Biocompatibility of a peritoneal dialysis solution with amino acids: histological evaluation in the rabbit

OBJECTIVE: To determine the biocompatibility of a peritoneal dialysis (PD) solution containing amino acids compared to PD solutions containing glucose. DESIGN: The biocompatibility of three dialysis solutions containing 1.1% amino acids, 1.36% glucose, and 3.86% glucose, respectively, was evaluated in vivo in rabbits. METHODS: After 60 days of PD, peritoneal histological changes in rabbits were investigated by light and transmission electron microscopy. The parameters investigated were: (1) mesothelial damage; (2) submesothelial edema; (3) submesothelial cell infiltration; (4) submesothelial fibrosis; and (5) vascular alterations. Semiquantitative evaluations were performed for all the above alterations; quantitative morphometric evaluation was performed for mesothelial damage (cubic transformation of the mesothelium, areas devoid of mesothelium, submesothelial edema) and thickness of peritoneal arteriole walls. RESULTS: (1) Mesothelial damage was practically nonexistent in rabbits dialyzed with the solution containing amino acids, and intermediate and severe with low-glucose and high-glucose solutions, respectively. Both controls and rabbits dialyzed with amino acid solution showed flat continuous mesothelium; rabbits dialyzed with low-glucose solution showed cubic continuous mesothelium; and rabbits dialyzed with high-glucose solution showed cubic discontinuous mesothelium. Cytopathic mesothelial effects were slight with the solution containing amino acids and severe with both the low- and high-glucose solutions. Duplication and thickening of mesothelial basement membrane were never observed. (2) Submesothelial edema showed a worsening trend from controls to rabbits dialyzed with solution containing amino acids, low glucose, and high glucose. (3) No difference in submesothelial infiltration was found between groups. (4) Submesothelial fibrosis was never observed. (5) Vascular alterations were never observed. CONCLUSION: These results are evidence that PD solution with amino acids is more biocompatible than high- and also low-glucose solutions.     

Host defences in continuous ambulatory peritoneal dialysis and the genesis of peritonitis

Continuous ambulatory peritoneal dialysis (CAPD) has come to be extensively used for the treatment of end-stage renal failure in children, and especially infants, such that now more than half of children on dialysis worldwide receive treatment by this means. Peritonitis, however, is commoner in children than in adults receiving treatment, and is a major source of morbidity and treatment failure in children started on CAPD. Only recently has the immunology of the normal peritoneum been studied extensively, with the need to assess the impact of the installation of large volumes of fluid into the peritoneal sac during dialysis. The main phagocytic defences of the peritoneum depend upon a unique set of macrophages which are present free in the peritoneal fluid but also in the submesothelium and in perivascular collections together with B lymphocytes in the submesothelial area. Both the number of macrophages per unit volume and the concentration of opsonic proteins, such as IgG, complement and fibronectin, are reduced to between only 1% and 5% when dialysis fluid is continuously present in the peritoneal sac. In addition, the fluids used for CAPD are toxic to both macrophages and to mesothelial cells. Thus minor degrees of contamination frequently lead to peritonitis and in addition the majority of patients have catheters inserted in their peritoneum which become colonised with organisms capable of producing exopolysaccharide (slime), which promotes adhesion of the organism to the plastic and protects them against phagocytic attack and the penetration of antibiotics. Thus the peritoneum is in a state of continual inflammation, as well as being a markedly more vulnerable site than the normal peritoneum to the entry of organisms. Whether clinical peritonitis appears in this state of chronic contamination probably depends on perturbation in the balance between host defences and the organism. Whilst Staphylococcus epidermidis is the commonest cause of peritonitis, Staphylococcus aureus and Gram-negative organisms are much more serious and more frequently lead either to temporary catheter removal or discontinuation of dialysis altogether. This review describes the peritoneal defences in relation to the genesis of peritonitis.     

