Tissue reaction to urogynecologic meshes: effect of steroid soaking in two different mesh models

Karabulut, Aysun Bay; Simavlı, Serap; Abban, Gülçin; Akyer, Şahika Pınar; Keskin, Nazan; Tan, Semih; Sahin, Barbaros

doi:10.1007/s00192-016-3013-9

Cited by 4 publications

(4 citation statements)

References 27 publications

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“…All specimens presented a pronounced FBR, which was restricted to the vicinity of the mesh fibers consisting of dense cellular infiltrates of mostly mononuclear cells. Using circular ROIs placed around mesh fibers, macrophages and T cells were found to be the predominant cell types within the FBG, which is in line with other studies on PP meshes [16,17,22,23]. T regs and T h were the most frequent T subsets with 25% and 19.2%, respectively, whereas T c were found at a lower rate of 13.5%.…”

Section: Discussionsupporting

confidence: 90%

Characterization of innate and adaptive immune cells involved in the foreign body reaction to polypropylene meshes in the human abdomen

Dievernich

Achenbach

Klinge

2021

Hernia

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Background Polypropylene (PP) mesh is widely used to reinforce tissues. The foreign body reaction (FBR) to the implant is dominated by innate immune cells, especially macrophages. However, considerable numbers of adaptive immune cells, namely T cells, have also been regularly observed, which appear to play a crucial role in the long-term host response. Methods This study investigated the FBR to seven human PP meshes, which were removed from the abdomen for recurrence after a median of one year. Using immunofluorescence microscopy, the FBR was examined for various innate (CD11b+ myeloid, CD68+ macrophages, CD56+ NK) and adaptive immune cells (CD3+ T, CD4+ T-helper, CD8+ cytotoxic, FoxP3+ T-regulatory, CD20+ B) as well as “conventional” immune cells (defined as cells expressing their specific immune cell marker without co-expressing CD68). Results T-helper cells (19%) and regulatory T-cells (25%) were present at comparable rates to macrophages, and clustered significantly toward the mesh fibers. For all cell types the lowest proportions of “conventional” cells (< 60%) were observed at the mesh–tissue interface, but increased considerably at about 50–100 µm, indicating reduced stimulation with rising distance to the mesh fibers. Conclusion Both innate and adaptive immune cells participate in the chronic FBR to PP meshes with T cells and macrophages being the predominant cell types, respectively. In concordance with the previous data, many cells presented a “hybrid” pattern near the mesh fibers. The complexity of the immune reaction seen within the foreign body granuloma may explain why approaches focusing on specific cell types have not been very successful in reducing the chronic FBR.

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Section: Discussionsupporting

confidence: 90%

Characterization of innate and adaptive immune cells involved in the foreign body reaction to polypropylene meshes in the human abdomen

Dievernich

Achenbach

Klinge

2021

Hernia

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“…However, ECM has a risk of immunogenicity and is limited in wide application by high cost, and the inflammatory response has been even more intense after coating collagen . Second, tissue-response modifiers were loaded on PP meshes to modulate inflammation, − but they cannot balance the anti-inflammatory activity and side effects caused by inappropriate release behaviors. Especially for bioactive proteins, such as enzyme and cytokine, their bioactivity is fragile in procedure and storage.…”

Section: Introductionmentioning

confidence: 99%

Dopamine-Mediated Zwitterionic Polyelectrolyte-Coated Polypropylene Hernia Mesh with Synergistic Anti-inflammation Effects

