Original CommunicationsOverproduction of transforming growth factor-β1 (TGF-b1) is associated with adhesion formation and peritoneal fibrinolytic impairment*,**,*
Section snippets
Patients
Thirty-two peritoneal biopsy specimens were taken after informed consent from 22 patients undergoing abdominal operation, predominantly for colorectal diseases. All of the patients (10 men and 12 women) had previously undergone abdominal operation. The mean age was 68 years (range, 37-91 years). Patients with intra-abdominal infection or disseminated cancer were excluded. The study was approved by the Local Ethics Committee.
Categorization of adhesion formation and tissue collection
At operation, adhesion formation was scored in different categories on
Adhesion formation
All patients had adhesions develop. Eight patients were categorized in group 1 and 14 in group 2, men and women equally distributed in the groups. Five of the patients categorized into group 2 were operated on because of adhesion-related complications (eg, bowel obstruction).
The propensity to form adhesions
TGF-β1 was detectable in all peritoneal samples from all 22 patients except for 1 patient belonging to group 1. In this patient, the concentration of TGF-β1 was below the detection limit in nonacidified and acidified
Discussion
These findings, to our knowledge the first demonstration of quantitation of TGF-β1 in human peritoneum and adhesion tissue, indicate that overexpression of TGF-β1 is associated with adhesion formation in human beings. Moreover, the results suggest that a high level of TGF-β1 is associated with a local impairment of fibrinolytic capacity.
Because of the frequency of adhesion reformation after lysis,18 adhesion tissue represents a tissue that typically forms adhesion in any patient. In addition,
Conclusion
There may be multiple modes of actions for TGF-β1 in the events leading to adhesion formation: a stimulation of fibrin deposition; an early inhibition of fibrin degradation by stimulation of PAI-1; and a later promotion of connective tissue formation by stimulation of extracellular matrix formation, an event partly depending on the down-regulation of the fibrinolytic system by PAI-1. Clinically, it may not be desirable to abolish adhesion formation, but rather to control the extent. Therefore,
References (31)
- et al.
Abdominal adhesiolysis: inpatient care and expenditures in the United States in 1994
J Am Coll Surg
(1998) - et al.
Fibrinolysis in human peritoneum during operation
Surgery
(1996) - et al.
Effect of transforming growth factor beta on postoperative adhesion formation and intact peritoneum
J Surg Res
(1992) - et al.
Formation of abdominal adhesions is inhibited by antibodies to transforming growth factor-β1
J Surg Res
(1996) - et al.
Expression and kinetics of fibrinolytic components in plasma and peritoneum during abdominal surgery
Fibrinolysis & Proteolysis
(1998) - et al.
Transforming growth factor beta in human platelets
J Biol Chem
(1983) - et al.
The cell biology of transforming growth factor β
Biochim Biophys Acta
(1990) - et al.
Depression of peritoneal fibrinolysis during surgery is a local response to trauma
Surgery
(1998) - et al.
The plasminogen-plasmin system
Prog Cardiovasc Dis
(1991) - et al.
Adhesion prevention and complications in general surgery
Eur J Surg
(1997)
Cost of bowel obstruction resulting from adhesions
Eur J Surg
The role of fibrinolysis in the formation of adhesions
Eur J Surg
The role of fibrinolysis in the formation of postoperative adhesions
Wound Repair Regen
Reduced human peritoneal plasminogen activating activity: possible mechanism of adhesion formation
Br J Surg
Tissue markers as predictors of post-surgical adhesions
Br J Surg
Cited by (0)
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Supported by The Swedish Society of Medicine, The Swedish Medical Research Council (proj. no. K98-17X-12650), and Regent Medical, Norcross, Ga.
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Reprint requests: Lena Holmdahl, MD, PhD, Department of Surgery, Sahlgrenska University Hospital/Östra, Göteborg University, S-41685 Göteborg, Sweden.
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Surgery 2001;129:626-32.