Can platelet-rich plasma coating improve polypropylene mesh integration? An immunohistochemical analysis in rabbits

Abstract

Purpose: Despite high success rates in the treatment of urinary incontinence, complications related to the use of polypropylene (PP) meshes are still a concern, especially in vaginal prolapses surgeries. The objective of this study was to assess the effect of autologous platelet-rich plasma (PRP) coating on the integration of PP meshes implanted in the vaginal submucosa of rabbits.

Materials and methods: Thirty adult New Zealand rabbits were randomly divided into two groups (n=15): PP, implanted with conventional PP meshes; and PRP, implanted with autologous PRP coated PP meshes. Animals in both groups (n=5) were euthanized at 7, 30 and 90 days postoperatively, the vaginas extracted and sent to immunohistochemical analysis for the assessment of the pro-inflammatory agent TNF-α, anti-inflammatory agents TGF-β and IL-13, collagen metabolism marker MMP-2, and angiogenesis marker CD-31. AxioVision™ image analysis was used for the calculation of the immunoreactive area and density. Statistical analysis was performed with ANOVA followed by Tukey test (p <0.05).

Results: Animals in the PRP group showed significantly increased expression of the angiogenesis agent CD-31 at all experimental times when compared to the PP group (p <0.0001). However, no differences concerning the expression of the other markers were observed between the groups.

Conclusion: The addition of autologous PRP gel to PP meshes can be simply and safely achieved and seems to have a positive effect on implantation site angiogenesis. Further investigations are required to ascertain PPR coated meshes clinical efficacy in prolapses and stress urinary incontinence surgeries.

Keywords: Suburethral Slings; Tissue Engineering; Urinary Incontinence; Female.

Figure 1. A) immunoreactive expression of MMP2. B) A special feature of the AxioVision™ Microscope V 4.8.0.0 Software highlighting the reactive area in red for the automatic calculation of the reactive area (45.1%), and density (153.9). (20x magnification). Scale bars=20pm for A and B.

Figure 2. Voids marked with a black cross were previously occupied by mesh filaments, while the brownish areas in the surrounding tissue is the immunoreactive expression of CD-31. A, B and C) PP group at 7, 30 and 90 days, respectively. D, E, and F) PRP group at 7, 30, and 90 days, respectively. Immunoreactive areas A=2.4%; B=1.1%; C=1.6%; D=6.3; E=4.1%; F=5.8% (20x magnification). Scale bars=50μm for (A-f).