Angiogenic factors in peritoneal adhesion formation

Abstract

Abdominal surgery is considered as the leading cause of peritoneal adhesions and almost universally as adhesiogenic. Peritoneal injury at the time of surgery initiates an inflammatory reaction determining fibrin deposition on the wound surface. Depending on the balance between the different components of the plasminogen system, this fibrin can be either lysed, leading to normal peritoneal healing, or organised, serving as a scaffold for fibroblast ingrowth, extracellular matrix deposition and angiogenesis, leading to adhesion formation. The mechanism underlying the predisposition to form adhesions in some patients and in some specific anatomic sites and not in others after similar surgical procedures remains unknown. In spite of the many attempts proposed over the years for reducing the incidence of adhesion formation, peritoneal adhesions remain a major clinical problem, inducing intestinal obstruction, pelvic pain, female infertility and difficulties at the time of re-operation. The available evidence indicates that understanding the adhesion formation process at the molecular level is essential for developing successful strategies for preventing adhesions. Fortunately, the advancement in molecular biology during the last years has led to the identification of many molecules with the potential of regulating inflammatory and immune responses, tissue remodelling and angiogenesis, key events in peritoneal healing and adhesion formation. This review focuses on the role of angiogenesis and angiogenic factors in peritoneal adhesion formation.

Anti‐adhesive effect of chondrocyte‐derived extracellular matrix surface‐modified with poly‐L‐lysine

“…Activated fibroblasts convert the fibrin matrix to fibrous tissues by synthesizing abundant collagen and consequently, forming an adhesion between the injured tissue and contiguous tissue or organs (diZerega & Campeau, 2001;Maciver et al, 2011). In addition, angiogenesis by infiltrated endothelial cells supplies nutrition for the fibroblasts and facilitates the formation of fibrous tissue (Molinas et al, 2006).…”

Physical and biological effects of gellan gum on decreasing postoperative adhesion in a rat model

“…Type V collagen, a component of the ECM, which is located in a variety of tissues and capillary basement membranes, could play a role in angiogenesis. [27][28][29][30] Previous work indicated that vascular endothelial growth factor (VEGF) and type V collagen expression increase during angiogenesis and are necessary for adhesion formation. In this work, we found that the gene expression of type V collagen in the G/A70-treated group was not increased at the time of adhesion formation.…”

Post-Operative Adhesions: A Comprehensive Review of Mechanisms

“…Vascular endothelial growth factor A (VEGF-A) is a potent member of the angiogenic factor family, and involved in coagulation, fibrinolysis, and angiogenesis [ 144 , 145 ]. In this context, VEGF has been reported to play a pivotal role in adhesion formation as it increases vascular permeability and promotes the deposition of the fibrin-rich matrix required for subsequent cell migration and proliferation [ 146 ]. This may ultimately lead to post-operative VEGF surges [ 147 ].…”