Elsevier

Surgery

Volume 129, Issue 5, May 2001, Pages 626-632
Surgery

Original Communications
Overproduction of transforming growth factor-β1 (TGF-b1) is associated with adhesion formation and peritoneal fibrinolytic impairment*,**,*

https://doi.org/10.1067/msy.2001.113039Get rights and content

Abstract

Background. Reduction in peritoneal fibrinolytic capacity and increased transforming growth factor-β1 (TGF -β1) production are associated with adhesion development. This study investigated the expression of TGF-b1 in peritoneal tissue, and possible correlation with components of the fibrinolytic system locally in peritoneal tissue. Materials and methods. Peritoneal samples were taken from 22 patients at relaparotomy. Samples of adhesions were collected from 10 patients. The patients were categorized into different groups depending on the quantity and the quality of adhesions. TGF-β1 and components of the fibrinolytic system in tissue extracts were assayed using enzyme-linked immunosorbent assays. Results. The concentration of active TGF-β1 in peritoneal samples from patients with extensive adhesions was double (P <.01) that of healthy subjects, but the total levels of TGF-β1 were similar (P =.63). In adhesion tissue, both active (P <.003) and total (P <.008) TGF-β1 concentrations were more than twice as high as unaffected peritoneum. There was a significant correlation between the concentration of plasminogen activator inhibitor type 1 in peritoneal samples with active TGF-β1 (P <.03, r = 0.693) and adhesion tissue with total TGF-β1 (P =.001, r = 0.872). The other components of the fibrinolytic system did not correlate significantly with TGF-β1. Conclusions. These data indicate that an overexpression of TGF-β1 is associated with adhesion formation, possibly through a mechanism involving local regulation of plasminogen activator inhibitor type 1. (Surgery 2001;129:626-32.)

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,

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  • Cited by (0)

    *

    Supported by The Swedish Society of Medicine, The Swedish Medical Research Council (proj. no. K98-17X-12650), and Regent Medical, Norcross, Ga.

    **

    Reprint requests: Lena Holmdahl, MD, PhD, Department of Surgery, Sahlgrenska University Hospital/Östra, Göteborg University, S-41685 Göteborg, Sweden.

    *

    Surgery 2001;129:626-32.

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