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South SC, Shah AP, Hartigan JR. Intraoperative Diagnosis and Surgical Management of Encapsulating Peritoneal Sclerosis: A Case Report. Cureus 2024; 16:e64515. [PMID: 39139349 PMCID: PMC11321135 DOI: 10.7759/cureus.64515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 07/11/2024] [Indexed: 08/15/2024] Open
Abstract
Encapsulating peritoneal sclerosis (EPS) is a serious complication of chronic peritoneal dialysis (PD) that results in encapsulation of the bowel in a thick, fibrocollagenous membrane. Given its rare and complex nature, diagnosis of EPS often arises late in the disease process or intraoperatively. We report the case of an 86-year-old male with a history of renal failure managed with PD who presented with multiple hospital admissions for recurrent abdominal pain and symptoms of small bowel obstruction. Open laparotomy revealed encasement of the entire abdominal cavity in a cocoon-like membrane, consistent with EPS, which was successfully managed with extensive excision and adhesiolysis. This discussion, enriched by unique radiographic insights and delineation of a surgical strategy, seeks to enhance the understanding of this underreported disease characterized by a lack of definitive treatment and an enigmatic pathophysiology.
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Affiliation(s)
- Shannon C South
- Department of Medicine, Lake Erie College of Osteopathic Medicine, Bradenton, USA
| | - Avani P Shah
- Department of Medicine, Lake Erie College of Osteopathic Medicine, Bradenton, USA
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2
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Cheng XBJ, Bargman J. Complications of Peritoneal Dialysis Part II: Nonmechanical Complications. Clin J Am Soc Nephrol 2024; 19:791-799. [PMID: 38190143 PMCID: PMC11168822 DOI: 10.2215/cjn.0000000000000418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 12/21/2023] [Indexed: 01/09/2024]
Abstract
Peritoneal dialysis (PD) is a form of KRT that offers flexibility and autonomy to patients with ESKD. It is associated with lower costs compared with hemodialysis in many countries. Unlike mechanical complications that typical arise early in the course of treatment, noninfectious, nonmechanical complications often present late in patients who are established on PD. In this review, we first discuss abnormal-appearing drained dialysate, including hemoperitoneum, chyloperitoneum, and noninfectious cloudy dialysate. The underlying cause is frequently unrelated to PD. We then discuss encapsulating peritoneal sclerosis, a rare complication of PD. Finally, we review metabolic changes associated with PD and methods to mitigate its effects.
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Affiliation(s)
- Xin Bo Justin Cheng
- University Health Network, Toronto, Ontario, Canada
- Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Joanne Bargman
- University Health Network, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
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3
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Zhao JL, Zhao L, Zhan QN, Liu M, Zhang T, Chu WW. BMSC-derived Exosomes Ameliorate Peritoneal Dialysis-associated Peritoneal Fibrosis via the Mir-27a-3p/TP53 Pathway. Curr Med Sci 2024; 44:333-345. [PMID: 38622424 DOI: 10.1007/s11596-024-2853-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 02/19/2024] [Indexed: 04/17/2024]
Abstract
OBJECTIVE Peritoneal fibrosis (PF) is the main cause of declining efficiency and ultrafiltration failure of the peritoneum, which restricts the long-term application of peritoneal dialysis (PD). This study aimed to investigate the therapeutic effects and mechanisms of bone marrow mesenchymal stem cells-derived exosomes (BMSC-Exos) on PF in response to PD. METHODS Small RNA sequencing analysis of BMSC-Exos was performed by second-generation sequencing. C57BL/6J mice were infused with 4.25% glucose-based peritoneal dialysis fluid (PDF) for 6 consecutive weeks to establish a PF model. A total of 36 mice were randomly divided into 6 groups: control group, 1.5% PDF group, 2.5% PDF group, 4.25% PDF group, BMSC-Exos treatment group, and BMSC-Exos+TP53 treatment group. Reverse transcription quantitative polymerase chain reaction (RT-qPCR) was performed to measure the expression level of miR-27a-3p in BMSC-Exos and peritoneum of mice treated with different concentrations of PDF. HE and Masson staining were performed to evaluate the extent of PF. The therapeutic potential of BMSC-Exos for PF was examined through pathological examination, RT-qPCR, Western blotting, and peritoneal function analyses. Epithelial-mesenchymal transition (EMT) of HMrSV5 was induced with 4.25% PDF. Cells were divided into control group, 4.25% PDF group, BMSC-Exos treatment group, and BMSC-Exos+TP53 treatment group. Cell Counting Kit-8 assay was used to measure cell viability, and transwell migration assay was used to verify the capacity of BMSC-Exos to inhibit EMT in HMrSV5 cells. RESULTS Small RNA sequencing analysis showed that miR-27a-3p was highly expressed in BMSC-derived exosomes compared to BMSCs. The RT-qPCR results showed that the expression of miR-27a-3p was upregulated in BMSC-Exos, but decreased in PD mice. We found that PF was glucose concentration-dependently enhanced in the peritoneum of the PD mice. Compared with the control mice, the PD mice showed high solute transport and decreased ultrafiltration volume as well as an obvious fibroproliferative response, with markedly increased peritoneal thickness and higher expression of α-SMA, collagen-I, fibronectin, and ECM1. The mice with PD showed decreased miR-27a-3p. Peritoneal structural and functional damage was significantly attenuated after BMSC-Exos treatment, while PF and mesothelial damage were significantly ameliorated. Additionally, markers of fibrosis (α-SMA, collagen-I, fibronectin, ECM1) and profibrotic cytokines (TGF-β1, PDGF) were downregulated at the mRNA and protein levels after BMSC-Exos treatment. In HMrSV5 cells, BMSC-Exos reversed the decrease in cell viability and the increase in cell migratory capacity caused by high-glucose PDF. Western blotting and RT-qPCR analysis revealed that BMSC-Exos treatment resulted in increased expression of E-cadherin (epithelial marker) and decreased expression of α-SMA, Snail, and vimentin (mesenchymal markers) compared to those of the 4.25% PDF-treated cells. Importantly, a dual-luciferase reporter assay showed that TP53 was a target gene of miR-27a-3p. TP53 overexpression significantly reversed the decreases in PF and EMT progression induced by BMSC-Exos. CONCLUSION The present results demonstrate that BMSC-Exos showed an obvious protective effect on PD-related PF and suggest that BMSC-derived exosomal miR-27a-3p may exert its inhibitory effect on PF and EMT progression by targeting TP53.
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Affiliation(s)
- Jun-Li Zhao
- Department of Nephrology, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, 201318, China.
| | - Lin Zhao
- Orthopedic Department, Guangming Traditional Chinese Medicine Hospital of Pudong New Area, Shanghai, 201399, China
| | - Qiu-Nan Zhan
- Department of Nephrology, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, 201318, China
| | - Miao Liu
- Department of Nephrology, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, 201318, China
| | - Ting Zhang
- Department of Nephrology, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, 201318, China
| | - Wen-Wen Chu
- Department of Nephrology, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, 201318, China
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Luna León LG, Vargas Flores J, Carbajal Cabrera PR, Morales Tercero YA, Narvaez Gonzalez HF. Chronic Encapsulated Sclerosing Peritonitis: A Case Report. Cureus 2024; 16:e58003. [PMID: 38738064 PMCID: PMC11087664 DOI: 10.7759/cureus.58003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2024] [Indexed: 05/14/2024] Open
Abstract
Chronic encapsulated sclerosing peritonitis (CESP) is a very rare cause of intestinal obstruction that has been associated with certain chronic conditions. It is characterized by the thickening of the peritoneum, generating a membrane that covers the intestinal loops and prevents their adequate mobilization. Most cases present as a surgical emergency, leading to a diagnosis during surgery; however, imaging studies can support the pre-surgical diagnosis. Treatment is based on the clinical context of the patient, based on medical management with corticosteroids in a stable patient, or surgical management when it presents as an acute complication. The morbidity and mortality associated with this condition are high and epidemiological data are scarce. There is still a lack of studies to describe the associated demographic data, diagnosis, and treatment.
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Affiliation(s)
| | - Julian Vargas Flores
- Surgery, Hospital Regional "General Ignacio Zaragoza", ISSSTE, Ciudad de México, MEX
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Szebeni B, Veres-Székely A, Pap D, Bokrossy P, Varga Z, Gaál A, Mihály J, Pállinger É, Takács IM, Pajtók C, Bernáth M, Reusz GS, Szabó AJ, Vannay Á. Extracellular Vesicles of Patients on Peritoneal Dialysis Inhibit the TGF-β- and PDGF-B-Mediated Fibrotic Processes. Cells 2024; 13:605. [PMID: 38607044 PMCID: PMC11011990 DOI: 10.3390/cells13070605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 03/12/2024] [Accepted: 03/27/2024] [Indexed: 04/13/2024] Open
Abstract
Among patients on peritoneal dialysis (PD), 50-80% will develop peritoneal fibrosis, and 0.5-4.4% will develop life-threatening encapsulating peritoneal sclerosis (EPS). Here, we investigated the role of extracellular vesicles (EVs) on the TGF-β- and PDGF-B-driven processes of peritoneal fibrosis. EVs were isolated from the peritoneal dialysis effluent (PDE) of children receiving continuous ambulatory PD. The impact of PDE-EVs on the epithelial-mesenchymal transition (EMT) and collagen production of the peritoneal mesothelial cells and fibroblasts were investigated in vitro and in vivo in the chlorhexidine digluconate (CG)-induced mice model of peritoneal fibrosis. PDE-EVs showed spherical morphology in the 100 nm size range, and their spectral features, CD63, and annexin positivity were characteristic of EVs. PDE-EVs penetrated into the peritoneal mesothelial cells and fibroblasts and reduced their PDE- or PDGF-B-induced proliferation. Furthermore, PDE-EVs inhibited the PDE- or TGF-β-induced EMT and collagen production of the investigated cell types. PDE-EVs contributed to the mesothelial layer integrity and decreased the submesothelial thickening of CG-treated mice. We demonstrated that PDE-EVs significantly inhibit the PDGF-B- or TGF-β-induced fibrotic processes in vitro and in vivo, suggesting that EVs may contribute to new therapeutic strategies to treat peritoneal fibrosis and other fibroproliferative diseases.
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Affiliation(s)
- Beáta Szebeni
- Pediatric Center, MTA Center of Excellence, Semmelweis University, 1083 Budapest, Hungary
- HUN-REN–SU Pediatrics and Nephrology Research Group, 1052 Budapest, Hungary
| | - Apor Veres-Székely
- Pediatric Center, MTA Center of Excellence, Semmelweis University, 1083 Budapest, Hungary
- HUN-REN–SU Pediatrics and Nephrology Research Group, 1052 Budapest, Hungary
| | - Domonkos Pap
- Pediatric Center, MTA Center of Excellence, Semmelweis University, 1083 Budapest, Hungary
- HUN-REN–SU Pediatrics and Nephrology Research Group, 1052 Budapest, Hungary
| | - Péter Bokrossy
- Pediatric Center, MTA Center of Excellence, Semmelweis University, 1083 Budapest, Hungary
| | - Zoltán Varga
- TTK Biological Nanochemistry Research Group, Institute of Materials and Environmental Chemistry, Research Centre for Natural Sciences, 1117 Budapest, Hungary
| | - Anikó Gaál
- TTK Biological Nanochemistry Research Group, Institute of Materials and Environmental Chemistry, Research Centre for Natural Sciences, 1117 Budapest, Hungary
| | - Judith Mihály
- TTK Biological Nanochemistry Research Group, Institute of Materials and Environmental Chemistry, Research Centre for Natural Sciences, 1117 Budapest, Hungary
| | - Éva Pállinger
- Department of Genetics, Cell- and Immunobiology, Semmelweis University, 1089 Budapest, Hungary
| | - István M. Takács
- Pediatric Center, MTA Center of Excellence, Semmelweis University, 1083 Budapest, Hungary
| | - Csenge Pajtók
- Pediatric Center, MTA Center of Excellence, Semmelweis University, 1083 Budapest, Hungary
| | - Mária Bernáth
- Pediatric Center, MTA Center of Excellence, Semmelweis University, 1083 Budapest, Hungary
| | - György S. Reusz
- Pediatric Center, MTA Center of Excellence, Semmelweis University, 1083 Budapest, Hungary
| | - Attila J. Szabó
- Pediatric Center, MTA Center of Excellence, Semmelweis University, 1083 Budapest, Hungary
- HUN-REN–SU Pediatrics and Nephrology Research Group, 1052 Budapest, Hungary
| | - Ádám Vannay
- Pediatric Center, MTA Center of Excellence, Semmelweis University, 1083 Budapest, Hungary
- HUN-REN–SU Pediatrics and Nephrology Research Group, 1052 Budapest, Hungary
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Tang J, Wang D, Chen Y, Feng J. The association between new inflammation markers and frequent peritoneal dialysis-associated peritonitis. BMC Nephrol 2024; 25:81. [PMID: 38443857 PMCID: PMC10916203 DOI: 10.1186/s12882-024-03496-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 02/07/2024] [Indexed: 03/07/2024] Open
Abstract
OBJECTIVE To validate an association between new inflammation and frequent peritoneal dialysis-associated peritonitis (PDAP). MATERIALS AND METHODS In China, retrospective clinical data were collected on 208 patients who received continuous ambulatory peritoneal dialysis (CAPD) between 2010 and 2021. The patients were divided into two groups: non-frequent PDAP (the interval between two peritonitis episodes of more than one year) and frequent PDAP (the interval between two peritonitis episodes of less than one year). Patients with their first episode of peritonitis had their age, gender, history of hypertension, diabetic disease, underlying renal disease, bacterial infection, and laboratory data collected. The outcomes of bacterial dispersion, systemic immune-inflammation index (SII), high-density lipoprotein cholesterol (HDL-C), C-reactive protein (CRP), and risk variables associated with frequent PDAP were analyzed. RESULTS There are differences between the two groups in dialysis time (p = 0.006), hypertensive nephropathy (p = 0.038), staphylococcus (p = 0.035), white blood cells (p = 0.001), neutrophil (p < 0.01), lymphocyte (p < 0.01), platelet(p = 0.01), SII(p < 0.01), CRP/HDL-C (p = 0.002), CRP (p < 0.001), serum creatinine (p = 0.007), blood urea nitrogen (p = 0.05), serum magnesium (0.03), serum potassium (p = 0.007), and dialysate polymorphonuclear cells (p = 0.004). Multifactorial logistic regression analysis found that SII (p < 0.001), CRP/HDL-C (p = 0.041), and Diabetes mellitus (p = 0.027) were independent risk factors for frequent PDAP. The ROC curve analysis revealed that combining SII with CRP/HDL-C resulted in the largest AUC area (AUC = 0.814). CONCLUSIONS Our findings offer clinical proof of the combination of SII and CRP/HDL-C in patients with frequent PDAP.
