Ico-treated patients did better.
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Affiliation(s)
- Nynke Posthuma
- Departments of Nephrology and Internal Medicine, Amsterdam
| | | | - Ab J.M. Donker
- Departments of Nephrology and Internal Medicine, Amsterdam
- Departments of Internal Medicine, Free University Hospital, Amsterdam
| | | | - Po L. Oe
- Departments of Nephrology and Internal Medicine, Amsterdam
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5
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Breborowicz A, Oreopoulos DG. Evidence for the Presence of Chronic Inflammation during Peritoneal Dialysis: Therapeutic Implications. Perit Dial Int 2020. [DOI: 10.1177/089686089701702s07] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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6
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Bouts AH, Out TA, Schröder CH, Monnens LA, Nauta J, Krediet RT, Davin JC. Characteristics of Peripheral and Peritoneal White Blood Cells in Children with Chronic Renal Failure, Dialyzed or Not. Perit Dial Int 2020. [DOI: 10.1177/089686080002000628] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
ObjectiveTo explore further the mechanisms leading to immune deficiency in chronic renal failure and the role of dialysis treatment in these mechanisms.DesignCross-sectional and longitudinal analysis.PatientsWe studied 39 children treated with peritoneal dialysis (PD), 23 children treated with hemodialysis (HD), 33 children not yet dialyzed [chronic renal failure (CRF)], and 27 healthy children. Peritoneal cells were also obtained from PD children for analysis.MethodsWhite blood cells (WBCs) were isolated from blood and peritoneal dialysis effluent by centrifugation. The number of CD2+, CD4+, and CD8+T cells, B cells, and natural killer cells were measured by flow cytometry.ResultsThe total peripheral blood lymphocyte count was lower in PD children (2.6 x 109/L), HD children (2.1 x 109/L), and CRF children (2.0 x 109/L) compared with healthy children (3.1 x 109/L, p < 0.05). The B lymphocyte count was also lower in PD children (0.34x109/L), HD children (0.22 x 109/L), and CRF children (0.33 x 109/L) compared with healthy children (0.52 x 109/L, p < 0.01). Numbers of CD4+T cells were not different, but numbers of CD8+T cells were lower in PD children (0.56 x 109/L), HD children (0.63 x 109/L), and CRF children (0.53 x 109/L) compared with healthy children (0.77 x 109/L, p < 0.05). The count of natural killer cells was lower in PD children (0.21 x 109/L), HD children (0.17 x 109/L), and CRF children (0.18 x 109/L) compared with healthy children (0.50 x 109/L, p < 0.0001). The CD4/CD8 ratio of lymphocytes in peritoneal effluent was 0.8 versus 1.9 in peripheral blood ( p < 0.001). The CD2/CD19 ratio was not different. The cell subsets remained stable during the first year of PD treatment. The CD2/CD19 ratio in peritoneal effluent was higher in children with a peritonitis incidence ≥ 1 per year.ConclusionsThe reduced numbers of B lymphocytes, CD8+T cells, and natural killer cells found in CRF children, dialyzed or not, may favor the frequent occurrence of infections.
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Affiliation(s)
- Antonia H.M. Bouts
- Emma Children's Hospital, Amsterdam
- Clinical and Laboratory Immunology Unit, Amsterdam
| | - Theo A. Out
- Clinical and Laboratory Immunology Unit, Amsterdam
- CLB Sanquin Blood Supply Foundation, Amsterdam
| | | | - Leo A.H. Monnens
- Department of Pediatrics, St. Radboud University Hospital, Nijmegen
| | | | - Raymond T. Krediet
- Department of Nephrology, Academic Medical Center, Amsterdam, The Netherlands
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7
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Koopmans JG, Boeschoten EW, Pannekeet MM, Betjes MG, Zemel D, Kuijper EJ, Krediet RT. Impaired Initial Cell Reaction in Capd-Related Peritonitis. Perit Dial Int 2020. [DOI: 10.1177/089686089601601s69] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Our objective was to determine the incidence of peritonitis episodes with an impaired initial cell reaction (IICR: neutrophil number <100 x 1 061L) over a period often years, and to find possible explanations for this unusual presentation of peritonitis. A retrospective review of the files of continuous ambulatory peritoneal dialysis (CAPD) patients included in the CAPD program between 1984 and 1993 was done. Analysis of cytokine and prostanoid patterns during four peritonitis episodes with an IICR was compared to 12 episodes with a normal initial cell reaction (NICR). Dialysate cell numbers and immunoeffector characteristics of peritoneal cells were compared in 7 IICR patients in a stable situation and a control group of 70 stable CAPD patients. The setting was a CAPD unit in the Academic Medical Center in Amsterdam. Thirty-five CAPD patients who had one or more peritonitis episodes with an IICR and a control group of 249 CAPD patients were included in the study. The incidence of peritonitis with an IICR was 6%. These episodes occurred more than once in 51% of the patients who presented with IICR. In 72% the cell reaction was only delayed: a cell number exceeding 100 x 1 061L was reached later. Staphylococcus aureus was significantly more frequently the causative microorganism compared to all peritonitis episodes (PE) that occurred during the study period. Patients with IICR had lower dialysate cell counts in a stable situation, compared to a control group (p < 0.01). This was caused by a lower number of macro-phages and CD4 positive lymphocytes. The phagocytosis capacity of the macrophages appeared to be normal. In a comparison of four PE with an IICR and 12 episodes with an NICR, the tumor necrosis factor-α (TNF-α) response was similar and occurred on day 1, also pointing to normally functioning macrophages. However, the maximal appearance rates of interleukin-6 (IL-6) and IL-8 occurred later in the episodes with IICR compared to NICR (day 2 vs day 1, p < 0.05). No differences were found in vasodilating prostaglandins, mesothelial cell markers (cancer antigen 125, phospholipids, hyaluronan), and mesothelial cell numbers in the stable situation nor during peritonitis. Peritonitis can present as abdominal pain in the absence of a cloudy dialysate. In some of the patients this presentation occurred more than once. This impaired, most often delayed, cell reaction was associated with a delayed secondary cytokine response. As IL-6 and IL-8 can be synthesized by mesothelial cells, this suggests an impaired functioning mesothelium. This could not be confirmed, however, by a lower number of mesothelial cells in effluent or lower dialysate levels of mesothelial cell markers.
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Affiliation(s)
| | - Elisabeth W. Boeschoten
- Department of Internal Medicine, Renal Unit, Amsterdam
- Foundation for Home Dialysis Midden - West Nederland, Utrecht, the Netherlands
| | | | | | - Désirée Zemel
- Department of Internal Medicine, Renal Unit, Amsterdam
| | - Ed J. Kuijper
- Department of Medical Microbiology, Academic Medical Center, Amsterdam
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8
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Betjes MG, Visser CE, Zemel D, Tuk CW, Struijk DG, Krediet RT, Arisz L, Beelen RH. Intraperitoneal Interleukin-8 and Neutrophil Influx in the Initial Phase of a Capd Peritonitis. Perit Dial Int 2020. [DOI: 10.1177/089686089601600412] [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
Objective To investigate whether or not a change in dialysate interleukin-8 (IL-8) concentration precedes the onset of clinically overt peritonitis and is significant in the recruitment of granulocytes during continuous ambulatory peritoneal dialysis (CAPD)related peritonitis. Design CAPD patients stored their overnight effluent at 4°C, which was routinely thrown away after 2 days. If peritonitis developed, patients delivered their effluent of the preceding two nights and the peritonitis effluent for analysis. A control study was performed 1 to 3 months after recovery. Dialysate samples were analyzed for number of cells, differential cell count, IL-8 and elastase concentrations, and their neutrophil chemoattractive capacity. In addition, serum samples during peritonitis were analyzed for IL-8 concentrations. Results Ten peritonitis episodes in 7 patients were analyzed. Numbers of neutrophils and levels of dialysate IL-8 and elastase started to increase 4 to 12 hours before the first peritonitis effluent. The dialysate/serum IL-8 ratio was 423.5 during peritonitis and 7.0 in the postperitonitis controls. There was a significant correlation between the number of neutrophils and IL-8 concentration in the dialysate. The in vitro neutrophil chemotaxis was increased toward the peritonitis effluents, as compared to control effluents. Incubation of the peritonitis effluents with anti-IL-8 monoclonal antibody blocked the increase in neutrophil chemotaxis above controllevels by an average of 26.7%. Conclusion IL-8 is produced in the peritoneal cavity during CAPD treatment and may mediate part of the neutrophil recruitment and degranulation in the initial phase of a CAPD peritonitis.
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Affiliation(s)
- Michiel G.H. Betjes
- Department of Cell Biology, Academic Medical Center, Amsterdam, the Netherlands
| | - Carolien E. Visser
- Department of Cell Biology, Academic Medical Center, Amsterdam, the Netherlands
| | - Desiree Zemel
- Vrije Universiteit, and Renal Unit, Academic Medical Center, Amsterdam, the Netherlands
| | - Cornelis W. Tuk
- Department of Cell Biology, Academic Medical Center, Amsterdam, the Netherlands
| | - Dirk G. Struijk
- Vrije Universiteit, and Renal Unit, Academic Medical Center, Amsterdam, the Netherlands
| | - Raymond T. Krediet
- Vrije Universiteit, and Renal Unit, Academic Medical Center, Amsterdam, the Netherlands
| | - Lambertus Arisz
- Vrije Universiteit, and Renal Unit, Academic Medical Center, Amsterdam, the Netherlands
| | - Robert H.J. Beelen
- Department of Cell Biology, Academic Medical Center, Amsterdam, the Netherlands
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9
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Zareie M, Van Lambalgen AA, De Vriese AS, Van Gelderop E, Lameire N, Ter Wee PM, Beelen RH, van den Born J, Tangelder GJ. Increased Leukocyte Rolling in Newly Formed Mesenteric Vessels in the Rat during Peritoneal Dialysis. Perit Dial Int 2020. [DOI: 10.1177/089686080202200603] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Objective Long-term peritoneal dialysis (PD) is associated with the development of functional and structural alterations of the peritoneal membrane. The present study reports the effects of chronic exposure to PD fluid on mesenteric leukocyte–endothelium interactions, using intravital video microscopy. Methods Rats ( n = 7) received 10 mL lactate-buffered 3.86% glucose-containing PD fluid daily during a 5-week period via a subcutaneously implanted mini access port that was connected via a catheter to the peritoneal cavity. In a first control group ( n = 8), catheters were implanted but no fluid was instilled; a second control group ( n = 8) remained untreated. The number of rolling and adherent leukocytes as well as blood flow and other fluid dynamic variables were analyzed in mesenteric postcapillary (diameter 10 – 25 μ) and collecting (diameter 26 – 40 μ) venules. Neovascularization was semiquantitatively assessed after inspection of video images and by light and electron microscopy. Using FITC-labeled albumin, microvascular leakage was examined. Results Rats exposed to PD fluid showed a more than twofold increase in the number of rolling leukocytes ( p < 0.01); the number of adherent leukocytes was not changed. Furthermore, exposure to PD fluid induced severe neovascularization in rat mesentery. No microvascular leakage was observed in the various groups. The observed differences could not be explained by differences in systemic or local hemodynamic parameters or peripheral leukocyte counts, but is most likely associated with new vessel formation. Conclusions Exposure of rat peritoneal membrane to conventional PD fluid for 5 weeks affected local leukocyte–endothelium interactions. In addition, severe angiogenesis was induced, whereas microvascular permeability remained unaltered.
