Vaginal host response to polycarbonate urethane, an alternative material for the repair of pelvic organ prolapse.

Autor: Knight K; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States; Magee-Womens Research Institute, Pittsburgh, PA, United States. Electronic address: kmk144@pitt.edu., Breedlove S; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States., Obisesan T; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States; Magee-Womens Research Institute, Pittsburgh, PA, United States., Egnot M; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States; Magee-Womens Research Institute, Pittsburgh, PA, United States., Daneshdoost N; Departments of Mechanical Engineering and Material Science, Duke University, Durham, NC, United States., King G; Magee-Womens Research Institute, Pittsburgh, PA, United States., Meyn L; Magee-Womens Research Institute, Pittsburgh, PA, United States; Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA, United States., Gall K; Departments of Mechanical Engineering and Material Science, Duke University, Durham, NC, United States., Moalli P; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States; Magee-Womens Research Institute, Pittsburgh, PA, United States; Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA, United States.
Jazyk: angličtina
Zdroj: Acta biomaterialia [Acta Biomater] 2024 Nov; Vol. 189, pp. 298-310. Date of Electronic Publication: 2024 Oct 01.
DOI: 10.1016/j.actbio.2024.09.040
Abstrakt: Complications following surgical repair of pelvic organ prolapse (POP) with polypropylene mesh (PPM) are common. Recent data attributes complications, in part, to stiffness mismatches between the vagina and PPM. We developed a 3D printed elastomeric membrane (EM) from a softer polymer, polycarbonate urethane (PCU). EMs were manufactured with more material given the low inherent material strength of PCU. We hypothesized that the EMs would be associated with an improved host response as compared to PPM. A secondary goal was to optimize the material distribution (fiber width and device thickness) within EMs, in regards to the host response. EM constructs (2 × 1 cm 2 ) with varied polymer stiffness, fiber width, and device thickness were implanted onto the vagina of New Zealand white rabbits for 12 weeks and compared to similarly sized PPMs. Sham implanted animals served as controls. Mixed effects generalized linear models were used to compare the effect of construct type accounting for differences in independent variables. EMs had an overall superior host response compared to PPM as evidenced by preservation of vaginal smooth muscle morphology (p-values<0.01), decreased total cellular response to construct fibers (p-values<0.001), and a reduced percent of macrophages (p-values<0.02) independent of how the material was distributed. Both PPM and EMs negatively impacted vaginal contractility and glycosaminoglycan (GAG) content relative to Sham (all p-values<0.001) with EMs having less of an impact on GAGs (p-values<0.003). The results suggest that softer PCU EMs made with more material are well tolerated by the vagina and comprises a future material for POP repair devices. STATEMENT OF SIGNIFICANCE: Prolapse is a debilitating condition in which loss of support to the vagina causes it and the organs supported by it to descend from their normal position in the pelvis. Surgical solutions to rebuild support involves the use of polypropylene mesh which is orders of magnitude stiffer than the vagina. This mismatch results in complications including exposure of the mesh into the vagina and pain. To provide an innovative solution for women, we have developed an elastomeric membrane from a soft polymer that matches the stiffness of the vagina. Here, we show in a rabbit animal model that this device incorporates better into the vagina and is associated with an overall improved host response as compared to polypropylene mesh.
Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: We would like to draw the attention of the Editor to the following facts which may be considered as potential declaration of interests: Pamela Moalli reports equipment, drugs, or supplies was provided by Coloplast Corp. Katrina Knight reports financial support was provided by Magee-Womens Research Institute & Foundation. Pamela Moalli reports a relationship with Hologic Inc that includes board membership. However, there has been no significant financial support for this work that could have influenced its outcome. Additionally, Pamela Moalli is an Associate Editor for the following journals: Urogynecology and Female Urology (Frontiers in Urology).
(Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)
Databáze: MEDLINE
Externí odkaz: