1
|
Ma F, Huang X, Wang Y. Fabrication of a Triple-Layer Bionic Vascular Scaffold via Hybrid Electrospinning. J Funct Biomater 2024; 15:140. [PMID: 38921514 PMCID: PMC11204414 DOI: 10.3390/jfb15060140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 05/13/2024] [Accepted: 05/21/2024] [Indexed: 06/27/2024] Open
Abstract
Tissue engineering aims to develop bionic scaffolds as alternatives to autologous vascular grafts due to their limited availability. This study introduces a novel wet-electrospinning fabrication technique to create small-diameter, uniformly aligned tubular scaffolds. By combining this innovative method with conventional electrospinning, a bionic tri-layer scaffold that mimics the zonal structure of vascular tissues is produced. The inner and outer layers consist of PCL/Gelatin and PCL/PLGA fibers, respectively, while the middle layer is crafted using PCL through Wet Vertical Magnetic Rod Electrospinning (WVMRE). The scaffold's morphology is analyzed using Scanning Electron Microscopy (SEM) to confirm its bionic structure. The mechanical properties, degradation profile, wettability, and biocompatibility of the scaffold are also characterized. To enhance hemocompatibility, the scaffold is crosslinked with heparin. The results demonstrate sufficient mechanical properties, good wettability of the inner layer, proper degradability of the inner and middle layers, and overall good biocompatibility. In conclusion, this study successfully develops a small-diameter tri-layer tubular scaffold that meets the required specifications.
Collapse
Affiliation(s)
- Feier Ma
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing 100084, China
- Institute of Orthopaedic & Musculoskeletal Science, Division of Surgery and Interventional Science, University College London, The Royal National Orthopaedic Hospital, Stanmore, London HA7 4LP, UK
| | - Xiaojing Huang
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing 100084, China
| | - Yan Wang
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing 100084, China
| |
Collapse
|
2
|
Jiao Y, Yang X, Li Y, Wang F, Wang L, Li C. Spider-Silk-like Fiber Mat-Covered Polypropylene Warp-Knitted Hernia Mesh for Inhibition of Fibrosis under Dynamic Environment. Biomacromolecules 2024; 25:1214-1227. [PMID: 38295271 DOI: 10.1021/acs.biomac.3c01181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
Hernia surgery is a widely performed procedure, and the use of a polypropylene mesh is considered the standard approach. However, the mesh often leads to complications, including the development of scar tissue that wraps around the mesh and causes it to shrink. Consequently, there is a need to investigate the relationship between the mesh and scar formation as well as to develop a hernia mesh that can prevent fibrosis. In this study, three different commercial polypropylene hernia meshes were examined to explore the connection between the fabric structure and mechanical properties. In vitro dynamic culture was used to investigate the mechanism by which the mechanical properties of the mesh in a dynamic environment affect cell differentiation. Additionally, electrospinning was employed to create polycaprolactone spider-silk-like fiber mats to achieve mechanical energy dissipation in dynamic conditions. These fiber mats were then combined with the preferred hernia mesh. The results demonstrated that the composite mesh could reduce the activation of fibroblast mechanical signaling pathways and inhibit its differentiation into myofibroblasts in dynamic environments.
Collapse
Affiliation(s)
- Yongjie Jiao
- Key Laboratory of Textile Science and Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai 201620, China
| | - Xiaowei Yang
- Key Laboratory of Textile Science and Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai 201620, China
| | - Yan Li
- Key Laboratory of Textile Science and Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai 201620, China
| | - Fujun Wang
- Key Laboratory of Textile Science and Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai 201620, China
| | - Lu Wang
- Key Laboratory of Textile Science and Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai 201620, China
| | - Chaojing Li
- Key Laboratory of Textile Science and Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai 201620, China
| |
Collapse
|
3
|
Jiao Y, Li X, Liu X, Li C, Yang X, Sun X, Wang F, Wang L. Cobweb-Inspired Micro/Nanostructured Scaffolds for Soft Tissue Regeneration with Inhibition Effect of Fibrosis under Dynamic Environment. Adv Healthc Mater 2023; 12:e2300997. [PMID: 37713107 DOI: 10.1002/adhm.202300997] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 08/08/2023] [Indexed: 09/16/2023]
Abstract
In soft tissue repair, fibrosis can lead to repair failure and long-term chronic pain in patients. Excessive mechanical stimulation of fibroblasts is one of the causes of fibrosis during abdominal wall regeneration. Inspired by the cobweb, a polycaprolactone beaded fiber is prepared by electrospinning. The cobweb-inspired structure attenuates the mechanical stimulation of cells under a dynamic environment. Nano-protrusions are introduced into the scaffold for further inhibition of fibrosis by self-induced crystallization. A machine is built for in vitro dynamic culture and rat abdominal subcutaneous embedding experiments are performed to verify the inhibiting effect of fibrosis in a dynamic environment in vivo. Results show that the expression of integrin β1 and α-smooth muscle actin is inhibited by the cobweb-inspired structure under dynamic culture. The results of hematoxylin and eosin and Masson's trichrome indicate that the cobweb-inspired structure has a good inhibitory effect on fibrosis in a dynamic environment in vivo. In general, the cobweb-inspired scaffold with nano-protrusions has a good ability to inhibit fibrosis under both static and dynamic environments. It is believed that the scaffold has promising applications in the field of inhibiting fibrosis caused by mechanical stimulation.
