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  • Phloretin combined with sodium hyaluronate inhibits formation of postoperative abdominal adhesions in a rat model and its mechanism

    Objective To investigate the efficacy of phloretin combined with sodium hyaluronate in preventing postoperative abdominal adhesion formation in rats and its possible mechanisms. Methods Forty rats were randomly divided into five groups, the rats in the sham-operatinon group only underwent open and closed abdominal surgery, and the remaining rats of four groups underwent cecum scratch-and-rub method of modeling to receive different treatments: the rats in the control group and the phloretin group (PHL group) were closed abdominally after modeling, while the rats in the sodium hyaluronate group (HA group) and the phloretin combined with sodium hyaluronate group (PHL+HA group) were closed abdominally by using 2 mL of sodium hyaluronate gel coated with the damaged abdominal wall and the cecum; the postoperative groups treated with phloretin (the PHL and PHL+HA groups) were treated with 2 mL of40 mg/kg phloretin dissolved in 0.5% sodium carboxymethylcellulose by gavage daily, and the rest of the groups were treated with 2 mL of 0.5% sodium carboxymethylcellulose solution by gavage. After general anesthesia, the rats were executed on the 7th day after surgery, and the Nair’s score was used to evaluate the adhesion status of each group on the 7th day after surgery; the adhesive tissue or normal peritoneal tissue were collected (cecum and its opposite side of the peritoneal tissue was collected in the sham-operation group), and immunohistochemistry was performed to evaluate the degree of staining with Nrf2 antibody, HE staining was performed to evaluate the inflammation scores, and Sirius red staining was performed to evaluate the thickness of the collagen fibers, and levels of transforming growth factor β1 (TGF-β1), malondialdehyde (MDA) and superoxide dismutase (SOD) were measured. Results All rats successfully completed the experiment. Compared with the control group, Nair’s score, inflammation score, expression level of TGF-β1, thickness of collagen fibers in the adherent tissues, and MDA level were significantly lower in the PHL+HA group (P<0.05), but the SOD level and expression lever of Nrf2 were significantly higher in the PHL+HA group (P<0.05). Conclusion Phloretin combined with sodium hyaluronate can prevent the formation of postoperative abdominal adhesions in the rat model, which may be related to reducing inflammation, reducing collagen deposition, activating Nrf2 pathway and inhibiting oxidative stress.

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