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Wang Z, Hu K, Jiang Y, Zhang X, Zhao P, Li X, Ding F, Liu C, Yi S, Ren Z, Liu W, Ma B. Remodeling and Regenerative Properties of Fully Absorbable Meshes for Abdominal Wall Defect Repair: A Systematic Review and Meta-Analysis of Animal Studies. ACS Biomater Sci Eng 2024; 10:3968-3983. [PMID: 38788683 DOI: 10.1021/acsbiomaterials.4c00386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
Fully absorbable meshes can repair abdominal wall defects and effectively reduce the incidence of complications, but different types of fully absorbable meshes have different remodeling and regeneration effects. In order to investigate and compare the effects of different fully absorbable meshes on remodeling and regeneration in animals and reduce the biological risk of clinical translation, SYRCLE was adopted to evaluate the methodological quality of the included studies, and GRADE and ConQual were used to evaluate the quality of evidence. According to the inclusion and exclusion criteria, a total of 22 studies related to fully absorbable meshes were included in this systematic review. These results showed that fiber-based synthetic materials and fiber-based natural materials exhibited better restorative and regenerative effects indicated by infiltration and neovascularization, when compared with a porcine acellular dermal matrix. In addition, the human acellular dermal matrix was found to have a similar regenerative effect on the host extracellular matrix and scaffold degradation compared to the porcine acellular dermal matrix, porcine intestinal submucosa, and fiber-based natural materials, but it offered higher tensile strength than the other three. The quality of the evidence in this field was found to be poor. The reasons for downgrading were analyzed, and recommendations for future research included more rigor in study design, more transparency in result reporting, more standardization of animal models and follow-up time for better evaluation of the remodeling and regenerative performance of abdominal wall hernia repair meshes, and less biological risk in clinical translation.
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Affiliation(s)
- Zhe Wang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China
- Key Laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu Province, Lanzhou 730000, China
| | - Kaiyan Hu
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China
- Key Laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu Province, Lanzhou 730000, China
| | - Yanbiao Jiang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China
| | - Xu Zhang
- Center for Medical Device Evaluation, National Medical Products Administration, Beijing 100081, China
| | - Peng Zhao
- Center for Medical Device Evaluation, National Medical Products Administration, Beijing 100081, China
| | - Xingzhi Li
- School of Basic Medicine, Xinxiang Medical University, Xinxiang 453000, China
| | - Fengxing Ding
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China
| | - Chen Liu
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China
| | - Shaowei Yi
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China
| | - Ziyu Ren
- School of Public Health, Gansu University of Chinese Medicine, Lanzhou 730000, China
| | - Wenbo Liu
- Center for Medical Device Evaluation, National Medical Products Administration, Beijing 100081, China
| | - Bin Ma
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China
- Key Laboratory of Evidence-Based Medicine of Gansu Province, Lanzhou 730000, China
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2
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Kaveti R, Lee JH, Youn JK, Jang TM, Han WB, Yang SM, Shin JW, Ko GJ, Kim DJ, Han S, Kang H, Bandodkar AJ, Kim HY, Hwang SW. Soft, Long-Lived, Bioresorbable Electronic Surgical Mesh with Wireless Pressure Monitor and On-Demand Drug Delivery. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2024; 36:e2307391. [PMID: 37770105 DOI: 10.1002/adma.202307391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/02/2023] [Indexed: 10/03/2023]
Abstract
Current research in the area of surgical mesh implants is somewhat limited to traditional designs and synthesis of various mesh materials, whereas meshes with multiple functions may be an effective approach to address long-standing challenges including postoperative complications. Herein, a bioresorbable electronic surgical mesh is presented that offers high mechanical strength over extended timeframes, wireless post-operative pressure monitoring, and on-demand drug delivery for the restoration of tissue structure and function. The study of materials and mesh layouts provides a wide range of tunability of mechanical and biochemical properties. Dissolvable dielectric composite with porous structure in a pyramidal shape enhances sensitivity of a wireless capacitive pressure sensor, and resistive microheaters integrated with inductive coils provide thermo-responsive drug delivery system for an antibacterial agent. In vivo evaluations demonstrate reliable, long-lived operation, and effective treatment for abdominal hernia defects, by clear evidence of suppressed complications such as adhesion formation and infections.
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Affiliation(s)
- Rajaram Kaveti
- KU-KIST Graduate School of Converging Science and Technology, Korea University, 145 Anam-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - Joong Hoon Lee
- KU-KIST Graduate School of Converging Science and Technology, Korea University, 145 Anam-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
- SK Hynix Co., Ltd., 2091, Gyeongchung-daero, Bubal-eup, Incheon, Gyeonggi-do, 17336, Republic of Korea
| | - Joong Kee Youn
- Department of Pediatric Surgery, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Tae-Min Jang
- KU-KIST Graduate School of Converging Science and Technology, Korea University, 145 Anam-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - Won Bae Han
- KU-KIST Graduate School of Converging Science and Technology, Korea University, 145 Anam-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - Seung Min Yang
- KU-KIST Graduate School of Converging Science and Technology, Korea University, 145 Anam-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
- Hanwha Systems Co., Ltd., 188, Pangyoyeok-Ro, Bundang-Gu, Seongnam-si, Gyeonggi-do, 13524, Republic of Korea
| | - Jeong-Woong Shin
- KU-KIST Graduate School of Converging Science and Technology, Korea University, 145 Anam-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - Gwan-Jin Ko
- KU-KIST Graduate School of Converging Science and Technology, Korea University, 145 Anam-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - Dong-Je Kim
- KU-KIST Graduate School of Converging Science and Technology, Korea University, 145 Anam-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - Sungkeun Han
- KU-KIST Graduate School of Converging Science and Technology, Korea University, 145 Anam-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - Heeseok Kang
- KU-KIST Graduate School of Converging Science and Technology, Korea University, 145 Anam-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - Amay J Bandodkar
- Department of Electrical and Computer Engineering, North Carolina State University, Raleigh, NC, 27606, USA
- Center for Advanced Self-Powered Systems of Integrated Sensors and Technologies (ASSIST), North Carolina State University, Raleigh, NC, 27606, USA
| | - Hyun-Young Kim
- Department of Pediatric Surgery, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Suk-Won Hwang
- KU-KIST Graduate School of Converging Science and Technology, Korea University, 145 Anam-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
- Department of Integrative Energy Engineering, Korea University, 145 Anam-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
- Center for Biomaterials, Biomedical Research Institute, Korea Institute of Science and Technology (KIST), 5 Hwarang-ro 14-gil, Seongbuk-gu, Seoul, 02792, Republic of Korea
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3
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Qu L, Chen Z, Chen J, Gan Y, Tan X, Wang Y, Zhang C, Chen B, Dai J, Chen J, Shi C. Collagen biomaterials promote the regenerative repair of abdominal wall defects in Bama miniature pigs. Biomater Sci 2023; 11:7926-7937. [PMID: 37916513 DOI: 10.1039/d3bm01209c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
Due to adhesion and rejection of recent traditional materials, it is still challenging to promote the regenerative repair of abdominal wall defects caused by different hernias or severe trauma. However, biomaterials with a high biocompatibility and low immunogenicity have exhibited great potential in the regeneration of abdominal muscle tissue. Previously, we have designed a biological collagen scaffold material combined with growth factor, which enables a fusion protein-collagen binding domain (CBD)-basic fibroblast growth factor (bFGF) to bind and release specifically. Though experiments in rodent animals have indicated the regeneration function of CBD-bFGF modified biological collagen scaffolds, its translational properties in large animals or humans are still in need of solid evidence. In this study, the abdominal wall defect model of Bama miniature pigs was established by artificial operations, and the defective abdominal wall was sealed with or without a polypropylene patch, and unmodified and CBD-bFGF modified biological collagen scaffolds. Results showed that a recurrent abdominal hernia was observed in the defect control group (without the use of mesh). Although the polypropylene patch can repair the abdominal wall defect, it also induced serious adhesion and inflammation. Meanwhile, both kinds of collagen biomaterials exhibited positive effects in repairing abdominal wall defects and reducing regional adhesion and inflammation. However, CBD-bFGF-modified collagen biomaterials failed to induce the regenerative repair reported in rat experiments. In addition, unmodified collagen biomaterials induced abdominal wall muscle regeneration rather than fibrotic repair. These results indicated that the unmodified collagen biomaterials are a better option among translational patches for the treatment of abdominal wall defects.
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Affiliation(s)
- Langfan Qu
- Institute of Rocket Force Medicine, State Key Laboratory of Trauma and Chemical Poisoning, Third Military Medical University, Chongqing 400038, China.
| | - Zelin Chen
- Institute of Rocket Force Medicine, State Key Laboratory of Trauma and Chemical Poisoning, Third Military Medical University, Chongqing 400038, China.
| | - Jianhua Chen
- Key Laboratory of OptoElectronic Science and Technology for Medicine of Ministry of Education, Fujian Provincial Key Laboratory of Photonics Technology, Fujian Normal University, Fuzhou 350117, China.
