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Liang K, Ding C, Li J, Yao X, Yu J, Wu H, Chen L, Zhang M. A Review of Advanced Abdominal Wall Hernia Patch Materials. Adv Healthc Mater 2024; 13:e2303506. [PMID: 38055999 DOI: 10.1002/adhm.202303506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 12/05/2023] [Indexed: 12/08/2023]
Abstract
Tension-free abdominal wall hernia patch materials (AWHPMs) play an important role in the repair of abdominal wall defects (AWDs), which have a recurrence rate of <1%. Nevertheless, there are still significant challenges in the development of tailored, biomimetic, and extracellular matrix (ECM)-like AWHPMs that satisfy the clinical demands of abdominal wall repair (AWR) while effectively handling post-operative complications associated with abdominal hernias, such as intra-abdominal visceral adhesion and abnormal healing. This extensive review presents a comprehensive guide to the high-end fabrication and the precise selection of these advanced AWHPMs. The review begins by briefly introducing the structures, sources, and properties of AWHPMs, and critically evaluates the advantages and disadvantages of different types of AWHPMs for AWR applications. The review subsequently summarizes and elaborates upon state-of-the-art AWHPM fabrication methods and their key characteristics (e.g., mechanical, physicochemical, and biological properties in vitro/vivo). This review uses compelling examples to demonstrate that advanced AWHPMs with multiple functionalities (e.g., anti-deformation, anti-inflammation, anti-adhesion, pro-healing properties, etc.) can meet the fundamental clinical demands required to successfully repair AWDs. In particular, there have been several developments in the enhancement of biomimetic AWHPMs with multiple properties, and additional breakthroughs are expected in the near future.
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Affiliation(s)
- Kaiwen Liang
- College of Material Engineering, Fujian Agriculture and Forestry University, Fuzhou, Fujian, 350002, P. R. China
| | - Cuicui Ding
- College of Ecological Environment and Urban Construction, Fujian University of Technology, Fuzhou, Fujian, 350118, P. R. China
| | - Jingyi Li
- School of Basic Medicine, Fujian Medical University, Fuzhou, Fujian, 350122, P. R. China
| | - Xiao Yao
- College of Ecological Environment and Urban Construction, Fujian University of Technology, Fuzhou, Fujian, 350118, P. R. China
| | - Jingjing Yu
- College of Ecological Environment and Urban Construction, Fujian University of Technology, Fuzhou, Fujian, 350118, P. R. China
| | - Hui Wu
- College of Material Engineering, Fujian Agriculture and Forestry University, Fuzhou, Fujian, 350002, P. R. China
| | - Lihui Chen
- College of Material Engineering, Fujian Agriculture and Forestry University, Fuzhou, Fujian, 350002, P. R. China
| | - Min Zhang
- College of Material Engineering, Fujian Agriculture and Forestry University, Fuzhou, Fujian, 350002, P. R. China
- National Forestry & Grassland Administration Key Laboratory for Plant Fiber Functional Materials, Fuzhou, Fujian, 350000, P. R. China
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Abudalu M, Aqawi M, Sionov RV, Friedman M, Gati I, Munz Y, Ohana G, Steinberg D. Polyglactin 910 Meshes Coated with Sustained-Release Cannabigerol Varnish Inhibit Staphylococcus aureus Biofilm Formation and Macrophage Cytokine Secretion: An In Vitro Study. Pharmaceuticals (Basel) 2023; 16:ph16050745. [PMID: 37242528 DOI: 10.3390/ph16050745] [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: 04/03/2023] [Revised: 05/02/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
Synthetic surgical meshes are commonly used in abdominal wall reconstruction surgeries to strengthen a weak abdominal wall. Common mesh-related complications include local infection and inflammatory processes. Because cannabigerol (CBG) has both antibacterial and anti-inflammatory properties, we proposed that coating VICRYL (polyglactin 910) mesh with a sustained-release varnish (SRV) containing CBG would prevent these complications. We used an in vitro infection model with Staphylococcus aureus and an in vitro inflammation model of lipopolysaccharide (LPS)-stimulated macrophages. Meshes coated with either SRV-placebo or SRV-CBG were exposed daily to S. aureus in tryptic soy medium (TSB) or macrophage Dulbecco's modified eagle medium (DMEM). Bacterial growth and biofilm formation in the environment and on the meshes were