Author(s): Diamond MP, ElHammady E, Munkarah A, Bieber EJ, Saed G
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Abstract OBJECTIVE: To examine the up-regulation of vascular endothelial growth factor (VEGF) expression by hypoxia, a crucial event leading to neovascularization, as the reduction in VEGF expression may facilitate minimization of adhesion development. DESIGN: Prospective experimental study. SETTING: University medical center. PATIENT(S): Five patients with adhesions undergoing laparotomy with excision of adhesions and normal peritoneum. INTERVENTION(S): Adhesion and normal peritoneal fibroblasts were treated with dichloroacetic acid (DCA) or NS-398 (a cyclooxygenase-2 [COX-2] inhibitor) for 24 to 48 hours. MAIN OUTCOME MEASURE(S): A real-time reverse transcriptase polymerase chain reaction (RT-PCR) to quantify relative changes in mRNA levels of VEGF from each treatment. RESULT(S): In both normal peritoneal and adhesion fibroblasts, VEGF mRNA was present with statistically significantly higher levels in adhesion fibroblasts (32\%). The DCA treatment resulted in a statistically significant decrease in VEGF mRNA levels in adhesion (20\%) and normal peritoneal (18\%) fibroblasts. The NS-398 treatment resulted in a statistically significant decrease in VEGF mRNA levels in adhesion (25\%) and normal peritoneal (16\%) fibroblasts. CONCLUSION(S): Stimulation of aerobic metabolism by DCA or inhibition of COX-2 by NS-398 reduces VEGF expression. Angiogenesis, which is an integral component in the development of dense vascular adhesions, may be reduced by either COX-2 inhibitors or stimulation of aerobic metabolism by DCA.
This article was published in Fertil Steril
and referenced in Journal of Tissue Science & Engineering