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Affiliation(s)
- Mohammad Zareie
- Departments of Molecular Cell Biology, University Hospital, Gent, Belgium
| | | | - An S. De Vriese
- VU University Medical Center, Amsterdam, The Netherlands; Renal Unit, University Hospital, Gent, Belgium
| | - Edwin Van Gelderop
- Departments of Molecular Cell Biology, University Hospital, Gent, Belgium
| | - Norbert Lameire
- VU University Medical Center, Amsterdam, The Netherlands; Renal Unit, University Hospital, Gent, Belgium
| | | | - Robert H.J. Beelen
- Departments of Molecular Cell Biology, University Hospital, Gent, Belgium
| | - Jacob van den Born
- Departments of Molecular Cell Biology, University Hospital, Gent, Belgium
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10
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Selgas R, De Castro MF, Viguer JM, Burgos E, Bajo MA, Carcamo C, Vara F. Transformed Mesothelial Cells in Patients on CAPD for Medium to Long Term Periods. Perit Dial Int 2020. [DOI: 10.1177/089686089501500405] [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
Objective To describe the characteristics of abnormal cells present in the peritoneal effluent of 4 continuous ambulatory peritoneal dialysis (CAPD) patients; the cells were accidentally detected in a longitudinal study of cell populations in 83 patients. Design Descriptive study. Participants Four stable CAPD patients (2 male, 2 female). Interventions Peritoneal cells were collected from nocturnal peritoneal effluent (NPE) by centrifugation. Measurements Light microscopy, ultrastructural, cytochemical, and immunohistochemical characteristics were studied. Results The abnormal cells were characterized by a flat appearance, large size (diameter 100 μm) -six to ten times larger than a normal macrophage, a broad acidophilic cytoplasm with rare granulations, and a low nucleus/cytoplasm ratio. The nucleus was pyknotic, with dense chromatin and sometimes appeared fragmented. Its number presented a considerable variability between the patients and was much higher in the 2 females. This number remained stable in each patient over time. These cells were negative for betaglucuronidase and positive for PAS stain with variable intensity. A very low number of flat cells were positive for vimentin with weak intensity, whereas cytokeratin and epithelial membrane antigen (EMA) were positive in a higher number of cells with medium to strong intensity. Ultrastructural studies showed numerous short surface microvilli, cytoplasm well-developed with intracytoplasmic lumina and abundant, dispersed intermediate filaments, scattered mitochondria, and stacks of rough endoplasmic reticulum were observed. Dispersed secretory vacuoles and isolated lipid vacuoles were present. Conclusion All these features imply that they are mesothelial in origin and are suggestive of a change known as peritoneal squamous metaplasia. To date, the clinical follow-up of our patients has shown a benign outcome; further studies are necessary to elucidate the significance of this peritoneal squamous metaplasia in CAPD patients.
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Affiliation(s)
| | | | | | - Emilio Burgos
- Pathology Departments, Universidad Autonoma, Madrid, Spain
| | | | | | - Francisco Vara
- Hospital La Paz; Biochemistry Department, Universidad Autonoma, Madrid, Spain
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11
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Krediet RT, Zweers MM, Ho-Dac-Pannekeet MM, Van Der Wal AC, Smit W, Douma CE, Mateijsen MA, Struijk DG. The Effect of Various Dialysis Solutions on Peritoneal Membrane Viability. Perit Dial Int 2020. [DOI: 10.1177/089686089901902s43] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Raymond T. Krediet
- Division of Nephrology, Department of Medicine, University of Amsterdam, Dianet Foundation, Utrecht-Amsterdam, The Netherlands
| | - Machteld M. Zweers
- Division of Nephrology, Department of Medicine, University of Amsterdam, Dianet Foundation, Utrecht-Amsterdam, The Netherlands
| | - Marja M. Ho-Dac-Pannekeet
- Division of Nephrology, Department of Medicine, University of Amsterdam, Dianet Foundation, Utrecht-Amsterdam, The Netherlands
| | - Allard C. Van Der Wal
- Department of Cardiovascular Pathology, University of Amsterdam, Dianet Foundation, Utrecht-Amsterdam, The Netherlands
| | - Watske Smit
- Division of Nephrology, Department of Medicine, University of Amsterdam, Dianet Foundation, Utrecht-Amsterdam, The Netherlands
| | - Caroline E. Douma
- Division of Nephrology, Department of Medicine, University of Amsterdam, Dianet Foundation, Utrecht-Amsterdam, The Netherlands
| | - Maartje A.M. Mateijsen
- Division of Nephrology, Department of Medicine, University of Amsterdam, Dianet Foundation, Utrecht-Amsterdam, The Netherlands
| | - Dirk G. Struijk
- Division of Nephrology, Department of Medicine, University of Amsterdam, Dianet Foundation, Utrecht-Amsterdam, The Netherlands
- Academic Medical Center, University of Amsterdam, Dianet Foundation, Utrecht-Amsterdam, The Netherlands
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12
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Brauner A, Hertting O, Alkstrand E, Sandberg E, Chromek M, Chen ZW, Östenson CG. Capd Peritonitis Induces the Production of a Novel Peptide, Daintain/Allograft Inflammatory Factor-1. Perit Dial Int 2020. [DOI: 10.1177/089686080302300101] [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
← Objectives To study the occurrence of a novel macrophage-derived peptide, daintain/allograft inflammatory factor-1 (AIF-1), in dialysate from continuous ambulatory peritoneal dialysis (CAPD) patients at commencement and after a follow-up period of therapy and during peritonitis. In addition, we studied peptide production in response to bacterial stimulation of monocytes and macrophages. ← Design Peritoneal fluid and supernatants from cells stimulated with different bacteria were analyzed for daintain/AIF-1. ← Patients and Setting Peritoneal fluid was obtained from 5 patients at commencement of CAPD therapy and during 8 weeks follow-up, and from 14 patients (10 males, 4 females) during CAPD peritonitis and during the noninfected steady state. All patients were admitted to the Karolinska Hospital. A human monocyte cell-line, THP-1 was differentiated to macrophages, and both monocytes and macrophages were stimulated with live and heat-inactivated Escherichia coli, Staphylococcus aureus, and S. epidermidis Cells were also stimulated with interleukin (IL)-1β and interferon gamma (IFNγ). Daintain/AIF-1 was analyzed with radioimmunoassay technique and IL-8 with enzyme immunoassay technique. ← Results An increased production of daintain/AIF-1 was observed in the first spent dialysate in the newly started CAPD patients, with a decrease during the follow-up period ( p < 0.05). During peritonitis, the first spent dialysate revealed significantly higher levels of daintain/AIF-1 (3.9 ng/mL) compared to the noninfected state (0.8 ng/mL), with production normalizing after 9 – 12 days. Bacterial stimulation with E. coli, S. aureus or S. epidermidi sinduced higher daintain/AIF-1 response in monocytes compared to macrophages ( p < 0.05). Live bacteria induced higher production of the peptide compared to heat-inactivated bacteria ( p < 0.05). Interleukin-1β and IFNγ were used to stimulate monocytes and macrophages; however, no daintain/AIF-1 production was found, although increased IL-8 levels were detected. ← Conclusion CAPD peritonitis induces a high and prominent daintain/AIF-1 response. Bacteria are able to induce a response of the peptide from monocytes and macrophages, and it is likely that the virulent parts of the bacteria are heat-labile structures. The early rise in daintain/AIF-1 might be used as a marker of CAPD peritonitis.
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Affiliation(s)
- Annelie Brauner
- Departments of Clinical Microbiology and MTC, Karolinska Hospital and Karolinska Institute, Stockholm, Sweden
| | - Olof Hertting
- Departments of Clinical Microbiology and MTC, Karolinska Hospital and Karolinska Institute, Stockholm, Sweden
| | - Eva Alkstrand
- Departments of Clinical Microbiology and MTC, Karolinska Hospital and Karolinska Institute, Stockholm, Sweden
| | - Elvi Sandberg
- Department of Molecular Medicine, Endocrine and Diabetes Unit, Karolinska Hospital, Stockholm, Sweden
| | - Milan Chromek
- Departments of Clinical Microbiology and MTC, Karolinska Hospital and Karolinska Institute, Stockholm, Sweden
| | - Zheng-Wang Chen
- Department of Biochemistry, Karolinska Institute, Stockholm, Sweden
| | - Claes-Göran Östenson
- Departments of Clinical Microbiology and MTC, Karolinska Hospital and Karolinska Institute, Stockholm, Sweden
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13
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Serre A, Marie C, Beaujon G, Betail G, Cavaillon J, Deteix P. Variations of Cytokine Levels and Production in CAPD Patients. Int J Artif Organs 2018. [DOI: 10.1177/039139889702001104] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Macrophages, predominant cells in dialysates of patients on CAPD without peritonitis, produce a wide variety of substances including cytokines. The aim of this study was to examine the cytokine production in five uninfected patients. This work investigated the presence in dialysates of interleukin-1ß, interleukin-6, interleukin-8, tumor necrosis factor α and the ability of peritoneal macrophages to produce these cytokines. These results were compared with values obtained from control group in non-uremic conditions (peritoneal lavage with isotonic saline or dialysis fluid). All cytokines were detectable in dialysates. Interindividual variations in cytokine concentration in dialysates were wider than variations of production of cytokines ex vivo by stimulated and unstimulated cells. In control group, dialysis fluid inhibited the cytokine production and with isotonic saline, cells produced less cytokines than dialysis patients'cells. The highest levels of interleukin-1 and tumor necrosis factor in dialysates and the highest capacity to respond to LPS were observed in patients having the shortest duration of dialysis. The variability observed did not seem to be due to cells themselves but to their environment.
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Affiliation(s)
- A.F. Serre
- Laboratoire d'Hématologie-lmmunologie, Faculté de Pharmacie, Clermont-Ferrand
| | - C. Marie
- Laboratoire d'lmmuno-Allergie, Institut Pasteur, Paris
| | - G. Beaujon
- Laboratoire des radioisotopes in vitro, Centre Jean Perrin, Clermont-Ferrand
| | - G. Betail
- Laboratoire d'Hématologie-lmmunologie, Faculté de Pharmacie, Clermont-Ferrand
| | | | - P. Deteix
- Service de Néphrologie, Hôpital Gabriel Montpied, Clermont-Ferrand - France
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Lambie MR, Chess J, Summers AM, Williams PF, Topley N, Davies SJ. Peritoneal inflammation precedes encapsulating peritoneal sclerosis: results from the GLOBAL Fluid Study. Nephrol Dial Transplant 2016; 31:480-6. [PMID: 26908833 DOI: 10.1093/ndt/gfv440] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 12/01/2015] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Encapsulating peritoneal sclerosis (EPS) is an uncommon condition, strongly associated with a long duration of peritoneal dialysis (PD), which is itself associated with increased fibrosis in the peritoneal membrane. The peritoneal membrane is inflamed during PD and inflammation is often associated with fibrosis. We hypothesized that patients who subsequently develop EPS might have a more inflamed peritoneal membrane during PD. METHODS We performed a nested, case-control study identifying all EPS cases in the UK arm of the GLOBAL Fluid Study and matching them by centre and duration of PD with two to three controls. Dialysate and plasma samples were taken during repeated peritoneal equilibration tests prior to cessation of PD from cases and controls. Samples were assayed by electrochemiluminescence immunoassay for interleukin-1β (IL-1β), tumour necrosis factor α (TNF-α), interferon-γ (IFN-γ) and IL-6. Results were analysed by linear mixed models adjusted for age and time on PD. RESULTS Eleven EPS cases were matched with 26 controls. Dialysate TNF-α {0.64 [95% confidence interval (CI) 0.23, 1.05]} and IL-6 [0.79 (95% CI 0.03, 1.56)] were significantly higher in EPS cases, while IL-1β [1.06 (95% CI -0.11, 2.23)] and IFN-γ [0.62 (95% CI -0.06, 1.29)] showed a similar trend. Only IL-6 was significantly higher in the plasma [0.42 (95% CI 0.07, 0.78)]. Solute transport was not significantly different between cases and controls but did increase in both groups with the duration of PD. CONCLUSIONS The peritoneal cavity has higher levels of inflammatory cytokines during PD in patients who subsequently develop EPS, but neither inflammatory cytokines nor peritoneal solute transport clearly discriminates EPS cases. Increased systemic inflammation is also evident and is probably driven by increased peritoneal inflammation.
