Abstract
Periostin, a recently found matricellular protein, has been implicated in neointima formation after balloon injury. However, the relationship between periostin and hyperplastic intima formation after PTFE graft implantation is unclear. Under mixed anesthesia, PTFE grafts were implanted between the canine carotid artery and jugular vein, and PTFE graft samples were harvested 1, 2, and 4 months after implantation. Intima formation started on the luminal surface of PTFE grafts at the venous anastomotic region 1 month after implantation. Thereafter, the increase in intimal volume was not only observed in the venous and arterial anastomotic regions, but also in the middle region of the PTFE grafts. In accordance with the increased intimal formation, time-dependent increases in mRNA expressions of periostin and transforming growth factor beta 1 (TGF-β1), as well as a strong positive correlation between periostin and TGF-β1, were observed. These findings suggest that periostin may play a very important role in the pathogenesis of hemodialysis vascular access stenosis through the acceleration of intimal formation. Thus, periostin may be a very important therapeutic target for the treatment of vascular access graft dysfunction in hemodialysis patients.
Highlights
If kidney function drops to less than 85 to 90 percent of the normal condition in patients with end-stage renal disease (ESRD), these patients will need to have hemodialysis treatment for their whole life unless they are able to obtain a kidney transplant
Two months later (Figure 1B), intimal formation was more notable on the inner PTFE graft luminal surface at the venous anastomotic region, and this intima appeared on the middle region of the PTFE graft luminal surface
As can be seen in these bar graphs, total intima formation was time-dependently increased until 4 months after PTFE graft implantation
Summary
If kidney function drops to less than 85 to 90 percent of the normal condition in patients with end-stage renal disease (ESRD), these patients will need to have hemodialysis treatment for their whole life unless they are able to obtain a kidney transplant. To support efficient hemodialysis in these patients for such a long term, a well-functioning vascular access route is indispensable. A native arteriovenous (AV) fistula in hemodialysis patients as a vascular access route is the first-choice vascular access route due to a lower incidence of complications and better long-term patency [2]. If a fistula is not an option for patients, the best type of hemodialysis access is an AV graft, namely, a surgically created artificial conduit that connects an artery to a vein as a vascular access route. It has been reported that about 40–50% of hemodialysis patients with PTFE grafts needed percutaneous transluminal angioplasty (PTA) or reconstruction of another vascular access route within 1 year due to vascular access dysfunction [3].
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