Is There a Genetic Predisposition to Postoperative Adhesion Development?

Mili Thakur, Anupama Rambhatla, Farnoosh Qadri, Charalampos Chatzicharalampous, Modupe Awonuga, Ghassan Saed, Michael P Diamond, Awoniyi O Awonuga, Mili Thakur, Anupama Rambhatla, Farnoosh Qadri, Charalampos Chatzicharalampous, Modupe Awonuga, Ghassan Saed, Michael P Diamond, Awoniyi O Awonuga

Abstract

Adhesions are permanent fibrovascular bands between peritoneal surfaces, which develop following virtually all body cavity surgeries. The susceptibility to develop, and the severity, of adhesions following intra-abdominal surgery varies within and between individuals, suggesting that heritable factors influence adhesion development. In this manuscript, we discuss the pathophysiology of adhesion development from the perspective of genetic susceptibility. We restrict our discussion to genes and single-nucleotide polymorphisms (SNPs) that are specifically involved in, or that cause modification of, the adhesion development process. We performed a literature search using the PubMed database for all relevant English language articles up to March 2020 (n = 186). We identified and carefully reviewed all relevant articles addressing genetic mutations or single-nucleotide polymorphisms (SNPs) that impact the risk for adhesion development. We also reviewed references from these articles for additional information. We found several reported SNPs, genetic mutations, and upregulation of messenger RNAs that directly or indirectly increase the propensity for postoperative adhesion development, namely in genes for transforming growth factor beta, vascular endothelial growth factor, interferon-gamma, matrix metalloproteinase, plasminogen activator inhibitor-1, and the interleukins. An understanding of genetic variants could provide insight into the pathophysiology of adhesion development. The information presented in this review contributes to a greater understanding of adhesion development at the genetic level and may allow modification of these genetic risks, which may subsequently guide management in preventing and treating this challenging complication of abdominal surgery. In particular, the information could help identify patients at greater risk for adhesion development, which would make them candidates for anti-adhesion prophylaxis. Currently, agents to reduce postoperative adhesion development exist, and in the future, development of agents, which specifically target individual genetic profile, would be more specific in preventing intraperitoneal adhesion development.

Keywords: Genetic mutations; Pathophysiology; Postoperative adhesion development; Single nucleotide polymorphism.

© 2020. Society for Reproductive Investigation.

Figures

Fig. 1
Fig. 1
Pathogenesis of adhesion development. ECM, extracellular matrix; HIF, hypoxia-induced factor; NADPH, nicotine adenine dinucleotide phosphate; PAI, plasminogen activator inhibitor; TGF-β, transforming growth factor beta; tPA, tissue plasminogen activator; VEGF, vascular endothelial growth factor
Fig. 2
Fig. 2
Proposed chain of events; growth factors, cytokines, associated gene mutations, and SNPs involved in adhesion development. ↑ denotes an increase and ↓ a decrease; BCl-2, B cell CLL/lymphoma 2; BAX, BCl2-associated X; COX-2, cyclooxygenase 2; ECM, extracellular matrix; HO, hydroxyl radical; H2O2, hydrogen peroxide; HIF, hypoxia-induced factor; HSP90, heat shock protein 90; IFN-γ, interferon-gamma; IL, interleukin; iNOS, inducible nitrous oxide synthase; IRF-1, interferon regulatory factor-1; MMP, matrix metalloproteinases; NADP, nicotine adenine dinucleotide phosphate; NF-kB, nuclear factor-kB; NO, nitric oxide; NOS, nitric oxide synthase; O2•−, superoxide; ONOO−, peroxynitrite; P53, tumor protein 53; PAI-1, plasminogen activator inhibitor; PGE2, prostaglandin E2; TGF-β1, transforming growth-beta1; TIMP, tissue inhibitor of matrix metalloproteinases; TNF-α, tumor necrosis factor; tPA, tissue plasminogen activator; VEGF, vascular endothelial growth factor

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