Biomaterial-dependent MMP-2 expression in fibroblasts from patients with recurrent incisional hernias

Abstract

With regard to the pathogenesis of recurrent incisional hernia, an impaired connective tissue quality leading to an aberrant scarring process has been proposed. For the matrix metalloproteinase (MMP-2) a pathogenetic involvement in direct inguinal hernia development is reported. With mesh implantation as the gold standard treatment for incisional hernias, the aim of the present study was to investigate the MMP-2 expression in patients with recurrent incisional hernias with and without mesh-materials. In primary fibroblast cultures obtained from skin scars in patients with and without recurrent incisional hernias, MMP-2 synthesis and gene expression were investigated. Furthermore, MMP-2 synthesis and gene expression of fibroblasts were compared after incubation with two different mesh materials: polypropylene and absorbable polyglactin filaments. MMP-2 enzyme activity was determined by semiquantitative zymography and mRNA synthesis by quantitative RT-PCR. Both MMP-2 enzyme activity and mRNA expression were similar in hernia and control fibroblasts in vitro. In control fibroblasts mesh incubation did not significantly affect MMP-2 expression, whereas polypropylene mesh contact of fibroblasts from patients with recurrent incisional hernias led to a major decrease of MMP-2 activity and of mRNA expression. In the absence of biomaterials fibroblasts from recurrent incisional hernia, patients have no alterations of their MMP-2 synthesis compared to control fibroblasts, whereas a specific response was found after biomaterial contact hereby indicating differences in fibroblast phenotype.

Impact of gentamicin-supplemented polyvinylidenfluoride mesh materials on MMP-2 expression and tissue integration in a transgenic mice model

“…It is suggested that the inflammatory mesh response is an underlying pathophysiological mechanism for chronic pain after mesh implantation [36]. Biomaterial implantation frequently induces a chronic wound that is characterized by activation of matrix metalloproteinases (MMPs) [26,37]. MMPs constitute a family of enzymes that degrade extracellular matrix components [38,39].…”

“…Whereas MMP-2 expression is necessary for a proper wound healing, high levels of MMP-2 are associated with chronic inflammatory processes such as arthritis or foreign body reaction [26]. Advanced investigations by Jansen et al revealed that mesh implantation mediates enhanced MMP-2 gene transcription with concomitantly up-regulated MMP-2 protein synthesis and enzymatic activity [27].…”

Connective tissue alteration in abdominal wall hernia

“…A fourth study found no difference in the MMP-1 level in the fascia transversalis of patients with an incisional hernia compared with controls, but the MMP-2 level was significantly increased 63 . A final study found no difference in the MMP-2 level in skin fibroblasts of patients with a recurrent incisional hernia compared with controls 74 . More research is needed on MMP activity in incisional hernia before conclusions can be drawn.…”

The incidence of incisional hernia after aortic aneurysm is not higher than after benign colorectal interventions

“…They are particularly important in the regulation of growth and apoptotic processes [21, 22]. There appears to be significant overexpression of MMP-2 in incisional hernia [23]. Since collagen synthesis can be suppressed by inflammatory processes, such as postoperative sepsis, the functionality of the various MMP and collagens may be impaired by the wound milieu [24].…”