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Mardina Z, Venezuela J, Maher C, Shi Z, Dargusch M, Atrens A. Design, mechanical and degradation requirements of biodegradable metal mesh for pelvic floor reconstruction. Biomater Sci 2022; 10:3371-3392. [DOI: 10.1039/d2bm00179a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Pelvic organ prolapse (POP) is the herniation of surrounding tissue and organs into the vagina and or rectum, and is a result of weakening of pelvic floor muscles, connective tissue,...
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Bronzatto E, Riccetto CLZ. Pro - inflammatory cytokines and metalloproteinase activation in polypropylene mesh implant in rat subcutaneous tissue. Int Braz J Urol 2018; 44:819-825. [PMID: 29757569 PMCID: PMC6092648 DOI: 10.1590/s1677-5538.ibju.2016.0553] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 03/06/2018] [Indexed: 11/22/2022] Open
Abstract
AIMS AND OBJECTIVES Polypropylene meshes have been increasingly adopted for correction of pelvic organ prolapse due to its lower recurrence rate when compared to surgeries without meshes. The study of the interaction of these materials with the host tissue may contribute to the development of materials with best biocompatibility and, consequently, less complication rates. MATERIALS AND METHODS The present study compares the inflammatory reaction of standard-weight (SW) and lightweight (LW) meshes (72 g/m216g/m2 respectively), implanted in the abdomen of 20 adult rats, which were euthanized in four or 30 days. Quantification of pro-inflammatory markers, IL-1 and TNF-α, and of metalloproteinases, MMP2 and MMP3, were carried out through immunohistochemistry with AxioVision ® software. RESULTS There were no significant differences in the quantification of IL-1 and TNF-α in LW versus SW meshes. However, IL-1 quantification increased along time (30 days >4 days, p=0.0269). Also, MMP-2 quantification was similar to SW and LW and both presented a significant increase along time (30 days >4 days, p < 0.0001). MMP-3 quantification also showed no difference between the SW and LW groups, but increased along time (30 days >4 days, p=0.02). CONCLUSIONS Mesh's density did not influence the quantification of pro-inflammatory cytokines IL-1 and TNF-α and metalloproteinases 2 and 3. The increased expression of IL-1, MMP-2 and MMP-3 over time could represent a longstanding inflammatory response after PP mesh implantation. Possibly, the occurrence of adverse events following PP prosthetic implants can be influenced by other factors, not solely related to the amount of implanted material.
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Affiliation(s)
- Elaine Bronzatto
- Departamento de Urologia, Universidade Estadual de Campinas - Unicamp, Campinas, SP, Brasil
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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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Prudente A, Favaro WJ, Latuf P, Riccetto CLZ. Host inflammatory response to polypropylene implants: insights from a quantitative immunohistochemical and birefringence analysis in a rat subcutaneous model. Int Braz J Urol 2017; 42:585-93. [PMID: 27286125 PMCID: PMC4920579 DOI: 10.1590/s1677-5538.ibju.2015.0289] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 08/18/2015] [Indexed: 01/22/2023] Open
Abstract
Objectives To describe acute and sub acute aspects of histological and immunohistochemical response to PP implant in a rat subcutaneous model based on objective methods. Materials and Methods Thirty rats had a PP mesh subcutaneously implanted and the same dissection on the other side of abdomen but without mesh (sham). The animals were euthanized after 4 and 30 days. Six slides were prepared using the tissue removed: one stained with hematoxylin-eosin (inflammation assessment); one unstained (birefringence evaluation) and four slides for immunohistochemical processing: IL-1 and TNF-α (pro-inflammatory cytokines), MMP-2 (collagen metabolism) and CD-31 (angiogenesis). The area of inflammation, the birefringence index, the area of immunoreactivity and the number of vessels were objectively measured. Results A larger area of inflammatory reaction was observed in PP compared to sham on the 4th and on the 30th day (p=0.0002). After 4 days, PP presented higher TNF (p=0.0001) immunoreactivity than sham and no differences were observed in MMP-2 (p=0.06) and IL-1 (p=0.08). After 30 days, a reduction of IL-1 (p=0.010) and TNF (p=0.016) for PP and of IL-1 (p=0.010) for sham were observed. Moreover, area of MMP-2 immunoreactivity decreased over time for PP group (p=0.018). Birefringence index and vessel counting showed no differences between PP and sham (p=0.27 and p=0.58, respectively). Conclusions The implantation of monofilament and macroporous polypropylene in the subcutaneous of rats resulted in increased inflammatory activity and higher TNF production in the early post implant phase. After 30 days, PP has similar cytokines immunoreactivity, vessel density and extracellular matrix organization.