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Affiliation(s)
- Jing Tang
- Department of Nephrology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, Wuxi, China
| | - Dongxue Wang
- Department of Rheumatology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Yun Chen
- Department of Nephrology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Jinhong Feng
- Department of Nephrology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.
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Chen HL, Hung CC, Tian YC, Chen KH. Weekly intraperitoneal steroid infusion to treat recurrent ascites in a patient with early stage of peritoneal dialysis-related encapsulating peritoneal sclerosis: A case report. Perit Dial Int 2024; 44:141-144. [PMID: 37905306 DOI: 10.1177/08968608231205851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023] Open
Abstract
Encapsulating peritoneal sclerosis (EPS) is a rare and potentially fatal complication of long-term peritoneal dialysis (PD). EPS-induced large volume and recurrent ascites represents a challenging condition. We report a 51-year-old man with kidney failure treated with PD for 13 years who eventually developed early stage of EPS accompanied with poor intake and recurrent ascites. After management including discontinuing PD and switching to haemodialysis, as well as oral steroids and tamoxifen administration, the patient had refractory ascites. An intervention of weekly intraperitoneal steroid infusion with methylprednisolone was implemented for a year. Gradually, we observed a reduction in ascites drainage, an improvement of clinical symptoms and the patient's nutritional status. The PD catheter was successfully removed as there was no recurrence of ascites. Intraperitoneal corticosteroid administration represents a new intervention for patients with early stage of EPS and recurrent ascites after PD cessation.
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Affiliation(s)
- Huai-Liang Chen
- Kidney Research Center, Chang Gung Memorial Hospital, School of Medicine, Chang Gung University, Taoyuan
| | - Cheng-Chieh Hung
- Kidney Research Center, Chang Gung Memorial Hospital, School of Medicine, Chang Gung University, Taoyuan
| | - Ya-Chung Tian
- Kidney Research Center, Chang Gung Memorial Hospital, School of Medicine, Chang Gung University, Taoyuan
| | - Kuan-Hsing Chen
- Kidney Research Center, Chang Gung Memorial Hospital, School of Medicine, Chang Gung University, Taoyuan
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Zhao T, Ding T, Sun Z, Shao X, Li S, Lu H, Yuan JH, Guo Z. SPHK1/S1P/S1PR pathway promotes the progression of peritoneal fibrosis by mesothelial-mesenchymal transition. FASEB J 2024; 38:e23417. [PMID: 38226856 DOI: 10.1096/fj.202301323r] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 11/23/2023] [Accepted: 12/27/2023] [Indexed: 01/17/2024]
Abstract
Long-term exposure to non-physiologically compatible dialysate inevitably leads to peritoneal fibrosis (PF) in patients undergoing peritoneal dialysis (PD), and there is no effective prevention or treatment for PF. Sphingosine-1-phosphate (S1P) is a bioactive sphingolipid produced after catalysis by sphingosine kinase (SPHK) 1/2 and activates signals through the S1P receptor (S1PR) via autocrine or paracrine. However, the role of SPHK1/S1P/S1PR signaling has never been elucidated in PF. In our research, we investigated S1P levels in peritoneal effluents and demonstrated the role of SPHK1/S1P/S1PR pathway in peritoneal fibrosis. It was found that S1P levels in peritoneal effluents were positively correlated with D/P Cr (r = 0.724, p < .001) and negatively correlated with 4 h ultrafiltration volume (r = -0.457, p < .001). S1PR1 and S1PR3 on peritoneal cells were increased after high glucose exposure in vivo and in vitro. Fingolimod was applied to suppress S1P/S1PR pathway. Fingolimod restored mouse peritoneal function by reducing interstitial hyperplasia, maintaining ultrafiltration volume, reducing peritoneal transport solute rate, and mitigating the protein expression changes of fibronectin, vimentin, α-SMA, and E-cadherin induced by PD and S1P. Fingolimod preserved the morphology of the human peritoneal mesothelial cells, MeT-5A, and moderated the mesothelial-mesenchymal transition (MMT) process. We further delineated that SPHK1 was elevated in peritoneal cells after high glucose exposure and suppression of SPHK1 in MeT-5A cells reduced S1P release. Overexpression of SPHK1 in MeT-5A cells increased S1P levels in the supernatant and fostered the MMT process. PF-543 treatment, targeting SPHK1, alleviated deterioration of mouse peritoneal function. In conclusion, S1P levels in peritoneal effluent were correlated with the deterioration of peritoneal function. SPHK1/S1P/S1PR pathway played an important role in PF.
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Affiliation(s)
- Tingting Zhao
- Department of Nephrology, First Affiliated Hospital of Naval Medical University, Shanghai Changhai Hospital, Shanghai, China
- Department of Nephrology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Tao Ding
- Department of Endocrinology, Xizang Military General Hospital, Lhasa City, China
| | - Zhengyu Sun
- Department of Nephrology, First Affiliated Hospital of Naval Medical University, Shanghai Changhai Hospital, Shanghai, China
| | - Xin Shao
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shuangxi Li
- Department of Nephrology, First Affiliated Hospital of Naval Medical University, Shanghai Changhai Hospital, Shanghai, China
| | - Hongtao Lu
- Department of Nutrition, Naval Medical University, Shanghai, China
| | - Ji-Hang Yuan
- Department of Medical Genetics, Naval Medical University, Shanghai, China
| | - Zhiyong Guo
- Department of Nephrology, First Affiliated Hospital of Naval Medical University, Shanghai Changhai Hospital, Shanghai, China
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Huang SH, Hong ZJ, Chen MF, Tsai MW, Chen SJ, Cheng CP, Sytwu HK, Lin GJ. Melatonin inhibits the formation of chemically induced experimental encapsulating peritoneal sclerosis through modulation of T cell differentiation by suppressing of NF-κB activation in dendritic cells. Int Immunopharmacol 2024; 126:111300. [PMID: 38016346 DOI: 10.1016/j.intimp.2023.111300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 11/19/2023] [Accepted: 11/24/2023] [Indexed: 11/30/2023]
Abstract
Encapsulating peritoneal sclerosis (EPS) is a severe complication of peritoneal dialysis (PD). Surgery is a therapeutic strategy for the treatment of complete intestinal obstruction. However, complete intestinal obstruction in long-term PD results in high mortality and morbidity rates after surgery. Immunopathogenesis participates in EPS formation: CD8, Th1, and Th17 cell numbers increased during the formation of EPS. The anti-inflammatory and immunomodulatory effects of melatonin may have beneficial effects on this EPS. In the present study, we determined that melatonin treatment significantly decreases the Th1 and Th17 cell populations in mice with EPS, decreases the production of IL-1β, TNF-α, IL-6, and IFN-γ, and increases the production of IL-10. The suppression of Th1 and Th17 cell differentiation by melatonin occurs through the inhibition of dendritic cell (DC) activation by affecting the initiation of the NF-κB signaling pathway in DCs. Our study suggests that melatonin has preventive potential against the formation of EPS in patients with PD.
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Affiliation(s)
- Shing-Hwa Huang
- Department of Biology and Anatomy, National Defense Medical Center, Taipei, Taiwan; Department of General Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Department of General Surgery, En Chu Kong Hospital, New Taipei, Taiwan
| | - Zhi-Jie Hong
- Department of General Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Department of Microbiology and Immunology, National Defense Medical Center, Taipei, Taiwan
| | - Mei-Fei Chen
- Department of Biology and Anatomy, National Defense Medical Center, Taipei, Taiwan
| | - Meng-Wei Tsai
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Shyi-Jou Chen
- Department of Microbiology and Immunology, National Defense Medical Center, Taipei, Taiwan
| | - Chia-Pi Cheng
- Department of Biology and Anatomy, National Defense Medical Center, Taipei, Taiwan
| | - Huey-Kang Sytwu
- Department of Microbiology and Immunology, National Defense Medical Center, Taipei, Taiwan; National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Zhunan, Miaoli County, Taiwan
| | - Gu-Jiun Lin
- Department of Biology and Anatomy, National Defense Medical Center, Taipei, Taiwan; Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan.
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Wang CJ, Chao YJ, Liu YS, Liao FT, Chang SS, Liao TK, Lu WH, Su PJ, Shan YS. Prediction of surgical outcomes in severe encapsulating peritoneal sclerosis using a computed tomography scoring system. J Formos Med Assoc 2024; 123:98-105. [PMID: 37365098 DOI: 10.1016/j.jfma.2023.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 04/27/2023] [Accepted: 06/14/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND/PURPOSE Encapsulating peritoneal sclerosis (EPS) is a rare and potential lethal complication of peritoneal dialysis characterized by bowel obstruction. Surgical enterolysis is the only curative therapy. Currently, there are no tools for predicting postsurgical prognosis. This study aimed to identify a computed tomography (CT) scoring system that could predict mortality after surgery in patients with severe EPS. METHODS This retrospective study enrolled patients with severe EPS who underwent surgical enterolysis in a tertiary referral medical center. The association of CT score with surgical outcomes including mortality, blood loss, and bowel perforation was analyzed. RESULTS Thirty-four patients who underwent 37 procedures were recruited and divided into a survivor and non-survivor group. The survivor group had higher body mass indices (BMIs, 18.1 vs. 16.7 kg/m2, p = 0.035) and lower CT scores (11 vs. 17, p < 0.001) than the non-survivor group. The receiver operating characteristic curve revealed that a CT score of ≥15 could be considered a cutoff point to predict surgical mortality, with an area under the curve of 0.93, sensitivity of 88.9%, and specificity of 82.1%. Compared with the group with CT scores of <15, the group with CT scores of ≥15 had a lower BMI (19.7 vs. 16.2 kg/m2, p = 0.004), higher mortality (4.2% vs. 61.5%, p < 0.001), greater blood loss (50 vs. 400 mL, p = 0.007), and higher incidence of bowel perforation (12.5% vs. 61.5%, p = 0.006). CONCLUSION The CT scoring system could be useful in predicting surgical risk in patients with severe EPS receiving enterolysis.
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Affiliation(s)
- Chih-Jung Wang
- Division of Trauma, Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan; Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ying Jui Chao
- Division of General Surgery, Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Yi-Sheng Liu
- Department of Radiology, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Fan-Ting Liao
- Division of General Surgery, Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Shen-Shin Chang
- Division of Transplantation, Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Ting-Kai Liao
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Division of General Surgery, Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Wei-Hsun Lu
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Division of General Surgery, Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Ping-Jui Su
- Division of General Surgery, Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Yan-Shen Shan
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Division of General Surgery, Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan.
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11
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Zhang Y, Xu M, Xie X, Chen Y. Mesentery stiffness changes in a patient with encapsulated peritoneal sclerosis by real-time shear-wave elastography ultrasound with histological reference. Ren Fail 2023; 45:2183042. [PMID: 36856320 PMCID: PMC9980413 DOI: 10.1080/0886022x.2023.2183042] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Affiliation(s)
- Yutong Zhang
- Department of Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Ming Xu
- Department of Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xiaoyan Xie
- Department of Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yujun Chen
- Department of Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China,
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Kunitatsu K, Yamamoto Y, Nasu S, Taniji A, Kawashima S, Yamagishi N, Ito T, Inoue S, Kanai Y. Novel Peritoneal Sclerosis Rat Model Developed by Administration of Bleomycin and Lansoprazole. Int J Mol Sci 2023; 24:16108. [PMID: 38003303 PMCID: PMC10671295 DOI: 10.3390/ijms242216108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 11/02/2023] [Accepted: 11/03/2023] [Indexed: 11/26/2023] Open
Abstract
In our preliminary experiment, peritoneal sclerosis likely induced by peritoneal dialysis was unexpectedly observed in the livers of rats given bleomycin and lansoprazole. We examined whether this peritoneal thickening around the liver was time-dependently induced by administration of both drugs. Male Wistar rats were injected with bleomycin and/or lansoprazole for 2 or 4 weeks. The 3YB-1 cell line derived from rat fibroblasts was treated by bleomycin and/or lansoprazole for 24 h. The administration of both drugs together, but not individually, thickened the peritoneal tissue around the liver. There was accumulation of collagen fibers, macrophages, and eosinophils under mesothelial cells. Expressions of Col1a1, Mcp1 and Mcp3 genes were increased in the peritoneal tissue around the liver and in 3YB-1 cells by the administration of both drugs together, and Opn genes had increased expressions in this tissue and 3YB-1 cells. Mesothelial cells indicated immunoreactivity against both cytokeratin, a mesothelial cell marker, and αSMA, a fibroblast marker, around the livers of rats given both drugs. Administration of both drugs induced the migration of macrophages and eosinophils and induced fibrosis associated with the possible activation of fibroblasts and the possible promotion of the mesothelial-mesenchymal transition. This might become a novel model of peritoneal sclerosis for peritoneal dialysis.
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Affiliation(s)
- Kosei Kunitatsu
- Department of Emergency and Critical Care Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8509, Japan
| | - Yuta Yamamoto
- Department of Anatomy and Cell Biology, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8509, Japan
| | - Shota Nasu
- Department of Anatomy and Cell Biology, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8509, Japan
| | - Akira Taniji
- Department of Anatomy and Cell Biology, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8509, Japan
| | - Shuji Kawashima
- Department of Emergency and Critical Care Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8509, Japan
| | - Naoko Yamagishi
- Department of Anatomy and Cell Biology, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8509, Japan
| | - Takao Ito
- Department of Anatomy and Cell Biology, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8509, Japan
| | - Shigeaki Inoue
- Department of Emergency and Critical Care Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8509, Japan
| | - Yoshimitsu Kanai
- Department of Anatomy and Cell Biology, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8509, Japan
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13
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Huang W, Xia D, Bi W, Lai X, Yu B, Chen W. Advances in stem cell therapy for peritoneal fibrosis: from mechanisms to therapeutics. Stem Cell Res Ther 2023; 14:293. [PMID: 37817212 PMCID: PMC10566108 DOI: 10.1186/s13287-023-03520-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 09/26/2023] [Indexed: 10/12/2023] Open
Abstract
Peritoneal fibrosis (PF) is a pathophysiological condition caused by a variety of pathogenic factors. The most important features of PF are mesothelial-mesenchymal transition and accumulation of activated (myo-)fibroblasts, which hinder effective treatment; thus, it is critical to identify other practical approaches. Recently, stem cell (SC) therapy has been indicated to be a potential strategy for this disease. Increasing evidence suggests that many kinds of SCs alleviate PF mainly by differentiating into mesothelial cells; secreting cytokines and extracellular vesicles; or modulating immune cells, particularly macrophages. However, there are relatively few articles summarizing research in this direction. In this review, we summarize the risk factors for PF and discuss the therapeutic roles of SCs from different sources. In addition, we outline effective approaches and potential mechanisms of SC therapy for PF. We hope that our review of articles in this area will provide further inspiration for research on the use of SCs in PF treatment.
