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2014 ; 2014
(ä): 473134
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Mesenchymal Conversion of Mesothelial Cells Is a Key Event in the Pathophysiology
of the Peritoneum during Peritoneal Dialysis
#MMPMID26556413
López-Cabrera M
Adv Med
2014[]; 2014
(ä): 473134
PMID26556413
show ga
Peritoneal dialysis (PD) is a therapeutic option for the treatment of end-stage
renal disease and is based on the use of the peritoneum as a semipermeable
membrane for the exchange of toxic solutes and water. Long-term exposure of the
peritoneal membrane to hyperosmotic PD fluids causes inflammation, loss of the
mesothelial cells monolayer, fibrosis, vasculopathy, and angiogenesis, which may
lead to peritoneal functional decline. Peritonitis may further exacerbate the
injury of the peritoneal membrane. In parallel with these peritoneal alterations,
mesothelial cells undergo an epithelial to mesenchymal transition (EMT), which
has been associated with peritoneal deterioration. Factors contributing to the
bioincompatibility of classical PD fluids include the high content of
glucose/glucose degradation products (GDPs) and their acidic pH. New generation
low-GDPs-neutral pH fluids have improved biocompatibility resulting in better
preservation of the peritoneum. However, standard glucose-based fluids are still
needed, as biocompatible solutions are expensive for many potential users. An
alternative approach to preserve the peritoneal membrane, complementary to the
efforts to improve fluid biocompatibility, is the use of pharmacological agents
protecting the mesothelium. This paper provides a comprehensive review of recent
advances that point to the EMT of mesothelial cells as a potential therapeutic
target to preserve membrane function.