- College of Life Science, Fujian Normal University, Fuzhou 350117, China
| | - Yibo Gan
- Department of Spine Surgery, Center of Orthopedics, State Key Laboratory of Trauma and Chemical Poisoning, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing 400042, China
| | - Xu Tan
- Institute of Rocket Force Medicine, State Key Laboratory of Trauma and Chemical Poisoning, Third Military Medical University, Chongqing 400038, China.
| | - Yu Wang
- Institute of Rocket Force Medicine, State Key Laboratory of Trauma and Chemical Poisoning, Third Military Medical University, Chongqing 400038, China.
| | - Can Zhang
- Institute of Rocket Force Medicine, State Key Laboratory of Trauma and Chemical Poisoning, Third Military Medical University, Chongqing 400038, China.
| | - Bing Chen
- Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, Beijing 100101, China.
| | - Jianwu Dai
- Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, Beijing 100101, China.
| | - Jianxin Chen
- Key Laboratory of OptoElectronic Science and Technology for Medicine of Ministry of Education, Fujian Provincial Key Laboratory of Photonics Technology, Fujian Normal University, Fuzhou 350117, China.
| | - Chunmeng Shi
- Institute of Rocket Force Medicine, State Key Laboratory of Trauma and Chemical Poisoning, Third Military Medical University, Chongqing 400038, China.
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Mingot J, Benejam N, Víllora G, Alemán C, Armelin E, Lanzalaco S. Multimodal Biomedical Implant with Plasmonic and Simulated Body Temperature Responses. Macromol Biosci 2023; 23:e2300118. [PMID: 37081810 DOI: 10.1002/mabi.202300118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Indexed: 04/22/2023]
Abstract
This work presents a novel nanoparticle-based thermosensor implant able to reveal the precise temperature variations along the polymer filaments, as it contracts and expands due to changes in the macroscale local temperature. The multimodal device is able to trace the position and the temperature of a polypropylene mesh, employed in abdominal hernia repair, by combining plasmon resonance and Raman spectroscopy with hydrogel responsive system. The novelty relies on the attachment of the biocompatible nanoparticles, based on gold stabilized by a chitosan-shell, already charged with the Raman reporter (RaR) molecules, to the robust prosthesis, without the need of chemical linkers. The SERS enhanced effect observed is potentiated by the presence of a quite thick layer of the copolymer (poly(N-isopropylacrylamide)-co-poly(acrylamide)) hydrogel. At temperatures above the LCST of PNIPAAm-co-PAAm, the water molecules are expulsed and the hydrogel layer contracts, leaving the RaR molecules more accessible to the Raman source. In vitro studies with fibroblast cells reveal that the functionalized surgical mesh is biocompatible and no toxic substances are leached in the medium. The mesh sensor opens new frontiers to semi-invasive diagnosis and infection prevention in hernia repair by using SERS spectroscopy. It also offers new possibilities to the functionalization of other healthcare products.
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Affiliation(s)
- Júlia Mingot
- Departament of Chemical Engineering, Universitat Politècnica de Catalunya (UPC), C/d'Eduard Maristany, 10-14, Building I, Barcelona, 08019, Spain
- Barcelona Research Centre for Multiscale Science and Engineering, Universitat Politècnica de Catalunya (UPC), C/d'Eduard Maristany, 10-14, Building I, 08019, Barcelona, Spain
| | - Nícolas Benejam
- Departament of Chemical Engineering, Universitat Politècnica de Catalunya (UPC), C/d'Eduard Maristany, 10-14, Building I, Barcelona, 08019, Spain
| | - Gloria Víllora
- Chemical Engineering Department, Faculty of Chemistry, University of Murcia, Campus Espinardo, 30100, Murcia, Spain
| | - Carlos Alemán
- Departament of Chemical Engineering, Universitat Politècnica de Catalunya (UPC), C/d'Eduard Maristany, 10-14, Building I, Barcelona, 08019, Spain
- Barcelona Research Centre for Multiscale Science and Engineering, Universitat Politècnica de Catalunya (UPC), C/d'Eduard Maristany, 10-14, Building I, 08019, Barcelona, Spain
- Institute for Bioengineering of Catalonia (IBEC), The Barcelona Institute of Science and Technology, C/Baldiri Reixac 10-12, 08028, Barcelona, Spain
| | - Elaine Armelin
- Departament of Chemical Engineering, Universitat Politècnica de Catalunya (UPC), C/d'Eduard Maristany, 10-14, Building I, Barcelona, 08019, Spain
- Barcelona Research Centre for Multiscale Science and Engineering, Universitat Politècnica de Catalunya (UPC), C/d'Eduard Maristany, 10-14, Building I, 08019, Barcelona, Spain
| | - Sonia Lanzalaco
- Departament of Chemical Engineering, Universitat Politècnica de Catalunya (UPC), C/d'Eduard Maristany, 10-14, Building I, Barcelona, 08019, Spain
- Barcelona Research Centre for Multiscale Science and Engineering, Universitat Politècnica de Catalunya (UPC), C/d'Eduard Maristany, 10-14, Building I, 08019, Barcelona, Spain
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5
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Harman M, Champaigne K, Cobb W, Lu X, Chawla V, Wei L, Luzinov I, Mefford OT, Nagatomi J. A Novel Bio-Adhesive Mesh System for Medical Implant Applications: In Vivo Assessment in a Rabbit Model. Gels 2023; 9:372. [PMID: 37232966 PMCID: PMC10217475 DOI: 10.3390/gels9050372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/08/2023] [Accepted: 04/13/2023] [Indexed: 05/27/2023] Open
Abstract
Injectable surgical sealants and adhesives, such as biologically derived fibrin gels and synthetic hydrogels, are widely used in medical products. While such products adequately adhere to blood proteins and tissue amines, they have poor adhesion with polymer biomaterials used in medical implants. To address these shortcomings, we developed a novel bio-adhesive mesh system utilizing the combined application of two patented technologies: a bifunctional poloxamine hydrogel adhesive and a surface modification technique that provides a poly-glycidyl methacrylate (PGMA) layer grafted with human serum albumin (HSA) to form a highly adhesive protein surface on polymer biomaterials. Our initial in vitro tests confirmed significantly improved adhesive strength for PGMA/HSA grafted polypropylene mesh fixed with the hydrogel adhesive compared to unmodified mesh. Toward the development of our bio-adhesive mesh system for abdominal hernia repair, we evaluated its surgical utility and in vivo performance in a rabbit model with retromuscular repair mimicking the totally extra-peritoneal surgical technique used in humans. We assessed mesh slippage/contraction using gross assessment and imaging, mesh fixation using tensile mechanical testing, and biocompatibility using histology. Compared to polypropylene mesh fixed with fibrin sealant, our bio-adhesive mesh system exhibited superior fixation without the gross bunching or distortion that was observed in the majority (80%) of the fibrin-fixed polypropylene mesh. This was evidenced by tissue integration within the bio-adhesive mesh pores after 42 days of implantation and adhesive strength sufficient to withstand the physiological forces expected in hernia repair applications. These results support the combined use of PGMA/HSA grafted polypropylene and bifunctional poloxamine hydrogel adhesive for medical implant applications.
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Affiliation(s)
- Melinda Harman
- 301 Rhodes Engineering Research Center, Bioengineering Department, Clemson University, Clemson, SC 29634, USA
- School of Medicine Greenville, Prisma Health Upstate, University of South Carolina, Greenville, SC 29605, USA
| | - Kevin Champaigne
- 301 Rhodes Engineering Research Center, Bioengineering Department, Clemson University, Clemson, SC 29634, USA
- Circa Bioscience, Charleston, SC 29412, USA
| | - William Cobb
- School of Medicine Greenville, Prisma Health Upstate, University of South Carolina, Greenville, SC 29605, USA
| | - Xinyue Lu
- 301 Rhodes Engineering Research Center, Bioengineering Department, Clemson University, Clemson, SC 29634, USA
| | | | - Liying Wei
- Materials Science & Engineering Department, Clemson University, Clemson, SC 29634, USA
| | - Igor Luzinov
- Materials Science & Engineering Department, Clemson University, Clemson, SC 29634, USA
| | - O. Thompson Mefford
- 301 Rhodes Engineering Research Center, Bioengineering Department, Clemson University, Clemson, SC 29634, USA
- Materials Science & Engineering Department, Clemson University, Clemson, SC 29634, USA
| | - Jiro Nagatomi
- 301 Rhodes Engineering Research Center, Bioengineering Department, Clemson University, Clemson, SC 29634, USA
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Nishiguchi A, Ito S, Nagasaka K, Taguchi T. Tissue-Adhesive Decellularized Extracellular Matrix Patches Reinforced by a Supramolecular Gelator to Repair Abdominal Wall Defects. Biomacromolecules 2023; 24:1545-1554. [PMID: 36880637 DOI: 10.1021/acs.biomac.2c01210] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
Implantation of surgical meshes composed of synthetic and biological materials has been applied for abdominal wall defect repair. Despite many efforts, there are no reliable meshes that fully satisfy clinical requirements because of their lack of biodegradability, mechanical strength, and tissue-adhesive properties. Here, we report biodegradable, decellularized extracellular matrix (dECM)-based biological patches to treat abdominal wall defects. By incorporating a water-insoluble supramolecular gelator that forms physical cross-linking networks through intermolecular hydrogen bonding, dECM patches were reinforced to improve mechanical strength. Reinforced dECM patches possessed higher tissue adhesion strength and underwater stability compared with the original dECM because of enhanced interfacial adhesion strength. In vivo experiments using an abdominal wall defect rat model showed that reinforced dECM patches induced collagen deposition and the formation of blood vessels during material degradation, and the accumulation of CD68-positive macrophages was suppressed compared to nonbiodegradable synthetic meshes. Tissue-adhesive and biodegradable dECM patches with improved mechanical strength by a supramolecular gelator have enormous potential for use in the repair of abdominal wall defects.
