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NDT Advance Access originally published online on May 17, 2007
Nephrology Dialysis Transplantation 2007 22(9):2469-2475; doi:10.1093/ndt/gfm240
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© The Author [2007]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Expression of C-reactive protein in myointimal hyperplasia in a porcine arteriovenous graft model

Tadashi Kuji1, Takahisa Masaki1, Li Li1 and Alfred K. Cheung1,2

1Department of Medicine, University of Utah and 2Medical Services, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, UT, USA

Correspondence and offprint requests to: Alfred K. Cheung, Dialysis Program, University of Utah, 85 North Medical Drive East, Salt Lake City, UT 84112, USA. Email: alfred.cheung{at}hsc.utah.edu



  Abstract

Background. The migration and proliferation of myofibroblasts are prominent features of myointimal hyperplasia associated with haemodialysis polytetrafluoroethylene (PTFE) grafts. Since C-reactive protein (CRP) possesses functional activities on vascular smooth muscle cells (SMCs), we examined the expression of this protein in PTFE grafts early in the course of myointimal hyperplasia development in a porcine model.

Method. Bilateral carotid-jugular PTFE loop grafts were placed in pigs. After euthanasia at 2–4 weeks, the graft-venous and graft-arterial anastomoses and the adjacent blood vessels were excised en bloc and subjected to immunohistochemical analyses and in situ hybridization for CRP. The ability of CRP to stimulate proliferation was examined in cultured porcine venous SMCs using the bromodeoxyuridine assay after incubation for 48 h.

Results. Severe myointimal hyperplasia was found at 3 weeks after graft placement at both graft-venous and graft-arterial anastomoses. Compared to normal tissues, staining for CRP was far more intense in cells in the hyperplastic lesions at both anastomoses, which also stained positive for smooth muscle {alpha}-actin. In situ hybridization showed that these cells also expressed mRNA for CRP. At 1 µg/ml, CRP increased the proliferation of cultured porcine venous SMCs by 45.9 ± 5.8%.

Conclusion. CRP was produced in venous and arterial SMCs and its expression was enhanced in the hyperplastic lesions associated with arteriovenous PTFE grafts in a porcine model. Together with the ability of CRP to promote SMC proliferation, these data suggest that CRP might play a pathogenic role in the development of myointimal hyperplasia in PTFE grafts.

Keywords: C-reactive protein; haemodialysis; myointimal hyperplasia; synthetic graft; vascular access; vascular smooth muscle cells

Received for publication: 13. 8.06
Accepted in revised form: 29. 3.07


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