Collapse
Affiliation(s)
- Yongjie Jiao
- Key Laboratory of Textile Science & Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai, 201620, China
- Key Laboratory of Textile Industry for Biomedical Textile Materials and Technology, Donghua University, Shanghai, 201620, China
| | - Xiaojing Li
- Key Laboratory of Textile Science & Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai, 201620, China
| | - Xingxing Liu
- Key Laboratory of Textile Science & Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai, 201620, China
- Key Laboratory of Textile Industry for Biomedical Textile Materials and Technology, Donghua University, Shanghai, 201620, China
| | - Chaojing Li
- Key Laboratory of Textile Science & Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai, 201620, China
- Key Laboratory of Textile Industry for Biomedical Textile Materials and Technology, Donghua University, Shanghai, 201620, China
| | - Xiao Yang
- Key Laboratory of Textile Science & Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai, 201620, China
| | - Xuwei Sun
- Key Laboratory of Textile Science & Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai, 201620, China
| | - Fujun Wang
- Key Laboratory of Textile Science & Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai, 201620, China
| | - Lu Wang
- Key Laboratory of Textile Science & Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai, 201620, China
- Key Laboratory of Textile Industry for Biomedical Textile Materials and Technology, Donghua University, Shanghai, 201620, China
| |
Collapse
|
4
|
Miller B, Wolfe W, Gentry JL, Grewal MG, Highley CB, De Vita R, Vaughan MH, Caliari SR. Supramolecular Fibrous Hydrogel Augmentation of Uterosacral Ligament Suspension for Treatment of Pelvic Organ Prolapse. Adv Healthc Mater 2023; 12:e2300086. [PMID: 37220996 DOI: 10.1002/adhm.202300086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 05/11/2023] [Indexed: 05/25/2023]
Abstract
Uterosacral ligament suspension (USLS) is a common surgical treatment for pelvic organ prolapse (POP). However, the relatively high failure rate of up to 40% underscores a strong clinical need for complementary treatment strategies, such as biomaterial augmentation. Herein, the first hydrogel biomaterial augmentation of USLS in a recently established rat model is described using an injectable fibrous hydrogel composite. Supramolecularly-assembled hyaluronic acid (HA) hydrogel nanofibers encapsulated in a matrix metalloproteinase (MMP)-degradable HA hydrogel create an injectable scaffold showing excellent biocompatibility and hemocompatibility. The hydrogel can be successfully delivered and localized to the suture sites of the USLS procedure, where it gradually degrades over six weeks. In situ mechanical testing 24 weeks post-operative in the multiparous USLS rat model shows the ultimate load (load at failure) to be 1.70 ± 0.36 N for the intact uterosacral ligament (USL), 0.89 ± 0.28 N for the USLS repair, and 1.37 ± 0.31 N for the USLS + hydrogel (USLS+H) repair (n = 8). These results indicate that the hydrogel composite significantly improves load required for tissue failure compared to the standard USLS, even after the hydrogel degrades, and that this hydrogel-based approach can potentially reduce the high failure rate associated with USLS procedures.
Collapse
Affiliation(s)
- Beverly Miller
- Department of Chemical Engineering, University of Virginia, Charlottesville, VA, 22903, USA
| | - Wiley Wolfe
- Scripps Institution of Oceanography, University of California, San Diego, La Jolla, CA, 92 093, USA
| | - James L Gentry
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, 22 903, USA
| | - M Gregory Grewal
- Department of Chemical Engineering, University of Virginia, Charlottesville, VA, 22903, USA
| | - Christopher B Highley
- Department of Chemical Engineering, University of Virginia, Charlottesville, VA, 22903, USA
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, 22 903, USA
| | - Raffaella De Vita
- Stretch Lab, Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA, 24 061, USA
| | - Monique H Vaughan
- Department of Obstetrics and Gynecology, University of Virginia, Charlottesville, VA, 22 903, USA
| | - Steven R Caliari
- Department of Chemical Engineering, University of Virginia, Charlottesville, VA, 22903, USA
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, 22 903, USA
| |
Collapse
|
5
|
Farzamfar S, Elia E, Richer M, Chabaud S, Naji M, Bolduc S. Extracellular Matrix-Based and Electrospun Scaffolding Systems for Vaginal Reconstruction. Bioengineering (Basel) 2023; 10:790. [PMID: 37508817 PMCID: PMC10376078 DOI: 10.3390/bioengineering10070790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 06/14/2023] [Accepted: 06/22/2023] [Indexed: 07/30/2023] Open
Abstract
Congenital vaginal anomalies and pelvic organ prolapse affect different age groups of women and both have significant negative impacts on patients' psychological well-being and quality of life. While surgical and non-surgical treatments are available for vaginal defects, their efficacy is limited, and they often result in long-term complications. Therefore, alternative treatment options are urgently needed. Fortunately, tissue-engineered scaffolds are promising new treatment modalities that provide an extracellular matrix (ECM)-like environment for vaginal cells to adhere, secrete ECM, and be remodeled by host cells. To this end, ECM-based scaffolds or the constructs that resemble ECM, generated by self-assembly, decellularization, or electrospinning techniques, have gained attention from both clinicians and researchers. These biomimetic scaffolds are highly similar to the native vaginal ECM and have great potential for clinical translation. This review article aims to discuss recent applications, challenges, and future perspectives of these scaffolds in vaginal reconstruction or repair strategies.
