The use of 5‐fluorouracil in the prevention of tendon adhesions: A systematic review

Nazifi, Omid; Stuart, Andrew; Nikkhah, Dariush

doi:10.1002/ame2.12110

Anim Models and Exp Med

2020

DOI: 10.1002/ame2.12110

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The use of 5‐fluorouracil in the prevention of tendon adhesions: A systematic review

Omid Nazifi

Andrew Stuart

Dariush Nikkhah

Abstract: Background: This systematic review aims to study the effectiveness of 5-fluorouracil (5FU) in the reduction of tendon adhesions postsurgical repair. Method: A systematic review was performed involving four databases, Cochrane,PubMed, MEDLINE, and Embase, looking for evidence of at least Level I or Level II (according to NHMRC) in the use of 5FU in tendon repairs in human or animal studies.Results: Across the four databases 546 articles were identified. Of these 12 were identified as relevant, with a further tw… Show more

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Cited by 3 publications

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“…Various chemical (5-fluorouracil, tranexamic acid) and biological (amniotic membrane) materials have been used to prevent adhesions in tendon repair. [3][4][5] Currently, there is no product that is routinely used for the prevention of tendon adhesions.…”

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confidence: 99%

Can pirfenidone prevent tendon adhesions? An experimental study in rats

Türközü,

Güven,

Altindağ

et al. 2023

Jt Dis Relat Surg

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Objectives In this experimental study, we aimed to investigate the effectiveness of oral pirfenidone (PFD) treatment on preventing tendon adhesion and tendon healing in rats. Materials and methods A total of 21 rats were assigned into three groups including seven rats in each group. In Group 1 (sham group), no surgical procedure was performed. In Group 2 (control group), tendon repair was performed following right achillotomy. In Group 3 (treatment group), the rats also underwent tendon repair after right achillotomy. Additionally, 30 mg/kg of oral PFD was initiated from the postoperative Day 1 and administered via gavage for 28 days. At the end of the study, tendon healing and fibrosis levels in the tendon repair site were compared macroscopically, histopathologically, and immunohistochemically among the groups. Results Macroscopically, moderate and severe adhesions were observed in four and three rats, respectively in the control group, while no adhesion was found in four rats and filmy adhesions were observed in three rats in the treatment group (p<0.01). Microscopically, there was moderate adhesions in three rats and severe adhesions in four rats in the control group, while three rats had no adhesions and four rats had slight adhesions in the treatment group (p<0.01). Microscopically, tendon healing was good in six rats and fair in one rat in the control group, while five rats showed excellent tendon healing and two rats showed good tendon healing in the treatment group (p<0.01). Immunohistochemically, expressions of collagen I (p<0.01), collagen III (p<0.001), vascular endothelial growth factor (VEGF) (p<0.001), and proliferating cell nuclear antigen (PCNA) (p<0.001) significantly decreased in the treatment group compared to the control group. Conclusion Our study results indicated that PFD decreased collagen synthesis and prevented the formation of peritendinous adhesion in rats; however, it did not impair tendon healing.

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mentioning

confidence: 99%

Can pirfenidone prevent tendon adhesions? An experimental study in rats

Türközü,

Güven,

Altindağ

et al. 2023

Jt Dis Relat Surg

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Neutralization of excessive levels of active TGF-β1 reduces MSC recruitment and differentiation to mitigate peritendinous adhesion

Wang

et al. 2023

Bone Res

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Peritendinous adhesion formation (PAF) can substantially limit the range of motion of digits. However, the origin of myofibroblasts in PAF tissues is still unclear. In this study, we found that the concentration of active TGF-β1 and the numbers of macrophages, mesenchymal stromal cells (MSCs), and myofibroblasts in human and mouse adhesion tissues were increased. Furthermore, knockout of TGF-β1 in macrophages or TGF-β1R2 in MSCs inhibited PAF by reducing MSC and myofibroblast infiltration and collagen I and III deposition, respectively. Moreover, we found that MSCs differentiated into myofibroblasts to form adhesion tissues. Systemic injection of the TGF-β–neutralizing antibody 1D11 during the granulation formation stage of PAF significantly reduced the infiltration of MSCs and myofibroblasts and, subsequently, PAF. These results suggest that macrophage-derived TGF-β1 recruits MSCs to form myofibroblasts in peritendinous adhesions. An improved understanding of PAF mechanisms could help identify a potential therapeutic strategy.

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Effects of 5-flourouracil released from different prosthetic meshes on postoperative adhesion formation in rats

Balas¹

2021

North Clin Istanbul

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The use of 5‐fluorouracil in the prevention of tendon adhesions: A systematic review

Cited by 3 publications

References 18 publications

Can pirfenidone prevent tendon adhesions? An experimental study in rats

Can pirfenidone prevent tendon adhesions? An experimental study in rats

Neutralization of excessive levels of active TGF-β1 reduces MSC recruitment and differentiation to mitigate peritendinous adhesion

Effects of 5-flourouracil released from different prosthetic meshes on postoperative adhesion formation in rats

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