Ultrastructure and pathology of the peritoneum in peritoneal dialysis

Dobbie, James W.

doi:10.1007/978-94-011-0814-0_2

Cited by 67 publications

(68 citation statements)

References 33 publications

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“…The most detailed dissection of the visceral peritoneum was performed by Baron (2), who demonstrated five layers of connective tissue and the layer of mesothelial cells for a total thickness of ϳ90 m. There were very few blood vessels within the peritoneum, and those that existed were ϳ40 m from the surface. The mesothelial cells play a major role in the secretion of lubricant solutions made of primarily phospholipids and glycosaminoglycans (21). This ensures a smooth sliding surface between the visceral and parietal peritoneum, which is not only important for gut motility but for distribution of the therapeutic solution.…”

Section: Role Of the Peritoneummentioning

confidence: 99%

The transport barrier in intraperitoneal therapy

Flessner

2005

American Journal of Physiology-Renal Physiology

202

171

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The peritoneal cavity is important in clinical medicine because of its use as a portal of entry for drugs utilized in regional chemotherapy and as a means of dialysis for anephric patients. The barrier between the therapeutic solution in the cavity and the plasma does not correspond to the classic semipermeable membrane but instead is a complex structure of cells, extracellular matrix, and blood microvessels in the surrounding tissue. New research on the nature of the capillary barrier and on the orderly array of extracellular matrix molecules has provided insights into the physiological basis of osmosis and the alterations in transport that result from infusion of large volumes of fluid. The anatomic peritoneum is highly permeable to water, small solutes, and proteins and therefore is not a physical barrier. However, the cells of the mesothelium play an essential role in the immune response in the cavity and produce cytokines and chemokines in response to contact with noncompatible solutions. The process of inflammation, which depends on the interaction of mesothelial, interstitial, and endothelial cells, ultimately leads to angiogenesis and fibrosis and the functional alteration of the barrier. New animal models, such as the transgenic mouse, will accelerate the discovery of methods to preserve the functional peritoneal barrier.

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Section: Role Of the Peritoneummentioning

confidence: 99%

The transport barrier in intraperitoneal therapy

Flessner

2005

American Journal of Physiology-Renal Physiology

202

171

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“…The data indicate a remarkable resistance of the microcirculation and of the capillary endothelium to toxic GDP in the short term. Furthermore, there were no morphological alterations mimicking what may occur in the peritoneum over months or years of CAPD treatment [24,25]. However, there was a slight decrease in lymph flow and albumin Cl out of the peritoneal cavity in the group exposed to carbonyl compounds.…”

Section: Discussionmentioning

confidence: 86%

“…increases in the 'vascular surface area' independent of any interstitial alterations [27]. Such changes include a thickened and more fibrotic interstitium, where the presence of AGE, especially in the submesothelial space and in vascular walls, is prominent [25,27,28]. This interstitial remodeling would actually, a priori, be expected to reduce, not to increase, overall peritoneal solute transport.…”

Section: Discussionmentioning

confidence: 99%

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Very High Daily Intraperitoneal Doses of Carbonyl Compounds Affect the Morphology, but Not the Exchange Characteristics, of Rat Peritoneum

