Prevention of peritoneal adhesions: A promising role for gene therapy

doi:10.3748/wjg.v17.i46.5049

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Gastroenterol. Dec 14, 2011; 17(46): 5049-5058
Published online Dec 14, 2011. doi: 10.3748/wjg.v17.i46.5049

Prevention of peritoneal adhesions: A promising role for gene therapy

Hussein M Atta

Hussein M Atta, Department of Surgery, Faculty of Medicine, Minia University, El-Minia 61519, Egypt

Author contributions: Atta HM solely contributed to this paper.

Supported by The United States-Egypt Science and Technology Joint Fund in cooperation with United States Department of Agriculture and the Egyptian Science and Technology Development Fund under Project 739

Correspondence to: Hussein M Atta, MD, PhD, Professor, Department of Surgery, Faculty of Medicine, Minia University, Misr-Aswan Road, El-Minia 61519, Egypt. attahm@ems.org.eg

Telephone: +20-1-001407222 Fax: +20-2-22917077

Received: May 15, 2011
Revised: July 14, 2011
Accepted: July 21, 2011
Published online: December 14, 2011

Abstract

Adhesions are the most frequent complication of abdominopelvic surgery, yet the extent of the problem, and its serious consequences, has not been adequately recognized. Adhesions evolved as a life-saving mechanism to limit the spread of intraperitoneal inflammatory conditions. Three different pathophysiological mechanisms can independently trigger adhesion formation. Mesothelial cell injury and loss during operations, tissue hypoxia and inflammation each promotes adhesion formation separately, and potentiate the effect of each other. Studies have repeatedly demonstrated that interruption of a single pathway does not completely prevent adhesion formation. This review summarizes the pathogenesis of adhesion formation and the results of single gene therapy interventions. It explores the promising role of combinatorial gene therapy and vector modifications for the prevention of adhesion formation in order to stimulate new ideas and encourage rapid advancements in this field.

Keywords: Peritoneal adhesions; Tissue plasminogen activator; Gene therapy; Plasminogen activator inhibitor; Tissue inhibitor of metalloproteinase; Transforming growth factor β