Recombinant Human Lubricin for Prevention of Postoperative Intra-abdominal Adhesions in a Rat Model

• Published in: The Journal of surgical research Vol. 208; pp. 20 - 25
• Main Authors: Oh, Jaewook, MD, Kuan, Kean G., MD, Tiong, Leong U., MD, MS, FRACS, Trochsler, Markus I., MD, FMH, MMIS, FRACS, Jay, Gregory, MD, PhD, Schmidt, Tammin, Peng, PhD, Barnett, Harry, JD, Maddern, Guy J., MD, PhD, MS, FRACS
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2017
• Subjects: Abdominal surgery; Adhesion barrier; Adhesion prevention; Adhesions; Animals; Drug Evaluation, Preclinical; Glycoproteins - therapeutic use; Humans; Intraabdominal; Male; Pilot Projects; Rats; Rats, Wistar; Recombinant Proteins - therapeutic use; Surgery; Tissue Adhesions - prevention & control; abdominal surgery; adhesions; Intra-abdominal; adhesion barrier; adhesion prevention; Abdominal surgery; Intraabdominal; Adhesion barrier; Adhesions; Adhesion prevention
• ISSN: 0022-4804; 1095-8673
• DOI: 10.1016/j.jss.2016.08.092

Abstract Background Postoperative intra-abdominal adhesions are a major cause of morbidity and mortality and heavy burden to health care resources. At present, numerous introduced adhesion prevention products demonstrated some benefit but none is consistently effective. The aim of this study is to examine the effectiveness of recombinant human lubricin in preventing intra-abdominal adhesion formation. Materials and Methods A total of 62 male Wistar Albino rats were randomly assigned to the study. Six rats were used to the initial pilot study and 56 rats were randomized into 4 groups: (i) control caecal abrasion; (ii) treatment caecal abrasion with 0.5mg/mL lubricin solution; (iii) control caecal enterotomy and primary closure; and (iv) treatment caecal enterotomy and primary closure with 0.5mg/mL lubricin solution. Rats were sacrificed 3 and 21 days post-operatively for pilot and main study respectively. Macroscopic and microscopic adhesion severity was graded by blinded investigators. Results For the pilot study, all six rats successfully reached the end point indicating safety of the Lubricin gel. In main randomised study, adhesions in the caecal abrasion group were significantly reduced for the treatment group macroscopically ( p =0.001) as well as microscopically (Fibrosis p =0.009, Inflammation p <0.0001) compared to the control group. In the caecal enterotomy group, adhesions were less reduced for the treatment group from macroscopic ( p =0.011) and microscopic grading (Fibrosis p =0.500, Inflammation p =0.206) compared to the control group. Conclusions Recombinant human lubricin significantly reduced both macroscopic and microscopic intra-abdominal adhesions in caecal abrasion group. The caecal enterotomy group showed modest macroscopic adhesion reduction. Future study using higher concentration of lubricin solution is needed to investigate its toxicity and more profound anti-adhesion property in significant operations.