assessed by changes in optical density, bacterial ATP content, metabolic activity, crystal violet staining, spinning disk confocal microscopy (SDCM), and high-resolution scanning electron microscopy (HR-SEM). The anti-inflammatory effect of the culture medium that was exposed daily to the coated meshes was analyzed by measuring the release of the cytokines IL-6 and IL-10 from LPS-stimulated RAW 264.7 macrophages with appropriate ELISA kits. Additionally, a cytotoxicity assay was performed on Vero epithelial cell lines. We observed that compared with SRV-placebo, the segments coated with SRV-CBG inhibited the bacterial growth of S. aureus in the mesh environment for 9 days by 86 ± 4% and prevented biofilm formation and metabolic activity in the surroundings for 9 days, with respective 70 ± 2% and 95 ± 0.2% reductions. The culture medium that was incubated with the SRV-CBG-coated mesh inhibited LPS-induced secretion of IL-6 and IL-10 from the RAW 264.7 macrophages for up to 6 days without affecting macrophage viability. A partial anti-inflammatory effect was also observed with SRV-placebo. The conditioned culture medium was not toxic to Vero epithelial cells, which had an IC50 of 25 µg/mL for CBG. In conclusion, our data indicate a potential role of coating VICRYL mesh with SRV-CBG in preventing infection and inflammation in the initial period after surgery.
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Affiliation(s)
- Mustafa Abudalu
- The Biofilm Research Laboratory, The Institute of Biomedical and Oral Research (IBOR), The Faculty of Dental Medicine, The Hebrew University of Jerusalem, Jerusalem 9112102, Israel
- Department of General Surgery, Barzilai Medical Center, Ashkelon 7830604, Israel
| | - Muna Aqawi
- The Biofilm Research Laboratory, The Institute of Biomedical and Oral Research (IBOR), The Faculty of Dental Medicine, The Hebrew University of Jerusalem, Jerusalem 9112102, Israel
- The Institute of Drug Research, School of Pharmacy, The Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Ronit Vogt Sionov
- The Biofilm Research Laboratory, The Institute of Biomedical and Oral Research (IBOR), The Faculty of Dental Medicine, The Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Michael Friedman
- The Institute of Drug Research, School of Pharmacy, The Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Irith Gati
- The Institute of Drug Research, School of Pharmacy, The Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Yaron Munz
- Department of General Surgery, Barzilai Medical Center, Ashkelon 7830604, Israel
| | - Gil Ohana
- Department of General Surgery, Barzilai Medical Center, Ashkelon 7830604, Israel
| | - Doron Steinberg
- The Biofilm Research Laboratory, The Institute of Biomedical and Oral Research (IBOR), The Faculty of Dental Medicine, The Hebrew University of Jerusalem, Jerusalem 9112102, Israel
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Deeken CR, Chen DC, Lopez-Cano M, Martin DP, Badhwar A. Fully resorbable poly-4-hydroxybutyrate (P4HB) mesh for soft tissue repair and reconstruction: A scoping review. Front Surg 2023; 10:1157661. [PMID: 37123542 PMCID: PMC10130450 DOI: 10.3389/fsurg.2023.1157661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 03/22/2023] [Indexed: 05/02/2023] Open
Abstract
Background Poly-4-hydroxybutyrate (P4HB) is a fully resorbable, biologically-produced polymer with a strength and flexibility comparable to permanent synthetic polymers. The objective was to identify/summarize all peer-reviewed publications involving P4HB mesh. Methods A scoping review was conducted within PubMed and included articles published through October 2022. Results A total of n = 79 studies were identified (n = 12 in vitro/bench; n = 14 preclinical; n = 6 commentaries; n = 50 clinical). Of the clinical studies, n = 40 reported results applicable to hernia and n = 10 to plastic/reconstructive surgery and involved patients of all Centers for Disease Control (CDC) wound classes and Ventral Hernia Working Group (VHWG) grades. Conclusion P4HB mesh provides long-term hernia repair strength and exhibits promising clinical outcomes beyond its resorption period. Future studies should include randomized controlled trials comparing P4HB to other biomaterials, as well as optimal patient selection, operative technique, long-term outcomes, minimization of potential mesh-related complications, and potential contraindications/complications for P4HB in hernia/abdominal wall reconstruction.