Nucleotide sequence of 5''-upstream region and expression of a silkworm gene encoding a new member of the attacin family

The morphometric and morphological changes in the mesothelial cell population were studied in rabbits in peritoneal dialysis with lactate and bicarbonate buffer solution. During dialysis the mesothelial population underwent radical changes in morphology and morphometric analysis showed a significant increase in cell size. Light microscope examination showed two types of changes: hyperplasia of the mesothelial cell with diameters of up to 80 microns, nucleus proportional to the cytoplasm, a large nucleole giving an owl's eye appearance and cytoplasm rich in granular material. The second change was multiple nuclei and arrest of cell division. Nuclear division occurred, but no separation of the cytoplasm. The cells became larger than 200 microns, packed with nuclei and relatively little cytoplasm. Electron microscopy confirmed that the hyperplastic cells had perfect structure whereas the polynucleate cells contained vacuoles and little cytoplasmic reticulum. Immunohistochemistry using monoclonal antibodies SK2-27 and SK 60-61 specific to cytokeratins 14, 16, 17 and 8, 18, respectively, identified the cells as mesothelial. The changes were related to the glucose content of the peritoneal dialysis solution. Glucose is therefore the bioincompatible agent that modifies the mesothelium during peritoneal dialysis, causing it to become hyperplastic or blocking replication.     

Partial peripheral neuropathy and denervation induced adrenoceptor supersensitivity. Functional studies in an experimental model

OBJECTIVE: To determine the influence of iron dextran intraperitoneal administration on the function and histology of the peritoneum in rats undergoing chronic peritoneal dialysis. DESIGN: Prospective, randomized experimental study. MATERIALS: Fifty-four Sprague-Dawley rats were divided into five groups: 3 study groups--high dose group (H), n = 12; intermediate dose (M), n = 12; and low dose group (L), n = 12--a dialysis control group (D), n = 12; and a tissue control (C), n = 7. INTERVENTIONS: The study groups were given Dianeal containing iron dextran in a concentration of 0.5, 0.25, and 0.125 mg/L (groups H, M, and L respectively). Group D was given standard Dianeal. Group C was never dialyzed. MAIN OUTCOME MEASURES: A 2-hour peritoneal equilibrium test (PET) was performed on the eighth day, at 3 months, and at 6 months. After the final PET, the animals were sacrificed and the peritoneal membrane was evaluated by gross inspection and light microscopy (silver, prussian blue, and trichrome staining). RESULTS: Peritoneal transport of small solutes followed the same pattern in all groups, increasing over time. The peritonitis index was similar in the groups. No iron deposits or morphologic differences were seen in the gross inspection of the peritoneal cavity. No peritoneal iron deposition was detected in the histological analysis with prussian blue staining. No differences were noted in the light microscopic analysis of the mesothelial cell layer (silver staining), nor did the morphometric analysis of the submesothelial space show any differences in thickness between the groups. CONCLUSION: These findings suggest the absence of toxic effects of iron dextran on the peritoneal cavity of rats in the concentrations studied. Further studies should be performed to evaluate the effectiveness of these dosages delivered intraperitoneally to maintain iron homeostasis.     

Effect of vitamin E on peroxidation and permeability of the peritoneum

Because of the evidence that peritoneal macrophages are activated during peritoneal dialysis, we hypothesised that the injury of the peritoneum is, at least in part, dependent on the intraperitoneal generation of free radicals. The aim of the study was to evaluate the effect of vitamin E on the peroxidation and permeability of the peritoneum during chronic peritoneal dialysis in rats. Supplementation of the intraperitoneally infused saline with vitamin E decreased the peroxidation of peritoneum estimated as the malondialdehyde (MDA) level in rats' omentum. However the permeability of the peritoneum to glucose and protein in vitamin E treated rats was increased. In in vitro study we have found that vitamin E is cytotoxic to human mesothelial cells (HMC) as measured by inhibition of their proliferation and this effect was irreversible. We conclude that vitamin E, despite its antioxidant effect, causes the changes of the peritoneum permeability which could decrease the effectiveness of peritoneal dialysis.     

The effect of mesothelium damage on peritoneal transport functions: in vitro studies

Bidirectional transport across rabbit parietal peritoneum of urea, uric acid, gentamycin and albumin were examined in control conditions and after mechanical or chemical mesothelium damage. The transport mean values, exprerssed as transport coefficients, of intact peritoneum amounted 1.37; 1.18; 4.30; 0.20 [10(-4) cm s-1] respectively. The destruction of mesothelial barrier increased, in similar range, both absorption and excretion component of the transport of urea, uric acid and albumin but not gentamycin. In the latter case, mesothelium injury enhanced peritoneal excretion by 86% and absorption by 162%. An asymmetry in gentamycin transport was observed which can be unfavourable for peritoneal dialysis patients.     