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Affiliation(s)
- Akihiro Nishiguchi
- Polymers and Biomaterials Field, Research Center for Functional Materials, National Institute for Materials Science, 1-1 Namiki, Tsukuba, Ibaraki 305-0044, Japan
| | - Shima Ito
- Polymers and Biomaterials Field, Research Center for Functional Materials, National Institute for Materials Science, 1-1 Namiki, Tsukuba, Ibaraki 305-0044, Japan
| | - Kazuhiro Nagasaka
- Polymers and Biomaterials Field, Research Center for Functional Materials, National Institute for Materials Science, 1-1 Namiki, Tsukuba, Ibaraki 305-0044, Japan
| | - Tetsushi Taguchi
- Polymers and Biomaterials Field, Research Center for Functional Materials, National Institute for Materials Science, 1-1 Namiki, Tsukuba, Ibaraki 305-0044, Japan
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Nikam SP, Hsu YH, Marks JR, Mateas C, Brigham NC, McDonald SM, Guggenheim DS, Ruppert D, Everitt JI, Levinson H, Becker ML. Anti-adhesive bioresorbable elastomer-coated composite hernia mesh that reduce intraperitoneal adhesions. Biomaterials 2023; 292:121940. [PMID: 36493714 DOI: 10.1016/j.biomaterials.2022.121940] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 11/26/2022] [Accepted: 12/02/2022] [Indexed: 12/07/2022]
Abstract
Intraperitoneal adhesions (IAs) are a major complication arising from abdominal repair surgeries, including hernia repair procedures. Herein, we fabricated a composite mesh device using a macroporous monofilament polypropylene mesh and a degradable elastomer coating designed to meet the requirements of this clinical application. The degradable elastomer was synthesized using an organo-base catalyzed thiol-yne addition polymerization that affords independent control of degradation rate and mechanical properties. The elastomeric coating was further enhanced by the covalent tethering of antifouling zwitterion molecules. Mechanical testing demonstrated the elastomer forms a robust coating on the polypropylene mesh does not exhibit micro-fractures, cracks or mechanical delamination under cyclic fatigue testing that exceeds peak abdominal loads (50 N/cm). Quartz crystal microbalance measurements showed the zwitterionic functionalized elastomer further reduced fibrinogen adsorption by 73% in vitro when compared to unfunctionalized elastomer controls. The elastomer exhibited degradation with limited tissue response in a 10-week murine subcutaneous implantation model. We also evaluated the composite mesh in an 84-day study in a rabbit cecal abrasion hernia adhesion model. The zwitterionic composite mesh significantly reduced the extent and tenacity of IAs by 94% and 90% respectively with respect to uncoated polypropylene mesh. The resulting composite mesh device is an excellent candidate to reduce complications related to abdominal repair through suppressed fouling and adhesion formation, reduced tissue inflammation, and appropriate degradation rate.
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Affiliation(s)
- Shantanu P Nikam
- Department of Chemistry, Duke University, Durham, NC, 27708, United States; Department of Polymer Science, The University of Akron, Akron, OH 44325, United States
| | - Yen-Hao Hsu
- Department of Chemistry, Duke University, Durham, NC, 27708, United States; Department of Polymer Science, The University of Akron, Akron, OH 44325, United States
| | - Jessica R Marks
- Department of Chemistry, Duke University, Durham, NC, 27708, United States
| | - Catalin Mateas
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Duke University Medical Center, Durham, NC 27710, United States
| | - Natasha C Brigham
- Department of Chemistry, Duke University, Durham, NC, 27708, United States
| | | | - Dana S Guggenheim
- Department of Chemistry, Duke University, Durham, NC, 27708, United States
| | - David Ruppert
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Duke University Medical Center, Durham, NC 27710, United States
| | - Jeffrey I Everitt
- Department of Pathology, Duke University, Durham, NC, 27708, United States
| | - Howard Levinson
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Duke University Medical Center, Durham, NC 27710, United States.
| | - Matthew L Becker
- Department of Chemistry, Duke University, Durham, NC, 27708, United States; Thomas Lord Department of Mechanical Engineering and Materials Science, Duke University, Durham, NC, 27708, United States; Department of Orthopaedic Surgery, Duke University, Durham, NC, 27708, United States; Department of Biomedical Engineering, Duke University, Durham, NC, 27708, United States.
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8
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Mirel S, Pusta A, Moldovan M, Moldovan S. Antimicrobial Meshes for Hernia Repair: Current Progress and Perspectives. J Clin Med 2022; 11:jcm11030883. [PMID: 35160332 PMCID: PMC8836564 DOI: 10.3390/jcm11030883] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/03/2022] [Accepted: 02/04/2022] [Indexed: 12/14/2022] Open
Abstract
Recent advances in the development of biomaterials have given rise to new options for surgery. New-generation medical devices can control chemical breakdown and resorption, prevent post-operative adhesion, and stimulate tissue regeneration. For the fabrication of medical devices, numerous biomaterials can be employed, including non-degradable biomaterials (silicone, polypropylene, expanded polytetrafluoroethylene) or biodegradable polymers, including implants and three-dimensional scaffolds for tissue engineering, which require particular physicochemical and biological properties. Based on the combination of new generation technologies and cell-based therapies, the biocompatible and bioactive properties of some of these medical products can lead to progress in the repair of injured or harmed tissue and in tissue regeneration. An important aspect in the use of these prosthetic devices is the associated infection risk, due to the medical complications and socio-economic impact. This paper provides the latest achievements in the field of antimicrobial surgical meshes for hernia repair and discusses the perspectives in the development of these innovative biomaterials.
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Affiliation(s)
- Simona Mirel
- Department of Medical Devices, Iuliu Hațieganu University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania;
| | - Alexandra Pusta
- Department of Medical Devices, Iuliu Hațieganu University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania;
- Correspondence:
| | - Mihaela Moldovan
- Pediatric Surgery Department, Emergency Clinical Children’s Hospital, 400370 Cluj-Napoca, Romania;
| | - Septimiu Moldovan
- Surgery Department, Prof. Dr. O. Fodor Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania;
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Liu Z, Wei N, Tang R. Functionalized Strategies and Mechanisms of the Emerging Mesh for Abdominal Wall Repair and Regeneration. ACS Biomater Sci Eng 2021; 7:2064-2082. [PMID: 33856203 DOI: 10.1021/acsbiomaterials.1c00118] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Meshes have been the overwhelmingly popular choice for the repair of abdominal wall defects to retrieve the bodily integrity of musculofascial layer. Broadly, they are classified into synthetic, biological and composite mesh based on their mechanical and biocompatible features. With the development of anatomical repair techniques and the increasing requirements of constructive remodeling, however, none of these options satisfactorily manages the conditional repair. In both preclinical and clinical studies, materials/agents equipped with distinct functions have been characterized and applied to improve mesh-aided repair, with the importance of mesh functionalization being highlighted. However, limited information exists on systemic comparisons of the underlying mechanisms with respect to functionalized strategies, which are fundamental throughout repair and regeneration. Herein, we address this topic and summarize the current literature by subdividing common functions of the mesh into biomechanics-matched, macrophage-mediated, integration-enhanced, anti-infective and antiadhesive characteristics for a comprehensive overview. In particular, we elaborate their effects separately with respect to host response and integration and discuss their respective advances, challenges and future directions toward a clinical alternative. From the vastly different approaches, we provide insight into the mechanisms involved and offer suggestions for personalized modifications of these emerging meshes.
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Affiliation(s)
- Zhengni Liu
- Department of Hernia and Abdominal Wall Surgery, Shanghai East Hospital, TongJi University, 150 Ji Mo Road, Shanghai 200120, PR China
| | - Nina Wei
- Department of Hernia and Abdominal Wall Surgery, Shanghai East Hospital, TongJi University, 150 Ji Mo Road, Shanghai 200120, PR China
| | - Rui Tang
- Department of Hernia and Abdominal Wall Surgery, Shanghai East Hospital, TongJi University, 150 Ji Mo Road, Shanghai 200120, PR China
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10
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Rong L, Yang D, Wang B, Xiao D, Lu M, Mao Z, Xu H, Gu Y, Feng X, Sui X. Durable and Effective Antibacterial Cotton Fabric Collaborated with Polypropylene Tissue Mesh for Abdominal Wall Defect Repair. ACS Biomater Sci Eng 2020; 6:3868-3877. [PMID: 33463345 DOI: 10.1021/acsbiomaterials.0c00626] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
A feasible, efficient antibacterial and anti-infective mesh for clinical abdominal wall defect repair is significant, but challenging due to the complexity of the postoperative wound environment. Herein, a simple strategy was provided to construct woven cotton fabric modified with gentamicin (Gem) via the enamine bonds. The obtained cotton fabric possessed favorable antibacterial properties against E. coli and S. aureus with the bactericidal rate of over 99.99% and could be combined with a commercial polypropylene (PP) mesh to serve as a two-layer composite mesh for abdominal wall defect repair. The antibacterial cotton layer was systematically characterized by FTIR, XPS, SEM, EDS, and mechanical measurements. The C2C12 cells and human fibroblasts were employed to assess the cytocompatibility of the composite mesh in vitro. Furthermore, the rat abdominal wall defect model was used to evaluate the efficacy of antibacterial and anti-infection properties. It was demonstrated that the two-layer composite mesh possessed favorable biocompatibility and satisfactory anti-infection properties involved in abdominal wall defect repair. Therefore, this synergetic two-layer composite mesh would out-perform surgical PP meshes in preventing infectious complications.
