Latest Trends on the Attenuation of Systemic Foreign Body Response and Infectious Complications of Synthetic Hernia Meshes.

Throughout the past few years, hernia incidence has remained at a high level worldwide, with more than 20 million people requiring hernia surgery each year. Synthetic hernia meshes play an important role, providing a microenvironment that attracts and harbors host cells and acting as a permanent roadmap for intact abdominal wall reconstruction. Nevertheless, it is still inevitable to cause not-so-trivial complications, especially chronic pain and adhesion. In long-term studies, it was found that the complications are mainly caused by excessive fibrosis from the foreign body reaction (FBR) and infection resulting from bacterial colonization. For a thorough understanding of their complex mechanism and providing a richer background for mesh development, herein, we discuss different clinical mesh products and explore the interactions between their structure and complications. We further explored progress in reducing mesh complications to provide varied strategies that are informative and instructive for mesh modification in different research directions. We hope that this work will spur hernia mesh designers to step up their efforts to develop more practical and accessible meshes by improving the physical structure and chemical properties of meshes to combat the increasing risk of adhesions, infections, and inflammatory reactions. We conclude that further work is needed to solve this pressing problem, especially in the analysis and functionalization of mesh materials, provided of course that the initial performance of the mesh is guaranteed.

Synergistic Anti-inflammatory Coating "Zipped Up" on Polypropylene Hernia Mesh.

Violent inflammation has impeded worry-free application of polypropylene (PP) hernia meshes. Efficient anti-inflammatory coatings are urgently needed to alter the situation. Here, we present a zipper-like, two-layer coating with an intermediate antioxidant layer (I) and an outer antifouling layer (II) to endow PP meshes with synergistic anti-inflammatory effects. The controllable antioxidant ability of layer I was obtained by modulating the assembly cycle of the metal-phenolic network (MPN) composed of tannic acid (TA) and Fe3+. Polyzwitterionic (PMAD) brush-based layer II was generated upon multiple interactions between the catechol side groups of PMAD and layer I. To consolidate the entire assembly architecture, aryloxy radical coupling was initiated through alkali-catalyzed oxidation. The reaction is similar to a "zipping up" process to construct covalent bonds in the I-II interface and layer I by coupling adjacent catechol groups, which facilely achieved grafting and cross-linking. The obtained coating (PMAD-TA/Fe) did not affect the original properties of the PP mesh and remained stable during cyclic tensile testing or degradation. Most importantly, the excellent antioxidant and antifouling capacities enabled PMAD-TA/Fe-PP to exhibit desirable anti-inflammatory effects and reduce collagen deposition when compared with the bare material. The synergistic anti-inflammatory coating eliminates a major hindrance in the design of biocompatible meshes, and its potential application in developing medical implants with low immunogenicity is promising.

Chitosan/gelatin-tannic acid decorated porous tape suture with multifunctionality for tendon healing.

The inferior tendon healing after surgery is inextricably linked to the surgical suture. Poor load transfer along the suture often results in a high tendon re-tear rate. Besides, the severe inflammation and infection induced by sutures even cause a second surgery. Herein, to alleviate the above-mentioned issues, a multifunctional suture was fabricated by decorating chitosan/gelatin-tannic acid (CS/GE-TA) on the porous tape suture. The porous tape suture ensured the required mechanical properties and sufficient space for tissue integration. Compared to the pristine suture, the CS/GE-TA decorated suture (TA100) presented a 332% increase in pull-out force from the tendon, indicating potentially decreased re-tear rates. Meanwhile, TA100 showed superior anti-inflammatory and antibacterial performances. In vivo experiments further proved that TA100 could not only reduce inflammatory action but also facilitate collagen deposition and blood vessel formation. These results indicate that the multifunctional sutures are promising candidates for accelerating tendon healing.

Filament-anchored hydrogel layer on polypropylene hernia mesh with robust anti-inflammatory effects.

The efficacy of implanted polypropylene (PP) hernia meshes is often compromised by an inflammatory response. Thus, engineering an anti-inflammatory mesh has significant implications for hernioplasty. Here, we report a facile strategy to develop a filament-anchored hydrogel layer (FAHL) on PP mesh (FAHL-P). The network of FAHL, made up of chondroitin sulfate and gelatin (CG), provided a biomimetic surface with immunoregulatory properties. The use of tannic acid (TA) as a crosslinker for CG additionally enhanced its anti-inflammatory properties. In addition, the fabrication protocol ensured that the hydrogel maintained the properties of the knitted mesh and the firmly adherent FAHL during general handling (dry state) and in the simulated body environment (wet state). CG/TA-PP killed 99.99% of S. aureus and retained 73% of its original antioxidant properties after 7 d. The FAHL durably performed with a controlled release of TA for 15 d. The strong anti-inflammatory effects of FAHL-P reduced collagen deposition and increased vascularization, which promoted native tissue generation. The fabrication strategy has potential applications in hernioplasty and may provide new insights into the design of other anti-inflammatory implants. STATEMENT OF SIGNIFICANCE: A hydrogel layer with robust anti-inflammatory effects was anchored firmly on mesh filament for hernia repair. Requiring no drug loading, this chondroitin sulphate -gelatin (CG) based hydrogel itself could inhibit the immunological attack owing to the biomimetic microenvironment created by the CG. Moreover, the hydrogel's crosslinker (tannic acid) content served as an effective scavenger for reducing pro-inflammatory factors, significantly mitigating the inflammation. Interestingly, the antibacterial effect of such hydrogel layer was also observed. In terms of the synergistic outcome of the design, our mesh can remarkably attenuate inflammation and promote constructive tissue regeneration in vivo. Furthermore, considering the relatively simple and easily scaled up formulation process, our strategy may indeed have great potential in alleviating post-implantation outcomes.

