Efficacy of Supercritical Fluid Decellularized Porcine Acellular Dermal Matrix in the Post-Repair of Full-Thickness Abdominal Wall Defects in the Rabbit Hernia Model

Abstract

Damage to abdominal wall integrity occurs in accidents, infection and herniation. Repairing the hernia remains to be one of the most recurrent common surgical techniques. Supercritical carbon dioxide (SCCO2) was used to decellularize porcine skin to manufacture acellular dermal matrix (ADM) for the reparation of full-thickness abdominal wall defects and hernia. The ADM produced by SCCO2 is chemically equivalent and biocompatible with human skin. The ADM was characterized by hematoxylin and eosin (H&E) staining, 4,6-Diamidino-2-phenylindole, dihydrochloride (DAPI) staining, residual deoxyribonucleic acid (DNA) contents and alpha-galactosidase (α-gal staining), to ensure the complete decellularization of ADM. The ADM mechanical strength was tested following the repair of full-thickness abdominal wall defects (4 × 4 cm) created on the left and right sides in the anterior abdominal wall of New Zealand White rabbits. The ADM produced by SCCO2 technology revealed complete decellularization, as characterized by H&E, DAPI staining, DNA contents (average of 26.92 ng/mg) and α-gal staining. In addition, ADM exhibited excellent performance in the repair of full-thickness abdominal wall defects. Furthermore, the mechanical strength of the reconstructed abdominal wall after using ADM was significantly (p < 0.05) increased in suture retention strength (30.42 ± 1.23 N), tear strength (63.45 ± 7.64 N and 37.34 ± 11.72 N) and burst strength (153.92 ± 20.39 N) as compared to the suture retention (13.33 ± 5.05 N), tear strength (6.83 ± 0.40 N and 15.27 ± 3.46 N) and burst strength (71.77 ± 18.09 N) when the predicate device materials were concomitantly tested. However, the efficacy in hernia reconstruction of ADM is substantially equivalent to that of predicate material in both macroscopic and microscopic observations. To conclude, ADM manufactured by SCCO2 technology revealed good biocompatibility and excellent mechanical strength in post-repair of full-thickness abdominal wall defects in the rabbit hernia model.

Efficient Decellularization of the Full-Thickness Rat-Derived Abdominal Wall to Produce Acellular Biologic Scaffolds for Tissue Reconstruction: Promising Evidence Acquired from In Vitro Results

“…In addition to this evidence for altered mechanical properties, stiffer abdominal wall scaffolds have been observed in other studies conducted with similar preparation methods. Specifically, Sanchez et al [36], Buell et al [37], and Chiu et al [38] demonstrated decellularized abdominal wall constructs with similar biomechanical properties as those presented herein. The immunogenicity of decellularized scaffolds constitutes another important parameter for them to serve as potential biological grafts.…”

“…The preservation of collagen type I in decellularized samples is of significant importance, being one of the major proteins of the ECM structure, thus contributing to a great number of processes, such as hemostasis performance and regulation of the wound-healing process in the injured area [ 41 ]. In addition to its function in tissue healing, collagen type I plays a significant role in the recruitment and attachment of specific cellular populations to the wounded region through binding to arginine–glycine–aspartic acid (RGD) binding motifs [ 34 , 35 , 37 , 38 , 42 , 43 , 44 , 45 , 46 , 47 ]. Indeed, various cellular populations, such as fibroblasts, pericytes, and mesenchymal stromal cells, can bind to collagen fibers through the interaction of α1β1, α2β1, and ανβ1 with the RGD binding motifs of well-aligned collagen fibers, thus further promoting wound healing and tissue regeneration [ 34 , 35 , 37 , 38 , 42 , 43 , 44 , 45 , 46 , 47 ].…”

“…In addition to its function in tissue healing, collagen type I plays a significant role in the recruitment and attachment of specific cellular populations to the wounded region through binding to arginine–glycine–aspartic acid (RGD) binding motifs [ 34 , 35 , 37 , 38 , 42 , 43 , 44 , 45 , 46 , 47 ]. Indeed, various cellular populations, such as fibroblasts, pericytes, and mesenchymal stromal cells, can bind to collagen fibers through the interaction of α1β1, α2β1, and ανβ1 with the RGD binding motifs of well-aligned collagen fibers, thus further promoting wound healing and tissue regeneration [ 34 , 35 , 37 , 38 , 42 , 43 , 44 , 45 , 46 , 47 ]. Specifically, it has been shown that integrin-mediated binding with the RGD motifs can lead to an important intracellular signaling cascade through the upregulation of ILK–NF-κb and GSK3β–AP1–cyclinD1, promoting in this way cell survival, migration, and proliferation to the injured site [ 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 ].…”

“…Nowadays, the use of scaffolds obtained from decellularized matrices is comprehensively investigated as a pioneer tissue engineering approach and alternative therapeutic strategy for several life-threatening diseases, such as cardiovascular disease (CVD), bone defects, and dental and craniofacial issues [ 29 , 30 , 31 , 32 , 33 , 34 , 35 ]. Different research groups have elaborated on protocols for the successful decellularization of abdominal wall scaffolds of animal origin [ 36 , 37 , 38 , 39 ]. The application of a decellularization protocol can be easily performed in a great variety of tissues, although the preservation of the full-thickness ECM comprises a highly demanding task.…”

“…The application of a decellularization protocol can be easily performed in a great variety of tissues, although the preservation of the full-thickness ECM comprises a highly demanding task. For this reason, the literature regarding the successful production of full-thickness abdominal wall scaffolds is limited [ 36 , 37 , 38 , 39 ], yet the needs for reconstructive surgery demand the production of such structures. In the past, perfusion decellularization was proposed for the production of whole-organ scaffolds; however, this process is laborious and requires advanced equipment and well-trained personnel [ 40 ].…”