In vivo model to study the biocompatibility of peritoneal dialysis solutions

This study was designed to analyze the complex morphologic and functional effects of dialysis solutions on peritoneum in a rat model on chronic peritoneal dialysis. Peritoneal catheters were inserted into 10 male, Wistar rats and the animals were dialyzed twice daily for 4 weeks with 4.25% Dianeal. During the study we observed two opposite effects: healing of the peritoneum after catheter implantation--decreased cell count in dialysate, decreased permeability of the peritoneum to glucose and total protein, increased volume of drained dialysate; and damage to the membrane due to its exposure to peritoneal dialysis solution--increased hyaluronic acid levels in dialysate, a tendency of the peritoneum to thicken when compared to non-dialyzed animals. Our rat model of CAPD may be used for quantitative and qualitative assessment of the effects of peritoneal dialysis solution on the peritoneum during chronic dialysis.     

Effects of induction and inhibition of cytochromes P450 on the hepatotoxicity of methapyrilene

The peritoneum is more than a mechanical covering that allows for the easy gliding of opposed peritoneal surfaces. The peritoneal mesothelial cells facilitate the action of powerful innate immune mechanisms. In addition, the peritoneal-associated lymphoid tissues contain unique cells that may play a crucial role in the localization of intraperitoneal infection. A clearer understanding of the molecular and cellular events underlying peritoneal functions in both the unstimulated and stimulated state will aid future treatment of peritonitis.     

Ultrastructure of the mesothelioma of the atrioventricular node

In order to determine the histogenesis of tumors of the atrioventricular node, so-called conduction tumors, two such tumors were serially blocked for electron microscopy. Ultrastructurally these tumors were composed of nests of cells arranged in small channels and tubules set in a connective tissue stroma. The cells lining the tubules were flattened or low cuboidal and had abundant microvilli over the lumen surface. The cells were joined by specialized junctions along their lateral adjacent borders, especially at the luminal surfaces, and intercellular spaces delineated by specialized junctions were frequent. Microvilli, intercellular spaces bounded by tight junctions, and complex intercellular junctions are features of mesothelial cells, and especially of benign mesothelioma of the genital tract. These results strongly suggest that the cardiac conduction tumor is derived from mesothelial cells and is in fact a mesothelioma of the atrioventricular node.     

Scanning electron microscopic and immunohistochemical studies of pelvic endometriosis

The pathogenesis of pelvic endometriosis has been studied by using scanning electron and light microscopy, observing the surface structure of bluish lesions obtained from 26 patients during laparotomy. Paraffin sections included another 17 tissue samples of endometriosis, based on immunohistochemical responses to epithelial membrane antigen, keratin and vimentin. Ultrastructurally, the surface epithelial cells could not be detected in 13 out of 17 pelvic peritoneal endometriosis samples. In one case in which the surface peritoneal cells were seen histologically to dip into the subperitoneal stroma, many surface peritoneal infoldings were observed, and ciliated cells were detected at the edge of these infoldings. Ovarian endometriosis was composed of three types of cells, none of which had any cilia. These findings were observed in continuity with adjacent normal mesothelial cells. No characteristic structure of the endometrial surface was observed for the bluish lesion, but the gland surface of endometriosis located in the subperitoneal stroma initially had ciliated cells. The immunoreactions in both the columnar mesothelial cells with surface peritoneal infoldings and the glands of endometriotic tissues were similar to those of normal endometrial glands, but different from those of normal mesothelial cells. Pelvic endometriosis might originate by a process of metaplasia from the pelvic peritoneum.     

Separation of megakaryocytes from mouse bone marrow by density gradient centrifugation

Freeze-etch preparations of mesothelial cells taken from the peritoneum of mouse reveal the presence of vesicles invaginating the apical and the basal cell surfaces. These vesicles are scarcely seen within the cytoplasm. Long tortuous tubular profiles extend for considerable distance within the cytoplasm and are frequently associated with the vesicles. The possible nature and role of the vesicles and the tubules in transport phenomena across the mesothelial barrier, are discussed in relation to the pore theory advanced by physiologists and the "stomata" concept observed by early German and contemporary anatomists. "Occludens" junctions of the leaky type are seen though their macular or zonular nature is yet to be established.     

