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Lutfi H, Kirsch-Mangu TK, Fletcher-King NM, Ruden DM, Diamond MP, Saed GM. Epigenetics: new insights into postoperative adhesion development. Minerva Obstet Gynecol 2024; 76:231-237. [PMID: 36222785 DOI: 10.23736/s2724-606x.22.05158-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND The link between post-operative adhesion development and epigenetic modifications is important in understanding the mechanism behind their formation. The aim of this study was to determine whether epigenetic differences exist between primary fibroblasts of normal peritoneum and adhesion tissues isolated from the same patient(s). METHODS DNA from fibroblasts isolated from normal peritoneum and adhesion tissues was isolated using Qiagen's EZ1 Advanced Kit. Methylation patterns of genes were quantified and compared in both cell lines using the Infinium Human Methylation 27 BeadChip® system (Illumina, San Diego, CA, USA). RESULTS A total of 7364 genes had been found to manifest significantly different DNA methylation levels in adhesion fibroblasts as compared to normal peritoneal fibroblasts (P<0.01). A total of 1685 genes were found to have increased DNA methylation by 50% in adhesion compared to peritoneal fibroblasts, and were enriched in gene ontology categories, glycoprotein, and defense response. Furthermore, 1287 genes were found to have decreased DNA methylation patterns with enriched gene ontology categories, "homeobox," and transcription factor activity in adhesion fibroblasts. CONCLUSIONS Epigenetic differences in fibroblasts isolated from normal peritoneum and adhesion tissues were observed. Future studies focusing on the precise role of these genes in the development of postoperative adhesions will allow us to more fully appreciate regulatory mechanisms leading to adhesion development, thereby establishing targets for therapeutic interventions to prevent or limit adhesion development.
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Affiliation(s)
- Hala Lutfi
- School of Medicine, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, The C.S. Mott Center for Human Growth and Development, Wayne State University, Detroit, MI, USA
| | - Thea K Kirsch-Mangu
- School of Medicine, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, The C.S. Mott Center for Human Growth and Development, Wayne State University, Detroit, MI, USA
| | - Nicole M Fletcher-King
- School of Medicine, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, The C.S. Mott Center for Human Growth and Development, Wayne State University, Detroit, MI, USA
| | - Douglas M Ruden
- School of Medicine, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, The C.S. Mott Center for Human Growth and Development, Wayne State University, Detroit, MI, USA
| | - Michael P Diamond
- Department of Obstetrics and Gynecology, Medical College of Georgia Augusta University, Augusta, GA, USA
| | - Ghassan M Saed
- School of Medicine, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, The C.S. Mott Center for Human Growth and Development, Wayne State University, Detroit, MI, USA -
- Karmanos Cancer Center, Detroit, MI, USA
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2
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Liao J, Li X, Fan Y. Prevention strategies of postoperative adhesion in soft tissues by applying biomaterials: Based on the mechanisms of occurrence and development of adhesions. Bioact Mater 2023; 26:387-412. [PMID: 36969107 PMCID: PMC10030827 DOI: 10.1016/j.bioactmat.2023.02.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 01/26/2023] [Accepted: 02/23/2023] [Indexed: 03/19/2023] Open
Abstract
Postoperative adhesion (POA) widely occurs in soft tissues and usually leads to chronic pain, dysfunction of adjacent organs and some acute complications, seriously reducing patients' quality of life and even being life-threatening. Except for adhesiolysis, there are few effective methods to release existing adhesion. However, it requires a second operation and inpatient care and usually triggers recurrent adhesion in a great incidence. Hence, preventing POA formation has been regarded as the most effective clinical strategy. Biomaterials have attracted great attention in preventing POA because they can act as both barriers and drug carriers. Nevertheless, even though much reported research has been demonstrated their efficacy on POA inhibition to a certain extent, thoroughly preventing POA formation is still challenging. Meanwhile, most biomaterials for POA prevention were designed based on limited experiences, not a solid theoretical basis, showing blindness. Hence, we aimed to provide guidance for designing anti-adhesion materials applied in different soft tissues based on the mechanisms of POA occurrence and development. We first classified the postoperative adhesions into four categories according to the different components of diverse adhesion tissues, and named them as "membranous adhesion", "vascular adhesion", "adhesive adhesion" and "scarred adhesion", respectively. Then, the process of the occurrence and development of POA were analyzed, and the main influencing factors in different stages were clarified. Further, we proposed seven strategies for POA prevention by using biomaterials according to these influencing factors. Meanwhile, the relevant practices were summarized according to the corresponding strategies and the future perspectives were analyzed.
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3
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Dong K, Lei H, Kang J, Leng X, Ma R, Wang D, Zhou Q, Yu J, Lu T, Xing J. Application of a Dual-Probe Coloading Nanodetection System in the Process Monitoring and Efficacy Assessment of Photodynamic Therapy: An In Vitro Study. ACS Biomater Sci Eng 2023; 9:1089-1103. [PMID: 36700559 DOI: 10.1021/acsbiomaterials.2c01388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The oxygen-consuming property of photodynamic therapy (PDT) affects its effects and aggravates tumor hypoxia, thus upregulating the vascular endothelial growth factor (VEGF) to exacerbate tumor metastasis and lead to treatment failure. Therefore, it is necessary to monitor the dynamic changes in the factors related to PDT and tumor development trends in real time, thus helping to improve PDT efficiency. This study fabricated a fluorescent probe, TPE-2HPro, and a fluorescein-labeled aptamer probe, FAM-AptamerVEGF, to detect hydrogen peroxide (H2O2) and VEGF through the photoinduced electron-transfer effect and the specific affinity of the aptamer to VEGF, respectively. The two probes were loaded into the inner pores and absorbed on the surface of polydopamine coating-wrapped mesoporous silica nanoparticles (MSN@PDA) to construct the dual-probe-loaded system, MSNTH@PDAApt, which was kept stable in fetal bovine serum (FBS) solution and achieved pH-responsive release behavior, thus helping to increase the accumulation of the two probes in tumor cells. The dichloroacetic acid-mediated in vitro antitumor tests showed that the changing trends of H2O2 and VEGF levels were consistent with the results of related mechanism studies and could be monitored by MSNTH@PDAApt. The in vitro chlorin e6 (Ce6)-mediated PDT treatment demonstrated that when the illumination condition was 650 nm, 50 mW/cm2 for 10 min, cells were more inclined to metastasis and invasion rather than death due to a substantial increase in VEGF expression at the low Ce6 concentrations. With the increase of the Ce6 concentration, the growth of the H2O2 level gradually exceeded that of VEGF, and the reactive oxygen species (ROS)-mediated cell death dominated when the Ce6 concentration was about 2 times its IC50 values. Besides, hypoxia also affected the H2O2 and VEGF changes. These results demonstrated that MSNTH@PDAApt could precisely monitor and assess the tumor development trends during PDT treatment, thus helping improve the treatment effect.
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Affiliation(s)
- Kai Dong
- School of Pharmacy, Xi'an Jiaotong University, 76 Yanta West Road, Xi'an710061, Shaanxi, China
| | - Hengyu Lei
- School of Pharmacy, Xi'an Jiaotong University, 76 Yanta West Road, Xi'an710061, Shaanxi, China
| | - Jian Kang
- Key Laboratory for Space Bioscience and Biotechnology, School of Life Sciences, Northwestern Polytechnical University, Xi'an710072, Shaanxi, China
| | - Xue Leng
- School of Pharmacy, Xi'an Jiaotong University, 76 Yanta West Road, Xi'an710061, Shaanxi, China
| | - Ruirui Ma
- School of Pharmacy, Xi'an Jiaotong University, 76 Yanta West Road, Xi'an710061, Shaanxi, China
| | - Danyang Wang
- School of Pharmacy, Xi'an Jiaotong University, 76 Yanta West Road, Xi'an710061, Shaanxi, China
| | - Qingyuan Zhou
- School of Pharmacy, Xi'an Jiaotong University, 76 Yanta West Road, Xi'an710061, Shaanxi, China
| | - Jie Yu
- School of Pharmacy, Xi'an Jiaotong University, 76 Yanta West Road, Xi'an710061, Shaanxi, China
| | - Tingli Lu
- Key Laboratory for Space Bioscience and Biotechnology, School of Life Sciences, Northwestern Polytechnical University, Xi'an710072, Shaanxi, China
| | - Jianfeng Xing
- School of Pharmacy, Xi'an Jiaotong University, 76 Yanta West Road, Xi'an710061, Shaanxi, China
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Rosendorf J, Klicova M, Herrmann I, Anthis A, Cervenkova L, Palek R, Treska V, Liska V. Intestinal Anastomotic Healing: What do We Know About Processes Behind Anastomotic Complications. Front Surg 2022; 9:904810. [PMID: 35747439 PMCID: PMC9209641 DOI: 10.3389/fsurg.2022.904810] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 05/11/2022] [Indexed: 11/13/2022] Open
Abstract
Colorectal surgery has developed rapidly in the recent decades. Nevertheless, colorectal anastomotic leakage continues to appear postoperatively in unpleasant rates and leads to life-threatening conditions. The development of valid complication-preventing methods is inefficient in many aspects as we are still lacking knowledge about the basics of the process of anastomotic wound healing in the gastrointestinal tract. Without the proper understanding of the crucial mechanisms, research for prevention of anastomotic leakage is predestined to be unsuccessful. This review article discusses known pathophysiological mechanisms together with the most lately found processes to be further studied. The aim of the article is to facilitate the orientation in the topic, support the better understanding of known mechanisms and suggest promising possibilities and directions for further research.