Collapse
Affiliation(s)
- Saeed Farzamfar
- Centre de Recherche en Organogénèse Expérimentale/LOEX, Regenerative Medicine Division, CHU de Québec-Université Laval Research Center, Québec, QC G1J 1Z4, Canada
| | - Elissa Elia
- Centre de Recherche en Organogénèse Expérimentale/LOEX, Regenerative Medicine Division, CHU de Québec-Université Laval Research Center, Québec, QC G1J 1Z4, Canada
| | - Megan Richer
- Centre de Recherche en Organogénèse Expérimentale/LOEX, Regenerative Medicine Division, CHU de Québec-Université Laval Research Center, Québec, QC G1J 1Z4, Canada
| | - Stéphane Chabaud
- Centre de Recherche en Organogénèse Expérimentale/LOEX, Regenerative Medicine Division, CHU de Québec-Université Laval Research Center, Québec, QC G1J 1Z4, Canada
| | - Mohammad Naji
- Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Tehran 1666677951, Iran
| | - Stéphane Bolduc
- Centre de Recherche en Organogénèse Expérimentale/LOEX, Regenerative Medicine Division, CHU de Québec-Université Laval Research Center, Québec, QC G1J 1Z4, Canada
- Department of Surgery, Faculty of Medicine, Laval University, Québec, QC G1V 0A6, Canada
| |
Collapse
|
6
|
Wu C, Zhang Z, He H, Zhou Z, Li H, Tong X. Six-year follow-up outcomes of the P(LLA-CL)/Fg bio-patch for anterior vaginal wall prolapse treatment. Int Urogynecol J 2023; 34:115-124. [PMID: 35831453 DOI: 10.1007/s00192-022-05284-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 06/11/2022] [Indexed: 01/14/2023]
Abstract
INTRODUCTION AND HYPOTHESIS There were few data about the long-term outcomes of bio-compatible patches for pelvic organ prolapse (POP). The efficacy of poly (L-lactide-co-caprolactone) blended with fibrinogen [P(LLA-CL)/Fg] bio-patches were investigated for anterior vaginal wall prolapse treatment in a 6-year follow-up. METHODS The P(LLA-CL)/Fg bio-patch was fabricated through electrospinning. Nineteen patients with symptomatic anterior prolapse (Pelvic Organ Prolapse Quantification [POP-Q] stage ≥ 2) were treated with anterior pelvic reconstruction surgery using a P(LLA-CL)/Fg bio-patch and were followed up at 1, 2, 3, 6 months, and 6 years. The primary outcome was objective anatomical cure (anterior POP-Q stage ≤ 1). Secondary outcomes included complications, MRI evaluation, and scores of the Pelvic Floor Impact Questionnaire-7 (PFIQ-7) and the Pelvic Floor Distress Inventory-20 (PFDI-20). RESULTS The micro-morphology of the bio-patch resembled the extracellular matrix, which was suitable for the growth of fibroblasts. Sixteen (84.2%) patients were finally assessed, with a mean follow-up of 6.08 ± 0.18 years. The cure rate without anterior prolapse recurrence was 93.8% at 6 years. Compared with baseline, the POP-Q measurements of Aa, Ba, and C points and scores of PFIQ-7 and PFDI-20 manifested significant differences at all times (all p < 0.05). One (5.26%) case of bio-patch-related infection, 1 (5.26%) case of urinary retention, and no exposures and erosion occurred. MRI evaluation showed that the bio-patch gradually degraded to fragments at 1 month and was completely absorbed at 3 months. CONCLUSIONS Among long-term follow-ups, anterior pelvic reconstruction surgery with a P(LLA-CL)/Fg bio-patch demonstrated significant improvements in anatomical correction of anterior pelvic prolapse and pelvic function without severe morbidity.
Collapse
Affiliation(s)
- Chenghao Wu
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji University School of Medicine, No.389 Xincun Road, Shanghai, 200065, People's Republic of China
| | - Zhixia Zhang
- Department of Obstetrics and Gynecology, Jiading District Maternal and Child Health Hospital, Shanghai, 201800, People's Republic of China
| | - Hongbing He
- Shanghai Pine & Power Biotech Co. Ltd., Shanghai, 201108, People's Republic of China.
| | - Zixuan Zhou
- Department of Burn Surgery, The First Affiliated Hospital of Naval Medical University, Burn Institute of PLA, Shanghai, 200433, People's Republic of China
| | - Huaifang Li
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji University School of Medicine, No.389 Xincun Road, Shanghai, 200065, People's Republic of China.
| | - Xiaowen Tong
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji University School of Medicine, No.389 Xincun Road, Shanghai, 200065, People's Republic of China.
| |
Collapse
|
7
|
Verhorstert K, Gudde A, Weitsz C, Bezuidenhout D, Roovers JP, Guler Z. Absorbable Electrospun Poly-4-hydroxybutyrate Scaffolds as a Potential Solution for Pelvic Organ Prolapse Surgery. ACS APPLIED BIO MATERIALS 2022; 5:5270-5280. [PMID: 36315937 PMCID: PMC9682484 DOI: 10.1021/acsabm.2c00691] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Women with pelvic organ prolapse (POP) have bothersome complaints that significantly affect their quality of life. While native tissue repair is associated with high recurrence rates, polypropylene knitted implants have caused specific implant-related adverse events that have detrimental, often irreversible, effects. We hypothesize that surgical outcome can be improved with a tissue-engineered solution using an absorbable implant that mimics the natural extracellular matrix (ECM) structure, releases estrogen, and activates collagen metabolism by fibroblasts as the main regulators of wound healing. To this aim, we produced electrospun poly-4-hydroxybutyrate (P4HB) scaffolds and biofunctionalized them with estradiol (E2). The cell-implant interactions relevant for POP repair were assessed by seeding primary POP vaginal fibroblasts isolated from patients on electrospun P4HB scaffolds with 1%, 2%, or 5% E2 and without E2. To test our hypothesis on whether ECM mimicking structures should improve regeneration, electrospun P4HB was compared to knitted P4HB implants. We evaluated vaginal fibroblast proliferation, ECM deposition, and metabolism by quantification of collagen, elastin, and matrix metalloproteinases and by gene expression analysis for 28 days. We established effective E2 drug loading with a steady release over time. Significantly higher cell proliferation, collagen-, and elastin deposition were observed on electrospun P4HB scaffolds as compared to knitted P4HB. For this study, physical properties of the scaffolds were more determinant on the cell response than the release of E2. These results indicate that making these electrospun P4HB scaffolds E2-releasing appears to be technically feasible. In addition, electrospun P4HB scaffolds promote the cellular response of vaginal fibroblasts and further studies are merited to assess if their use results in improved surgical outcomes in case of POP repair.