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Affiliation(s)
- Weiyan Huang
- Department of Nephrology, Shanghai Changhai Hospital, Naval Medical University, Shanghai, China
| | - Demeng Xia
- Department of Pharmacy, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Wendi Bi
- Department of Nephrology, Shanghai Changhai Hospital, Naval Medical University, Shanghai, China
| | - Xueli Lai
- Department of Nephrology, Shanghai Changhai Hospital, Naval Medical University, Shanghai, China
| | - Bing Yu
- Department of Cell Biology, Center for Stem Cell and Medicine, Naval Medical University (Second Military Medical University), Shanghai, China.
| | - Wei Chen
- Department of Nephrology, Shanghai Changhai Hospital, Naval Medical University, Shanghai, China.
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14
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Zhang C, Bartosova M, Marinovic I, Schwab C, Schaefer B, Vondrak K, Ariceta G, Zaloszyc A, Ranchin B, Taylan C, Büscher R, Oh J, Mehrabi A, Schmitt CP. Peritoneal transformation shortly after kidney transplantation in pediatric patients with preceding chronic peritoneal dialysis. Nephrol Dial Transplant 2023; 38:2170-2181. [PMID: 36754369 DOI: 10.1093/ndt/gfad031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND The unphysiological composition of peritoneal dialysis (PD) fluids induces progressive peritoneal fibrosis, hypervascularization and vasculopathy. Information on these alterations after kidney transplantation (KTx) is scant. METHODS Parietal peritoneal tissues were obtained from 81 pediatric patients with chronic kidney disease stage 5 (CKD5), 72 children on PD with low glucose degradation product (GDP) PD fluids, and from 20 children 4-8 weeks after KTx and preceding low-GDP PD. Tissues were analyzed by digital histomorphometry and quantitative immunohistochemistry. RESULTS While chronic PD was associated with peritoneal hypervascularization, after KTx vascularization was comparable to CKD5 level. Submesothelial CD45 counts were 40% lower compared with PD, and in multivariable analyses independently associated with microvessel density. In contrast, peritoneal mesothelial denudation, submesothelial thickness and fibrin abundance, number of activated, submesothelial fibroblasts and of mesothelial-mesenchymal transitioned cells were similar after KTx. Diffuse peritoneal podoplanin positivity was present in 40% of the transplanted patients. In subgroups matched for age, PD vintage, dialytic glucose exposure and peritonitis incidence, submesothelial hypoxia-inducible factor 1-alpha abundance and angiopoietin 1/2 ratio were lower after KTx, reflecting vessel maturation, while arteriolar and microvessel p16 and cleaved Casp3 were higher. Submesothelial mast cell count and interleukin-6 were lower, whereas transforming growth factor-beta induced pSMAD2/3 was similar as compared with children on PD. CONCLUSIONS Peritoneal membrane damage induced with chronic administration of low-GDP PD fluids was less severe after KTx. While peritoneal microvessel density, primarily defining PD transport and ultrafiltration capacity, was normal after KTx and peritoneal inflammation less pronounced, diffuse podoplanin positivity and profibrotic activity were prevalent.
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Affiliation(s)
- Conghui Zhang
- Center for Pediatric and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany
| | - Maria Bartosova
- Center for Pediatric and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany
| | - Iva Marinovic
- Center for Pediatric and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany
| | - Constantin Schwab
- Institute of Pathology, University of Heidelberg, Heidelberg, Germany
| | - Betti Schaefer
- Center for Pediatric and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany
| | - Karel Vondrak
- Department of Pediatrics, University Hospital Motol, Prague, Czech Republic
| | - Gema Ariceta
- Hospital Universitario Materno-Infantil Vall d'Hebron, Barcelona, Spain
| | - Ariane Zaloszyc
- Department of Pediatrics 1, University Hospital of Strasbourg, Strasbourg, France
| | - Bruno Ranchin
- Service de Néphrologie Pédiatrique, Hôpital Femme Mere Enfant, Lyon, France
| | - Christina Taylan
- Pediatric Nephrology, Children's and Adolescent's Hospital, University Hospital of Cologne, Cologne, Germany
| | - Rainer Büscher
- Pediatric Nephrology, University Children's Hospital, Essen, Germany
| | - Jun Oh
- Department of Pediatric Nephrology, University Children's Medical Clinic, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Arianeb Mehrabi
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Claus Peter Schmitt
- Center for Pediatric and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany
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15
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Zhao T, Sun Z, Lai X, Lu H, Liu L, Li S, Yuan JH, Guo Z. Tamoxifen exerts anti-peritoneal fibrosis effects by inhibiting H19-activated VEGFA transcription. J Transl Med 2023; 21:614. [PMID: 37697303 PMCID: PMC10494369 DOI: 10.1186/s12967-023-04470-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/25/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Peritoneal dialysis (PD) remains limited due to dialysis failure caused by peritoneal fibrosis. Tamoxifen (TAM), an inhibitor of estrogen receptor 1 (ESR1), has been reported to treat fibrosis, but the underlying mechanism remains unknown. In this study, we sought to explore whether tamoxifen played an anti-fibrotic role by affecting transcription factor ESR1. METHODS ESR1 expression was detected in the human peritoneum. Mice were daily intraperitoneally injected with 4.25% glucose PD dialysate containing 40 mM methylglyoxal for 2 weeks to establish PD-induced peritoneal fibrosis. Tamoxifen was administrated by daily gavage, at the dose of 10 mg/kg. Chromatin immunoprecipitation (ChIP) and dual-luciferase reporter assay were performed to validate ESR1 bound H19 promoter. Gain-of-function and loss-of-function experiments were performed to investigate the biological roles of H19 on the mesothelial-mesenchymal transition (MMT) of human peritoneal mesothelial cells (HPMCs). Intraperitoneal injection of nanomaterial-wrapped 2'-O-Me-modified small interfering RNA was applied to suppress H19 in the mouse peritoneum. RNA immunoprecipitation and RNA pull-down assays demonstrated binding between H19 and p300. Exfoliated peritoneal cells were obtained from peritoneal dialysis effluent to analyze the correlations between ESR1 (or H19) and peritoneal solute transfer rate (PSTR). RESULTS ESR1 was increased significantly in the peritoneum after long-term exposure to PD dialysate. Tamoxifen treatment ameliorated high glucose-induced MMT of HPMCs, improved ultrafiltration rate, and decreased PSTR of mouse peritoneum. Tamoxifen reduced the H19 level by decreasing the ESR1 transcription of H19. Depletion of H19 reversed the pro-fibrotic effect of high glucose while ectopic expression of H19 exacerbated fibrotic pathological changes. Intraperitoneal injection of nanomaterial-wrapped 2'-O-Me-modified siRNAs targeting H19 mitigated PD-related fibrosis in mice. RNA immunoprecipitation (RIP) and RNA pull-down results delineated that H19 activated VEGFA expression by binding p300 to the VEGFA promoter and inducing histone acetylation of the VEGFA promoter. ESR1 and H19 were promising targets to predict peritoneal function. CONCLUSIONS High glucose-induced MMT of peritoneal mesothelial cells in peritoneal dialysis via activating ESR1. In peritoneal mesothelial cells, ESR1 transcribed the H19 and H19 binds to transcription cofactor p300 to activate the VEGFA. Targeting ESR1/H19/VEGFA pathway provided new hope for patients undergoing peritoneal dialysis.
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Affiliation(s)
- Tingting Zhao
- Department of Nephrology, First Affiliated Hospital of Naval Medical University, Shanghai Changhai Hospital, Shanghai, 200433, China
- Department of Nephrology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200433, China
| | - Zhengyu Sun
- Department of Nephrology, First Affiliated Hospital of Naval Medical University, Shanghai Changhai Hospital, Shanghai, 200433, China
| | - Xueli Lai
- Department of Nephrology, First Affiliated Hospital of Naval Medical University, Shanghai Changhai Hospital, Shanghai, 200433, China
| | - Hongtao Lu
- Department of Nutrition, Naval Medical University, Shanghai, 200433, China
| | - Lulu Liu
- Department of Nephrology, First Affiliated Hospital of Naval Medical University, Shanghai Changhai Hospital, Shanghai, 200433, China
| | - Shuangxi Li
- Department of Nephrology, First Affiliated Hospital of Naval Medical University, Shanghai Changhai Hospital, Shanghai, 200433, China
| | - Ji-Hang Yuan
- Department of Medical Genetics, Naval Medical University, Shanghai, 200433, China.
| | - Zhiyong Guo
- Department of Nephrology, First Affiliated Hospital of Naval Medical University, Shanghai Changhai Hospital, Shanghai, 200433, China.
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16
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Pap D, Pajtók C, Veres-Székely A, Szebeni B, Szász C, Bokrossy P, Zrufkó R, Vannay Á, Tulassay T, Szabó AJ. High Salt Promotes Inflammatory and Fibrotic Response in Peritoneal Cells. Int J Mol Sci 2023; 24:13765. [PMID: 37762068 PMCID: PMC10531298 DOI: 10.3390/ijms241813765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 09/01/2023] [Accepted: 09/04/2023] [Indexed: 09/29/2023] Open
Abstract
Recent studies draw attention to how excessive salt (NaCl) intake induces fibrotic alterations in the peritoneum through sodium accumulation and osmotic events. The aim of our study was to better understand the underlying mechanisms. The effects of additional NaCl were investigated on human primary mesothelial cells (HPMC), human primary peritoneal fibroblasts (HPF), endothelial cells (HUVEC), immune cells (PBMC), as well as ex vivo on peritoneal tissue samples. Our results showed that a high-salt environment and the consequently increased osmolarity increase the production of inflammatory cytokines, profibrotic growth factors, and components of the renin-angiotensin-aldosterone system, including IL1B, IL6, MCP1, TGFB1, PDGFB, CTGF, Renin and Ace both in vitro and ex vivo. We also demonstrated that high salt induces mesenchymal transition by decreasing the expression of epithelial marker CDH1 and increasing the expression of mesenchymal marker ACTA2 and SNAIL1 in HPMCs, HUVECs and peritoneal samples. Furthermore, high salt increased extracellular matrix production in HPFs. We demonstrated that excess Na+ and the consequently increased osmolarity induce a comprehensive profibrotic response in the peritoneal cells, thereby facilitating the development of peritoneal fibrosis.
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Affiliation(s)
- Domonkos Pap
- Pediatric Center, MTA Center of Excellence, Semmelweis University, 1085 Budapest, Hungary
- HUN-REN–SU Pediatrics and Nephrology Research Group, 1052 Budapest, Hungary
| | - Csenge Pajtók
- Pediatric Center, MTA Center of Excellence, Semmelweis University, 1085 Budapest, Hungary
| | - Apor Veres-Székely
- Pediatric Center, MTA Center of Excellence, Semmelweis University, 1085 Budapest, Hungary
- HUN-REN–SU Pediatrics and Nephrology Research Group, 1052 Budapest, Hungary
| | - Beáta Szebeni
- Pediatric Center, MTA Center of Excellence, Semmelweis University, 1085 Budapest, Hungary
- HUN-REN–SU Pediatrics and Nephrology Research Group, 1052 Budapest, Hungary
| | - Csenge Szász
- Pediatric Center, MTA Center of Excellence, Semmelweis University, 1085 Budapest, Hungary
| | - Péter Bokrossy
- Pediatric Center, MTA Center of Excellence, Semmelweis University, 1085 Budapest, Hungary
| | - Réka Zrufkó
- Pediatric Center, MTA Center of Excellence, Semmelweis University, 1085 Budapest, Hungary
| | - Ádám Vannay
- Pediatric Center, MTA Center of Excellence, Semmelweis University, 1085 Budapest, Hungary
- HUN-REN–SU Pediatrics and Nephrology Research Group, 1052 Budapest, Hungary
| | - Tivadar Tulassay
- Pediatric Center, MTA Center of Excellence, Semmelweis University, 1085 Budapest, Hungary
- HUN-REN–SU Pediatrics and Nephrology Research Group, 1052 Budapest, Hungary
| | - Attila J. Szabó
- Pediatric Center, MTA Center of Excellence, Semmelweis University, 1085 Budapest, Hungary
- HUN-REN–SU Pediatrics and Nephrology Research Group, 1052 Budapest, Hungary
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17
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Pintar T, Tavčar M, Šušteršič A, Volavšek M. Primary sclerosing encapsulating peritonitis: a case report. J Med Case Rep 2023; 17:318. [PMID: 37443141 DOI: 10.1186/s13256-023-04020-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 06/02/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Sclerosing encapsulating peritonitis is a rare condition with a typical macroscopic appearance, with fibrocollagenous membrane enclosing loops of the small intestine, causing intestinal obstruction. Unexplained recurrent abdominal pain, obstruction, and a large array of other possible clinical signs and symptoms make sclerosing encapsulating peritonitis a diagnostic challenge. CASE PRESENTATION A 48-year-old man of Persian ethnicity was admitted multiple times to the emergency surgery department due to recurrent sudden abdominal pain and chronic obstruction without significant findings in medical history or clinical evaluation. Computed tomography was positive for proximal jejunal dilatation and duodenojejunal flexure stenosis due to internal mesenteric hernia. Exploratory laparoscopy, followed by laparotomy, confirmed thick membrane-like fibrous tissue with complete small intestinal loop envelopment. Extensive membrane excision and adhesiolysis was performed, but no mesenteric herniation was found. Early postoperative paralytic ileus with introduction of low-dose steroid therapy, based on histopathological and immunological results, confirming type III sclerosing encapsulating peritonitis, was completely resolved. CONCLUSION Sclerosing encapsulating peritonitis is a rare and difficult-to-diagnose condition, further divided into primary and secondary sclerosing encapsulating peritonitis, on the basis of underlying etiology, dictating treatment modality and prognosis. Intraoperative diagnosis and surgical treatment are mandatory, besides a wide variety of abdominal computed tomography scans, inconclusive results, and clinical presentations. There are so far no known specific markers for the diagnosis of sclerosing encapsulating peritonitis.
