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A Developmental Roadmap Toward Abdominal Adhesions Prevention Technologies
Reid R Christensen1, Kyla E Wright2, James K Ives1
1From the Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, NC.
Abstract:
Abdominal adhesions are a globally disruptive problem to patients and healthcare systems, with limited preventative strategies. Multiple discovery prophylactics have been evaluated previously for adhesions prevention with inadequate transfer to patient care. Clinical translation is fundamentally restricted by the ability of a discovery prophylactic to simultaneously navigate 3 key components of adhesions formation throughout the entire abdomen: the innate immune system, the coagulation system, and the local peritoneal cell populations. Furthermore, challenging handling characteristics and product restrictions have decreased the utilization of clinically available prophylactics by surgeons. The success of future adhesions prevention strategies must also be anchored in clinically valid animal modeling with attention towards future regulatory approval. The purpose of the present roadmap article is to provide a state-of-the-art review of adhesions pathophysiology, hydrogel development, animal modeling, and regulatory science, from which a framework for future developmental strategies may be outlined.
Insights
Abdominal adhesions pose significant challenges, but new strategies focusing on the immune system, coagulation, and peritoneal cells show promise. Future prevention requires advanced hydrogels and validated animal models for clinical success.
Area of Science:
- Biomedical Engineering
- Surgical Innovation
- Adhesions Pathophysiology
Background:
- Abdominal adhesions are a major global health issue with limited effective prevention methods.
- Current prophylactics face challenges in clinical translation due to complex pathophysiology and handling issues.
- Limited preventative strategies impact patients and healthcare systems worldwide.
Purpose of the Study:
- To review the current state of adhesions pathophysiology and hydrogel development.
- To outline a framework for future abdominal adhesions prevention strategies.
- To discuss animal modeling and regulatory science for clinical translation.
Main Methods:
- Comprehensive literature review of adhesions formation.
- Analysis of hydrogel properties for adhesion prevention.
- Evaluation of animal models and regulatory pathways.
Main Results:
- Adhesions formation involves innate immunity, coagulation, and peritoneal cells.
- Hydrogel technology offers potential for improved adhesion prevention.
- Validated animal models are crucial for regulatory approval.
Conclusions:
- Future strategies must address multiple adhesion components and have favorable handling characteristics.
- Development requires integrating pathophysiology, material science, and regulatory considerations.
- A roadmap is proposed to guide the development of effective adhesion prevention prophylactics.
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