Background Encapsulating peritoneal sclerosis (EPS) is an excessive fibrotic response of the peritoneum that may occur after long-term peritoneal dialysis (PD). The underlying pathophysiology is poorly understood, but involvement of peritoneal inflammatory T helper 1 cells may be pivotal. Methods Soluble interleukin-2 receptor alpha (sCD25) concentration was measured as a marker for T-cell activation in serum and ascites from EPS patients and various control patient groups. Peritoneal biopsies were stained for the presence of T cells, and T cells isolated from ascites of EPS patients were characterized in detail for differentiation status and cytokine expression. Results Serum sCD25 concentrations are significantly and specifically increased in EPS patients compared with haemodialysis, PD and predialysis patients. Peritoneal effluent of stable PD patients contains very low levels of sCD25, while sCD25 levels in ascites of EPS patients are high and indicative of local production. In the years preceding the diagnosis of EPS, the serum sCD25 concentrations increased while remaining at stable levels in control PD patients. The peritoneum and ascites of EPS patients showed a significant influx of T cells with relatively increased numbers of CD4<sup>+</sup> T cells. These T cells were fully differentiated and displayed a T helper 1 cell type with a pro-inflammatory cytokine profile. Conclusions Increased serum sCD25 concentrations and peritoneal lymphocytosis in EPS patients indicate the involvement of activated T cells in the pathophysiology of excessive fibrosis.

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Keywords Biomarker, encapsulating peritoneal sclerosis, peritoneal dialysis, sCD25, T cells
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Journal Nephrology, Dialysis, Transplantation
Betjes, M.G.H, Habib, M.S, Struijk, D, Lopes Barreto, D, Korte, M.R, Abrahams, A.C, … Litjens, N.H.R. (2015). Encapsulating peritoneal sclerosis is associated with T-cell activation. Nephrology, Dialysis, Transplantation, 30(9), 1568–1576. doi:10.1093/ndt/gfv092