Peritoneal Defence Mechanisms and Staphylococcus Aureus in Patients Treated with Continuous Ambulatory Peritoneal Dialysis (CAPD)

Abstract

Peritonitis in continuous ambulatory peritoneal dialysis (CAPD) patients due to S. aureus is associated with an adverse clinical outcome, suggesting impaired clearance of this organism by the host. The ability of peritoneal macrophages (PMO) derived from CAPD patients to take up S. aureus and mount a respiratory burst was investigated. Whilst significant activity was observed in the absence of opsonin, both parameters of phagocytosis were augmented by addition of 20% pooled human serum (PHS), complement-depleted PHS, and fibronectin. When used as sole opsonin, fibronectin resulted in a dose-related increase in chemiluminescent response by both blood neutrophils and PMO. The opsonic activity of dialysis effluent, as judged by neutrophil chemiluminescence, correlated with IgG and fibronectin content, but not with complement as assessed by C3 levels. The addition of urokinase to dialysate improved its opsonic properties whilst having no effect on the activity of PHS-20%; this would suggest that the formation of fibrin in dialysate, promoted by S. aureus, interferes with phagocytosis. This and the low IgG, complement and fibronectin levels in dialysate may explain in part the relatively poor clearance of this organism from the peritoneum.

The Peritoneum: Beyond the Tissue – A Review

“…The peritoneum is generally described as a protective barrier and frictionless interphase that covers abdominal viscera ( Herrick and Mutsaers, 2004 ; Mutsaers, 2004 ; Yung et al, 2006 ; Susan and Tak Mao, 2012 ), but it is a much more complex structure with a great variety of functions. Besides from participating in the embryogenesis of primitive gut ( Burn and Hill, 2009 ), peritoneal functions include: selective fluid and cell transport ( Mutsaers, 2002 , 2004 ; Susan and Tak Mao, 2012 ; Retana et al, 2015 ; van Baal et al, 2017 ); physiological barrier ( Davies et al, 1990 ; Heel and Hall, 1996 ; Zarrinkalam et al, 2001 ; Grupp et al, 2007 ; Kazancioglu, 2009 ; Susan and Tak Mao, 2012 ); immune induction, modulation, and inhibition ( Bird et al, 2004 ; Susan and Tak Mao, 2012 ; van Baal et al, 2017 ); tissue repair and scarring ( Susan and Tak Mao, 2012 ; van Baal et al, 2017 ); preventing adhesion and tumoral dissemination ( Mutsaers, 2002 , 2004 ); and trans -cellular migration (see Figure 5 ) ( Mutsaers, 2002 ; Herrick and Mutsaers, 2004 ; Yung et al, 2006 ; Wang et al, 2010 ; van Baal et al, 2017 ).…”

“…This mesothelial change might be an active form that participates through the complete inflammatory process, including tissue repair. Additionally, mesothelial cells have demonstrated the ability to participate in fibrinolytic ( Van Hinsbergh et al, 1990 ), procoagulant ( Pronk et al, 1992 ), and fibrinogenic activity ( Davies et al, 1990 ).…”

“…The peritoneal fluid separates both layers of mesothelium with a quantity of 5–100 ml in volume ( Blackburn and Stanton, 2014 ; van Baal et al, 2017 ). It is described as an ultra-filtrated blood derivate ( Heel and Hall, 1996 ; Blackburn and Stanton, 2014 ), containing immune elements like complement’s C3, C4 ( Heel and Hall, 1996 ; Tang et al, 2004 ), and immunoglobulin G ( Davies et al, 1990 ); antimicrobial peptides like Human neutrophil peptide (HNP) 1 and 3, and Human β defensins (HβD) 1 to 3 ( Zarrinkalam et al, 2001 ; Grupp et al, 2007 ); immune cells like macrophages, lymphocytes, eosinophils, mesothelial cells and mast cells ( van Baal et al, 2017 ). All these humoral elements are produced by mesothelial cell ( Zarrinkalam et al, 2001 ; Tang et al, 2004 ; Grupp et al, 2007 ) (see Table 2 ), and along with the cellular components, make the peritoneal fluid a physiological barrier against infection.…”

Urokinase of plasminogen activator (uPA) in peritoneal fluid in patients with peritonitis

“…This mesothelial change might be an active form that participates through the complete inflammatory process, including tissue repair [17]. Additionally, mesothelial cells have demonstrated the ability to participate in fibrinolytic, procoagulant and fibrinogenic activity [6,7,8].…”

“…One is tissue repair and scarring [5]. The mesothelial cells have demonstrated the ability to participate in fibrinolytic, procoagulant and fibrinogenic activity [6,7,8]. The fibrinolytic system includes a broad spectrum of proteolytic enzymes with physiological and pathophysiological functions in several processes, such as haemostatic balance, tissue remodeling, tumor invasion, angiogenesis and reproduction.…”