Hepatocyte growth factor (HGF) produced by peritoneal fibroblasts may affect mesothelial cell morphology and promote peritoneal dissemination

Mesothelial cell monolayers have been reported to prevent infiltration of cancer cells into the peritoneum. We have previously reported that peritoneal fibrosis induced by gastric cancer cells prior to metastatization may provide a congenial environment for peritoneal metastases. In this study, we investigated the effects of peritoneal fibroblasts on peritoneal mesothelial cell morphology. Human gastric cancer (OCUM-2MD3), peritoneal fibroblast (NF-2P) and mesothelial (MS-1) cell lines were established in our laboratory. Histology of the peritoneum was investigated following intraperitoneal inoculation of serum-free conditioned media (SF-CM) from OCUM-2MD3 cells into nude mice. SF-CM from peritoneal fibroblasts was added to monolayer-cultured mesothelial cells, and their morphology was examined by phase-contrast microscopy. This experiment was conducted in the presence and absence of neutralizing antibodies against various factors. Mesothelial cells exposed to fibroblasts proliferation became hemispherical and separated from each other, while unexposed mesothelium remained as a flat monolayer. Cultured-mesothelial cells rounded up or exhibited a fibroblast-like shape following the addition of peritoneal fibroblast SF-CM. Anti-hepatocyte growth factor (HGF) neutralizing antibody partly inhibited this effect. We suggest that soluble factors, such as HGF, produced by peritoneal fibroblasts affect the morphology of mesothelial cells in monolayers so that the resulting environment may become prone to the peritoneal dissemination of cancer cells.     

Freeze-etch and histochemical evidence for cycling in crayfish photoreceptor membranes

Freeze-etched rhabdoms and adjacent cytoplasmic cytoplasmic organelles from crayfish compound eyes have been studied for evidence of photoreceptor membrane cycling. The protoplasmic leaflet face (PF) of split photoreceptor membrane of the microvilli is richly particulate. The particles (92 +/- 16 A in diameter in surface fractures; 70 +/- 9 A in cross fractures; density about 8000/mum2) probably indicate rhodopsin molecule localization. Closely similar particles appear in membranes of pinocytotic vesicles, multivesicular bodies (MVB) and secondary lysosomes. In contrast other retinular cell membranes like plasma membrane remote from the rhabdom are quite distinct (60 +/- 23 A particle diameter, density ca 1000/mum2.) Histochemical tests for acid phosphatase demonstrate its presence in well-developed (but not early stage) MVBs, mixed lamellar vesicular bodies (LVB) and lamellar bodies. Density of PF particles decreases from 8000 in MVB to roughly 4500/mum2 in LVB indicating a degradative sequence from rhabdom to lamellar bodies. Membrane leaflet orientations show that primary endocytosis from microvilli must be followed by secondary endocytosis of fused coated vesicles to form MVB. Morphological evidence for photoreceptor membrane resynthesis has not been found yet in crayfish but some has been obtained in other crustaceans.     

Bikunin present in human peritoneal fluid is in part derived from the interaction of serum with peritoneal mesothelial cells

We recently reported that peritoneal fluid mainly contains two proteoglycans; one is the interstitial proteoglycan referred to as decorin, and the other an uncharacterized small chondroitin sulfate proteoglycan. In the present study, we have used a two-step process to isolate the small chondroitin sulfate proteoglycan free of decorin. The purified molecule ran as a single band on sodium dodecyl sulfate-polyacrylamide gel electrophoresis with apparent molecular mass 50 kd made up of a chondroitin-4-sulfate glycosaminoglycan chain and a 30-kd core protein. NH2-terminal analysis of the core protein showed significant sequence homology with bikunin, a component of the human inter-alpha-trypsin inhibitor (IalphaI) family. A Western blot analysis using anti-human inter-alpha-trypsin inhibitor confirmed the identity of the small chondroitin sulfate proteoglycan as bikunin, and a trypsin inhibitor counterstain assay confirmed its anti-trypsin activity. Examination of serum from patients receiving continuous peritoneal dialysis suggests that free bikunin in peritoneal fluid may be the result of leakage of serum proteins into the peritoneum. Our findings further show that the interaction of serum with peritoneal mesothelial cells offers a new and novel explanation for the presence of bikunin in peritoneal fluid.     

An electron microscopic study of the interaction of polarized neoplastic fibroblasts of the L line with the substrate in tissue culture

Neoplastic fibroblasts of L strain were studied 24 hours after attachment to the solid artifical substrate. The cells were oriented on sections perpendicular to the substrate plane. Transformed fibroblasts moved forward 24 hours after attachment, being polarized. The main difference between normal fibroblasts studied earlier and the transformed ones was observed in the area of the spread lamellar cytoplasm on the front edge of the cell. In this place in malignant cells, a diminition of size and number of bundles of microfilaments and zones of close junction with the substrate was seen. These elements lie close to each other in normal cells, and far from each other in malignant ones. Another difference between normal and transformed cells is that the latter have many microvilli in the lower part of the surface of lamellar cytoplasm. Ultrastructural differences between normal neoplasmic cells observed in this work may be the cause of the behaviour of neoplastic cells in tissue culture.     