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Affiliation(s)
- J. Rosendorf
- Department of Surgery, University Hospital in Pilsen, Pilsen, Czech Republic
- Laboratory of Cancer Treatment and Tissue Regeneration, Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
- Correspondence: Jachym Rosendorf
| | - M. Klicova
- Department of Nonwovens and Nanofibrous Materials, Faculty of Textile Engineering, Technical University of Liberec, Liberec, Czech Republic
| | - I. Herrmann
- Department of Mechanical and Process Engineering, Nanoparticle Systems Engineering Laboratory, ETH Zurich, Switzerland
| | - A. Anthis
- Department of Mechanical and Process Engineering, Nanoparticle Systems Engineering Laboratory, ETH Zurich, Switzerland
| | - L. Cervenkova
- Laboratory of Cancer Treatment and Tissue Regeneration, Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - R. Palek
- Department of Surgery, University Hospital in Pilsen, Pilsen, Czech Republic
- Laboratory of Cancer Treatment and Tissue Regeneration, Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - V. Treska
- Laboratory of Cancer Treatment and Tissue Regeneration, Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - V. Liska
- Department of Surgery, University Hospital in Pilsen, Pilsen, Czech Republic
- Laboratory of Cancer Treatment and Tissue Regeneration, Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
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5
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Chua JW, Madden L, Lim SBH, Philips ARJ, Becker DL. Development of a refined ex vivo model of peritoneal adhesion formation, and a role for connexin 43 in their development. Mol Cell Biochem 2021; 477:295-305. [PMID: 34716547 DOI: 10.1007/s11010-021-04282-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 10/21/2021] [Indexed: 11/30/2022]
Abstract
Despite many advances across the surgical sciences, post-surgical peritoneal adhesions still pose a considerable risk in modern-day procedures and are highly undesirable. We have developed a novel mouse peritoneal strip ex vivo adhesion model which may serve to bridge the gap between single cell culture systems and in vivo animal drug testing for the assessment of potential anti-adhesion agents, and study of causality of the process. We investigated the optimal conditions for adhesion formation with mouse peritoneal tissue strips by modifying an existing ex vivo rat model of peritoneal adhesions. We assessed the impact of the following conditions on the formation of adhesions: contact pressure, abrasions, and the presence of clotted blood. Macroscopic adhesions were detected in all mouse peritoneal strips exposed to specific conditions, namely abrasions and clotted blood, where peritoneal surfaces were kept in contact with pressure using cotton gauze in a tissue cassette. Adhesions were confirmed microscopically. Interestingly, connexin 43, a gap junction protein, was found to be upregulated at sites of adhesions. Key features of this model were the use of padding the abraded tissue with gauze and the use of a standardised volume of clotted blood. Using this model, peritoneal strips cultured with clotted blood between abraded surfaces were found to reproducibly develop adhesion bands at 72 h. Our goal is to develop a model that can be used in genetically modified mice in order to dissect out the role of particular genes in adhesion formation and to test drugs to prevent adhesion formation.
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Affiliation(s)
- Jia Wang Chua
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Clinical Sciences Building, 11, Mandalay Road, Singapore, 308232, Singapore
| | - Leigh Madden
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Clinical Sciences Building, 11, Mandalay Road, Singapore, 308232, Singapore
| | - Sophia Beng Hui Lim
- Skin Research Institute Singapore, Level 17, Clinical Sciences Building, 11, Mandalay Road, Singapore, 308232, Singapore
| | | | - David L Becker
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Clinical Sciences Building, 11, Mandalay Road, Singapore, 308232, Singapore. .,Skin Research Institute Singapore, Level 17, Clinical Sciences Building, 11, Mandalay Road, Singapore, 308232, Singapore.
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6
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Awonuga AO, Chatzicharalampous C, Thakur M, Rambhatla A, Qadri F, Awonuga M, Saed G, Diamond MP. Genetic and Epidemiological Similarities, and Differences Between Postoperative Intraperitoneal Adhesion Development and Other Benign Fibro-proliferative Disorders. Reprod Sci 2021; 29:3055-3077. [PMID: 34515982 DOI: 10.1007/s43032-021-00726-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 08/22/2021] [Indexed: 12/11/2022]
Abstract
Intraperitoneal adhesions complicate over half of abdominal-pelvic surgeries with immediate, short, and long-term sequelae of major healthcare concern. The pathogenesis of adhesion development is similar to the pathogenesis of wound healing in all tissues, which if unchecked result in production of fibrotic conditions. Given the similarities, we explore the published literature to highlight the similarities in the pathogenesis of intra-abdominal adhesion development (IPAD) and other fibrotic diseases such as keloids, endometriosis, uterine fibroids, bronchopulmonary dysplasia, and pulmonary, intraperitoneal, and retroperitoneal fibrosis. Following a literature search using PubMed database for all relevant English language articles up to November 2020, we reviewed relevant articles addressing the genetic and epidemiological similarities and differences in the pathogenesis and pathobiology of fibrotic diseases. We found genetic and epidemiological similarities and differences between the pathobiology of postoperative IPAD and other diseases that involve altered fibroblast-derived cells. We also found several genes and single nucleotide polymorphisms that are up- or downregulated and whose products directly or indirectly increase the propensity for postoperative adhesion development and other fibrotic diseases. An understanding of the similarities in pathophysiology of adhesion development and other fibrotic diseases contributes to a greater understanding of IPAD and these disease processes. At a very fundamental level, blocking changes in the expression or function of genes necessary for the transformation of normal to altered fibroblasts may curtail adhesion formation and other fibrotic disease since this is a prerequisite for their development. Similarly, applying measures to induce apoptosis of altered fibroblast may do the same; however, apoptosis should be at a desired level to simultaneously ameliorate development of fibrotic diseases while allowing for normal healing. Scientists may use such information to develop pharmacologic interventions for those most at risk for developing these fibrotic conditions.
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Affiliation(s)
- Awoniyi O Awonuga
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, 48201, USA.
| | - Charalampos Chatzicharalampous
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, 48201, USA
| | - Mili Thakur
- Reproductive Genomics Program, The Fertility Center, Grand Rapids, MI, USA.,Department of Obstetrics, Gynecology and Reproductive Biology, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA
| | - Anupama Rambhatla
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, 48201, USA
| | - Farnoosh Qadri
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, 48201, USA
| | - Modupe Awonuga
- Division of Neonatology, Department of Pediatrics and Human Development, Michigan State University, 1355 Bogue Street, East Lansing, MI, USA
| | - Ghassan Saed
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, 48201, USA
| | - Michael P Diamond
- Department of Obstetrics and Gynecology, Augusta University, 1120 15th Street, CJ-1036, Augusta, GA, 30912, USA
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7
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Chandel AKS, Shimizu A, Hasegawa K, Ito T. Advancement of Biomaterial-Based Postoperative Adhesion Barriers. Macromol Biosci 2021; 21:e2000395. [PMID: 33463888 DOI: 10.1002/mabi.202000395] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 12/28/2020] [Indexed: 01/16/2023]
Abstract
Postoperative peritoneal adhesion (PPA) is a prevalent incidence that generally happens during the healing process of traumatized tissues. It causes multiple severe complications such as intestinal obstruction, chronic abdominal pain, and female infertility. To prevent PPA, several antiadhesion materials and drug delivery systems composed of biomaterials are used clinically, and clinical antiadhesive is one of the important applications nowadays. In addition to several commercially available materials, like film, spray, injectable hydrogel, powder, or solution type have been energetically studied based on natural and synthetic biomaterials such as alginate, hyaluronan, cellulose, starch, chondroitin sulfate, polyethylene glycol, polylactic acid, etc. Moreover, many kinds of animal adhesion models, such as cecum abrasion models and unitary horn models, are developed to evaluate new materials' efficacy. A new animal adhesion model based on hepatectomy and conventional animal adhesion models is recently developed and a new adhesion barrier by this new model is also developed. In summary, many kinds of materials and animal models are studied; thus, it is quite important to overview this field's current progress. Here, PPA is reviewed in terms of the species of biomaterials and animal models and several problems to be solved to develop better antiadhesion materials in the future are discussed.
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Affiliation(s)
- Arvind K Singh Chandel
- Center for Disease Biology and Integrative Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Atsushi Shimizu
- Department of Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8656, Japan
| | - Kiyoshi Hasegawa
- Department of Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8656, Japan
| | - Taichi Ito
- Center for Disease Biology and Integrative Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
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8
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Giannis D, Geropoulos G, Ziogas IA, Gitlin J, Oropallo A. The anti-adhesive effect of anti-VEGF agents in experimental models: A systematic review. Wound Repair Regen 2020; 29:168-182. [PMID: 33316850 DOI: 10.1111/wrr.12879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 11/04/2020] [Accepted: 11/25/2020] [Indexed: 02/01/2023]
Abstract
Adhesions constitute a major problem in abdominal-pelvic and thoracic surgery with significant impact in the postoperative quality of life and healthcare services utilization. Adhesiogenesis is the result of increased fibrin formation, impaired fibrinolysis, angiogenesis, and fibrosis. Despite the recent advancements, the ideal anti-adhesive agent remains to be determined. To this end, we performed a comprehensive literature search in PubMed, EMBASE, and Scopus databases to identify studies investigating the antiadhesive role of anti-VEGF agents in peritoneal, pleural, and pericardial experimental adhesion models. Fifteen studies were eligible for inclusion with a total population of 602 animals (334 rats, 180 rabbits, and 88 mice). The majority of included studies (11/15) used bevacizumab, while three studies used other anti-VEGF antibodies and one study used an anti-VEGFR-antibody. A rat model was used in nine studies, while rabbit (n = 3) or mouse (n = 3) models were used less frequently. Eleven studies used peritoneal models, three studies used pleural models, and one study used a pericardial model. The scales (n = 12) and interval (Range: 1-42 days) used for the evaluation of adhesions varied between the studies. All studies demonstrated a significant decrease in adhesion scores between the anti-VEGF and control groups up to 42 days postprocedure. VEGF blockade resulted in decreased fibrosis in four out of five studies that used peritoneal models, while the effect on pleural models depended on the pleurodesis agent and was significant between 7 and 28 days. The effect of anti-VEGF agents on anastomosis integrity depends on the dose and the model that is used (inconclusive results).Current data support the anti-adhesive role of Anti-VEGF agents in all three serosal surfaces up to 6 weeks postprocedure. Further studies are needed to confirm the anti-adhesive role of anti-VEGF agents in pleural and pericardial adhesion experimental models and investigate any effect on anastomosis integrity in peritoneal models.