Collapse
Affiliation(s)
- Kim Verhorstert
- Department
of Obstetrics and Gynecology, Amsterdam
UMC, University of Amsterdam, Meibergdreef 9, 1105
AZAmsterdam, The Netherlands,Amsterdam
Reproduction and Development Research Institute, Meibergdreef 9, 1105
AZAmsterdam, The Netherlands
| | - Aksel Gudde
- Department
of Obstetrics and Gynecology, Amsterdam
UMC, University of Amsterdam, Meibergdreef 9, 1105
AZAmsterdam, The Netherlands,Amsterdam
Reproduction and Development Research Institute, Meibergdreef 9, 1105
AZAmsterdam, The Netherlands
| | - Carmen Weitsz
- Cardiovascular
Research Unit, Department of Surgery, University
of Cape Town, 203 Chris Barnard Building, Anzio Road, Observatory7925Cape Town, South Africa
| | - Deon Bezuidenhout
- Cardiovascular
Research Unit, Department of Surgery, University
of Cape Town, 203 Chris Barnard Building, Anzio Road, Observatory7925Cape Town, South Africa
| | - Jan-Paul Roovers
- Department
of Obstetrics and Gynecology, Amsterdam
UMC, University of Amsterdam, Meibergdreef 9, 1105
AZAmsterdam, The Netherlands,Amsterdam
Reproduction and Development Research Institute, Meibergdreef 9, 1105
AZAmsterdam, The Netherlands
| | - Zeliha Guler
- Department
of Obstetrics and Gynecology, Amsterdam
UMC, University of Amsterdam, Meibergdreef 9, 1105
AZAmsterdam, The Netherlands,Amsterdam
Reproduction and Development Research Institute, Meibergdreef 9, 1105
AZAmsterdam, The Netherlands,
| |
Collapse
|
8
|
Wang X, Chen Y, Fan Z, Hua K. Evaluating tissue-engineered repair material for pelvic floor dysfunction: a comparison of in vivo response to meshes implanted in rats. Int Urogynecol J 2021; 33:2143-2150. [PMID: 34741620 DOI: 10.1007/s00192-021-05008-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 10/04/2021] [Indexed: 11/26/2022]
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.
Collapse
Affiliation(s)
- Xiaojuan Wang
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, 128 Shenyang Road, Shanghai, 200090, People's Republic of China
| | - Yisong Chen
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, 128 Shenyang Road, Shanghai, 200090, People's Republic of China
| | - Zhongyong Fan
- Department of Materials Science, Fudan University, No. 220 Handan Road, Shanghai, 200433, People's Republic of China
| | - Keqin Hua
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, 128 Shenyang Road, Shanghai, 200090, People's Republic of China.
| |
Collapse
|
9
|
Hennes DMZB, Rosamilia A, Werkmeister JA, Gargett CE, Mukherjee S. Endometrial SUSD2 + Mesenchymal Stem/Stromal Cells in Tissue Engineering: Advances in Novel Cellular Constructs for Pelvic Organ Prolapse. J Pers Med 2021; 11:jpm11090840. [PMID: 34575617 PMCID: PMC8471527 DOI: 10.3390/jpm11090840] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 08/19/2021] [Accepted: 08/21/2021] [Indexed: 12/15/2022] Open
Abstract
Cellular therapy is an emerging field in clinical and personalised medicine. Many adult mesenchymal stem/progenitor cells (MSC) or pluripotent derivatives are being assessed simultaneously in preclinical trials for their potential treatment applications in chronic and degenerative human diseases. Endometrial mesenchymal stem/progenitor cells (eMSC) have been identified as clonogenic cells that exist in unique perivascular niches within the uterine endometrium. Compared with MSC isolated from other tissue sources, such as bone marrow and adipose tissue, eMSC can be extracted through less invasive methods of tissue sampling, and they exhibit improvements in potency, proliferative capacity, and control of culture-induced differentiation. In this review, we summarize the potential cell therapy and tissue engineering applications of eMSC in pelvic organ prolapse (POP), emphasising their ability to exert angiogenic and strong immunomodulatory responses that improve tissue integration of novel surgical constructs for POP and promote vaginal tissue healing.
Collapse
Affiliation(s)
- David M. Z. B. Hennes
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, VIC 3168, Australia; (A.R.); (J.A.W.); (C.E.G.)
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC 3168, Australia
- Pelvic Floor Disorders Unit, Monash Health, Clayton, VIC 3168, Australia
- Correspondence: (D.M.Z.B.H.); (S.M.)
| | - Anna Rosamilia
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, VIC 3168, Australia; (A.R.); (J.A.W.); (C.E.G.)
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC 3168, Australia
- Pelvic Floor Disorders Unit, Monash Health, Clayton, VIC 3168, Australia
| | - Jerome A. Werkmeister
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, VIC 3168, Australia; (A.R.); (J.A.W.); (C.E.G.)
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC 3168, Australia
| | - Caroline E. Gargett
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, VIC 3168, Australia; (A.R.); (J.A.W.); (C.E.G.)
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC 3168, Australia
| | - Shayanti Mukherjee
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, VIC 3168, Australia; (A.R.); (J.A.W.); (C.E.G.)
