title: Periostin: a matricellular protein involved in peritoneal injury during peritoneal dialysis.
abstract: BACKGROUND
  Periostin is a matricellular protein involved in tissue remodeling through the promotion of adhesion, cell survival, cellular dedifferentiation, and fibrogenesis. It can be induced by transforming growth factor beta and high glucose concentrations. We hypothesized that this protein might be expressed in the peritoneal cavity of patients on peritoneal dialysis (PD) and even more in patients with signs of encapsulating peritoneal sclerosis (EPS).
  
  
  METHODS
  In this retrospective study, we included peritoneal biopsies from patients on PD with EPS (n = 7) and without signs of EPS (n = 10), and we compared them with biopsies taken during hernia repair from patients not on PD (n = 11) and during various procedures from uremic patients not on PD (n = 6). Periostin was localized by immunohistochemistry, scored semiquantitatively, and quantified by morphometry. Periostin protein concentrations were measured by ELISA in dialysates from 15 patients. Periostin messenger RNA was quantified in vitro in peritoneal fibroblasts.
  
  
  RESULTS
  In control biopsies, periostin was present in the walls of larger arteries and focally in extracellular matrix in the submesothelial zone. Patients on PD demonstrated interstitial periostin in variable amounts depending on the severity of submesothelial fibrosis. In EPS, periostin expression was very prominent in the sclerosis layer. The area of periostin was significantly larger in EPS biopsies than in control biopsies, and the percentage of periostin-positive area correlated with the thickness of the submesothelial fibrosis zone. Periostin concentrations in dialysate increased significantly with time on PD in patients without signs of EPS; in patients with EPS, periostin concentrations in dialysate were low and demonstrated the smallest increase with time. In vitro, periostin was found to be strongly expressed by peritoneal fibroblasts.
  
  
  CONCLUSIONS
  Periostin is strongly expressed by fibroblasts and deposited in the peritoneal cavity of patients with EPS and with simple peritoneal fibrosis on PD. This protein might play a role in the progression of peritoneal injury, and low levels of periostin after prolonged time on PD might be a marker of EPS.
authors: Department of Internal Medicine,1 Division of General Internal Medicine and Nephrology, Robert-Bosch-Hospital, and Institute of Digital Medicine,2 Stuttgart, Germany;
authors: Niko
authors: N
authors: Braun
authors: Kontheari
authors: K
authors: Sen
authors: M Dominik
authors: MD
authors: Alscher
authors: Peter
authors: P
authors: Fritz
authors: Martin
authors: M
authors: Kimmel
authors: Johann
authors: J
authors: Morelle
authors: Eric
authors: E
authors: Goffin
authors: Achim
authors: A
authors: Jörres
authors: Rudolf P
authors: RP
authors: Wüthrich
authors: Clemens D
authors: CD
authors: Cohen
authors: Stephan
authors: S
authors: Segerer
mesh_terms: D001706:Biopsy; D015815:Cell Adhesion Molecules / Q000096:biosynthesis / Q000235:genetics*; D018450:Disease Progression; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005347:Fibroblasts / Q000378:metabolism / Q000473:pathology; D005500:Follow-Up Studies; D005786:Gene Expression Regulation; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000009:adverse effects*; D056627:Peritoneal Fibrosis / Q000235:genetics* / Q000378:metabolism / Q000473:pathology; D010537:Peritoneum / Q000378:metabolism / Q000473:pathology; D012333:RNA, Messenger / Q000235:genetics*; D012189:Retrospective Studies; D020133:Reverse Transcriptase Polymerase Chain Reaction
chemical_list: D015815:Cell Adhesion Molecules; C512835:POSTN protein, human; D012333:RNA, Messenger
keywords: Matricellular protein; encapsulating peritoneal sclerosis; periostin; peritoneal fibrosis; simple peritoneal fibrosis
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