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Affiliation(s)
- Dimitrios Giannis
- Institute of Health Innovations and Outcomes Research, The Feinstein Institutes for Medical Research, Manhasset, New York, USA.,Surgery Working Group, Society of Junior Doctors, Athens, Greece
| | - Georgios Geropoulos
- Surgery Working Group, Society of Junior Doctors, Athens, Greece.,Thoracic Surgery Department, University College London Hospitals, NHS Foundation Trust, London, UK
| | - Ioannis A Ziogas
- Surgery Working Group, Society of Junior Doctors, Athens, Greece.,Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece
| | - Jordan Gitlin
- The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, New York, USA
| | - Alisha Oropallo
- Department of Vascular Surgery, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, New Hyde Park, New York, USA
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9
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Is There a Genetic Predisposition to Postoperative Adhesion Development? Reprod Sci 2020; 28:2076-2086. [PMID: 33090376 PMCID: PMC7579853 DOI: 10.1007/s43032-020-00356-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 10/11/2020] [Indexed: 12/11/2022]
Abstract
Adhesions are permanent fibrovascular bands between peritoneal surfaces, which develop following virtually all body cavity surgeries. The susceptibility to develop, and the severity, of adhesions following intra-abdominal surgery varies within and between individuals, suggesting that heritable factors influence adhesion development. In this manuscript, we discuss the pathophysiology of adhesion development from the perspective of genetic susceptibility. We restrict our discussion to genes and single-nucleotide polymorphisms (SNPs) that are specifically involved in, or that cause modification of, the adhesion development process. We performed a literature search using the PubMed database for all relevant English language articles up to March 2020 (n = 186). We identified and carefully reviewed all relevant articles addressing genetic mutations or single-nucleotide polymorphisms (SNPs) that impact the risk for adhesion development. We also reviewed references from these articles for additional information. We found several reported SNPs, genetic mutations, and upregulation of messenger RNAs that directly or indirectly increase the propensity for postoperative adhesion development, namely in genes for transforming growth factor beta, vascular endothelial growth factor, interferon-gamma, matrix metalloproteinase, plasminogen activator inhibitor-1, and the interleukins. An understanding of genetic variants could provide insight into the pathophysiology of adhesion development. The information presented in this review contributes to a greater understanding of adhesion development at the genetic level and may allow modification of these genetic risks, which may subsequently guide management in preventing and treating this challenging complication of abdominal surgery. In particular, the information could help identify patients at greater risk for adhesion development, which would make them candidates for anti-adhesion prophylaxis. Currently, agents to reduce postoperative adhesion development exist, and in the future, development of agents, which specifically target individual genetic profile, would be more specific in preventing intraperitoneal adhesion development.
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10
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Witowski J, Jörres A. Technological Advances in Peritoneal Dialysis Research Peritoneal Cell Culture: Fibroblasts. Perit Dial Int 2020. [DOI: 10.1177/089686080602600302] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Fibroblasts have been traditionally viewed as providing little more than a structural lattice for other cell types. However, recent data indicate that fibroblasts play a key and early role in many pathophysiological processes, including inflammation, fibrosis, and neoplasia. Moreover, depending on the anatomical location, fibroblasts display significant functional heterogeneity. Therefore, it is important to study the subpopulation of fibroblasts derived exactly from the organ of interest rather than to extrapolate the observations made in other fibroblast subsets. Cell culture provides a powerful tool for studying the role of fibroblasts in various contexts. In this review, we describe procedures for establishing and identifying primary cultures of human peritoneal fibroblasts. We also briefly discuss the potential involvement of peritoneal fibroblasts in peritoneal pathology.
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Affiliation(s)
- Janusz Witowski
- Department of Pathophysiology,
University Medical School, Poznań, Poland
| | - Achim Jörres
- Department of Nephrology and Medical
Intensive Care, Charité Universitätsmedizin Berlin, Campus
Virchow-Klinikum, Berlin, Germany
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11
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Micha AE, Psarras K, Ouroumidis O, Siska E, Vlachaki E, Lymperopoulos A, Symeonidis N, Nikolaidou C, Venizelos I, Koliakos G, Pavlidis TE. A Time Course of Bevacizumab (Anti-VEGF) Effect on Rat Peritoneum: Relations Between Antiadhesive Action and Fibrin Regulation Enzymes. Surg Innov 2017; 24:543-551. [PMID: 28877644 DOI: 10.1177/1553350617729510] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND To investigate the early and late antiadhesive effect and any changes of fibrin matrix regulation enzymes on rat peritoneum, after local administration of bevacizumab. METHODS Rats were subjected to cecal abrasion. Bevacizumab (5 mg/kg) against placebo was given intraperitoneally. On the 2nd, 14th, and 28th postoperative days adhesions were scored, and tissue plasminogen activator (tPA), plasminogen activator inhibitor-1 (PAI-1), matrix metalloproteinase-9 (MMP-9), degree of fibrosis, and angiogenesis were measured in abrased cecum and in intact parietal peritoneum. RESULTS Bevacizumab significantly reduced adhesions up to 15% on the 2nd, 52.5% on the 14th, and 55% on the 28th postoperative day, and significantly increased tPA concentrations in peritoneum. PAI-1 was decreased, and a significantly higher tPA/PAI-1 ratio along with an increase of MMP-9 was measured at all time points. Fibrosis and angiogenesis were significantly lower on the 14th and 28th postoperative days. CONCLUSIONS Local bevacizumab administration has a strong early and late antiadhesive action on rat peritoneum, mediated by changes in the tPA/PAI-1 and MMP balance in favor of fibrinolysis up to 28 days after operations.
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Affiliation(s)
| | | | | | - Evangelia Siska
- 1 Aristotle University School of Medicine, Thessaloniki, Greece
| | | | | | | | | | | | - George Koliakos
- 1 Aristotle University School of Medicine, Thessaloniki, Greece
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12
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Brochhausen C, Schmitt VH, Mamilos A, Schmitt C, Planck CNE, Rajab TK, Hierlemann H, Kirkpatrick CJ. Expression of CD68 positive macrophages in the use of different barrier materials to prevent peritoneal adhesions-an animal study. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2017; 28:15. [PMID: 27995493 PMCID: PMC5167770 DOI: 10.1007/s10856-016-5821-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 11/26/2016] [Indexed: 05/19/2023]
Abstract
In preventing postoperative adhesion formation the optimal barrier material has still not been found. It is therefore imperative to assess the biocompatibility of potential barrier devices. Macrophages play a decisive role in the regulation of wound healing, tissue regeneration and foreign body reaction. Since the number of CD68-positive macrophages represents an important parameter within biomaterial testing, in the present study it was analysed whether a correlation exists between the total number of CD68-positive macrophages and the extent of fibrosis or inflammation in peritoneal adhesion prevention using biomaterials. After standardized peritoneal wounding, Wistar rats were treated with five adhesion barriers or remained untreated as a control. After 14 days, animals were sacrificed and the treated areas were evaluated histomorphologically and immunohistologically. A heterogeneous pattern of macrophage count in relation to fibrosis or inflammation was found. While some groups described a moderate macrophage infiltration without fibrosis, others showed similar numbers of macrophages, but accompanied by moderate fibrosis. Moreover, a minimal number of macrophages was associated with minimal fibrosis. Mild inflammation was seen both with minimal and moderate macrophage infiltration. Altogether, no correlation could be established between the tissue response and the count of CD68-positive macrophages. With a view to macrophage heterogeneity further studies are required to determine the different macrophage subpopulations and clarify the role of these in the tissue responses to barrier materials.
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Affiliation(s)
| | - Volker H Schmitt
- Cardiology I, Centre for Cardiology, University Medical Centre, Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Andreas Mamilos
- REPAIR-lab, Institute of Pathology, University of Regensburg, Regensburg, Germany
| | - Christine Schmitt
- Department of Internal Medicine, St. Vincenz and Elisabeth Hospital of Mainz (KKM), Mainz, Germany
| | - Constanze N E Planck
- Department of Gynaecology and Obstetrics, University of Tuebingen, Tuebingen, Germany
- German Centre of Biomaterials and Artificial Organs e.V. Denkendorf, Denkendorf, Germany
| | - Taufiek K Rajab
- Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Helmut Hierlemann
- German Centre of Biomaterials and Artificial Organs e.V. Denkendorf, Denkendorf, Germany
- Institute of Textile Technology and Process Engineering, Denkendorf, Germany
| | - C James Kirkpatrick
- Department of Biomaterials, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Fletcher NM, Awonuga AO, Abusamaan MS, Saed MG, Diamond MP, Saed GM. Adhesion phenotype manifests an altered metabolic profile favoring glycolysis. Fertil Steril 2016; 105:1628-1637.e1. [PMID: 26920255 DOI: 10.1016/j.fertnstert.2016.02.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 02/03/2016] [Accepted: 02/03/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To determine whether metabolic markers are differentially expressed in normal and adhesion fibroblasts with and without hypoxia exposure. DESIGN Prospective experimental study. SETTING University research laboratory. PATIENT(S) Fibroblasts established from normal peritoneum and adhesion tissues from the same patients. INTERVENTION(S) In vitro experiments on normal peritoneal and adhesion fibroblasts under normal and hypoxic (2% O2) conditions. MAIN OUTCOME MEASURE(S) Expression of metabolic markers, glyceraldehyde 3-phosphate dehydrogenase (GAPDH), glucose transporter 1 (GLUT1), hypoxia inducible factor (HIF)-1α, hexokinase 2 (HK2), lactose dehydrogenase A (LDHA), and pyruvate dehydrogenase alpha 1 (PDHA1) were measured using real-time reverse transcription polymerase chain reaction; adenosine triphosphate (ATP), HIF-1α, and lactate levels were assessed with ELISAs. RESULT(S) Baseline mRNA levels of GAPDH and HIF-1α were increased, while GLUT1 and PDHA1 were decreased in adhesion as compared with in normal peritoneal fibroblasts. There was no change in baseline levels of HK2 or LDHA between the cell lines. Hypoxia increased protein levels of HIF-1α and mRNA levels of GAPDH, GLUT1, and HK2 and decreased levels of PDHA1 in both cell lines. Hypoxia increased LDHA mRNA levels in normal peritoneal fibroblasts. Baseline levels of lactate and ATP were lower in adhesion as compared with in normal peritoneal fibroblasts. In response to hypoxia, there was an increase in lactate in both cell lines and a decrease in ATP in normal fibroblasts. CONCLUSION(S) Adhesion fibroblasts manifested an altered metabolic profile, which favors the glycolytic pathway, and is further altered by hypoxia. Targeting these specific metabolic markers during surgery can be an important therapeutic intervention minimizing the development of postoperative adhesions.
