Promotion of Hernia Repair with High-Strength, Flexible, and Bioresorbable Silk Fibroin Mesh in a Large Abdominal Hernia Model

Macro/nano topological modification of a silk fibroin mesh with mimicked extracellular matrix structure and excellent biocompatibility

Synthetic surgical meshes have been widely used for repairing hernias, but their performance, such as nonabsorbability and insufficient mechanical strength, requires further improvement due to postsurgical complications, including chronic pain and inflammation. In this work, naturally derived and bioresorbable silk fibroin meshes (SFM) with three knit patterns were optimized and modified by a combination of regenerated silk fibroin (RSF) and polydopamine (PDA), to endow SFM with a mimicked extracellular matrix (ECM) structure and excellent biocompatibility. Our study confirmed that the modified meshes (SFM@PDA-RSF) exhibited ECM-like structure and good structural stability. Tensile testing results revealed that the SFM substrate played a dominant role in mechanical properties, and SFM@PDA-RSF showed high tensile strength (49.58 N cm-1 transversely, 68.42 N cm-1 longitudinally), which could afford sufficient mechanical support for abdominal wall hernia (AWH) repair (16 N cm-1). Moreover, SFM@PDA-RSF was found to be significantly antioxidant, non-hemolytic, and favorable for cell adhesion and growth, showing great potential for effective hernia repair.

Potentially commercializable nerve guidance conduits for peripheral nerve injury: Past, present, and future

Peripheral nerve injuries are a prevalent global issue that has garnered great concern. Although autografts remain the preferred clinical approach to repair, their efficacy is hampered by factors like donor scarcity. The emergence of nerve guidance conduits as novel tissue engineering tools offers a promising alternative strategy. This review aims to interpret nerve guidance conduits and their commercialization from both clinical and laboratory perspectives. To enhance comprehension of clinical situations, this article provides a comprehensive analysis of the clinical efficacy of nerve conduits approved by the United States Food and Drug Administration. It proposes that the initial six months post-transplantation is a critical window period for evaluating their efficacy. Additionally, this study conducts a systematic discussion on the research progress of laboratory conduits, focusing on biomaterials and add-on strategies as pivotal factors for nerve regeneration, as supported by the literature analysis. The clinical conduit materials and prospective optimal materials are thoroughly discussed. The add-on strategies, together with their distinct obstacles and potentials are deeply analyzed. Based on the above evaluations, the development path and manufacturing strategy for the commercialization of nerve guidance conduits are envisioned. The critical conclusion promoting commercialization is summarized as follows: 1) The optimization of biomaterials is the fundamental means; 2) The phased application of additional strategies is the emphasized direction; 3) The additive manufacturing techniques are the necessary tools. As a result, the findings of this research provide academic and clinical practitioners with valuable insights that may facilitate future commercialization endeavors of nerve guidance conduits.

Cellular Interactions and Biological Effects of Silk Fibroin: Implications for Tissue Engineering and Regenerative Medicine

Silk fibroin (SF), the core structural protein derived from Bombyx mori silk, is extensively employed in tissue engineering and regenerative medicine due to its exceptional mechanical properties, favorable biocompatibility, tunable biodegradability, and versatile processing capabilities. Despite these advantages, current research predominantly focuses on SF biomaterials as structural scaffolds or drug carriers, often overlooking their potential role in modulating cellular behavior and tissue regeneration. This review aims to present a comprehensive overview of the inherent biological effects of SF biomaterials, independent of any exogenous biomolecules, and their implications for various tissue regeneration. It will cover in vitro cellular interactions of SF with various cell types, including stem cells and functional tissue cells such as osteoblasts, chondrocytes, keratinocytes, endothelial cells, fibroblasts, and epithelial cells. Moreover, it will summarize in vivo immune responses, cellular responses, and tissue regeneration following SF implantation, specifically focusing on vascular, bone, skin, cartilage, ocular, and tendon/ligament regeneration. Furthermore, it will address current limitations and future perspectives in the design of bioactive SF biomaterials. A comprehensive understanding of these cellular interactions and the biological effects of SF is crucial for predicting regenerative outcomes with precision and for designing SF-based biomaterials tailored to specific properties, enabling broader applications in regenerative medicine.

