Mesh biocompatibility: effects of cellular inflammation and tissue remodelling

Abstract

Mesh biocompatibility is basically determined by the foreign body reaction (FBR). In contrast to physiological wound healing and scar formation, the FBR at the host-tissue/biomaterial interface is present for the lifetime of the medical device. The cellular interactions at the mesh/tissue interface proceed over time ending up in a chronic inflammatory process. The time course of the FBR has been studied extensively and consists of three crucial steps that are protein absorption, cell recruitment and, finally, fibrotic encapsulation and extracellular matrix formation. Each of these steps involves a complex cascade of immune modulators including soluble mediators and various cell types. Recent research has focused on the cellular and molecular interactions of the distinct phases of the FBR offering a new basis for therapeutical strategies. The highly dynamic process of the FBR is considerably influenced by the biomaterial composition. Modifications of the type of polymer, the material weight, the filament structure and the pore size are realized and have substantial effects on the in vivo biocompatibility. Moreover, modern mesh technology aims to utilize the available implants as carrier systems for bioactive drugs. Studies in animal models account for the efficiency of these drugs that aim to reduce mesh-related infections or to minimize FBR by influencing inflammation or extracellular matrix remodelling. A thorough understanding of the molecular mechanisms of FBR provides a sophisticated background for the development of new biomaterials at least as carrier systems for bioactive reagents to reduce inflammation and to improve clinical outcome.

Physical Properties of Polypeptide Electrospun Nanofiber Cell Culture Scaffolds on a Wettable Substrate

“…Cell-substrate interactions in serum-supplemented tissue culture in vitro are relevant to cell adhesion, proliferation, morphology, activation, differentiation and senescence [34]. In vivo, serum protein adsorption onto a biomaterial plays a crucial role in the foreign body response, leading in turn to the broad range of clinical complications associated with device implantation [35].…”

The range and potential contribution of irreversibly adsorbed proteins on the surface of artificial implants

“…Это определяет не только способность протеза к интеграции, но и его терапевтический потенциал, направленный не только на устранение грыжи, но и снижение числа осложнений, связанных с его имплантацией [5]. Особую роль в этих процессах отводят белкам, содержащим RGD-последовательности: фибриноген, фибронектин и витронектин, иммуноглобулин G, компонент комплемента С 3 , принимающий участие в каскадной активации комплемента и продукции хемотаксических агентов С 4-5b и С 3a [6].…”

Surgical mesh for ventral incisional hernia repairs:Understanding mesh design

“…Subsequently, immune cells are recruited and giant cells form and establish granulomas around the foreign material. Ultimately, a fibrotic capsule forms around the foreign material (55,56). Of the materials commonly used as mesh, polypropylene may elicit the strongest foreign-body reaction (56).…”

“…Ultimately, a fibrotic capsule forms around the foreign material (55,56). Of the materials commonly used as mesh, polypropylene may elicit the strongest foreign-body reaction (56). Additionally, multifilamentous polypropylene mesh may promote added fibrosis compared with monofilamentous polypropylene (57).…”

“…As the pore size increases to 100 μm to 300 μm, neovascularization and tissue integration are frequently observed, but granuloma bridging becomes a concern (56). Granuloma bridging, or the coalescence of the foreign body response around mesh fibres, can clog the pores and prevent further tissue integration (Figure 4) (56). In polypropylene meshes, when pore sizes are <1 mm, granulomas can become confluent, encapsulate the mesh and create a stiff plate with reduced flexibility (70,(74)(75)(76).…”