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Affiliation(s)
- Mark R Lambie
- Department of Nephrology, University Hospitals of North Staffordshire, Royal Infirmary, Princess Road, Stoke on Trent, Staffordshire ST4 7LN, UK
| | - James Chess
- Renal Unit, Morriston Hospital, Swansea, UK Institute of Nephrology, Cardiff University School of Medicine, Heath Park, Cardiff, UK
| | - Angela M Summers
- Manchester Institute of Nephrology and Transplantation, Manchester Royal Infirmary, Manchester, UK
| | | | - Nicholas Topley
- Institute of Nephrology, Cardiff University School of Medicine, Heath Park, Cardiff, UK Section of Nephrology, Institute of Molecular and Experimental Medicine, Cardiff University School of Medicine, Heath Park, Cardiff CF14 4XN, UK
| | - Simon J Davies
- Department of Nephrology, University Hospitals of North Staffordshire, Royal Infirmary, Princess Road, Stoke on Trent, Staffordshire ST4 7LN, UK
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Kowalewska PM, Margetts PJ, Fox-Robichaud AE. Peritoneal Dialysis Catheter Increases Leukocyte Recruitment in the Mouse Parietal Peritoneum Microcirculation and Causes Fibrosis. Perit Dial Int 2015; 36:7-15. [PMID: 26475840 DOI: 10.3747/pdi.2014.00211] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 02/16/2015] [Indexed: 11/15/2022] Open
Abstract
UNLABELLED ♦ BACKGROUND The objective of this study was to examine the effects of a conventional dialysis solution and peritoneal catheter on leukocyte-endothelial cell interactions in the microcirculation of the parietal peritoneum in a subacute peritoneal dialysis (PD) mouse model. ♦ METHODS An intraperitoneal (IP) catheter with a subcutaneous injection port was implanted into mice and, after a 2-week healing period, the animals were injected daily for 6 weeks with a 2.5% dextrose solution. Intravital microscopy (IVM) of the parietal peritoneum microcirculation was performed 4 hours after the last injection of the dialysis solution. Leukocyte-endothelial cell interactions were quantified and compared with catheterized controls without dialysis treatment and naïve mice. ♦ RESULTS The number of rolling and extravascular leukocytes along with peritoneal fibrosis and neovascularization were significantly increased in the catheterized animals compared with naïve mice but did not significantly differ between the 2 groups of catheterized animals with sham injections or dialysis solution treatment. ♦ CONCLUSION The peritoneal catheter implant increased leukocyte rolling and extravasation, peritoneal fibrosis and vascularization in the parietal peritoneum independently from the dialysis solution treatment.
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Affiliation(s)
| | - Peter J Margetts
- Division of Nephrology, St. Joseph's Hospital Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Alison E Fox-Robichaud
- Thrombosis and Atherosclerosis Research Institute and the Department of Medicine, McMaster University, Hamilton, ON, Canada
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16
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Betjes MGH. Clinical consequences of circulating CD28-negative T cells for solid organ transplantation. Transpl Int 2015; 29:274-84. [DOI: 10.1111/tri.12658] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Revised: 07/06/2015] [Accepted: 08/11/2015] [Indexed: 12/14/2022]
Affiliation(s)
- Michiel G. H. Betjes
- Department of Nephrology and Transplantation; Erasmus Medical Center; Rotterdam the Netherlands
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17
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Habib SM, Abrahams AC, Korte MR, Zietse R, de Vogel LL, Boer WH, Dendooven A, Clahsen-van Groningen MC, Betjes MGH. CD4-Positive T Cells and M2 Macrophages Dominate the Peritoneal Infiltrate of Patients with Encapsulating Peritoneal Sclerosis. PLoS One 2015; 10:e0120174. [PMID: 25910222 PMCID: PMC4409209 DOI: 10.1371/journal.pone.0120174] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Accepted: 02/03/2015] [Indexed: 11/18/2022] Open
Abstract
Background Encapsulating peritoneal sclerosis (EPS) is a severe complication of peritoneal dialysis (PD). Previously, it has been shown that infiltrating CD4-positive T cells and M2 macrophages are associated with several fibrotic conditions. Therefore, the characteristics of the peritoneal cell infiltrate in EPS may be of interest to understand EPS pathogenesis. In this study, we aim to elucidate the composition of the peritoneal cell infiltrate in EPS patients and relate the findings to clinical outcome. Study Design, Setting, and Participants We studied peritoneal membrane biopsies of 23 EPS patients and compared them to biopsies of 15 PD patients without EPS. The cellular infiltrate was characterized by immunohistochemistry to detect T cells(CD3-positive), CD4-positive (CD4+) and CD8-positive T cell subsets, B cells(CD20-positive), granulocytes(CD15-positive), macrophages(CD68-positive), M1(CD80-positive), and M2(CD163-positive) macrophages. Tissues were analysed using digital image analysis. Kaplan-Meier survival analysis was performed to investigate the survival in the different staining groups. Results The cellular infiltrate in EPS biopsies was dominated by mononuclear cells. For both CD3 and CD68, the median percentage of area stained was higher in biopsies of EPS as opposed to non-EPS patients (p<0.001). EPS biopsies showed a higher percentage of area stained for CD4 (1.29%(0.61-3.20)) compared to CD8 (0.71%(0.46-1.01), p = 0.04), while in the non-EPS group these cells were almost equally represented (respectively 0.28%(0.05-0.83) versus 0.22%(0.17-0.43), p = 0.97). The percentage of area stained for both CD80 and CD163 was higher in EPS than in non-EPS biopsies (p<0.001), with CD163+ cells being the most abundant phenotype. Virtually no CD20-positive and CD15-positive cells were present in biopsies of a subgroup of EPS patients. No relation was found between the composition of the mononuclear cell infiltrate and clinical outcome. Conclusions A characteristic mononuclear cell infiltrate consisting of CD4+ and CD163+ cells dominates the peritoneum of EPS patients. These findings suggest a role for both CD4+ T cells and M2 macrophages in the pathogenesis of EPS.
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Affiliation(s)
- Sayed M. Habib
- Department of Internal Medicine, Division of Nephrology and Transplantation, Erasmus Medical Center, Rotterdam, The Netherlands
- * E-mail:
| | - Alferso C. Abrahams
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Mario R. Korte
- Department of Internal Medicine, Division of Nephrology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Robert Zietse
- Department of Internal Medicine, Division of Nephrology and Transplantation, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Walther H. Boer
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Amélie Dendooven
- Department of Pathology, University Medical Center Utrecht, Utrecht The Netherlands
| | | | - Michiel G. H. Betjes
- Department of Internal Medicine, Division of Nephrology and Transplantation, Erasmus Medical Center, Rotterdam, The Netherlands
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18
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Bacchetta J, Chun RF, Gales B, Zaritsky JJ, Leroy S, Wesseling-Perry K, Boregaard N, Rastogi A, Salusky IB, Hewison M. Antibacterial responses by peritoneal macrophages are enhanced following vitamin D supplementation. PLoS One 2014; 9:e116530. [PMID: 25549329 PMCID: PMC4280222 DOI: 10.1371/journal.pone.0116530] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 12/08/2014] [Indexed: 12/30/2022] Open
Abstract
Patients with chronic kidney disease (CKD), who usually display low serum 25-hydroxyvitamin D (25D) and 1,25-dihydroxyvitamin D (1,25D), are at high risk of infection, notably those undergoing peritoneal dialysis (PD). We hypothesized that peritoneal macrophages from PD patients are an important target for vitamin D-induced antibacterial activity. Dialysate effluent fluid was obtained from 27 non-infected PD patients. Flow cytometry indicated that PD cells were mainly monocytic (37.9±17.7% cells CD14+/CD45+). Ex vivo analyses showed that PD cells treated with 25D (100 nM, 6 hrs) or 1,25D (5 nM, 6 hrs) induced mRNA for antibacterial cathelicidin (CAMP) but conversely suppressed mRNA for hepcidin (HAMP). PD cells from patients with peritonitis (n = 3) showed higher baseline expression of CAMP (18-fold±9, p<0.05) and HAMP (64-fold±7) relative to cells from non-infected patients. In 12 non-infected PD patients, oral supplementation with a single dose of vitamin D2 (100,000 IU) increased serum levels of 25D from 18±8 to 41±15 ng/ml (p = 0.002). This had no significant effect on PD cell CD14/CD45 expression, but mRNA for HAMP was suppressed significantly (0.5-fold, p = 0.04). Adjustment for PD cell CD14/CD45 expression using a mixed linear statistical model also revealed increased expression of CAMP (mRNA in PD cells and protein in effluent) in vitamin D-supplemented patients. These data show for the first time that vitamin D supplementation in vitro and in vivo promotes innate immune responses that may enhance macrophage antibacterial responses in patients undergoing PD. This highlights a potentially important function for vitamin D in preventing infection-related complications in CKD.
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Affiliation(s)
- Justine Bacchetta
- Orthopedic Hospital Research Center, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, United States of America
- Department of Pediatrics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
- Centre de Référence des Maladies Rénales Rares, Institut de Génomique Fonctionnelle à l’Ecole Normale Supérieure de Lyon et Université de Lyon, Lyon, France
| | - Rene F. Chun
- Orthopedic Hospital Research Center, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, United States of America
| | - Barbara Gales
- Department of Pediatrics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Joshua J. Zaritsky
- Department of Pediatrics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Sandrine Leroy
- Unité d’épidémiologie des maladies émergentes, Institut Pasteur, Paris, France
| | - Katherine Wesseling-Perry
- Department of Pediatrics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Niels Boregaard
- Department of Hematology, University of Copenhagen, Copenhagen, Denmark
| | - Anjay Rastogi
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Isidro B. Salusky
- Department of Pediatrics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Martin Hewison
- Orthopedic Hospital Research Center, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, United States of America
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Abstract
Uraemia causes inflammation and reduces immune system function as evidenced by an increased risk of viral-associated cancers, increased susceptibility to infections and decreased vaccination responses in patients with end-stage renal disease (ESRD). The substantially increased risk of atherosclerosis in these patients is also probably related to uraemia-associated inflammation. Uraemia is associated with a reduction in the number and function of lymphoid cells, whereas numbers of myeloid cells in uraemic patients are normal or increased with increased production of inflammatory cytokines and reactive oxygen species. Similar to healthy elderly individuals, patients with ESRD have increased numbers of specific proinflammatory subsets of T cells and monocytes, suggesting the presence of premature immunological ageing in these patients. These cells might contribute to inflammation and destabilization of atherosclerotic plaques, and have, therefore, been identified as novel nonclassical cardiovascular risk factors. The cellular composition of the immune system does not normalize after successful kidney transplantation despite a rapid reduction in inflammation and oxidative stress. This finding suggests that premature ageing of the immune system in patients with ESRD might be related to a permanent skewing of the haematopoetic stem cell population towards myeloid-generating subsets, similar to that seen in healthy elderly individuals.
