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The two major clinical conditions treated with chemical pleurodesis are recurrent pleural effusion (PE) and recurrent spontaneous pneumothorax. Although the history of chemical pleurodesis began over a century ago, detailed data on the mechanisms of action of sclerosing agents are highly incomplete. The following article aims to present the state of knowledge on this subject.<\/jats:p><jats:p>It is believed that mesothelial cells are the main structural axis of pleurodesis. In response to sclerosing agents they secrete a variety of mediators including chemokines such as interleukin 8 (IL-8) and monocyte chemoattractant protein (MCP-1), as well as\u00a0growth factors - vascular endothelial growth factor (VEGF), platelet-derived growth factor (PDGF), basic fibroblast growth factor (bFGF) and\u00a0transforming growth factor- \u03b2 (TGF-\u03b2). Numerous data suggest that intact mesothelial cells and the above cytokines play a crucial role in the initiation and maintenance of different pathways of pleural inflammation\u00a0and pleural space obliteration.<\/jats:p><jats:p>It seems that the process of pleurodesis is largely nonspecific to the sclerosant and involves the same\u00a0ultimate pathways including activation of pleural cells, coagulation cascade, fibrin chain formation, fibroblast proliferation and production of collagen and extracellular matrix components. Of these processes, the coagulation cascade with decreased fibrinolytic activity and increased fibrinogenesis probably plays a pivotal role, at least during the early response to\u00a0sclerosant administration.<\/jats:p><jats:p>A better understanding of various\u00a0pathways involved in pleurodesis may be a prerequisite for more effective and safe use of various sclerosants and for the development of new, perhaps more personalized therapeutic approaches.<\/jats:p>","DOI":"10.1186\/s12931-019-1204-x","type":"journal-article","created":{"date-parts":[[2019,11,7]],"date-time":"2019-11-07T10:02:58Z","timestamp":1573120978000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":68,"title":["Chemical pleurodesis \u2013 a review of mechanisms involved in pleural space obliteration"],"prefix":"10.1186","volume":"20","author":[{"given":"Michal","family":"Mierzejewski","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Piotr","family":"Korczynski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0087-2031","authenticated-orcid":false,"given":"Rafal","family":"Krenke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julius P.","family":"Janssen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2019,11,7]]},"reference":[{"key":"1204_CR1","doi-asserted-by":"publisher","first-page":"1055","DOI":"10.1016\/j.mcna.2011.08.005","volume":"95","author":"RW Light","year":"2011","unstructured":"Light RW. 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