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Affiliation(s)
- T Pintar
- Medical Faculty, University of Ljubljana, Ljubljana, Slovenia.
- University Medical Center Ljubljana, Ljubljana, Slovenia.
| | - M Tavčar
- Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - A Šušteršič
- University Medical Center Ljubljana, Ljubljana, Slovenia
| | - M Volavšek
- Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
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18
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Yokoyama N, Kinoshita R, Ohta H, Okada K, Shimbo G, Sasaoka K, Nagata N, Sasaki N, Morishita K, Nakamura K, Kagawa Y, Takiguchi M. Successful treatment of sclerosing encapsulating peritonitis in a cat using bioresorbable hyaluronate-carboxymethylcellulose membrane after surgical adhesiolysis and long-term prednisolone. JFMS Open Rep 2023; 9:20551169231209917. [PMID: 38022706 PMCID: PMC10676633 DOI: 10.1177/20551169231209917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023] Open
Abstract
Case summary An 8-year-old neutered male domestic shorthair indoor cat was presented with an 8-week history of intermittent vomiting, anorexia and weight loss that had been unresponsive to supportive treatment. Abdominal ultrasound revealed plication of the small intestine and fluid accumulation proximal to the lesion, and a linear foreign body was suspected. An exploratory celiotomy showed cocoon-like encapsulation of the entire intestine. Surgical adhesiolysis and full-thickness biopsy were performed, and histopathologic examination revealed mild thickening of the visceral peritoneum with fibrin deposition, as well as mild neutrophil and lymphocyte infiltration. These findings were compatible with sclerosing encapsulating peritonitis (SEP). The cat recovered well postoperatively and was discharged the next day. Prednisolone was administered for 7 weeks to prevent recurrence of SEP. Five months after surgery, the cat was re-presented with anorexia and chronic vomiting. Based on the clinical examination findings, recurrent SEP was suspected. At the second surgery, surgical adhesiolysis was repeated and a bioresorbable hyaluronate-carboxymethylcellulose membrane was used to cover the serosal surface and thus prevent adhesion formation. Histopathologic findings of the peritoneal biopsy specimen confirmed SEP. Long-term prednisolone treatment (1 mg/kg for the first dose and 0.5 mg/kg every 48 h for maintenance) was administered postoperatively. The cat survived for more than 1239 days without recurrence. Relevance and novel information To our knowledge, this is the first report of SEP in a cat with long-term survival. The use of a bioresorbable hyaluronate-carboxymethylcellulose membrane and long-term prednisolone treatment may have prevented short-term and long-term recurrence, respectively, in this case.
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Affiliation(s)
- Nozomu Yokoyama
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Japan
| | - Ryohei Kinoshita
- Veterinary Teaching Hospital, Department of Veterinary Clinical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Japan
| | - Hiroshi Ohta
- Department of Companion Animal Clinical Sciences, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Japan
| | | | - Genya Shimbo
- Veterinary Teaching Hospital, Department of Veterinary Clinical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Japan
| | - Kazuyoshi Sasaoka
- Veterinary Teaching Hospital, Department of Veterinary Clinical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Japan
| | - Noriyuki Nagata
- Veterinary Teaching Hospital, Department of Veterinary Clinical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Japan
| | - Noboru Sasaki
- Veterinary Teaching Hospital, Department of Veterinary Clinical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Japan
| | - Keitaro Morishita
- Veterinary Teaching Hospital, Department of Veterinary Clinical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Japan
| | - Kensuke Nakamura
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Japan
| | | | - Mitsuyoshi Takiguchi
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Japan
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19
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Kiniger C, Janssen JN, Lederer KA, Lipnik K, Doulidis PG. Sclerosing encapsulating peritonitis in cats: a two-case report and literature review. JFMS Open Rep 2023; 9:20551169231178447. [PMID: 37434990 PMCID: PMC10331345 DOI: 10.1177/20551169231178447] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2023] Open
Abstract
Case series summary Two castrated male domestic shorthair cats (aged 8 months [case 1] and 13 years [case 2]) were presented at the Small Animal Clinic of the Veterinary Medicine University of Vienna, Austria, both with acute vomiting and distended abdomen, as well as a history of chronic apathy, recurrent vomiting and diarrhoea. Both cats underwent invasive diagnostic procedures approximately 1 month before the diagnosis of sclerosing encapsulating peritonitis (SEP), namely an exploratory laparotomy and a bronchoscopy, respectively. Abdominal ultrasound revealed severely corrugated intestinal loops and, in case 2, the presence of peritoneal effusion. A thick and diffuse fibrous capsule around the intestine was detected and removed surgically, and biopsies were taken from the affected organs confirming the SEP. Case 1 recovered well, was discharged some days after surgery and was clinically unremarkable for the next 2 years. Case 2 showed unsatisfactory improvement directly after surgery and was euthanased a few days later, as the owner declined any further therapy. Relevance and novel information SEP is a very rare condition of unclear origins in cats. Here we describe the clinical and diagnostic imaging features, surgical treatment, and outcome of SEP in two cats. The results indicate that prompt diagnosis and appropriate interventions may improve the outcome.
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Affiliation(s)
- Caterina Kiniger
- Clinical Unit of Small Animal Internal Medicine, Department for Small Animals and Horses, University of Veterinary Medicine, Vienna, Austria
| | - Janina N Janssen
- Clinical Unit of Small Animal Surgery, Department for Small Animals and Horses, University of Veterinary Medicine, Vienna, Austria
| | - Kristina A Lederer
- Diagnostic Imaging, Department for Small Animals and Horses, University of Veterinary Medicine, Vienna, Austria
| | - Karoline Lipnik
- Institute of Pathology, Department of Pathobiology, University of Veterinary Medicine, Vienna, Austria
| | - Pavlos G Doulidis
- Clinical Unit of Small Animal Internal Medicine, Department for Small Animals and Horses, University of Veterinary Medicine, Vienna, Austria
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20
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McCrory MA, Heard MA, Wright JG, Roche KF. Sclerosing Encapsulating Peritonitis: A Rare Cause of Bowel Obstruction. Am Surg 2023:31348231160821. [PMID: 36872044 DOI: 10.1177/00031348231160821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
Sclerosing encapsulating peritonitis (SEP), also referred to as abdominal cocoon syndrome, is a rare cause of bowel obstruction characterized by a thickened fibrous peritoneum that encapsulates the intestines. The exact etiology is idiopathic but may be associated with long-term peritoneal dialysis (PD). In the absence of risk factors for adhesive disease, preoperative diagnosis can be difficult and may require operative intervention or advanced imaging to diagnose. Thus, the inclusion of SEP in the differential diagnosis for bowel obstruction is essential for early detection. Existing literature is focused on renal disease as an origin, but it can be multifactorial. Here, we discuss a case of sclerosing encapsulating peritonitis in a patient without known risk factors.
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Affiliation(s)
- Mary A McCrory
- Quillen College of Medicine, 12324East Tennessee State University, Johnson City, TN, USA
| | - Matthew A Heard
- Quillen College of Medicine, 12324East Tennessee State University, Johnson City, TN, USA
| | - Jessica G Wright
- Quillen College of Medicine, 12324East Tennessee State University, Johnson City, TN, USA
| | - Keelin F Roche
- Quillen College of Medicine, 12324East Tennessee State University, Johnson City, TN, USA
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21
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Li F, Wang Y, Tian J, Zhou Z, Yin W, Qin X, Wang H, Zeng T, Li A, Jiang J. Inhibition of calpain9 attenuates peritoneal dialysis-related peritoneal fibrosis. Front Pharmacol 2022; 13:962770. [DOI: 10.3389/fphar.2022.962770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 11/18/2022] [Indexed: 12/04/2022] Open
Abstract
Aim: Peritoneal dialysis is a common renal replacement method for end-stage renal disease. Long-term peritoneal dialysis leads to peritoneal dialysis-related peritoneal fibrosis, which leads to a cessation of treatment. Calpain is a protein belonging to calcium-dependent endopeptidase family and plays an important role in extracellular matrix remodeling. Here, we evaluated the effect of calpain in peritoneal dialysis-related peritoneal fibrosis.Methods: We established two animal models of peritoneal fibrosis and inhibited the activity of Calpain, and then collected peritoneal tissue to evaluate the progress of fibrosis and the changes of Calpain and β-catenin. We obtained Rat peritoneal mesothelial cells and Human peritoneal mesothelial cell line and stimulated with TGF-β to produce extracellular matrix. Next we inhibited Calpain activity or reduced Calpain9 expression, and then assessed changes in extracellular matrix and β-catenin.Results: Inhibition of calpain activity attenuated chlorhexidine glucose and peritoneal dialysis-induced peritoneal thickening and β-catenin expression in mice. In addition, compared with the control group, when primary rat peritoneal mesothelial cells or human peritoneal mesothelial cells were treated with transforming growth factor beta, down-regulation of calpain activity inhibited the expression of Fibronectin and Collagen I, and increased the expression of E-cadherin. These changes could be adjusted after silencing calpain9. Finally, calpain9 deficiency was associated with down-regulation of Fibronectin and β-catenin in human peritoneal mesothelial cells.Conclusion: Our results suggest that calpain9 may be a key molecule in mediating peritoneal dialysis-related peritoneal fibrosis.
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22
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Finnegan A, Glass S, Mookherjee S. An encompassing issue. J Hosp Med 2022; 17:921-925. [PMID: 36052703 DOI: 10.1002/jhm.12950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 08/01/2022] [Accepted: 08/10/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Anila Finnegan
- Division of General Internal Medicine, University of Washington, Seattle, Washington, USA
- VA Puget Sound Health Care System, Seattle, Washington, USA
| | - Susan Glass
- Division of General Internal Medicine, University of Washington, Seattle, Washington, USA
- VA Puget Sound Health Care System, Seattle, Washington, USA
| | - Somnath Mookherjee
- Division of General Internal Medicine, University of Washington, Seattle, Washington, USA
- University of Washington Medical Center, Seattle, Washington, USA
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Pepereke S, Shah AD, Brown EA. Encapsulating peritoneal sclerosis: Your questions answered. Perit Dial Int 2022; 43:119-127. [PMID: 36189954 DOI: 10.1177/08968608221125606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Encapsulating peritoneal sclerosis (EPS) is a clinical syndrome hallmarked by the formation of a fibrous cocoon encapsulating the bowel resulting in morbidity and mortality. EPS is most frequently associated with peritoneal dialysis (PD), particularly with its discontinuation. While EPS is one of the most feared complications of PD, the majority of patients receiving PD will not go on to develop EPS. Risk factors for development include time on PD, some types of peritonitis and discontinuation of PD. Owing to its rarity, much of the knowledge of EPS comes from case series and registries and treatments are extrapolated from low-quality evidence. Malnutrition is a significant driver of mortality, and nutritional support is critical in management. We present a case of EPS and frequently asked questions including the definition, diagnosis, epidemiology, pathophysiology, risk factors, role of infection, management and roles of nutrition and surgery.
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Affiliation(s)
- Shingai Pepereke
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, UK
| | - Ankur D Shah
- Division of Kidney Disease and Hypertension, Department of Medicine, Rhode Island Hospital, Providence, RI, USA
- Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Edwina A Brown
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, UK
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24
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Gong F, Qu R, Li Y, Lv Y, Dai J. Astragalus Mongholicus: A review of its anti-fibrosis properties. Front Pharmacol 2022; 13:976561. [PMID: 36160396 PMCID: PMC9490009 DOI: 10.3389/fphar.2022.976561] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 08/18/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Fibrosis-related diseases (FRD) include cerebral fibrosis, pulmonary fibrosis, cardiac fibrosis, liver fibrosis, renal fibrosis, peritoneal fibrosis, etc. The effects of fibrosis can be severe, resulting in organ dysfunction, functional decline, and even organ failure, which can cause serious health problems.Aim: Currently, there is no effective modern medicine for anti-fibrosis in the clinics; however, Chinese medicine has a certain beneficial effect on treating such diseases. Astragalus Mongholicus (AM) has rich medicinal value, and its anti-fibrosis effect has been recently investigated. In recent years, more and more experimental studies have been conducted on the intervention of astragaloside IV (AS-IV), astragalus polysaccharide (APS), astragalus flavone, cycloastragalus alcohol, astragalus water extract and other pharmacological components in fibrosis-related diseases, attracting the interest of researchers. We aim to provide ideas for future research by summarizing recent research advances of AM in treating fibrosis-related diseases.Methods: A literature search was conducted from the core collections of electronic databases such as Baidu Literature, Sciencen.com, Google Scholar, PubMed, and Science Direct using the above keywords and the pharmacological and phytochemical details of the plant.Results: AM can be used to intervene in fibrosis-disease progression by regulating inflammation, oxidative stress, the immune system, and metabolism.Conclusion: AS-IV, APS, and astragalus flavone were studied and discussed in detail. These components have high potential anti-fibrosis activity. Overall, this review aims to gain insight into the AM’s role in treating fibro-related diseases.