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20
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Laudański K, Nowak Z. Aberrant function and differentiation of monocytes in end stage renal disease. Arch Immunol Ther Exp (Warsz) 2012; 60:453-9. [PMID: 23080050 DOI: 10.1007/s00005-012-0191-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Accepted: 07/23/2012] [Indexed: 02/07/2023]
Abstract
Patients with end stage renal disease (ESRD) suffer from many disturbances of the immune system. These immunopathologies are related to the higher failure of vaccination, and increased prevalence of infections and neoplasms. In the presented article, we review the current data regarding the role of monocytes in immune dysfunctions which are observed in terminal renal failure. As monocytes play a pivotal role in regulating the function of the immune system, their dysfunction can have a profound effect on the immune system and may lead to accelerated arteriosclerosis and deteriorating overall health conditions. More specifically, we suggest that peripheral blood monocytes in patients with ESRD are chronically activated, and their functional and phenotypical features resemble those of inflammatory macrophages. This state of chronic inflammation is unfavorable for dendritic cells and consequently, the prevalence of dendritic cells is reduced. As these effects are consistent across different modes of dialysis, they are probably mediated by the uremia itself.
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Affiliation(s)
- Krzysztof Laudański
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Dullas 6, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
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21
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le Poole CY, Welten AGA, ter Wee PM, Paauw NJ, Djorai AN, Valentijn RM, Beelen RHJ, van den Born J, van Ittersum FJ. A peritoneal dialysis regimen low in glucose and glucose degradation products results in increased cancer antigen 125 and peritoneal activation. Perit Dial Int 2011; 32:305-15. [PMID: 22045100 DOI: 10.3747/pdi.2010.00115] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Glucose and glucose degradation products (GDPs) in peritoneal dialysis fluids (PDFs) are both thought to mediate progressive peritoneal worsening. METHODS In a multicenter, prospective, randomized crossover study, incident continuous ambulatory peritoneal dialysis patients were treated either with conventional lactate-buffered PDF (sPD regimen) or with a regimen low in glucose and GDPs: Nutrineal×1, Extraneal×1, and Physioneal×2 (NEPP regimen; all solutions: Baxter Healthcare, Utrecht, The Netherlands). After 6 months, patients were switched to the alternative regimen for another 6 months. After 6 weeks of run-in, before the switch, and at the end of the study, 4-hour peritoneal equilibration tests were performed, and overnight effluents were analyzed for cells and biomarkers. Differences between the regimens were assessed by multivariate analysis corrected for time and regimen sequence. RESULTS The 45 patients who completed the study were equally distributed over both groups. During NEPP treatment, D(4)/D(0) glucose was lower (p < 0.01) and D/P creatinine was higher (p = 0.04). In NEPP overnight effluent, mesothelial cells (p < 0.0001), cancer antigen 125 (p < 0.0001), hyaluronan (p < 0.0001), leukocytes (p < 0.001), interleukins 6 (p = 0.001) and 8 (p = 0.0001), and vascular endothelial growth factor (VEGF, p < 0.0001) were increased by a factor of 2-3 compared with levels in sPD effluent. The NEPP regimen was associated with higher transport parameters, but that association disappeared after the addition of VEGF to the model. The association between NEPP and higher effluent levels of VEGF could not be attributed to glucose and GDP loads. CONCLUSIONS Study results indicate preservation of the mesothelium and increased peritoneal activation during NEPP treatment. Whether the increase in VEGF reflects an increase in mesothelial cell mass or whether it points to another, undesirable mechanism cannot be determined from the present study. Longitudinal studies are needed to finally evaluate the usefulness of the NEPP regimen for further clinical use.
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Affiliation(s)
- Caatje Y le Poole
- Department of Nephrology, VU University Medical Center, Amsterdam, The Netherlands
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22
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Jung K, Lüthje P, Lundahl J, Brauner A. Low immunogenicity allows Staphylococcus epidermidis to cause PD peritonitis. Perit Dial Int 2010; 31:672-8. [PMID: 20448241 DOI: 10.3747/pdi.2009.00150] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Peritonitis is a common and serious complication of peritoneal dialysis (PD). Coagulase-negative staphylococci from the patient's own skin flora are the most commonly found micro-organisms. OBJECTIVE In the present study we aim to elucidate the immune response in the early stage of infection and to clarify the importance of bacterial attachment to fibrinogen. METHODS Clinical Staphylococcus epidermidis isolates collected from PD peritonitis or the residential skin flora of healthy individuals were used to infect monocytes, macrophages, and peripheral blood mononuclear cells (PBMC) in the presence or absence of fibrinogen. The S. epidermidis strain HB (fbe(+)), expressing the fibrinogen-binding protein Fbe, and its isogenic mutant ST056 (fbe(-)) were used to study the impact of Fbe during cell infection. Immune induction was measured as interleukin-8 (IL-8) production determined by ELISA. Modulation of CD11b/CD18 expression in neutrophils incubated in conditioned medium from these experiments was analyzed in order to judge the cellular response. RESULTS S. epidermidis causing peritonitis was less immunogenic compared to strains belonging to the residential skin flora, as measured by IL-8 induction in monocytes and CD11b/CD18 expression in neutrophils. At low bacterial concentrations, attachment to fibrinogen was a prerequisite for an IL-8 induction in monocytes and PBMC. The fibrinogen-binding protein Fbe did not, however, influence immune induction under this condition. CONCLUSIONS We suggest that S. epidermidis strains may be able to cause clinical infection by evoking an inadequate immunological response in the early stage of infection. Bacterial attachment to fibrinogen is a relevant event during this phase but independent of the fibrinogen-binding protein Fbe.
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Affiliation(s)
- Karin Jung
- Clinical Microbiology, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
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23
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Integrins mediate adherence and migration of T lymphocytes on human peritoneal mesothelial cells. Kidney Int 2008; 74:808-16. [DOI: 10.1038/ki.2008.330] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Chen CY, Wu CY, Tsai TC, Lin WT, Lee WJ, Su CC, Chen HC, Chiang HC. Fas expression on peritoneal macrophages during continuous ambulatory peritoneal dialysis peritonitis. Ren Fail 2008; 30:297-301. [PMID: 18350449 DOI: 10.1080/08860220701860872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Peritonitis is a common complication of end stage renal failure (ESRF) patients receiving continuous ambulatory peritoneal dialysis (CAPD). Peritoneal macrophage may participate in the activation of specific T cells and in the generation of local cell-mediated immunity to various pathogens. The purpose of this study is to investigate the possible role of macrophage in CAPD patients with peritonitis. METHODS We evaluated the expression of Fas receptor (CD95), ICAM-1 (CD54), CD25, and CD69 by two-color flow cytometry on extravasted macrophages from 16 ESRF patients on CAPD with peritonitis (peritonitis-positive) and compared them to 11 ESRF patients on CAPD without peritonitis (peritonitis-negative) and normal controls. RESULTS We found an increased expression of CD95, CD54, and CD25 on macrophage in peritonitis-positive group compared to controls (all p < 0.001). In the peritonitis-positive group, the CD95 expression was significantly higher than that of the peritonitis-negative group (p < 0.001). The expression of CD54, CD25, and CD69, however, was not significantly different between the peritonitis-positive and peritonitis-negative CAPD subgroups. CONCLUSION We found an abnormally increased percentage of macrophage-expressing Fas receptor and ICAM-1, and the percentage of CD95+ macrophage, but not those of other markers, were increased among the subset of CAPD patients with peritonitis. The later finding suggests that this macrophage phenotype is associated with peritonitis occurring in CAPD.
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Affiliation(s)
- Chen-Yin Chen
- Division of Nephrology, Department of Medicine, Tian-Sheng Memorial Hospital, Tong-Kang, Ping-Tong, Taiwan
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25
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McCully ML, Baroja ML, Chau TA, Jain AK, Barra L, Salgado A, Blake PG, Madrenas J. Receptor-interacting protein 2 is a marker for resolution of peritoneal dialysis-associated peritonitis. Kidney Int 2007; 72:1273-81. [PMID: 17851464 DOI: 10.1038/sj.ki.5002534] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
There are no predictive factors for peritoneal dialysis-associated peritonitis; however, its resolution correlates with a cell-mediated Th1 immune response. We tested the hypothesis that induction of receptor-interacting protein 2 (RIP2), an assumed kinase linked with Th1 responses, is a useful marker in this clinical setting. Basal RIP2 expression was measured in human immune cells and during dialysis-associated peritonitis. RIP2 increased with bacterial toxin cell activation and the temporal profile for this differed depending on immune cell involvement in the innate or adaptive phases of the response. Importantly, RIP2 expression increased in peritoneal immune cells during dialysis-associated peritonitis and this upregulation correlated with clinical outcome. An early induction in peritoneal CD14(+) cells correlated with rapid resolution, whereas minimal induction correlated with protracted infection and with catheter loss in 36% of patients. These latter patients had higher levels of MCP-1 consistent with a delayed transition from innate to adaptive immunity. Our study shows that upregulation of RIP2 is a useful marker to monitor dialysis-associated peritonitis and in predicting the clinical outcome of these infections.
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Affiliation(s)
- M L McCully
- The FOCIS Centre for Clinical Immunology and Immunotherapeutics, Robarts Research Institute, London, Ontario, Canada
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26
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Wang HH, Lin CY. Interleukin-12 and -18 Levels in Peritoneal Dialysate Effluent Correlate With the Outcome of Peritonitis in Patients Undergoing Peritoneal Dialysis: Implications for the Type I/Type II T-Cell Immune Response. Am J Kidney Dis 2005; 46:328-38. [PMID: 16112053 DOI: 10.1053/j.ajkd.2005.05.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2005] [Accepted: 05/03/2005] [Indexed: 11/11/2022]
Abstract
BACKGROUND We previously showed that a positive impact of peritoneal defense response on the outcome of peritoneal dialysis (PD)-related peritonitis is characterized by an increased pattern of peritoneal CD4/CD8 T-cell ratio with a predominant CD4(+)-T helper subtype 1 phenotype. To further explore longitudinal changes in peritoneal immunity during PD-related peritonitis, we examined the production of interleukin 12 (IL-12), IL-18, and interferon gamma (IFN-gamma) in peritoneal dialysate effluent (PDE) and kinetic expression of the transcription factors T box expressed in T cells (T-bet) and guanine adenine thymine adenine (GATA) binding protein 3 (GATA-3) in peritoneal T cells during peritonitis. Correlations between these observations and responses to antibiotics were analyzed. METHODS IL-12, IL-18, and IFN-gamma protein and IFN-gamma, T-bet, and GATA-3 messenger RNA (mRNA) were measured in PDE during various phases of peritonitis in 40 patients undergoing PD. Patients were divided into 2 groups according to whether they had a rapid versus delayed response to antibiotic treatment. RESULTS In the early phase of peritonitis, IL-12, IL-18, and IFN-gamma levels in PDE were significantly greater in the rapid-response group (P < 0.05). Changes in peritoneal IL-12 and IL-18 levels preceded changes in IFN-gamma levels. The kinetics of IFN-gamma, T-bet, and GATA-3 mRNA expression in peritoneal T cells, measured by means of real-time polymerase chain reaction, differed between the 2 groups. In the rapid-response group, IFN-gamma and T-bet mRNA expression increased, whereas that of GATA-3 decreased over time. Results were opposite in the delayed-response group, with IFN-gamma and T-bet levels decreasing and GATA-3 levels increasing over time. CONCLUSION These data suggest that local IL-12 and IL-18 production is part of a protective early immune response to PD-related peritonitis. High IL-12 and IL-18 levels in PDE during the early phase of peritonitis correlated with a predominant type 1 immune response and favorable outcome.