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Affiliation(s)
- Nicole M Fletcher
- Department of Obstetrics and Gynecology, C.S. Mott Center for Human Growth and Development, Wayne State University School of Medicine, Detroit, Michigan
| | - Awoniyi O Awonuga
- Department of Obstetrics and Gynecology, C.S. Mott Center for Human Growth and Development, Wayne State University School of Medicine, Detroit, Michigan
| | - Mohammed S Abusamaan
- Department of Obstetrics and Gynecology, C.S. Mott Center for Human Growth and Development, Wayne State University School of Medicine, Detroit, Michigan
| | - Mohammed G Saed
- Department of Obstetrics and Gynecology, C.S. Mott Center for Human Growth and Development, Wayne State University School of Medicine, Detroit, Michigan
| | - Michael P Diamond
- Department of Obstetrics and Gynecology, Georgia Regents University, Augusta, Georgia
| | - Ghassan M Saed
- Department of Obstetrics and Gynecology, C.S. Mott Center for Human Growth and Development, Wayne State University School of Medicine, Detroit, Michigan.
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Fletcher NM, Awonuga AO, Neubauer BR, Abusamaan MS, Saed MG, Diamond MP, Saed GM. Shifting anaerobic to aerobic metabolism stimulates apoptosis through modulation of redox balance: potential intervention in the pathogenesis of postoperative adhesions. Fertil Steril 2015. [DOI: 10.1016/j.fertnstert.2015.06.041] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Saed GM, Fletcher NM, Diamond MP. The Creation of a Model for Ex Vivo Development of Postoperative Adhesions. Reprod Sci 2015; 23:610-2. [PMID: 26408397 DOI: 10.1177/1933719115607997] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Postoperative adhesions occur in the overwhelming majority of patients after laparotomy and laparoscopy. The clinical consequences of adhesions can be devastating. Adhesions are believed to contribute to infertility and are the most common cause of small bowel obstruction and abdominal pelvic pain. Our objective is to develop a model for ex vivo development of postoperative adhesions. METHODS Peritoneal tissue strips were obtained from Sprague Dawley rats and were abraded by scraping the tissue surface with a scalpel. Tissues were incubated in a special medium, and visible adhesion bands were assessed. Experiments were performed in a university setting. RESULTS Adhesion bands were observed as early as 24 hours after abrasion. No adhesion bands were observed in the control tissue strips. CONCLUSIONS This is a model system for the creation of actual adhesive bands utilizing an ex vivo culture of peritoneal strips.
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Affiliation(s)
- Ghassan M Saed
- Department of Obstetrics and Gynecology, The C. S. Mott Center for Human Growth and Development, Wayne State University School of Medicine, Detroit, MI, USA
| | - Nicole M Fletcher
- Department of Obstetrics and Gynecology, The C. S. Mott Center for Human Growth and Development, Wayne State University School of Medicine, Detroit, MI, USA
| | - Michael P Diamond
- Department of Obstetrics and Gynecology, Clinical and Translational Sciences, Medical College of Georgia, Georgia Regents University, Augusta, GA, USA
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Bolnick A, Bolnick J, Diamond MP. Postoperative Adhesions as a Consequence of Pelvic Surgery. J Minim Invasive Gynecol 2015; 22:549-63. [DOI: 10.1016/j.jmig.2014.12.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 12/05/2014] [Accepted: 12/08/2014] [Indexed: 01/12/2023]
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Eggers C, Müller J, Schultze-Mosgau S. VEGF transfer based on gene-modified fibroblasts using a hypoxia-induced vector to modulate neoangiogenesis in ischaemic regions of myocutaneous transplants. Int J Oral Maxillofac Surg 2014; 44:267-76. [PMID: 25441860 DOI: 10.1016/j.ijom.2014.06.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Revised: 06/29/2014] [Accepted: 06/30/2014] [Indexed: 11/28/2022]
Abstract
The effect of a hypoxia-inducible VEGF-expressing on wound healing in an ischaemic hind leg rat model was evaluated in this study. 180 Wistar rats were assigned randomly to three groups. After ligation of the femoral artery, group 1 received pRTP801-VEGF165, group 2 untransfected fibroblasts, group 3 saline; injection was into the subcutaneous tissue, proximal and distal to the artery ligation. Biopsy specimens were obtained on days 3, 5, 7, 14 after implementation. VEGF transgene expression, vessel architecture, the amount and total area of vessel formation were investigated. Results showed a significantly higher level of VEGF protein expression in group 1 compared to group 2 (P≤0.001) throughout the investigational period. Group 1 exhibited a significant growth of CD31-positive blood vessels in the subcutaneous tissue on day 14 compared to groups 2 and 3 (P≤0.001) (group 1, 62.20±1.92; group 2, 20.60±1.67; group 3, 12.40±1.14). Alpha-SMA-positive staining also showed significant vessel growth in group 1 on day 5 (group 1, 27.00±1.87; group 2, 7.20±1.48; group 3, 10.00±1.73). These results were confirmed in the distal muscle tissue. No significant results were obtained for the proximal muscle tissue. The subcutaneous application of pRTP801-VEGF165 showed a long-lasting effect, with an increased expression of VEGF over the entire observation period. It appears that the use of fibroblasts transfected with VEGF is a promising way to increase early angiogenesis in ischaemic tissue.
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Affiliation(s)
- C Eggers
- Department of Oral and Cranio-Maxillofacial Surgery/Plastic Surgery, Friedrich-Schiller University, Jena, Germany.
| | - J Müller
- Department of Oral and Cranio-Maxillofacial Surgery/Plastic Surgery, Friedrich-Schiller University, Jena, Germany
| | - S Schultze-Mosgau
- Department of Oral and Cranio-Maxillofacial Surgery/Plastic Surgery, Friedrich-Schiller University, Jena, Germany
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18
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Abu-Elhasan AM, Abdellah MS, Hamed HO. Safety and efficacy of postoperative continuous intra-peritoneal wash with lactated Ringer's for minimizing post-myomectomy pelvic adhesions: a pilot clinical trial. Eur J Obstet Gynecol Reprod Biol 2014; 183:78-82. [PMID: 25461357 DOI: 10.1016/j.ejogrb.2014.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 08/15/2014] [Accepted: 09/03/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To assess efficacy and safety of post-operative intra-peritoneal wash with lactated Ringer's for 48h after myomectomy in reduction of adhesions compared to routine intra-operative irrigation. Study design A prospective, randomized trial that included 52 eligible participants who had undergone abdominal myomectomy. Participants were randomly allocated to a treatment group (n=26) which was subjected to continuous peritoneal wash for 48h via two intraperitoneal drains, and a control group (n=26). The incidence of de novo adhesions and their severity and extent were scored at a second-look laparoscopy 8-10 weeks postoperatively. Adhesions were graded using the local adhesion barrier scoring system score. Adverse effects were also assessed and reported. RESULTS There was no statistically significant difference in duration of hospital stay or in the incidence of adverse events. A significantly higher proportion of adhesion-free patients was found in the treatment group [11/23, 47.8%] compared to the control group [4/21, 19%] (P<0.01). The mean number of pelvic sites covered by adhesions was significantly lower in the treatment group than in the control group (2.2±0.3 versus 4.6±0.8, P<0.05). The total adhesion score was significantly lower in the treatment group than in the control group (2.1±0.5 versus 4.8±1.4, P<0.05) and the adhesion score was significantly lower at most of the individual anatomical sites. CONCLUSIONS Application of postoperative intraperitoneal wash with lactated Ringer's solution for 48h may have reasonable safety and efficacy in minimizing postoperative pelvic de novo adhesions following abdominal myomectomy.
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Affiliation(s)
- Ahmad M Abu-Elhasan
- Department of Obstetrics and Gynecology, Woman's Health Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt.
| | - Mohamad S Abdellah
- Department of Obstetrics and Gynecology, Woman's Health Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt.
| | - Hossam O Hamed
- Department of Obstetrics and Gynecology, Woman's Health Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt; Department of Obstetrics and Gynecology, Qassim University, Burraidah, Saudi Arabia.
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19
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Awonuga AO, Belotte J, Abuanzeh S, Fletcher NM, Diamond MP, Saed GM. Advances in the Pathogenesis of Adhesion Development: The Role of Oxidative Stress. Reprod Sci 2014; 21:823-836. [PMID: 24520085 DOI: 10.1177/1933719114522550] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Over the past several years, there has been increasing recognition that pathogenesis of adhesion development includes significant contributions of hypoxia induced at the site of surgery, the resulting oxidative stress, and the subsequent free radical production. Mitochondrial dysfunction generated by surgically induced tissue hypoxia and inflammation can lead to the production of reactive oxygen and nitrogen species as well as antioxidant enzymes such as superoxide dismutase, catalase, and glutathione peroxidase which when optimal have the potential to abrogate mitochondrial dysfunction and oxidative stress, preventing the cascade of events leading to the development of adhesions in injured peritoneum. There is a significant cross talk between the several processes leading to whether or not adhesions would eventually develop. Several of these processes present avenues for the development of measures that can help in abrogating adhesion formation or reformation after intraabdominal surgery.
