Development of a cellulose-based prosthetic mesh for pelvic organ prolapse treatment: In vivo long-term evaluation in an ewe vagina model

Abstract

The use of vaginal surgical mesh to treat pelvic organ prolapse (POP) has been associated with high rates of mesh-related complications. In the present study, we prepared new kinds of meshes based on bacterial cellulose (BC) and collagen-coated BC (BCCOL) using a laser cutting method and perforation technique. The mechanical properties of pre-implanted BC meshes, including breaking strength, suture strength and rigidity, were equal to or exceeded those of available clinically used polypropylene meshes. An in vitro cellular assay revealed that BCCOL meshes exhibited enhanced biocompatibility by increasing collagen secretion and cell adhesion. Both BC and BCCOL meshes only caused weak inflammation and were surrounded by newly formed connective tissue composed of type I collagen after implantation in a rabbit subcutaneous model for one week, demonstrating that the novel mesh is fully biocompatible and can integrate into surrounding tissues. Furthermore, a long-term (ninety days) ewe vaginal implantation model was used to evaluate foreign body reactions and suitability of BC and BCCOL meshes as vaginal meshes. The results showed that the tissue surrounding the BC meshes returned to its original physiology as muscle tissue, indicating the excellent integration of BC meshes into the surrounding tissues without triggering severe local inflammatory response post-implantation. The collagen coating appeared to induce a chronic inflammatory response due to glutaraldehyde remnants. The present exploratory research demonstrated that the developed BC mesh might be a suitable candidate for treating POP.

In Vitro Cytotoxicity, Colonisation by Fibroblasts and Antimicrobial Properties of Surgical Meshes Coated with Bacterial Cellulose

“…After one week it was demonstrated that BC mesh was fully biocompatible and integrated into surrounding tissues. A long-term (90 days) study using a ewe vaginal implantation model showed no foreign body reactions [65]. An opposite result was obtained by Ai et al, who studied BC meshes as a material for pelvic organ prolapse treatment in an in vivo sheep model.…”

“…Our in vitro results are consistent with other research teams' in vitro results and also with (to the level indicated by careful extrapolation) with in vivo studies performed on such small animals as rats and rabbits. Studies with larger animals such as dogs or sheep give inconsistent results, and there is very little research of this kind using BC [63][64][65][66].…”

The impact of bacterial contamination on the host response towards fully absorbable poly-4-hydroxybutyrate and nonabsorbable polypropylene pelvic floor implants

“…To assess the possibilities, future studies should focus on the long-term host response to P4HB in larger animal models, e.g. sheep [ [56] , [57] , [58] ], including the effect of mesh degradation and mechanical properties. Finally, as bacterial contamination significantly affects the host response, we would recommend future studies to take into account the effect of the vaginal microflora on mesh acceptance and integration.…”

Chemical Scalpel: An Experimental Collagenase-Based Treatment for Peritoneal Adhesions

“…Foreign body reaction is normal around a mesh that has been implanted for months [ 28 , 29 ]. Intraperitoneal adhesions are seen as fibrous scar tissue.…”