Preclinical animal study and human clinical trial data of co-electrospun poly(L-lactide-co-caprolactone) and fibrinogen mesh for anterior pelvic floor reconstruction

Abstract

Synthetic and biological materials are commonly used for pelvic floor reconstruction. In this study, host tissue response and biomechanical properties of mesh fabricated from co-electrospun poly( l -lactide-co-caprolactone) (PLCL) and fibrinogen (Fg) were compared with those of polypropylene mesh (PPM) in a canine abdominal defect model. Macroscopic, microscopic, histological, and biomechanical evaluations were performed over a 24-week period. The results showed that PLCL/Fg mesh had similar host tissue responses but better initial vascularization and graft site tissue organization than PPM. The efficacy of the PLCL/Fg mesh was further examined in human pelvic floor reconstruction. Operation time, intraoperative blood loss, and pelvic organ prolapse quantification during 6-month follow-up were compared for patients receiving PLCL/Fg mesh versus PPM. According to the pelvic organ prolapse quantification scores, the anterior vaginal wall 3 cm proximal to the hymen point (Aa point), most distal edge of the cervix or vaginal cuff scar point (C point), and posterior fornix point (D point) showed significant improvement ( P <0.01) at 1, 3, and 6 months for both groups compared with preoperatively. At 6 months, improvements at the Aa point in the PLCL/Fg group were significantly more ( P <0.005) than the PPM group, indicating that, while both materials improve the patient symptoms, PLCL/Fg mesh resulted in more obvious improvement.

Association of 17-β Estradiol with Adipose-Derived Stem Cells: New Strategy to Produce Functional Myogenic Differentiated Cells with a Nano-Scaffold for Tissue Engineering

“…The National Health and Nutrition Examination Survey showed that nearly 25% of women older than 20 years suffered from SUI, and more than half of these cases were caused by ISD [46]. Implantation of a polypropylene mesh for pelvic floor reconstruction has been widely used in clinical setting; however, the major drawback of tissue erosion remains a problem [47]. Injection of ASCs has shown good potential for curing ISD [18].…”

Emerging Nano/Micro-Structured Degradable Polymeric Meshes for Pelvic Floor Reconstruction

“…Biological materials are often blended with synthetic polymers to improve their tissue biocompatibility. Electrospun nanofibers of PLCL blended with macromolecules such as fibrinogen have been developed to reduce the FBR in terms of capsule thickness and fibrous tissue formation in a canine model of abdominal defect compared to polypropylene meshes [ 153 ]. However, PLCL/fibrinogen(Fg) blended nanofiber meshes showed higher angiogenesis in the short term only and not much difference in the long term.…”

“…However, PLCL/fibrinogen(Fg) blended nanofiber meshes showed higher angiogenesis in the short term only and not much difference in the long term. Yet, PLCL/Fg resulted in faster neo-vascularisation, better collagen fibre organisation and muscle regeneration compared with the polypropylene meshes, and did not erode at all [ 153 ]. Therefore, in order to develop successful surgical meshes for POP, it may be crucial to drive early neo-vascularisation processes to reduce the risk of deleterious FBR, erosion and other adversities.…”

Mesenchymal stem cell cultivation in electrospun scaffolds: mechanistic modeling for tissue engineering

“…2 Electrospinning setup scheme secretion [64]. Polymeric nanofibrous electrospun scaffolds have also been applied in clinical trials for the treatment of cutaneous leishmaniasis [65], diabetic foot ulcers [66], and for human pelvic floor reconstruction [67].…”