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Affiliation(s)
- Hsin-Hui Wang
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
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27
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Bouts AHM, Davin JC, Krediet RT, Schröder CH, Monnens LAH, Nauta J, van de Winkel JGJ, Out TA. IgG and complement receptor expression in children treated by peritoneal dialysis. Pediatr Nephrol 2005; 20:1161-7. [PMID: 15856320 DOI: 10.1007/s00467-005-1850-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2004] [Revised: 12/21/2004] [Accepted: 12/21/2004] [Indexed: 10/25/2022]
Abstract
Children treated by peritoneal dialysis (PD) are at increased risk of infections. IgG receptors (FcgammaRs) and complement receptors (CRs) on white blood cells (WBCs) are important for the phagocytic process. We have investigated FcgammaR and CR expression on monocytes, macrophages and neutrophils in blood and in peritoneal dialysis effluent (PDE) of 39 PD children. WBCs were isolated from blood and PDE, labelled with FITC-conjugated CD16 (FcgammaRIII), CD32 (FcgammaRII), CD64 (FcgammaRI), CD11b (CR3) and CD35 (CR1) monoclonal antibodies, and analysed by flow cytometry. Peritoneal cells had lower percentages of FcgammaR-positive or CR-positive cells than blood. On the other hand, the receptor number per cell [mean fluorescence intensity (MFI)] was higher on peritoneal macrophages and neutrophils than blood, except for CD16. The FcgammaR and CR expression in blood and dialysate did not change significantly during the first year of PD treatment. During a peritonitis episode the MFI of all receptors in blood increased only on monocytes, with the exception of CD32. The percentages of FcgammaR-positive and CR-positive macrophages and neutrophils in the PDE increased, whereas the MFI did not increase consistently. Peritoneal cells of PD children showed a lower percentage of FcgammaR-positive and CR-positive neutrophils and macrophages, combined with an increased MFI, indicating a state of activation. Blood and peritoneal cells are capable of up-regulating the receptor expression during peritonitis but probably not to a maximum level.
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Affiliation(s)
- Antonia H M Bouts
- Emma Children's Hospital AMC, University of Amsterdam, The Netherlands.
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McCully ML, Chau TA, Luke P, Blake PG, Madrenas J. Characterization of human peritoneal dendritic cell precursors and their involvement in peritonitis. Clin Exp Immunol 2005; 139:513-25. [PMID: 15730398 PMCID: PMC1809323 DOI: 10.1111/j.1365-2249.2005.02713.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Scattered evidence suggests that the human peritoneal cavity contains cells of the dendritic cell (DC) lineage but their characterization is missing. Here, we report that the peritoneal cavity of normal subjects and of stable patients on peritoneal dialysis (PD) contains a population of CD14(+) cells that can differentiate into DCs or macrophages. Within this pool, we characterized a CD14(+)CD4(+) cell subset (2.2% of the peritoneal cells) fulfilling the definition of myeloid DC precursors or pre-DC1 cells. These cells expressed high levels of HLA-DR, CD13, CD33, and CD86, and low levels of CD40, CD80, CD83, CD123, CD209, TLR-2 and TLR-4. These cells retained CD14 expression until late stages of differentiation, despite concomitant up-regulation of DC-SIGN (CD209), CD1a, CD80 and CD40. Peritoneal pre-DC1 cells had endocytic capacity that was down-regulated upon LPS/IFN-gamma stimulation, were more potent allo-stimulators than peritoneal CD14(+)CD4(-/lo) cells and monocyte-derived macrophages, and induced Th1 cytokine responses. More importantly, the number of peritoneal pre-DC1 cells increased during PD-associated peritonitis, with a different profile for Gram positive and Gram negative peritonitis, suggesting that these cells participate in the induction of peritoneal adaptive immune responses, and may be responsible for the bias towards Th1 responses during peritonitis.
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Affiliation(s)
- M L McCully
- The FOCIS Centre for Clinical Immunology and Immunotherapeutics, Robarts Research Institute, London, Ontario, Canada
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Chiesa S, Vigo G, Cappa F, Prigione I, Pistoia V, Verrina E, Perfumo F, Barbano G. Peritoneal T cell responses can be polarized toward Th1 or Th2 in children on chronic peritoneal dialysis. Artif Organs 2004; 28:750-2. [PMID: 15270959 DOI: 10.1111/j.1525-1594.2004.00055.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Peritoneal T cell responses can be polarized toward Th1 or Th2 in children on chronic peritoneal dialysis. Previous studies on the peritoneal immune system described the presence of activated T lymphocytes in peritoneal effluents from subjects on chronic peritoneal dialysis (CPD). Since Th1/Th2 polarized response can influence the outcome of specific infectious diseases, we investigated if activated Th1/Th2 cells can be detected in peritoneal effluents during peritoneal dialysis, in order to better understand the role of T cells in the mechanisms of peritoneal defense. We have studied 8 children (4 males, 4 females, mean age 5.8 +/- 5.7 years, range 0.3-13.4) on CPD. Peritoneal cells have been isolated from peritoneal effluents by centrifugation. Immunofluorescent staining of intracellular cytokines for flow cytometric analysis was used to detect the percentage of T cells producing either IFN-gamma (Th1) or IL-4 (Th2). In the initial study 3 months after CPD initiation, high percentages of IFN-gamma positive peritoneal T cells (38% and 63%) were detected in two subjects; this finding is consistent with a Th1 polarization of peritoneal T cells. In another subject, high percentages of IL-4 positive T cells (31%) were detected, suggesting a Th2 polarization of peritoneal T cell response. Small amounts of either Th1 or Th2 T cells (2-4%) were also detected in the other subjects. At the 1 year follow-up, Th1 polarization persisted in one subject (18% IFN-gamma positive peritoneal T cells), in another a shift from Th1 to Th2 was observed, and in the other subject a down regulation of both T cell subsets occurred. The finding that a predominance of T cells producing either IFN-gamma or IL-4 was found in 3 out of 8 children strongly suggests that peritoneal T cell responses can be polarized toward Th1 or Th2. The decrease of Th1 and/or Th2 polarized T cells in the peritoneum of 4 out of 6 subjects (after 1 year) suggests that CPD can play an immunosuppressive role on T cell peritoneal responses. Further studies are needed in order to define whether different T helper activation patterns are associated with a higher risk of peritoneal infection or of peritoneal damage.
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Affiliation(s)
- Sabrina Chiesa
- Nephrology Department, G. Gaslini Children's Hospital, Genoa, Italy
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Abstract
The incidence of peritonitis in peritoneal dialysis (PD) has further decreased after the introduction of automated peritoneal dialysis (APD) into clinical routine. Technical advances such as a reduction in the number of connections, more motivated patients, and improved host defense mechanisms in APD have been described. We found that the long daytime interval without dialysate exchanges leads to a higher absolute number of peritoneal macrophages which are capable of an improved first-line host defense. This is demonstrated by a higher release of cytokines of peritoneal macrophages after stimulation with lipopolysaccharides. The dry "day" in nightly intermittent PD seems to have no relevant additional positive effects on peritoneal host defense compared to continuous cyclic peritoneal dialysis. The regeneration of peritoneal cell populations induced by intervals without PD remains relevant even in times when more "biocompatible" PD solutions become available.
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Hekking LHP, Zareie M, Driesprong BAJ, Faict D, Welten AGA, de Greeuw I, Schadee-Eestermans IL, Havenith CEG, van den Born J, Ter Wee PM, Beelen RHJ. Better preservation of peritoneal morphologic features and defense in rats after long-term exposure to a bicarbonate/lactate-buffered solution. J Am Soc Nephrol 2001; 12:2775-2786. [PMID: 11729248 DOI: 10.1681/asn.v12122775] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The long-term effects of a standard lactate-buffered dialysis fluid and a new, two-chamber, bicarbonate/lactate-buffered dialysis fluid (with fewer glucose degradation products and a neutral pH) were compared in an in vivo peritoneal exposure model. Rats were given daily injections, via an access port, of 10 ml of standard solution or bicarbonate/lactate-buffered solution for 9 to 10 wk. The omentum, peritoneum, and mesothelial cell layer were screened for morphologic changes. In addition, the bacterial clearing capacity of the peritoneal cells was studied. Significantly more milky spots and blood vessels were observed in the omenta of animals treated with standard solution (P < 0.03 for both parameters). Electron-microscopic analysis demonstrated dramatic changes in the appearance of the vascular endothelial cells of the milky spots and a severely damaged or even absent mesothelium on the peritoneal membrane of the standard solution-treated animals. In contrast, the mesothelium was still present in the bicarbonate/lactate-buffered solution group, although the cells lost microvilli. Both peritoneal dialysis fluids significantly increased the density of mesothelial cells (per square millimeter) on the surface of the liver and the thickness of the submesothelial extracellular matrix of the peritoneum (both P < 0.04 for both fluids versus control). A significantly better ex vivo bacterial clearing capacity was observed with peritoneal cells from the bicarbonate/lactate-buffered solution group, compared with the standard solution group (P < 0.05 in both experiments). These results demonstrate that instillation of bicarbonate/lactate-buffered solution into rats for 9 to 10 wk preserves both morphologic and immune parameters much more effectively, compared with standard solution. These findings may be of considerable clinical importance.
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Affiliation(s)
- Liesbeth H P Hekking
- *Department of Cell Biology and Immunology, Faculty of Medicine, and Department of Nephrology, University Hospital Vrije Universiteit, Amsterdam, The Netherlands, and Baxter R&D Europe, Nivelles, Belgium
| | - Mohammad Zareie
- *Department of Cell Biology and Immunology, Faculty of Medicine, and Department of Nephrology, University Hospital Vrije Universiteit, Amsterdam, The Netherlands, and Baxter R&D Europe, Nivelles, Belgium
| | - Bas A J Driesprong
- *Department of Cell Biology and Immunology, Faculty of Medicine, and Department of Nephrology, University Hospital Vrije Universiteit, Amsterdam, The Netherlands, and Baxter R&D Europe, Nivelles, Belgium
| | - Dirk Faict
- *Department of Cell Biology and Immunology, Faculty of Medicine, and Department of Nephrology, University Hospital Vrije Universiteit, Amsterdam, The Netherlands, and Baxter R&D Europe, Nivelles, Belgium
| | - Angelique G A Welten
- *Department of Cell Biology and Immunology, Faculty of Medicine, and Department of Nephrology, University Hospital Vrije Universiteit, Amsterdam, The Netherlands, and Baxter R&D Europe, Nivelles, Belgium
| | - Inge de Greeuw
- *Department of Cell Biology and Immunology, Faculty of Medicine, and Department of Nephrology, University Hospital Vrije Universiteit, Amsterdam, The Netherlands, and Baxter R&D Europe, Nivelles, Belgium
| | - Inge L Schadee-Eestermans
- *Department of Cell Biology and Immunology, Faculty of Medicine, and Department of Nephrology, University Hospital Vrije Universiteit, Amsterdam, The Netherlands, and Baxter R&D Europe, Nivelles, Belgium
| | - Carin E G Havenith
- *Department of Cell Biology and Immunology, Faculty of Medicine, and Department of Nephrology, University Hospital Vrije Universiteit, Amsterdam, The Netherlands, and Baxter R&D Europe, Nivelles, Belgium
| | - Jacob van den Born
- *Department of Cell Biology and Immunology, Faculty of Medicine, and Department of Nephrology, University Hospital Vrije Universiteit, Amsterdam, The Netherlands, and Baxter R&D Europe, Nivelles, Belgium
| | - Piet M Ter Wee
- *Department of Cell Biology and Immunology, Faculty of Medicine, and Department of Nephrology, University Hospital Vrije Universiteit, Amsterdam, The Netherlands, and Baxter R&D Europe, Nivelles, Belgium
| | - Robert H J Beelen
- *Department of Cell Biology and Immunology, Faculty of Medicine, and Department of Nephrology, University Hospital Vrije Universiteit, Amsterdam, The Netherlands, and Baxter R&D Europe, Nivelles, Belgium
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Witowski J, Wisniewska J, Korybalska K, Bender TO, Breborowicz A, Gahl GM, Frei U, Passlick-Deetjen J, Jörres A. Prolonged exposure to glucose degradation products impairs viability and function of human peritoneal mesothelial cells. J Am Soc Nephrol 2001; 12:2434-2441. [PMID: 11675420 DOI: 10.1681/asn.v12112434] [Citation(s) in RCA: 122] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Bioincompatibility of peritoneal dialysis fluids (PDF) has been linked to the presence of glucose degradation products (GDP). Previous experiments have shown that short-term exposure to several GDP at concentrations found in commercially available PDF had no significant effect on human peritoneal mesothelial cells (HPMC). During continuous ambulatory peritoneal dialysis, however, cells are continually exposed to GDP for extended periods of time. Thus, the impact of GDP on HPMC during long-term exposure was assessed. HPMC were cultured for up to 36 d in the presence of 6 identified GDP (acetaldehyde, formaldehyde, furaldehyde, glyoxal, methylglyoxal, and 5-HMF) at doses that reflect their concentrations in conventional PDF. At regular time intervals, the ability of HPMC to secrete cytokines (interleukin-6 [IL-6]) and extracellular matrix molecules (fibronectin) was evaluated. In addition, cell viability, morphology, and proliferative potential were assessed. Exposure to GDP resulted in a significant reduction in mesothelial IL-6 and fibronectin release. Approximately 80% of this decrease occurred during the first 12 d of the exposure and was paralleled by a gradual loss of cell viability and development of morphologic alterations. After 36 d of exposure, the number of cells in GDP-treated cultures was reduced by nearly 60%. However, GDP-treated cells were able to resume normal proliferation when transferred to a normal GDP-free medium. HPMC viability and function may be impaired during long-term exposure to clinically relevant concentrations of GDP, which suggests a potential role of GDP in the pathogenesis of peritoneal membrane dysfunction during chronic peritoneal dialysis.