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Affiliation(s)
- Awoniyi O Awonuga
- Department of Obstetrics and Gynecology, CS Mott Center for Human Growth and Development, Wayne State University School of Medicine, Detroit, MI, USA Department of Obstetrics and Gynecology, Reproductive Endocrinology and Infertility, Wayne State University, School of Medicine, Detroit, MI, USA
| | - Jimmy Belotte
- Department of Obstetrics and Gynecology, CS Mott Center for Human Growth and Development, Wayne State University School of Medicine, Detroit, MI, USA
| | - Suleiman Abuanzeh
- Department of Obstetrics and Gynecology, CS Mott Center for Human Growth and Development, Wayne State University School of Medicine, Detroit, MI, USA
| | - Nicole M Fletcher
- Department of Obstetrics and Gynecology, CS Mott Center for Human Growth and Development, Wayne State University School of Medicine, Detroit, MI, USA
| | - Michael P Diamond
- Department of Obstetrics and Gynecology, Georgia Regents University, Augusta, GA, USA
| | - Ghassan M Saed
- Department of Obstetrics and Gynecology, CS Mott Center for Human Growth and Development, Wayne State University School of Medicine, Detroit, MI, USA Department of Obstetrics and Gynecology, Reproductive Endocrinology and Infertility, Wayne State University, School of Medicine, Detroit, MI, USA Department of Physiology, Program for Reproductive Sciences, Wayne State University, School of Medicine, Detroit, MI, USA Karmanos Cancer Institute, Molecular Biology and Genetics Program, Wayne State University School of Medicine, Detroit, MI, USA
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20
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Fletcher NM, Abuanzeh S, Saed MG, Diamond MP, Abu-Soud HM, Saed GM. Nicotinamide Adenine Dinucleotide Phosphate Oxidase Expression Is Differentially Regulated to Favor a Pro-oxidant State That Contributes to Postoperative Adhesion Development. Reprod Sci 2014; 21:1050-1059. [PMID: 24516041 DOI: 10.1177/1933719114522524] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
We have previously reported that superoxide (O2•-) contributes to the development of postoperative adhesions. In this study, we determined whether O2•- generating nicotinamide adenine dinucleotide phosphate oxidase (NOX) is differentially expressed in normal peritoneal and adhesion fibroblasts and tissues. The NOX isoforms were measured utilizing Western blot, immunohistochemistry, high-performance liquid chromatography, and real-time reverse transcription polymerase chain reaction. Expression and activity of NOX were found to be significantly higher in adhesion tissues and cells than that in normal peritoneal tissues and cells (P < .05). Levels of NOX2, NOX4, NOX activating protein 1, DUOX1, p47phox, and p22phox messenger RNA increased in adhesion fibroblasts when compared to normal peritoneal and increased in response to hypoxia in normal peritoneal fibroblasts. Thus, adhesion fibroblasts are characterized by a unique NOX expression profile, which maintains a pro-oxidant state that may be responsible for the persistence of the adhesion phenotype. Decreasing the activity of NOX by targeting these isoforms may be beneficial for future therapeutic interventions of postoperative adhesions.
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Affiliation(s)
- N M Fletcher
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, USA
| | - S Abuanzeh
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, USA
| | - M G Saed
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, USA
| | - M P Diamond
- Department of Obstetrics and Gynecology, Georgia Regents University, Augusta, GA, USA
| | - H M Abu-Soud
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, USA
| | - Ghassan M Saed
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, USA
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Fletcher NM, Awonuga AO, Saed MG, Abu-Soud HM, Diamond MP, Saed GM. Lycopene, a powerful antioxidant, significantly reduces the development of the adhesion phenotype. Syst Biol Reprod Med 2013; 60:14-20. [PMID: 24219141 DOI: 10.3109/19396368.2013.847129] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Postoperative adhesions are a common medical complication of gynecologic and other pelvic surgeries resulting in persistent pelvic pain, obstruction of the intestines, and even infertility. The molecular mechanisms of postoperative adhesion development remain to be elucidated. We have recently described a role for reactive oxygen species, specifically superoxide, in the development of postoperative adhesions. In this study, we sought to determine whether lycopene, a potent antioxidant, reduces markers characteristic of the adhesion phenotype. Primary fibroblast cultures from normal peritoneum and adhesion tissues were utilized to determine mRNA levels of adhesion phenotype markers type I collagen, transforming growth factor-beta 1 (TGF-β1), and vascular endothelial growth factor (VEGF) in response to lycopene (24 hours, 10 μM) treatment. There was a 2 (p < 0.003), 4.7 (p < 0.004), and 1.6 fold (p < 0.004) increase in mRNA levels of type I collagen, TGF-β1, and VEGF, respectively, in adhesion as compared to normal peritoneal fibroblasts. Lycopene treatment led to a 6.8 and a 12.4 fold decrease in type I collagen mRNA levels, in normal peritoneal and adhesion fibroblasts, respectively (p < 0.005). Lycopene treatment led to a 4.2 (p < 0.03) and a 4.6 (p < 0.05) fold decrease in VEGF mRNA levels, in normal peritoneal and adhesion fibroblasts, respectively. Lycopene treatment led to a 7.0 fold decrease in TGF-β1 mRNA levels, in adhesion fibroblasts (p < 0.03). A 1.9 fold decrease in TGF-β1 mRNA was observed in normal peritoneal fibroblasts in response to treatment, although it was not significant. Lycopene substantially reduced levels of adhesion phenotype markers in normal peritoneal and adhesion fibroblasts and whether it will reduce postoperative adhesions needs to be further investigated.
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Affiliation(s)
- Nicole M Fletcher
- Department of Obstetrics and Gynecology, The C.S. Mott Center for Human Growth and Development, Wayne State University School of Medicine , Detroit , Michigan and
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Rajab TK, Kimonis KO, Ali E, Offodile AC, Brady M, Bleday R. Practical implications of postoperative adhesions for preoperative consent and operative technique. Int J Surg 2013; 11:753-6. [PMID: 23962663 DOI: 10.1016/j.ijsu.2013.07.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Revised: 05/02/2013] [Accepted: 07/29/2013] [Indexed: 11/20/2022]
Abstract
Adhesions complicate most intra-peritoneal operations. Once adhesions have formed, patients are at life-long risk for complications that include small bowel obstruction, increased risks during subsequent operations and female infertility. This has two implications for the daily work of surgeons. On the one hand, surgeons need to include the risks from adhesions during pre-operative consent. On the other hand, surgeons need to use operative techniques that minimize adhesions. Therefore this review focuses on the practical implications of adhesions for preoperative consent and operative technique.
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Affiliation(s)
- Taufiek Konrad Rajab
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
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Rajab TK, Smaxwil L, Wallwiener M. Animal Model for Local Pharmacotherapy in Adhesion Prophylaxis—A Proof of Concept. J INVEST SURG 2013; 26:200-3. [DOI: 10.3109/08941939.2012.741657] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Karanlik H, Kurt A, Kunduz E, Serin K, Saglam S, Soydinc HO, Yasasever V, Olgac V, Asoglu O. Effects of Intraperitoneal Bevacizumab Administration on Colonic Anastomosis and Early Postoperative Adhesion Formation. Surg Innov 2013; 20:559-65. [PMID: 23487032 DOI: 10.1177/1553350613480855] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Aim. The purpose of this study is to investigate the effect of intraperitoneal (IP) bevacizumab on colonic anastomosis and evaluate the effects on early postoperative adhesion formation. Materials and Methods. A total of 24 mature female Sprague-Dawley rats were used for this study. Rats were randomly assigned to a control group that received saline (n = 8) or to experimental groups (n = 8 each) that received bevacizumab at a dose of 2.5 mg/kg (group 1) or 5 mg/kg (group 2). Animals were killed humanely on the seventh day after operation, and measurements of anastomotic strength and biochemical variables were performed. Results. The mean adhesion grade was 2.63 ± 0.92, and 1 ± 0.93 and 0.75 ± 0.71 for the control and test groups, respectively. Bevacizumab significantly reduced adhesion formation in both low-dose and high-dose IP applications ( P < .05). When all groups were compared, it was found that VEGF levels decreased significantly only in the tissue ( P = .001), whereas there was no significant difference in the blood and the IP fluid ( P = .73 and .08, respectively). We evaluated hydroxyproline levels, anastomosis bursting pressure, and histopathological healing scores. When each of these parameters were examined, there was statistical difference between groups ( P = .01, .004, and .01, respectively). It was found that these parameters significantly decreased depending on increasing drug dose. Conclusion. IP administration of bevacizumab effectively reduced the formation of adhesions and caused significant impairment of anastomotic wound healing when standard doses were administered (5 mg/kg), but the 2.5-mg/kg dosage did not affect the anastomotic wound healing and also effectively reduced the formation of adhesions.
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Affiliation(s)
- Hasan Karanlik
- Istanbul University Institute of Oncology, Istanbul, Turkey
| | - Atilla Kurt
- Cumhuriyet University Medical Faculty, Sivas, Turkey
| | - Enver Kunduz
- Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Kursat Serin
- Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Sezer Saglam
- Istanbul University Institute of Oncology, Istanbul, Turkey
| | | | | | - Vakur Olgac
- Istanbul University Institute of Oncology, Istanbul, Turkey
| | - Oktar Asoglu
- Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
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25
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Emami MJ, Jaberi FM, Azarpira N, Vosoughi AR, Tanideh N. Prevention of arthrofibrosis by monoclonal antibody against vascular endothelial growth factor: a novel use of bevacizumab in rabbits. Orthop Traumatol Surg Res 2012; 98:759-64. [PMID: 23062445 DOI: 10.1016/j.otsr.2012.05.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Revised: 04/10/2012] [Accepted: 05/09/2012] [Indexed: 02/02/2023]
Abstract
BACKGROUND Prevention of arthrofibrosis by different drugs and surgical techniques is an essential issue in modern orthopedics. HYPOTHESIS Intra-articular injection of bevacizumab can reduce arthrofibrosis on the rabbit's stifle joint model. MATERIALS AND METHODS Arthrofibrosis was induced in the right stifle joint of thirty male New Zealand white rabbits by removing the cortical bone of the medial femoral condyle under general anesthesia. The rabbits were randomly divided into three equal groups. The control group received intra-articular injection of saline; the one-injection group received a single dose of bevacizumab (2.5mg/kg), and the two-injection group received two intra-articular injections; the operation day and 14 days later. Forty-five days after surgery, animals were sacrificed. The severity of fibrosis was assessed based on the range of motion of the joint, a macroscopic adhesion score, and histopathologic variables such as the number of fibroblasts and of inflammatory cells, collagenous matrix deposition, synovial hyperplasia, granulation tissue formation, vascular proliferation, and presence of giant cells. RESULTS Although no statistically significant differences were found between the range of motion (P=0.222) and the macroscopic evaluation (P=0.067) of the control group and the one-injection group, all microscopic variables regarding the prevention of arthrofibrosis were significantly superior in the one-injection group except granulation tissue (P=0.347). Compared to the one-injection group, the two-injection group had better results not only in terms of macroscopic evaluation (P=0.001 for range of motion and 0.012 for visual adhesion score) but also in most of the histopathologic variables especially the number of fibroblasts (P=0.002), vascularity (P=0.028) and collagenous matrix deposition (P=0.039). CONCLUSION A single intra-articular injection of bevacizumab was effective for prevention of microscopically detected arthrofibrosis in the rabbit. Compared to single injection, two injections of bevacizumab improved the clinical outcome. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- M J Emami
- Research Center for Bone and Joint Diseases, Department of Orthopedic Surgery, Chamran Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
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26
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Brochhausen C, Schmitt VH, Planck CNE, Rajab TK, Hollemann D, Tapprich C, Krämer B, Wallwiener C, Hierlemann H, Zehbe R, Planck H, Kirkpatrick CJ. Current strategies and future perspectives for intraperitoneal adhesion prevention. J Gastrointest Surg 2012; 16:1256-74. [PMID: 22297658 DOI: 10.1007/s11605-011-1819-9] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Accepted: 12/28/2011] [Indexed: 01/31/2023]
Abstract
INTRODUCTION The formation of peritoneal adhesions still is a relevant clinical problem after abdominal surgery. Until today, the most important clinical strategies for adhesion prevention are accurate surgical technique and the physical separation of traumatized serosal areas. Despite a variety of barriers which are available in clinical use, the optimal material has not yet been found. DISCUSSION Mesothelial cells play a crucial physiological role in friction less gliding of the serosa and the maintenance of anantiadhesive surface. The formation of postoperative adhesions results from a cascade of events and is regulated by various cellular and humoral factors. Therefore, optimization or functionalization of barrier materials by developments interacting with this cascade on a structural or pharmacological level could give an innovative input for future strategies in peritoneal adhesion prevention. For this purpose, the proper understanding of the formal pathogenesis of adhesion formation is essential. Based on the physiology of the serosa and the pathophysiology of adhesion formation, the available barriers in current clinical practice as well as new innovations are discussed in the present review.