Qiao

Zhang

et al. 2020

Langmuir

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Over 20 million ventral hernia repairs are performed worldwide annually and only a minority (<10%) of cases are not mesh-based. However, even polypropylene (PP), endorsed as the "gold standard" of all prosthetic materials used in this field, is still subject to many complications caused by the foreign body reaction (FBR). Here, we describe the buildup of dopamine-mediated zwitterionic poly(sulfobetaine methacrylate) (PSBMA) coatings to inhibit nonspecific protein adsorption. Based on the universal adhesive ability of polydopamine (PDA), PSBMA has been coated on the PP mesh surface via two strategies: sequential deposition (PSBMA-PDA-PP) and co-deposition (PSBMA@PDA-PP). The presence of PSBMA shows great contribution to obviously decreased hydrophobicity of the PP surface (WCA co = 36.3°and WCA seq = 30.7°) as well as improved protein resistance (Reduction co = 74% and Reduction seq = 82%). Notably, as the intermedia between PP and PSBMA, PDA can endow the PP mesh with antioxidant activity, further featuring synergistic anti-inflammation therapeutic effect when coupled with PSBMA. With almost equal surface content of PSBMA, PSBMA-PDA-PP exhibited a more superior ability against macrophage adhesion and proliferation and showed more significantly decreased releases of TNF-α and IL-6 (p < 0.05) than those of PSBMA@PDA-PP, fundamentally attributed to its more neutral surface potential and the protection for polyphenols of PDA from oxidation with PSBMA as the outer layer. Furthermore, the coating layers demonstrated good stability and no sacrifice of the pristine mechanical property. The proposed dopamine-mediated PSBMA coatings possess high potential in biomedical implant areas for attenuating the FBR.

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“…8 In murine models, polyvinylidene fluoride (PVDF) mesh has been shown to be less inflammatory than polypropylene mesh. 9 In the present study, the DynaMesh-CESA (cervico-sacropexy following subtotal hysterectomy) or DynaMesh-VASA (vagino-sacropexy for post-hysterectomy vault prolapse) system (FEG Textiltechnik mbH, Aachen, Germany) was used. It is a macroporous monofilament PVDF mesh which allows mobility of the pelvic floor when under stress via its high shape stability and defined elasticity.…”

Section: Introductionmentioning

confidence: 99%

“…Abdominal sacrocolpopexy is associated with lower recurrence rates of vaginal vault prolapse, less post‐operative stress urinary incontinence, and less post‐operative dyspareunia than sacrospinous fixation . In murine models, polyvinylidene fluoride (PVDF) mesh has been shown to be less inflammatory than polypropylene mesh …”

Section: Introductionmentioning

confidence: 99%

Standardizing abdominal sacrocolpopexy for the treatment of apical prolapse: One year on

Cassis

Mukhopadhyay

Morris

2019

Intl J Gynecology & Obste

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Objective To determine the safety and efficacy of a standardized bilateral abdominal sacrocolpopexy using polyvinylidene fluoride mesh 1‐year post‐operatively. Methods In a retrospective observational study of women undergoing bilateral abdominal sacrocolpo/cervicopexy between July 2013 and October 2016 at the Norfolk and Norwich University Hospital, Norwich, UK, patients were assessed 1 year post‐operatively using the International Consultation on Incontinence Questionnaire—Vaginal Symptoms (ICIQ–VS). Results The study involved 100 women, 93 of whom were followed up 1 year post‐operatively. The primary outcome was apical prolapse rate, of which there were none. Eight women had anterior and four had posterior wall prolapses; four women required vaginal repairs. Eleven women complained of urinary stress incontinence (six worsening and five de novo) and five had subsequent tension‐free vaginal tape procedures. One woman had urethral pain and one had mesh exposure into the vagina. Pre‐operatively, mean ICIQ–VS score was 27.87 (standard deviation [SD] 6.8), and at 1 year post‐operatively it was 5.82 (SD 3.8). Impact on quality of life score dropped by 83.4%, from 8.35 (SD 2.1) to 1.39 (SD 1.1). Conclusion The modified technique used in the present study retained the advantages of traditional sacrocolpopexy, but required smaller volumes of mesh. We found it to be safe and effective with excellent patient satisfaction at 1 year, and providing a promising treatment option for patients suffering from apical prolapse.

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Tissue reaction to urogynecologic meshes: effect of steroid soaking in two different mesh models

Abstract: PVF mesh induces less inflammation than PP mesh, and in both mesh types steroid soaking further decreases inflammation without changing the pore size.

Cited by 4 publications

References 27 publications

Characterization of innate and adaptive immune cells involved in the foreign body reaction to polypropylene meshes in the human abdomen

Characterization of innate and adaptive immune cells involved in the foreign body reaction to polypropylene meshes in the human abdomen

Dopamine-Mediated Zwitterionic Polyelectrolyte-Coated Polypropylene Hernia Mesh with Synergistic Anti-inflammation Effects

Standardizing abdominal sacrocolpopexy for the treatment of apical prolapse: One year on

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