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International Urogynecology Journal

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06-11-2021 | Stress Incontinence | Original Article

Evaluating tissue-engineered repair material for pelvic floor dysfunction: a comparison of in vivo response to meshes implanted in rats

Authors: Xiaojuan Wang, Yisong Chen, Zhongyong Fan, Keqin Hua

Published in: International Urogynecology Journal | Issue 8/2022

Abstract

Introduction and hypothesis

Achieving better anatomic restoration and decreasing the associated complications are necessary for material repair of pelvic floor dysfunction (PFD). This study was aimed to investigate host response to tissue-engineered repair material (TERM) in rat models by comparing different materials and study the changes in biomechanical properties over time.

Methods

TERM was constructed by seeding adipose-derived stem cells (ADSCs) on electrospun poly(L-lactide)-trimethylene carbonate-glycolide (PLTG) terpolymers. The TERM, PLTG, porcine small intestine submucosa mesh (SIS), and polypropylene (PP) (n = 6 / group per time point) were implanted in rats for 7, 30, 60, and 90 days. Hematoxylin-eosin and Masson’s trichrome staining were used to assess the host response, and mechanical testing was used to evaluate the changes in biomechanical properties.

Results

In vivo imaging showed that the ADSCs were confined to the abdominal wall and did not migrate to other organs or tissues. The TERM was encapsulated by a thicker layer of connective tissue and was associated with less reduced inflammatory scores compared with PLTG and PP over time. The vascularization of the TERM was greater than that with PP and PLTG over time (p < 0.05) and was greater than that with SIS on day 90. The ultimate tensile strain and Young’s modulus of the PP group showed the greatest increases, and the TERM group followed on day 90.

Conclusions

This TERM achieved better host integration in rat models and better biomechanical properties, and it may be an alternative material for PFD.

Li Z, Xu T, Li Z, Gong J, Liu Q, Wang Y, et al. An epidemiologic study of pelvic organ prolapse in postmenopausal women: a population-based sample in China. Clim: J Intern Menop Soc. 2019;22(1):79–84. https://doi.org/10.1080/13697137.2018.1520824.CrossRef

Maher CF, Baessler KK, Barber MD, Cheong C, Consten ECJ, Cooper KG, et al. Surgical management of pelvic organ prolapse. Clim J Intern Menop Soc. 2019;22(3):229–35. https://doi.org/10.1080/13697137.2018.1551348.

Baessler K, Christmann-Schmid C, Maher C, Haya N, Crawford TJ, Brown J. Surgery for women with pelvic organ prolapse with or without stress urinary incontinence. Cochrane Database Syst Rev. 2018;8(8):Cd013108. https://doi.org/10.1002/14651858.Cd013108.

Maher C, Feiner B, Baessler K, Christmann-Schmid C, Haya N, Brown J. Surgery for women with apical vaginal prolapse. Cochrane Database Syst Rev. 2016;10(10):Cd012376. https://doi.org/10.1002/14651858.Cd012376.

Murphy M, Holzberg A, van Raalte H, Kohli N, Goldman HB, Lucente V. Time to rethink: an evidence-based response from pelvic surgeons to the FDA safety communication: "UPDATE on serious complications associated with transvaginal placement of surgical mesh for pelvic organ prolapse". Int Urogynecol J. 2012;23(1):5–9. https://doi.org/10.1007/s00192-011-1581-2.CrossRefPubMed

Obstetrical and Gynecological Devices; Reclassification of Surgical Mesh for Transvaginal Pelvic Organ Prolapse Repair; Final order. Federal Register. 2016;81(2):353–61.

Winkelman WD, Modest AM, Richardson ML. U.S. Food and Drug Administration statements about transvaginal mesh and changes in apical prolapse surgery. Obstet Gynecol. 2019;134(4):745–52. https://doi.org/10.1097/aog.0000000000003488.CrossRefPubMed

Gigliobianco G, Regueros SR, Osman NI, Bissoli J, Bullock AJ, Chapple CR, et al. Biomaterials for pelvic floor reconstructive surgery: how can we do better? Biomed Res Int. 2015;2015:968087. https://doi.org/10.1155/2015/968087.CrossRefPubMedPubMedCentral

Roman S, Mangera A, Osman NI, Bullock AJ, Chapple CR, MacNeil S. Developing a tissue engineered repair material for treatment of stress urinary incontinence and pelvic organ prolapse-which cell source? Neurourol Urodyn. 2014;33(5):531–7. https://doi.org/10.1002/nau.22443.CrossRefPubMed

10.

Emmerson S, Mukherjee S, Melendez-Munoz J, Cousins F, Edwards SL, Karjalainen P, et al. Composite mesh design for delivery of autologous mesenchymal stem cells influences mesh integration, exposure and biocompatibility in an ovine model of pelvic organ prolapse. Biomaterials. 2019;225:119495. https://doi.org/10.1016/j.biomaterials.

11.

Londono R, Badylak SF. Biologic scaffolds for regenerative medicine: mechanisms of in vivo remodeling. Ann Biomed Eng. 2015;43(3):577–92. https://doi.org/10.1007/s10439-014-1103-8.CrossRefPubMed

12.

Hansen SG, Taskin MB, Chen M, Wogensen L, Vinge Nygaard J, Axelsen SM. Electrospun nanofiber mesh with fibroblast growth factor and stem cells for pelvic floor repair. J Biomed Mater Res B Appl Biomater. 2020;108(1):48–55. https://doi.org/10.1002/jbm.b.34364.CrossRefPubMed

13.

