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Reduced human peritoneal plasminogen activating activity: possible mechanism of adhesion formation
J N Thompson1, S Paterson-Brown, T Harbourne
1Academic Surgical Unit, St. Mary's Hospital Medical School, London, UK.
Abstract:
A unifying pathophysiological hypothesis states that the plasminogen activating activity (PAA) of the peritoneal mesothelium determines whether the fibrin which forms after peritoneal injury is either lysed or organized into permanent fibrous adhesions. The PAA of human peritoneal biopsies was measured using a fibrin plate lysis technique to assess the changes that occur in inflammation and ischaemia, conditions which both produce fibrous adhesions. Activity was found in all biopsies from normal parietal and visceral (appendix, bowel and omentum) peritoneum with no significant site-to-site variation. Inflamed peritoneum (parietal, appendicular and mesenteric) had significantly less PAA compared with normal peritoneum; visceral ischaemia also resulted in a significant decrease of PAA. These reductions in human peritoneal PAA observed in inflammation and ischaemia support the view that mesothelial PAA plays a key part in the prevention of events leading to the production of fibrous adhesions.
Insights
Reduced plasminogen activating activity (PAA) in the peritoneum during inflammation and ischemia leads to fibrous adhesions. This study highlights the role of mesothelial PAA in preventing adhesion formation after peritoneal injury.
Area of Science:
- Peritoneal biology
- Wound healing
- Hemostasis and thrombosis
Background:
- Fibrous adhesions after peritoneal injury are linked to reduced plasminogen activating activity (PAA).
- Inflammation and ischemia are conditions associated with fibrous adhesion formation.
- The peritoneal mesothelium's PAA is hypothesized to regulate fibrinolysis versus organization.
Purpose of the Study:
- To measure PAA in human peritoneal biopsies.
- To assess changes in PAA during inflammation and ischemia.
- To evaluate the role of mesothelial PAA in preventing fibrous adhesions.
Main Methods:
- Human peritoneal biopsies were collected from normal, inflamed, and ischemic tissues.
- Plasminogen activating activity (PAA) was quantified using a fibrin plate lysis technique.
Main Results:
- PAA was detected in all normal peritoneal biopsies, with no significant site variation.
- Inflamed peritoneum (parietal, appendicular, mesenteric) showed significantly reduced PAA compared to normal.
- Visceral ischemia also led to a significant decrease in peritoneal PAA.
Conclusions:
- Reduced mesothelial PAA in inflammation and ischemia supports its role in preventing fibrous adhesions.
- The findings reinforce the hypothesis that mesothelial PAA is crucial for fibrinolysis after peritoneal injury.
- Therapeutic strategies targeting mesothelial PAA could potentially reduce adhesion formation.