Artificial vs biological meshes: can in vitro cellular responses predict the outcome in patients?

Abstract

Synthetic and biological matrices for abdominal wall repair have been developed and commercialized in recent years. Biological meshes have been proposed as an alternative when synthetic implants are not indicated, as in the case of contaminated surgical field and may present fewer complications such as chronic pain and visceral adhesions after hernia repair. However, their use is still debated, due to high cost to benefit ratio. Moreover, knowledge of the molecular pathways activated in the different types of cells by their use is still lacking. This study aimed to investigate the molecular processes activated by fibroblasts during their interaction with different types of biological and synthetic matrices, comparing the fibroblast-matrix interactions morphologically, monitoring cell proliferation and the expression of genes involved in the deposition and reabsorption of collagen, as well as some cytokines and markers of differentiation into myofibroblasts. We found that fibroblasts grew differently on the different biological meshes. Few fibroblasts grew on the synthetic mesh, impairing gene expression analysis. Fibroblasts on biological meshes induced specific metalloproteinases and reduced expression of collagen genes compared to control cells. Expression of markers for myofibroblast differentiation was also reduced. We found limited differences in gene expression programs among the different biological meshes