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Affiliation(s)
- Fengying Gong
- Department of Traditional Chinese Medicine, Nanfang Hospital of Southern Medical University, Guangzhou, China
| | - Rongmei Qu
- Guangdong Provincial Key Laboratory of Medical Biomechanics and Guangdong Engineering Research Center for Translation of Medical 3D Printing Application and National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
| | - Yongchun Li
- Department of Traditional Chinese Medicine, Nanfang Hospital of Southern Medical University, Guangzhou, China
| | - Ying Lv
- Department of Traditional Chinese Medicine, Nanfang Hospital of Southern Medical University, Guangzhou, China
- *Correspondence: Ying Lv, ; Jingxing Dai,
| | - Jingxing Dai
- Guangdong Provincial Key Laboratory of Medical Biomechanics and Guangdong Engineering Research Center for Translation of Medical 3D Printing Application and National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
- *Correspondence: Ying Lv, ; Jingxing Dai,
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25
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Role of Peritoneal Mesothelial Cells in the Progression of Peritoneal Metastases. Cancers (Basel) 2022; 14:cancers14122856. [PMID: 35740521 PMCID: PMC9221366 DOI: 10.3390/cancers14122856] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/19/2022] [Accepted: 06/06/2022] [Indexed: 11/17/2022] Open
Abstract
Peritoneal metastatic cancer comprises a heterogeneous group of primary tumors that originate in the peritoneal cavity or metastasize into the peritoneal cavity from a different origin. Metastasis is a characteristic of end-stage disease, often indicative of a poor prognosis with limited treatment options. Peritoneal mesothelial cells (PMCs) are a thin layer of cells present on the surface of the peritoneum. They display differentiated characteristics in embryonic development and adults, representing the first cell layer encountering peritoneal tumors to affect their progression. PMCs have been traditionally considered a barrier to the intraperitoneal implantation and metastasis of tumors; however, recent studies indicate that PMCs can either inhibit or actively promote tumor progression through distinct mechanisms. This article presents a review of the role of PMCs in the progression of peritoneum implanted tumors, offering new ideas for therapeutic targets and related research.
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26
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Proteomics and Extracellular Vesicles as Novel Biomarker Sources in Peritoneal Dialysis in Children. Int J Mol Sci 2022; 23:ijms23105655. [PMID: 35628461 PMCID: PMC9144397 DOI: 10.3390/ijms23105655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 05/13/2022] [Accepted: 05/16/2022] [Indexed: 12/13/2022] Open
Abstract
Peritoneal dialysis (PD) represents the dialysis modality of choice for pediatric patients with end-stage kidney disease. Indeed, compared with hemodialysis (HD), it offers many advantages, including more flexibility, reduction of the risk of hospital-acquired infections, preservation of residual kidney function, and a better quality of life. However, despite these positive aspects, PD may be associated with several long-term complications that may impair both patient's general health and PD adequacy. In this view, chronic inflammation, caused by different factors, has a detrimental impact on the structure and function of the peritoneal membrane, leading to sclerosis and consequent PD failure both in adults and children. Although several studies investigated the complex pathogenic pathways underlying peritoneal membrane alterations, these processes remain still to explore. Understanding these mechanisms may provide novel approaches to improve the clinical outcome of pediatric PD patients through the identification of subjects at high risk of complications and the implementation of personalized interventions. In this review, we discuss the main experimental and clinical experiences exploring the potentiality of the proteomic analysis of peritoneal fluids and extracellular vesicles as a source of novel biomarkers in pediatric peritoneal dialysis.
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Leventoğlu E, Büyükkaragöz B, Dalgıç A, Fidan K, Söylemezoğlu O, Bakkaloğlu SA. Encapsulated Peritoneal Sclerosis in an Adolescent With Kidney Transplant After Long-Term Peritoneal Dialysis. EXP CLIN TRANSPLANT 2022; 20:112-114. [PMID: 35570613 DOI: 10.6002/ect.pediatricsymp2022.o35] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Encapsulated peritoneal sclerosis is a rare complication of long-term peritoneal dialysis that has a high rate of morbidity and mortality. We present an 18-year-old female patient who was first diagnosed with renal failure at 8 years of age and who had 7 years of peritoneal dialysis and then hemodialysis before kidney transplant from a deceased donor. Before transplant, the patient developed encapsulated peritoneal sclerosis and was treated with tamoxifen and steroids. Three years after transplant, the patient presented with complaints of vomiting, abdominal pain, and abdominal distension and was again diagnosed with encapsulated peritoneal sclerosis. The patient required excretory paracentesis, pulse steroid treatment for 3 days, and treatment with methylprednisone and tamoxifen, which resulted in regression of signs and symptoms. Factors such as long-term peritoneal dialysis, a history of bacterial peritonitis, and use of high-concentration dialysate may cause encapsulated peritoneal sclerosis, but symptoms can recur after transplant, as shown in our patient. Thus, it is important to recognize that encapsulated peritoneal sclerosis may cause graft loss due to the various complications that it can cause.
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Affiliation(s)
- Emre Leventoğlu
- From the Department of Pediatric Nephrology, Gazi University, Ankara, Turkey
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28
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Brückner M, Bogisch S. Laparoscopic ovariectomy in a dog with type III sclerosing encapsulating peritonitis and literature review. TIERARZTLICHE PRAXIS. AUSGABE K, KLEINTIERE/HEIMTIERE 2022; 50:138-143. [PMID: 35523167 DOI: 10.1055/a-1811-4052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Sclerosing encapsulating peritonitis is a rare and not well-recognized disease in veterinary medicine. A 14-month-old female intact mixed-breed dog was diagnosed with sclerosing encapsulating peritonitis (SEP) at the age of 5 months after a routine work-up including biopsies from an exploratory laparotomy. Symptomatic treatment with an immunosuppressive dose of prednisolone was started, but dose reduction was unsuccessful. Combined treatment with tamoxifen, a selective estrogen receptor modulator used for its TGF-β1 suppression of fibroblasts was discussed; the owner was informed about the risk for developing a pyometra. About one year later the owner wanted to spay her dog and an ovariectomy was recommended, especially due to the extensive adhesions. A laparoscopic approach was chosen to reduce the amount of intraoperative tissue manipulation and inflammation, as well as to minimize the size of the incision. The dog continues to be doing well one year after surgery and prednisolone could be reduced to a low maintenance dose after surgery; so far, the addition of tamoxifen was not required. In selected cases, laparoscopy appears as a safe alternative in patients with adhesions, but the surgeon should always be prepared to convert in case of impaired vision, especially in the absence of tactile sensation. This case report is the first description of laparoscopy in a dog with SEP. Laparoscopy may serve as an easily accomplished minimally invasive method to diagnose SEP, but further studies are required.
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29
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Wei YS, Cheng HP, Wu CH, Chang YC, Lin RW, Hsu YT, Chen YT, Lin SL, Tsai SY, Wu SC, Tsai PS. Oxidative Stress-Induced Alterations of Cellular Localization and Expression of Aquaporin 1 Lead to Defected Water Transport upon Peritoneal Fibrosis. Biomedicines 2022; 10:biomedicines10040810. [PMID: 35453560 PMCID: PMC9031283 DOI: 10.3390/biomedicines10040810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 03/27/2022] [Accepted: 03/28/2022] [Indexed: 11/16/2022] Open
Abstract
Being one of the renal replacement therapies, peritoneal dialysis (PD) maintains around 15% of end-stage kidney disease patients’ lives; however, complications such as peritoneal fibrosis and ultrafiltration failure during long-term PD compromise its application. Previously, we established a sodium hypochlorite (NaClO)-induced peritoneal fibrosis porcine model, which helped to bridge the rodent model toward pre-clinical human peritoneal fibrosis research. In this study, the peritoneal equilibration test (PET) was established to evaluate instant functional changes in the peritoneum in the pig model. Similar to observations from long-term PD patients, increasing small solutes transport and loss of sodium sieving were observed. Mechanistic investigation from both in vivo and in vitro data suggested that disruption of cytoskeleton induced by excessive reactive oxygen species defected intracellular transport of aquaporin 1, this likely resulted in the disappearance of sodium sieving upon PET. Functional interference of aquaporin 1 on free water transport would result in PD failure in patients.
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Affiliation(s)
- Yu-Syuan Wei
- Graduate Institute of Veterinary Medicine, School of Veterinary Medicine, National Taiwan University, Taipei 10617, Taiwan; (Y.-S.W.); (H.-P.C.); (Y.-T.H.)
- Department of Veterinary Medicine, School of Veterinary Medicine, National Taiwan University, Taipei 10617, Taiwan; (C.-H.W.); (Y.-C.C.); (R.-W.L.)
| | - Hui-Ping Cheng
- Graduate Institute of Veterinary Medicine, School of Veterinary Medicine, National Taiwan University, Taipei 10617, Taiwan; (Y.-S.W.); (H.-P.C.); (Y.-T.H.)
| | - Ching-Ho Wu
- Department of Veterinary Medicine, School of Veterinary Medicine, National Taiwan University, Taipei 10617, Taiwan; (C.-H.W.); (Y.-C.C.); (R.-W.L.)
- Graduate Institute of Veterinary Clinical Science, School of Veterinary Medicine, National Taiwan University, Taipei 10617, Taiwan
| | - Yen-Chen Chang
- Department of Veterinary Medicine, School of Veterinary Medicine, National Taiwan University, Taipei 10617, Taiwan; (C.-H.W.); (Y.-C.C.); (R.-W.L.)
- Graduate Institute of Molecular and Comparative Pathobiology, School of Veterinary Medicine, National Taiwan University, Taipei 10617, Taiwan
| | - Ruo-Wei Lin
- Department of Veterinary Medicine, School of Veterinary Medicine, National Taiwan University, Taipei 10617, Taiwan; (C.-H.W.); (Y.-C.C.); (R.-W.L.)
| | - Yu-Ting Hsu
- Graduate Institute of Veterinary Medicine, School of Veterinary Medicine, National Taiwan University, Taipei 10617, Taiwan; (Y.-S.W.); (H.-P.C.); (Y.-T.H.)
| | - Yi-Ting Chen
- Department of Internal Medicine, National Taiwan University Hospital, Taipei 10002, Taiwan; (Y.-T.C.); (S.-L.L.)
- Department of Integrated Diagnostics & Therapeutics, National Taiwan University Hospital, Taipei 10002, Taiwan
| | - Shuei-Liong Lin
- Department of Internal Medicine, National Taiwan University Hospital, Taipei 10002, Taiwan; (Y.-T.C.); (S.-L.L.)
- Department of Integrated Diagnostics & Therapeutics, National Taiwan University Hospital, Taipei 10002, Taiwan
- Graduate Institute of Physiology, College of Medicine, National Taiwan University, Taipei 10051, Taiwan
- Research Center for Developmental Biology and Regenerative Medicine, National Taiwan University, Taipei 10617, Taiwan;
| | - Su-Yi Tsai
- Research Center for Developmental Biology and Regenerative Medicine, National Taiwan University, Taipei 10617, Taiwan;
- Department of Life Science, College of Life Science, National Taiwan University, Taipei 10617, Taiwan
| | - Shinn-Chih Wu
- Department of Animal Science and Technology, College of Bioresources and Agriculture, National Taiwan University, Taipei 10617, Taiwan;
| | - Pei-Shiue Tsai
- Graduate Institute of Veterinary Medicine, School of Veterinary Medicine, National Taiwan University, Taipei 10617, Taiwan; (Y.-S.W.); (H.-P.C.); (Y.-T.H.)
- Department of Veterinary Medicine, School of Veterinary Medicine, National Taiwan University, Taipei 10617, Taiwan; (C.-H.W.); (Y.-C.C.); (R.-W.L.)
- Research Center for Developmental Biology and Regenerative Medicine, National Taiwan University, Taipei 10617, Taiwan;
- Correspondence: ; Tel.: +886-(0)2-3366-1806; Fax: +886-(0)2-2366-1475
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30
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Li D, Li Y, Zeng H, Wu Y. Risk factors for Encapsulating Peritoneal Sclerosis in patients undergoing peritoneal dialysis: A meta-analysis. PLoS One 2022; 17:e0265584. [PMID: 35312717 PMCID: PMC8936465 DOI: 10.1371/journal.pone.0265584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 03/05/2022] [Indexed: 11/18/2022] Open
Abstract
Purpose
Encapsulating Peritoneal Sclerosis (EPS) is the most serious complication of long-term peritoneal dialysis (PD), which considerably reduces the patient’s quality of life, leading to patients discontinuing PD. Considering these negative effects, it is necessary to systematically review and determine the risk factors of EPS.
Methods
The PubMed, Embase, Web of Science, Cochrane Library, and China Biology Medicine (CBM) were searched from their inception to January 1st, 2022, and the bibliographies from the citations of relevant articles were manually searched. The ROBINS-I (Risk of Bias in Non-randomized studies of Interventions) tool was used to evaluate the risk of bias of included studies.
Results
Ten studies involving 12595 participants were included in this meta-analysis. The results revealed that a younger age at PD onset (MD = -7.70, 95% CI, -11.53~-3.86), a higher transporter (MD = 0.13, 95% CI, 0.09~0.18), a longer PD duration (SMD = 1.15, 95% CI, 0.68~1.61), a longer peritonitis duration (MD = 12.66, 95% CI, 3.85~21.47), and history of glomerulonephritis (OR = 1.42, 95% CI, 1.02~1.97) were significant risk factors for EPS. However, sex, use of icodextrin, the number of peritonitis episodes, and history of multicystic kidney disease did not affect the risk of EPS.
Conclusions
This review provides a scientific basis for further understanding the etiology of PD-related EPS and improving prevention strategies. More high-quality studies are necessary to validate this paper’s findings.
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Affiliation(s)
- Dashan Li
- Department of Nephropathy, the First Affiliated Hospital, Anhui Medical University, Hefei, Anhui, China
| | - Yuanyuan Li
- Department of Nephropathy, the First Affiliated Hospital, Anhui Medical University, Hefei, Anhui, China
| | - Hanxu Zeng
- Department of Nephropathy, the First Affiliated Hospital, Anhui Medical University, Hefei, Anhui, China
| | - Yonggui Wu
- Department of Nephropathy, the First Affiliated Hospital, Anhui Medical University, Hefei, Anhui, China
- * E-mail:
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Chang Y, Chang JT, Lee MY, Huang MZ, Chao YFCC, Shih YL, Hwang YR. Does Far-Infrared Therapy Improve Peritoneal Function and Reduce Recurrent Peritonitis in Peritoneal Dialysis Patients? J Clin Med 2022; 11:jcm11061624. [PMID: 35329948 PMCID: PMC8955287 DOI: 10.3390/jcm11061624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/22/2022] [Accepted: 03/08/2022] [Indexed: 01/30/2023] Open
Abstract
The use of peritoneal dialysis in end-stage renal disease is increasing in clinical practice. The main purpose of this study was to evaluate the effect of far-infrared radiation therapy on inflammation and the cellular immunity of patients undergoing peritoneal dialysis. We recruited 56 patients undergoing peritoneal dialysis, and we included 32 patients for the experimental group and 24 patients from the control group in the final analysis. The experimental evaluation in our study was as follows: (1) We used abdominal computed tomography to explore the changes in abdominal blood vessels. (2) We compared the effects of peritoneal dialysis using blood glucose, HbAlC, albumin, urea nitrogen, creatinine, white blood cells, hs-CRP; peritoneal Kt/V of peritoneal function, and eGFR. (3) We compared the cytokines’ concentrations in the two groups while controlling for the other cytokines. Results and Discussion: (1) There was no significant difference in the abdominal blood vessels of the experimental group relative to the control group according to abdominal CT over the 6 months. (2) Our study demonstrates statistically significant effects of FIR therapy on the following parameters: creatinine (p = 0.039 *) and hs-CRP (p < 0.001 **) levels decreased significantly, and eGFR (p = 0.043 *), glucose (p < 0.001 **), and albumin (p = 0.048 *) levels increased significantly. Our study found that in the experimental group, creatinine and hs-CRP levels decreased significantly due to FIR therapy for 6 months. However, our study also found that the glucose level was significantly different after FIR therapy for 6 months. Peritoneal dialysis combined with FIR can reduce the side effects of the glucose in the dialysis buffer, which interferes with peritoneal inflammation and peritoneal mesothelial cell fibrosis. (3) In addition, we also found that no statistically significant difference in any inflammatory cytokine after FIR therapy. IFN-γ (p = 0.124), IL-12p70 (p = 0.093), IL-18 (p = 0.213), and TNF-α (p = 0.254) did not exhibit significant improvements after peritoneal dialysis with FIR treatment over 6 months. Conclusions: We found that the effectiveness of peritoneal dialysis was improved significantly with FIR therapy, and significant improvements in the peritoneal permeability and inflammatory response were observed.