Sonographic determination of the thickness of the peritoneum in healthy children and paediatric patients on CAPD

BACKGROUND: Prolonged peritoneal dialysis and frequent episodes of peritonitis lead to structural changes and thickening of the peritoneum. Ultrasonography investigations may provide the opportunity to detect morphological changes early, but no systematic investigations have been performed yet. METHODS: Normal values of peritoneal thickness were obtained by systematically examining 131 healthy children (0-15 years) by ultrasound. Parietal peritoneal thickness was best measured at the sternal-umbical line distal from the xiphoid. Growth charts with 95% intervals were prepared. The data of 26 patients with end-stage renal failure (5-18 years) were compared to those of the normal children. RESULTS: The variation coefficient for the consecutive measurements was only 5%, interobserver error was approximately 7%. Whereas gender did not have any influence, peritoneal thickness was significantly correlated to age, weight and most obviously to height (r = 0.81; P<0.001). Children treated only by haemodialysis had normal values, while an increased thickness, loss of movement, and adhesion of the two peritoneal layers were found in children on CAPD. These changes were only noted in patients who had a history of peritonitis. CONCLUSION: Ultrasound examination is a simple, noninvasive and precise method to measure the peritoneal changes in children on CAPD.     

Structures in material transference and vitelline envelope formation in Betta splendens follicles

Structures were found by transmission electron microscopy, they were located within follicular cells and the oocyte, and in the interspace between them in follicles of the teleost fish Betta splendens. Some structures with features characteristic or lamellar bodies were found in small follicles. The possible role of these structures in the formation of the vitelline envelope as well as in the material transference is discussed. Vacuoles, vesticles and particles intensely stained were found in the microvilli and the cortical cytoplasm of the oocyte at the onset of vitellogenesis. These results suggest that different substances present in the cellular components of the follicle might be transferred from cell to cell through the extracellular space and through the prolongations that cross the extracellular space.     

Macrophage-colony forming cells (M-CFC), with different sensitivities to colony stimulating factors, from peritoneal exudates and tissues of chronically inflamed mice

OBJECTIVE AND DESIGN: To determine whether nonadherent macrophage precursors are present within the inflamed peritoneal cavity in mice, we analysed the mononuclear cell populations from different peritoneal tissues. OBJECTS: A group of 90 female mice BDF1 (C57BL/ 6 x DBA/2) was used for the study. Mononuclear cells were harvested from the peripheral blood, bone marrow, peritoneal exudate, omentum, mesentery, parietal peritoneum and diaphragm. TREATMENT: Mice were injected intraperitoneally with 0.2 ml of Freund's incomplete adjuvant. Animals were sacrificed at 6, 13, 16, 21 and 30 days. Three to six animals were examined for each time period. METHODS: Progenitor cell assay was performed in 1 ml of semi-solid agarose (0.3% Seakem GTG) DMEM which was supplied either with recombinant colony stimulating factors or with mesothelial cell-conditioned medium. RESULTS: Nonadherent macrophage-colony forming cells were present in all peritoneal compartments (35-140 precursor cells/5 x 10(4) mononuclear cells). Granulocyte/ macrophage-colony forming cells were found in the inflamed omentum. Combined simultaneous treatment with GM-CSF and M-CSF blocked the proliferation of the exudate and mesentery-derived macrophage precursors, but not other peritoneal tissue-derived macrophage precursors. Sequential stimulation with GM-CSF and M-CSF did not inhibit macrophage colony formation. CONCLUSIONS: GM-CSF can possibly influence the proliferative response induced by M-CSF. Nonadherent macrophage precursors recovered from different tissue compartments seem to differ in their sensitivity to growth regulation.     

Novel screening technique for dissemination potential of ovarian cancer cells to peritoneum

Invasiveness to the peritoneum reconstituted with a mesothelial cell line and Engelbreth-Holm-Swam extract by metastatic cancer cell lines of the uterine cervix, endometrium, and ovary was always higher than that by primary cell lines. The invasiveness by metastatic ovarian cancer cell lines was significantly stronger than that by the other gynecological primary or metastatic cell lines. In the clinical ovarian cancers studied, cancer cells from the metastatic lesion were more invasive than those from the primary lesion. This suggests that metastatic ovarian cancer cells might inherently possess strong invasiveness to the peritoneum. The assay system used in the present study is useful in investigating the clinical behavior and basic biology of peritoneal dissemination.