The Therapeutic Potential of Targeting Key Signaling Pathways as a Novel Approach to Ameliorating Post-Surgical Adhesions

Abstract

Background: Peritoneal adhesions (PA) are a common complication of abdominal operations. There is a growing body of evidence showing that inhibition of inflammation and fibrosis at sites of peritoneal damaging could prevent the development of intra-abdominal adhesions. Method: A search of PubMed, Medline, CINAHL and Embase databases was performed using the keywords ‘postsurgical adhesion’, ‘post-operative adhesion’, ‘peritoneal adhesion’, ‘surgery-induced adhesion’ and ‘abdominal adhesion’. Studies detailing the use of pharmacological and non-pharmacological agents for peritoneal adhesion prevention were identified, and their bibliographies were thoroughly reviewed to identify further related articles. Result: several signaling pathways such as tumor necrosis factor alpha, tissue plasminogen activator, and type 1 plasminogen activator inhibitor, macrophages, fibroblasts, and mesothelial cells play a key part in the development of plasminogen activator. Several therapeutic approaches based on anti-PA drugs barriers, and traditional herbal medicines have been developed to prevent and treat adhesion formation. In recent years, the most promising method to prevent PA is believed to be treatment using biomaterial-based barriers. Conclusion: Here we provide an overview on the pathophysiology of adhesion formation and various agents targeting different pathways including chemical agents, herbal agents, physical barriers, and clinical trials concerning this matter.

Human peritoneal tight junction, transporter and channel expression in health and kidney failure, and associated solute transport

“…The peritoneum plays a key role in abdominal homeostasis, in the development of post-inflammatory and post-interventional adhesions, ascites formation and cancer progression 31 , 32 , all processes in which TJs are essentially involved. Nephrologists take advantage of the semipermeable peritoneum as a natural dialysis membrane for the rising number of patients with end stage kidney disease, but due to PD fluid bioincompatibility progressive peritoneal alterations limit its use.…”