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Open Access Review

Surgical inflammatory stress: the embryo takes hold of the reins again

Maria-Angeles Aller1, Jose-Ignacio Arias2, Isabel Prieto3, Carlos Gilsanz4, Ana Arias5, Heping Yang6 and Jaime Arias1*

Author Affiliations

1 Department of Surgery, School of Medicine, Complutense University of Madrid, Madrid, Spain

2 General and Digestive Surgery Unit, Monte Naranco Hospital, Oviedo, Asturias, Spain

3 Department of General and Digestive Surgery, La Paz Hospital, Autonomous University, Madrid, Spain

4 General and Digestive Surgery Unit, Sudeste University Hospital, Arganda del Rey, Madrid, Spain

5 Department of Medicine, Puerta de Hierro Hospital, Autonomous University, Madrid, Spain

6 Division of Gastroenterology and Liver Disease, USC Research Centre for Liver Diseases, Los Angeles, CA, USA

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Theoretical Biology and Medical Modelling 2013, 10:6  doi:10.1186/1742-4682-10-6

Published: 1 February 2013

Abstract

The surgical inflammatory response can be a type of high-grade acute stress response associated with an increasingly complex trophic functional system for using oxygen. This systemic neuro-immune-endocrine response seems to induce the re-expression of 2 extraembryonic-like functional axes, i.e. coelomic-amniotic and trophoblastic-yolk-sac-related, within injured tissues and organs, thus favoring their re-development. Accordingly, through the up-regulation of two systemic inflammatory phenotypes, i.e. neurogenic and immune-related, a gestational-like response using embryonic functions would be induced in the patient’s injured tissues and organs, which would therefore result in their repair. Here we establish a comparison between the pathophysiological mechanisms that are produced during the inflammatory response and the physiological mechanisms that are expressed during early embryonic development. In this way, surgical inflammation could be a high-grade stress response whose pathophysiological mechanisms would be based on the recapitulation of ontogenic and phylogenetic-related functions. Thus, the ultimate objective of surgical inflammation, as a gestational process, is creating new tissues/organs for repairing the injured ones. Since surgical inflammation and early embryonic development share common production mechanisms, the factors that hamper the wound healing reaction in surgical patients could be similar to those that impair the gestational process.

Keywords:
Surgical inflammation; Stress; Wound healing; Amniotic; Yolk sac; Vitelline; Gastrulation