Effect of oxidized regenerated cellulose (Interceed®) on the expression of tissue plasminogen activator and plasminogen activator inhibitor-1 in human peritoneal fibroblasts and mesothelial cells

The biology of adhesion formation in the peritoneal cavity

“…This in turn increases PAI-1 and uPA mRNA expression in endothelial cells with the ratio of uPA:PAI-1 favoring enhancement of anti-proteolysis; there is also a decreased synthesis of collagenase and plasminogen activator. 8,17 In normal peritoneal fibroblasts, exposure to hypoxia results in an irreversible increase in TGF-β1 and collagen type I levels to those found in adhesion fibroblasts. 16 In addition, TGF-β1 increases when exposed to superoxide in both peritoneal and adhesion fibroblasts.…”

“…Good surgical technique was described by Boys "5 Fundamental attacks" directed towards prevention of adhesions which include the following: (1) limiting initial injury, (2) preventing coagulation of serous exudates, (3) dissolving or removing deposited fibrin, (4) keeping apart the fibrin-coated surfaces, and 5) inhibiting fibroblastic proliferation once established. 17 Although the value of "microsurgical" technique is well accepted, it is clearly not enough in preventing adhesion formation and reformation as demonstrated by the high recurrence rate of adhesions noted on second-look laparoscopy. 11 To supplement surgical technique, three physical barriers are currently FDA approved in the US for prevention of adhesion development.…”

Postoperative Adhesions: From Formation to Prevention

“…It has been shown that Interceed increased the tPA/PAI-1 ratio in fibroblasts isolated from adhesion tissues to levels observed in fibroblast isolates from normal peritoneum obtained from the same patient(s). 40 Also, it has been demonstrated that Interceed altered the inflammatory response by acting on macrophages and causing a diminished immunologic response with the potential to decrease adhesion formation. 41 Interceed has been studied in animal models and has been shown to reduce adhesion formation and re-formation significantly in rabbit uterine horn.…”

Adhesion formation after intracapsular myomectomy with or without adhesion barrier

“…It helps to prevent postoperative adhesions by protecting and separating the surfaces of denuded peritoneum where adhesions are likely to form, and it dissolves as healing occurs. ORC increases the tissue plasminogen activator (tPA)/plasminogen activator inhibitor (PAI) 1 ratio in fibroblasts isolated from adhesion tissues (10) and reduces the inflammatory response by acting on macrophages, another potential mechanism to decrease adhesion formation (11). One study reported that 55%-97% of women undergoing pelvic surgery form adhesions; several investigators reported that adhesions after myomectomy by laparotomy occurred in all patients (12).…”