Patients using peritoneal dialysis (PD) to treat end-stage renal failure must often discontinue treatment owing to an eventual loss of peritoneal filtration ability. This loss is preceded by peritoneal cell changes reminiscent of epithelial-to-mesenchymal transition (EMT), which in turn lead to inflammation and fibrosis of the peritoneum. Although EMT is a normal process during development, it has also been observed and studied in tumorigenesis and chronic inflammation. Here, Raffaele Strippoli and colleagues show that an ERK/NF-κB/Snail1 signaling cascade triggers EMT in peritoneal mesothelial cells. ERK and NF-κB inhibition can prevent and reverse this transformation in mesothelial cells collected from PD patients, suggesting that this pathway can be a therapeutic target for maintaining the efficacy of PD.

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