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Affiliation(s)
- Janusz Witowski
- Department of Nephrology and Medical Intensive Care, Universitätsklinikum Charité, Campus Virchow-Klinikum, Medizinische Fakultät der Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Pathophysiology, University Medical School, Poznañ, Poland
| | - Justyna Wisniewska
- Department of Pathophysiology, University Medical School, Poznañ, Poland
| | | | - Thorsten O Bender
- Department of Nephrology and Medical Intensive Care, Universitätsklinikum Charité, Campus Virchow-Klinikum, Medizinische Fakultät der Humboldt-Universität zu Berlin, Berlin, Germany
| | | | - Gerhard M Gahl
- Department of Nephrology and Medical Intensive Care, Universitätsklinikum Charité, Campus Virchow-Klinikum, Medizinische Fakultät der Humboldt-Universität zu Berlin, Berlin, Germany
| | - Ulrich Frei
- Department of Nephrology and Medical Intensive Care, Universitätsklinikum Charité, Campus Virchow-Klinikum, Medizinische Fakultät der Humboldt-Universität zu Berlin, Berlin, Germany
| | | | - Achim Jörres
- Department of Nephrology and Medical Intensive Care, Universitätsklinikum Charité, Campus Virchow-Klinikum, Medizinische Fakultät der Humboldt-Universität zu Berlin, Berlin, Germany
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33
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Witowski J, Pawlaczyk K, Breborowicz A, Scheuren A, Kuzlan-Pawlaczyk M, Wisniewska J, Polubinska A, Friess H, Gahl GM, Frei U, Jörres A. IL-17 stimulates intraperitoneal neutrophil infiltration through the release of GRO alpha chemokine from mesothelial cells. JOURNAL OF IMMUNOLOGY (BALTIMORE, MD. : 1950) 2000; 165:5814-21. [PMID: 11067941 DOI: 10.4049/jimmunol.165.10.5814] [Citation(s) in RCA: 255] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
IL-17 is a newly discovered cytokine implicated in the regulation of hemopoiesis and inflammation. Because IL-17 production is restricted to activated T lymphocytes, the effects exerted by IL-17 may help one to understand the contribution of T cells to the inflammatory response. We investigated the role of IL-17 in leukocyte recruitment into the peritoneal cavity. Leukocyte infiltration in vivo was assessed in BALB/Cj mice. Effects of IL-17 on chemokine generation in vitro were examined in human peritoneal mesothelial cells (HPMC). Administration of IL-17 i.p. resulted in a selective recruitment of neutrophils into the peritoneum and increased levels of KC chemokine (murine homologue of human growth-related oncogene alpha (GROalpha). Pretreatment with anti-KC Ab significantly reduced the IL-17-driven neutrophil accumulation. Primary cultures of HPMC expressed IL-17 receptor mRNA. Exposure of HPMC to IL-17 led to a dose- and time-dependent induction of GROalpha mRNA and protein. Combination of IL-17 together with TNF-alpha resulted in an increased stability of GROalpha mRNA and synergistic release of GROalpha protein. Anti-IL-17 Ab blocked the effects of IL-17 in vitro and in vivo. IL-17 is capable of selectively recruiting neutrophils into the peritoneal cavity via the release of neutrophil-specific chemokines from the peritoneal mesothelium.
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Affiliation(s)
- J Witowski
- Department of Pathophysiology, University Medical School, Poznan, Poland
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34
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Lameire N, Van Biesen W, Van Landschoot M, Wang T, Heimbürger O, Bergström J, Lindholm B, Hekking LP, Havenith CE, Beelen RH. Experimental models in peritoneal dialysis: a European experience. Kidney Int 1998; 54:2194-206. [PMID: 9853286 DOI: 10.1046/j.1523-1755.1998.00179.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The development of adequate animal models is important for the in vivo study of selected aspects of peritoneal dialysis (PD) that cannot be evaluated by an in vitro model, such as peritoneal membrane transport, the influence of local defense mechanisms, and for testing new osmotic agents and their biocompatibilities. METHODS Our experience with animal models for PD, including the acute Stockholm model in non-uremic rats, the acute and chronic Amsterdam model in non-uremic rats, and the chronic Gent model in uremic rats, is described. RESULTS The Stockholm model proved to be useful in understanding the normal physiology of peritoneal transport, and for testing new dialysis solutions and their biocompatibilities. It is a rather simple and inexpensive model, and thus is suitable for screening new solutions and additives. The Amsterdam model permits the study of chemokines and mesothelial cell regeneration in vivo, and is applied in a model of chronic peritonitis. The results of the Gent model suggest that chronic peritoneal dialysis in uremic rats is feasible for at least eight weeks. This model is, however, very laborious, time consuming, and expensive. CONCLUSION Further improvement of the technique and increase of the dialysis dose should result in a better and more realistic model for peritoneal dialysis. It is hoped that in the future these models will be useful to test the effects of long-term intraperitoneal application of different dialysis solutions and additives in uremic animals.
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Affiliation(s)
- N Lameire
- Department of Internal Medicine, University Hospital Gent, Belgium
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35
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Li FK, Davenport A, Robson RL, Loetscher P, Rothlein R, Williams JD, Topley N. Leukocyte migration across human peritoneal mesothelial cells is dependent on directed chemokine secretion and ICAM-1 expression. Kidney Int 1998; 54:2170-83. [PMID: 9853284 DOI: 10.1046/j.1523-1755.1998.00174.x] [Citation(s) in RCA: 94] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Leukocyte migration into the peritoneal cavity is a diagnostic feature of peritonitis in patients treated with peritoneal dialysis (PD). While neutrophil (PMN) influx is characteristic of the acute phase of peritoneal infection, significant mononuclear cell (MNC) infiltration, occurs throughout the whole period of infection. Recent data suggests that human peritoneal mesothelial cell (HPMC) adhesion molecule expression and the synthesis of chemotactic cytokines may be important in the process. METHODS In the present study we have examined, the regulation and directed secretion of chemokines (IL-8, MCP-1 and RANTES) and the basolateral to apical migration of unstimulated leukocytes across mesothelial cell monolayers using an in vitro model where HPMC were grown on the porous membrane of tissue culture inserts. Separate experiments have defined the importance of chemokine synthesis and ICAM-1 expression in the transmigration process. RESULTS Apical stimulation of HPMC with IL-1 beta or TNF alpha resulted in a time and dose dependent up-regulation of IL-8, MCP-1 and RANTES mRNA expression and synthesis. This secretion was predominately into the apical compartment (> 85%) with all chemokines. Apical pre-stimulation of HPMC resulted in a dose- and time-dependent migration of both PMN and MNC across HPMC. Neutrophil migration was significantly reduced in the presence of appropriate concentrations of polyclonal IL-8 antibody (IL-1 beta (100 pg/ml) 153 +/- 12 versus anti-IL-8 (100 ng/ml) 71 +/- 7 (X 10(3)) PMN, N = 6, P < 0.02) and in the presence of anti-ICAM-1 F(ab)'2 fragments or soluble ICAM-1. Constitutive and cytokine stimulated mononuclear cell migration was significantly reduced in the simultaneous presence of polyclonal MCP-1 or RANTES antibody. CONCLUSIONS These data demonstrate that HPMC synthesize IL-8, MCP-1 and RANTES in response to inflammatory cytokines. HPMC-derived C-x-C and C-C chemokines might contribute to the intra-peritoneal recruitment of leukocytes during peritoneal inflammation.
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Affiliation(s)
- F K Li
- Institute of Nephrology, University of Wales College of Medicine, Cardiff Royal Infirmary, United Kingdom
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Brauner A, Lu Y, Halldén G, Hylander B, Lundahl J. Difference in the blood monocyte phenotype between uremic patients and healthy controls: its relation to monocyte differentiation into macrophages in the peritoneal cavity. Inflammation 1998; 22:55-66. [PMID: 9484650 DOI: 10.1023/a:1022395723972] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The phenotypic alterations between blood monocytes from 11 patients with end-stage renal disease, who had been on peritoneal dialysis for less than one week, and blood monocytes from 10 healthy controls, were analyzed. In addition, peritoneal macrophages in the dialysate effluent were enclosed. Analysis of functional receptor density was performed using immunostaining and flow cytometry. The phenotypic characterization was selected to represent various biological functions such as adhesion, phagocytosis (CD11b/CD18, CD11c/CD18, CD16), antigen-presentation (HLA-DR, ICAM-1), differentiation (transferrin receptor, CD71), receptor for LPS (CD14) and initiation of the coagulation cascade (Tissue factor, CD142). The proportion of CD16-positive blood monocytes and the quantitative level of ICAM-1 were higher in the patient group, compared to healthy controls. A significant increase in the quantitative level of CD11b/CD18, CD11c/CD18, HLA-DR and ICAM-1, transferrin receptor, CD14 and CD16, was found on peritoneal macrophages, compared to monocytes, harvested both from the corresponding patients, as well as from healthy donors. In contrast, we did not find any significant differences in the expression of tissue factor between monocytes and peritoneal macrophages. In conclusion, phenotypic differences exist between monocyte populations in the blood circulation of CAPD patients, and healthy individuals. We also show that transmigration of monocytes into the peritoneal cavity implies a selective up-regulation of functional receptors, preferentially related to adhesion, and antigen-presentation in a steady-state situation in non-infected CAPD patients.
