Potential role of resveratrol in abdominal cocoon syndrome: targeting inflammation, oxidative stress, and fibrosis via food-derived bioactive compounds resveratrol for treatment of abdominal cocoon syndrome

Abdominal cocoon syndrome (ACS) is a rare refractory peritoneal fibrotic disease marked by intestinal encapsulation by dense fibrous membranes. Its pathogenesis involves chronic inflammation, oxidative stress, pathological angiogenesis, immune dysregulation and peritoneal fibrosis, and targeted pharmacotherapy remains unavailable. Resveratrol, a natural medicine-food homologous polyphenol, exerts anti-inflammatory, antioxidant, anti-angiogenic, immunomodulatory and anti-fibrotic effects through NF-κB, Nrf2, TGF-β/Smad and SIRT1 pathways, showing potential as an ACS adjuvant agent. Nevertheless, poor water solubility, heavy first pass metabolism, low bioavailability, photoisomerization and biphasic dose-dependent effects greatly hinder its clinical translation. Nanocarriers, prodrugs, stimulus-responsive carriers and local intraperitoneal delivery can ameliorate these pharmacokinetic defects. Direct evidence for resveratrol against ACS is still lacking. Further studies should establish standardized ACS animal models, clarify intraperitoneal pharmacokinetics and unify raw material quality standards. Resveratrol represents a promising candidate for ACS therapy with advances in precision delivery.