Modern surgical hernia repair depends increasingly on synthetic meshes for reconstruction of the abdominal wall. Despite the undisputed advantages of the synthetic meshes currently available, reports of late complications after implantation are accumulating. It is essential that the synthetic meshes be improved, but this makes a standardized animal model necessary for evaluation of their biocompatibility on both functional and morphological levels. In the present study, commercially available polypropylene and polyester meshes were implanted in a rat model, and detailed morphological and morphometric analysis were carried out. Correlations between the morphological and morphometric data and the function of the artificial abdominal wall were then sought. In summary, the data show that the mesh construction currently available are oversized and definitely restrict the function of the artificial abdominal wall. The degree of inflammation and fibrosis, the pattern of fibrosis, and the composition of the extracellular matrix exert decisive influences on the function. Fibrosis and inflammation are caused less by the material itself, however, than by its density, the way it is processed, and its surface. Future, that is to say second-generated, mesh constructions should be designed with the aims of reducing the amount of material used and finding material-specific processing methods in mind, to improve the functionally and morphologically defined biocompatibility.
For the in vitro study of cell-biomaterial surface interactions, the choice of cell type is crucial. In vivo data indicate that during the healing of the implant in the tissues, the pivotal cell types are the macrophages. These cells, upon interaction with any foreign material, might initiate a spectrum of responses, which could lead to acute and chronic inflammatory changes affecting the biocompatibility of the implant. Whether the mechanisms governing the type of evolving inflammatory reaction could be attributed to the macrophages functional differentiation mirrored by monocyte subsets during the polymer interaction, is poorly described. This in vitro study, therefore, attempted to investigate whether different biomaterials influence monocyte cellular activity, determined by the myeloperoxidase level and mitochondrial XTT cleavage, and phenotype dynamics characterized by the presence of CD14, RM 3/1 and 27E10 antigens. It is shown that different polymers exert differential potential to influence monocytes, both in their cellular activity and their phenotypic pattern. Thus, these findings demonstrating material-induced monocyte activation and monocyte phenotype modulation, are suggestive of the monocyte role as reporter cells in evaluating the biocompatibility of a synthetic medical device.
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