An aptasensor strip-based colorimetric determination method for kanamycin using cellulose acetate nanofibers decorated DNA-gold nanoparticle bioconjugates.

The preparation of portable colorimetric biosensor strips is described by combining aptamer-immobilized electrospun nanofiber membranes (A-NFMs) with signal probes (DNA-conjugated gold nanoparticles (AuNPs)) for determination of kanamycin (KMC) as a model analyte. The A-NFMs were decorated with complementary single-stranded DNA (cDNA) of KMC aptamer-conjugated AuNPs (cDNA@Au) to get the colorimetric biosensor strips. The constructed biosensor strips showed a significant absorbance decreasing band at 510 nm which induce a visual color change from pink to white when exposed to KMC, with a low detection limit of 2.5 nM (at S/N = 3). The effect is due to disassembling of cDNA@Au from NFMs in the presence of KMC because the aptamer has a higher affinity to KMC than its complementary DNA, which resulted in replacing cDNA@Au with KMC. Satisfactory performance was observed in real sample (drinking water and milk) analysis with a recovery of 98.9-102.2%. The constructed colorimetric biosensor test strips hold great application promise for food safety control. Graphical abstract Schematic representation of biosensor strips for kanamycin detection prepared with the cDNA@Au immobilized aptamer-based cellulose acetate nanofibers.

Dopamine-Mediated Zwitterionic Polyelectrolyte-Coated Polypropylene Hernia Mesh with Synergistic Anti-inflammation Effects.

Over 20 million ventral hernia repairs are performed worldwide annually and only a minority (<10%) of cases are not mesh-based. However, even polypropylene (PP), endorsed as the "gold standard" of all prosthetic materials used in this field, is still subject to many complications caused by the foreign body reaction (FBR). Here, we describe the buildup of dopamine-mediated zwitterionic poly(sulfobetaine methacrylate) (PSBMA) coatings to inhibit nonspecific protein adsorption. Based on the universal adhesive ability of polydopamine (PDA), PSBMA has been coated on the PP mesh surface via two strategies: sequential deposition (PSBMA-PDA-PP) and co-deposition (PSBMA@PDA-PP). The presence of PSBMA shows great contribution to obviously decreased hydrophobicity of the PP surface (WCAco = 36.3° and WCAseq = 30.7°) as well as improved protein resistance (Reductionco = 74% and Reductionseq = 82%). Notably, as the intermedia between PP and PSBMA, PDA can endow the PP mesh with antioxidant activity, further featuring synergistic anti-inflammation therapeutic effect when coupled with PSBMA. With almost equal surface content of PSBMA, PSBMA-PDA-PP exhibited a more superior ability against macrophage adhesion and proliferation and showed more significantly decreased releases of TNF-α and IL-6 (p < 0.05) than those of PSBMA@PDA-PP, fundamentally attributed to its more neutral surface potential and the protection for polyphenols of PDA from oxidation with PSBMA as the outer layer. Furthermore, the coating layers demonstrated good stability and no sacrifice of the pristine mechanical property. The proposed dopamine-mediated PSBMA coatings possess high potential in biomedical implant areas for attenuating the FBR.

[Research progress of non-biological meshes for breast reconstruction].

Objective: To review the application progress of non-biological meshes for breast reconstruction (BR). Methods: The related home and abroad researches in BR were reviewed and summarized. Results: Non-biological meshes can be divided into degradable and nondegradable. The former has many types, whether its degradation rate can match with the grow rate of repair tissue will significantly affect the wound healing and tissue intergradation. TiLOOP, on behalf of the latter, has a good postoperative performance due to its nano TiO 2 layer, lightness and flexibility. Non-biological meshes have been gradually used to cover and fix implant in BR. Compared with biological meshes, non-biological meshes are cheaper and have a more positive postoperative performance generally, but definite comparison can't be concluded due to the limited data. Conclusion: As non-biological meshes are applied to BR preliminarily, their effectiveness are still needed to be observed further.