Polypropylene mesh implantation for hernia repair causes myeloid cell–driven persistent inflammation

Heymann, Felix; Trotha, Klaus-Thilo von; Preisinger, Christian; Lynen-Jansen, P.; Roeth, Anjali A.; Geiger, Melanie; Geisler, Lukas; Frank, Anna Katharina; Conze, Joachim; Luedde, Tom; Binnebösel, Marcel; Neumann, Ulf; Tacke, Frank

doi:10.1172/jci.insight.123862

Cited by 60 publications

(47 citation statements)

References 52 publications

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“…This finding is supported by recent kinetic analysis of cellular colonisation on both alginate spheres and polypropylene mesh. (Heymann et al, 2019). Furthermore, the eventual accumulation of monocytic cells on titanium surfaces corroborates with previous evidence for multinucleated foreign body giant cells (FBGC) on titanium surfaces following 5-7 d in rabbit cortical bone, as multinucleated giant cells form from the fusion of macrophages (Gottlow et al, 2010;Sennerby et al, 1993).…”

Section: Discussionsupporting

confidence: 82%

Revisiting the “race for the surface” in a pre-clinical model of implant infection

Shiels

Mangum

Wenke

2020

eCM

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Orthopaedic implant use increases infection risk. Implant infection risk can be explained by the "race for the surface" concept, where there is competition between host-cell integration and bacterial colonisation. Although generally accepted, the temporal dynamics have not been elucidated in vivo. Using a bilateral intramedullary rat model, Staphylococcus aureus was injected into the tail vein either immediately after or 1, 3 and 7 d following implant placement. This allowed assessment of the temporal interplay between bacterial colonisation and host-cell adhesion by uncoupling implant placement and bacterial challenge. 2 weeks following inoculation, animals were anaesthetised, euthanised and implants and tissues harvested for bacterial enumeration. To assess host participation in implant protection, additional animals were not inoculated but euthanised at 1, 3 or 7 d and the host cells adhered to the implant were evaluated by flow cytometry and microscopy. As time between implant placement and bacterial challenge increased, infection rate and bioburden decreased. All implants had measurable bioburden when challenged at day 1, but only two implants had recoverable bacteria when inoculated 7 d after implant placement. This protection against infection corresponded to a shift in host cell population surrounding the implant. Initially, cells present were primarily non-differentiated stem cells, such as bone marrow mesenchymal stem cells, or immature haematopoietic cells. At day 7, there was a mature monocyte/macrophage population. The present study illustrated a direct relationship between host immune cell attachment and decrease in bacterial colonisation, providing guidance for antimicrobial release devices to protect orthopaedic implants against bacterial colonisation.

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Section: Discussionsupporting

confidence: 82%

Revisiting the “race for the surface” in a pre-clinical model of implant infection

Shiels

Mangum

Wenke

2020

eCM

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“…In this study, a subcutaneous implantation model was used to study how a MAA coating altered the tissue response to PP mesh. The murine subcutaneous implantation model has been widely used to test the biocompatibility of surgical mesh as it reproduces some histopathologic features found in explanted human mesh, such as the formation of foreign body giant cells and chronic inflammation . Here, it enabled a study of host response without the confounding factors of mechanics or injury.…”

Section: Discussionmentioning

confidence: 99%

Methacrylic Acid Copolymer Coating Enhances Constructive Remodeling of Polypropylene Mesh by Increasing the Vascular Response

Coindre

Carleton

Sefton

2019

Adv Healthcare Materials

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This study reports that a methacrylic acid (MAA)‐based copolymer coating generates constructive remodeling of polypropylene (PP) surgical mesh in a subcutaneous model. This coating is non‐bioresorbable and follows the architecture of the mesh without impeding connective tissue integration. Following implantation, the tissue response is biased toward vascularization instead of fibrosis. The vessel density around the MAA mesh is double that of the uncoated mesh two weeks after implantation. This initial vasculature regresses after two weeks while mature vessels remain, suggesting an enhanced healing response. Concurrently, the MAA coating alters the foreign body response to the mesh. Fewer infiltrating cells, macrophages, and foreign body giant cells are found at the tissue–material interface three weeks after implantation. The coating also dampens inflammation, with lower expression levels of pro‐inflammatory and fibrogenic signals (e.g., Tgf‐β1, Tnf‐α, and Il1‐β) and similar expression levels of anti‐inflammatory cytokines (e.g., Il10 and Il6) compared to the uncoated mesh. Contrary to other coatings that aim to mitigate the foreign body response to PP mesh, a MAA coating does not require the addition of any biological agents to have an effect, making the coated mesh an attractive candidate for soft tissue repair.

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“…Inflammatory responses due to these materials may result in postoperative complications. The implantation of prostheses is generally associated with rapid and highly orchestrated processes, including inflammatory foreign body reaction or granuloma formation, humoral immune activation, coagulation, molecular pattern recognition, and release of the hazard signal from the damaged tissue . If prolonged inflammation develops following implantation, it may lead to clinical complications such as chronic pain, defective wound healing, damage to the implant, and need for re‐surgery .…”

Section: Discussionmentioning

confidence: 99%

“…The implantation of prostheses is generally associated with rapid and highly orchestrated processes, including inflammatory foreign body reaction or granuloma formation, humoral immune activation, coagulation, molecular pattern recognition, and release of the hazard signal from the damaged tissue. 5,6 If prolonged inflammation develops following implantation, it may lead to clinical complications such as chronic pain, defective wound healing, damage to the implant, and need for re-surgery. 7 The aetiology in our patients was due to non-absorbable prolene suture in four cases, silk suture in two cases, and graft-related reaction in two patients, resulting in non-healing wounds.…”

Section: Discussionmentioning

confidence: 99%

Non‐healing wounds: Can it take different diagnosis?

Çalış

Şengül

Güler

et al. 2019

International Wound Journal

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Wound healing is a complex cellular and biochemical process and can be affected by several systemic and local factors. In this study, we aimed to discuss the aetiologic factors of non‐healing wounds and the management of this complicated process with current information. The medical data of the patients who were admitted to our clinic due to non‐healing or chronic wounds were analysed retrospectively. A total of 27 patients were evaluated retrospectively during the 14 months of the study. The data of 6 patients who were followed up for chronic wound that developed after abdominal incisional hernia repair and pilonidal sinus surgery were not included in the study as their data could not be reached. A total of 21 patients were included in the study. Malignancy was diagnosed in two patients and granulomatous disease was found in four patients. The aetiology of the other cases included foreign body reaction, infection, and mechanical causes. Non‐healing wounds are a serious social and economic problem for patients. Further studies on the pathophysiology of various aetiologies in non‐healing wounds in both clinical settings and experimental animal models would be a useful step in treatment.

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Polypropylene mesh implantation for hernia repair causes myeloid cell–driven persistent inflammation

Cited by 60 publications

References 52 publications

Revisiting the “race for the surface” in a pre-clinical model of implant infection

Revisiting the “race for the surface” in a pre-clinical model of implant infection

Methacrylic Acid Copolymer Coating Enhances Constructive Remodeling of Polypropylene Mesh by Increasing the Vascular Response

Non‐healing wounds: Can it take different diagnosis?

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