An antibacterial biologic patch based on bacterial cellulose for repair of infected hernias

Infection-associated complications and repair failures and antibiotic resistance have emerged as a formidable challenge in hernia repair surgery. Consequently, the development of antibiotic-free antibacterial patches for hernia repair has become an exigent clinical necessity. Herein, a GBC/Gel/LL37 biological patch (biopatch) with exceptional antibacterial properties is fabricated by grafting 2-Methacryloyloxyethyl trimethylammonium chloride (METAC), a unique quaternary ammonium salt with vinyl, onto bacterial cellulose (GBC), followed by compounding with gelatin (Gel) and LL37. The GBC/Gel/LL37 biopatch exhibits stable swelling capacity, remarkable mechanical properties, flexibility, and favorable biocompatibility. The synergistic effect of METAC and LL37 confers upon the GBC/Gel/LL37 biopatch excellent antibacterial efficacy against Staphylococcus aureus and Escherichia coli, effectively eliminating invading bacteria without the aid of exogenous antibiotics in vivo while significantly reducing local acute inflammation caused by infection. Furthermore, the practical efficacy of the GBC/Gel/LL37 biopatch is evaluated in an infected ventral hernia model, revealing that the GBC/Gel/LL37 biopatch can prevent the formation of visceral adhesions, facilitate the repair of infected ventral hernia, and effectively mitigate chronic inflammation. The prepared antibacterial GBC/Gel/LL37 biopatch is very effective in dealing with the risk of infection in hernia repair surgery and offers potential clinical opportunities for other soft injuries, exhibiting considerable clinical application prospects.

A Review of Advanced Abdominal Wall Hernia Patch Materials

Tension-free abdominal wall hernia patch materials (AWHPMs) play an important role in the repair of abdominal wall defects (AWDs), which have a recurrence rate of <1%. Nevertheless, there are still significant challenges in the development of tailored, biomimetic, and extracellular matrix (ECM)-like AWHPMs that satisfy the clinical demands of abdominal wall repair (AWR) while effectively handling post-operative complications associated with abdominal hernias, such as intra-abdominal visceral adhesion and abnormal healing. This extensive review presents a comprehensive guide to the high-end fabrication and the precise selection of these advanced AWHPMs. The review begins by briefly introducing the structures, sources, and properties of AWHPMs, and critically evaluates the advantages and disadvantages of different types of AWHPMs for AWR applications. The review subsequently summarizes and elaborates upon state-of-the-art AWHPM fabrication methods and their key characteristics (e.g., mechanical, physicochemical, and biological properties in vitro/vivo). This review uses compelling examples to demonstrate that advanced AWHPMs with multiple functionalities (e.g., anti-deformation, anti-inflammation, anti-adhesion, pro-healing properties, etc.) can meet the fundamental clinical demands required to successfully repair AWDs. In particular, there have been several developments in the enhancement of biomimetic AWHPMs with multiple properties, and additional breakthroughs are expected in the near future.

Silk Fibroin Materials: Biomedical Applications and Perspectives

The golden rule in tissue engineering is the creation of a synthetic device that simulates the native tissue, thus leading to the proper restoration of its anatomical and functional integrity, avoiding the limitations related to approaches based on autografts and allografts. The emergence of synthetic biocompatible materials has led to the production of innovative scaffolds that, if combined with cells and/or bioactive molecules, can improve tissue regeneration. In the last decade, silk fibroin (SF) has gained attention as a promising biomaterial in regenerative medicine due to its enhanced bio/cytocompatibility, chemical stability, and mechanical properties. Moreover, the possibility to produce advanced medical tools such as films, fibers, hydrogels, 3D porous scaffolds, non-woven scaffolds, particles or composite materials from a raw aqueous solution emphasizes the versatility of SF. Such devices are capable of meeting the most diverse tissue needs; hence, they represent an innovative clinical solution for the treatment of bone/cartilage, the cardiovascular system, neural, skin, and pancreatic tissue regeneration, as well as for many other biomedical applications. The present narrative review encompasses topics such as (i) the most interesting features of SF-based biomaterials, bare SF's biological nature and structural features, and comprehending the related chemo-physical properties and techniques used to produce the desired formulations of SF; (ii) the different applications of SF-based biomaterials and their related composite structures, discussing their biocompatibility and effectiveness in the medical field. Particularly, applications in regenerative medicine are also analyzed herein to highlight the different therapeutic strategies applied to various body sectors.

Biomaterial based implants caused remote liver fatty deposition through activated blood-derived macrophages

Understanding the biocompatibility of biomaterials is a prerequisite for the prediction of its clinical application, and the present assessments mainly rely on in vitro cell culture and in situ histopathology. However, remote organs responses after biomaterials implantation is unclear. Here, by leveraging body-wide-transcriptomics data, we performed in-depth systems analysis of biomaterials - remote organs crosstalk after abdominal implantation of polypropylene and silk fibroin using a rodent model, demonstrating local implantation caused remote organs responses dominated by acute-phase responses, immune system responses and lipid metabolism disorders. Of note, liver function was specially disturbed, defined as hepatic lipid deposition. Combining flow cytometry analyses and liver monocyte recruitment inhibition experiments, we proved that blood derived monocyte-derived macrophages in the liver underlying the mechanism of abnormal lipid deposition induced by local biomaterials implantation. Moreover, from the perspective of temporality, the remote organs responses and liver lipid deposition of silk fibroin group faded away with biomaterial degradation and restored to normal at end, which highlighted its superiority of degradability. These findings were further indirectly evidenced by human blood biochemical ALT and AST examination from 141 clinical cases of hernia repair using silk fibroin mesh and polypropylene mesh. In conclusion, this study provided new insights on the crosstalk between local biomaterial implants and remote organs, which is of help for future selecting and evaluating biomaterial implants with the consideration of whole-body response.

Abdominal wall hernia repair: from prosthetic meshes to smart materials

Hernia reconstruction is one of the most frequently practiced surgical procedures worldwide. Plastic surgery plays a pivotal role in reestablishing desired abdominal wall structure and function without the drawbacks traditionally associated with general surgery as excessive tension, postoperative pain, poor repair outcomes, and frequent recurrence. Surgical meshes have been the preferential choice for abdominal wall hernia repair to achieve the physical integrity and equivalent components of musculofascial layers. Despite the relevant progress in recent years, there are still unsolved challenges in surgical mesh design and complication settlement. This review provides a systemic summary of the hernia surgical mesh development deeply related to abdominal wall hernia pathology and classification. Commercial meshes, the first-generation prosthetic materials, and the most commonly used repair materials in the clinic are described in detail, addressing constrain side effects and rational strategies to establish characteristics of ideal hernia repair meshes. The engineered prosthetics are defined as a transit to the biomimetic smart hernia repair scaffolds with specific advantages and disadvantages, including hydrogel scaffolds, electrospinning membranes, and three-dimensional patches. Lastly, this review critically outlines the future research direction for successful hernia repair solutions by combing state-of-the-art techniques and materials.

Exploring the match between the degradation of the ECM-based composites and tissue remodeling in a full-thickness abdominal wall defect model

The repair of abdominal wall defects is currently a clinical challenge. A naturally derived extracellular matrix (ECM) such as small intestine submucosa (SIS) has received great attention in abdominal wall defect repair because of its remarkable bioactivity, biodegradability and tissue regeneration. The match between material degradation and tissue remodeling is very important for the realization of ideal repair effectiveness. In this study, a near-infrared (NIR) fluorescent dye Cy5.5 NHS ester was used to label ECM-based (ECMB) composites consisting of SIS and chitosan/elastin electrospun nanofibers for monitoring material degradation. The tissue remodeling in the ECMB composites for a full-thickness abdominal wall defect repair was systematically investigated by a series of tests including wall thickness measurement, muscle regeneration analysis and angiogenesis assessment. The main findings were: (1) real-time and noninvasive degradation monitoring of the ECMB composites until complete degradation could be realized by chemical conjugation with a Cy5.5 NHS ester. (2) In a full-thickness abdominal wall defect model, the explant thickness could be used as an intuitional indicator for evaluating the tissue remodeling efficiency in the ECMB composites, and the accuracy of this indicator was verified by various examinations including collagen deposition, angiogenesis, and muscle regeneration. The present study could provide new insight into evaluating tissue repair effectiveness of the ECMB composites.

Enzymatically crosslinked silk-nanosilicate reinforced hydrogel with dual-lineage bioactivity for osteochondral tissue engineering