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Affiliation(s)
- Christoph Brochhausen
- REPAIR-lab, Institute of Pathology, University Medical Centre, Johannes Gutenberg-University, Langenbeckstraße 1,55101 Mainz, Germany.
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Uncoupling oxidative phosphorylation with 2,4-dinitrophenol promotes development of the adhesion phenotype. Fertil Steril 2012; 97:729-33. [DOI: 10.1016/j.fertnstert.2011.12.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Revised: 12/02/2011] [Accepted: 12/06/2011] [Indexed: 12/24/2022]
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Atta HM. Prevention of peritoneal adhesions: a promising role for gene therapy. World J Gastroenterol 2011; 17:5049-58. [PMID: 22171139 PMCID: PMC3235588 DOI: 10.3748/wjg.v17.i46.5049] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2011] [Revised: 07/14/2011] [Accepted: 07/21/2011] [Indexed: 02/06/2023] Open
Abstract
Adhesions are the most frequent complication of abdominopelvic surgery, yet the extent of the problem, and its serious consequences, has not been adequately recognized. Adhesions evolved as a life-saving mechanism to limit the spread of intraperitoneal inflammatory conditions. Three different pathophysiological mechanisms can independently trigger adhesion formation. Mesothelial cell injury and loss during operations, tissue hypoxia and inflammation each promotes adhesion formation separately, and potentiate the effect of each other. Studies have repeatedly demonstrated that interruption of a single pathway does not completely prevent adhesion formation. This review summarizes the pathogenesis of adhesion formation and the results of single gene therapy interventions. It explores the promising role of combinatorial gene therapy and vector modifications for the prevention of adhesion formation in order to stimulate new ideas and encourage rapid advancements in this field.
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Hirschelmann A, Tchartchian G, Wallwiener M, Hackethal A, De Wilde RL. A review of the problematic adhesion prophylaxis in gynaecological surgery. Arch Gynecol Obstet 2011; 285:1089-97. [PMID: 22037682 PMCID: PMC3303068 DOI: 10.1007/s00404-011-2097-1] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Accepted: 09/21/2011] [Indexed: 01/15/2023]
Abstract
Background Adhesions lead to considerable patient morbidity and are a mounting burden on surgeons and the health care system alike. Although adhesion formation is the most frequent complication in abdominal and pelvic surgery, many surgeons are still not aware of the extent of the problem. To provide the best care for their patients, surgeons should consistently inform themselves of anti-adhesion strategies and include these methods in their daily routine. Methods Searches were conducted in PubMed and The Cochrane Library to identify relevant literature. Findings Various complications are associated with adhesion formation, including small bowel obstruction, infertility and chronic pelvic pain. Increasingly, an understanding of adhesion formation as a complex process influenced by many different factors has led to various conceivable anti-adhesion strategies. At present, a number of different anti-adhesion agents are available. Although some agents have proved effective in reducing adhesion formation in randomised controlled trials, none of them can completely prevent adhesion formation. Conclusion To fulfil our duty to provide best possible care for our patients, it is now time to regard adhesions as the most common complication in surgery. Further research is needed to fully understand adhesion formation and to develop new strategies for adhesion prevention. Large clinical efficacy trials of anti-adhesion agents will make it easier for surgeons to decide which agent to use in daily routine.
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Affiliation(s)
- Anja Hirschelmann
- Pius-Hospital, Klinik für Frauenheilkunde und Geburtshilfe, Georgstraße 12, 26121 Oldenburg, Germany
| | - Garri Tchartchian
- Klinik für Minimal Invasive Chirurgie, Kurstraße 11, 14129 Berlin-Zehlendorf, Germany
| | - Markus Wallwiener
- Department of Obstetrics and Gynaecology, Heidelberg University Hospital, Voßstraße 9, 69115 Heidelberg, Germany
| | - Andreas Hackethal
- Giessen School of Endoscopic Surgery, Klinikstraße 32, 35392 Giessen, Germany
| | - Rudy Leon De Wilde
- Pius-Hospital, Klinik für Frauenheilkunde und Geburtshilfe, Georgstraße 12, 26121 Oldenburg, Germany
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Maciver AH, McCall M, James Shapiro AM. Intra-abdominal adhesions: cellular mechanisms and strategies for prevention. Int J Surg 2011; 9:589-94. [PMID: 21964216 DOI: 10.1016/j.ijsu.2011.08.008] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2011] [Accepted: 08/24/2011] [Indexed: 10/17/2022]
Abstract
Postoperative intra-abdominal adhesions represent a serious clinical problem. In this review, we have focused on recent progress in the cellular and humoral mechanisms underpinning adhesion formation, and have reviewed strategies that interfere with these pathways as a means to prevent their occurrence. Current and previous English-language literature on the pathogenesis of adhesion formation was identified. As the burden of surgical disease in the world population increases, and the frequency of reoperation increases, prevention of adhesion formation has become a pressing goal in surgical research.
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Affiliation(s)
- Allison H Maciver
- Department of Surgery, University of Alberta Hospitals, 2000 College Plaza, 8215 112th Street, Edmonton, Alberta, Canada T6G 2C8
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Awonuga AO, Fletcher NM, Saed GM, Diamond MP. Postoperative adhesion development following cesarean and open intra-abdominal gynecological operations: a review. Reprod Sci 2011; 18:1166-85. [PMID: 21775773 DOI: 10.1177/1933719111414206] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
In this review, we discuss the pathophysiology of adhesion development, the impact of physiological changes associated with pregnancy on markers of adhesion development, and the clinical implications of adhesion development following cesarean delivery (CD). Although peritoneal adhesions develop after the overwhelming majority of intra-abdominal and pelvic surgery, there is evidence in the literature that suggests that patients having CD may develop adhesions less frequently. However, adhesions continue to be a concern after CD, and are likely significant, albeit on average less than after gynecological operations, but with potential to cause significant delay in the delivery of the baby with serious, lifelong consequences. Appreciation of the pathophysiology of adhesion development described herein should allow a more informed approach to the rapidly evolving field of intra-abdominal adhesions and should serve as a reference for an evidence-based approach to consideration for the prevention and treatment of adhesions.
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Affiliation(s)
- Awoniyi O Awonuga
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI 48201, USA
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Fossum GT, Silverberg KM, Miller CE, Diamond MP, Holmdahl L. Gynecologic use of Sepraspray Adhesion Barrier for reduction of adhesion development after laparoscopic myomectomy: a pilot study. Fertil Steril 2011; 96:487-91. [PMID: 21718999 DOI: 10.1016/j.fertnstert.2011.05.081] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2011] [Revised: 05/24/2011] [Accepted: 05/25/2011] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To assess the safety and efficacy of Sepraspray Adhesion Barrier (a modified hyaluronic acid and carboxymethylcellulose powder) after laparoscopic surgery, in view of both the high efficacy of Seprafilm Adhesion Barrier in reducing postoperative adhesions after open surgical procedures and the difficulty with laparoscopic delivery. DESIGN Multicenter, randomized, reviewer-blinded trial. SETTING Reproductive endocrinology and infertility clinics. PATIENT(S) Women undergoing laparoscopic myomectomy for indications including infertility. INTERVENTION(S) Randomization to treatment with (n = 21) or without (n = 20) Sepraspray Adhesion Barrier. MAIN OUTCOME MEASURE(S) Postoperative adhesions development was assessed at early second-look laparoscopy. Adhesions were scored using the modified American Fertility Society scoring system. RESULT(S) Surgical procedure duration length was 99 versus 102 minutes in the control versus Sepraspray Adhesion Barrier groups, respectively, with the median number of fibroids removed being two in each group and corresponding fibroid weights of 134 ± 103 versus 113 ± 161 g, respectively. Adhesions scores increased in both the control and Sepraspray Adhesion Barrier groups, with larger although nonstatistically significant increases noted in control subjects when evaluating for the anterior uterus, the posterior uterus, and the entire uterus. CONCLUSION(S) Laparoscopic application of Sepraspray Adhesion Barrier after myomectomy in this pilot study was associated with a trend toward a reduction in postoperative adhesion development, as well as an encouraging safety profile. Further evaluation is warranted. CLINICAL TRIAL NUMBER Sepraspray Adhesion Barrier #NCT00624930.
