A carboxymethyl cellulose enhanced F127 hydrogel with anti-inflammation and peritoneum regeneration activities for preventing peritoneal adhesion.

Postoperative peritoneal adhesion (PPA) is a common and severe postoperative complication that does not require satisfactory precautions by surgeons. By combining Pluronic F127 and carboxymethyl cellulose (CMC), we developed an F127- CMC hydrogel (designated as FC hydrogel), and characterized and tested its physicochemical properties, biosafety, bioactivities, and anti-PPA effects. The FC hydrogel was free-flowing and injectable below 12.5 °C and gelled in situ at body temperature. The CMC network provided anti-inflammatory and wound healing abilities to FC hydrogel, which demonstrated 35.2 % healing of human peritoneal mesothelial cells in 48 h and 90 % clearance of transforming growth factor beta-1 (TGF-β1) in 12 h in vitro. Treatment with FC hydrogel significantly reduced the incidence of PPA, and adhesion scores for H group were substantially reduced. Pathological analysis confirmed these effects and revealed complete regeneration of the peritoneum. In addition, immunohistochemical, immunofluorescence, and western blot analyses revealed significant reduction in the levels of TGF-β1, interleukin-6, and alpha smooth muscle actin in abdominal wall and cecum of rats in the hydrogel-treated group. Overall, the FC hydrogel may be considered as a safe, reliable, and user-friendly anti-adhesion barrier, capable of showing anti-inflammatory effects and regeneration of the peritoneum.