Ghazaleh Khalili-Tanha, Nima Khalili-Tanha, Seyedeh Elnaz Nazari, Negin Chaeichi-Tehrani, Majid Khazaei, Mohsen Aliakbarian, Seyed Mahdi Hassanian, Majid Ghayour-Mobarhan, Gordon A. Ferns and Amir Avan* Pages 180 - 186 ( 7 )
Background: Post-surgical adhesion is a common complication after abdominal or pelvic surgeries. Despite improvements in surgical techniques or the application of physical barriers, few improvements have been achieved. It causes bowel obstruction, pelvic pain, and infertility in women and has an adverse effect on the quality of life. Renin-Angiotensin System (RAS) is traditionally considered a blood pressure regulator. However, recent studies have indicated that the RAS plays a vital role in other processes, including oxidative stress, fibrosis, proliferation, inflammation, and wound healing. Angiotensin II (Ang II) is the main upstream effector of the RAS that can bind to the AT1 receptor (ATIR). A growing body of evidence has revealed that targeting Angiotensin-Converting Enzyme Inhibitors (ACEIs), Angiotensin II type 1 Receptor Blockers (ARBs), and Direct Renin Inhibitors (DRIs) can prevent post-surgical adhesions. Here we provide an overview of the therapeutic effect of RAS antagonists for adhesion.
Methods: PubMed, EMBASE, and the Cochrane library were reviewed to identify potential agents targeting the RAS system as a potential approach for post-surgical adhesion.
Results: Available evidence suggests the involvement of the RAS signaling pathway in inflammation, proliferation, and fibrosis pathways as well as in post-surgical adhesions. Several FDA-approved drugs are used for targeting the RAS system, and some of them are being tested in different models to reduce fibrosis and improve adhesion after surgery, including telmisartan, valsartan, and enalapril.
Conclusion: Identification of the pathological causes of post-surgical adhesion and the potential role of targeting the Renin-Angiotensin System may help to prevent this problem. Based on the pathological function of RAS signaling after surgeries, the administration of ARBs may be considered a novel and efficient approach to prevent postsurgical adhesions. Pre-clinical and clinical studies should be carried out to have better information on the clinical significance of this therapy against post-surgical adhesion formation.
Renin-Angiotensin system, ACEIs, ARBs, postsurgical adhesion, fibrosis, inflammation.
Metabolic Syndrome Research Centre, Mashhad University of Medical Sciences, Mashhad, Veterinary Medicine Student, Faculty of Veterinary Medicine, Ferdowsi University Mashhad, Metabolic Syndrome Research Centre, Mashhad University of Medical Sciences, Mashhad, Medical Genetics Research Centre, Mashhad University of Medical Sciences, Mashhad, Metabolic Syndrome Research Centre, Mashhad University of Medical Sciences, Mashhad, Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Metabolic Syndrome Research Centre, Mashhad University of Medical Sciences, Mashhad, Metabolic Syndrome Research Centre, Mashhad University of Medical Sciences, Mashhad, Brighton & Sussex Medical School, Division of Medical Education, Falmer, Brighton, Sussex BN1 9PH, Metabolic Syndrome Research Centre, Mashhad University of Medical Sciences, Mashhad