Mangir N, Roman S, MacNeil S. Improving the biocompatibility of biomaterial constructs and constructs delivering cells for the pelvic floor. Curr Opin Urol. 2019;29(4):419–25. https://doi.org/10.1097/mou.0000000000000621.CrossRefPubMed

14.

Bye FJ, Bissoli J, Black L, Bullock AJ, Puwanun S, Moharamzadeh K, et al. Development of bilayer and trilayer nanofibrous/microfibrous scaffolds for regenerative medicine. Biomaterialsence. 2013;1(9):942–51.CrossRef

15.

Wang X, Chen Y, Fan Z, Hua K. Comparing different tissue-engineered repair materials for the treatment of pelvic organ prolapse and urinary incontinence: which material is better? Int Urogynecol J. 2018;29(1):131–8. https://doi.org/10.1007/s00192-017-3406-4.CrossRefPubMed

16.

Selim M, Bullock AJ, Blackwood KA, Chapple CR, MacNeil S. Developing biodegradable scaffolds for tissue engineering of the urethra. BJU Int. 2011;107(2):296–302. https://doi.org/10.1111/j.1464-410X.2010.09310.x.CrossRefPubMed

17.

Ulrich D, Edwards SL, Alexander DLJ, Rosamilia A, Werkmeister JA, Gargett CE, et al. Changes in pelvic organ prolapse mesh mechanical properties following implantation in rats. Am J Obstet Gynecol. 2016;214(2):260.e261–8. https://doi.org/10.1016/j.ajog.2015.08.071.

18.

Ulrich D, Edwards SL, White JF, Supit T, Ramshaw JAM, Lo C, et al. A preclinical evaluation of alternative synthetic biomaterials for fascial defect repair using a rat abdominal hernia model. PLoS One. 2012;7(11). https://doi.org/10.1371/journal.pone.0050044.

19.

Zheng F, Wang S, Wen S, Shen M, Zhu M, Shi X. Characterization and antibacterial activity of amoxicillin-loaded electrospun nano-hydroxyapatite/poly(lactic-co-glycolic acid) composite nanofibers. Biomaterials. 2013;34(4):1402–12. https://doi.org/10.1016/j.biomaterials.2012.10.071.CrossRefPubMed

20.

Pierce LM, Rao A, Baumann SS, Glassberg JE, Kuehl TJ, Muir TW. Long-term histologic response to synthetic and biologic graft materials implanted in the vagina and abdomen of a rabbit model. Am J Obstet Gynecol. 2009;200(5):546.e541–8. https://doi.org/10.1016/j.ajog.2008.12.040.

21.

Walters NJ, Gentleman E. Evolving insights in cell-matrix interactions: elucidating how non-soluble properties of the extracellular niche direct stem cell fate. Acta Biomater. 2015;11:3–16. https://doi.org/10.1016/j.actbio.2014.09.038.CrossRefPubMed

22.

Vashaghian M, Ruiz-Zapata AM, Kerkhof MH, Zandieh-Doulabi B, Werner A, Roovers JP, et al. Toward a new generation of pelvic floor implants with electrospun nanofibrous matrices: a feasibility study. Neurourol Urodyn. 2017;36(3):565–73. https://doi.org/10.1002/nau.22969.CrossRefPubMed

23.

Vashaghian M, Zaat SJ, Smit TH, Roovers JP. Biomimetic implants for pelvic floor repair. Neurourol Urodyn. 2018;37(2):566–80. https://doi.org/10.1002/nau.23367.CrossRefPubMed

24.

Vashaghian M, Diedrich CM, Zandieh-Doulabi B, Werner A, Smit TH, Roovers JP. Gentle cyclic straining of human fibroblasts on electrospun scaffolds enhances their regenerative potential. Acta Biomater. 2019;84:159–68. https://doi.org/10.1016/j.actbio.2018.11.034.CrossRefPubMed

25.

Kelly M, Macdougall K, Olabisi O, McGuire N. In vivo response to polypropylene following implantation in animal models: a review of biocompatibility. Int Urogynecol J. 2017;28(2):171–80. https://doi.org/10.1007/s00192-016-3029-1.CrossRefPubMed

26.

Utiyama EM, Rosa MB, Andres Mde P, Miranda JS, Damous SH, Birolini CA, et al. Polypropylene and polypropylene/polyglecaprone (Ultrapro(R)) meshes in the repair of incisional hernia in rats. Acta cirurgica brasileira. 2015;30(6):376–81. https://doi.org/10.1590/s0102-865020150060000001.CrossRefPubMed

Title: Evaluating tissue-engineered repair material for pelvic floor dysfunction: a comparison of in vivo response to meshes implanted in rats
Authors: Xiaojuan Wang
Yisong Chen
Zhongyong Fan
Keqin Hua
Publication date: 06-11-2021
Publisher: Springer International Publishing
Keyword: Stress Incontinence
Published in: International Urogynecology Journal / Issue 8/2022
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI: https://doi.org/10.1007/s00192-021-05008-1

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Springer Medicine

Evaluating tissue-engineered repair material for pelvic floor dysfunction: a comparison of in vivo response to meshes implanted in rats

Abstract

Introduction and hypothesis

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Introduction and hypothesis

Methods

Results

Conclusions

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