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Affiliation(s)
- Yuanmay Chang
- Institute of Long-Term Care, MacKay Medical College, New Taipei 25245, Taiwan;
- Correspondence: ; Tel.: +886-919991261
| | - Jui-Ting Chang
- Division of Nephrology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei 11101, Taiwan;
| | - Mei-Yi Lee
- Department of Physical Therapy, Fooyin University, Kaohsiung 83102, Taiwan;
| | - Mei-Zen Huang
- Department of Nursing, National Tainan Junior College of Nursing, Tainan 70007, Taiwan;
| | | | - Yung-Luen Shih
- Laboratory Medicine, Department of Pathology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei 11101, Taiwan;
| | - Yao-Rong Hwang
- Institute of Long-Term Care, MacKay Medical College, New Taipei 25245, Taiwan;
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Brown CEL. An apparently healthy female crossbred Labrador retriever-poodle dog with severe intra-abdominal adhesions as an incidental finding to ovariohysterectomy. THE CANADIAN VETERINARY JOURNAL = LA REVUE VETERINAIRE CANADIENNE 2022; 63:194-196. [PMID: 35110778 PMCID: PMC8759341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
An apparently healthy 1-year-old, female crossbred Labrador retriever-poodle dog was brought to a veterinary clinic for elective ovariohysterectomy (OVH). Severe abdominal adhesions complicated the procedure. There was no report of a previous illness or surgical procedure that would be a predisposing cause for the adhesions. The OVH was completed despite the adhesions and the dog recovered well. It is unclear whether this was simply a case of severe intra-abdominal adhesions or an atypical sclerosing encapsulating peritonitis (SEP). The differential diagnoses include inflammatory processes, a genetic predisposition, or an idiopathic cause. Fourteen days later, at the time of surgical staple removal, the dog was healthy and had reportedly been doing very well. Although rare, intra-abdominal adhesions can occur in young and previously healthy dogs without causing clinical signs. Veterinarians should be aware of such a condition when approaching abdominal surgeries and be prepared to manage these cases appropriately.
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Affiliation(s)
- Caitlin E L Brown
- Ontario Veterinary College, University of Guelph, Guelph, Ontario N1G 2W1
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33
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Male with Diffuse Abdominal Pain. Ann Emerg Med 2021; 78:605-673. [PMID: 34688438 DOI: 10.1016/j.annemergmed.2021.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Indexed: 11/23/2022]
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Proteomic profile of mesothelial exosomes isolated from peritoneal dialysis effluent of children with focal segmental glomerulosclerosis. Sci Rep 2021; 11:20807. [PMID: 34675284 PMCID: PMC8531449 DOI: 10.1038/s41598-021-00324-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 10/08/2021] [Indexed: 01/06/2023] Open
Abstract
Peritoneal dialysis (PD) is the worldwide recognized preferred dialysis treatment for children affected by end-stage kidney disease (ESKD). However, due to the unphysiological composition of PD fluids, the peritoneal membrane (PM) of these patients may undergo structural and functional alterations, which may cause fibrosis. Several factors may accelerate this process and primary kidney disease may have a causative role. In particular, patients affected by steroid resistant primary focal segmental glomerulosclerosis, a rare glomerular disease leading to nephrotic syndrome and ESKD, seem more prone to develop peritoneal fibrosis. The mechanism causing this predisposition is still unrecognized. To better define this condition, we carried out, for the first time, a new comprehensive comparative proteomic mass spectrometry analysis of mesothelial exosomes from peritoneal dialysis effluent (PDE) of 6 pediatric patients with focal segmental glomerular sclerosis (FSGS) versus 6 patients affected by other primary renal diseases (No FSGS). Our omic study demonstrated that, despite the high overlap in the protein milieu between the two study groups, machine learning allowed to identify a core list of 40 proteins, with ANXA13 as most promising potential biomarker, to distinguish, in our patient population, peritoneal dialysis effluent exosomes of FSGS from No FSGS patients (with 100% accuracy). Additionally, the Weight Gene Co-expression Network Analysis algorithm identified 17 proteins, with PTP4A1 as the most statistically significant biomarker associated to PD vintage and decreased PM function. Altogether, our data suggest that mesothelial cells of FSGS patients are more prone to activate a pro-fibrotic machinery. The role of the proposed biomarkers in the PM pathology deserves further investigation. Our results need further investigations in a larger population to corroborate these findings and investigate a possible increased risk of PM loss of function or development of encapsulating peritoneal sclerosis in FSGS patients, thus to eventually carry out changes in PD treatment and management or implement new solutions.
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Yamada M, Hirai Y, Inoue D, Komatsu S, Uchida T, Kojima T, Tomiyasu T, Yoshikawa N, Oda T. Increased expression of epimorphin in a peritoneal fibrosis mouse model. Perit Dial Int 2021; 42:522-529. [PMID: 34641723 DOI: 10.1177/08968608211051572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Long-term peritoneal dialysis results in functional and histopathological alterations of the peritoneal membrane, leading to peritoneal fibrosis (PF). The mechanism of PF has not been fully elucidated, and at present there is no effective therapy for PF. Epimorphin is a mesenchymal protein that not only regulates morphogenesis in organ development but is implicated in tissue repair. However, the role of epimorphin in PF has not yet been clarified. METHODS PF was induced in C57/Bl6 mice by intraperitoneal injection of chlorhexidine gluconate (CG-injected mice) three times a week for 3 weeks. The parietal peritoneum was subsequently dissected and assessed by Masson's trichrome staining, and epimorphin expression was analysed by immunohistochemistry and real-time reverse transcription polymerase chain reaction (RT-PCR). Furthermore, epimorphin-positive regions were analysed by multiple immunofluorescence staining using fibrosis-associated markers. In addition, normal rat fibroblast cells (NRK-49F) were treated with transforming growth factor-β (TGF-β) in the presence or absence of epimorphin. The expression of fibrosis-associated markers was assessed by real-time RT-PCR. RESULTS In CG-injected mice, Masson's trichrome staining showed marked thickening of the submesothelial compact zone. Weak epimorphin expression was observed in the narrow submesothelial compact zone beneath the mesothelial cells in control mice; however, epimorphin expression was stronger in the submesothelial compact zone in CG-injected mice. Epimorphin expression was observed mainly in α-smooth muscle actin (α-SMA)-positive myofibroblasts. Epimorphin suppressed the TGF-β-induced upregulation of α-SMA and platelet-derived growth factor receptor-β in cultured cells. CONCLUSIONS Our results suggest that epimorphin may be a therapeutic target for fibrotic diseases of the peritoneum.
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Affiliation(s)
- Muneharu Yamada
- Department of Nephrology and Blood Purification, Kidney Disease Center, Tokyo Medical University Hachioji Medical Center, Hachioji, Tokyo, Japan
| | - Yohei Hirai
- Department of Biomedical Chemistry, Graduate School of Science and Technology, Kwansei Gakuin University, Sanda, Hyogo, Japan
| | - Dan Inoue
- Department of Nephrology and Blood Purification, Kidney Disease Center, Tokyo Medical University Hachioji Medical Center, Hachioji, Tokyo, Japan
| | - Shuhei Komatsu
- Department of Nephrology and Blood Purification, Kidney Disease Center, Tokyo Medical University Hachioji Medical Center, Hachioji, Tokyo, Japan
| | - Takahiro Uchida
- Department of Nephrology and Blood Purification, Kidney Disease Center, Tokyo Medical University Hachioji Medical Center, Hachioji, Tokyo, Japan
| | - Tadasu Kojima
- Department of Nephrology and Blood Purification, Kidney Disease Center, Tokyo Medical University Hachioji Medical Center, Hachioji, Tokyo, Japan
| | - Tomohiro Tomiyasu
- Department of Nephrology and Blood Purification, Kidney Disease Center, Tokyo Medical University Hachioji Medical Center, Hachioji, Tokyo, Japan
| | - Noriko Yoshikawa
- Department of Nephrology and Blood Purification, Kidney Disease Center, Tokyo Medical University Hachioji Medical Center, Hachioji, Tokyo, Japan
| | - Takashi Oda
- Department of Nephrology and Blood Purification, Kidney Disease Center, Tokyo Medical University Hachioji Medical Center, Hachioji, Tokyo, Japan
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Bhatta OP, Verma R, Shrestha G, Sharma D, Dahal R, Kansakar PBS. An unusual case of intestinal obstruction due to abdominal cocoon: A case report. Int J Surg Case Rep 2021; 85:106282. [PMID: 34388909 PMCID: PMC8358643 DOI: 10.1016/j.ijscr.2021.106282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 08/02/2021] [Accepted: 08/02/2021] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Abdominal cocoon (AC) or Encapsulating Peritoneal Sclerosis (EPS) is a rare cause of bowel obstruction and due to non-specific presentation, it can be misdiagnosed and often mistreated. CASE PRESENTATION We present the case of 42 years male with a history suggestive of complete small bowel obstruction (SBO) without a history of pulmonary tuberculosis (TB) or peritoneal dialysis. CT imaging as well as the intraoperative finding of a cocoon membrane encasing the small bowel led to the diagnosis of abdominal cocoon. CLINICAL DISCUSSION Abdominal cocoon can be idiopathic or secondary to peritoneal dialysis, tuberculosis, or other rare causes. Patients usually present with features of SBO with varying severity. Diagnosis is aided by imaging investigations mainly CT scan and management is primarily surgical and usually involves adhesiolysis, total removal of the membrane with or without bowel loop resection. CONCLUSION Diagnosis of abdominal cocoon warrants awareness of the disease and a high index of suspicion of the treating clinician in patients with intestinal obstruction and an abdominal lump without a history of previous abdominal surgery. CT can guide diagnosis and early operative management seems to bear the best outcomes.
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Affiliation(s)
- Om Prakash Bhatta
- Maharajgunj Medical Campus, Institute of Medicine, Kathmandu, Nepal.
| | - Rupesh Verma
- Department of GI and General Surgery, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal
| | - Gyaneswor Shrestha
- Department of GI and General Surgery, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal
| | - Deepak Sharma
- Department of GI and General Surgery, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal
| | - Romi Dahal
- Department of GI and General Surgery, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal
| | - Prasan Bir Singh Kansakar
- Department of GI and General Surgery, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal
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Lu M, Ye H, Chen D, Yi C, Lin J, Mao H, Yang X, Yu X, Chen W. Risk factors and clinical outcomes of encapsulating peritoneal sclerosis: A case-control study from China. Perit Dial Int 2021; 42:505-512. [PMID: 34259109 DOI: 10.1177/08968608211029224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Encapsulating peritoneal sclerosis (EPS) is an uncommon, but serious complication in patients with continuous ambulatory peritoneal dialysis (PD) who have a considerable mortality rate. This study aimed to identify risk factors and outcomes of EPS in Chinese patients on PD. METHODS Sixteen patients on PD who met the International Society for Peritoneal Dialysis criteria for diagnosis of EPS in the First Affiliated Hospital of Sun Yat-Sen University from 1997 to 2018 were included. Patients without EPS were matched for age, sex and the duration of PD and selected at a 1:3 ratio for the controls. A case-control study was conducted to analyse the clinical profile and risk factors associated with EPS in patients. RESULTS The prevalence of EPS in patients on PD in our centre was 0.55%. The percentage of EPS significantly increased with the duration of PD. In univariate regression analysis, a history of peritonitis (odds ratios (OR): 2.83; 95% confidence interval (CI): 0.82-9.68; p = 0.08), peritoneal glucose exposure (OR: 1.12; 95% CI: 1.03-1.22; p < 0.01) and a high peritoneal transport status (OR: 14.70; 95% CI: 1.85-117.02; p < 0.01) were associated with EPS in patients on PD. However in the multivariate model, only a high peritoneal transport status (adjusted odds ratios (aOR): 13.65; 95% CI: 1.69-109.96; p = 0.01) was independently associated with EPS. CONCLUSION The rate of EPS significantly increases with the duration of PD. Progressive peritoneal dysfunction, especially a high peritoneal transport status, is associated with a higher risk of EPS in this population.
