Influence of Mesh Materials on the Expression of Mediators Involved in Wound Healing

Abstract

The use of synthetic mesh for ventral hernia repair is widely accepted, but mesh-induced inflammatory responses may lead to postoperative complications. Molecular mechanisms that direct the extent of the foreign body reaction to implanted materials are poorly understood. This study compares the influence of three macroporous meshes on the expression of genes critical for wound healing and extracellular matrix remodeling in a rat model. Full thickness abdominal wall defects were corrected with polypropylene, polyester, polytetrafluoroethylene (PTFE), or suture repair with no mesh. Explants were harvested 7 or 90 days after repair and were divided for histological, immunohistochemical, and mRNA analyses. Real-time quantitative polymerase chain reaction arrays were used to profile the expression of 84 genes involved in angiogenesis at the tissue-mesh interface. Evaluation of gene expression profiles and histologic specimens revealed that polypropylene and polyester induced a greater and more persistent inflammatory response than PTFE, which elicited a response most similar to that induced by suture repair. Mesh implantation induced the differential expression (>3-fold change and p < .01) of genes encoding inflammatory cytokines, growth factors, and extracellular matrix proteins relative to suture repair without mesh. Genes most markedly upregulated included the neutrophil chemoattractant CXCL2 and matrix metalloproteinases 3 and 9. Polyester induced the greatest number of differentially expressed genes relative to suture repair both at 7 and 90 days after implantation. Results from this study suggest that the particular type of mesh used in a hernia repair may affect the patient's wound healing response and clinical outcome.

Tissue integration and inflammatory reaction in full-thickness abdominal wall repair using an innovative composite mesh

“…In contrast, other groups [25] have used a rat abdominal wall repair model to demonstrate that the polymeric nature of mesh affects the expression of inflammation and matrix remodeling mediators. Their results indicate that PP and polyester induce a greater inflammatory response than PTFE.…”

Biocompatibility and biomechanical analysis of elastic TPU threads as new suture material

“…PP is still seen as one of the favourite materials for the construction of biomaterials, like sutures. The polymer is seen as a material with good biocompatibility being a stable and relatively inert material and being able to induce only a moderate inflammatory reaction, with the ability to remain in the human body for extended periods of time . However, one of the negative aspects of this material is the relatively high bending stiffness, because some degree of elasticity is required for materials like sutures and meshes .…”

“…Although PU seems to have superior mechanical properties, the first and most important factor for its success should be the degree of foreign body reaction to the material. The presence of a more severe host response, leading to an excessive inflammatory and fibrotic response, could lead to more complications . A first indicator for this host response is the general composition and size of the foreign body granuloma surrounding the biomaterial .…”

The Comparison of Inflammatory Responses and Clinical Results After Groin Hernia Repair Using Polypropylene or Polyester Meshes

“…In a recent study, Asarias et al [18] evaluating gene expression profiles and histologic specimens reported that polypropylene and polyester induced a greater and more persistent inflammatory response than PTFE, which elicited a response most similar to that induced by suture repair. In the present study, it was shown that inflammatory response declined to baseline level at 48 h in Shouldice repair.…”