Surface Modification of Polypropylene Mesh with a Porcine Cholecystic Extracellular Matrix Hydrogel for Mitigating Host Tissue Reaction

Abstract

Polypropylene (PP) meshes are widely used for repairing skeletal muscle defects like abdominal hernia despite the chances of undesirable pro-inflammatory tissue reactions that demand revision surgeries in about 45% of cases. Attempts have been made to address the problem by modifying the mesh surface and architecture. These procedures have yielded only incremental improvements in the management of overall postoperative complications, and the search for a clinically viable therapeutic strategy continues. This study deployed a tissue engineering approach for mitigating PP-induced adverse tissue reaction by dip-coating the mesh with a hydrogel formulation of the porcine cholecystic extracellular matrix (CECM). The biomaterial properties of the CECM hydrogel-coated PP (C-PP) meshes were studied and their biocompatibility was evaluated by in vitro and in vivo tests based on ISO standards. Further, the nature of tissue reactions induced by the hydrogel-coated mesh and a commercial PP hernia repair graft was compared in a rat model of partial-thickness abdominal wall defect. Histomorphologically, in comparison with the PP graft-induced tissue reaction, C-PP caused a favorable graft-acceptance response characterized by reduced numbers of pro-inflammatory M1 macrophages and cytotoxic lymphocytes. Remarkably, the differential inflammatory response of the C-PP graft-assisted healing was associated with a fibrotic reaction predominated by deposition of type I collagen rather than type III collagen, as desired during skeletal muscle repair. It was concluded that the CECM hydrogel is a potential biomaterial for surface modification of polymeric biomedical devices.

Coatings for Permanent Meshes Used to Enhance Healing in Abdominal Hernia Repair: A Scoping Review

“…24,28 Extracellular matrix coatings showed either negative or neutral impacts on collagen deposition, neovascularization, and tensile strength, yet they were beneficial for reducing inflammation and foreign body reactions. [31][32][33] Hydrogel and collagen coatings yielded mixed results, ranging from positive to no significant differences. 36,37,39,41 Chitosan, a resorbable coating, showed no biomechanical response in two studies, but one study reported improvements in collagen deposition, neovascularization, inflammation, and foreign body reaction.…”

“…The studies used different test subjects: five used mice, 19-23 36 rats, 24-59 eight rabbits, 60-67 one dogs, 68 two pigs, 69,70 and six used humans. 10,12,71-74 The studies comprised a total of 408 humans and 2679 animals.…”

Research and application of polypropylene: a review

“…Ganjalinia et al reported PP with a Lactic acid-based mat for use as a scaffold in the body [ 41 ]. Also, a mesh with PP, after modifying its surface, has been prepared for the preparation of biomedical devices [ 42 ]. PP/CNT and hydroxyapatite nanocomposite in human subchondral bone are produced by Khan et al [ 43 ].…”

Latest Trends on the Attenuation of Systemic Foreign Body Response and Infectious Complications of Synthetic Hernia Meshes

“…It dramatically reduced collagen deposition and increased angiogenesis, promoting the regeneration of natural tissues. Raj et al attenuated the adverse tissue reaction induced by PP mesh by dip-coating the mesh with a hydrogel formulation of porcine gallbladder ECM. In a rat model, C-PP attenuated the tissue response and reduced the number of pro-inflammatory M1 macrophages and cytotoxic lymphocytes compared to PP mesh, resulting in an altered fibrotic response that facilitated the repair of tissue defects.…”