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Affiliation(s)
- Miaoqing Lu
- 196531Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, China
| | - Hongjian Ye
- 196531Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, China
| | - Dongni Chen
- 196531Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, China
| | - Chunyan Yi
- 196531Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, China
| | - Jianxiong Lin
- 196531Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, China
| | - Haiping Mao
- 196531Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, China
| | - Xiao Yang
- 196531Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, China
| | - Xueqing Yu
- 196531Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, China
| | - Wei Chen
- 196531Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, China
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Liu F, Yu C, Qin H, Zhang S, Fang L, Wang Y, Wang J, Cui B, Hu S, Liu N, Zhuang S. Nintedanib attenuates peritoneal fibrosis by inhibiting mesothelial-to-mesenchymal transition, inflammation and angiogenesis. J Cell Mol Med 2021; 25:6103-6114. [PMID: 33949772 PMCID: PMC8256343 DOI: 10.1111/jcmm.16518] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 02/17/2021] [Accepted: 03/23/2021] [Indexed: 12/13/2022] Open
Abstract
Nintedanib, an Food and Drug Administration (FDA) approved multiple tyrosine kinase inhibitor, exhibits an anti-fibrotic effect in lung and kidneys. Its effect on peritoneal fibrosis remains unexplored. In this study, we found that nintedanib administration lessened chlorhexidine gluconate (CG)-induced peritoneal fibrosis and reduced collagen I and fibronectin expression. This coincided with suppressed phosphorylation of platelet-derived growth factor receptor, fibroblast growth factor receptors, vascular endothelial growth factor receptor and Src family kinase. Mechanistically, nintedanib inhibited injury-induced mesothelial-to-mesenchymal transition (MMT), as demonstrated by decreased expression of α-smooth muscle antigen and vimentin and preserved expression of E-cadherin in the CG-injured peritoneum and cultured human peritoneal mesothelial cells exposed to transforming growth factor-β1. Nintedanib also suppressed expression of Snail and Twist, two transcription factors associated with MMT in vivo and in vitro. Moreover, nintedanib treatment inhibited expression of several cytokines/chemokines, including tumour necrosis factor-α, interleukin-1β and interleukin-6, monocyte chemoattractant protein-1 and prevented infiltration of macrophages to the injured peritoneum. Finally, nintedanib reduced CG-induced peritoneal vascularization. These data suggest that nintedanib may attenuate peritoneal fibrosis by inhibiting MMT, inflammation, and angiogenesis and have therapeutic potential for the prevention and treatment of peritoneal fibrosis in patients on peritoneal dialysis.
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Affiliation(s)
- Feng Liu
- Department of NephrologyShanghai East HospitalTongji University School of MedicineShanghaiChina
| | - Chao Yu
- Department of NephrologyShanghai East HospitalTongji University School of MedicineShanghaiChina
| | - Huan Qin
- Department of NephrologyShanghai East HospitalTongji University School of MedicineShanghaiChina
| | - Shenglei Zhang
- Department of NephrologyShanghai East HospitalTongji University School of MedicineShanghaiChina
| | - Lu Fang
- Department of NephrologyShanghai East HospitalTongji University School of MedicineShanghaiChina
| | - Yi Wang
- Department of NephrologyShanghai East HospitalTongji University School of MedicineShanghaiChina
| | - Jun Wang
- Department of NephrologyShanghai East HospitalTongji University School of MedicineShanghaiChina
| | - Binbin Cui
- Department of NephrologyShanghai East HospitalTongji University School of MedicineShanghaiChina
| | - Susie Hu
- Department of MedicineRhode Island Hospital and Alpert Medical SchoolBrown UniversityProvidenceRIUSA
| | - Na Liu
- Department of NephrologyShanghai East HospitalTongji University School of MedicineShanghaiChina
| | - Shougang Zhuang
- Department of NephrologyShanghai East HospitalTongji University School of MedicineShanghaiChina
- Department of MedicineRhode Island Hospital and Alpert Medical SchoolBrown UniversityProvidenceRIUSA
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Effects of TGF-β1 Receptor Inhibitor GW788388 on the Epithelial to Mesenchymal Transition of Peritoneal Mesothelial Cells. Int J Mol Sci 2021; 22:ijms22094739. [PMID: 33947038 PMCID: PMC8124410 DOI: 10.3390/ijms22094739] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 04/17/2021] [Accepted: 04/27/2021] [Indexed: 12/27/2022] Open
Abstract
We investigated the effectiveness of the transforming growth factor beta-1 (TGF-β) receptor inhibitor GW788388 on the epithelial to mesenchymal transition (EMT) using human peritoneal mesothelial cells (HPMCs) and examined the effectiveness of GW788388 on the peritoneal membrane using a peritoneal fibrosis mouse model. HPMCs were treated with TGF-β with or without GW788388. Animal experiments were conducted on male C57/BL6 mice. Peritoneal fibrosis was induced by intraperitoneal injection of chlorhexidine gluconate. GW788388 was administered by once-daily oral gavage. The morphological change, cell migration, and invasion resulted from TGF-β treatment, but these changes were attenuated by cotreatment with GW788388. TGF-β-treated HPMCs decreased the level of the epithelial cell marker and increased the levels of the mesenchymal cell markers. Cotreatment with GW788388 reversed these changes. Phosphorylated Smad2 and Smad3 protein levels were stimulated with TGF-β and the change was attenuated by cotreatment with GW788388. For the peritoneal fibrosis mice, thickness and collagen deposition of parietal peritoneum was increased, but this change was attenuated by cotreatment with GW788388. GW788388, an orally available potent TGF-β receptor type 1 inhibitor, effectively attenuated TGF-β-induced EMT in HPMCs. Cotreatment with GW788388 improved peritoneal thickness and fibrosis, and recovered peritoneal membrane function in a peritoneal fibrosis mouse model.
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40
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Liang M, Dang H, Li Q, Huang W, Liu C. Effects of rapamycin and OSI-027 on α-SMA in lung tissue of SD rat pups with hyperoxic lung injury. Biochem Biophys Res Commun 2021; 556:39-44. [PMID: 33836346 DOI: 10.1016/j.bbrc.2021.02.061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 02/15/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To investigate the effect and significance of mammalian target of rapamycin (mTOR) inhibitors on the expression of α-SMA in lung injury induced by high volume fraction of inspired oxygen (hyperoxygen) in SD rat pups. METHODS Seventy-two Sprague-Dawley rat pups (age: 3 weeks) were randomly divided into air + saline, hyperoxia + saline, hyperoxia + OSI-027, and hyperoxia + rapamycin groups. Animal models were constructed (n = 18). Hyperoxia was induced by continuous administration of 90% oxygen. Normal saline, OSI-027, and rapamycin are administered by intraperitoneal injection on 1d, 3d, 6d, 8d, 10d, 13d of the observation period, respectively. Following assessments were made on the 3rd, 7th, and 14th day of modeling: pathological changes in lung tissues, lung injury score, Western Blot to assess the distribution and expressions of mTOR, pS6K1, and α-SMA protein in lung tissues. RESULTS In terms of time factors, the protein expressions of mTOR, pS6K1, and α-SMA increased with time. Except for the air group, the lung injury scores of the other groups increased with time, In terms of grouping factors, lung injury score in the air group was significantly lower than that in the other groups. In the hyperoxia group, the protein expressions of mTOR, PS6K1, and α-SMA were significantly higher than those in the other groups. The lung injury score in the hyperoxia group was significantly higher than that in the other groups. The lung injury score in the hyperoxia OSI group was significantly lower than that in the hyperoxia rapamycin group. CONCLUSION In hyperoxia lung injury, inhibiting the activation of mTOR signaling pathway can effectively reduce the expression of α-SMA; however, only mTORC1/2 dual inhibitor OSI-027 exhibited an anti-proliferative effect, and alleviated hyperoxia-induced lung injury and fibrosis in SD rat pups.
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Affiliation(s)
- Mulin Liang
- Department of Neonatal Intensive Care Unit, The Fifth Affiliated Hospital, Southern Medical University Guangzhou, China
| | - Hongxing Dang
- Department of Pediatric Intensive Care Unit, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Qinghe Li
- Department of Neonatal Intensive Care Unit, The Fifth Affiliated Hospital, Southern Medical University Guangzhou, China
| | - Weiben Huang
- Department of Neonatal Intensive Care Unit, The Fifth Affiliated Hospital, Southern Medical University Guangzhou, China
| | - Chengjun Liu
- Department of Pediatric Intensive Care Unit, Children's Hospital of Chongqing Medical University, Chongqing, China.
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Terri M, Trionfetti F, Montaldo C, Cordani M, Tripodi M, Lopez-Cabrera M, Strippoli R. Mechanisms of Peritoneal Fibrosis: Focus on Immune Cells-Peritoneal Stroma Interactions. Front Immunol 2021; 12:607204. [PMID: 33854496 PMCID: PMC8039516 DOI: 10.3389/fimmu.2021.607204] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 01/19/2021] [Indexed: 12/12/2022] Open
Abstract
Peritoneal fibrosis is characterized by abnormal production of extracellular matrix proteins leading to progressive thickening of the submesothelial compact zone of the peritoneal membrane. This process may be caused by a number of insults including pathological conditions linked to clinical practice, such as peritoneal dialysis, abdominal surgery, hemoperitoneum, and infectious peritonitis. All these events may cause acute/chronic inflammation and injury to the peritoneal membrane, which undergoes progressive fibrosis, angiogenesis, and vasculopathy. Among the cellular processes implicated in these peritoneal alterations is the generation of myofibroblasts from mesothelial cells and other cellular sources that are central in the induction of fibrosis and in the subsequent functional deterioration of the peritoneal membrane. Myofibroblast generation and activity is actually integrated in a complex network of extracellular signals generated by the various cellular types, including leukocytes, stably residing or recirculating along the peritoneal membrane. Here, the main extracellular factors and the cellular players are described with emphasis on the cross-talk between immune system and cells of the peritoneal stroma. The understanding of cellular and molecular mechanisms underlying fibrosis of the peritoneal membrane has both a basic and a translational relevance, since it may be useful for setup of therapies aimed at counteracting the deterioration as well as restoring the homeostasis of the peritoneal membrane.
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Affiliation(s)
- Michela Terri
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
- National Institute for Infectious Diseases L. Spallanzani, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Flavia Trionfetti
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
- National Institute for Infectious Diseases L. Spallanzani, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Claudia Montaldo
- National Institute for Infectious Diseases L. Spallanzani, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Marco Cordani
- instituto Madrileño de Estudios Avanzados en Nanociencia (IMDEA) Nanociencia, Madrid, Spain
| | - Marco Tripodi
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
- National Institute for Infectious Diseases L. Spallanzani, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
- Istituto Pasteur Italia-Fondazione Cenci Bolognetti, Sapienza University of Rome, Rome, Italy
| | - Manuel Lopez-Cabrera
- Programa de Homeostasis de Tejidos y Organos, Centro de Biología Molecular “Severo Ochoa”-Consejo Superior de Investigaciones Científicas (CSIC), Madrid, Spain
| | - Raffaele Strippoli
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
- National Institute for Infectious Diseases L. Spallanzani, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
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Zvizdic Z, Summers A, Moinuddin Z, Van Dellen D, Pasic-Sefic I, Skenderi F, Vranic S, Augustine T. A Successful Treatment of Encapsulating Peritoneal Sclerosis in an Adolescent Boy on Long-term Peritoneal Dialysis: A Case Report. Prague Med Rep 2021; 121:254-261. [PMID: 33270013 DOI: 10.14712/23362936.2020.22] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Encapsulating peritoneal sclerosis (EPS) is a rare life-threatening complication associated with peritoneal dialysis (PD). EPS is characterized by progressive fibrosis and sclerosis of the peritoneum, with the formation of a membrane and tethering of loops of the small intestine resulting in intestinal obstruction. It is very rare in children. We present a case of a 16-year-old adolescent boy who developed EPS seven years after being placed on continuous ambulatory peritoneal dialysis (CAPD) complicated by several episodes of bacterial peritonitis. The diagnosis was based on clinical, radiological, intraoperative and histopathological findings. The patient was successfully treated with surgical enterolysis. During a 7-year follow-up, there have been no further episodes of small bowel obstruction documented. He still continues to be on regular hemodialysis and is awaiting a deceased donor kidney transplant. EPS is a long-term complication of peritoneal dialysis and is typically seen in adults. Rare cases may be seen in the pediatric population and require an appropriate surgical approach that is effective and lifesaving for these patients.
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Affiliation(s)
- Zlatan Zvizdic
- Department of Pediatric Surgery, University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Angela Summers
- Department of Transplant and Endocrine Surgery, Manchester Royal Infirmary, Manchester University Foundation Trust; An United Kingdom National Specialized Centre for Surgery for Encapsulating Peritoneal Sclerosis, Manchester, United Kingdom
| | - Zia Moinuddin
- Department of Transplant and Endocrine Surgery, Manchester Royal Infirmary, Manchester University Foundation Trust; An United Kingdom National Specialized Centre for Surgery for Encapsulating Peritoneal Sclerosis, Manchester, United Kingdom
| | - David Van Dellen
- Department of Transplant and Endocrine Surgery, Manchester Royal Infirmary, Manchester University Foundation Trust; An United Kingdom National Specialized Centre for Surgery for Encapsulating Peritoneal Sclerosis, Manchester, United Kingdom
| | - Irmina Pasic-Sefic
- Department of Radiology, University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Faruk Skenderi
- Department of Pathology, University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Semir Vranic
- College of Medicine, QU Health, Qatar University, Qatar.
| | - Titus Augustine
- Department of Transplant and Endocrine Surgery, Manchester Royal Infirmary, Manchester University Foundation Trust; An United Kingdom National Specialized Centre for Surgery for Encapsulating Peritoneal Sclerosis, Manchester, United Kingdom
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Djebala S, Evrard J, Moula N, Gille L, Sartelet A, Bossaert P. Parietal fibrinous peritonitis in cattle: A literature review. Vet Rec 2021; 188:e30. [PMID: 33729566 DOI: 10.1002/vetr.30] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 10/08/2020] [Accepted: 11/09/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Parietal fibrinous peritonitis (PFP) is a complication of laparotomy in cattle, consisting of fluid and fibrin accumulation within a fibrous capsule between the parietal peritoneum and the abdominal muscles. Since scientific information on PFP is scarce, we aim to collect available information to help practitioners in its diagnosis and treatment, and to formulate research perspectives. METHODS PubMed and GoogleScholar databases were scanned using "cattle" or "bovine", and one of the following keywords: "seroma", "parietal fibrinous peritonitis", "retroperitoneal abscess", or "wound infection". RESULTS Although scientific information is often anecdotal, two recent larger studies shed more light on PFP symptoms, diagnosis and treatment. Symptoms vary according to the cavity's localisation and size, and include anorexia, weight loss and an inflammatory status. Rectal palpation is strongly indicative, but the definitive diagnosis is made by ultrasound. Trueperella pyogenes and Escherichia coli are frequently isolated germs, although it remains unclear whether they are primary or secondary agents. Good survival rates were reported after surgical drainage. CONCLUSION Although the diagnosis and treatment seem clear, the exact pathogenesis of PFP should be the focus of ongoing research. This can be achieved by epidemiological data analysis focusing on risk factors like surgery technique, housing and ration.
