Document Detail


The John F. Maher Recipient Lecture 2004: Rage in the peritoneum.
MedLine Citation:
PMID:  15770917     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Several conditions in the peritoneal membrane of peritoneal dialysis (PD) patients promote the accumulation of advanced glycation end-products (AGEs), that is, the uremic state, exposure to high glucose concentrations, and exposure to glucose degradation products (GDPs). AGEs exert some of their biologic actions through binding with a cell surface receptor, termed RAGE. Interaction of AGEs with RAGE induces sustained cellular activation, including the production of the fibrogenic growth factor, transforming growth factor-beta (TGF-beta). TGF-beta is pivotal in the process of epithelial-to-mesenchymal transition, through which cells of epithelial origin acquire myofibroblastic characteristics. Myofibroblasts are involved in virtually all conditions of pathological fibrosis. Submesothelial fibrosis is an important feature in peritoneal biopsies of PD patients, especially of those with clinical problems. We therefore examined the role of RAGE in peritoneal fibrosis, in an animal model of uremia, of high glucose exposure, and of peritoneal dialysate exposure. All three models were characterized by accumulation of AGEs, upregulation of RAGE, and fibrosis. Antagonism of RAGE prevented the upregulation of TGF-beta and fibrosis in the peritoneal membrane. We further examined the underlying mechanism of peritoneal fibrosis in the uremic model. Prominent myofibroblast transdifferentiation of mesothelial cells was identified by co-localization of cytokeratin and alpha-smooth muscle actin in submesothelial and interstitial fibrotic tissue. Antagonism of RAGE prevented conversion of mesothelial cells to myofibroblasts in uremia. In conclusion, we hypothesize that accumulation of AGEs in the peritoneal membrane, as a consequence of the uremic environment, chronic exposure to high glucose, and exposure to GDPs, results in an increased expression of RAGE. The interaction of AGEs with RAGE induces peritoneal fibrosis by virtue of upregulation of TGF-beta and subsequent conversion of mesothelial cells into myofibroblasts.
Authors:
An S De Vriese
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Publication Detail:
Type:  Lectures    
Journal Detail:
Title:  Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis     Volume:  25     ISSN:  0896-8608     ISO Abbreviation:  Perit Dial Int     Publication Date:    2005 Jan-Feb
Date Detail:
Created Date:  2005-03-17     Completed Date:  2005-07-05     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8904033     Medline TA:  Perit Dial Int     Country:  Canada    
Other Details:
Languages:  eng     Pagination:  8-11     Citation Subset:  IM    
Affiliation:
Renal Unit, University Hospital Gent, Belgium. an.devriese@azbrugge.be
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MeSH Terms
Descriptor/Qualifier:
Dialysis Solutions / adverse effects,  chemistry
Fibrosis / etiology*,  physiopathology
Glycosylation End Products, Advanced / physiology*
Humans
Peritoneal Dialysis / adverse effects*
Peritoneum / pathology*,  physiopathology
Receptors, Immunologic / physiology*
Uremia / physiopathology,  therapy
Chemical
Reg. No./Substance:
0/Dialysis Solutions; 0/Glycosylation End Products, Advanced; 0/Receptors, Immunologic; 0/advanced glycosylation end-product receptor

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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