Sterile inflammation in the pathogenesis of maturation failure of arteriovenous fistula

Nguyen, Megan; Thankam, Finosh G.; Agrawal, Devendra K.

doi:10.1007/s00109-021-02056-4

Cited by 9 publications

(5 citation statements)

References 118 publications

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“…Conversely, arteriovenous access methods such as AVGs and AVFs are more suited for long-term usage; however, AVGs require greater interventional requirements for maintenance and have a shorter functional lifespan than AVFs owing to increased risk of complications, such as infection and thrombosis [ 3 , 5 , 6 ]. Among the options for vascular access for hemodialysis, AVFs are associated with the highest patency rate, provided there is sufficient AVF maturation [ 7 , 8 , 9 , 10 ]. While endovascular and open surgical interventions are available to salvage AVFs that fail to mature and AVFs that suffer decreased flow rates over time, success rates for these salvage procedures are variable, their long-term durability is low, and the associated health care costs and burdens are necessarily increased [ 11 ].…”

Section: Arteriovenous Fistula Access For Hemodialysis Usementioning

confidence: 99%

Localized Perivascular Therapeutic Approaches to Inhibit Venous Neointimal Hyperplasia in Arteriovenous Fistula Access for Hemodialysis Use

et al. 2022

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An arteriovenous fistula (AVF) is the preferred vascular access for chronic hemodialysis, but high failure rates restrict its use. Optimizing patients’ perioperative status and the surgical technique, among other methods for preventing primary AVF failure, continue to fall short in lowering failure rates in clinical practice. One of the predominant causes of AVF failure is neointimal hyperplasia (NIH), a process that results from the synergistic effects of inflammation, hypoxia, and hemodynamic shear stress on vascular tissue. Although several systemic therapies have aimed at suppressing NIH, none has shown a clear benefit towards this goal. Localized therapeutic approaches may improve rates of AVF maturation by providing direct structural and functional support to the maturating fistula, as well as by delivering higher doses of pharmacologic agents while avoiding the adverse effects associated with systemic administration of therapeutic agents. Novel materials—such as polymeric scaffolds and nanoparticles—have enabled the development of different perivascular therapies, such as supportive mechanical devices, targeted drug delivery, and cell-based therapeutics. In this review, we summarize various perivascular therapeutic approaches, available data on their effectiveness, and the outlook for localized therapies targeting NIH in the setting of AVF for hemodialysis use. Highlights: Most systemic therapies do not improve AVF patency outcomes; therefore, localized therapeutic approaches may be beneficial. Locally delivered drugs and medical devices may improve AVF patency outcomes by providing biological and mechanical support. Cell-based therapies have shown promise in suppressing NIH by delivering a more extensive array of bioactive substances in response to the biochemical changes in the AVF microenvironment.

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Section: Arteriovenous Fistula Access For Hemodialysis Usementioning

confidence: 99%

Localized Perivascular Therapeutic Approaches to Inhibit Venous Neointimal Hyperplasia in Arteriovenous Fistula Access for Hemodialysis Use

et al. 2022

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“…Chronic inflammation, and progressive NIH, and atherosclerosis are associated with vessel thrombosis and stenosis, and increased expression of inflammatory mediators TREM-1, regulated by TLR-4 activation [ 9 , 18 , 23 , 37 , 38 ], might play a role in sterile inflammation in AVF maturation failure and patency of AVF [ 39 ]. Thus attenuating TREM-1 expression may attenuate inflammation and vessel stenosis and a decreased TREM-1 expression in the TAK-242 group compared to the ethanol group (9.62 ±1.42 vs 10.62 ± 3.40) suggest that TAK-242 not only decreases TLR-4 expression but also TREM-1 though not significant ( Figure 3 ).…”

Section: Discussionmentioning

confidence: 99%

TLR-4 Inhibition Attenuates Inflammation, Thrombosis, and Stenosis in Arteriovenous Fistula in Yucatan Miniswine

Rai¹,

Radwan²,

Nooti³

et al. 2022

Cardiol Cardiovasc Med

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Arteriovenous fistula (AVF) is the preferred vascular access in hemodialysis patients; however, it is afflicted with a high failure rate. Chronic inflammation, excessive neointimal hyperplasia (NIH), vessel stenosis, early thrombosis, and failure of outward remodeling are the major causes of AVF maturation failure. Inflammatory mediator toll-like receptor (TLR)-4 plays a critical role in NIH, arterial thrombosis, and stenosis. We investigated the effect of TLR-4 inhibition on early thrombosis. Yucatan miniswine were used to create AVF involving femoral artery and femoral vein and treated with TLR-4 inhibitor TAK-242 with ethanol as the vehicle. The vessels were assessed after 12 weeks using histomorphometry, immunostaining, ultrasound, angiography, and optical coherence tomography. Inhibition of TLR-4 attenuated inflammation and early thrombosis in 50% of animals, and blood flow was present through AVF in 25% of animals. Thus, targeting TLR-4 to attenuate inflammation and early thrombosis might be a therapeutic approach to keep AVF patent and maintain blood flow through the outflow vein.

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“…Similar to ECM remodelling, inflammation requires a balanced approach between pro-inflammatory and anti-inflammatory signalling to facilitate OR and wall thickening. The influence of inflammation on AVF vascular remodelling is thoroughly reviewed [ 130 , 131 , 132 , 133 , 134 , 135 ].…”

Section: Rebuilding the Vascular Framework: Ecm Remodelling During Av...mentioning

confidence: 99%

Building a Scaffold for Arteriovenous Fistula Maturation: Unravelling the Role of the Extracellular Matrix

Laboyrie

Vries

Bijkerk

et al. 2023

IJMS

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Vascular access is the lifeline for patients receiving haemodialysis as kidney replacement therapy. As a surgically created arteriovenous fistula (AVF) provides a high-flow conduit suitable for cannulation, it remains the vascular access of choice. In order to use an AVF successfully, the luminal diameter and the vessel wall of the venous outflow tract have to increase. This process is referred to as AVF maturation. AVF non-maturation is an important limitation of AVFs that contributes to their poor primary patency rates. To date, there is no clear overview of the overall role of the extracellular matrix (ECM) in AVF maturation. The ECM is essential for vascular functioning, as it provides structural and mechanical strength and communicates with vascular cells to regulate their differentiation and proliferation. Thus, the ECM is involved in multiple processes that regulate AVF maturation, and it is essential to study its anatomy and vascular response to AVF surgery to define therapeutic targets to improve AVF maturation. In this review, we discuss the composition of both the arterial and venous ECM and its incorporation in the three vessel layers: the tunica intima, media, and adventitia. Furthermore, we examine the effect of chronic kidney failure on the vasculature, the timing of ECM remodelling post-AVF surgery, and current ECM interventions to improve AVF maturation. Lastly, the suitability of ECM interventions as a therapeutic target for AVF maturation will be discussed.

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Sterile inflammation in the pathogenesis of maturation failure of arteriovenous fistula

Cited by 9 publications

References 118 publications

Localized Perivascular Therapeutic Approaches to Inhibit Venous Neointimal Hyperplasia in Arteriovenous Fistula Access for Hemodialysis Use

Localized Perivascular Therapeutic Approaches to Inhibit Venous Neointimal Hyperplasia in Arteriovenous Fistula Access for Hemodialysis Use

TLR-4 Inhibition Attenuates Inflammation, Thrombosis, and Stenosis in Arteriovenous Fistula in Yucatan Miniswine

Building a Scaffold for Arteriovenous Fistula Maturation: Unravelling the Role of the Extracellular Matrix

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