Surgical adhesions: A sticky macrophage problem

It is estimated that ∼66% of patients who have gastrointestinal surgery will develop adhesions (1). These bands of scar tissue arise in the abdominal cavity and can lead to small bowel obstruction and infertility in women as well as severe chronic abdominal pain. Unfortunately, there are no satisfactory ways to prevent adhesions, and once formed, surgery is often required to lyse them, which predisposes to further adhesions. Thus, there is an urgent need to develop more effective means to prevent them from forming or to minimize their growth. On page 1013 of this issue, Zindel et al. (2) demonstrate that macrophages in the peritoneal cavity home to sites of damage, forming an immediate protective wound covering. In response to surgical insult, these macrophages act like platelets to form superaggregates, which then develop into adhesions. A fascinating parallel exists with invertebrates whereby body-cavity macrophages express evolutionarily ancient receptors, which may be potential targets for adhesion prevention.