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Affiliation(s)
- Liduo Rong
- Key Lab of Science and Technology of Eco-textile, Ministry of Education, College of Chemistry, Chemical Engineering and Biotechnology, Donghua University, Shanghai, 201620, People's Republic of China
| | - Dongchao Yang
- Department of General Surgery, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200011, People's Republic of China
| | - Bijia Wang
- Key Lab of Science and Technology of Eco-textile, Ministry of Education, College of Chemistry, Chemical Engineering and Biotechnology, Donghua University, Shanghai, 201620, People's Republic of China
| | - Dongdong Xiao
- Department of Urology and Andrology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200001, People's Republic of China.,Shanghai Key Laboratory of Tissue Engineering, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200011, People's Republic of China
| | - Mujun Lu
- Department of Urology and Andrology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200001, People's Republic of China
| | - Zhiping Mao
- Key Lab of Science and Technology of Eco-textile, Ministry of Education, College of Chemistry, Chemical Engineering and Biotechnology, Donghua University, Shanghai, 201620, People's Republic of China
| | - Hong Xu
- Key Lab of Science and Technology of Eco-textile, Ministry of Education, College of Chemistry, Chemical Engineering and Biotechnology, Donghua University, Shanghai, 201620, People's Republic of China
| | - Yan Gu
- Department of General Surgery, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200011, People's Republic of China
| | - Xueling Feng
- Key Lab of Science and Technology of Eco-textile, Ministry of Education, College of Chemistry, Chemical Engineering and Biotechnology, Donghua University, Shanghai, 201620, People's Republic of China
| | - Xiaofeng Sui
- Key Lab of Science and Technology of Eco-textile, Ministry of Education, College of Chemistry, Chemical Engineering and Biotechnology, Donghua University, Shanghai, 201620, People's Republic of China
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11
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Pérez-Köhler B, Pascual G, Benito-Martínez S, Bellón JM, Eglin D, Guillaume O. Thermo-Responsive Antimicrobial Hydrogel for the In-Situ Coating of Mesh Materials for Hernia Repair. Polymers (Basel) 2020; 12:polym12061245. [PMID: 32486080 PMCID: PMC7362238 DOI: 10.3390/polym12061245] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 05/25/2020] [Accepted: 05/26/2020] [Indexed: 02/07/2023] Open
Abstract
The prophylactic coating of prosthetic mesh materials for hernia repair with antimicrobial compounds is commonly performed before implantation of the mesh in the abdominal wall. We propose a novel alternative, which is a rifampicin-loaded thermo-responsive hydrogel formulation, to be applied on the mesh after its implantation. This formulation becomes a gel in-situ once reached body temperature, allowing an optimal coating of the mesh along with the surrounding tissues. In vitro, the hydrogel cytotoxicity was assessed using rabbit fibroblasts and antimicrobial efficacy was determined against Staphylococcus aureus. An in vivo rabbit model of hernia repair was performed; implanted polypropylene meshes (5 × 2 cm) were challenged with S. aureus (106 CFU), for two study groups—unloaded (n = 4) and 0.1 mg/cm2 rifampicin-loaded hydrogel (n = 8). In vitro, antibacterial activity of the hydrogel lasted for 5 days, without sign of cytotoxicity. Fourteen days after implantation, meshes coated with drug-free hydrogel developed a strong infection and resulted in poor tissue integration. Coating meshes with the rifampicin-loaded hydrogel fully prevented implant infection and permitted an optimal tissue integration. Due to its great performance, this, degradable, thermo-responsive antimicrobial hydrogel could potentially be a strong prophylactic armamentarium to be combined with prosthesis in the surgical field.
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Affiliation(s)
- Bárbara Pérez-Köhler
- Department of Medicine and Medical Specialties, University of Alcalá, 28805 Madrid, Spain; (B.P.-K.); (G.P.)
- Biomedical Networking Research Centre on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), 28029 Madrid, Spain; (S.B.-M.); (J.M.B.)
- Ramón y Cajal Health Research Institute (IRYCIS), 28034 Madrid, Spain
| | - Gemma Pascual
- Department of Medicine and Medical Specialties, University of Alcalá, 28805 Madrid, Spain; (B.P.-K.); (G.P.)
- Biomedical Networking Research Centre on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), 28029 Madrid, Spain; (S.B.-M.); (J.M.B.)
- Ramón y Cajal Health Research Institute (IRYCIS), 28034 Madrid, Spain
| | - Selma Benito-Martínez
- Biomedical Networking Research Centre on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), 28029 Madrid, Spain; (S.B.-M.); (J.M.B.)
- Ramón y Cajal Health Research Institute (IRYCIS), 28034 Madrid, Spain
- Department of Surgery, Medical and Social Sciences, University of Alcalá, 28805 Madrid, Spain
| | - Juan Manuel Bellón
- Biomedical Networking Research Centre on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), 28029 Madrid, Spain; (S.B.-M.); (J.M.B.)
- Ramón y Cajal Health Research Institute (IRYCIS), 28034 Madrid, Spain
- Department of Surgery, Medical and Social Sciences, University of Alcalá, 28805 Madrid, Spain
| | - David Eglin
- AO Research Institute Davos, Davos 7270, Switzerland;
| | - Olivier Guillaume
- 3D Printing and Biofabrication Group, Institute of Materials Science and Technology, TU Wien, 1060 Vienna, Austria
- Correspondence:
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12
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Whooley J, Cunnane EM, Do Amaral R, Joyce M, MacCraith E, Flood HD, O'Brien FJ, Davis NF. Stress Urinary Incontinence and Pelvic Organ Prolapse: Biologic Graft Materials Revisited. TISSUE ENGINEERING PART B-REVIEWS 2020; 26:475-483. [PMID: 32192400 DOI: 10.1089/ten.teb.2020.0024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Symptomatic stress urinary incontinence (SUI) and pelvic organ prolapse (POP) refractory to conservative management with pelvic floor muscle training or vaginal pessaries may warrant surgical intervention with different forms of biologic or synthetic material. However, in recent years, several global regulatory agencies have issued health warnings and recalled several mesh products due to an increase in complications such as mesh erosion, infection, chronic pain, and perioperative bleeding. At present, current surgical treatment strategies for SUI and POP are aimed at developing biological graft materials with similar mechanical properties to established synthetic meshes, but with improved tissue integration and minimal host response. This narrative review aims to highlight recent studies related to the development of biomimetic and biologic graft materials as alternatives to traditional synthetic materials for SUI/POP repair in female patients. We also investigate complications and technical limitations associated with synthetic mesh and biological biomaterials in conventional SUI and POP surgery. Our findings demonstrate that newly developed biologic grafts have a lower incidence of adverse events compared to synthetic biomaterials. However there remains a significant disparity between success in preclinical trials and long-term clinical translation. Further characterization on the optimal structural, integrative, and mechanical properties of biological grafts is required before they can be reliably introduced into clinical practice for SUI and POP surgery. Impact statement Our review article aims to outline the clinical history of developments and controversies associated with the use of synthetic mesh materials in the surgical treatment of stress urinary incontinence and pelvic organ prolapse, as well as highlighting recent advancements in the area of biological graft materials and their potential importance in an area that remains an enduring issue for patients and clinicians alike. This article aims to provide a concise summary of previous controversies in the field of urinary incontinence, while evaluating the future of potential biomaterials in this field.
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Affiliation(s)
- Jack Whooley
- Department of Urology and Transplant Surgery, Beaumont Hospital, Co Dublin, Ireland
| | - Eoghan M Cunnane
- Tissue Engineering Research Group, Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland.,Trinity Centre for Biomedical Engineering, Trinity College Dublin, Dublin, Ireland.,Advanced Materials and Bioengineering Research Centre (AMBER), RCSI and TCD, Dublin, Ireland
| | - Ronaldo Do Amaral
- Tissue Engineering Research Group, Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland.,Trinity Centre for Biomedical Engineering, Trinity College Dublin, Dublin, Ireland.,Advanced Materials and Bioengineering Research Centre (AMBER), RCSI and TCD, Dublin, Ireland
| | - Michael Joyce
- Tissue Engineering Research Group, Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland.,Trinity Centre for Biomedical Engineering, Trinity College Dublin, Dublin, Ireland.,Advanced Materials and Bioengineering Research Centre (AMBER), RCSI and TCD, Dublin, Ireland
| | - Eoin MacCraith
- Department of Urology and Transplant Surgery, Beaumont Hospital, Co Dublin, Ireland
| | - Hugh D Flood
- Tissue Engineering Research Group, Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland.,Trinity Centre for Biomedical Engineering, Trinity College Dublin, Dublin, Ireland.,Advanced Materials and Bioengineering Research Centre (AMBER), RCSI and TCD, Dublin, Ireland
| | - Fergal J O'Brien
- Tissue Engineering Research Group, Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland.,Trinity Centre for Biomedical Engineering, Trinity College Dublin, Dublin, Ireland.,Advanced Materials and Bioengineering Research Centre (AMBER), RCSI and TCD, Dublin, Ireland
| | - Niall F Davis
- Department of Urology and Transplant Surgery, Beaumont Hospital, Co Dublin, Ireland.,Tissue Engineering Research Group, Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland.,Trinity Centre for Biomedical Engineering, Trinity College Dublin, Dublin, Ireland.,Advanced Materials and Bioengineering Research Centre (AMBER), RCSI and TCD, Dublin, Ireland
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13
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Yuan M, Dai F, Li D, Fan Y, Xiang W, Tao F, Cheng Y, Deng H. Lysozyme/collagen multilayers layer-by-layer deposited nanofibers with enhanced biocompatibility and antibacterial activity. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2020; 112:110868. [PMID: 32409037 DOI: 10.1016/j.msec.2020.110868] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 03/13/2020] [Accepted: 03/19/2020] [Indexed: 12/19/2022]
Abstract
Biological meshes have always posed a challenge in biological medicine, for which nanocomposites with enhanced biocompatibility and antibacterial activity may be beneficial. In this study, lysozyme (LY) and collagen (Col) were alternately deposited on silk fibroin (SF) and nylon 6 (N6) composite nanofibrous mats using a layer-by-layer (LBL) self-assembly technique. The mechanical properties, biocompatibility, and antibacterial activity of the LBL structured mats were characterized systematically to investigate the impact of the LBL process on the biological properties of SF/N6 nanofibrous mats. Our results showed that the effective deposition of LY and Col may affect the surface topography, mechanical properties, and wetting behavior of the SF/N6 nanofibrous mats. Moreover, LBL structured mats exhibited excellent biocompatibility and antibacterial properties. Among all the tested mats, those coated with 10 bilayers of LY and Col displayed the best biocompatibility, and relatively good mechanical and antibacterial properties. Thus, LBL structured mats, especially those with a 10 bilayer coating, are potentially valuable in clinical therapy for pelvic organ prolapse in the future.
