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Diaphragm Repair with a Novel Cross-Linked Collagen Biomaterial in a Growing Rabbit Model.

Mayer S, Decaluwe H, Ruol M, Manodoro S, Kramer M, Till H, Deprest J - PLoS ONE (2015)

Bottom Line: We compared reconstruction with a purpose-designed cross-linked ACM (Matricel) to 4-layer non-cross-linked small intestinal submucosa (SIS) and a 1-layer synthetic Dual Mesh (Gore-Tex).Tensiometry revealed a reduced bursting strength but normal compliance for SIS.Compliance was reduced in Matricel and Gore-Tex (p<0.01).

View Article: PubMed Central - PubMed

Affiliation: Center for Surgical Technologies and Organ Systems Cluster, Department of Development and Regeneration, Faculty of Medicine, KU Leuven, Leuven, Belgium; Department of Pediatric Surgery, University Hospital Leipzig, Leipzig, Germany.

ABSTRACT

Background: Neonates with congenital diaphragmatic hernia and large defects often require patch closure. Acellular collagen matrices (ACM) have been suggested as an alternative to synthetic durable patches as they are remodeled by the host or could also be used for tissue engineering purposes.

Materials and methods: 2.0x1.0 cm diaphragmatic defects were created in 6-weeks old New-Zealand white rabbits. We compared reconstruction with a purpose-designed cross-linked ACM (Matricel) to 4-layer non-cross-linked small intestinal submucosa (SIS) and a 1-layer synthetic Dual Mesh (Gore-Tex). Unoperated animals or animals undergoing primary closure (4/0 polyglecaprone) served as age-matched controls. 60 (n = 25) resp. 90 (n = 17) days later, animals underwent chest x-ray and obduction for gross examination of explants, scoring of adhesion and inflammatory response. Also, uniaxial tensiometry was done, comparing explants to contralateral native diaphragmatic tissue.

Results: Overall weight nearly doubled from 1,554±242 g at surgery to 2,837±265 g at obduction (+84%). X-rays did show rare elevation of the left diaphragm (SIS = 1, Gore-Tex = 1, unoperated control = 1), but no herniation of abdominal organs. 56% of SIS and 10% of Matricel patches degraded with visceral bulging in four (SIS = 3, Matricel = 1). Adhesion scores were limited: 0.5 (Matricel) to 1 (SIS, Gore-Tex) to the left lung (p = 0.008) and 2.5 (Gore-Tex), 3 (SIS) and 4 (Matricel) to the liver (p<0.0001). Tensiometry revealed a reduced bursting strength but normal compliance for SIS. Compliance was reduced in Matricel and Gore-Tex (p<0.01). Inflammatory response was characterized by a more polymorphonuclear cell (SIS) resp. macrophage (Matricel) type of infiltrate (p<0.05). Fibrosis was similar for all groups, except there was less mature collagen deposited to Gore-Tex implants (p<0.05).

Conclusions: Matricel induced a macrophage-dominated inflammatory response, more adhesions, had appropriate strength but a lesser compliance compared to native tissue. The herein investigated ACM is not a viable option for CDH repair.

No MeSH data available.


Related in: MedlinePlus

Histology.Representative micrographs of all groups (columns) obtained at x400 magnification with identical settings for each stain from the mesh-tissue interface. Meshes are invisible form degradation or processing, respectively. Inflammation is represented by the number of macrophages (first row, black arrows), foreign body giant cells (second row, black arrows) and polymorphonuclear cells (second row, white arrows), fibrosis depicted by the amount of neovascularization (second row, v vessel) as well as the amount and composition of collagen (third row, * muscle, ⏏ mature collagen, ⌃ immature collagen, ★ patch). H&E: Hematoxylin-eosin.
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pone.0132021.g005: Histology.Representative micrographs of all groups (columns) obtained at x400 magnification with identical settings for each stain from the mesh-tissue interface. Meshes are invisible form degradation or processing, respectively. Inflammation is represented by the number of macrophages (first row, black arrows), foreign body giant cells (second row, black arrows) and polymorphonuclear cells (second row, white arrows), fibrosis depicted by the amount of neovascularization (second row, v vessel) as well as the amount and composition of collagen (third row, * muscle, ⏏ mature collagen, ⌃ immature collagen, ★ patch). H&E: Hematoxylin-eosin.

Mentions: The overall inflammatory response (Fig 4C and Fig 5) was higher in patched groups as compared to primary repairs. Gore-Tex explants showed moderate levels of inflammation. Matricel induced higher numbers of macrophages in comparison to Gore-Tex (stained by RAM-11; p = 0.01). In the SIS group, there were fewer foreign body giant cells yet more polymorphonuclear cells as compared to Gore-Tex (p = 0.01; p = 0.04) and Matricel (p = 0.009; p<0.05). The fibrotic response did not differ between groups (Fig 4D), in other words, the degree of neo-angiogenesis as well as the amount and organization of collagen deposited by the host were comparable. However, Gore-Tex was surrounded by less mature collagen as compared to SIS (p = 0.01) and Matricel (p = 0.0007). When considering SIS explants with or without material remnants, we could not detect a measurable difference in inflammatory or fibrotic scores, except that there were less polymorphonuclear cells when SIS was already absorbed (p = 0.04).


