Are the mesothelial-to-mesenchymal transition, sclerotic peritonitis syndromes, and encapsulating peritoneal sclerosis part of the same process?

摘要

Mesothelial-to-mesenchymal transition (MMT) is an autoregulated physiological process of tissue repair that in uncontrolled conditions,such as peritoneal dialysis (PD), can lead to peritoneal fibrosis. The maximumexpression of sclerotic peritoneal syndromes(SPS) is the encapsulating peritoneal sclerosis (EPS) for which no specific treatment exists. The SPS includes a wide range ofperitoneal fibrosis that appears progressively and is considered as a reversible process, while EPS does not. EPS is a seriouscomplication of PD characterized by a progressive intra-abdominal inflammatory process that results in bridles and severe fibroustissue formation which cover and constrict the viscera. Recent studies show that transdifferentiated mesothelial cells isolated fromthe PD effluent correlate very well with the clinical events such as the number of hemoperitoneum and peritonitis, as well as withPD function (lower ultrafiltration and high Cr-MTC). In addition, in peritoneal biopsies from PD patients, the MMT correlatesvery well with anatomical changes (fibrosis and angiogenesis). However, the pathway to reach EPS from SPS has not been fully andcompletely established. Herein, we present important evidence pointing to the MMT that is present in the initial peritoneal fibrosisstages and it is perpetual over time, with at least theoretical possibility that MMT initiated the fibrosing process to reach EPS