Preparation of a Small Intestinal Submucosa Modified Polypropylene Hybrid Mesh via a Mussel-inspired Polydopamine Coating for Pelvic Reconstruction

Liangpeng Ge (Chongqing Academy of Animal Sciences)
Lubin Liu (Chongqing Academy of Animal Sciences)
Haoche Wei (Chongqing Academy of Animal Sciences)
Lei Du (Chongqing Academy of Animal Sciences)
Shixuan Chen (Chongqing Academy of Animal Sciences)
Yong Huang (Chongqing Academy of Animal Sciences)
Renshu Huang (Chongqing Academy of Animal Sciences)

Introduction

Pelvic organ prolapse (POP) is a serious health issue that affects many adult women. Surgical treatments for POP patients comprise a common strategy in which scaffold materials are used to reconstruct the prolapsed pelvic. However, the existing materials for pelvic reconstruction cannot meet clinical requirements in terms of biocompatibility, mechanics and immunological rejection. Polypropylene mesh is a synthetic material characterized by long-lasting, inert, non-toxic, and non- antigenicity; a high vaginal mesh erosion rate and complications, such as dyspareunia and infections, have been reported. Thus, it should be modified for clinic use. The naturally derived material small intestinal submucosa (SIS) has excellent biocompatibility and bio-inductive properties, and the structural and functional proteins are similar to the native mammalian extracellular matrix, which facilitates tissue remodeling and reduces the complications of erosion and fistula formation. Therefore, hybrid materials by immobilizing SIS on the polypropylene mesh surface are undoubtedly the ideal choice to meet the demands of POP reconstruction.

Materials and Methods

The purpose of this study is to use SIS to improve the biocompatibility of polypro- pylene mesh for pelvic reconstruction. The modification process included two steps: polydopamine was first introduced on the surface of the polypropylene mesh, followed by covalent coupling with SIS. We subse- quently investigated the physical characteristics and cytotoxicity of the polypropylene/SIS hybrid mesh. Finally, the meshes were implanted under pelvic sub- mucosa in Sprague–Dawley rats, and the host responses were monitored to verify the biocompatibility of the hybrid mesh. All procedures were performed in accordance with the National Institutes of Health guidelines and with the approval of the Institutional Animal Care and Use Committee at the Chongqing Academy of Animal Sciences. Quantitative data were expressed as the means

Results

The scanning electron microscopy (SEM) and atomic force microscopy (AFM) results demonstrated that SIS was successfully conjugated on the surface of the PP mesh. Moreover, the cytotoxicity results indicated that the PP mesh and SIS-modified PP mesh were safe to use. Furthermore, in vivo tests demonstrated that the fibroplasia around the implanted site in the SIS-modified PP mesh group was significantly less than the fibroplasia around the PP mesh group. In addition, the immunohistochemistry staining results indicated that the expression of pro-inflammatory macrophages (M1) was substantially lower and that the expression of pro-healing macrophages (M2) was higher in the SIS-modified PP mesh group. Furthermore, ELISA detection indicated that the expression of IL-1b and IL-6 in the SIS-modified PP mesh group was reduced compared with the PP mesh group.

 

Discussion and Conclusion

In this study, a simple and efficient method was developed to covalently immobilize SIS on the surface of a dopamine-coated polypropylene mesh for a novel application of pelvic reconstruction. The hybrid materials combined the biocompatibility of the biomaterials and the mechanical strength of the synthetic materials. Furthermore, the hybrid material did not induce significant or observable cytotoxicity and exhibited substantial graft accommodation in the pelvic submucosa following implantation, as determined by pathological and immunohistochemical examination. Therefore, SIS covalent immobilization facilitated by polydopamine coating is a better approach for optimizing the surface properties of polypropylene implants to enhance biocompatibility.


Figure 1. Physical characterization of SIS modified polypropylene mesh. (a) Morphology of polypropylene (PP), dopamine coating polypropylene (PP-DOPA) and SIS modified PP-DOPA hybrid mesh (PP-DOPA-SIS), which was detected by SEM. (b) Morphology of PP, PP-DOPA and PP-DOPA-SIS, which was detected by A

Figure 2. HE staining shows tissues in the polypropylene (PP) and SIS modified PP-DOPA hybrid mesh (PP-DOPA-SIS) implanted sites. The black arrows indicate the hyperplastic tissue in the implanted site.

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