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC 3168, Australia
- Correspondence: (D.M.Z.B.H.); (S.M.)
| |
Collapse
|
10
|
Tailor V, Digesu A, Swift SE. Update in Transvaginal Grafts: The Role of Lightweight Meshes, Biologics, and Hybrid Grafts in Pelvic Organ Prolapse Surgery. Obstet Gynecol Clin North Am 2021; 48:515-533. [PMID: 34416935 DOI: 10.1016/j.ogc.2021.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Transvaginal mesh/grafts have been popularized over the past 20 years in an attempt to improve the longevity of traditional vaginal pelvic organ prolapse (POP) surgery. Several national bodies have concluded that the proposed benefits of mesh/graft implantation are outweighed by the significant increase in surgery complications related to these products. As a consequence mesh products for vaginal POP surgery have been withdrawn from use in many countries. This article is a narrative review of newer mesh and graft products including lightweight polypropylene mesh products, biological grafts, hybrid grafts, and tissue engineered grafts.
Collapse
Affiliation(s)
- Visha Tailor
- Department of Urogynaecology, St Marys Hospital, Imperial College Healthcare NHS Trust, Praed Street, London W2 1NY, United Kingdom.
| | - Alex Digesu
- Department of Urogynaecology, St Marys Hospital, Imperial College Healthcare NHS Trust, Praed Street, London W2 1NY, United Kingdom
| | - Steven Edward Swift
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC 29425, USA
| |
Collapse
|
11
|
Silva MET, Bessa JNM, Parente MPL, Mascarenhas T, Natal Jorge RM, Fernandes AA. Effect of mesh anchoring technique in uterine prolapse repair surgery: A finite element analysis. J Biomech 2021; 127:110649. [PMID: 34375905 DOI: 10.1016/j.jbiomech.2021.110649] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 05/28/2021] [Accepted: 07/25/2021] [Indexed: 11/17/2022]
Abstract
The female pelvic cavity involves muscles, ligaments, endopelvic fasciae and multiple organs where different pathologies may occur, namely the pelvic organ prolapse (POP). The synthetic implants are used for the reconstructive surgery of POP, but severe complications associated with their use have been reported, mainly related to their mechanical properties (e.g., implant stiffness) and microstructure. In this study, we mimicked a transvaginal reconstructive surgery to repair the apical ligaments (uterosacral ligaments (USLs) and cardinal ligaments (CLs)), by modeling, their impairment (90% and 50%) and/or total rupture. The implants to reinforce/replace these ligaments were built based on literature specifications and their mechanical properties were obtained through uniaxial tensile tests. The main aim of this study was to simulate the effect of mesh anchoring technique (simple stich and continuous stitch), and compare the displacement magnitude of the pelvic tissues, during Valsalva maneuver. The absence/presence of the synthetic implant was simulated when total rupture of the CLs and USLs occurs, causing a variation of the vaginal displacement (9% for the CLs and 27% for the USLs). Additionally, the simulations showed that there was a variation of the supero-inferior displacement of the vaginal wall between different anchoring techniques (simple stich and continuous stitch) being approximately of 10% for the simulation USLs and CLs implant. The computational simulation was able to mimic the biomechanical behavior of the USLs and CLs, in response to different anchoring techniques, which can be help improving the outcomes of the prolapse surgery.
Collapse
Affiliation(s)
- M E T Silva
- LAETA, INEGI, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias s/n, Porto 4200 - 465, Portugal.
| | - J N M Bessa
- Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias s/n, Porto 4200 - 465, Portugal.
| | - M P L Parente
- LAETA, INEGI, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias s/n, Porto 4200 - 465, Portugal.
| | - T Mascarenhas
- Dep. of Obstetrics and Gynecology, CHSJ-EPE / Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, Porto 4200 - 319, Portugal.
| | - R M Natal Jorge
- LAETA, INEGI, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias s/n, Porto 4200 - 465, Portugal.
| | - A A Fernandes
- LAETA, INEGI, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias s/n, Porto 4200 - 465, Portugal.
| |
Collapse
|
12
|
Terrell JA, Jones CG, Kabandana GKM, Chen C. From cells-on-a-chip to organs-on-a-chip: scaffolding materials for 3D cell culture in microfluidics. J Mater Chem B 2021; 8:6667-6685. [PMID: 32567628 DOI: 10.1039/d0tb00718h] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
It is an emerging research area to integrate scaffolding materials in microfluidic devices for 3D cell culture (organs-on-a-chip). The technology of organs-on-a-chip holds the potential to obviate the gaps between pre-clinical and clinical studies. As accumulating evidence shows the importance of extracellular matrix in in vitro cell culture, significant efforts have been made to integrate 3D ECM/scaffolding materials in microfluidics. There are two families of materials that are commonly used for this purpose: hydrogels and electrospun fibers. In this review, we briefly discuss the properties of the materials, and focus on the various technologies to obtain the materials (e.g. extraction of collagen from animal tissues) and to include the materials in microfluidic devices. Challenges and potential solutions of the current materials and technologies were also thoroughly discussed. At the end, we provide a perspective on future efforts to make these technologies more translational to broadly benefit pharmaceutical and pathophysiological research.
