Verhorstert Kim W J, Riool Martijn, Bulten Tess, Guler Zeliha, de Boer Leonie, Roovers Jan-Paul W R, Zaat Sebastian A J
Amsterdam UMC, University of Amsterdam, Department of Obstetrics and Gynecology, Meibergdreef 9, Amsterdam, the Netherlands.
Amsterdam Reproduction and Development, Amsterdam, the Netherlands.
Mater Today Bio. 2022 Apr 19;15:100268. doi: 10.1016/j.mtbio.2022.100268. eCollection 2022 Jun.
Polypropylene (PP) implants for the vaginal surgical correction of pelvic organ prolapse (POP) are known for adverse events, like vaginal or visceral exposures. It is hypothesized that this is a result of a prolonged inflammatory response. One of the triggering factors of prolonged inflammation might be bacterial contamination. A possible solution might lie in an absorbable biomaterial, which provides initial mechanical support while being gradually replaced by the host tissue. With this study we aimed to compare the host response, in a subcutaneous mouse implant infection model, to delayed absorbable poly-4-hydroxybutyrate (P4HB) and a latest generation PP implant. By comparing non-infected to infected mice, we assessed how bacterial contamination affects the host response and its role in the development of complications. Further, we included sham surgery as a control, mimicking the wound response in native tissue repair. Despite the higher surface area of the P4HB implants, the clearance of infection was similarly delayed in the presence of a P4HB or PP implant, as compared to sham. Further, the host response towards P4HB and PP was quite comparable, yet collagen deposition was significantly increased around infected P4HB implants at early time points. Adverse event rates were similar, though implant exposures were only seen in infected mice and more often with PP (11.1%) than P4HB implants (5.6%). Infected mice overall had significantly higher levels of infiltration of inflammatory cells and lower levels of vascularization and collagen deposition compared to non-infected mice. Thus, for both P4HB and PP, bacterial contamination negatively affected mesh integration by increased inflammation and an increased adverse event rate. Altogether, our results from this subcutaneous mouse implant infection study suggest that P4HB could be a promising degradable alternative to PP, warranting further research to study its potential as a new surgical solution for women with POP.
用于盆腔器官脱垂（POP）阴道手术矫正的聚丙烯（PP）植入物因不良事件而闻名，如阴道或内脏暴露。据推测，这是长期炎症反应的结果。长期炎症的触发因素之一可能是细菌污染。一个可能的解决方案可能在于一种可吸收的生物材料，它在提供初始机械支撑的同时逐渐被宿主组织取代。在本研究中，我们旨在比较皮下小鼠植入物感染模型中宿主对延迟吸收性聚4-羟基丁酸酯（P4HB）和最新一代PP植入物的反应。通过比较未感染小鼠和感染小鼠，我们评估了细菌污染如何影响宿主反应及其在并发症发生中的作用。此外，我们纳入了假手术作为对照，模拟天然组织修复中的伤口反应。尽管P4HB植入物的表面积更大，但与假手术相比，在存在P4HB或PP植入物的情况下，感染清除同样延迟。此外，宿主对P4HB和PP的反应相当，但在早期时间点，感染的P4HB植入物周围的胶原蛋白沉积显著增加。不良事件发生率相似，尽管植入物暴露仅在感染小鼠中出现，且PP（11.1%）比P4HB植入物（5.6%）更常见。与未感染小鼠相比，感染小鼠总体上炎症细胞浸润水平显著更高，血管化和胶原蛋白沉积水平更低。因此，对于P4HB和PP而言，细菌污染通过增加炎症和不良事件发生率对网片整合产生负面影响。总之，我们在皮下小鼠植入物感染研究中的结果表明，P4HB可能是PP的一种有前景的可降解替代品，值得进一步研究以探讨其作为POP女性新手术解决方案的潜力。