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Affiliation(s)
- Mengqin Yuan
- Department of Obstetrics and Gynecology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, China; Hubei International Scientific and Technological Cooperation Base of Sustainable Resource and Energy, Hubei Key Laboratory of Biomass Resource Chemistry and Environmental Biotechnology, School of Resource and Environmental Science, Wuhan University, Wuhan 430079, China
| | - Fangfang Dai
- Department of Obstetrics and Gynecology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, China; Hubei International Scientific and Technological Cooperation Base of Sustainable Resource and Energy, Hubei Key Laboratory of Biomass Resource Chemistry and Environmental Biotechnology, School of Resource and Environmental Science, Wuhan University, Wuhan 430079, China
| | - Dan Li
- Hubei International Scientific and Technological Cooperation Base of Sustainable Resource and Energy, Hubei Key Laboratory of Biomass Resource Chemistry and Environmental Biotechnology, School of Resource and Environmental Science, Wuhan University, Wuhan 430079, China
| | - Yaqi Fan
- Shanghai Skin Disease Hospital, Shanghai 200443, China
| | - Wei Xiang
- Department of Orthopedics, Renmin Hospital of Wuhan University, Wuhan University, Wuhan 430060, China
| | - Fenghua Tao
- Department of Orthopedics, Renmin Hospital of Wuhan University, Wuhan University, Wuhan 430060, China
| | - Yanxiang Cheng
- Department of Obstetrics and Gynecology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, China.
| | - Hongbing Deng
- Hubei International Scientific and Technological Cooperation Base of Sustainable Resource and Energy, Hubei Key Laboratory of Biomass Resource Chemistry and Environmental Biotechnology, School of Resource and Environmental Science, Wuhan University, Wuhan 430079, China.
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14
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Guillaume O, Pérez-Köhler B, Schädl B, Keibl C, Saxenhuber N, Heimel P, Priglinger E, Wolbank S, Redl H, Petter-Puchner A, Fortelny R. Stromal vascular fraction cells as biologic coating of mesh for hernia repair. Hernia 2020; 24:1233-1243. [PMID: 32096088 PMCID: PMC7701131 DOI: 10.1007/s10029-020-02135-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 01/29/2020] [Indexed: 12/19/2022]
Abstract
Background The interest in non-manipulated cells originating from adipose tissue has raised tremendously in the field of tissue engineering and regenerative medicine. The resulting stromal vascular fraction (SVF) cells have been successfully used in numerous clinical applications. The aim of this experimental work is, first to combine a macroporous synthetic mesh with SVF isolated using a mechanical disruption process, and to assess the effect of those cells on the early healing phase of hernia. Methods Human SVF cells combined with fibrin were used to coat commercial titanized polypropylene meshes. In vitro, viability and growth of the SVF cells were assessed using live/dead staining and scanning electron microscopy. The influence of SVF cells on abdominal wall hernia healing was conducted on immunodeficient rats, with a focus on short-term vascularization and fibrogenesis. Results Macroporous meshes were easily coated with SVF using a fibrin gel as temporary carrier. The in vitro experiments showed that the whole process including the isolation of human SVF cells and their coating on PP meshes did not impact on the SVF cells’ viability and on their capacity to attach and to proliferate. In vivo, the SVF cells were well tolerated by the animals, and coating mesh with SVF resulted in a decrease degree of vascularity compared to control group at day 21. Conclusions The utilization of SVF-coated mesh influences the level of angiogenesis during the early onset of tissue healing. Further long-term animal experiments are needed to confirm that this effect correlates with a more robust mesh integration compared to non-SVF-coated mesh.
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Affiliation(s)
- O Guillaume
- 3D Printing and Biofabrication Group, Institute of Materials Science and Technology, TU Wien, Vienna, Austria. .,Austrian Cluster for Tissue Regeneration, Vienna, Austria.
| | - B Pérez-Köhler
- Department of Medicine and Medical Specialties, University of Alcalá, Madrid, Spain.,Biomedical Networking Research Centre On Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain.,Ramón y Cajal Health Research Institute (IRYCIS), Madrid, Spain
| | - B Schädl
- Austrian Cluster for Tissue Regeneration, Vienna, Austria.,Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria.,University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
| | - C Keibl
- Austrian Cluster for Tissue Regeneration, Vienna, Austria.,Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria
| | - N Saxenhuber
- Austrian Cluster for Tissue Regeneration, Vienna, Austria.,Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria
| | - P Heimel
- Austrian Cluster for Tissue Regeneration, Vienna, Austria.,Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria.,University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
| | - E Priglinger
- Austrian Cluster for Tissue Regeneration, Vienna, Austria.,Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria
| | - S Wolbank
- Austrian Cluster for Tissue Regeneration, Vienna, Austria.,Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria
| | - H Redl
- Austrian Cluster for Tissue Regeneration, Vienna, Austria.,Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria
| | - A Petter-Puchner
- Austrian Cluster for Tissue Regeneration, Vienna, Austria.,Department of General, Visceral and Oncologic Surgery, Wilhelminenspital, Vienna, Austria
| | - R Fortelny
- Austrian Cluster for Tissue Regeneration, Vienna, Austria.,Department of General, Visceral and Oncologic Surgery, Wilhelminenspital, Vienna, Austria
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15
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16
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Pérez-Köhler B, Linardi F, Pascual G, Bellón JM, Eglin D, Guillaume O. Efficacy of antimicrobial agents delivered to hernia meshes using an adaptable thermo-responsive hyaluronic acid-based coating. Hernia 2019; 24:1201-1210. [DOI: 10.1007/s10029-019-02096-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 11/17/2019] [Indexed: 12/31/2022]
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17
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Zhao C, Wu X, Huang J, Chen C, Yu J, Fang M, Wang G, Ren J. Hybrid material for open abdomen: saving the wound from intestinal fistula. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2019; 30:109. [PMID: 31535210 DOI: 10.1007/s10856-019-6311-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 09/04/2019] [Indexed: 06/10/2023]
Abstract
Treatment of an open abdomen (OA) wound combined with an intestinal fistula is a challenge in the clinic. Here, inspired by the antibacterial activity of graphene (G) and its derivatives, we present a hybrid patch based on the ability of graphene and polycaprolactone (PCL) to kill bacteria and save the cells in a wound. Benefiting from the antibacterial ability of graphene oxide (GO), cells could survive in the presence of bacteria. With the increased ability to protect cells, this patch accelerated wound healing in an OA and intestinal fistula wound model. Additionally, the sub-acute toxicity score showed no extra damage to organs. In conclusion, the employment of the hybrid material for an OA and an intestinal fistula wound healing is encouraging. A hybrid patch based on graphene oxide and polycaprolactone electrospun was generated for open abdomen and fistula wound. The application of the hybrid patch could save the cells from bacteria which contribute to accelerating wound healing.
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Affiliation(s)
- Cheng Zhao
- Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, 305 East Zhongshan Road, 210002, Nanjing, China
| | - Xiuwen Wu
- Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, 305 East Zhongshan Road, 210002, Nanjing, China.
| | - Jinjian Huang
- Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, 305 East Zhongshan Road, 210002, Nanjing, China
| | - Canwen Chen
- Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, 305 East Zhongshan Road, 210002, Nanjing, China
| | - Jiafei Yu
- Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, 305 East Zhongshan Road, 210002, Nanjing, China
| | - Miao Fang
- Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, 305 East Zhongshan Road, 210002, Nanjing, China
| | - Gefei Wang
- Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, 305 East Zhongshan Road, 210002, Nanjing, China
| | - Jianan Ren
- Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, 305 East Zhongshan Road, 210002, Nanjing, China.
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18
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Biomaterial Implants in Abdominal Wall Hernia Repair: A Review on the Importance of the Peritoneal Interface. Processes (Basel) 2019. [DOI: 10.3390/pr7020105] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Biomaterials have long been used to repair defects in the clinical setting, which has led to the development of a wide variety of new materials tailored to specific therapeutic purposes. The efficiency in the repair of the defect and the safety of the different materials employed are determined not only by the nature and structure of their components, but also by the anatomical site where they will be located. Biomaterial implantation into the abdominal cavity in the form of a surgical mesh, such as in the case of abdominal hernia repair, involves the contact between the foreign material and the peritoneum. This review summarizes the different biomaterials currently available in hernia mesh repair and provides insights into a series of peculiarities that must be addressed when designing the optimal mesh to be used in this interface.