Collapse
Affiliation(s)
- John A Terrell
- Department of Chemistry and Biochemistry, University of Maryland Baltimore County, 21250, MD, USA.
| | | | | | | |
Collapse
|
13
|
Aghaei-Ghareh-Bolagh B, Mukherjee S, Lockley KM, Mithieux SM, Wang Z, Emmerson S, Darzi S, Gargett CE, Weiss AS. A novel tropoelastin-based resorbable surgical mesh for pelvic organ prolapse repair. Mater Today Bio 2020; 8:100081. [PMID: 33210083 PMCID: PMC7658716 DOI: 10.1016/j.mtbio.2020.100081] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 09/30/2020] [Accepted: 10/05/2020] [Indexed: 11/03/2022] Open
Abstract
Pelvic organ prolapse is a common condition that affects 1 in 4 women across all age groups. It is mainly caused by vaginal birth injury and can be exacerbated by obesity and increased age. Until recently, treatment strategies often used non-degradable synthetic meshes for reconstructive surgery. However, owing to their frequent, unacceptable rate of adverse events such as mesh erosion, transvaginal meshes have been banned in many countries. Recent reports have highlighted the urgent need for biocompatible design of meshes for a safe and effective treatment in the long term. This study reports the design and evaluation of a novel, elastin based degradable mesh using an ovine model of POP as a potential surgical treatment. Elastin is a protein component of the ECM and provides elasticity to tissues throughout the body. Tropoelastin, the monomer subunit of elastin, has been used with success in electrospun constructs as it is a naturally cell interactive polymer. Biomaterials that incorporate tropoelastin support cell attachment and proliferation, and have been proven to encourage elastogenesis and angiogenesis in vitro and in vivo. The biological properties of tropoelastin were combined with the physical properties of PCL, a degradable synthetic polymer, with the aim of producing, characterizing and assessing the performance of continuous tropoelastin:PCL electrospun yarns. Using a modified spinneret electrospinning system and adjusting settings based on relative humidity, four blends of tropoelastin:PCL yarns were fabricated with concentration ratios of 75:25, 50:50, 25:75 and 0:100. Yarns were assessed for ease of manufacture, fibrous architecture, protein/polymer content, yarn stability - including initial tropoelastin release, mechanical strength, and ability to support cell growth. Based on overall favorable properties, a mesh woven from the 50:50 tropoelastin:PCL yarn was implanted into the vagina of a parous ewe with vaginal wall weakness as a model of pelvic organ prolapse. This mesh showed excellent integration with new collagen deposition by SEM and a predominant M2 macrophage response with few pro-inflammatory M1 macrophages after 30 days. The woven tropoelastin:PCL electrospun mesh shows potential as an alternative to non-degradable, synthetic pelvic organ prolapse mesh products.
Collapse
Affiliation(s)
- B Aghaei-Ghareh-Bolagh
- Charles Perkins Centre, University of Sydney, NSW, 2006, Australia.,School of Life and Environmental Sciences, University of Sydney, NSW, 2006, Australia
| | - S Mukherjee
- The Ritchie Centre, Hudson Institute of Medical Research, Victoria, 3168, Australia.,Department of Obstetrics and Gynaecology, Monash University, Victoria, 3168, Australia
| | - K M Lockley
- Charles Perkins Centre, University of Sydney, NSW, 2006, Australia.,School of Life and Environmental Sciences, University of Sydney, NSW, 2006, Australia
| | - S M Mithieux
- Charles Perkins Centre, University of Sydney, NSW, 2006, Australia.,School of Life and Environmental Sciences, University of Sydney, NSW, 2006, Australia
| | - Z Wang
- Charles Perkins Centre, University of Sydney, NSW, 2006, Australia.,School of Life and Environmental Sciences, University of Sydney, NSW, 2006, Australia
| | - S Emmerson
- The Ritchie Centre, Hudson Institute of Medical Research, Victoria, 3168, Australia.,Department of Obstetrics and Gynaecology, Monash University, Victoria, 3168, Australia
| | - S Darzi
- The Ritchie Centre, Hudson Institute of Medical Research, Victoria, 3168, Australia
| | - C E Gargett
- The Ritchie Centre, Hudson Institute of Medical Research, Victoria, 3168, Australia.,Department of Obstetrics and Gynaecology, Monash University, Victoria, 3168, Australia
| | - A S Weiss
- Charles Perkins Centre, University of Sydney, NSW, 2006, Australia.,School of Life and Environmental Sciences, University of Sydney, NSW, 2006, Australia.,The University of Sydney Nano Institute, University of Sydney, NSW, 2006, Australia
| |
Collapse
|
14
|
Wu X, Jia Y, Sun X, Wang J. Tissue engineering in female pelvic floor reconstruction. Eng Life Sci 2020; 20:275-286. [PMID: 32647506 PMCID: PMC7336160 DOI: 10.1002/elsc.202000003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 03/06/2020] [Accepted: 03/08/2020] [Indexed: 12/16/2022] Open
Abstract
Pelvic organ prolapse is a common and frequently occurring disease in middle-aged and elderly women. Mesh implantation is an ideal surgical treatment. The polypropylene mesh commonly used in clinical practice has good mechanical properties, but there are long-term complications. The application of tissue engineering technology in the treatment of pelvic organ prolapse disease can not only meet the mechanical requirements of pelvic floor support, but also be more biocompatible than traditional polypropylene mesh, and can promote tissue repair to a certain extent. In this paper, the progress of tissue engineering was summarized to understand the application of tissue engineering in the treatment of pelvic organ prolapse disease and will help in research.
