The Effect of Steroid-Sirolimus Combination on the Experimental Model of Encapsulating Peritoneal Sclerosis in Rats

ABS TRACT Objective: Encapsulating peritoneal sclerosis (EPS) is a devastating complication of peritoneal dialysis terminating with peritoneal sclerosis and coccooning of intestinal loops. The inhibitors of mammalian target of rapamycin (mTOR), everolimus and sirolimus, have attenuated EPS findings in experimental animal models. The effect of combination of sirolimus with steroid has not been documented so far. The aim of the study was to determine the effect of combination of sirolimus and steroid on experimental sclerosing peritonitis model. Material and Methods: 41 wistar albino male rats were divided into 6 groups : control group (C; isotonic saline injected intraperitoneally), chlorhexidine gluconate group (CG; model group), resting group (R; CG then peritoneal rest, prednisolone group (P; CG then prednisolone), sirolimus group (Sir; CG then sirolimus), and prednisolone-sirolimus group (P-Sir; CG then prednisolone plus sirolimus). Peritoneal specimens obtained after sacrification at the end of study were examined for peritoneal thickness, fibrosis, and vascular intensities under light microscopy. Results: In the CG and R groups there was a significant increase in peritoneal thickness, fibrosis score and vascular intensity compared to C, P, Sir, and P-Sir groups in both parietal and visceral peritoneum (p<0.05). The parameters at the end of the study were not different in C, P, Sir, and P-Sir groups. The difference between P, Sir, and P-Sir groups were not significant. Resting was shown to be ineffective in attenuating EPS parameters. Conclusion: In this study we observed that sirolimus-prednisolone combination was equally effective in experimental EPS model compared to prednisolone and sirolimus only regimens.