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NDT Advance Access published online on April 17, 2009
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfn708
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© The Author [2009]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org


Cellular phenotypes in human stenotic lesions from haemodialysis vascular access

Prabir Roy-Chaudhury1, Yang Wang1, Mahesh Krishnamoorthy2, Jianhua Zhang1, Rupak Banerjee2, Rino Munda3, Sue Heffelfinger4 and Lois Arend4

1 Cincinnati Dialysis Access Research Program (CAP), Departments of Medicine 2 Mechanical Industrial and Nuclear Engineering 3 Surgery 4 Pathology, University of Cincinnati, Cincinnati, OH, USA

Correspondence and offprint requests to: Prabir Roy-Chaudhury, Division of Nephrology, University of Cincinnati, MSB G251, 231 Albert Sabin Way, Cincinnati, OH 45267-0585, USA. Tel: +1-513 558 4006; Fax: +1-513 558 4309; E-mail: Prabir.roychaudhury{at}uc.edu



  Abstract

Background. Haemodialysis vascular access dysfunction (due to venous stenosis and thrombosis) is a leading cause of hospitalization and morbidity. The aim of the current study was to identify the specific cell types present within stenotic tissue samples from patients with AV fistula and graft failure.

Methods. Discarded tissue segments were collected from the stenotic portions (usually near the graft-vein anastomosis or the AV anastomosis) of 23 dialysis grafts and 20 AV fistulae, and examined for expression of smooth muscle alpha actin, desmin, vimentin and a macrophage marker.

Results. The majority of cells within the venous neointima (both grafts and fistulae) were myofibroblasts, with a smaller number of desmin positive smooth muscle cells. The graft neointima had a similar cellular phenotype, albeit without any desmin positive contractile smooth muscle cells. The majority of cells within the PTFE graft material were macrophages. Analysis of sequential sections revealed the presence of fibroblasts within the venous neointima and intragraft region.

Conclusions. Our results demonstrate that contractile smooth muscle cells, myofibroblasts, fibroblasts and macrophages all play a role in the pathogenesis of dialysis access dysfunction (grafts and fistulae). Targeting these specific cell types might result in the development of novel therapeutic paradigms for haemodialysis vascular access dysfunction.

Keywords: cellular phenotypes; dialysis access; venous neointimal hyperplasia

Received for publication: 27. 7.08
Accepted in revised form: 24.11.08


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