Rui Liang1, Wenjun Zong1, Stacy Palcsey1, Steven Abramowitch2, Pamela A Moalli3. 1. Department of Obstetrics and Gynecology, Magee-Womens Research Institute, School of Medicine, University of Pittsburgh, Pittsburgh, PA. 2. Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA. 3. Department of Obstetrics and Gynecology, Magee-Womens Research Institute, School of Medicine, University of Pittsburgh, Pittsburgh, PA. Electronic address: moalpa@mail.magee.edu.
Abstract
OBJECTIVE: The impact of polypropylene mesh implantation on vaginal collagen and elastin metabolism was analyzed using a nonhuman primate model to further delineate the mechanism of mesh induced complications. STUDY DESIGN: Forty-nine middle-aged parous rhesus macaques underwent surgical implantation of 3 synthetic meshes via sacrocolpopexy. Gynemesh PS (n = 12) (Ethicon, Somerville, NJ) and 2 lower-weight, higher-porosity, lower-stiffness meshes (UltraPro [n = 19] [Ethicon] and Restorelle [n = 8] [Coloplast, Minneapolis, MN]) were implanted, in which UltraPro was implanted with its blue orientation lines perpendicular (low stiffness direction, n = 11) and parallel (high stiffness direction, n = 8) to the longitudinal axis of the vagina. Sham-operated animals were used as controls (n = 10). Twelve weeks after surgery, the mesh-tissue complex was excised and analyzed. RESULTS: Relative to sham, Gynemesh PS had a negative impact on the metabolism of both collagen and elastin-favoring catabolic reactions, whereas UltraPro induced an increase only in elastin degradation. Restorelle had the least impact. As compared with sham, the degradation of collagen and elastin in the vagina implanted with Gynemesh PS was increased with a simultaneous increase in active matrix metalloproteinase (MMP)-1, -8, -13, and total MMP-2 and -9 (all P < .05). The degradation of elastin (tropoelastin and mature elastin) was increased in the UltraPro-implanted vagina with a concomitant increase of MMP-2, and -9 (all P < .05). Collagen subtype ratio III/I was increased in Gynemesh PS and UltraPro perpendicular groups (P < .05). CONCLUSION: Following implantation with the heavier, less porous, and stiffer mesh, Gynemesh PS, the degradation of vaginal collagen and elastin exceeded synthesis, most likely as a result of increased activity of MMPs, resulting in a structurally compromised tissue.
OBJECTIVE: The impact of polypropylene mesh implantation on vaginal collagen and elastin metabolism was analyzed using a nonhuman primate model to further delineate the mechanism of mesh induced complications. STUDY DESIGN: Forty-nine middle-aged parous rhesus macaques underwent surgical implantation of 3 synthetic meshes via sacrocolpopexy. Gynemesh PS (n = 12) (Ethicon, Somerville, NJ) and 2 lower-weight, higher-porosity, lower-stiffness meshes (UltraPro [n = 19] [Ethicon] and Restorelle [n = 8] [Coloplast, Minneapolis, MN]) were implanted, in which UltraPro was implanted with its blue orientation lines perpendicular (low stiffness direction, n = 11) and parallel (high stiffness direction, n = 8) to the longitudinal axis of the vagina. Sham-operated animals were used as controls (n = 10). Twelve weeks after surgery, the mesh-tissue complex was excised and analyzed. RESULTS: Relative to sham, Gynemesh PS had a negative impact on the metabolism of both collagen and elastin-favoring catabolic reactions, whereas UltraPro induced an increase only in elastin degradation. Restorelle had the least impact. As compared with sham, the degradation of collagen and elastin in the vagina implanted with Gynemesh PS was increased with a simultaneous increase in active matrix metalloproteinase (MMP)-1, -8, -13, and total MMP-2 and -9 (all P < .05). The degradation of elastin (tropoelastin and mature elastin) was increased in the UltraPro-implanted vagina with a concomitant increase of MMP-2, and -9 (all P < .05). Collagen subtype ratio III/I was increased in Gynemesh PS and UltraPro perpendicular groups (P < .05). CONCLUSION: Following implantation with the heavier, less porous, and stiffer mesh, Gynemesh PS, the degradation of vaginal collagen and elastin exceeded synthesis, most likely as a result of increased activity of MMPs, resulting in a structurally compromised tissue.
Authors: Ingrid Nygaard; Linda Brubaker; Halina M Zyczynski; Geoffrey Cundiff; Holly Richter; Marie Gantz; Paul Fine; Shawn Menefee; Beri Ridgeway; Anthony Visco; Lauren Klein Warren; Min Zhang; Susan Meikle Journal: JAMA Date: 2013-05-15 Impact factor: 56.272
Authors: Charles W Nager; Halina Zyczynski; Rebecca G Rogers; Matthew D Barber; Holly E Richter; Anthony G Visco; Charles R Rardin; Heidi Harvie; Dennis Wallace; Susan F Meikle Journal: Female Pelvic Med Reconstr Surg Date: 2016 Jul-Aug Impact factor: 2.091
Authors: Amanda M Artsen; Matthew Rytel; Rui Liang; Gabrielle E King; Leslie Meyn; Steven D Abramowitch; Pamela A Moalli Journal: Acta Biomater Date: 2019-07-19 Impact factor: 8.947
Authors: Bryan N Brown; Deepa Mani; Alexis L Nolfi; Rui Liang; Steven D Abramowitch; Pamela A Moalli Journal: Am J Obstet Gynecol Date: 2015-08-07 Impact factor: 8.661
Authors: Alexis L Nolfi; Bryan N Brown; Rui Liang; Stacy L Palcsey; Michael J Bonidie; Steven D Abramowitch; Pamela A Moalli Journal: Am J Obstet Gynecol Date: 2016-04-16 Impact factor: 8.661
Authors: Rui Liang; Katrina Knight; William Barone; Robert W Powers; Alexis Nolfi; Stacy Palcsey; Steven Abramowitch; Pamela A Moalli Journal: Am J Obstet Gynecol Date: 2016-09-08 Impact factor: 8.661