Molecular Underpinnings of Zwitterionic Adhesion Barrier Biomaterials in Intestinal Surgery and Tissue Repair

Abdominal adhesions are a major cause of morbidity after gastrointestinal (GI) surgeries. Interventions, including those based on novel biomaterials, that reduce the incidence, severity, and adverse outcomes of postsurgical abdominal adhesions are still a critical unmet need. Here, we review the molecular mechanisms underlying the design and engineering of antiadhesion zwitterionic biomaterials, which function primarily as physical barriers and prevent the formation of fibrous adhesions between tissues. Key molecular strategies governing antiadhesion hydrogels, fibrous membranes, and absorbable films include the ability to mimic extracellular matrix properties and to promote endogenous healing. These materials can also incorporate bioactive molecules that modulate inflammatory responses and enhance the biocompatibility and biodegradability. We discuss recent advances in the physicochemical engineering of antiadhesive zwitterionic biomaterials, with emphasis on their molecular composition and delivery mechanisms. We also describe the progress of these biomaterials in preclinical studies and discuss their potential for clinical translation.