Pathophysiology of the peritoneal membrane during peritoneal dialysis: the role of hyaluronan.
During peritoneal dialysis (PD), constant exposure of mesothelial cells to bioincompatible PD solutions results in the denudation of the mesothelial monolayer and impairment of mesothelial cell function. Hyaluronan, a major component of extracellular matrices, is synthesized by mesothelial cells and contributes to remesothelialization, maintenance of cell phenotype, and tissue remodeling and provides structural support to the peritoneal membrane. Chronic peritoneal inflammation is observed in long-term PD patients and is associated with increased hyaluronan synthesis. During inflammation, depolymerization of hyaluronan may occur with the generation of hyaluronan fragments. In contrast to native hyaluronan which offers a protective role to the peritoneum, hyaluronan fragments exacerbate inflammatory and fibrotic processes and therefore assist in the destruction of the tissue. This paper will discuss the contribution of mesothelial cells to peritoneal membrane alterations that are induced by PD and the putative role of hyaluronan in these processes.
Department of Medicine, The University of Hong Kong, Room 302 New Clinical Building, Queen Mary Hospital, Pokfulam, Hong Kong. ssyyung@hku.hk
Susan
S
Yung
Tak Mao
TM
Chan
D015415:Biomarkers / Q000378:metabolism; D054338:Cell Transdifferentiation; D015314:Dialysis Solutions / Q000009:adverse effects*; D004847:Epithelial Cells / Q000378:metabolism*; D006801:Humans; D006820:Hyaluronic Acid / Q000378:metabolism*; D007249:Inflammation / Q000209:etiology; D008970:Molecular Weight; D010530:Peritoneal Dialysis / Q000009:adverse effects*; D056627:Peritoneal Fibrosis / Q000209:etiology; D010537:Peritoneum / Q000503:physiopathology*
D015415:Biomarkers; D015314:Dialysis Solutions; D006820:Hyaluronic Acid