Unidad de Biología Molecular, Hospital Universitario de la Princesa, Madrid, Spain.
Lab Invest. 2010 Oct;90(10):1517-32. doi: 10.1038/labinvest.2010.111. Epub 2010 Jun 7.
Exposure to non-physiological solutions during peritoneal dialysis (PD) produces structural alterations to the peritoneal membrane and ultrafiltration dysfunction. The high concentration of glucose and glucose degradation products in standard PD fluids induce a local diabetic environment, which leads to the formation of advanced glycation end products (AGEs) that have an important role in peritoneal membrane deterioration. Peroxisome proliferator-activated receptor γ (PPAR-γ) agonists are used to treat type II diabetes and they have beneficial effects on inflammation, fibrosis, and angiogenesis. Hence, we evaluated the efficacy of the PPAR-γ agonist rosiglitazone (RSG) in ameliorating peritoneal membrane damage in a mouse PD model, and we analyzed the mechanisms underlying the protection offered by RSG. Exposure of the peritoneum to PD fluid resulted in AGEs accumulation, an inflammatory response, the loss of mesothelial cell monolayer and invasion of the compact zone by mesothelial cells, fibrosis, angiogenesis, and functional impairment of the peritoneum. Administration of RSG diminished the accumulation of AGEs, preserved the mesothelial monolayer, decreased the number of invading mesothelial cells, reduced fibrosis and angiogenesis, and improved peritoneal function. Interestingly, instead of reducing the leukocyte recruitment, RSG administration enhanced this process and specifically, the recruitment of CD3+ lymphocytes. Furthermore, RSG treatment augmented the levels of the anti-inflammatory cytokine interleukin (IL)-10 and increased the recruitment of CD4+ CD25+ FoxP3+ cells, suggesting that regulatory T cells mediated the protection of the peritoneal membrane. In cell-culture experiments, RSG did not prevent or reverse the mesothelial to mesenchymal transition, although it decreased mesothelial cells apoptosis. Accordingly, RSG appears to produce pleiotropic protective effects on the peritoneal membrane by reducing the accumulation of AGEs and inflammation, and by preserving the mesothelial cells monolayer, highlighting the potential of PPAR-γ activation to ameliorate peritoneal deterioration in PD patients.
在腹膜透析(PD)过程中接触非生理溶液会导致腹膜结构改变和超滤功能障碍。标准 PD 液中高浓度的葡萄糖和葡萄糖降解产物会诱导局部糖尿病环境,导致晚期糖基化终产物(AGEs)的形成,而 AGEs 在腹膜恶化中起重要作用。过氧化物酶体增殖物激活受体 γ(PPAR-γ)激动剂用于治疗 2 型糖尿病,对炎症、纤维化和血管生成有有益作用。因此,我们评估了 PPAR-γ 激动剂罗格列酮(RSG)在改善小鼠 PD 模型中腹膜损伤的疗效,并分析了 RSG 提供保护的机制。PD 液暴露会导致 AGEs 积累、炎症反应、间皮细胞单层丧失和间皮细胞侵入致密区、纤维化、血管生成以及腹膜功能受损。RSG 给药减少了 AGEs 的积累,维持了间皮细胞单层,减少了侵入的间皮细胞数量,减少了纤维化和血管生成,并改善了腹膜功能。有趣的是,RSG 给药并没有减少白细胞募集,反而增强了这一过程,特别是 CD3+淋巴细胞的募集。此外,RSG 治疗增加了抗炎细胞因子白细胞介素(IL)-10 的水平,并增加了 CD4+CD25+FoxP3+细胞的募集,表明调节性 T 细胞介导了对腹膜的保护作用。在细胞培养实验中,RSG 没有预防或逆转间皮细胞向间充质细胞的转化,尽管它减少了间皮细胞凋亡。因此,RSG 似乎通过减少 AGEs 和炎症的积累以及维持间皮细胞单层对腹膜产生多种保护作用,突出了 PPAR-γ 激活在改善 PD 患者腹膜恶化方面的潜力。