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Moraloglu Ö, Işık H, Kılıç S, Şahin U, Çaydere M, Üstün H, Batıoglu S. Effect of bevacizumab on postoperative adhesion formation in a rat uterine horn adhesion model and the correlation with vascular endothelial growth factor and Ki-67 immunopositivity. Fertil Steril 2011; 95:2638-41. [DOI: 10.1016/j.fertnstert.2011.02.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Revised: 02/02/2011] [Accepted: 02/02/2011] [Indexed: 10/18/2022]
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McMaken S, Exline MC, Mehta P, Piper M, Wang Y, Fischer SN, Newland CA, Schrader CA, Balser SR, Sarkar A, Baran CP, Marsh CB, Cook CH, Phillips GS, Ali NA. Thrombospondin-1 contributes to mortality in murine sepsis through effects on innate immunity. PLoS One 2011; 6:e19654. [PMID: 21573017 PMCID: PMC3090410 DOI: 10.1371/journal.pone.0019654] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2010] [Accepted: 04/13/2011] [Indexed: 01/15/2023] Open
Abstract
Background Thrombospondin-1 (TSP-1) is involved in many biological processes, including immune and tissue injury response, but its role in sepsis is unknown. Cell surface expression of TSP-1 on platelets is increased in sepsis and could activate the anti-inflammatory cytokine transforming growth factor beta (TGFβ1) affecting outcome. Because of these observations we sought to determine the importance of TSP-1 in sepsis. Methodology/Principal Findings We performed studies on TSP-1 null and wild type (WT) C57BL/6J mice to determine the importance of TSP-1 in sepsis. We utilized the cecal ligation puncture (CLP) and intraperitoneal E.coli injection (IP E.coli) models of peritoneal sepsis. Additionally, bone-marrow-derived macrophages (BMMs) were used to determine phagocytic activity. TSP-1−/− animals experienced lower mortality than WT mice after CLP. Tissue and peritoneal lavage TGFβ1 levels were unchanged between animals of each genotype. In addition, there is no difference between the levels of major innate cytokines between the two groups of animals. PLF from WT mice contained a greater bacterial load than TSP-1−/− mice after CLP. The survival advantage for TSP-1−/− animals persisted when IP E.coli injections were performed. TSP-1−/− BMMs had increased phagocytic capacity compared to WT. Conclusions TSP-1 deficiency was protective in two murine models of peritoneal sepsis, independent of TGFβ1 activation. Our studies suggest TSP-1 expression is associated with decreased phagocytosis and possibly bacterial clearance, leading to increased peritoneal inflammation and mortality in WT mice. These data support the contention that TSP-1 should be more fully explored in the human condition.
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Affiliation(s)
- Sara McMaken
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Internal Medicine, The Dorothy M. Davis Heart and Lung Research Institute, Ohio State University, Columbus, Ohio, United States of America
| | - Matthew C. Exline
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Internal Medicine, The Dorothy M. Davis Heart and Lung Research Institute, Ohio State University, Columbus, Ohio, United States of America
| | - Payal Mehta
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Internal Medicine, The Dorothy M. Davis Heart and Lung Research Institute, Ohio State University, Columbus, Ohio, United States of America
| | - Melissa Piper
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Internal Medicine, The Dorothy M. Davis Heart and Lung Research Institute, Ohio State University, Columbus, Ohio, United States of America
| | - Yijie Wang
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Internal Medicine, The Dorothy M. Davis Heart and Lung Research Institute, Ohio State University, Columbus, Ohio, United States of America
| | - Sara N. Fischer
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Internal Medicine, The Dorothy M. Davis Heart and Lung Research Institute, Ohio State University, Columbus, Ohio, United States of America
| | - Christie A. Newland
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Internal Medicine, The Dorothy M. Davis Heart and Lung Research Institute, Ohio State University, Columbus, Ohio, United States of America
| | - Carrie A. Schrader
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Internal Medicine, The Dorothy M. Davis Heart and Lung Research Institute, Ohio State University, Columbus, Ohio, United States of America
| | - Shannon R. Balser
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Internal Medicine, The Dorothy M. Davis Heart and Lung Research Institute, Ohio State University, Columbus, Ohio, United States of America
| | - Anasuya Sarkar
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Internal Medicine, The Dorothy M. Davis Heart and Lung Research Institute, Ohio State University, Columbus, Ohio, United States of America
| | - Christopher P. Baran
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Internal Medicine, The Dorothy M. Davis Heart and Lung Research Institute, Ohio State University, Columbus, Ohio, United States of America
| | - Clay B. Marsh
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Internal Medicine, The Dorothy M. Davis Heart and Lung Research Institute, Ohio State University, Columbus, Ohio, United States of America
| | - Charles H. Cook
- Department of Surgery, Ohio State University, Columbus, Ohio, United States of America
| | - Gary S. Phillips
- The Center for Biostatistics, Ohio State University, Columbus, Ohio, United States of America
| | - Naeem A. Ali
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Internal Medicine, The Dorothy M. Davis Heart and Lung Research Institute, Ohio State University, Columbus, Ohio, United States of America
- * E-mail:
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Brochhausen C, Schmitt VH, Rajab TK, Planck CNE, Krämer B, Wallwiener M, Hierlemann H, Kirkpatrick CJ. Intraperitoneal adhesions--an ongoing challenge between biomedical engineering and the life sciences. J Biomed Mater Res A 2011; 98:143-56. [PMID: 21548063 DOI: 10.1002/jbm.a.33083] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2010] [Revised: 01/12/2011] [Accepted: 01/20/2011] [Indexed: 01/29/2023]
Abstract
Peritoneal adhesions remain a relevant clinical problem despite the currently available prophylactic barrier materials. So far, the physical separation of traumatized serosa areas using barriers represents the most important clinical strategy for adhesion prevention. However, the optimal material has not yet been found. Further optimization or pharmacological functionalization of these barriers could give an innovative input for peritoneal adhesion prevention. Therefore, a more complete understanding of pathogenesis is required. On the basis of the pathophysiology of adhesion formation the main barriers currently in clinical practice as well as new innovations are discussed in the present review. Physiologically, mesothelial cells play a decisive role in providing a frictionless gliding surface on the serosa. Adhesion formation results from a cascade of events and is regulated by a variety of cellular and humoral factors. The main clinically applied strategy for adhesion prevention is based on the use of liquid or solid adhesion barriers to separate physically any denuded tissue. Both animal and human trials have not yet been able to identify the optimal barrier to prevent adhesion formation in a sustainable way. Therefore, further developments are required for effective prevention of postoperative adhesion formation. To reach this goal the combination of structural modification and pharmacological functionalization of barrier materials should be addressed. Achieving this aim requires the interaction between basic research, materials science and clinical expertise.
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Affiliation(s)
- Christoph Brochhausen
- REPAIR-Lab, Institute of Pathology, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany.
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Basbug M, Bulbuller N, Camci C, Ayten R, Aygen E, Ozercan IH, Arikanoglu Z, Akbulut S. The effect of antivascular endothelial growth factor on the development of adhesion formation in laparotomized rats: experimental study. Gastroenterol Res Pract 2011; 2011:578691. [PMID: 21760775 PMCID: PMC3132490 DOI: 10.1155/2011/578691] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Accepted: 05/02/2011] [Indexed: 02/07/2023] Open
Abstract
Aims. This study determined the effects of a single dose of bevacizumab, an antiangiogenic recombinant monoclonal antibody that specifically targets vascular endothelial growth factor (VEGF), on adhesion formation in the rat cecal abrasion model. Methodology. Thirty female Wistar albino rats (200-224 g) were divided into three groups. All rats underwent laparotomy at which time cecal wall abrasion and abdominal wall injuries were induced. Group I (control) underwent only the abrasion procedure; Groups II and III received saline or bevacizumab intraperitoneally, respectively, following the abrasion. The rats were killed on postoperative day 7, and the severity of adhesions was evaluated, together with histopathological fibrosis parameters and immunohistochemical staining to identify the VEGF receptor. Results. The mean adhesion severity score in Groups I-III was 2.5 ± 0.52, 2.4 ± 0.69, and 0.7 ± 0.82, respectively; the score in Group III was significantly lower than that in Groups I (P < 0.001) and II (P < 0.001). In the histopathological evaluation, the mean fibrosis score in Group III was significantly lower that the scores in Groups I (P < 0.001) and II (P < 0.001). VEGF staining of the adhesion areas in Group III was significantly lower than that in Groups I (P < 0.001) and II (P < 0.001). Conclusion. Bevacizumab decreases adhesion formation following laparotomy in rats by blocking VEGF receptor occupancy.
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Affiliation(s)
- Murat Basbug
- 1Department of General Surgery, Diyarbakir Education and Research Hospital, 21400 Diyarbakir, Turkey
| | - Nurullah Bulbuller
- 2Department of General Surgery, Faculty of Medicine, Firat University, 23100 Elazig, Turkey
| | - Cemalettin Camci
- 2Department of General Surgery, Faculty of Medicine, Firat University, 23100 Elazig, Turkey
| | - Refik Ayten
- 2Department of General Surgery, Faculty of Medicine, Firat University, 23100 Elazig, Turkey
| | - Erhan Aygen
- 2Department of General Surgery, Faculty of Medicine, Firat University, 23100 Elazig, Turkey
| | - Ibrahim Hanifi Ozercan
- 3Department of Medical Pathology, Faculty of Medicine, Firat University, 23100 Elazig, Turkey
| | - Zulfu Arikanoglu
- 1Department of General Surgery, Diyarbakir Education and Research Hospital, 21400 Diyarbakir, Turkey
| | - Sami Akbulut
- 1Department of General Surgery, Diyarbakir Education and Research Hospital, 21400 Diyarbakir, Turkey
- *Sami Akbulut:
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Rajab TK, Wauschkuhn CA, Smaxwil L, Kraemer B, Wallwiener M, Wallwiener CW. An Improved Model for the Induction of Experimental Adhesions. J INVEST SURG 2010; 23:35-9. [DOI: 10.3109/08941930903469474] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Ignjatovic D, Aasland K, Pettersen M, Sund S, Chen Y, Spasojevic M, Nesgaard JM. Intra-abdominal administration of bevacizumab diminishes intra-peritoneal adhesions. Am J Surg 2010; 200:270-5. [PMID: 20227057 DOI: 10.1016/j.amjsurg.2009.08.038] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2009] [Revised: 08/07/2009] [Accepted: 08/31/2009] [Indexed: 01/16/2023]
Abstract
AIM To determine the effect of a single dose of bevacizumab on adhesion formation in the rat cecum abrasion model. METHODS The cecum and parietal peritoneum of 38 male Wistar rats were abraded to promote adhesion formation. The rats were randomized into 2 groups: group 1 received bevacizumab (2.5 mg/kg) intraperitoneally, and group 2 received saline. On day 30 animals were killed, adhesions scored, and histopathological samples taken. RESULTS There was no wound dehiscence; there were 2 incision hernias (5.3%), 1 per group. Thirty-seven animals developed adhesions (97.4%). Adhesion grade and severity scores were significantly different between groups 1 and 2 at 2.7:1.6 (P = .018) and 3.8:2.7 (P = .007), respectively. There was no difference in adhesion square area (27.7:25.0%; P = .16), location (P = 1.00), or number (2.1:1.3; P = .06). Histopathology confirmed the statistical difference between groups (P = .049), and a highly significant correlation between results was shown (r = .758; P = .0001). CONCLUSION A single dose of intraperitoneal bevacizumab significantly reduces grade and severity of abdominal adhesions in the cecum abrasion rat model.