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Affiliation(s)
- A Brauner
- Dept of Microbiology, Karolinska Hospital Stockholm, Sweden
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37
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Selgas R, Fernández de Castro M, Jiménez C, Cárcamo C, Contreras T, Bajo MA, Vara F, Corbí A. Immunomodulation of peritoneal macrophages by granulocyte-macrophage colony-stimulating factor in humans. Kidney Int 1996; 50:2070-8. [PMID: 8943492 DOI: 10.1038/ki.1996.531] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Colony-stimulating factors are growth factors which induce differentiation of the hematopoietic stem cells. Granulocyte-macrophage colony-stimulating factor (GM-CSF) stimulates proliferation and improves functions of neutrophils and monocyte/macrophages. A macrophage submesothelial stratum has been suggested to constitute the first line of peritoneal defense. We have tested whether intraperitoneally administered GM-CSF could increase the number and activation of peritoneal macrophages in peritoneal dialysis patients. Eight stable patients injected 17 micrograms of GM-CSF in each of their four daily CAPD bags over three days. The clinical status, the peritoneal effluent and peripheral blood cell count, membrane receptor expression, phagocytosis activity and cytokine levels were monitored at days 0, 1, 3, 10 and 28. GM-CSF administration caused a large increase in peritoneal macrophage number (89-fold mean increase after 72 hr), returning to baseline seven days after withdrawal. GM-CSF triggered an increase in the expression of CD11b/CD18 (CR3) and its counterreceptor CD54, indicating the cellular progression into a more activated state. Both the number of phagocytic cells (55 +/- 15% to 83 +/- 10%, P < 0.05) and the phagocytic index (137 +/- 29 to 255 +/- 61, P < 0.01) were also augmented. Peritoneal effluent cytokine-chemokine levels demonstrated an increase in IL-6 and MCP-1 levels while TNF-alpha, IL-1, IL-8, MIP-1 alpha and RANTES were not significantly altered. GM-CSF administration did not affect the peritoneal transport of water or solutes. Minor side-effects were registered in two patients. In conclusion, intraperitoneal GM-CSF causes a marked and transient recruitment of primed macrophages into the peritoneum without inducing inflammatory parameters. GM-CSF should improve the peritoneal defensive capacity through potentiation of the effector functions of resident and newly-recruited macrophages.
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Affiliation(s)
- R Selgas
- Servicio de Nefrologia, Hospital Universitario La Paz, Madrid, Spain
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38
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Abstract
Research in recent years has examined the mechanisms underlying cellular host defence in the peritoneal cavity. These studies have established that the resident cells of the peritoneal cavity, the peritoneal macrophages (PM phi) and the mesothelial cells (HPMC) contribute to the initiation, amplification and resolution of peritoneal inflammation. Ex vivo measurements of intra-peritoneal inflammatory mediators during peritonitis has elucidated the time courses for the generation of proinflammatory, chemotactic and anti-inflammatory cytokines and have identified that their secretion occurs largely within the peritoneum. These studies provide evidence that both PM phi- and HPMC-derived mediators are directly involved in controlling inflammation. It has been widely accepted that resident PM phi form the first line of defence against peritoneal infection, a more contemporary view would suggest that the direct or indirect (via secreted pro-inflammatory cytokines) interaction between PM phi and HPMC is pivotal to the activation and subsequent amplification of the peritoneum's response to infection. Whilst the site of these interactions is unknown, considerable evidence suggests that it occurs on the surface of the mesothelium, where invading micro-organisms may colonize. In this respect Staphylococcal exoproducts can directly activate HPMC cytokine synthesis. Once the inflammatory response is initiated, recent evidence suggests, that mesothelial cells upon activation by PM phi-derived IL-1 beta and TNF-alpha, are capable of amplifying inflammation and generating signals (via the creation of a gradient of chemotactic cytokines, IL-8, MCP-1 and RANTES) for the recruitment of leukocytes into the peritoneum. This process is also facilitated via the cytokine driven up-regulation of adhesion molecule expression (ICAM-1 and VCAM-1) on HPMC. Much less is understood about the mechanisms by which inflammation is resolved, although the secretion of anti-inflammatory molecules (IL-6, IL-1ra and soluble TNF-p55/75) by receptors by PM phi and HPMC may be important in the process. The existence of a peritoneal cytokine network controlling inflammation is now well established, within this the interaction of PM phi and HPMC appears to play a pivotal role in the hosts response to peritoneal infection.
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Affiliation(s)
- N Topley
- Institute of Nephrology, University of Wales College of Medicine, Cardiff Royal Infirmary, UK
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39
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TOPLEY NICHOLAS, DAVENPORT ANDREW, LI FUKEUNG, FEAR HUW, WILLIAMS JOHND. Peritoneal defence in peritoneal dialysis. Nephrology (Carlton) 1996. [DOI: 10.1111/j.1440-1797.1996.tb00165.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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40
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Vanholder R, Lameire N, Waterloos MA, Van Landschoot N, De Smet R, Vogeleere P, Lambert MC, Vijt D, Ringoir S. Disturbed host defense in peritoneal cavity during CAPD: characterization of responsible factors in dwell fluid. Kidney Int 1996; 50:643-52. [PMID: 8840297 DOI: 10.1038/ki.1996.360] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
In this study, the factors in overnight dwell fluid (8 to 10 hr dwell) depressing granulocyte (GC) NAD(P)H-oxidase dependent radical species production are characterized. At present, most studies have essentially focused on fresh, unspent dialysate and on peritoneal macrophages. The response to Staphylococcus aureus (Staph A) was dose-dependently depressed for both GC CO2 production (from 91.3 +/- 8.4 to 9.0 +/- 1.5 dpm/10(3) GC, P < 0.01) and chemiluminescence (CL) (peak from 7.3 +/- 0.8 to 1.6 +/- 0.8 cps x 10(3)/GC, P < 0.01). Stimulation with formyl-methionine-leucine-phenylalanine (f-MLP), phorbol myristic acid (PMA), Staphylococcus epidermidis (Staph Epi), E. coli, latex and zymosan revealed a parallel depression, pointing to an intrinsic metabolic defect, rather than failure of particle ingestion. The addition of glucose to the normal cell medium to obtain the same concentration as in the CAPD effluent (2.9 +/- 0.3 mg/dl) depressed function but not to the same extent as the genuine PD effluent. Opsonization of Staph A and E. coli induced a partial correction. No effect of pH or osmolality was observed. HPLC fractionation of CAPD effluent on a polarity based gradient revealed an elution of depressive factors in hydrophobic fractions with a nadir in F7 and F12. Analysis of the elution pattern of various uremic solutes revealed elution in F12 of p-cresol, a solute with known inhibitory effect on GC function. These events may be related to recent peritonitis (CL in response to Staph A 0.3 +/- 0.1 in effluent of 6 patients with recent peritonitis versus 2.6 +/- 0.8 cps x 10(3)/GC in 12 patients without recent peritonitis (P < 0.01). We conclude that the GC response is depressed in the presence of CAPD effluent due to excess glucose, lack of opsonization, and uremic solutes of which p-cresol is one of the responsible compounds.
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Affiliation(s)
- R Vanholder
- Nephrology Department, Universty Hospital, Gent, Belgium
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41
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Fricke H, Hartmann J, Sitter T, Steldinger R, Rieber P, Schiffl H. Continuous ambulatory peritoneal dialysis impairs T lymphocyte selection in the peritoneum. Kidney Int 1996; 49:1386-95. [PMID: 8731104 DOI: 10.1038/ki.1996.195] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Peritoneal lymphocytes (PCL) of 45 healthy individuals, four uremic patients with end-stage renal disease (ESRD) and 25 long-term continuous ambulatory peritoneal dialysis (CAPD) patients were characterized by flow cytometry to investigate whether CAPD alters the phenotype of PCL. B lineage cells constitute a minority of PCL (2.5% of cells). Although the majority of peritoneal T cells expressed alpha beta T cell receptor (TcR), 7% expressed gamma delta TcR, a proportion which was significantly higher than that in peripheral blood (PBMC) (approximately 4%). The majority of PCL T cells exhibited markers of the thymus-dependent lineage (CD2, CD3, TcR alpha beta, CD8 alpha beta or CD4) and surface antigens associated with memory and activation (CD45RO, CD11a, CD18, CD49d, HLA-DR). An average of 75% of both CD4+ and CD8+ PCL T cells of healthy subjects and CAPD patients were CDw60+, thus characterizing the T cell subset containing the helper activity for the mitogen-driven B cell differentiation. CD44s was abundantly expressed on PCL T cells. In contrast to PCL T cells of healthy subjects peritoneal T lymphocytes of CAPD patients exhibited CD44 splice variants containing products of exon-v9 and the proportion of CD44v9+ cells correlated with the frequency of peritonitis episodes the patients had gone through. The majority of PCL T cells of both healthy subjects and CAPD patients were CD8+. A large proportion of CD8+ PCL T cells from healthy subjects expressed the homodimeric CD8 alpha alpha isoform; however, such cells were not found in CAPD patients. In healthy subjects mRNA for the recombination activating gene 1 (RAG-1) was detectable in a PCL population containing CD7-CD34+ and CD7+CD34+ cells. In contrast, neither mRNA transcripts of the RAG-1 gene nor CD34+ cells were detectable in PCL of CAPD patients.
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Affiliation(s)
- H Fricke
- Department of Medicine, Ludwig-Maximilians-University Munich, Germany
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McGregor SJ, Topley N, Jörres A, Speekenbrink AB, Gordon A, Gahl GM, Junor BJ, Briggs JD, Brock JH. Longitudinal evaluation of peritoneal macrophage function and activation during CAPD: maturity, cytokine synthesis and arachidonic acid metabolism. Kidney Int 1996; 49:525-33. [PMID: 8821840 DOI: 10.1038/ki.1996.75] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The release of cytokines and prostaglandins (PG) by peritoneal macrophages (PM luminal diameter of) may influence the cytokine network controlling peritoneal inflammation and in the long-term the function of the peritoneum as a dialysis membrane. In the present study, an evaluation of the long-term effects of peritoneal dialysis on the release of cytokines and prostaglandins, and the expression of surface markers of cellular maturation on blood and mononuclear cells has been performed in patients during their first year on CAPD. Spontaneous release of tumour necrosis factor alpha (TNF alpha) and interleukins 6 (IL-6) by PM luminal diameter of, after 4 or 24 hours in culture, increased significantly with time on CAPD, while there was a small but significant decrease in release of prostaglandin E2 (PGE2). Production of TNF alpha and IL-6 was enhanced following incubation of the cells with lipopolysaccharide (LPS), but the effect of LPS was proportionally greater on blood monocytes than on PM luminal diameter of. There was a significant increase in the concentrations of PGE2 and 6-keto-prostaglandin F1 alpha in overnight dwell peritoneal dialysis effluent with time on CAPD. The levels of TNF alpha and IL-6 in uninfected PDE were below the detection limit of the immunoassay over the whole time period studied. Expression of CD15, which correlates with immaturity, by PM luminal diameter of and blood monocytes increased with time on CAPD, while expression of CD11c, a marker of maturation, decreased on blood monocytes, but did not change significantly on PM luminal diameter of. There was also a slight increase in expression of transferrin receptor in both PM luminal diameter of and monocytes, but this did not reach statistical significance. These findings suggest that peritoneal macrophages and blood monocytes isolated from CAPD patients over a one year period become increasingly immature with time, and this is accompanied by a significant modulation of their ability to secrete inflammatory cytokines. Dysregulation of macrophage function may have important consequences with respect to inflammatory processes and the long-term function of the peritoneal membrane in CAPD patients.