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Affiliation(s)
| | - David C. Chen
- Section of Minimally Invasive Surgery, David Geffen School of Medicine at University of California, Los Angeles, Santa Monica, CA, United States
| | - Manuel Lopez-Cano
- Hospital Universitario Vall d'Hebrón, Universidad Autónoma de Barcelona, Barcelona, Spain
| | | | - Amit Badhwar
- Becton, Dickinson and Company, Warwick, RI, United States
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Biehl A, Gracioso Martins AM, Davis ZG, Sze D, Collins L, Mora-Navarro C, Fisher MB, Freytes DO. Towards a standardized multi-tissue decellularization protocol for the derivation of extracellular matrix materials. Biomater Sci 2023; 11:641-654. [PMID: 36504129 PMCID: PMC9844390 DOI: 10.1039/d2bm01012g] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 11/21/2022] [Indexed: 12/14/2022]
Abstract
The goal of tissue decellularization is to efficiently remove unwanted cellular components, such as DNA and cellular debris, while retaining the complex structural and molecular milieu within the extracellular matrix (ECM). Decellularization protocols to date are centered on customized tissue-specific and lab-specific protocols that involve consecutive manual steps which results in variable and protocol-specific ECM material. The differences that result from the inconsistent protocols between decellularized ECMs affect consistency across batches, limit comparisons between results obtained from different laboratories, and could limit the transferability of the material for consistent laboratory or clinical use. The present study is the first proof-of-concept towards the development of a standardized protocol that can be used to derive multiple ECM biomaterials (powders and hydrogels) via a previously established automated system. The automated decellularization method developed by our group was used due to its short decellularization time (4 hours) and its ability to reduce batch-to-batch variability. The ECM obtained using this first iteration of a unified protocol was able to produce ECM hydrogels from skin, lung, muscle, tendons, cartilage, and laryngeal tissues. All hydrogels formed in this study were cytocompatible and showed gelation and rheological properties consistent with previous ECM hydrogels. The ECMs also showed unique proteomic composition. The present study represents the first step towards developing standardized protocols that can be used on multiple tissues in a fast, scalable, and reproducible manner.
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Affiliation(s)
- Andreea Biehl
- Joint Department of Biomedical Engineering, North Carolina State University & University of North Carolina-Chapel Hill, 4130 Engineering Building III, Campus Box 7115, Raleigh, NC 27695, USA.
- Comparative Medicine Institute, North Carolina State University, 1060 William Moore Drive, Raleigh, NC 27606, USA
| | - Ana M Gracioso Martins
- Joint Department of Biomedical Engineering, North Carolina State University & University of North Carolina-Chapel Hill, 4130 Engineering Building III, Campus Box 7115, Raleigh, NC 27695, USA.
- Comparative Medicine Institute, North Carolina State University, 1060 William Moore Drive, Raleigh, NC 27606, USA
| | - Zachary G Davis
- Joint Department of Biomedical Engineering, North Carolina State University & University of North Carolina-Chapel Hill, 4130 Engineering Building III, Campus Box 7115, Raleigh, NC 27695, USA.
- Comparative Medicine Institute, North Carolina State University, 1060 William Moore Drive, Raleigh, NC 27606, USA
| | - Daphne Sze
- Joint Department of Biomedical Engineering, North Carolina State University & University of North Carolina-Chapel Hill, 4130 Engineering Building III, Campus Box 7115, Raleigh, NC 27695, USA.
- Comparative Medicine Institute, North Carolina State University, 1060 William Moore Drive, Raleigh, NC 27606, USA
| | - Leonard Collins
- Molecular Education, Technology and Research Innovation Center (METRIC), North Carolina State University, Dabney Hall, 2620 Yarbrough Drive, Raleigh, NC 27607, USA
| | - Camilo Mora-Navarro
- Department of Chemical Engineering, University of Puerto Rico-Mayaguez, Route 108, Mayaguez, Puerto Rico, USA
| | - Matthew B Fisher
- Joint Department of Biomedical Engineering, North Carolina State University & University of North Carolina-Chapel Hill, 4130 Engineering Building III, Campus Box 7115, Raleigh, NC 27695, USA.
