Coating with Autologous Plasma Improves Biocompatibility of Mesh GraftsIn Vitro: Development Stage of a Surgical Innovation

Abstract

Purpose. To investigate mesh coating modalities with autologous blood components in a recently developed in vitro test system for biocompatibility assessment of alloplastic materials. Materials and Methods. Seven different mesh types, currently used in various indications, were randomly investigated. Meshes were coated prior to cultivation with autologous peripheral blood mononuclear cells (PBMCs), platelets, and blood plasma. Pretreated meshes were incubated over 6 weeks in a minced tissue assay, representative for fibroblasts, muscle cells, and endothelial cells originating from 10 different patients. Adherence of those tissues on the meshes was microscopically investigated and semiquantitatively assessed using a previously described scoring system. Results. Coating with peripheral blood mononuclear cells did not affect the adherence score, whereas coating with platelets and blood plasma increased the score suggesting improved biocompatibility in vitro. The previous ranking of native meshes remained consistent after coating. Conclusion. Plasma coating of meshes improves their biocompatibility score in a novel in vitro test system.

Coating of Mesh Grafts for Prolapse and Urinary Incontinence Repair with Autologous Plasma: Exploration Stage of a Surgical Innovation

“…A biocompatibility is described by the foreign body reaction (FBR) at the host-tissue/biomaterial interface. The dynamic of the FBR is given by the inflammatory host response depending on the biomaterial composition ( Table 1 ) [ 7 , 9 , 10 ]. The current understanding about an optimized surgical mesh describes a material that permits the transmigration and localisation of beneficial host cells and if directly exposed to visceral organs, vessels, or nerves it strongly inhibits the adherence of the respective organs in order to avoid erosion, foreign body provoked pain, and so forth.…”

“…A validated in vitro test system to compare biocompatibility features of different meshes has been developed ( Idea , first stage) [ 9 ]. This test system was subsequently expanded, to show that mesh modification by autologous plasma coating results in higher biocompatibility and adherence score in vitro [ 9 , 10 ]. The predictability of these approaches, biocompatibility evaluation, and improvement by plasma coating could then be validated and confirmed in a two-year large animal study ( Development , second stage) [ 14 ].…”

Emerging Trends in Abdominal Wall Reinforcement: Bringing Bio‐Functionality to Meshes

“…As an alternative to chemical modification of the surface of meshes, various biological coatings have been applied to meshes resulting in improved compatibility. For instance, investigations realized on different commercialized meshes demonstrated an increased score in regard to the in vitro cytocompatibility evaluation after human plasma coating …”

Autologous plasma coating

“…The extent of macrophage invasion and inflammatory tissue does not relevantly increase after 120 min as compared with the values for 3 months after explantation or later. Our previously described method to improve the biocompatibility performance of meshes in vivo and in vitro by autologous plasma coating before implantation did not have an effect on the early inflammatory events, as the respective values for inflammatory infiltrate and macrophage invasion did not differ from coated to native meshes 1,29,32. However, markers such as connective tissue organization, myofibroblast invasion and endothelial cells, characteristic of vascularization, are detectable after 3 months post-implantation and show different extents in the 3 investigated meshes.…”

“…In vitro ranking of native meshes29 In vitro ranking of meshes after coating with different blood components32 Tables…”