title: Sirolimus drug-eluting, hydrogel-impregnated polypropylene mesh reduces intra-abdominal adhesion formation in a mouse model.
abstract: BACKGROUND
  Prosthetic mesh is used frequently in abdominal wall hernia reconstruction but is prone to postoperative adhesion formation. Complications resulting from intra-abdominal adhesions represent a considerable clinical and cost burden. We, herein, investigate the antiproliferative and antiadhesiogenic properties of sirolimus and hydrogel-impregnated, drug-eluting mesh to decrease such complications in a mouse model of abdominal wall hernia repair.
  
  
  METHODS
  A 1 × 1cm(2) polypropylene mesh from 1 of 3 groups (group 1, plain control; group 2, hydrogel [2% agarose]; and group 3, hydrogel + 10 mcg sirolimus) was implanted operatively into the peritoneal cavity of BALB/c mice and followed for up to 4 weeks. Adhesions were scored by percent surface area of mesh (range, 0-100%), severity (range, 0-3), and tenacity (range, 0-4). Representative samples were assessed by scanning electron microscopy.
  
  
  RESULTS
  Mesh impregnated with the combination of hydrogel and sirolimus led to a significant decrease in adhesion formation. The percent surface area of adhesional attachment to mesh was decreased from 100.0 ± 0% in the plain mesh control group versus 18 ± 8% (P < .001) in the combined impregnated mesh group. Similarly, adhesion severity scores were decreased from a score of 2.9 ± 0.1 (plain mesh) versus 1.4 ± 0.1 (sirolimus/hydrogel-impregnated mesh) (P < .001). Scores for tenacity were also decreased markedly from 3.5 ± 0.2 (plain mesh) versus 1.5 ± 0.1 (sirolimus/hydrogel-impregnated mesh (P < .001).
  
  
  CONCLUSIONS
  Creation of a sirolimus drug-eluting and hydrogel-impregnated polypropylene mesh resulted in marked decrease of adhesion formation in this mouse model, was well tolerated without side effects, and has potential for clinical application.
authors.affiliation: Department of Surgery, University of Alberta Hospitals, Edmonton, Alberta, Canada.
authors.forename: Allison H
authors.initials: AH
authors.lastname: Maciver
authors.forename: Michael D
authors.initials: MD
authors.lastname: McCall
authors.forename: Ryan L
authors.initials: RL
authors.lastname: Edgar
authors.forename: Aducio L
authors.initials: AL
authors.lastname: Thiesen
authors.forename: David L
authors.initials: DL
authors.lastname: Bigam
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Churchill
authors.forename: A M James
authors.initials: AM
authors.lastname: Shapiro
mesh_terms: D034861:Abdominal Wall / Q000601:surgery*; D058107:Abdominal Wound Closure Techniques / Q000295:instrumentation*; D000818:Animals; D001672:Biocompatible Materials / Q000494:pharmacology; D004195:Disease Models, Animal; D046449:Hernia, Abdominal / Q000601:surgery*; D020136:Hydrogel, Polyethylene Glycol Dimethacrylate; D007166:Immunosuppressive Agents / Q000494:pharmacology; D008297:Male; D051379:Mice; D008807:Mice, Inbred BALB C; D008855:Microscopy, Electron, Scanning; D011126:Polypropylenes; D020123:Sirolimus / Q000494:pharmacology*; D013526:Surgical Mesh; D000267:Tissue Adhesions / Q000517:prevention & control*
chemical_list: D001672:Biocompatible Materials; D007166:Immunosuppressive Agents; D011126:Polypropylenes; D020136:Hydrogel, Polyethylene Glycol Dimethacrylate; D020123:Sirolimus