Restoration of Epithelial to Mesenchymal Transition (EMT) after Switching from High Glucose Degradation Products (GDP) to Low GDP Dialysis Solution in Continuous Ambulatory Peritoneal Dialysis (CAPD) Patients

Park, Jong Won; Do, Jun Young; Kim, Tae Woo

Abstract

BACKGROUND: We reported the beneficial effect of low GDP solution on rapid remesothelialization and less EMT in the peritoneum with time on CAPD. In a prospective study, we investigated the effect of switching solution from high GDP to low GDP on the restoration of EMT from human peritoneal mesothelial cells (HPMCs) in CAPD patients via ex vivo.
METHODS
21 patients (11 females, DM:11, mean age: 52.1+/-13.4 years old) who had used high GDP solution (pH 5.5, stay-safe(R), FMC) for more than 1 year (mean 14+/-6.4 months) were treated with the low GDPs solution (pH 7.0, stay-safe Balance(R), FMC) at least additional 12 months. Drained HPMCs from overnight effluent were cultured on T25 flask at the 6 months before switching to low GDPs solution (Time -6), just before switching (Time 0), 3 months after switching (Time +3), 6 months after switching (Time +6) and 12 months after switching (Time +12). When they had nearly reached to confluence, cell scores were blindly measured by the same person (Score 1: cobble stone shaped HPMCs, Score 2: mixed, Score 3:fibroblast dominant). Cell scores and clinical indices were compared between Time 0 and the others. We analyzed data with paired t-test.
RESULTS
Cell score was a significantly lower at Time -6 than Time 0 (1.63+/-0.8 vs. 2.06+/-0.85, p= 0.014). But, there was no difference of level of D-CA125 between two groups (23.4+/-13.0 vs. 23.7+/-13.4 (IU/mL), p=N.S., N=16). There was no difference of cell scores between Time +3 and Time 0 (2.24+/-0.94 vs. 2.19+/-0.87, p=N.S., N=21). There were significantly lower cell score (1.71+/-0.90 vs. 2.19+/-0.87, p=0.038) and significantly higher level of D-CA125 (37.4+/-20.3 vs. 24.4+/-13.4 (IU/mL), p=0.004) at Time +6 than Time 0 (N=17). There were significantly lower cell score (1.60+/-0.88 vs. 2.20+/-0.89, p=0.014) and significantly higher level of D-CA125 (46.2+/-20.9 vs. 20.1+/-11.5 (IU/mL), p=0.000) in Time +12 than Time 0 (N=17).
CONCLUSION
Our study suggests that, although restoration of EMT took some time, the switching into GDP solution from conventional solution might be helpful to pre-Jong-Won Park, et al.: Restoration of Epithelial to Mesenchymal Transition in CAPD Patients-serve the peritoneal membrane with time on PD.