{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T04:26:06Z","timestamp":1787199966195,"version":"build-2736575974"},"reference-count":39,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T00:00:00Z","timestamp":1787184000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001659","name":"Deutsche Forschungsgemeinschaft","doi-asserted-by":"publisher","award":["446358093"],"award-info":[{"award-number":["446358093"]}],"id":[{"id":"10.13039\/501100001659","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:p>Peritoneal dialysis (PD) is associated with progressive remodeling of the peritoneal membrane, with fibrosis, vasculopathy, and transport deterioration that culminate in ultrafiltration failure (UFF); a smaller subset of patients progresses to encapsulating peritoneal sclerosis (EPS). Myeloid-driven sterile inflammation is a central feature of this process, yet the evidence base differs sharply across the immune actors implicated. In this Perspective, we evaluate that evidence through a three-layer framework separating PD-direct data from non-PD peritoneal injury data and other-organ analogies. Macrophages are the best-established organizers of peritoneal niche remodeling. Neutrophils are well characterized in peritonitis but only gradually appear in chronic non-infectious functional disorders. Among extracellular traps, neutrophil extracellular traps (NETs) carry the strongest PD-specific signal: effluent proxies are linked to membrane transport phenotype and risk for technical failure. Macrophage extracellular traps (METs) rest on a single PD-specific mechanistic study and preliminary conference-level human data. We propose that chronic PD exposure conditions this niche and that second-hit inflammatory events (such as peritonitis) accelerate injury. If extracellular trap formation proceeds faster than nuclease- and macrophage-mediated clearance, trap-derived extracellular DNA may persist in the peritoneal cavity. We further hypothesize that, after uptake by bystander cells, cytosolic DNA sensing through cGAS\u2013STING is engaged and may amplify membrane failure.<\/jats:p>","DOI":"10.3389\/fimmu.2026.1875068","type":"journal-article","created":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T04:16:08Z","timestamp":1787199368000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["The peritoneal immune niche in peritoneal dialysis-induced membrane failure: macrophages, neutrophils and extracellular trap biology"],"prefix":"10.3389","volume":"17","author":[{"given":"Yuqing","family":"Lu","sequence":"first","affiliation":[{"name":"Department of Pediatric Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University","place":["Mannheim, Germany"]},{"name":"European Center for Angioscience (ECAS), Medical Faculty Mannheim, Heidelberg University","place":["Mannheim, Germany"]},{"name":"Mannheim 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Angioscience (ECAS), Medical Faculty Mannheim, Heidelberg University","place":["Mannheim, Germany"]},{"name":"Mannheim Institute for Innate Immunoscience (MI3), Medical Faculty Mannheim, Heidelberg University","place":["Mannheim, Germany"]},{"name":"Department of Rheumatology and Immunology, West China Hospital, Sichuan University","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leyi","family":"Gu","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Molecular Cell Lab for Kidney Disease, Shanghai Peritoneal Dialysis Research Center, Renji Hospital, Shanghai Jiao Tong University, School of Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Boettcher","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University","place":["Mannheim, 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