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Oxidized regenerated cellulose induces pleural thickening in patients with pneumothorax: possible involvement of the mesothelial–mesenchymal transition

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Abstract

Purpose

The pleural covering technique, i.e., wrapping a part of or the entire surface of the lung with oxidized regenerative cellulose (ORC), reinforces visceral pleura through pleural thickening for patients with pneumothorax and cystic lung diseases. However, it remains undetermined how ORC induces pleural thickening.

Methods

A histopathological examination was performed for lung specimens from patients who had recurrent pneumothoraces after pleural covering and re-operation (n = 5). To evaluate the influence of ORC on the pleura in vitro, we used MeT-5A cells (a human pleural mesothelial cell line).

Results

Pleural thickening was confirmed in all lung specimens examined. Three months after covering, the thickened pleura showed inflammatory cell infiltration, proliferation of myofibroblasts, and expression of fibronectin and TGF-β. However, after 1 year, those findings virtually disappeared, and the thickened pleura was composed mainly of abundant collagen. When MeT-5A cells were cultured in ORC-immersed medium, their morphology changed from a cobblestone to spindle-shaped appearance. The expression of E-cadherin decreased, whereas that of N-cadherin, α-smooth muscle actin, and fibronectin increased, suggesting mesothelial–mesenchymal transition (Meso–MT).

Conclusions

Our results suggest that Meso–MT may be involved as a mechanism of pleural thickening induced by pleural covering with ORC.

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Acknowledgements

We thank Ms. Phyllis Minick for her excellent proofreading of our English writing.

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Authors and Affiliations

  1. Division of Respiratory Medicine, Faculty of Medicine, Graduate School of Medicine, Juntendo University, 3-1-3 Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan

    Hiroki Ebana, Etsuko Kobayashi, Fumiyuki Takahashi, Kazuhisa Takahashi & Kuniaki Seyama

  2. Division of Human Pathology, Faculty of Medicine, Graduate School of Medicine, Juntendo University, Tokyo, Japan

    Takuo Hayashi & Keiko Mitani

  3. Division of Thoracic Surgery, Pneumothorax Research Center, Nissan Tamagawa Hospital, Tokyo, Japan

    Hiroki Ebana, Teruaki Mizobuchi & Masatoshi Kurihara

  4. Department of Pathology, Japanese Red Cross Medical Centre, Tokyo, Japan

    Toshio Kumasaka

  5. The Study Group for Pneumothorax and Cystic Lung Diseases, Tokyo, Japan

    Hiroki Ebana, Takuo Hayashi, Keiko Mitani, Etsuko Kobayashi, Toshio Kumasaka, Teruaki Mizobuchi, Masatoshi Kurihara & Kuniaki Seyama

Authors
  1. Hiroki Ebana
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  2. Takuo Hayashi
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  3. Keiko Mitani
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  8. Fumiyuki Takahashi
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  9. Kazuhisa Takahashi
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Correspondence to Hiroki Ebana.

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The authors have nothing to disclose with regard to commercial support.

Conflict of interest

Ebana H. and the other co-authors have no conflicts of interests to declare.

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Ebana, H., Hayashi, T., Mitani, K. et al. Oxidized regenerated cellulose induces pleural thickening in patients with pneumothorax: possible involvement of the mesothelial–mesenchymal transition. Surg Today 48, 462–472 (2018). https://doi.org/10.1007/s00595-017-1597-4

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  • DOI: https://doi.org/10.1007/s00595-017-1597-4

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