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19
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Marinaro F, Sánchez-Margallo FM, Álvarez V, López E, Tarazona R, Brun MV, Blázquez R, Casado JG. Meshes in a mess: Mesenchymal stem cell-based therapies for soft tissue reinforcement. Acta Biomater 2019; 85:60-74. [PMID: 30500445 DOI: 10.1016/j.actbio.2018.11.042] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 11/21/2018] [Accepted: 11/26/2018] [Indexed: 12/19/2022]
Abstract
Surgical meshes are frequently used for the treatment of abdominal hernias, pelvic organ prolapse, and stress urinary incontinence. Though these meshes are designed for tissue reinforcement, many complications have been reported. Both differentiated cell- and mesenchymal stem cell-based therapies have become attractive tools to improve their biocompatibility and tissue integration, minimizing adverse inflammatory reactions. However, current studies are highly heterogeneous, making it difficult to establish comparisons between cell types or cell coating methodologies. Moreover, only a few studies have been performed in clinically relevant animal models, leading to contradictory results. Finally, a thorough understanding of the biological mechanisms of mesenchymal stem cells in the context of foreign body reaction is lacking. This review aims to summarize in vitro and in vivo studies involving the use of differentiated and mesenchymal stem cells in combination with surgical meshes. According to preclinical and clinical studies and considering the therapeutic potential of mesenchymal stem cells, it is expected that these cells will become valuable tools in the treatment of pathologies requiring tissue reinforcement. STATEMENT OF SIGNIFICANCE: The implantation of surgical meshes is the standard procedure to reinforce tissue defects such as hernias. However, an adverse inflammatory response secondary to this implantation is frequently observed, leading to a strong discomfort and chronic pain in the patients. In many cases, an additional surgical intervention is needed to remove the mesh. Both differentiated cell- and stem cell-based therapies have become attractive tools to improve biocompatibility and tissue integration, minimizing adverse inflammatory reactions. However, current studies are incredibly heterogeneous and it is difficult to establish a comparison between cell types or cell coating methodologies. This review aims to summarize in vitro and in vivo studies where differentiated and stem cells have been combined with surgical meshes.
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Affiliation(s)
- F Marinaro
- Stem Cell Therapy Unit, Jesús Usón Minimally Invasive Surgery Centre, Ctra. N-521, km 41.8, 10071 Cáceres, Spain
| | - F M Sánchez-Margallo
- Stem Cell Therapy Unit, Jesús Usón Minimally Invasive Surgery Centre, Ctra. N-521, km 41.8, 10071 Cáceres, Spain; CIBER de Enfermedades Cardiovasculares, Avenida Monforte de Lemos, 3-5. Pabellón 11. Planta 0, 28029 Madrid, Spain
| | - V Álvarez
- Stem Cell Therapy Unit, Jesús Usón Minimally Invasive Surgery Centre, Ctra. N-521, km 41.8, 10071 Cáceres, Spain
| | - E López
- Stem Cell Therapy Unit, Jesús Usón Minimally Invasive Surgery Centre, Ctra. N-521, km 41.8, 10071 Cáceres, Spain
| | - R Tarazona
- Immunology Unit, Department of Physiology, University of Extremadura, 10071 Caceres, Spain
| | - M V Brun
- Department of Small Animal Medicine, Federal University of Santa Maria (UFSM), Av. Roraima, 1000 - 7 - Camobi, Santa Maria, 97105-900 Rio Grande do Sul, Brazil
| | - R Blázquez
- Stem Cell Therapy Unit, Jesús Usón Minimally Invasive Surgery Centre, Ctra. N-521, km 41.8, 10071 Cáceres, Spain; CIBER de Enfermedades Cardiovasculares, Avenida Monforte de Lemos, 3-5. Pabellón 11. Planta 0, 28029 Madrid, Spain.
| | - J G Casado
- Stem Cell Therapy Unit, Jesús Usón Minimally Invasive Surgery Centre, Ctra. N-521, km 41.8, 10071 Cáceres, Spain; CIBER de Enfermedades Cardiovasculares, Avenida Monforte de Lemos, 3-5. Pabellón 11. Planta 0, 28029 Madrid, Spain
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20
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A critical review of the in vitro and in vivo models for the evaluation of anti-infective meshes. Hernia 2018; 22:961-974. [PMID: 30168006 DOI: 10.1007/s10029-018-1807-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 08/18/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Infectious complications following mesh implantation for abdominal wall repair appear in 0.7 up to 26.6% of hernia repairs and can have a detrimental impact for the patient. To prevent or to treat mesh-related infection, the scientific community is currently developing a veritable arsenal of antibacterial meshes. The numerous and increasing reports published every year describing new technologies indicate a clear clinical need, and an academic interest in solving this problem. Nevertheless, to really appreciate, to challenge, to compare and to optimize the antibacterial properties of next generation meshes, it is important to know which models are available and to understand them. PURPOSE We proposed for the first time, a complete overview focusing only on the in vitro and in vivo models which have been employed specifically in the field of antibacterial meshes for hernia repair. RESULTS AND CONCLUSION From this investigation, it is clear that there has been vast progress and breadth in new technologies and models to test them. However, it also shows that standardization or adoption of a more restricted number of models would improve comparability and be a benefit to the field of study.
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21
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Aydogdu MO, Altun E, Crabbe-Mann M, Brako F, Koc F, Ozen G, Kuruca SE, Edirisinghe U, Luo CJ, Gunduz O, Edirisinghe M. Cellular interactions with bacterial cellulose: Polycaprolactone nanofibrous scaffolds produced by a portable electrohydrodynamic gun for point-of-need wound dressing. Int Wound J 2018; 15:789-797. [PMID: 29806201 DOI: 10.1111/iwj.12929] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 03/26/2018] [Accepted: 04/04/2018] [Indexed: 01/10/2023] Open
Abstract
Electrospun nanofibrous scaffolds are promising regenerative wound dressing options but have yet to be widely used in practice. The challenge is that nanofibre productions rely on bench-top apparatuses, and the delicate product integrity is hard to preserve before reaching the point of need. Timing is critically important to wound healing. The purpose of this investigation is to produce novel nanofibrous scaffolds using a portable, hand-held "gun", which enables production at the wound site in a time-dependent fashion, thereby preserving product integrity. We select bacterial cellulose, a natural hydrophilic biopolymer, and polycaprolactone, a synthetic hydrophobic polymer, to generate composite nanofibres that can tune the scaffold hydrophilicity, which strongly affects cell proliferation. Composite scaffolds made of 8 different ratios of bacterial cellulose and polycaprolactone were successfully electrospun. The morphological features and cell-scaffold interactions were analysed using scanning electron microscopy. The biocompatibility was studied using Saos-2 cell viability test. The scaffolds were found to show good biocompatibility and allow different proliferation rates that varied with the composition of the scaffolds. A nanofibrous dressing that can be accurately moulded and standardised via the portable technique is advantageous for wound healing in practicality and in its consistency through mass production.
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Affiliation(s)
- Mehmet Onur Aydogdu
- Department of Metallurgical and Materials Engineering, Marmara University, Istanbul, Turkey
| | - Esra Altun
- Department of Metallurgical and Materials Engineering, Marmara University, Istanbul, Turkey
| | - Maryam Crabbe-Mann
- Department of Mechanical Engineering, University College London (UCL), London, UK
| | - Francis Brako
- Department of Mechanical Engineering, University College London (UCL), London, UK
| | - Fatma Koc
- Department of Medical Microbiology, Medipol University, Istanbul, Turkey
| | - Gunes Ozen
- Department of Molecular Medicine, Istanbul University, Istanbul, Turkey
| | | | | | - C J Luo
- Department of Mechanical Engineering, University College London (UCL), London, UK
| | - Oguzhan Gunduz
- Department of Metallurgical and Materials Engineering, Marmara University, Istanbul, Turkey
| | - Mohan Edirisinghe
- Department of Mechanical Engineering, University College London (UCL), London, UK
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22
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Fibrin glue mesh fixation combined with mesenchymal stem cells or exosomes modulates the inflammatory reaction in a murine model of incisional hernia. Acta Biomater 2018; 71:318-329. [PMID: 29462710 DOI: 10.1016/j.actbio.2018.02.014] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 02/09/2018] [Accepted: 02/12/2018] [Indexed: 02/07/2023]
Abstract
Surgical meshes are effective and frequently used to reinforce soft tissues. Fibrin glue (FG) has been widely used for mesh fixation and is also considered an optimal vehicle for stem cell delivery. The aim of this preclinical study was to evaluate the therapeutic effect of MSCs and their exosomes combined with FG for the treatment of incisional hernia. A murine incisional hernia model was used to implant surgical meshes and different treatments with FG, MSCs and exo-MSCs were applied. The implanted meshes were evaluated at day 7 by anatomopathology, cellular analysis of infiltrating leukocytes and gene expression analysis of TH1/TH2 cytokines, MMPs, TIMPs and collagens. Our results demonstrated a significant increase of anti-inflammatory M2 macrophages and TH2 cytokines when MSCs or exo-MSCs were used. Moreover, the analysis of MMPs, TIMPs and collagen exerted significant differences in the extracellular matrix and in the remodeling process. Our in vivo study suggests that the fixation of surgical meshes with FG and MSCs or exo-MSCs will have a beneficial effect for the treatment of incisional hernia in terms of improved outcomes of damaged tissue, and especially, in the modulation of inflammatory responses towards a less aggressive and pro-regenerative profile. STATEMENT OF SIGNIFICANCE The implantation of surgical meshes is the standard procedure to reinforce tissue defects such as hernias. However, an exacerbated and persistent inflammatory response secondary to this implantation is frequently observed, leading to a strong discomfort and chronic pain in the patients. In many cases, an additional surgical intervention is needed to remove the mesh. This study shows that mesenchymal stem cells and their exosomes, combined with a fibrin sealant, can be used for the successful fixation of these meshes. This new therapeutic approach, assayed in a murine model of incisional hernia, favors the modulation of the inflammatory response towards a less aggressive and pro-regenerative profile.
