Open AccessMolecular targets for improving arteriovenous fistula maturation and patency
Author(s) -
Jolanta Gorecka,
Arash Fereydooni,
Luis Gonzalez,
Shin Rong Lee,
Shirley Liu,
Shun Ono,
Jianbiao Xu,
Jia Liu,
Rin Ichiro Taniguchi,
Yutaka Matsubara,
Xixiang Gao,
Mingjie Gao,
John Langford,
Bogdan Yatsula,
Alan Dardik
Publication year - 2019
Publication title -
vascular investigation and therapy
Language(s) - English
Resource type - Journals
eISSN - 2589-9686
pISSN - 2589-9481
DOI - 10.4103/vit.vit_9_19
Subject(s) - arteriovenous fistula , medicine , fistula , erythropoietin producing hepatocellular (eph) receptor , ephrin , extracellular matrix , receptor , cardiology , surgery , microbiology and biotechnology , biology , receptor tyrosine kinase
The increasing prevalence of chronic and end-stage renal disease creates an increased need for reliable vascular access, and although arteriovenous fistulae (AVF) are the preferred mode of hemodialysis access, 60% fail to mature and only 50% remain patent at one year. Fistulae mature by diameter expansion and wall thickening; this outward remodeling of the venous wall in the fistula environment relies on a delicate balance of extracellular matrix (ECM) remodeling, inflammation, growth factor secretion, and cell adhesion molecule upregulation in the venous wall. AVF failure occurs via two distinct mechanisms with early failure secondary to lack of outward remodeling, that is insufficient diameter expansion or wall thickening, whereas late failure occurs with excessive wall thickening due to neointimal hyperplasia (NIH) and insufficient diameter expansion in a previously functional fistula. In recent years, the molecular basis of AVF maturation and failure are becoming understood in order to develop potential therapeutic targets to aide maturation and prevent access loss. Erythropoietin-producing hepatocellular carcinoma (Eph) receptors, along with their ligands, ephrins, determine vascular identity and are critical for vascular remodeling in the embryo. Manipulation of Eph receptor signaling in adults, as well as downstream pathways, is a potential treatment strategy to improve the rates of AVF maturation and patency. This review examines our current understanding of molecular changes occurring following fistula creation, factors predictive of fistula success, and potential areas of intervention to decrease AVF failure.