Inhibition of thrombin-activated fibrinolysis inhibitor decreases postoperative adhesion

Background Postoperative adhesion is a problematic issue. The aim of this study is to identify the effect of a TAFI inhibitor (potato tuber carboxypeptidase inhibitor [PTCI]), novel agent, which reconciles formation and degradation of fibrosis, in the prevention of postoperative adhesions in rats.

Methods A total of 48 rats were allocated in three groups; control group C, normal saline group N, and PTCI group P. After surgical adhesion formation under anesthesia, group N received 5 mL of normal saline, group P; 5 mg of PTCI in 5 mL normal saline was instilled in the peritoneum. Four weeks after surgery, rats were sacrificed and adhesions were assessed in gross macroscopic, microscopic, and immunohistologic aspects, and scoring was performed in each category.

Results Besides two rats, one from each group N and C who died on the third postoperative day, no adverse events were found among the groups throughout the study. In gross adhesions, group P had significantly lower adhesion score than all other groups (P < 0.001). Group P had a significantly lower fibrosis and inflammation in microscopic assessments (P < 0.05) and immunohistochemistry (P < 0.001) compared with groups C and N.

Conclusions In conclusion, TAFI pathway inhibition resulted in reduction of postoperative adhesion number and severity. Clinical and microscopic findings show that TAFI inhibition plays a role in modulating adhesion formation.