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Affiliation(s)
- Alessandro Prudente
- Faculdade de Ciências Médicas da Universidade de Campinas, Campinas, SP, Brasil
| | | | - Paulo Latuf
- Laboratório de Investigação Patologica, Centro de Investigação em Pediatria,Universidade de Campinas, Campinas, SP, Brasil
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Transforming growth factor β1 and extracellular matrix protease expression in the uterosacral ligaments of patients with and without pelvic organ prolapse. Female Pelvic Med Reconstr Surg 2016; 21:53-8. [PMID: 25185601 DOI: 10.1097/spv.0000000000000130] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES This study was undertaken to evaluate the expression of transforming growth factor β1 (TGF-β1) and matrix metalloproteinase 9 (MMP-9), key regulators of the extracellular matrix composition, in the uterosacral ligaments (USLs) of women with pelvic organ prolapse (POP) compared with controls. METHODS Under an institutional review board approval, USL samples were obtained from women undergoing vaginal hysterectomy for stage 2 or greater POP (cases, n = 21) and from women without POP undergoing vaginal hysterectomy for benign indications (controls, n = 19). Hematoxylin and eosin and trichrome staining were performed on the USL sections, and the distribution of smooth muscle and fibrous tissue were quantified. Immunohistochemical staining was performed using anti-TGF-β1 and anti-MMP-9 antibodies. The expressions of TGF-β1 and MMP-9 were evaluated by the pathologist, who was blinded to all clinical data. RESULTS Transforming growth factor β1 expression positively correlated with MMP-9 expression (R = 0.4, P = 0.01). The expressions of TGF-β1 and MMP-9 were similar in subjects with POP versus controls. There was a significant increase in fibrous tissue (P = 0.008) and a corresponding decrease in smooth muscle (P = 0.03), associated with increasing age. The TGF-β1 expression, but not MMP-9 expression, also significantly increased with age (P = 0.02). DISCUSSION Although our study uncovered age-related alterations in USL composition and TGF-β1 expression, there was no difference in the expression of TGF-β1 or MMP-9 in the subjects with POP versus controls.
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Xu R, Taskin MB, Rubert M, Seliktar D, Besenbacher F, Chen M. hiPS-MSCs differentiation towards fibroblasts on a 3D ECM mimicking scaffold. Sci Rep 2015; 5:8480. [PMID: 25684543 PMCID: PMC4329554 DOI: 10.1038/srep08480] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 01/22/2015] [Indexed: 12/11/2022] Open
Abstract
Fibroblasts are ubiquitous cells that constitute the stroma of virtually all tissues and play vital roles in homeostasis. The poor innate healing capacity of fibroblastic tissues is attributed to the scarcity of fibroblasts as collagen-producing cells. In this study, we have developed a functional ECM mimicking scaffold that is capable to supply spatial allocation of stem cells as well as anchorage and storage of growth factors (GFs) to direct stem cells differentiate towards fibroblasts. Electrospun PCL fibers were embedded in a PEG-fibrinogen (PF) hydrogel, which was infiltrated with connective tissue growth factor (CTGF) to form the 3D nanocomposite PFP-C. The human induced pluripotent stem cells derived mesenchymal stem cells (hiPS-MSCs) with an advance in growth over adult MSCs were applied to validate the fibrogenic capacity of the 3D nanocomposite scaffold. The PFP-C scaffold was found not only biocompatible with the hiPS-MSCs, but also presented intriguingly strong fibroblastic commitments, to an extent comparable to the positive control, tissue culture plastic surfaces (TCP) timely refreshed with 100% CTGF. The novel scaffold presented not only biomimetic ECM nanostructures for homing stem cells, but also sufficient cell-approachable bio-signaling cues, which may synergistically facilitate the control of stem cell fates for regenerative therapies.
