Electrospun biodegradable microfibers induce new collagen formation in a rat abdominal wall defect model: A possible treatment for pelvic floor repair?

Abstract

Half of the female population over age 50 years will experience pelvic organ prolapse. We suggest a new approach based on tissue engineering principles to functionally reconstruct the anatomical structures of the pelvic floor. The aim of this study is to investigate the mechanical performance and effect on collagen and elastin production of a degradable mesh releasing basic fibroblast growth factor (bFGF). Implantation of biodegradable mesh with or without bFGF in their core has been conducted in 40 rats in an abdominal wall defect model. Samples were explanted after 4, 8, and 24 weeks, and tested for mechanical properties and the composition of connective tissue. The study showed an increase in mRNA expression for collagen-I (p = 0.0060) and collagen-III (p = 0.0086) in the 4 weeks group with bFGF. The difference was equalized at 8 and 24 weeks. No difference was found at any time for protein amount for collagen-I, collagen-III, and fibronectin. The amount of collagen decreased from 4 to 24 weeks but the fraction of collagen increased. The maximal load of the newly formed tissue showed no effect of bFGF at any time. Exclusively, histology showed a limited ingrowth of collagen fibers after 4 weeks with bFGF but signs of elastin fibers were seen at 24 weeks. The investigation showed that a biodegradable mesh promotes tissue formation with a promising strength. The mesh with bFGF did not represent any advantage on either long or short term in comparison to the mesh without bFGF. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 680-688, 2018.

Electrospun nanofiber mesh with fibroblast growth factor and stem cells for pelvic floor repair

“…This indicates an undesirable regenerative capacity of hollow fibers PCL fibers resulting in an imbalance between mesh degradation rate and collagen formation resulting in herniation. The herniation tendency following implantation of hollow fiber PCL meshes was also demonstrated by Glindtvad et al, 1 where bFGF-loaded hollow fibers were implanted in an identical rat model. Therefore, PCL meshes of hollow fibers alone do not meet the criteria for an optimal tissue-engineering strategy in the treatment of POP, because such a mesh is not capable of providing mechanical support, while the collagen formation is ongoing.…”

“…Histopathological examination also revealed a massive ingrowth of FBGCs in all sections consistent with an inflammatory response—a natural, physiologic process following implantation of a foreign material. The ingrowth of FBGCs in response to implantation of a PCL mesh is a known phenomenon . A severe inflammatory response can potentially compromise the functional outcome as well as integration of the mesh.…”

“…Alternative approaches in reconstruction of pelvic organ prolapse (POP) are requested to improve long‐term surgical outcomes. The optimal solution has been explored but not yet found . An estimation of 50% of parous women are affected by POP causing significant decrease in quality of life due to discomfort, chronic pain, urinary and fecal incontinence, and dyspareunia .…”

“…The optimal solution has been explored but not yet found. 1,2 An estimation of 50% of parous women are affected by POP causing significant decrease in quality of life due to discomfort, chronic pain, urinary and fecal incontinence, and dyspareunia. 3,4 Internationally, POP is defined as the descent of one or more of the vaginal wall, the uterus, the apex of the vagina, or cuff scar after hysterectomy.…”

The use of polymeric meshes for pelvic organ prolapse: Current concepts, challenges, and future perspectives

“…Moreover, fiberbased matrix in comparison to commercial surgical meshes have higher porosity, with pore size in a wider range, and fiber diameters down to the nanoscale (Liu et al, 2013). These characteristics provide environmental and physical cues to cell attachment, growth, and proliferation making them a suitable POP strategy (Glindtvad et al, 2018;Wang, Chen, Fan, & Hua, 2018;Watanabe, Kim, & Kim, 2011).…”