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Affiliation(s)
- Dejan Ignjatovic
- Department of Gastrointestinal Surgery, Vestfold Hospital, Tonsberg, Norway.
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Shavell VI, Saed GM, Diamond MP. Review: cellular metabolism: contribution to postoperative adhesion development. Reprod Sci 2009; 16:627-34. [PMID: 19293132 DOI: 10.1177/1933719109332826] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Postoperative adhesions are a significant source of morbidity, including contributions to pelvic pain, bowel obstruction, and infertility. While the mechanisms of postoperative adhesion development are complex and incompletely understood, hypoxia appears to trigger a cascade of intracellular responses involving hypoxia-inducible factors, lactate, reactive oxygen species, reactive nitrogen species, and insulin-like growth factors that results in manifestation of the adhesion phenotype. Thus, substantial evidence exists to implicate the direct role of cellular metabolism in wound repair and adhesion development.
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Affiliation(s)
- Valerie I Shavell
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Wayne State University School of Medicine, Detroit, Michigan 48201, USA
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Kim S, Lee S, Greene AK, Arsenault DA, Le H, Meisel J, Novak K, Flynn E, Heymach JV, Puder M. Inhibition of Intra-Abdominal Adhesion Formation With the Angiogenesis Inhibitor Sunitinib. J Surg Res 2008; 149:115-9. [DOI: 10.1016/j.jss.2007.10.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2007] [Revised: 09/25/2007] [Accepted: 10/12/2007] [Indexed: 12/01/2022]
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Abstract
Peritoneal adhesions are a near inevitable occurrence after laparotomy and a major cause of both patient and physician misery. To date, clinical attempts at their amelioration have concentrated on manipulating the physical factors that affect their development despite a wealth of experimental data elucidating the molecular mechanisms that underlie their initiation, development and maturation. However, the advent of targeted, specific anti-cytokine agents as directed therapy for inflammatory and neoplastic conditions raises the prospect of a new era for anti-adhesion strategies. To harness this potential will require considerable cross-disciplinary collaboration and that surgeon-scientists propel themselves to the forefront of this emerging field.
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Lin J, Lindsey ML, Zhu B, Agrawal CM, Bailey SR. Effects of surface-modified scaffolds on the growth and differentiation of mouse adipose-derived stromal cells. J Tissue Eng Regen Med 2008; 1:211-7. [PMID: 18038413 DOI: 10.1002/term.27] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE Adipose-derived stromal cells (ADSCs) have been shown to increase angiogenesis in ischemic tissue. Maintaining cell survival and facilitating angiogenesis in ischemic tissue, however, continues to be the major challenge of ADSCs implantation. Recently, bioengineered scaffolds were introduced to support and facilitate cell culture and differentiation. The effects of a surface modified three-dimensional (3D) scaffold on ADSC function have not been investigated. Accordingly, the objective of this study was to determine the influence of a gas-plasma treated scaffold on ADSC growth, differentiation into endothelial cell, and angiogenic gene expression. METHODS Freshly isolated mouse ADSCs were characterized by flow cytometry and cultured into wells containing gas-plasma treated scaffolds, non-treated scaffolds, or control wells. Either endothelial growth media or differentiation media was used to alter cell environment. After 3 and 6 days, cell proliferation was analyzed. VEGF concentration in the medium was measured by ELISA. Gene expression was quantified by real-time PCR for VEGF receptor-2 (KDR), cyclooxygenase-2 (COX-2) and matrix metalloproteinases-2 (MMP-2). RESULTS ADSCs expressed stem/endothelial progenitor markers CD34 and CD133 and endothelial cell marker CD31. ADSCs grew in the 3D scaffold. Cells grown on gas-plasma treated scaffolds displayed significantly increased expression of VEGF, COX-2, and MMP-2 when grown in differentiation but not growth media. When cultured in endothelial growth media, VEGF secretion and the expression of KDR, COX-2 and MMP-2 were lower in 3D scaffolds than controls. CONCLUSIONS This study suggests that 3D scaffolds, especially gas-plasma treated scaffolds, support ADSC growth and support differentiation into endothelial cells.
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Affiliation(s)
- Jing Lin
- Janey Briscoe Center for Cardiovascular Research, Division of Cardiology, Department of Medicine, University of Texas Health Science Center at San Antonio, TX 78229-3900, USA.
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Macrophage and T-lymphocyte Infiltrates in Human Peritoneal Adhesions Indicate a Chronic Inflammatory Disease. World J Surg 2007; 32:296-304. [DOI: 10.1007/s00268-007-9330-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Diamond MP, Saed G. Modulation of the expression of peroxisome proliferators-activated receptors in human fibroblasts. Fertil Steril 2006; 87:706-9. [PMID: 17156782 DOI: 10.1016/j.fertnstert.2006.07.1513] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2005] [Revised: 07/06/2006] [Accepted: 07/06/2006] [Indexed: 11/28/2022]
Abstract
To determine the levels of peroxisome proliferators-activated receptors (PPARs) in normal and adhesion fibroblasts, we utilized real-time reverse transcription-polymerase chain reaction to measure messenger RNA (mRNA) levels in fibroblasts from normal peritoneum and adhesions from five patients in both the presence or absence of dichloroacetic acid (DCA) and a cyclooxygenase-2 (COX-2) inhibitor, NS-398. Peroxisome proliferators-activated receptor alpha, PPARbeta, PPARgamma1, and PPARgamma2 mRNA are all present in normal peritoneal and adhesion fibroblasts, and selectively rose in response to hypoxia and either DCA or NS-398.
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Cahill RA, Wang JH, Soohkai S, Redmond HP. Mast cells facilitate local VEGF release as an early event in the pathogenesis of postoperative peritoneal adhesions. Surgery 2006; 140:108-12. [PMID: 16857448 DOI: 10.1016/j.surg.2006.01.020] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2005] [Revised: 01/26/2006] [Accepted: 01/29/2006] [Indexed: 01/16/2023]
Abstract
BACKGROUND Peritoneal injury sustained at laparotomy may evoke local inflammatory responses that result in adhesion formation. Peritoneal mast cells are likely to initiate this process, whereas vascular permeability/endothelial growth factor (VEGF) may facilitate the degree to which subsequent adhesion formation occurs. METHODS Mast cell deficient mice (WBB6F1-/-), along with their mast cell sufficient counterparts (WBB6F1+/+), underwent a standardized adhesion-inducing operation (AIS) with subsequent sacrifice and adhesion assessment 14 days later in a blinded fashion. Additional CD-1 and WBB6F1+/+, and WBB6F1-/- mice were killed 2, 6, 12, and 24 hours after operation for measurement of VEGF by ELISA in systemic serum and peritoneal lavage fluid. Two further groups of CD-1 mice underwent AIS and received either a single perioperative dose of anti-VEGF monoclonal antibody (10 mug/mouse) or a similar volume of IgG isotypic antibody and adhesion formation 2 weeks later was evaluated. RESULTS WBB6F1-/- mice had less adhesions then did their WBB6F1+/+ counterparts (median [interquartile range] adhesion score 3[3-3] vs 1.5[1-2] respectively; P < .003). Local VEGF release peaked 6 hours after AIS in both WBB6F1+/+ and CD-1 mice whereas levels remained at baseline in WBB6F1-/- mice. CD-1 mice treated with a single dose of anti-VEGF therapy during operation had less adhesions than controls (2[1.25-2] vs 3[2.25-3], P = .0002). CONCLUSIONS Mast cells and VEGF are central to the formation of postoperative intra-abdominal adhesions with mast cells being responsible, either directly or indirectly, for VEGF release into the peritoneal cavity after operation. In tandem with the recent clinical success of anti-VEGF monoclonal antibodies in oncologic practice, our observations suggest an intriguing avenue for research and development of anti-adhesion strategy.
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Affiliation(s)
- Ronan A Cahill
- Department of Academic Surgery, Cork University Hospital, Ireland.
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Serebruany VL, Malinin AI, Bhatt DL. Paradoxical rebound platelet activation after painkillers cessation: missing risk for vascular events? Am J Med 2006; 119:707.e11-6. [PMID: 16887419 DOI: 10.1016/j.amjmed.2005.11.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2005] [Revised: 11/03/2005] [Accepted: 11/03/2005] [Indexed: 11/21/2022]
Abstract
BACKGROUND Several reliable reports strongly indicate that the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and cyclooxygenase-2 (COX-2) inhibitors is associated with an increased risk of cardiovascular events. Considering the key role of platelets in coronary atherosclerosis and the fact that antiplatelet therapy with aspirin (and more recently, clopidogrel) has been associated with reduced vascular mortality, we sought to determine the effect of therapy and withdrawal of NSAIDs and COX-2 inhibitors on platelet activity. METHODS Platelet characteristics from 34 aspirin-naive volunteers who were receiving NSAIDs and COX-2 inhibitors were compared with 138 drug-free controls. Platelets were assessed twice at baseline (at least 1 month of NSAIDs and COX-2 inhibitors) and after a 14-day washout. We used adenosine diphosphate-induced conventional aggregometry, the point-of-care Ultegra analyzer (Ultegra Accumetrics, San Diego, Calif), and whole blood flow cytometry. RESULTS Platelet activity during therapy with NSAIDs and COX-2 inhibitors was similar and unremarkable between groups. However, there was a highly significant increase of platelet activity as assessed by conventional aggregometry (P=.0003), Ultegra analyzer readings (P=.03), and expression of GPIIb/IIIa (P=.02), P-selectin (P=.03), and platelet endothelial cell adhesion molecule-1 (P=.001) after withdrawal from NSAIDs and COX-2 inhibitors. CONCLUSIONS These data suggest that drug cessation, rather than continuous therapy with NSAIDs and COX-2 inhibitors, may be associated with rebound platelet activation, which may predispose one to a higher risk of vascular events. This hypothesis requires intensive testing in crossover randomized studies and may justify more aggressive antiplatelet regimens in patients after discontinuation of therapy with NSAIDs and COX-2 inhibitors.
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