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Affiliation(s)
- S J McGregor
- Glasgow University Department of Immunology, Scotland
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Libetta C, De Nicola L, Rampino T, De Simone W, Memoli B. Inflammatory effects of peritoneal dialysis: evidence of systemic monocyte activation. Kidney Int 1996; 49:506-11. [PMID: 8821837 DOI: 10.1038/ki.1996.72] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
We evaluated in peritonitis-free patients undergoing continuous ambulatory peritoneal dialysis (CAPD) the release of both interleukin-6 (IL-6) and beta-2-microglobulin (beta 2m) by cultured peripheral blood mononuclear cells (PBMC), as well as the levels of serum amyloid A (SAA), that is, the main hepatic acute phase protein during inflammation. The same measurements were obtained in hemodialysis (HD) patients, uremic non-dialyzed patients (ESRD) and healthy controls (CON). In CAPD, IL-6 production from PBMC was markedly increased in comparison to the control value (600.7 +/- 104.3 vs. 14.2 +/- 3.6 pg/3 x 10(6) PBMC/24 hr, P < 0.005). Similarly, a striking enhancement of the PBMC release of beta 2m was detected in CAPD with respect to CON (10.1 +/- 2.6 vs. 0.063 +/- 0.013 micrograms/3 x 10(6) PBMC/24 hr, P < 0.001). Also, the SAA levels were significantly greater in CAPD patients (21.3 +/- 8.7 micrograms/dl) than in controls (3.14 +/- 0.17 micrograms/dl, P < 0.05). Analogous increases of both IL-6 and beta 2m cell releases, as well as of SAA levels, were observed in HD patients. No difference concerning the three parameters was detected between CON and ESRD. In conclusion, CAPD induces per se PBMC activation with an enhanced release of both IL-6 and beta 2m; this is associated to higher levels of SAA. These systemic inflammatory effects are comparable to those observed in HD patients indicating that CAPD is similar to HD in terms of biocompatibility of the treatment.
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Affiliation(s)
- C Libetta
- Department of Nephrology, University "Federico II" of Naples, Italy
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Visser CE, Steenbergen JJ, Betjes MG, Meijer S, Arisz L, Hoefsmit EC, Krediet RT, Beelen RH. Interleukin-8 production by human mesothelial cells after direct stimulation with staphylococci. Infect Immun 1995; 63:4206-9. [PMID: 7558346 PMCID: PMC173597 DOI: 10.1128/iai.63.10.4206-4209.1995] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Mesothelial cells (MC) are able to produce interleukin-8 (IL-8) after stimulation with IL-1 beta or tumor necrosis factor alpha. The aim of our study was to investigate whether MC are able to produce IL-8 after direct stimulation with clinically relevant bacteria. We observed a significant IL-8 response by the MC which were directly stimulated with viable staphylococci.
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Affiliation(s)
- C E Visser
- Department of Cell Biology & Immunology, Faculty of Medicine, Academic Hospital Vrije Universiteit, Amsterdam, The Netherlands
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Abstract
Continuous ambulatory peritoneal dialysis (CAPD) has come to be extensively used for the treatment of end-stage renal failure in children, and especially infants, such that now more than half of children on dialysis worldwide receive treatment by this means. Peritonitis, however, is commoner in children than in adults receiving treatment, and is a major source of morbidity and treatment failure in children started on CAPD. Only recently has the immunology of the normal peritoneum been studied extensively, with the need to assess the impact of the installation of large volumes of fluid into the peritoneal sac during dialysis. The main phagocytic defences of the peritoneum depend upon a unique set of macrophages which are present free in the peritoneal fluid but also in the submesothelium and in perivascular collections together with B lymphocytes in the submesothelial area. Both the number of macrophages per unit volume and the concentration of opsonic proteins, such as IgG, complement and fibronectin, are reduced to between only 1% and 5% when dialysis fluid is continuously present in the peritoneal sac. In addition, the fluids used for CAPD are toxic to both macrophages and to mesothelial cells. Thus minor degrees of contamination frequently lead to peritonitis and in addition the majority of patients have catheters inserted in their peritoneum which become colonised with organisms capable of producing exopolysaccharide (slime), which promotes adhesion of the organism to the plastic and protects them against phagocytic attack and the penetration of antibiotics. Thus the peritoneum is in a state of continual inflammation, as well as being a markedly more vulnerable site than the normal peritoneum to the entry of organisms. Whether clinical peritonitis appears in this state of chronic contamination probably depends on perturbation in the balance between host defences and the organism. Whilst Staphylococcus epidermidis is the commonest cause of peritonitis, Staphylococcus aureus and Gram-negative organisms are much more serious and more frequently lead either to temporary catheter removal or discontinuation of dialysis altogether. This review describes the peritoneal defences in relation to the genesis of peritonitis.
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Affiliation(s)
- J S Cameron
- Renal Unit, Division of Medicine, UMDS, London, UK
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Rózalska B, Ljungh A, Burow A, Rudnicka W. Biomaterial-associated infection with Candida albicans in mice. Microbiol Immunol 1995; 39:443-50. [PMID: 8569528 DOI: 10.1111/j.1348-0421.1995.tb02227.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Candida yeasts are frequently isolated from patients with continuous ambulatory peritoneal dialysis peritonitis or other biomaterial-associated infections. The mouse model of candidal peritonitis was used to study the interaction of Candida cells with end-point attached heparinized polyethylene (H-PE) and with polymorphonuclear leukocytes (PMNs) or macrophages (M phi). Two Candida strains differing in cell surface hydrophobicity and in expression of fibronectin (Fn) binding were used for the study. Cells of both Candida strains adhered at higher numbers to H-PE surfaces preadsorbed with Fn or with human dialysis fluid (HDF) than to non-modified H-PE, supporting a role of Fn in mediating adhesion. C. albicans 4016 cells expressing low hydrophobicity and low binding of soluble Fn demonstrated stronger adhesion to PMNs than the more hydrophobic C. albicans 3248 yeasts, which express high binding of soluble Fn. However, C. albicans 4016 cells were more resistant to phagocytic killing and were hardly eradicated in intraperitoneally infected mice. The animals depleted in PMNs by treatment with CY were neither able to eradicate C. albicans 3248 (rapidly eliminated by normal mice) nor C. albicans 4016 yeasts (with a tendency to persist in the tissues of normal mice).
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Affiliation(s)
- B Rózalska
- Department of Infectious Biology, University of Lódź, Poland
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Ko YC, Mukaida N, Kasahara T, Muto S, Matsushima K, Kusano E, Asano Y, Itoh Y, Yamagishi Y, Kawai T. Specific increase in interleukin-8 concentrations in dialysis fluid of patients with peritonitis receiving continuous ambulatory peritoneal dialysis. J Clin Pathol 1995; 48:115-9. [PMID: 7745108 PMCID: PMC502373 DOI: 10.1136/jcp.48.2.115] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
AIMS To evaluate the influence of interleukin-8 (IL-8) and other inflammatory cytokines (IL-6, IL-1 beta and tumour necrosis factor alpha (TNF alpha)) on the occurrence of peritonitis in patients receiving continuous ambulatory peritoneal dialysis (CAPD). METHODS The study population comprised 12 patients with peritonitis, 33 without peritonitis, all undergoing CAPD, and five patients undergoing peritoneal catheter implantation. Cytokine concentrations in dialysis fluid were determined by immunoassay and their values compared. RESULTS Concentrations of both IL-8 (median 147 pg/ml, range 20-2273 pg/ml; n = 12) and IL-6 (median 1120 pg/ml, range 96-10,600 pg/ml) were substantially elevated, while the IL-1 beta concentration was lower and TNF alpha was not detectable in patients at diagnosis. The IL-6 concentration was also elevated in patients undergoing catheter implantation as well as in those with peritonitis. The IL-8 concentration, however, was elevated only upon infection. Intraperitoneal production of IL-8 was evident on determination of paired serum and dialysis fluid cytokine concentrations, and immunostaining of peritoneal cells with monoclonal anti-IL-8 antibody. CONCLUSIONS These results suggest that determination of the IL-8 concentration in dialysis fluid maybe useful as a specific marker for following patients with peritonitis receiving CAPD.
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Affiliation(s)
- Y C Ko
- Department of Clinical Pathology, Jichi Medical School, Tochigi, Japan
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Struijk DG, Krediet RT, Koomen GC, Boeschoten EW, Hoek FJ, Arisz L. A prospective study of peritoneal transport in CAPD patients. Kidney Int 1994; 45:1739-44. [PMID: 7523752 DOI: 10.1038/ki.1994.226] [Citation(s) in RCA: 105] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
A prospective two year follow-up study of the functional characteristics of the peritoneal membrane was conducted in 61 CAPD patients. Peritoneal transport of solutes, calculated by mass transfer area coefficients for urea and creatinine, peritoneal clearances for proteins, percentage of absorption of glucose, as well as net ultrafiltration were measured every four months. After five months on CAPD a decrease was found for the transport of most solutes (P < 0.05, mean values, ml/min/1.73 m2): urea 18.1 to 16.2, creatinine 9.5 to 8.4, IgG 0.049 to 0.040 and alpha 2-macroglobulin 0.020 to 0.015, as well as for the absorption of glucose (57.9 to 53.2%, P < 0.05). Net ultrafiltration increased simultaneously from 44.6 to 100.5 ml/4 hr/1.73 m2, P < 0.05. From five months to two years on CAPD a significant increase in the transport of all solutes except alpha 2-macroglobulin was found, as well as a decrease in net ultrafiltration. Peritoneal transport at the end of the study was not significantly different from the starting values. Our findings indicate an initial effect of CAPD itself on peritoneal transport, probably due to the recent start of the treatment. Baseline values were reached after five months on CAPD. Thereafter a gradual increase in peritoneal solute transport occurred during two years of treatment. This can be explained by an increase in the effective peritoneal surface area.
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Affiliation(s)
- D G Struijk
- Department of Medicine, Academic Medical Center, Amsterdam, The Netherlands
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Betjes MG, Tuk CW, Struijk DG, Krediet RT, Arisz L, Beelen RH. Antigen-presenting capacity of macrophages and dendritic cells in the peritoneal cavity of patients treated with peritoneal dialysis. Clin Exp Immunol 1993; 94:377-84. [PMID: 8222330 PMCID: PMC1534228 DOI: 10.1111/j.1365-2249.1993.tb03460.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
In this study the antigen-presenting capacity of human peritoneal cells and the influence of continuous ambulant peritoneal dialysis (CAPD) were studied. On average 6% of the peritoneal cells were dendritic cells (DC), with no difference between CAPD and control peritoneal cells. DC were enriched by selecting for non-adherent, Fc receptor-negative, low density cells. A typical spot-like CD68 positivity was seen in DC, in contrast to the pancytoplasmic staining pattern in macrophages. Peritoneal DC morphologically and functionally showed features of cells belonging to the DC lineage. Peritoneal DC were superior antigen-presenting cells for both allo-antigen, and Candida albicans antigen or purified protein derivative. CAPD peritoneal macrophages were two- to three-fold better stimulator cells for allogeneic T cells compared with control macrophages. The level of integrins/adhesins or MHC class I or II, as measured semi-quantitatively on the FACS, could not account for this phenomenon. In addition, a double chamber system showed that dialysate-activated macrophages produced soluble factors that could enhance DC-induced allogeneic T cell proliferation. In conclusion, human peritoneal cells contain a relatively high percentage of classical DC. CAPD treatment does not impair the antigen-presenting capacity of peritoneal cells, but instead upregulates the allo-antigen-presenting capacity of peritoneal macrophages.
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Affiliation(s)
- M G Betjes
- Department of Cell Biology, Vrije Universiteit, Amsterdam, The Netherlands
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