Does Immunosuppressive Treatment Ameliorate Morphology Changes in Encapsulating Peritoneal Sclerosis?

Bozkurt, Devrim; Sipahi, Savaş; Cetin, P.; Hür, Ender; Özdemir, Oya; Ertilav, Muhittin; Şen, Sait; Duman, Soner

doi:10.1177/089686080902902s42

Cited by 25 publications

(26 citation statements)

References 9 publications

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“…A variety of other immunosuppressive medications like azathioprine, rapamycin, mycophenalate mofetil, sirolimus, and cyclosporine have also been used to treat EPS either alone or in combination with steroids (Rajani, 2002 ; Wong et al, 2005 ; Lafrance et al, 2008 ). However, apart from steroids, evidence regarding the efficacy of any other immunosuppressive therapy in EPS remains weak due to lack of robust randomized clinical trials (Bozkurt et al, 2009 ).…”

Section: Therapeutic Management Of Epsmentioning

confidence: 99%

Encapsulating peritoneal sclerosisâ€”a rare but devastating peritoneal disease

et al. 2015

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Encapsulating peritoneal sclerosis (EPS) is a devastating but, fortunately, rare complication of long-term peritoneal dialysis. The disease is associated with extensive thickening and fibrosis of the peritoneum resulting in the formation of a fibrous cocoon encapsulating the bowel leading to intestinal obstruction. The incidence of EPS ranges between 0.7 and 3.3% and increases with duration of peritoneal dialysis therapy. Dialysis fluid is hyperosmotic, hyperglycemic, and acidic causing chronic injury and inflammation in the peritoneum with loss of mesothelium and extensive tissue fibrosis. The pathogenesis of EPS, however, still remains uncertain, although a widely accepted hypothesis is the “two-hit theory,” where, the first hit is chronic peritoneal membrane injury from long standing peritoneal dialysis followed by a second hit such as an episode of peritonitis, genetic predisposition and/or acute cessation of peritoneal dialysis, leading to EPS. Recently, EPS has been reported in patients shortly after transplantation suggesting that this procedure may also act as a possible second insult. The process of epithelial–mesenchymal transition of mesothelial cells is proposed to play a central role in the development of peritoneal sclerosis, a common characteristic of patients on dialysis, however, its importance in EPS is less clear. There is no established treatment for EPS although evidence from small case studies suggests that corticosteroids and tamoxifen may be beneficial. Nutritional support is essential and surgical intervention (peritonectomy and enterolysis) is recommended in later stages to relieve bowel obstruction.

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Section: Therapeutic Management Of Epsmentioning

confidence: 99%

Encapsulating peritoneal sclerosisâ€”a rare but devastating peritoneal disease

et al. 2015

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“…3 Some studies suppose the role of calcineurin inhibitors (CNIs) in developing or aggravating EPS. 4,5 Many of these factors play roles in up-regulation of transforming growth factor-b (TGF-b) and vascular endothelial growth factor (VEGF) and subsequent epithelial to mesenchymal transition (EMT), fibrosis and neoangiogenesis. 6,7 Treatment of EPS differs from medical therapy for lower stages to surgery for higher stages.…”

Section: Introductionmentioning

confidence: 99%

mTOR inhibitors for management of encapsulating peritoneal sclerosis: a review of literatures

2016

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“…Another study showed that after MMF treatment, MMP-2 and TGF-β1 gene expressions decreased significantly []. Moreover, sirolimus showed no significant effect on MMP-2 levels [31]. MMF and sunitinib treatment have a significant impact on dialysate TGF-β1 levels as compared with the resting EPS rat model [,].…”

Section: Discussionmentioning

confidence: 99%

The effect of rituximab on encapsulated peritoneal sclerosis in an experimental rat model

Karakose¹,

Bal²,

Eser³

et al. 2020

Turk J Med Sci

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Introduction Peritoneal sclerosis may be observed in varied manifestations. However, the most serious form is encapsulated peritoneal sclerosis (EPS). EPS has a low prevalence of up to 3%, but it is associated with a high mortality rate of up to 51% in patients undergoing peritoneal dialysis (PD). Therefore, EPS is of major concern to nephrologists []. The characteristic feature of EPS is extreme sclerosis of the peritoneal membrane, which covers and constricts the intestines []. Although several studies have examined EPS, the exact pathophysiology of EPS remains unclear. The triggering factors involved in the pathogenesis of systemic fibrosis and EPS were M2type macrophages, CD4+T cells [], B cells [], the matrix metalloproteinase (MMP) family, particularly MMP-2 [,], and transforming growth factor-beta 1 (TGF-β1) []. Nishino et al. reported that T and B lymphocytes had important roles in the process of peritoneal fibrosis in a mouse peritoneal fibrosis model []. However, Habib et al. reported that there were no CD20 and CD15 positive cells in the biopsies of a subgroup of patients with EPS []. Conversely, Bosello reported the potential role of B cells in tissue fibrosis in some experimental models, thus, targeting B cells could be one method of reducing extracellular matrix deposition and lowering the inflammatory status [4]. Research has also shown the effect of the anti-B cell monoclonal antibody, rituximab, in the treatment of diseases involving fibrotic processes [4,,]. A variety of therapeutic approaches to EPS including surgical and medical options have been reported []. In recent studies, the effects of various immunosuppressive drugs such as prednisone, azathioprine, mycophenolate mofetil (MMF), and sirolimus have been investigated [,]. We reported the effect of the T cell blocker abatacept in the treatment of EPS in our previous study []. However, to our knowledge, no data on the effect of the anti-CD 20 + antibody, rituximab, in EPS models are available. Rituximab (MabThera/Rituxan), a chimeric murine/ human monoclonal antibody, binds specifically to the transmembrane antigen CD20 on B cells []. The aim of this study was to investigate the effect of rituximab in an experimental rat model in which Background/aim: Peritoneal sclerosis may be observed in varied manifestations. However, the most serious form is the encapsulated peritoneal sclerosis. We researched the effect of rituximab on peritoneal fibrosis in an experimental rat model. Materials and methods: Twenty-four Wistar Albino rats were divided into 4 equal groups. During weeks 0-3; group I received isotonic saline (IS) solution, group II, group III, and group IV received chlorhexidine gluconate (CG) via intraperitoneal (i.p.) route. In the next 3 weeks nothing adminestred to both group I and group II but IS solution was adminestred to group III via i.p. route and 375 mg/m2/ week rituximab was applied intravenously on days 21, 28, and 35 to group IV. Fibrosis, peritoneal thickness, and inflammation were evaluated. Immunohistochemical methods use...

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Does Immunosuppressive Treatment Ameliorate Morphology Changes in Encapsulating Peritoneal Sclerosis?

Cited by 25 publications

References 9 publications

Encapsulating peritoneal sclerosisâ€”a rare but devastating peritoneal disease

Encapsulating peritoneal sclerosisâ€”a rare but devastating peritoneal disease

mTOR inhibitors for management of encapsulating peritoneal sclerosis: a review of literatures

The effect of rituximab on encapsulated peritoneal sclerosis in an experimental rat model

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