Can pirfenidone prevent tendon adhesions? An experimental study in rats

Abstract

Objectives In this experimental study, we aimed to investigate the effectiveness of oral pirfenidone (PFD) treatment on preventing tendon adhesion and tendon healing in rats. Materials and methods A total of 21 rats were assigned into three groups including seven rats in each group. In Group 1 (sham group), no surgical procedure was performed. In Group 2 (control group), tendon repair was performed following right achillotomy. In Group 3 (treatment group), the rats also underwent tendon repair after right achillotomy. Additionally, 30 mg/kg of oral PFD was initiated from the postoperative Day 1 and administered via gavage for 28 days. At the end of the study, tendon healing and fibrosis levels in the tendon repair site were compared macroscopically, histopathologically, and immunohistochemically among the groups. Results Macroscopically, moderate and severe adhesions were observed in four and three rats, respectively in the control group, while no adhesion was found in four rats and filmy adhesions were observed in three rats in the treatment group (p<0.01). Microscopically, there was moderate adhesions in three rats and severe adhesions in four rats in the control group, while three rats had no adhesions and four rats had slight adhesions in the treatment group (p<0.01). Microscopically, tendon healing was good in six rats and fair in one rat in the control group, while five rats showed excellent tendon healing and two rats showed good tendon healing in the treatment group (p<0.01). Immunohistochemically, expressions of collagen I (p<0.01), collagen III (p<0.001), vascular endothelial growth factor (VEGF) (p<0.001), and proliferating cell nuclear antigen (PCNA) (p<0.001) significantly decreased in the treatment group compared to the control group. Conclusion Our study results indicated that PFD decreased collagen synthesis and prevented the formation of peritendinous adhesion in rats; however, it did not impair tendon healing.

The effect of papaverine on tendon healing and adhesion in rats following Achilles tendon repair

“…In a study, pirfenidone, a drug with antifibrotic and anti-inflammatory properties currently used in the treatment of idiopathic pulmonary fibrosis, was utilized to prevent tendon adhesion and tendon healing in rats with Achilles tendon damage. [ 26 ] The results indicated that pirfenidone decreased collagen synthesis and prevented the formation of peritendinous adhesion in rats; however, it did not impair tendon healing.…”

The effect of caffeic acid on tendon healing in rats with an Achilles tendon injury model

“…[1][2][3] Many reasons such as slow regeneration rate, low blood perfusion, and inability to use the implants used in the fixation of bone fractures for these tissues cause the healing process of injured tendons to prolong with respect to other tissues. [4] Studies are continuing on the effects of various antioxidant or anti-inflammatory substances in this difficult and long healing process of tendons. [5,6] Caffeic acid is one of the phenolic compounds synthesized by plants and commonly found in nature and in the human diet.…”