Osteochondral defects are characterized by damage to both articular cartilage and subchondral bone. Various tissue engineering strategies have been developed for osteochondral defect repair. However, strong mechanical properties and dual-lineage (osteogenesis and chondrogenesis) bioactivity still pose challenges for current biomaterial design. Silicate nanoclay has been reported to improve the mechanical properties and biofunctionality of polymer systems, but its effect on in vitro dual-lineage differentiation or in vivo osteochondral regeneration has not been extensively investigated before. Here, a novel enzymatically crosslinked silk fibroin (SF)-Laponite (LAP) nanocomposite hydrogel was fabricated and evaluated for osteochondral regeneration. The incorporation of a small amount of LAP (1% w/v) accelerated the gelation process of SF and greatly enhanced the mechanical properties and hydrophilicity of the hydrogel. In vitro investigations showed that the developed SF-LAP hydrogel was biocompatible and was able to induce osteogenic and chondrogenic differentiation of bone marrow-derived mesenchymal stem cells (BMSCs), validated by Alizarin red/Alcian blue staining, qPCR, and immunofluorescent staining. During an 8-week implantation into rabbit full-thickness osteochondral defects, the SF-LAP hydrogel promoted the simultaneous and enhanced regeneration of cartilage and subchondral bone. The repaired tissue in the chondral region was constituted mainly of hyaline cartilage with typical chondrocyte morphology and cartilaginous extracellular matrix (ECM). These findings suggested that the SF-LAP nanocomposite hydrogel developed in this study served as a promising biomaterial for osteochondral regeneration due to its mechanical reinforcement and dual-lineage bioactivity.

Multilayer fibroin/chitosan oligosaccharide lactate and pullulan immunomodulatory patch for treatment of hernia and prevention of intraperitoneal adhesion

This study aims to develop a novel intraperitoneal two- or three-layered patch with immunomodulatory property for treatment of hernia, regeneration of abdominal wall and prevention of intraperitoneal adhesions. Polypropylene (PP) mesh, middle layer, was intended to provide mechanical support whereas pullulan (PUL) hydrogel coating layer was designed to prevent intraperitoneal adhesions. Fibroin/chitosan oligosaccharide lactate (F/COS) layer electrospun on one side of pullulan was chosen for immunomodulation and abdominal wall regeneration. Physical and mechanical properties and regenerative capacity of intraperitoneal patches were determined. Immunomodulatory property of electrospun layer and whole patch was studied by determining nitric oxide amount produced by RAW 264.7 macrophages. 25 % (w/v) PUL hydrogel and F/COS with 90:10 (w/w) ratio yielded optimal results. Here, we report that fabricated intraperitoneal patches successfully prevented cell adhesion on one side and increased cell viability and proliferation on other side, along with immunomodulation, in vitro.

Cell-Free Biomimetic Scaffold with Cartilage Extracellular Matrix-Like Architectures for In Situ Inductive Regeneration of Osteochondral Defects

The development of a biomimetic scaffold designed to provide a native extracellular matrix (ECM)-like microenvironment is a potential strategy for cartilage repair. The ECM in native articular cartilage is structurally composed of three different architectural zones, i.e., horizontally aligned, randomly arranged, and vertically aligned collagen fibers. However, the effects of scaffolds with these three different ECM-like architectures on in vivo cartilage regeneration are not clear. In this study, we aim to systematically investigate and compare their in situ inductive regenerative efficacy on cartilage defects. ECM-mimetic silk fibroin scaffolds with horizontally aligned, vertically aligned, and random pore architectures are fabricated using the controlled directional freezing technique. All of these scaffolds exhibit similar pore area, swelling ratio, and in vitro degradation behavior. Nevertheless, the aligned scaffolds have a higher pore aspect ratio and hydrophilicity, and increase the proliferation of bone marrow-derived mesenchymal stem cells (BMSCs) in vitro. When implanted into rabbit osteochondral defects, the scaffold with vertically aligned pore architectures provides a more cell-favorable microenvironment conducive to endogenous BMSCs than other scaffolds and supports the simultaneous regeneration of cartilage and subchondral bone. These findings indicate that scaffolds with vertically aligned ECM-like architectures serve as an effective cell-free and growth factor-free scaffold for enhanced endogenous osteochondral regeneration.

Durable and Effective Antibacterial Cotton Fabric Collaborated with Polypropylene Tissue Mesh for Abdominal Wall Defect Repair

A feasible, efficient antibacterial and anti-infective mesh for clinical abdominal wall defect repair is significant, but challenging due to the complexity of the postoperative wound environment. Herein, a simple strategy was provided to construct woven cotton fabric modified with gentamicin (Gem) via the enamine bonds. The obtained cotton fabric possessed favorable antibacterial properties against E. coli and S. aureus with the bactericidal rate of over 99.99% and could be combined with a commercial polypropylene (PP) mesh to serve as a two-layer composite mesh for abdominal wall defect repair. The antibacterial cotton layer was systematically characterized by FTIR, XPS, SEM, EDS, and mechanical measurements. The C2C12 cells and human fibroblasts were employed to assess the cytocompatibility of the composite mesh in vitro. Furthermore, the rat abdominal wall defect model was used to evaluate the efficacy of antibacterial and anti-infection properties. It was demonstrated that the two-layer composite mesh possessed favorable biocompatibility and satisfactory anti-infection properties involved in abdominal wall defect repair. Therefore, this synergetic two-layer composite mesh would out-perform surgical PP meshes in preventing infectious complications.