Collapse
Affiliation(s)
- Xiaotong Wu
- Department of Obstetrics and GynecologyPeking University People's HospitalBeijingP. R. China
- Beijing Key Laboratory of Female Pelvic Floor DisordersBeijingP. R. China
| | - YuanYuan Jia
- Department of Obstetrics and GynecologyPeking University People's HospitalBeijingP. R. China
- Beijing Key Laboratory of Female Pelvic Floor DisordersBeijingP. R. China
| | - Xiuli Sun
- Department of Obstetrics and GynecologyPeking University People's HospitalBeijingP. R. China
- Beijing Key Laboratory of Female Pelvic Floor DisordersBeijingP. R. China
| | - Jianliu Wang
- Department of Obstetrics and GynecologyPeking University People's HospitalBeijingP. R. China
- Beijing Key Laboratory of Female Pelvic Floor DisordersBeijingP. R. China
| |
Collapse
|
15
|
Whooley J, Cunnane EM, Do Amaral R, Joyce M, MacCraith E, Flood HD, O'Brien FJ, Davis NF. Stress Urinary Incontinence and Pelvic Organ Prolapse: Biologic Graft Materials Revisited. TISSUE ENGINEERING PART B-REVIEWS 2020; 26:475-483. [PMID: 32192400 DOI: 10.1089/ten.teb.2020.0024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Symptomatic stress urinary incontinence (SUI) and pelvic organ prolapse (POP) refractory to conservative management with pelvic floor muscle training or vaginal pessaries may warrant surgical intervention with different forms of biologic or synthetic material. However, in recent years, several global regulatory agencies have issued health warnings and recalled several mesh products due to an increase in complications such as mesh erosion, infection, chronic pain, and perioperative bleeding. At present, current surgical treatment strategies for SUI and POP are aimed at developing biological graft materials with similar mechanical properties to established synthetic meshes, but with improved tissue integration and minimal host response. This narrative review aims to highlight recent studies related to the development of biomimetic and biologic graft materials as alternatives to traditional synthetic materials for SUI/POP repair in female patients. We also investigate complications and technical limitations associated with synthetic mesh and biological biomaterials in conventional SUI and POP surgery. Our findings demonstrate that newly developed biologic grafts have a lower incidence of adverse events compared to synthetic biomaterials. However there remains a significant disparity between success in preclinical trials and long-term clinical translation. Further characterization on the optimal structural, integrative, and mechanical properties of biological grafts is required before they can be reliably introduced into clinical practice for SUI and POP surgery. Impact statement Our review article aims to outline the clinical history of developments and controversies associated with the use of synthetic mesh materials in the surgical treatment of stress urinary incontinence and pelvic organ prolapse, as well as highlighting recent advancements in the area of biological graft materials and their potential importance in an area that remains an enduring issue for patients and clinicians alike. This article aims to provide a concise summary of previous controversies in the field of urinary incontinence, while evaluating the future of potential biomaterials in this field.
Collapse
Affiliation(s)
- Jack Whooley
- Department of Urology and Transplant Surgery, Beaumont Hospital, Co Dublin, Ireland
| | - Eoghan M Cunnane
- Tissue Engineering Research Group, Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland.,Trinity Centre for Biomedical Engineering, Trinity College Dublin, Dublin, Ireland.,Advanced Materials and Bioengineering Research Centre (AMBER), RCSI and TCD, Dublin, Ireland
| | - Ronaldo Do Amaral
- Tissue Engineering Research Group, Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland.,Trinity Centre for Biomedical Engineering, Trinity College Dublin, Dublin, Ireland.,Advanced Materials and Bioengineering Research Centre (AMBER), RCSI and TCD, Dublin, Ireland
| | - Michael Joyce
- Tissue Engineering Research Group, Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland.,Trinity Centre for Biomedical Engineering, Trinity College Dublin, Dublin, Ireland.,Advanced Materials and Bioengineering Research Centre (AMBER), RCSI and TCD, Dublin, Ireland
| | - Eoin MacCraith
- Department of Urology and Transplant Surgery, Beaumont Hospital, Co Dublin, Ireland
| | - Hugh D Flood
- Tissue Engineering Research Group, Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland.,Trinity Centre for Biomedical Engineering, Trinity College Dublin, Dublin, Ireland.,Advanced Materials and Bioengineering Research Centre (AMBER), RCSI and TCD, Dublin, Ireland
| | - Fergal J O'Brien
- Tissue Engineering Research Group, Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland.,Trinity Centre for Biomedical Engineering, Trinity College Dublin, Dublin, Ireland.,Advanced Materials and Bioengineering Research Centre (AMBER), RCSI and TCD, Dublin, Ireland
| | - Niall F Davis
- Department of Urology and Transplant Surgery, Beaumont Hospital, Co Dublin, Ireland.,Tissue Engineering Research Group, Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland.,Trinity Centre for Biomedical Engineering, Trinity College Dublin, Dublin, Ireland.,Advanced Materials and Bioengineering Research Centre (AMBER), RCSI and TCD, Dublin, Ireland
| |
Collapse
|
16
|
Gargett CE, Gurung S, Darzi S, Werkmeister JA, Mukherjee S. Tissue engineering approaches for treating pelvic organ prolapse using a novel source of stem/stromal cells and new materials. Curr Opin Urol 2020; 29:450-457. [PMID: 31008783 DOI: 10.1097/mou.0000000000000634] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE OF REVIEW Nondegradable transvaginal polypropylene meshes for treating pelvic organ prolapse (POP) are now generally unavailable or banned. In this review, we summarize recent developments using tissue engineering approaches combining alternate degradable scaffolds with a novel source of mesenchymal stem/stromal cells from human endometrium (eMSC). RECENT FINDINGS Tissue engineering constructs comprising immunomodulatory, reparative eMSC and biomimetic materials with nanoarchitecture are a promising approach for vaginal repair and improving outcomes of POP surgery. Culture expansion of eMSC that maintains them (and other MSC) in the undifferentiated state has been achieved using a small molecule transforming growth factor-β receptor inhibitor, A83-01. The mechanism of action of A83-01 has been determined and its suitability for translation into the clinic explored. Novel blends of electrospun synthetic and natural polymers combined with eMSC shows this approach promotes host cell infiltration and slows biomaterial degradation that has potential to strengthen the vaginal wall during healing. Improving the preclinical ovine transvaginal surgical model by adapting the human clinical POP-Quantification system for selection of multiparous ewes with vaginal wall weakness enables assessment of this autologous eMSC/nanobiomaterial construct. SUMMARY A tissue engineering approach using autologous eMSC with degradable nanobiomaterials offers a new approach for treating women with POP.
