Intraperitoneal Triamcinolone Reduces Postoperative Adhesions, Possibly through Alteration of Mitochondrial Function

Abstract

Adhesions frequently occur postoperatively, causing morbidity. In this noninterventional observational cohort study, we enrolled patients who presented for repeat abdominal surgery, after a history of previous abdominal myomectomy, from March 1998 to June 20210 at St. Vincent’s Catholic Medical Centers. The primary outcome of this pilot study was to compare adhesion rates, extent, and severity in patients who were treated with intraperitoneal triamcinolone acetonide during the initial abdominal myomectomy (n = 31) with those who did not receive any antiadhesion interventions (n = 21), as documented on retrospective chart review. Adhesions were blindly scored using a standard scoring system. About 32% of patients were found to have adhesions in the triamcinolone group compared to 71% in the untreated group (p < 0.01). Compared to controls, adhesions were significantly less in number (0.71 vs. 2.09, p < 0.005), severity (0.54 vs. 1.38, p < 0.004), and extent (0.45 vs. 1.28, p < 0.003). To understand the molecular mechanisms, human fibroblasts were incubated in hypoxic conditions and treated with triamcinolone or vehicle. In vitro studies showed that triamcinolone directly prevents the surge of reactive oxygen species triggered by 2% hypoxia and prevents the increase in TGF-β1 that leads to the irreversible conversion of fibroblasts to an adhesion phenotype. Triamcinolone prevents the increase in reactive oxygen species through alterations in mitochondrial function that are HIF-1α-independent. Controlling mitochondrial function may thus allow for adhesion-free surgery and reduced postoperative complications.

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“…Despite its effectiveness in reducing the in ammatory response, triamcinolone may induce immunosuppression and delayed wound healing 114 . However, its ability to prevent an increase in ROS by upregulating mitochondrial respiration makes it a potential candidate for mitigating the impact of space ight 113 , it does so by preventing a rise in TNF-β1. Per uorodecalin, a uorocarbon renowned for its remarkable oxygen dissolving capacity, serves a crucial role as an oxygen carrier 115,116 .…”

“…These drugs, known for their roles in modulating ROS levels and mitochondrial function, could be pivotal in developing strategies to reduce SGA risk among female astronauts. Triamcinolone, a versatile corticosteroid, is known for its application in preventing the rise of ROS during hypoxia by altering mitochondrial function 113 . Despite its effectiveness in reducing the in ammatory response, triamcinolone may induce immunosuppression and delayed wound healing 114 .…”