Musi

Braide²,

Wieslander³

et al. 2001

Blood Purif

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Glucose degradation products (GDP) are carbonyl compounds, that are formed by heat sterilization of conventional peritoneal dialysis (PD) fluids. Carbonyl compounds are known to be toxic in vitro and potentially toxic also in vivo. The aim of this study was to evaluate the effects of daily, short-term exposure of the peritoneum to very high concentrations of GDP in vivo on peritoneal transport parameters and on peritoneal morphology in a well-established rat model of PD. Rats were exposed to three daily intraperitoneal (IP) injections (10 ml) for 9 days of a largely neutral (pH 7.2) PD fluid containing 1.5% glucose and sterilized by filtration, with (n = 8) or without (n = 8) the presence of different carbonyl compounds in concentrations 100 times higher than those reported in commercial PD fluids. Seven rats, not subjected to any exposure, served as controls. After the exposure, the rats were subjected to acute PD in 4-hour dwells. Twenty milliliters of 4% glucose dialysis fluid were instilled into the rat peritoneal cavity. Blood and dialysate samples were taken during the dwell for measurements of dialysate sodium, and for assessments of the mass transfer area coefficient (PS) for glucose and ⁵¹Cr-EDTA and of transperitoneal clearance (Cl) or radiolabelled albumin (RISA). At the end of the dwell, parts of the liver, diaphragm and peritoneum were removed for measurements of tissue cell density and thickness of the submesothelial peritoneal tissue. The exposure of the peritoneum to very high doses of carbonyl compounds did not affect the peritoneal transport of fluid and small solutes significantly, but seemed to slightly reduce lymph flow and albumin clearance out of the peritoneal cavity. Assessed after a hypertonic dwell, and compared to the situation in nontreated rats after the same kind of dwell, there was a significant thinning of the submesothelial tissue, but no difference in tissue cell density. It is concluded that short-term exposure of the peritoneum in vivo to very high doses of GDP resulted in almost no signs of acute toxicity.

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“…The mesothelium is also a dynamic surface that regulates cellular traffic and tissue remodeling during chronic inflammation (53). Human mesothelial cells (HMCs) are exposed to chronic {nsuh during peritoneal dialysis (2,12,40) and have been the focus of numerous in vitro studies aimed at understanding and solving problems met during peritoneal dialysis and ascitis fluid reinfusion (19). Mesothelial cells can be harvested from the pericardium, pleura, or peritoneum.…”

Section: Introductionmentioning

confidence: 99%

Phenotypic and functional characteristics of porcine peritoneal mesothelial cells

Ohan

Gilbert

Brouland³

et al. 1999

In Vitro Cell.Dev.Biol.-Animal

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The objective of this study was to establish a technique to isolate porcine mesothelial cells (PMCs) from omental tissue and to compare them to human mesothelial cells (HMCs). The PMCs were dispersed by collagenase digestion and isolated on a Ficoll layer. Their morphologic and ultrastructural features were assessed at confluence by light and electronic microscopy, and they were characterized by immunohistochemistry using specific HMC markers. PMC proliferation was studied in the presence of growth factors platelet-derived growth factor (PDGF), epidermal growth factor (EGF) or transforming growth factors beta1, beta2, or beta3 (TGF). Fibrinolytic PMC activity was detected by zymography for tissue plasminogen activator (tPA) and by reverse zymography for plasminogen activator inhibitor-1 (PAI-1). The recalcification time of cell lysates was used to define PMC procoagulant activity, and gelatinase zymography was used to detect metalloproteinase production. At confluence, PMCs formed typical cobblestone monolayers and exhibited structural features characteristic of HMCs. Weibel Palade bodies were never seen. Specific HMC markers (HBME1, ME1, WT1) cross-reacted with PMCs. As HMCs and PMCs coexpressed cytokeratin and vimentin, and also expressed vinculin and alpha-actin. Addition of PDGF or EGF to the culture medium stimulated PMC proliferation. PMCs constitutively expressed fibrinolytic and procoagulant activity and secreted MMP9 and MMP2. The technique described in this study allows isolation of mesothelial cells from porcine omental tissue. These porcine cells exhibit a mesothelial phenotype and functional properties similar to those of HMCs. Our data warrant an evaluation of mesothelial cells as targets in several therapeutic strategies with porcine models.

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Ultrastructure and pathology of the peritoneum in peritoneal dialysis

Cited by 67 publications

References 33 publications

The transport barrier in intraperitoneal therapy

The transport barrier in intraperitoneal therapy

Very High Daily Intraperitoneal Doses of Carbonyl Compounds Affect the Morphology, but Not the Exchange Characteristics, of Rat Peritoneum

Phenotypic and functional characteristics of porcine peritoneal mesothelial cells

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