GROWTH FACTORS, NEUROPEPTIDE-CONTAINING INNERVATION, CELL ADHESION MOLECULES AND APOPTOSIS IN HUMAN FIBROUS ADHESIONS OF DIFFERENT LOCALIZATION.

Introduction. Adhesions occur in more than three fourths of patients after laparotomy following by numerous serious complications. Thus pathogenesis of adhesions still is the research field and the aim of our work was to reveal the growth factors, neuropeptide-containing innervations, cell adhesion molecules, and apoptosis in human intact and fibrous peritoneal tissues of different adhesion sites. Materials and methods. Fibrous adhesions were obtained from eight 10-14 years old patients. Tissues were proceeded for bFGF, FGFR, NGF, NGFR, TGFβ, PGP 9.5, VEGF, VIP, SP, ICAM-1, VCAM-1 immunohistochemically. TUNEL was used for the detection of apoptosis. Results. All the tested areas showed a high expression of FGFR and NGFR, but bFGF and NGF were low or negative. TGFβ-containing structures were richly distributed in the connective tissue of adhesions (except the small intestine area) and in intact peritoneum. Numerous to abundant PGP 9.5-containing nerves were detected only into the adhesions. Occasional SP positive nerves were observed only in all the adhesions, while VIP fibres here were slightly increased. VEGF was richly expressed by endothelial cells in appendix adhesions, notable in small intestine adhesions, but almost negative in large bowel adhesions and intact peritoneum. Numerous to abundant ICAM-1 and VCAM-1 expression was observed regionally in all the materials. Apoptosis affected regionally connective tissue cells, changed in shape mesothelial cells in adhesions and some cells in intact peritoneum. Conclusions. The inhomogeneous appearance of TGFβ and VEGF suggests about the individual variations in expression of these growth factors in adhesions. The abundant expression of ICAM-1 and VCAM-1 in endothelium and mesothelium proves the involvement of these adhesion molecules in functioning of blood vessels and simple squamous epithelium of adhesions. Increased occurrence of neuropeptide-containing nerves and NFGR also indicates the increased role of innervation in adhesions. However, PGP 9.5-containing innervation does not cover the appearance of VIP- and SP-nerves and also seems to include other neuropeptides in the pathogenesis of adhesions. Regional apoptosis is speculated to depend on the local expression of growth factors, inflammatory mediators and tissue degradating enzymes. The distribution of growth factors, neuropeptide-containing innervation and apoptosis do not depend on the adhesion site. [ABSTRACT FROM AUTHOR]