Abstract
The pathophysiology of adhesion formation needs to be clarified to reduce the adhesion-related morbidity. The epithelial characteristics of the peritoneum suggest a protective role against adhesion formation, yet how the peritoneum is involved in adhesion formation is not well characterized. We microscopically observed an experimental model of adhesion formation to investigate the effects of an injured tissue on the opposite intact peritoneum. Adhesions were induced between injured and intact hepatic lobes, and the intact peritoneum opposite to the injured tissue was examined for 8 days. The opposite intact peritoneum was denuded of mesothelial cells for 6 hours, and the remnant mesothelial cells changed morphologically for 24 hours. The detachment of mesothelial cells allowed fibrin to attach to the basement membrane of the opposite peritoneum, connecting the two lobes. Moreover, macrophages and myofibroblasts accumulated between the two lobes, and angiogenesis occurred from the opposite intact lobe to the injured lobe. These observations indicate that an injured tissue deprives the opposite intact peritoneum of its epithelial structure and causes fibrous adhesions to the opposite intact tissue. This study implies a possible role of mesothelial cells for barrier function against adhesion formation, that is, keeping mesothelial cells intact might lead to its prophylaxis.
Highlights
The pathophysiology of adhesion formation needs to be clarified to reduce the adhesion-related morbidity
The peritoneum may act as a protective epithelium against adhesion formation, as suggested by the fact that the peritoneum consists of mesothelial cells (MCs) and a basement membrane (BM) and displays epithelial characteristics[13]
This is the first study showing that a cauterized tissue causes significant structural changes in the opposite intact peritoneum and is repaired through interaction with the opposite intact tissue, resulting in the formation of a fibrous adhesion
Summary
The pathophysiology of adhesion formation needs to be clarified to reduce the adhesion-related morbidity. Macrophages and myofibroblasts accumulated between the two lobes, and angiogenesis occurred from the opposite intact lobe to the injured lobe These observations indicate that an injured tissue deprives the opposite intact peritoneum of its epithelial structure and causes fibrous adhesions to the opposite intact tissue. Lamont et al and Haney and Doty showed that adhesions more frequently formed when two opposing peritoneums were injured than when only one peritoneum was injured while the opposite peritoneum was left intact[15,16] These studies suggest that adhesions form only after both of the two opposing peritoneums lose their epithelial structure. One side of the two opposing peritoneums is intentionally injured in many experimental adhesion models[9,10,11], which implies that adhesions form when an injured tissue and the opposite intact peritonwww.nature.com/scientificreports eum are approximated. We hypothesized that an injured tissue would deprive the opposite intact peritoneum of its epithelial structure and form adhesions with the opposite intact tissue
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