Deterioration in biomechanical properties of the vagina following implantation of a high‐stiffness prolapse mesh

Feola, Andrew; Abramowitch, Steven D.; Jallah, Zegbeh; Stein, Suzan; Barone, William R.; Palcsey, Stacy; Moalli, Pamela

doi:10.1111/1471-0528.12077

Cited by 128 publications

(140 citation statements)

References 29 publications

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“…Following implantation with Gynemesh PS by sacrocolpopexy, the quantity of collagen and elastin in the grafted vagina decreased by 20% and 43%, respectively, with impaired tissue function as measured in biomechanical tests 6,9 . Here, we demonstrate that the decreases in these key structural proteins is via accelerated degradation associated with an increase in active MMPs including the interstitial collagenases MMPs-1, -8, and -13 and the elastases MMPs-2, and -9.…”

Section: Commentmentioning

confidence: 99%

Impact of Prolapse Meshes on the Metabolism of Vaginal Extracellular Matrix in Rhesus Macaque

Liang

Zong

Palcsey

et al. 2015

Obstetrical &Amp; Gynecological Survey

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Objective-The impact of polypropylene mesh implantation on vaginal collagen and elastin metabolism was analyzed using a nonhuman primate model to further delineate the mechanism of mesh induced complications.Methods-49 middle aged parous rhesus macaques underwent surgical implantation of 3 synthetic meshes via sacrocolpopexy. Gynemesh PS (n=12) and two lower weight, higher porosity, lower stiffness meshes -UltraPro (n = 19) and Restorelle (n=8) were implanted, in which UltraPro was implanted with its blue orientation lines perpendicular (low stiffness direction, n=11) and parallel (high stiffness direction, n=8) to the longitudinal axis of vagina. Sham operated animals were used as controls (n=10). Twelve weeks after surgery, the meshtissue complex was excised and analyzed.Results-Relative to Sham, Gynemesh PS had a negative impact on the metabolism of both collagen and elastin favoring catabolic reactions while UltraPro only induced an increase in elastin degradation. Restorelle had the least impact. As compared to Sham, the degradation of collagen and elastin in the vagina implanted with Gynemesh PS was increased with a simultaneous increase in active MMP-1, -8, -13 and total MMP-2, -9 (all P<0.05). The degradation of elastin (tropoelastin and mature elastin) was increased in the UltraPro implanted vagina with a concomitant increase of MMP-2, and -9 (all P<0.05). Collagen subtype ratio III/I was increased in both Gynemesh PS and UltraPro perpendicular groups (P<0.05). Condensation:The heavier, less porous and stiffer mesh Gynemesh PS increased the catabolism of collagen and elastin in the vagina, characterized by increased matrix degradation and MMPs.Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Conclusion-Following implantation with the heavier, less porous and stiffer mesh, Gynemesh PS, the degradation of vaginal collagen and elastin exceeded synthesis, most likely as a result of increased activity of MMPs, resulting in a structurally compromised tissue. NIH Public Access

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Section: Commentmentioning

confidence: 99%

Impact of Prolapse Meshes on the Metabolism of Vaginal Extracellular Matrix in Rhesus Macaque

Liang

Zong

Palcsey

et al. 2015

Obstetrical &Amp; Gynecological Survey

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“…Essentially the PPL mesh is too strong and not elastic enough to be used in the pelvic floor [62,63]. Additionally, animal studies have confirmed that the host response to the PPL initiated by macrophages in the mesh-tissue interface is mainly an M1 (proinflammatory) response, instead of an M2 (remodeling) response, characterized by secretion of matrix metalloproteinases and pro-inflammatory cytokines leading to a vigorous and persistent foreign body reaction [50].…”

Section: Biological Requirements Of Pelvic Floormentioning

confidence: 99%

Synthetic Materials Used in the Surgical Treatment of Pelvic Organ Prolapse: Problems of Currently Used Material and Designing the Ideal Material