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23
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Guillaume O, Pérez-Tanoira R, Fortelny R, Redl H, Moriarty TF, Richards RG, Eglin D, Petter Puchner A. Infections associated with mesh repairs of abdominal wall hernias: Are antimicrobial biomaterials the longed-for solution? Biomaterials 2018; 167:15-31. [PMID: 29554478 DOI: 10.1016/j.biomaterials.2018.03.017] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 03/09/2018] [Accepted: 03/12/2018] [Indexed: 12/30/2022]
Abstract
The incidence of mesh-related infection after abdominal wall hernia repair is low, generally between 1 and 4%; however, worldwide, this corresponds to tens of thousands of difficult cases to treat annually. Adopting best practices in prevention is one of the keys to reduce the incidence of mesh-related infection. Once the infection is established, however, only a limited number of options are available that provides an efficient and successful treatment outcome. Over the past few years, there has been a tremendous amount of research dedicated to the functionalization of prosthetic meshes with antimicrobial properties, with some receiving regulatory approval and are currently available for clinical use. In this context, it is important to review the clinical importance of mesh infection, its risk factors, prophylaxis and pathogenicity. In addition, we give an overview of the main functionalization approaches that have been applied on meshes to confer anti-bacterial protection, the respective benefits and limitations, and finally some relevant future directions.
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Affiliation(s)
- O Guillaume
- AO Research Institute Davos, Clavadelerstrasse 8, CH 7270, Davos, Switzerland.
| | - R Pérez-Tanoira
- Division of Infectious Diseases, IIS-Fundación Jiménez Díaz, Madrid, Spain; Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Finland
| | - R Fortelny
- Department of General, Visceral and Oncologic Surgery, Wilhelminen Hospital, Montleartstrasse 37, 1160, Vienna, Austria; Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Donaueschingenstraße 13, A-1200, Vienna, Austria; Sigmund Freud University, Medical Faculty, Kelsenstraße 2, A-1030, Vienna, Austria
| | - H Redl
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Donaueschingenstraße 13, A-1200, Vienna, Austria; Austrian Cluster for Tissue Regeneration, Donaueschingenstrasse 13, A-1200, Vienna, Austria
| | - T F Moriarty
- AO Research Institute Davos, Clavadelerstrasse 8, CH 7270, Davos, Switzerland
| | - R G Richards
- AO Research Institute Davos, Clavadelerstrasse 8, CH 7270, Davos, Switzerland
| | - D Eglin
- AO Research Institute Davos, Clavadelerstrasse 8, CH 7270, Davos, Switzerland
| | - A Petter Puchner
- Department of General, Visceral and Oncologic Surgery, Wilhelminen Hospital, Montleartstrasse 37, 1160, Vienna, Austria; Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Donaueschingenstraße 13, A-1200, Vienna, Austria
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24
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Böhm G, Groll J, Heffels KH, Heussen N, Ink P, Alizai HP, Neumann UP, Schnabel R, Mirastschijski U. Influence of MMP inhibitor GM6001 loading of fibre coated polypropylene meshes on wound healing: Implications for hernia repair. J Biomater Appl 2018; 32:1343-1359. [DOI: 10.1177/0885328218759043] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Polypropylene meshes are standard for hernia repair. Matrix metalloproteinases play a central role in inflammation. To reduce the inflammatory response and improve remodelling with an associated reduction of hernia recurrence, we modified polypropylene meshes by nanofibre coating and saturation with the broad-spectrum matrix metalloproteinase inhibitor GM6001. The aim was to modulate the inflammatory reaction, increase collagen deposition and improve mesh biointegration. Polypropylene meshes were surface-modified with star-configured NCO-sP(EO -stat-PO) and covered with electrospun nanofibres (polypropylene-nano) and GM6001 (polypropylene-nano-GM). In a hernia model, defects were reconstructed with one of the meshes. Inflammation, neovascularization, bio-integration, proliferation and apoptosis were assessed histologically, collagen content and gelatinases biochemically. Mesh surface modification resulted in higher inflammatory response compared to polypropylene. Pro-inflammatory matrix metalloproteinase-9 paralleled findings while GM6001 reduced matrix metalloproteinase-9 significantly. Significantly increased matrix metalloproteinase-2 beneficial for remodelling was noted with polypropylene-nano-meshes. Increased vascular endothelial growth factor, neo-vascularization and collagen content were measured in polypropylene-nano-meshes compared to polypropylene. GM6001 significantly reduced myofibroblasts. This effect ended after d14 due to engineering limitations with release of maximal GM6001 loading. Nanofibre-coating of polypropylene-meshes confers better tissue vascularization to the cost of increased inflammation. This phenomenon can be only partially compensated by GM6001. Future research will enable higher GM6001 uptake in nano-coated meshes and may alter mesh biointegration in a more pronounced way.
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Affiliation(s)
- Gabriele Böhm
- Department of General and Visceral Surgery, Klinikum Bremen-Ost, Bremen, Germany
- Department of General-, Visceral- and Transplant Surgery, University Hospital, Technical University of Aachen (RWTH), Germany
| | - Jürgen Groll
- Department of Functional Materials in Medicine and Dentistry, Julius Maximilians University, Wuerzburg, Germany
| | - Karl-Heinz Heffels
- Department of Functional Materials in Medicine and Dentistry, Julius Maximilians University, Wuerzburg, Germany
| | - Nicole Heussen
- Department of Medical Statistics, Technical University of Aachen (RWTH), Germany
- Center of Biostatistic and Epidemiology, Sigmund Freud Private University, Vienna, Austria
| | - Peter Ink
- Department of General-, Visceral- and Transplant Surgery, University Hospital, Technical University of Aachen (RWTH), Germany
| | - Hamid Patrick Alizai
- Department of General-, Visceral- and Transplant Surgery, University Hospital, Technical University of Aachen (RWTH), Germany
| | - Ulf Peter Neumann
- Department of General-, Visceral- and Transplant Surgery, University Hospital, Technical University of Aachen (RWTH), Germany
| | | | - Ursula Mirastschijski
- Department of Plastic, Reconstructive and Aesthetic Surgery, Klinikum Bremen-Mitte, Germany
- Centre for Biomolecular Interactions Bremen, University of Bremen, Bremen, Germany
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25
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Aydemir Sezer U, Sanko V, Gulmez M, Sayman E, Aru B, Yuksekdag ZN, Aktekin A, Vardar Aker F, Sezer S. A Polypropylene-Integrated Bilayer Composite Mesh with Bactericidal and Antiadhesive Efficiency for Hernia Operations. ACS Biomater Sci Eng 2017; 3:3662-3674. [DOI: 10.1021/acsbiomaterials.7b00757] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
| | | | | | | | - Basak Aru
- Department
of Immunology Section, School of Medicine, Yeditepe University, Istanbul 34755, Turkey
| | - Zehra Nur Yuksekdag
- Faculty
of
Sciences, Department of Biology, Gazi University, Ankara 06500, Turkey
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26
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Baylón K, Rodríguez-Camarillo P, Elías-Zúñiga A, Díaz-Elizondo JA, Gilkerson R, Lozano K. Past, Present and Future of Surgical Meshes: A Review. MEMBRANES 2017; 7:E47. [PMID: 28829367 PMCID: PMC5618132 DOI: 10.3390/membranes7030047] [Citation(s) in RCA: 141] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 08/09/2017] [Accepted: 08/17/2017] [Indexed: 12/14/2022]
Abstract
Surgical meshes, in particular those used to repair hernias, have been in use since 1891. Since then, research in the area has expanded, given the vast number of post-surgery complications such as infection, fibrosis, adhesions, mesh rejection, and hernia recurrence. Researchers have focused on the analysis and implementation of a wide range of materials: meshes with different fiber size and porosity, a variety of manufacturing methods, and certainly a variety of surgical and implantation procedures. Currently, surface modification methods and development of nanofiber based systems are actively being explored as areas of opportunity to retain material strength and increase biocompatibility of available meshes. This review summarizes the history of surgical meshes and presents an overview of commercial surgical meshes, their properties, manufacturing methods, and observed biological response, as well as the requirements for an ideal surgical mesh and potential manufacturing methods.
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Affiliation(s)
- Karen Baylón
- Centro de Innovación en Diseño y Tecnología, Tecnológico de Monterrey, Campus Monterrey, Monterrey 64849, Mexico.
| | - Perla Rodríguez-Camarillo
- Centro de Innovación en Diseño y Tecnología, Tecnológico de Monterrey, Campus Monterrey, Monterrey 64849, Mexico.
| | - Alex Elías-Zúñiga
- Centro de Innovación en Diseño y Tecnología, Tecnológico de Monterrey, Campus Monterrey, Monterrey 64849, Mexico.
| | | | - Robert Gilkerson
- Departments of Biology and Clinical Laboratory Sciences, The University of Texas Rio Grande Valley, Edinburg, TX 78539, USA.
| | - Karen Lozano
- Mechanical Engineering Department, The University of Texas Rio Grande Valley, Edinburg, TX 78539, USA.
