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Regulation of Postsurgical Fibrosis by the Programmed Death-1 Inhibitory Pathway¹

Matthew A. Holsti^2,*, Tanuja Chitnis, Ronald J. Panzo^*, Roderick T. Bronson, Hideo Yagita^¶, Mohamed H. Sayegh and Arthur O. Tzianabos^*

^* Channing Laboratory, Department of Medicine, and Center for Neurologic Diseases, Brigham and Women’s Hospital, Transplantation Research Center, Brigham and Women’s Hospital and Children’s Hospital Boston, Harvard Medical School, and Department of Pathology, Harvard Medical School, Boston, MA 02115; and ^¶ Department of Immunology, Juntendo University School of Medicine, Tokyo, Japan

Surgical adhesions are a common and often severe complication of abdominal or pelvic injury that cause pelvic pain, bowel obstruction, and infertility in women. Current treatments are of limited effectiveness because little is known about the cellular and subcellular processes underlying adhesiogenesis. Recently, we showed that Th1 CD4⁺ T cells mediate the pathogenesis of adhesion formation in a rodent model of this disease process. In this study, we demonstrate that in mice these T cells home directly to the site of surgically induced adhesions and control local chemokine production in a manner dependent on the CD28 T cell costimulatory pathway. Conversely, the inhibitory programmed death-1 pathway plays a central role in limiting adhesiogenesis, as programmed death-1 blockade was associated with increased T cell infiltration, chemokine production, and a concomitant exacerbation of disease. Our results reveal for the first time that the development of postsurgical fibrosis is under the tight control of positive and negative T cell costimulation, and suggest that targeting these pathways may provide promising therapies for the prevention of adhesion formation.

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