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Affiliation(s)
- Ruodan Xu
- interdisciplinary Nanoscience Center (iNANO), Aarhus University, Gustav Wieds Vej 14, 8000 Aarhus C, Denmark
| | - Mehmet Berat Taskin
- interdisciplinary Nanoscience Center (iNANO), Aarhus University, Gustav Wieds Vej 14, 8000 Aarhus C, Denmark
| | - Marina Rubert
- interdisciplinary Nanoscience Center (iNANO), Aarhus University, Gustav Wieds Vej 14, 8000 Aarhus C, Denmark
| | - Dror Seliktar
- Faculty of Biomedical Engineering, Technion-Israel Institute of Technology, Haifa 32000, Israel
- The Russell Berrie Nanotechnology Institute, Technion-Israel Institute of Technology, Haifa 32000, Israel
| | - Flemming Besenbacher
- interdisciplinary Nanoscience Center (iNANO), Aarhus University, Gustav Wieds Vej 14, 8000 Aarhus C, Denmark
| | - Menglin Chen
- interdisciplinary Nanoscience Center (iNANO), Aarhus University, Gustav Wieds Vej 14, 8000 Aarhus C, Denmark
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Lim VF, Khoo JK, Wong V, Moore KH. Recent studies of genetic dysfunction in pelvic organ prolapse: the role of collagen defects. Aust N Z J Obstet Gynaecol 2014; 54:198-205. [PMID: 24575973 DOI: 10.1111/ajo.12169] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 11/16/2013] [Indexed: 12/13/2022]
Abstract
Gynaecologists are becoming increasingly aware that women with a family history of prolapse are at an increased risk of prolapse refractory to treatment. In the past five years, several genetic mutations have been shown to correlate with increased prolapse susceptibility. These mutations can result in disordered collagen metabolism, which weaken the fascial support of the pelvic organs. This review examines the contemporary evidence regarding the role of collagen in prolapse.
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Affiliation(s)
- Veronica F Lim
- Pelvic Floor Unit, St George Hospital/University of New South Wales, Sydney, NSW, Australia
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Leppert PC. Tissue remodeling in the female reproductive tract--a complex process becomes more complex: the role of Hox genes. Biol Reprod 2012; 86:98. [PMID: 22302691 DOI: 10.1095/biolreprod.112.099283] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Phyllis C Leppert
- Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina 27710, USA.
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Pelvic organ distribution of mesenchymal stem cells injected intravenously after simulated childbirth injury in female rats. Obstet Gynecol Int 2011; 2012:612946. [PMID: 21941558 PMCID: PMC3177359 DOI: 10.1155/2012/612946] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2011] [Accepted: 06/26/2011] [Indexed: 12/30/2022] Open
Abstract
The local route of stem cell administration utilized presently in clinical trials for stress incontinence may not take full advantage of the capabilities of these cells. The goal of this study was to evaluate if intravenously injected mesenchymal stem cells (MSCs) home to pelvic organs after simulated childbirth injury in a rat model. Female rats underwent either vaginal distension (VD) or sham VD. All rats received 2 million GFP-labeled MSCs intravenously 1 hour after injury. Four or 10 days later pelvic organs and muscles were imaged for visualization of GFP-positive cells. Significantly more MSCs home to the urethra, vagina, rectum, and levator ani muscle 4 days after VD than after sham VD. MSCs were present 10 days after injection but GFP intensity had decreased. This study provides basic science evidence that intravenous administration of MSCs could provide an effective route for cell-based therapy to facilitate repair after injury and treat stress incontinence.
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Gill BC, Moore C, Damaser MS. Postpartum stress urinary incontinence: lessons from animal models. EXPERT REVIEW OF OBSTETRICS & GYNECOLOGY 2010; 5:567-580. [PMID: 21113428 PMCID: PMC2989536 DOI: 10.1586/eog.10.48] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Postpartum stress urinary incontinence (SUI) is associated with chronic SUI in later life, which is 240% more likely to occur in women who deliver vaginally than those who did not. The etiology of SUI is multifactoral and has been associated with defects in both neuromuscular and structural components of continence. Specifically, clinical studies have demonstrated that pudendal nerve damage occurs during vaginal delivery, supporting the concept that neuromuscular damage to the continence mechanism can result in postpartum SUI. Urethral hypermobility and the loss of pelvic floor support, such as that involved in pelvic organ prolapse, have also been associated with SUI. Animal models provide an opportunity to investigate these injuries, individually and in combination, enabling researchers to gain further insight into their relative contributions to the development of SUI and the effectiveness of potential therapies for it. This article discusses the use of animal models of postpartum SUI in addition to the broad insights into treatment efficacy they provide.
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Affiliation(s)
- Bradley C Gill
- Cleveland Clinic Lerner College of Medicine, Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH 44195, USA
| | - Courtenay Moore
- Glickman Urological and Kidney Institute, Lerner College of Medicine, Cleveland Clinic, 9500 Euclid Ave, Q10, Cleveland, OH 44195, USA
| | - Margot S Damaser
- Department of Biomedical Engineering, Glickman Urological and Kidney Institute, Lerner College of Medicine, Cleveland Clinic, 9500 Euclid Ave, ND20, Cleveland, OH 44195, USA
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