Mangır¹,

Chapple²,

MacNeil³

2018

Pelvic Floor Disorders

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Synthetic materials have long been used to provide structural support when surgically repairing pelvic organ prolapse (POP). The most widely used synthetic material is a mesh made of polypropylene (PPL). The use of mesh is intended to improve cure rates and prevent recurrences after POP surgery -however as more mesh materials have been implanted, it has become apparent that serious complications can occur in up to 30% of women, particularly when the mesh is implanted transvaginally. Over the years many different mesh kits have been marketed and used in the treatment of POP however polypropylene mesh was never designed or tested for use in pelvic floor. Instead it was approved for clinical use based on its biocompatibility and success in abdominal hernia repairs. It is now known that PPL meshes are neither compliant with the mechanical forces in the pelvic floor nor do they integrate well into paravaginal tissues. Better materials developed specifically for use in pelvic floor are urgently needed. The aim of this chapter is to define the requirements of an ideal mesh in terms of its material properties and to summarize the ongoing research on developing the next generation pelvic floor repair materials.

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“…For histomorphometrics, biomechanical testing, collagen, and GAG content, previously published data on sham and Gynemeshimplanted vagina were used for comparison. 6,7 Ball-burst test for biomechanical properties…”

Section: Surgical Proceduresmentioning

confidence: 99%

“…6 The contribution of soft tissues associated with the GVC was determined for ultimate load (load tissue ) and stiffness (k tissue ) by sub-tracting the average corresponding values of Gynemesh obtained ex vivo. 6 For samples that were grafted with MatriStem alone, the tissue contribution was equal to those values obtained for the entire complex. Since noncrosslinked ECM grafts degrade rapidly in vivo (10-ply 14 C-labeled ECM was completely degraded by 3 months), 21 we assumed that MatriStem grafts were completely degraded during the implantation period (3 months) and replaced by host connective tissue, and thus, the ECM graft did not contribute to the mechanical integrity at the time of tissue procurement.…”

Section: Surgical Proceduresmentioning

confidence: 99%

“…[1][2][3][4] Gynemesh PS (Ethicon, Sommersville, NJ), one of the most widely implanted polypropylene meshes, has been shown to induce a robust foreign-body response and degenerative changes in the vagina when implanted via sacrocolpopexy including a decrease in smooth muscle contractility and volume, a loss of mechanical integrity, a decrease in matrix structural proteins (collagen and elastin) accompanied by an increase in glycosaminoglycan (GAG) content, and an increase in the amount and activity of matrixdegrading proteases. [5][6][7][8] In theory, these negative effects could be overcome with the use of regenerative biomaterials either in combination with Gynemesh PS as a composite graft or alone with the elimination of permanent materials. However, given that the sacrocolpopexy is not an anatomical surgery and regenerative matrices are designed to restore or repair injured tissues in a sitespecific manner, it is not clear whether the use of a regenerative matrix in sacrocolpopexy surgery would be successful.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Extracellular Matrix Regenerative Graft Attenuates the Negative Impact of Polypropylene Prolapse Mesh on Vagina in Rhesus Macaque

Liang

Knight

Barone

et al. 2017

Obstet Gynecol Surv

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BACKGROUND-The use of wide pore lightweight polypropylene mesh to improve anatomical outcomes in the surgical repair of prolapse has been hampered by mesh complications. One of the prototype prolapse meshes has been found to negatively impact the vagina by inducing a decrease in smooth muscle volume and contractility and the degradation of key structural proteins (collagen and elastin), resulting in vaginal degeneration. Recently, bioscaffolds derived from extracellular matrix have been used to mediate tissue regeneration and have been widely adopted in tissue engineering applications.

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Deterioration in biomechanical properties of the vagina following implantation of a high‐stiffness prolapse mesh

Cited by 128 publications

References 29 publications

Impact of Prolapse Meshes on the Metabolism of Vaginal Extracellular Matrix in Rhesus Macaque

Impact of Prolapse Meshes on the Metabolism of Vaginal Extracellular Matrix in Rhesus Macaque

Synthetic Materials Used in the Surgical Treatment of Pelvic Organ Prolapse: Problems of Currently Used Material and Designing the Ideal Material

Extracellular Matrix Regenerative Graft Attenuates the Negative Impact of Polypropylene Prolapse Mesh on Vagina in Rhesus Macaque

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