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27
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Early Wound Morbidity after Open Ventral Hernia Repair with Biosynthetic or Polypropylene Mesh. J Am Coll Surg 2017; 225:472-480.e1. [PMID: 28826804 DOI: 10.1016/j.jamcollsurg.2017.07.1067] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 07/20/2017] [Accepted: 07/21/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND Recently introduced slow-resorbing biosynthetic and non-resorbing macroporous polypropylene meshes are being used in hernias with clean-contaminated and contaminated wounds. However, information about the use of biosynthetic meshes and their outcomes compared with polypropylene meshes in clean-contaminated and contaminated cases is lacking. Here we evaluate the use of biosynthetic mesh and polypropylene mesh in elective open ventral hernia repair (OVHR) and investigate differences in early wound morbidity after OVHR within clean-contaminated and contaminated cases. STUDY DESIGN All elective, OVHR with biosynthetic mesh or uncoated polypropylene mesh from January 2013 through October 2016 were identified within the Americas Hernia Society Quality Collaborative. Association of mesh type with 30-day wound events in clean-contaminated or contaminated wounds was investigated using a 1:3 propensity-matched analysis. RESULTS Biosynthetic meshes were used in 8.5% (175 of 2,051) of elective OVHR, with the majority (57.1%) used in low-risk or comorbid clean cases. Propensity-matched analysis in clean-contaminated and contaminated cases showed no significant difference between biosynthetic mesh and polypropylene mesh groups for 30-day surgical site occurrences (20.7% vs 16.7%; p = 0.49) or unplanned readmission (13.8% vs 9.8%; p = 0.4). However, surgical site infections (22.4% vs 10.9%; p = 0.03), surgical site occurrences requiring procedural intervention (24.1% vs 13.2%; p = 0.049), and reoperation rates (13.8% vs 4.0%; p = 0.009) were significantly higher in the biosynthetic group. CONCLUSIONS Biosynthetic mesh appears to have higher rates of 30-day wound morbidity compared with polypropylene mesh in elective OVHR with clean-contaminated or contaminated wounds. Additional post-market analysis is needed to provide evidence defining best mesh choices, location, and surgical technique for repairing contaminated ventral hernias.
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28
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Kalaba S, Gerhard E, Winder JS, Pauli EM, Haluck RS, Yang J. Design Strategies and Applications of Biomaterials and Devices for Hernia Repair. Bioact Mater 2016; 1:2-17. [PMID: 28349130 PMCID: PMC5365083 DOI: 10.1016/j.bioactmat.2016.05.002] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 05/10/2016] [Accepted: 05/20/2016] [Indexed: 12/17/2022] Open
Abstract
Hernia repair is one of the most commonly performed surgical procedures worldwide, with a multi-billion dollar global market. Implant design remains a critical challenge for the successful repair and prevention of recurrent hernias, and despite significant progress, there is no ideal mesh for every surgery. This review summarizes the evolution of prostheses design toward successful hernia repair beginning with a description of the anatomy of the disease and the classifications of hernias. Next, the major milestones in implant design are discussed. Commonly encountered complications and strategies to minimize these adverse effects are described, followed by a thorough description of the implant characteristics necessary for successful repair. Finally, available implants are categorized and their advantages and limitations elucidated, including non-absorbable and absorbable (synthetic and biologically derived) prostheses, composite prostheses, and coated prostheses. This review not only summarizes the state of the art in hernia repair, but also suggests future research directions toward improved hernia repair utilizing novel materials and fabrication methods.
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Affiliation(s)
- Surge Kalaba
- Department of Biomedical Engineering, Materials Research Institute, The Huck Institutes of the Life Sciences, The Pennsylvania State University, University Park, PA 16802, USA
| | - Ethan Gerhard
- Department of Biomedical Engineering, Materials Research Institute, The Huck Institutes of the Life Sciences, The Pennsylvania State University, University Park, PA 16802, USA
| | - Joshua S. Winder
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA 17033, USA
| | - Eric M. Pauli
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA 17033, USA
| | - Randy S. Haluck
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA 17033, USA
| | - Jian Yang
- Department of Biomedical Engineering, Materials Research Institute, The Huck Institutes of the Life Sciences, The Pennsylvania State University, University Park, PA 16802, USA
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29
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Guillaume O, Park J, Monforte X, Gruber-Blum S, Redl H, Petter-Puchner A, Teuschl AH. Fabrication of silk mesh with enhanced cytocompatibility: preliminary in vitro investigation toward cell-based therapy for hernia repair. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2016; 27:37. [PMID: 26704554 DOI: 10.1007/s10856-015-5648-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 12/07/2015] [Indexed: 06/05/2023]
Abstract
Recent studies have demonstrated that combining cells with meshes prior to implantation successfully enhanced hernia repair. The idea is to create a biologic coating surrounding the mesh with autologous cells, before transplantation into the patient. However, due to the lack of a prompt and robust cell adhesion to the meshes, extensive in vitro cultivation is required to obtain a homogenous cell layer covering the mesh. In this context, the objective of this publication is to manufacture meshes made of silk fibres and to enhance the cytoadhesion and cytocompatibility of the biomaterial by surface immobilization of a pro-adhesive wheat germ agglutinin (lectin WGA). We first investigated the affinity between the glycoprotein WGA and cells, in solution and then after covalent immobilization of WGA on silk films. Then, we manufactured meshes made of silk fibres, tailored them with WGA grafting and finally evaluated the cytocompatibility and the inflammatory response of silk and silk-lectin meshes compared to common polypropylene mesh, using fibroblasts and peripheral blood mononuclear cells, respectively. The in vitro experiments revealed that the cytocompatibility of silk can be enhanced by surface immobilization with lectin WGA without exhibiting negative response in terms of pro-inflammatory reaction. Grafting lectin to silk meshes could bring advantages to facilitate cell-coating of meshes prior to implantation, which is an imperative prerequisite for abdominal wall tissue regeneration using cell-based therapy.
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Affiliation(s)
- O Guillaume
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Donaueschingenstrasse 13, 1200, Vienna, Austria.
- The Austrian Cluster for Tissue Regeneration, Vienna, Austria.
| | - J Park
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Donaueschingenstrasse 13, 1200, Vienna, Austria
- The Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - X Monforte
- Department of Biochemical Engineering, University of Applied Sciences Technikum Wien, Höchstädtplatz 5, 1200, Vienna, Austria
- The Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - S Gruber-Blum
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Donaueschingenstrasse 13, 1200, Vienna, Austria
- Department of General, Visceral and Oncological Surgery, Wilhelminenspital der Stadt Wien, Montleartstrasse 37, 1171, Vienna, Austria
| | - H Redl
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Donaueschingenstrasse 13, 1200, Vienna, Austria
- The Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - A Petter-Puchner
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Donaueschingenstrasse 13, 1200, Vienna, Austria
- Department of General, Visceral and Oncological Surgery, Wilhelminenspital der Stadt Wien, Montleartstrasse 37, 1171, Vienna, Austria
- The Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - A H Teuschl
- Department of Biochemical Engineering, University of Applied Sciences Technikum Wien, Höchstädtplatz 5, 1200, Vienna, Austria
- The Austrian Cluster for Tissue Regeneration, Vienna, Austria
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30
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Pérez-Köhler B, García-Moreno F, Brune T, Pascual G, Bellón JM. Preclinical Bioassay of a Polypropylene Mesh for Hernia Repair Pretreated with Antibacterial Solutions of Chlorhexidine and Allicin: An In Vivo Study. PLoS One 2015; 10:e0142768. [PMID: 26556805 PMCID: PMC4640885 DOI: 10.1371/journal.pone.0142768] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 10/27/2015] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Prosthetic mesh infection constitutes one of the major complications following hernia repair. Antimicrobial, non-antibiotic biomaterials have the potential to reduce bacterial adhesion to the mesh surface and adjacent tissues while avoiding the development of novel antibiotic resistance. This study assesses the efficacy of presoaking reticular polypropylene meshes in chlorhexidine or a chlorhexidine and allicin combination (a natural antibacterial agent) for preventing bacterial infection in a short-time hernia-repair rabbit model. METHODS Partial hernia defects (5 x 2 cm) were created on the lateral right side of the abdominal wall of New Zealand White rabbits (n = 21). The defects were inoculated with 0.5 mL of a 106 CFU/mL Staphylococcus aureus ATCC25923 strain and repaired with a DualMesh Plus antimicrobial mesh or a Surgipro mesh presoaked in either chlorhexidine (0.05%) or allicin-chlorhexidine (900 μg/mL-0.05%). Fourteen days post-implant, mesh contraction was measured and tissue specimens were harvested to evaluate bacterial adhesion to the implant surface (via sonication, S. aureus immunolabeling), host-tissue incorporation (via staining, scanning electron microscopy) and macrophage response (via RAM-11 immunolabeling). RESULTS The polypropylene mesh showed improved tissue integration relative to the DualMesh Plus. Both the DualMesh Plus and the chlorhexidine-soaked polypropylene meshes exhibited high bacterial clearance, with the latter material showing lower bacterial yields. The implants from the allicin-chlorhexidine group displayed a neoformed tissue containing differently sized abscesses and living bacteria, as well as a diminished macrophage response. The allicin-chlorhexidine coated implants exhibited the highest contraction. CONCLUSIONS The presoaking of reticular polypropylene materials with a low concentration of chlorhexidine provides the mesh with antibacterial activity without disrupting tissue integration. Due to the similarities found with the antimicrobial DualMesh Plus material, the chlorhexidine concentration tested could be utilized as a prophylactic treatment to resist infection by prosthetic mesh during hernia repair.
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Affiliation(s)
- Bárbara Pérez-Köhler
- Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcalá. Madrid, Spain
- Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain
| | - Francisca García-Moreno
- Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcalá. Madrid, Spain
- Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain
| | | | - Gemma Pascual
- Department of Medicine and Medical Specialties, Faculty of Medicine and Health Sciences, University of Alcalá. Madrid, Spain
- Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain
| | - Juan Manuel Bellón
- Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcalá. Madrid, Spain
- Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain
- * E-mail:
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