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Affiliation(s)
- Salem Djebala
- Clinical Department of Ruminant, University of Liège, Liège, Belgium
| | - Julien Evrard
- Gestion et Prévention de Santé, Regional Association of Health and Animal Identification, Ciney, Belgium
| | - Nassim Moula
- Department of Animal Production, University of Liège, Liège, Belgium
| | - Linde Gille
- Clinical Department of Ruminant, University of Liège, Liège, Belgium
| | - Arnaud Sartelet
- Clinical Department of Ruminant, University of Liège, Liège, Belgium
| | - Philippe Bossaert
- Clinical Department of Ruminant, University of Liège, Liège, Belgium
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Zhang D, Jiang L, Wang M, Jin M, Zhang X, Liu D, Wang Z, Yang L, Xu X. Berberine inhibits intestinal epithelial barrier dysfunction in colon caused by peritoneal dialysis fluid by improving cell migration. JOURNAL OF ETHNOPHARMACOLOGY 2021; 264:113206. [PMID: 32750460 DOI: 10.1016/j.jep.2020.113206] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 07/02/2020] [Accepted: 07/18/2020] [Indexed: 06/11/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Berberine is generally extracted from Rhizoma Coptidis (Coptis chinensis Franch), a traditional Chinese medicine, which can be used in the treatment of intestinal diseases, respiratory infections and cardiovascular diseases. Berberine is especially effective for the treatment of gastrointestinal disorders such as diarrhea because of the effect of heat-clearing and detoxifying in traditional Chinese medicine theory. AIM OF THE STUDY This study aimed to examine the protective effect of berberine (BBR) on the damaged colonic epithelial barrier caused by peritoneal dialysis fluid (PDF). METHODS The damage to intestinal epithelial barrier was examined by intraperitoneally injecting 4.25% dextrose-containing PDF in mice and establishing a long-term PD model in rats with renal failure. Then, the therapeutic potential of berberine on PD-related colonic injuries was examined. T84 colonic epithelial cells were used to test the effect of PDF and berberine in vitro. The damaging effect of PDF and the protective effect of berberine were evaluated by histology staining, histofluorescence and transmission electron microscopy. The migration of colonic epithelial cell and actin-related protein 2 (Arp2) were tested by wound healing assay and Western blot to determine the possible mechanism in vitro. RESULTS PD administration induced intestinal epithelial barrier dysfunction in the colon, and berberine alleviated the injury by increasing the tight junction and adhesion junction protein, both in vivo and in vitro. Berberine could also improve the morphology of microvillus. In the wound healing assay, berberine exhibited the ability to promote cell migration, indicating that berberine could probably recover the function of intestinal epithelial cells when the intestinal epithelial barrier was damaged by the PDF. CONCLUSIONS The present study demonstrates that berberine can ameliorate intestinal epithelial barrier dysfunction in the colon caused by long-term PDF through improving cell migration.
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Affiliation(s)
- Dongliang Zhang
- Minhang Hospital, Department of Pharmacology, School of Pharmacy, Fudan University, Shanghai, China; State Key Laboratory of Innovative Natural Medicine and TCM Injections, Jiangxi Qingfeng Pharmaceutical Co. LTD, Ganzhou, 341000, China
| | - Lan Jiang
- Minhang Hospital, Department of Pharmacology, School of Pharmacy, Fudan University, Shanghai, China; State Key Laboratory of Innovative Natural Medicine and TCM Injections, Jiangxi Qingfeng Pharmaceutical Co. LTD, Ganzhou, 341000, China
| | - Mengling Wang
- Minhang Hospital, Department of Pharmacology, School of Pharmacy, Fudan University, Shanghai, China
| | - Meiping Jin
- Minhang Hospital, Department of Pharmacology, School of Pharmacy, Fudan University, Shanghai, China
| | - Xuemei Zhang
- Minhang Hospital, Department of Pharmacology, School of Pharmacy, Fudan University, Shanghai, China
| | - Difa Liu
- State Key Laboratory of Innovative Natural Medicine and TCM Injections, Jiangxi Qingfeng Pharmaceutical Co. LTD, Ganzhou, 341000, China
| | - Zhangwei Wang
- State Key Laboratory of Innovative Natural Medicine and TCM Injections, Jiangxi Qingfeng Pharmaceutical Co. LTD, Ganzhou, 341000, China
| | - Licai Yang
- Minhang Hospital, Department of Pharmacology, School of Pharmacy, Fudan University, Shanghai, China.
| | - Xudong Xu
- Minhang Hospital, Department of Pharmacology, School of Pharmacy, Fudan University, Shanghai, China.
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Al-Lawati AI, Shaibi MA, Mahruqi GA, Augustine T, Moinuddin Z, Hinai MA, Moqbali RA, Qadhi HA. Encapsulating Peritoneal Sclerosis: A Case Report and Literature Review. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e925341. [PMID: 33011732 PMCID: PMC7545366 DOI: 10.12659/ajcr.925341] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 08/24/2020] [Accepted: 07/19/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Encapsulating peritoneal sclerosis (EPS) is a rare, life-threatening, and serious complication of long-term peritoneal dialysis (PD). No evidence-based management strategy has been established until now. Surgical management, including enterolysis and excision of the sclerotic and obstructing adhesions, should be considered as soon as conservative management fails to work. We report a case of EPS soon after transplantation in a patient with end-stage kidney disease who had been on long-term PD. CASE REPORT A 26-year-old man had been found to have advanced chronic kidney disease secondary to glomerulonephritis on pre-employment investigation. He was on continuous ambulatory PD for 5 years, after which he underwent a living donor renal transplant from his full HLA-matched sibling. He did well postoperatively, with excellent graft function. One month after transplantation, he repeatedly presented to our Emergency Department with signs and symptoms of complete small-bowel obstruction. Computed tomography of the abdomen showed features of small-bowel obstruction secondary to interloop adhesions. The patient was initially managed conservatively; however, as his condition continued to deteriorate, an exploratory laparotomy was carried out. Operative findings were suggestive of early EPS localized to the terminal ileum. Total enterolysis along with peritonectomy was performed along with resection of the diseased and obstructing terminal ileum. The patient did well, and he was discharged home day 10 postoperatively. CONCLUSIONS EPS remains a serious and fatal complication of long-term PD. Early definitive diagnosis, treatment, and ultimately surgical intervention may be required to prevent the morbidity and mortality associated with this condition.
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Affiliation(s)
- Ali I. Al-Lawati
- Department of Nephrology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Maha Al Shaibi
- Department of Surgical Oncology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Ghaitha Al Mahruqi
- Department of General Surgery, Sultan Qaboos University Hospital, Muscat, Oman
| | - Titus Augustine
- Department of Renal and Pancreas Transplantation, Central Manchester University Hospitals NHS Foundation Trust, Manchester, U.K
| | - Zia Moinuddin
- Department of Renal and Pancreas Transplantation, Central Manchester University Hospitals NHS Foundation Trust, Manchester, U.K
| | - Meerah Al Hinai
- Department of General Surgery, Sultan Qaboos University Hospital, Muscat, Oman
| | - Rana Al Moqbali
- Department of General Surgery, Sultan Qaboos University Hospital, Muscat, Oman
| | - Hani Al Qadhi
- Department of General Surgery, Sultan Qaboos University Hospital, Muscat, Oman
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Acıkgoz Mert GS, Ceri M, Calli Demirkan N, Sahin B, Mert M, Dursun B. Effect of bevacizumab and everolimus combination treatment on peritoneal sclerosis in an experimental rat model. Ther Apher Dial 2020; 25:323-330. [PMID: 33439548 DOI: 10.1111/1744-9987.13565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 07/17/2020] [Accepted: 07/20/2020] [Indexed: 10/23/2022]
Abstract
The aim of this study was to investigate whether bevacizumab and everolimus combination therapy is superior to bevacizumab treatment alone as a treatment for peritoneal sclerosis. Forty Wistar albino rats were divided into five equal groups. The control group received isotonic saline solution (2 mL/day) intraperitoneal (IP) daily for 3 weeks. The CG group received 2 mL 0.1% chlorhexidine gluconate (CG) and 15% ethanol dissolved in saline IP daily for 3 weeks. Peritoneal tissue samples were taken at the end of 3 weeks. The resting group received CG (weeks 0-3), plus isotonic saline solution (2 mL/day) IP daily and tap water (2 mL/day) via a feeding tube daily (weeks 3-6).The bevacizumab group received CG (weeks 1-3) plus bevacizumab at 2.5 mg/kg/day (2 mL) IP daily and tap water (2 mL/day) via a feeding tube daily (weeks 3-6). The bevacizumab+everolimus group received CG (weeks 1-3) plus bevacizumab at 2.5 mg/kg/day (2 mL) IP daily and everolimus at 0.3 mg/kg/day (2 mL) via a feeding tube daily (weeks 3-6). Peritoneal tissue samples were taken from these three groups at the end of 6 weeks and were examined after staining with hematoxylin-eosin and Masson's trichrome. Inflammation, vasculopathy, fibrosis, and peritoneal thickness were evaluated under light microscopy. The samples were also stained with anti-TGF-β and anti-MMP-2. Inflammation and vasculopathy scores were significantly decreased in the VEGF-i group compared to the CG group. The addition of everolimus to VEGF-i showed significantly lower inflammation, vasculopathy, fibrosis scores, and an evident decrease in peritoneal thickening (respectively, 2.29 ± 0.76 vs 0.57 ± 0.53, P = .003; 2.71 ± 0.76 vs 1.43 ± 0.53, P = .008; 2.57 ± 0.79 vs 1.57 ± 0.79, P = .04; 247.5 ± 136.1 vs 84.5 ± 48.6, P = .048). MMP-2 levels were lower in the combination group compared to the resting group (2.63 ± 0.74 vs 1.86 ± 0.38, P = .019). The study results demonstrated that bevacizumab and everolimus combination therapy was more effective than bevacizumab therapy alone.
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Affiliation(s)
| | - Mevlut Ceri
- Department of Nephrology, Pamukkale University Faculty of Medicine, Denizli, Turkey
| | - Nese Calli Demirkan
- Department of Pathology, Pamukkale University Faculty of Medicine, Denizli, Turkey
| | - Barbaros Sahin
- Department of Experimental Surgery Application and Research, Pamukkale University Faculty of Medicine, Denizli, Turkey
| | - Mehmet Mert
- Department of Internal Medicine, Pamukkale University Faculty of Medicine, Denizli, Turkey
| | - Belda Dursun
- Department of Nephrology, Pamukkale University Faculty of Medicine, Denizli, Turkey
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Reprogramming of Mesothelial-Mesenchymal Transition in Chronic Peritoneal Diseases by Estrogen Receptor Modulation and TGF-β1 Inhibition. Int J Mol Sci 2020; 21:ijms21114158. [PMID: 32532126 PMCID: PMC7312018 DOI: 10.3390/ijms21114158] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/31/2020] [Accepted: 06/04/2020] [Indexed: 12/14/2022] Open
Abstract
In chronic peritoneal diseases, mesothelial-mesenchymal transition is determined by cues from the extracellular environment rather than just the cellular genome. The transformation of peritoneal mesothelial cells and other host cells into myofibroblasts is mediated by cell membrane receptors, Transforming Growth Factor β1 (TGF-β1), Src and Hypoxia-inducible factor (HIF). This article provides a narrative review of the reprogramming of mesothelial mesenchymal transition in chronic peritoneal diseases, drawing on the similarities in pathophysiology between encapsulating peritoneal sclerosis and peritoneal metastasis, with a particular focus on TGF-β1 signaling and estrogen receptor modulators. Estrogen receptors act at the cell membrane/cytosol as tyrosine kinases that can phosphorylate Src, in a similar way to other receptor tyrosine kinases; or can activate the estrogen response element via nuclear translocation. Tamoxifen can modulate estrogen membrane receptors, and has been shown to be a potent inhibitor of mesothelial-mesenchymal transition (MMT), peritoneal mesothelial cell migration, stromal fibrosis, and neoangiogenesis in the treatment of encapsulating peritoneal sclerosis, with a known side effect and safety profile. The ability of tamoxifen to inhibit the transduction pathways of TGF-β1 and HIF and achieve a quiescent peritoneal stroma makes it a potential candidate for use in cancer treatments. This is relevant to tumors that spread to the peritoneum, particularly those with mesenchymal phenotypes, such as colorectal CMS4 and MSS/EMT gastric cancers, and pancreatic cancer with its desmoplastic stroma. Morphological changes observed during mesothelial mesenchymal transition can be treated with estrogen receptor modulation and TGF-β1 inhibition, which may enable the regression of encapsulating peritoneal sclerosis and peritoneal metastasis.
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Roumeliotis S, Dounousi E, Salmas M, Eleftheriadis T, Liakopoulos V. Unfavorable Effects of Peritoneal Dialysis Solutions on the Peritoneal Membrane: The Role of Oxidative Stress. Biomolecules 2020; 10:biom10050768. [PMID: 32423139 PMCID: PMC7277773 DOI: 10.3390/biom10050768] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 05/08/2020] [Accepted: 05/12/2020] [Indexed: 02/07/2023] Open
Abstract
One of the main limitations to successful long-term use of peritoneal dialysis (PD) as a renal replacement therapy is the harmful effects of PD solutions to the structure and function of the peritoneal membrane (PM). In PD, the PM serves as a semipermeable membrane that, due to exposure to PD solutions, undergoes structural alterations, including peritoneal fibrosis, vasculopathy, and neoangiogenesis. In recent decades, oxidative stress (OS) has emerged as a novel risk factor for mortality and cardiovascular disease in PD patients. Moreover, it has become evident that OS plays a pivotal role in the pathogenesis and development of the chronic, progressive injury of the PM. In this review, we aimed to present several aspects of OS in PD patients, including the pathophysiologic effects on the PM, clinical implications, and possible therapeutic antioxidant strategies that might protect the integrity of PM during PD therapy.
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Affiliation(s)
- Stefanos Roumeliotis
- Division of Nephrology and Hypertension, 1st Department of Internal Medicine, School of Medicine, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece;
| | - Evangelia Dounousi
- Department of Nephrology, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece;
| | - Marios Salmas
- Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece;
| | | | - Vassilios Liakopoulos
- Division of Nephrology and Hypertension, 1st Department of Internal Medicine, School of Medicine, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece;
- Correspondence: ; Tel.: +30-2310-994-694
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