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Uncovering the relationship between macrophages and polypropylene surgical mesh

Biomaterials Advances 2024 14 citations ? Citation count from OpenAlex, updated daily. May differ slightly from the publisher's own count. Score: 60 ? 0–100 AI score estimating relevance to the microplastics field. Papers below 30 are filtered from public browse.
Nicholas T. H. Farr, Victoria L. Workman, Sanad Saad, Sabiniano Román, Vanessa Hearnden, Christopher R. Chapple, Craig Murdoch, Cornelia Rodenburg, Sheila MacNeil

Summary

Researchers studied how polypropylene surgical mesh, commonly used to treat stress urinary incontinence, degrades inside the body when exposed to mechanical forces and oxidation. The degraded mesh surface cracked and triggered inflammatory and scarring responses in immune cells, helping explain why these implants sometimes cause serious complications. This study demonstrates that plastic materials can break down within the body and provoke harmful immune responses, which is directly relevant to concerns about microplastic accumulation in human tissues.

Polymers
Body Systems
Study Type In vitro

Currently, in vitro testing examines the cytotoxicity of biomaterials but fails to consider how materials respond to mechanical forces and the immune response to them; both are crucial for successful long-term implantation. A notable example of this failure is polypropylene mid-urethral mesh used in the treatment of stress urinary incontinence (SUI). The mesh was largely successful in abdominal hernia repair but produced significant complications when repurposed to treat SUI. Developing more physiologically relevant in vitro test models would allow more physiologically relevant data to be collected about how biomaterials will interact with the body. This study investigates the effects of mechanochemical distress (a combination of oxidation and mechanical distention) on polypropylene mesh surfaces and the effect this has on macrophage gene expression. Surface topology of the mesh was characterised using SEM and AFM; ATR-FTIR, EDX and Raman spectroscopy was applied to detect surface oxidation and structural molecular alterations. Uniaxial mechanical testing was performed to reveal any bulk mechanical changes. RT-qPCR of selected pro-fibrotic and pro-inflammatory genes was carried out on macrophages cultured on control and mechanochemically distressed PP mesh. Following exposure to mechanochemical distress the mesh surface was observed to crack and craze and helical defects were detected in the polymer backbone. Surface oxidation of the mesh was seen after macrophage attachment for 7 days. These changes in mesh surface triggered modified gene expression in macrophages. Pro-fibrotic and pro-inflammatory genes were upregulated after macrophages were cultured on mechanochemically distressed mesh, whereas the same genes were down-regulated in macrophages exposed to control mesh. This study highlights the relationship between macrophages and polypropylene surgical mesh, thus offering more insight into the fate of an implanted material than existing in vitro testing.

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