Collapse
Affiliation(s)
- Caroline E Gargett
- The Ritchie Centre.,Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Shanti Gurung
- Centre for Reproductive Health, Hudson institute of Medical Research
| | - Saeedeh Darzi
- The Ritchie Centre.,Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Jerome A Werkmeister
- The Ritchie Centre.,Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Shayanti Mukherjee
- The Ritchie Centre.,Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| |
Collapse
|
17
|
Mancuso E, Downey C, Doxford‐Hook E, Bryant MG, Culmer P. The use of polymeric meshes for pelvic organ prolapse: Current concepts, challenges, and future perspectives. J Biomed Mater Res B Appl Biomater 2019; 108:771-789. [DOI: 10.1002/jbm.b.34432] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 05/07/2019] [Accepted: 05/31/2019] [Indexed: 12/18/2022]
Affiliation(s)
- Elena Mancuso
- Ulster UniversityNanotechnology and Integrated Bio‐Engineering Centre (NIBEC) Jordanstown campus ‐ Newtownabbey UK
| | - Candice Downey
- Leeds Institute of Medical Research at St James'sUniversity of Leeds Leeds UK
| | | | | | - Peter Culmer
- School of Mechanical EngineeringUniversity of Leeds Leeds UK
| |
Collapse
|
18
|
The challenge of stress incontinence and pelvic organ prolapse: revisiting biologic mesh materials. Curr Opin Urol 2019; 29:437-442. [PMID: 31083010 DOI: 10.1097/mou.0000000000000645] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE OF REVIEW The present article reviews the history of mesh-related complications and regulations in SUI and POP repair settings, clinical outcomes associated with the use of biologic and synthetic mesh materials, and novel approaches using modified mesh materials. RECENT FINDINGS Treatment of pelvic floor disorders, such as stress urinary incontinence (SUI) and pelvic organ prolapse (POP) commonly involves implantation of synthetic surgical mesh materials like polypropylene. Many synthetic mesh materials, however, are associated with a foreign body response upon implantation, which is characterized by fibrotic encapsulation. Complications, including erosion, infections, bleeding, and chronic pain, have led to warnings by regulatory agencies and the recall of several mesh products. To mitigate such complications, biologic mesh materials have been proposed as alternatives for SUI and POP repair. SUMMARY Clinical outcomes of surgical repair of POP/SUI are similar between biologic and synthetic meshes, but biologic meshes have a lower incidence of adverse effects. Several strategies for modifying or functionalizing biological and synthetic meshes have shown promising results in preclinical studies.
Collapse
|
19
|
Gentle cyclic straining of human fibroblasts on electrospun scaffolds enhances their regenerative potential. Acta Biomater 2019; 84:159-168. [PMID: 30471477 DOI: 10.1016/j.actbio.2018.11.034] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Revised: 11/18/2018] [Accepted: 11/20/2018] [Indexed: 12/17/2022]
Abstract
The extracellular matrix of fascia-like tissues is a resilient network of collagenous fibers that withstand the forces of daily life. When overstretched, the matrix may tear, with serious consequences like pelvic organ prolapse (POP). Synthetic implants can provide mechanical support and evoke a host response that induces new matrix production, thus reinforcing the fascia. However, there is considerable risk of scar formation and tissue contraction which result in severe complications. Matrix producing fibroblasts are both mechanosensitive and contractile; their behavior depends on the implant's surface texture and mechanical straining. Here we investigate the effect of both in a newly-designed experimental setting. Electrospun scaffolds of Nylon and PLGA/PCL and a non-porous PLGA/PCL film were clamped like a drumhead and seeded with fibroblasts of POP patients. Upon confluency, scaffolds were cyclically strained for 24 or 72 h at 10% and 0.2 Hz, mimicking gentle breathing. Non-loading condition was control. Strained fibroblasts loosened their actin-fibers, thereby preventing myofibroblastic differentiation. Mechanical loading upregulated genes involved in matrix synthesis (collagen I, III, V and elastin), matrix remodeling (α-SMA, TGF-β1, MMP-2) and inflammation (COX-2, TNF-α, IL8, IL1-β). Collagen genes were expressed earlier under mechanical loading and the ratio of I/III collagen increased. Matrix synthesis and remodeling were stronger on the electrospun scaffolds, while inflammation was more prominent on the non-porous film. Our findings indicate that mechanical straining enhances the regenerative potential of fibroblasts for the regeneration of fascia-type tissues and limit the risk of scar tissue formation. These effects are stronger on an electrospun texture. STATEMENT OF SIGNIFICANCE: Pelvic organ prolapsed is a dysfunctional disease in female pelvic floor that can reduce the quality of life women. Currently, trans-vaginal knitted meshes are used to anatomically correct the dysfunctional tissues. However, the meshes can create sever adverse complications in some patients (e.g. chronic pain) in longer-term. As an alternative, we developed nanofibrous matrices by electrospinning based on different materials. We designed an in-vitro culture system and subjected cell-seeded matrices to cyclic mechanical loading. Results revealed that gentle straining of POP-cells on electrospun matrices, advances their regenerative potential at morphological and gene expression levels. Our findings, provide a proof-of-concept for using electrospun matrices as an alternative implant for pelvic floor repair, given that the parameters are designed efficiently and safely.
Collapse
|
20
|
Cohen SA. Is There Still a Role for Transvaginal Mesh in Treatment of Pelvic Organ Prolapse? CURRENT BLADDER DYSFUNCTION REPORTS 2018. [DOI: 10.1007/s11884-018-0497-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|