- Comparative Medicine Institute, North Carolina State University, 1060 William Moore Drive, Raleigh, NC 27606, USA
- Department of Orthopaedics, University of North Carolina School of Medicine, 102 Mason Farm Road Second Floor, Chapel Hill, NC 27514, USA
| | - Donald O Freytes
- Joint Department of Biomedical Engineering, North Carolina State University & University of North Carolina-Chapel Hill, 4130 Engineering Building III, Campus Box 7115, Raleigh, NC 27695, USA.
- Comparative Medicine Institute, North Carolina State University, 1060 William Moore Drive, Raleigh, NC 27606, USA
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Mora-Navarro C, Garcia ME, Sarker P, Ozpinar EW, Enders JR, Khan S, Branski RC, Freytes DO. Monitoring decellularization via absorbance spectroscopy during the derivation of extracellular matrix scaffolds. Biomed Mater 2021; 17. [PMID: 34731852 PMCID: PMC9416610 DOI: 10.1088/1748-605x/ac361f] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 11/03/2021] [Indexed: 11/12/2022]
Abstract
Extracellular matrix (ECM) is a complex structure composed of bioactive molecules representative of the local tissue microenvironment. Decellularized ECM biomaterials harness these biomolecules for regenerative medicine applications. One potential therapeutic application is the use of vocal fold (VF) specific ECM to restore the VFs after injury. ECM scaffolds are derived through a process of decellularization, which aims to remove unwanted immunogenic biomolecules (e.g. DNA) while preserving the composition of the ECM. The effectiveness of the decellularization is typically assessed at the end by quantifying ECM attributes such as final dsDNA content. However, batch-to-batch variability in ECM manufacturing remains a significant challenge for the standardization, cost-effectiveness, and scale-up process. The limited number of tools available for in-process control heavily restricts the uncovering of the correlations between decellularization process parameters and ECM attributes. In this study, we developed a technique applicable to both the classical batch method and semi-continuous decellularization systems to trace the decellularization of two laryngeal tissues in real-time. We hypothesize that monitoring the bioreactor’s effluent absorbance at 260 nm as a function of time will provide a representative DNA release profile from the tissue and thus allow for process optimization. The DNA release profiles were obtained for laryngeal tissues and were successfully used to optimize the derivation of VF lamina propria-ECM (auVF-ECM) hydrogels. This hydrogel had comparable rheological properties to commonly used biomaterials to treat VF injuries. Also, the auVF-ECM hydrogel promoted the down-regulation of CCR7 by THP-1 macrophages upon lipopolysaccharide stimulation in vitro suggesting some anti-inflammatory properties. The results show that absorbance profiles are a good representation of DNA removal during the decellularization process thus providing an important tool to optimize future protocols.
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Affiliation(s)
- Camilo Mora-Navarro
- Joint Department of Biomedical Engineering, North Carolina State and University of North Carolina-Chapel Hill, Raleigh, NC, United States of America.,Comparative Medicine Institute, North Carolina State University, Raleigh, NC, United States of America.,Department of Chemical Engineering, University of Puerto Rico, Mayaguez, PR, United States of America
| | - Mario E Garcia
- Joint Department of Biomedical Engineering, North Carolina State and University of North Carolina-Chapel Hill, Raleigh, NC, United States of America
| | - Prottasha Sarker
- Department of Chemical and Biomolecular Engineering, North Carolina State University, Raleigh, NC 27695, United States of America
| | - Emily W Ozpinar
- Joint Department of Biomedical Engineering, North Carolina State and University of North Carolina-Chapel Hill, Raleigh, NC, United States of America.,Comparative Medicine Institute, North Carolina State University, Raleigh, NC, United States of America
| | - Jeffrey R Enders
- Molecular Education, Technology and Research Innovation Center, North Carolina State University, Raleigh, NC, United States of America.,Department of Biological Sciences, North Carolina State University, Raleigh, NC, United States of America
| | - Saad Khan
- Department of Chemical and Biomolecular Engineering, North Carolina State University, Raleigh, NC 27695, United States of America
| | - Ryan C Branski
- Departments of Rehabilitation Medicine and Otolaryngology-Head and Neck Surgery, NYU Grossman School of Medicine, New York, NY, United States of America
| | - Donald O Freytes
- Joint Department of Biomedical Engineering, North Carolina State and University of North Carolina-Chapel Hill, Raleigh, NC, United States of America.,Comparative Medicine Institute, North Carolina State University, Raleigh, NC, United States of America
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