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Journal of Biomedicine and Biotechnology
Volume 2011 (2011), Article ID 180594, 11 pages
http://dx.doi.org/10.1155/2011/180594
Review Article

Pathophysiology of the Peritoneal Membrane during Peritoneal Dialysis: The Role of Hyaluronan

Department of Medicine, The University of Hong Kong, Room 302 New Clinical Building, Queen Mary Hospital, Pokfulam, Hong Kong

Received 28 June 2011; Revised 11 September 2011; Accepted 12 September 2011

Academic Editor: Beric Henderson

Copyright © 2011 Susan Yung and Tak Mao Chan. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

During peritoneal dialysis (PD), constant exposure of mesothelial cells to bioincompatible PD solutions results in the denudation of the mesothelial monolayer and impairment of mesothelial cell function. Hyaluronan, a major component of extracellular matrices, is synthesized by mesothelial cells and contributes to remesothelialization, maintenance of cell phenotype, and tissue remodeling and provides structural support to the peritoneal membrane. Chronic peritoneal inflammation is observed in long-term PD patients and is associated with increased hyaluronan synthesis. During inflammation, depolymerization of hyaluronan may occur with the generation of hyaluronan fragments. In contrast to native hyaluronan which offers a protective role to the peritoneum, hyaluronan fragments exacerbate inflammatory and fibrotic processes and therefore assist in the destruction of the tissue. This paper will discuss the contribution of mesothelial cells to peritoneal membrane alterations that are induced by PD and the putative role of hyaluronan in these processes.