Novel Therapies for Hemodialysis Vascular Access Dysfunction: Fact or Fiction!

Roy‐Chaudhury, Prabir; Kelly, Burnett S.; Melhem, Murad; Zhang, Jianhua; Li, Jinsong; Desai, Pankaj B.; Munda, Rino; Heffelfinger, Sue C.

doi:10.1159/000082008

Cited by 19 publications

(13 citation statements)

References 111 publications

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“…Multiple factors are believed to contribute to NH in the AV ePTFE graft, including (a) surgical trauma to the vessel during graft placement; (b) bioincompatibility of the ePTFE graft material; (c) mechanical factors at the anastomoses; (d) endothelial dysfunction caused by uremia; and (e) vessel wall damage from repeated needle punctures for dialysis treatments. The effect of uremia on NH development has been discussed in other reviews 11,21. This review focuses on the first three factors.…”

Section: Pathogenesis Of Hemodialysis Graft Stenosismentioning

confidence: 99%

Neointimal hyperplasia associated with synthetic hemodialysis grafts

Terry

Shiu

et al. 2008

Kidney International

114

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Stenosis is a major cause of failure of hemodialysis vascular grafts and is primarily caused by neointimal hyperplasia (NH) at the anastomoses. The objective of this article is to provide a scientific review of the biology underlying this disorder and a critical review of the state-of-the-art investigational preventive strategies in order to stimulate further research in this exciting area. The histology of the NH shows myofibroblasts (that are probably derived from adventitial fibroblasts), extracellular matrices, pro-inflammatory cells including foreign-body giant cells, a variety of growth factors and cytokines, and neovasculature. The contributing factors of the pathogenesis of NH include surgical trauma, bioincompatibility of the synthetic graft, and the various mechanical stresses that result from luminal hypertension and compliance mismatch between the vessel wall and graft. These mechanical stimuli are focal in nature and may have a significant influence on the preferential localization of the NH. Novel mechanical graft designs and local drug delivery strategies show promise in animal models in preventing graft NH development. Successful prevention of graft stenosis would provide a superior alternative to the native fistula as hemodialysis vascular access.

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Section: Pathogenesis Of Hemodialysis Graft Stenosismentioning

confidence: 99%

Neointimal hyperplasia associated with synthetic hemodialysis grafts

Terry

Shiu

et al. 2008

Kidney International

114

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“…Ti(OBu) 4 , acrylic acid (AA), potassium persulfate, and bovine serum albumin (BSA; M w = 67,000 Da) were purchased from Sinopharm Chemical Reagent Co., Ltd (China). Analytical grade acetic acid, nitric acid, absolute ethanol, and ethylene glycol were obtained from Shanghai Lingfeng Chemical Reagent Co., Ltd (China).…”

Section: Experiments Materialsmentioning

confidence: 99%

“…In particular, porous PTFE membranes have found special importance in water treatment [1], separators of lithium-ion batteries [1,2], pervaporation [3], and blood purification [4]. However, the presence of strong C-F bonding and water repellence makes the application of PTFE membranes in water treatment field less competitive because of the rather low water flux.…”

Section: Introductionmentioning

confidence: 99%

Surface engineering and self-cleaning properties of the novel TiO2/PAA/PTFE ultrafiltration membranes

et al. 2016

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Immobilization of nano-scaled TiO 2 onto polymeric ultrafiltration (UF) membrane offers desirable antifouling and self-cleaning properties to the membrane, which is practical in wastewater purification only if the mechanical strength and long-term self-cleaning durability are realized. This paper reported the surface roughness, mechanical properties, thermal stability, and recycling selfcleaning performance of the novel TiO 2 /PAA/PTFE UF membranes, which were coated via an innovative plasmaintensified coating strategy. Through careful characterizations, the enhanced engineering properties and the selfcleaning performance were correlated with the surface chemical composition and the creative coating technique. In the recycling photocatalytic self-cleaning tests in photodegradation of methylene blue (MB) solution, about 90 % MB photocatalytic capability of TiO 2 /PAA/PTFE composite membranes could be recovered with simple hydraulic cleaning combined with UV irradiation. The mechanical properties and thermal stability of TiO 2 /PAA/ PTFE also satisfy the practical application in water and wastewater treatments, despite that the original engineering properties were slightly influenced by PAA grafting and TiO 2 coating. The changed properties of the composite UF membrane relative to PTFE are reasonably attributed to the variation of the surface chemical species and chemical bonding, as well as the thickness and evenness of the surface functional layers.

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“…In particular, cell types at the graft-vein anastomosis are exposed to a number of continuous stressors which include hemodynamic stress, compliance mismatch and an inflammatory response to PTFE graft [1,3,28] . In addition, there are multiple different cell types present at the graftvein anastomosis [5,8] and the cross talk between these cell types, together with exposure to the multiple stressors described above could result in a phenotype that is more susceptible to the effects of combination paclitaxel and radiation therapy as compared to the in vitro experiments with individual cell types.…”

Section: Discussionmentioning

confidence: 99%

In vitro Paclitaxel and Radiation Effects on the Cell Types Responsible for Vascular Stenosis: A Preliminary Analysis

Zhang

Melhem²,

Kassing³

et al. 2006

Blood Purif

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Hemodialysis vascular access dysfunction as a result of venous neointimal hyperplasia in dialysis access grafts and fistulae is currently a huge clinical problem. The aim of this study was to assess the effects of paclitaxel and radiation, both singly and in combination on the proliferation of cell types present within the lesion of venous neointimal hyperplasia (vascular smooth muscle cells, fibroblasts and endothelial cells within the neointimal microvessels). Vascular smooth muscle cells, fibroblasts and endothelial cells were plated onto 96-well plates and exposed to different concentrations and doses of paclitaxel and radiation, respectively (both individually and in combination). Growth inhibition was assessed with an MTT assay. Both paclitaxel and radiation resulted in significant growth inhibition of all three cell types. However, even small doses of paclitaxel appeared to attenuate the antiproliferative effect of radiation on these cell types. Further experiments to elucidate the mechanism behind these findings could result in a better understanding of combination antiproliferative therapies.

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Novel Therapies for Hemodialysis Vascular Access Dysfunction: Fact or Fiction!

Cited by 19 publications

References 111 publications

Neointimal hyperplasia associated with synthetic hemodialysis grafts

Neointimal hyperplasia associated with synthetic hemodialysis grafts

Surface engineering and self-cleaning properties of the novel TiO2/PAA/PTFE ultrafiltration membranes

In vitro Paclitaxel and Radiation Effects on the Cell Types Responsible for Vascular Stenosis: A Preliminary Analysis

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