Diaphragm Repair with a Novel Cross-Linked Collagen Biomaterial in a Growing Rabbit Model.

Mayer S, Decaluwe H, Ruol M, Manodoro S, Kramer M, Till H, Deprest J - PLoS ONE (2015)

Histology.Representative micrographs of all groups (columns) obtained at x400 magnification with identical settings for each stain from the mesh-tissue interface. Meshes are invisible form degradation or processing, respectively. Inflammation is represented by the number of macrophages (first row, black arrows), foreign body giant cells (second row, black arrows) and polymorphonuclear cells (second row, white arrows), fibrosis depicted by the amount of neovascularization (second row, v vessel) as well as the amount and composition of collagen (third row, * muscle, ⏏ mature collagen, ⌃ immature collagen, ★ patch). H&E: Hematoxylin-eosin.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4493058&req=5

pone.0132021.g005: Histology.Representative micrographs of all groups (columns) obtained at x400 magnification with identical settings for each stain from the mesh-tissue interface. Meshes are invisible form degradation or processing, respectively. Inflammation is represented by the number of macrophages (first row, black arrows), foreign body giant cells (second row, black arrows) and polymorphonuclear cells (second row, white arrows), fibrosis depicted by the amount of neovascularization (second row, v vessel) as well as the amount and composition of collagen (third row, * muscle, ⏏ mature collagen, ⌃ immature collagen, ★ patch). H&E: Hematoxylin-eosin.
Mentions: The overall inflammatory response (Fig 4C and Fig 5) was higher in patched groups as compared to primary repairs. Gore-Tex explants showed moderate levels of inflammation. Matricel induced higher numbers of macrophages in comparison to Gore-Tex (stained by RAM-11; p = 0.01). In the SIS group, there were fewer foreign body giant cells yet more polymorphonuclear cells as compared to Gore-Tex (p = 0.01; p = 0.04) and Matricel (p = 0.009; p<0.05). The fibrotic response did not differ between groups (Fig 4D), in other words, the degree of neo-angiogenesis as well as the amount and organization of collagen deposited by the host were comparable. However, Gore-Tex was surrounded by less mature collagen as compared to SIS (p = 0.01) and Matricel (p = 0.0007). When considering SIS explants with or without material remnants, we could not detect a measurable difference in inflammatory or fibrotic scores, except that there were less polymorphonuclear cells when SIS was already absorbed (p = 0.04).

Bottom Line: We compared reconstruction with a purpose-designed cross-linked ACM (Matricel) to 4-layer non-cross-linked small intestinal submucosa (SIS) and a 1-layer synthetic Dual Mesh (Gore-Tex).Tensiometry revealed a reduced bursting strength but normal compliance for SIS.Compliance was reduced in Matricel and Gore-Tex (p<0.01).

View Article: PubMed Central - PubMed

Affiliation: Center for Surgical Technologies and Organ Systems Cluster, Department of Development and Regeneration, Faculty of Medicine, KU Leuven, Leuven, Belgium; Department of Pediatric Surgery, University Hospital Leipzig, Leipzig, Germany.

ABSTRACT

Background: Neonates with congenital diaphragmatic hernia and large defects often require patch closure. Acellular collagen matrices (ACM) have been suggested as an alternative to synthetic durable patches as they are remodeled by the host or could also be used for tissue engineering purposes.

Materials and methods: 2.0x1.0 cm diaphragmatic defects were created in 6-weeks old New-Zealand white rabbits. We compared reconstruction with a purpose-designed cross-linked ACM (Matricel) to 4-layer non-cross-linked small intestinal submucosa (SIS) and a 1-layer synthetic Dual Mesh (Gore-Tex). Unoperated animals or animals undergoing primary closure (4/0 polyglecaprone) served as age-matched controls. 60 (n = 25) resp. 90 (n = 17) days later, animals underwent chest x-ray and obduction for gross examination of explants, scoring of adhesion and inflammatory response. Also, uniaxial tensiometry was done, comparing explants to contralateral native diaphragmatic tissue.

Results: Overall weight nearly doubled from 1,554±242 g at surgery to 2,837±265 g at obduction (+84%). X-rays did show rare elevation of the left diaphragm (SIS = 1, Gore-Tex = 1, unoperated control = 1), but no herniation of abdominal organs. 56% of SIS and 10% of Matricel patches degraded with visceral bulging in four (SIS = 3, Matricel = 1). Adhesion scores were limited: 0.5 (Matricel) to 1 (SIS, Gore-Tex) to the left lung (p = 0.008) and 2.5 (Gore-Tex), 3 (SIS) and 4 (Matricel) to the liver (p<0.0001). Tensiometry revealed a reduced bursting strength but normal compliance for SIS. Compliance was reduced in Matricel and Gore-Tex (p<0.01). Inflammatory response was characterized by a more polymorphonuclear cell (SIS) resp. macrophage (Matricel) type of infiltrate (p<0.05). Fibrosis was similar for all groups, except there was less mature collagen deposited to Gore-Tex implants (p<0.05).

Conclusions: Matricel induced a macrophage-dominated inflammatory response, more adhesions, had appropriate strength but a lesser compliance compared to native tissue. The herein investigated ACM is not a viable option for CDH repair.

No MeSH data available.


Related in: MedlinePlus