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강덕희,강신욱,정현주,김유선,양철우,Richard J. Johnson 연세대학교의과대학 2004 Yonsei medical journal Vol.45 No.6
Maintenance of healthy endothelium is essential to vascular homeostasis, and preservation of endothelial cell function is critical for transplant allograft function. Damage of microvascular endothelial cells is now regarded as a characteristic feature of acute vascular rejection and chronic allograft nephropathy, which is an important predictor of graft loss and is often associated with transplant vasculopathy. In this review, we will discuss the role of microvascular endothelium, in renal allograft dysfunction, particularly as it relates to markers of endothelial dysfunction and endothelial repair mechanisms. We also discuss the potential for therapies targeting endothelial dysfunction and transplant graft vasculopathy.
강덕희 대한신장학회 1998 Kidney Research and Clinical Practice Vol.17 No.5
Bacterial peritonitis remains one of the major problem in patients undegoing CAPD, resulting in massive mesothelial cell(MC) death, remesothelialization failure, fibrosis and sclerosis. Since the preservation of the functional integrity of peritoneal membrane as a dialyzing organ is essential, complete resolution and adequate remesothelialization are necessary. This study was performed to investigate the effects of peritonitis on the number, secretory and regulatory function of MC. Subjects were nine episodes of peritonitis in 7 CAPD patients(M:F 5:2, mean age 48 years, mean CAPD duration 46 months). Dialysate CA125 and phospholipid were measured as markers of MC mass, and we also check the level of IL-6 and TNF-α, specific cytokines which can be detected in dialysate effluent. The concentrations of above mentioned substances were measured from the first cloudy bag, and thereafter overnight effluent were collected daily during the course of peritonitis and 4 weeks after discontinuation of antibiotics. Dialyste CA125 reached a peak in 2nd day of peritonitis and showed a second peak in 7th day. Other substances also showed a sharp increase on 1st day of peritonitis, returned to the baseline value rapidly. No differences in changes in the dialysate CA125, phospholipid and cytokine levels were noted according to the causative organism. There was no significant correlation between the values of MC marker and cytokines. In one patients who experienced 3 consecutive peritonitis with one-month interval, there was no second peak in dialyste CA125 level, and phospholipid remained the lowest level. He finally died due to sclerosing peritonitis and sepsis. In conclusion, MC markers and cytokines in peritoneal effluent can be used to follow the effects of inflammation in the peritoneal cavity. CA125 can be regarded both as a marker of MC damage and regeneration. Therefore, regular follow-up of CA125 during peritonitis can be an indicator to adequate treatment and remesothelialization.
복막 투석액 내의 cancer antigen 125(CA125)의 농도 복막 중피세포의 용적 표지자로서의 의의
강덕희,윤견일 대한신장학회 1998 Kidney Research and Clinical Practice Vol.17 No.2
The longevity of the peritoneum has been an object of interests and speculation since the inception of CAPD. Peritoneal mesothelial cells(MC) are the mast important intraperitoneal cell quantitatively and have the capability to secret different types of substances including lubricant and various cytokines. It may therefore be essential to have information on the MC mass during peritoneal dialysis. However, there were no specific tools to evaluate the exact status of peritoneal membrane. CA125 is a 22kDa glycoprotein which is a clinically useful tumor marker of non-mucinous epithelial ovarian carcinoma. Recently, other cells including pleural and peritoneal MC have been proved to express CA125. This study was undertaken to determine whether CA125 can be used as a bulk marker of MC mass in clinically stable 23 CAPD patients. We also analyzed whether the observed intraperitoneal production of CA125 can be attributed to MC using the cultured human peritoneal MC from omentum. The CA125 production by MC in vitro was estimated with cultured MC of various number(10,000-5,000,000/well) for different period of time. The median concentration of CA125 was significantly higher in 24-hour spent dialysate than in serum(5.5 vs. 17.3U/ml, P$lt;0.05). There was signifcant negative correlation between the dialysate CA125 level and the incidence of peritonitis. In-vitro experiment using cultured MC cell showed an expo- nential increase of CA125 level during confluence(6th day of culture), and persistently increased till 15 days of culture, reaching a plateau. A linear relation between the number of MC and the amount of CA125 in supernatant was also observed. In conclusion, CA125 is locally produced in the peritoneal cavity and can be an useful marker of MC mass in stable CAPD patients. Since the clinical significance of the inverse correlation between the CA125 level and peritonitis incidence is uncertain(low CA125 as a second result of repeated peritonitis or the importance of MC mass to regulate the antibacterial defense mechanism?), a prospective follow-up study is nece- ssary to confirm the relation between dialysate CA125 and the incidence of peritonitis.