Biomimetic SIS-based biocomposites with improved biodegradability, antibacterial activity and angiogenesis for abdominal wall repair

Small intestinal submucosa (SIS) is a widely concerned acellular material for reconstructing tissue defects, but during the restoration of abdominal wall, it has been restricted due to the fast degradation causing poor long-term mechanical properties, the infection caused by bacteria contamination, and insufficient neovascularization post-operation. In this study, we developed a biomimetic SIS-based biocomposite (CS/ES-SIS) for abdominal wall repair, in which chitosan (CS) and elastin (ES) electrospun nanofibers were used to improve the biodegradability, antibacterial activity, and angiogenesis. The CS/ES-SIS composites were examined through a series of testing experiments, especially in vitro degradation was assessed by a constant deformation loading device and the micromechanical properties during enzymatic degradation under biomechanical environment were measured by nanoindentation. In vitro antibacterial test and cytocompatibility, and in vivo biocompatibility, neovascularisation and tissue regeneration were also investigated. The main research results as follows: (1) After 7 days enzymatic degradation under biomechanical environment, the degradation rate of CS/ES-SIS composites was slower than that of SIS by about 24.5%. Moreover, the CS/ES-SIS composites could better maintain the stability of microstructure and micromechanical properties compared with SIS. (2) The antibacterial rates of CS/ES-SIS composites against E. coli and S. aureus were respectively 98.87% and 98.26% while the SIS demonstrated no obvious antibacterial capacity. (3) The CS/ES-SIS composites supported the viability and proliferation of fibroblast cell L929. In vivo studies showed that the CS/ES-SIS composites could promote tissue regeneration upon implantation without serious inflammatory reaction. Additionally, the vascular number in the CS/ES-SIS composites was as 1.69 times as that in the SIS at 4 weeks. Collectively, all the findings suggested that the newly developed CS/ES-SIS composites might be promising and attractive candidates for applications of abdominal wall repair.

Combination of Polypropylene Mesh and in Situ Injectable Mussel-Inspired Hydrogel in Laparoscopic Hernia Repair for Preventing Post-Surgical Adhesions in the Piglet Model

Polypropylene (PP) mesh has been used successfully for a long time in clinical practice as an impressive prosthesis for ventral hernia repair. To utilize a physical barrier for separating mesh from viscera is a general approach for preventing adhesions in clinical practice. However, a serious abdominal adhesion between the mesh and viscera can possibly occur post-hernia, especially with the small intestine; this can lead to a series of complications, such as chronic pain, intestinal obstruction, and fistula. Thus, determining how to prevent abdominal adhesions between the mesh and viscera is still an urgent clinical problem. In this study, a dopamine-functionalized polysaccharide derivative (oxidized-carboxymethylcellulose-g-dopamine, OCMC-DA) was synthesized; this was blended with carboxymethylchitosan (CMCS) to form a hydrogel (OCMC-DA/CMCS) in situ at the appropriate time. The physical and chemical properties of the hydrogel were characterized successfully, and its excellent biocompatibility was presented by the in vitro cell test. The combination of this hydrogel and PP mesh was used in laparoscopic surgery for repairing the abdominal wall defect, where the hydrogel could become fixed in situ on the PP mesh to form an anti-adhesion gel-mesh. The results showed that the gel-mesh could prevent abdominal adhesions effectively in the piglet model. Moreover, the histology and immunohistochemical staining proved that the gel-mesh could effectively alleviate the inflammation reaction and deposition of collagen around the mesh, and it did not disturb the integration between mesh and abdominal wall. Thus, the gel-mesh has superior tissue compatibility.

Mussel-inspired copolymer-coated polypropylene mesh with anti-adhesion efficiency for abdominal wall defect repair

Construction of anti-adhesive polypropylene meshes through the in situ copolymerization grafting of poly(ethylene glycol) methacrylate and dopamine methacrylamide.

Assembled anti-adhesion polypropylene mesh with self-fixable and degradable in situ mussel-inspired hydrogel coating for abdominal wall defect repair

Construction of assembled anti-adhesion polypropylene mesh through in situ coating with self-fixable and degradable hydrogels.