title: Impact of prolapse meshes on the metabolism of vaginal extracellular matrix in rhesus macaque.
abstract: OBJECTIVE
  The impact of polypropylene mesh implantation on vaginal collagen and elastin metabolism was analyzed using a nonhuman primate model to further delineate the mechanism of mesh induced complications.
  
  
  METHODS
  Forty-nine middle-aged parous rhesus macaques underwent surgical implantation of 3 synthetic meshes via sacrocolpopexy. Gynemesh PS (n = 12) (Ethicon, Somerville, NJ) and 2 lower-weight, higher-porosity, lower-stiffness meshes (UltraPro [n = 19] [Ethicon] and Restorelle [n = 8] [Coloplast, Minneapolis, MN]) were implanted, in which UltraPro was implanted with its blue orientation lines perpendicular (low stiffness direction, n = 11) and parallel (high stiffness direction, n = 8) to the longitudinal axis of the vagina. Sham-operated animals were used as controls (n = 10). Twelve weeks after surgery, the mesh-tissue complex was excised and analyzed.
  
  
  RESULTS
  Relative to sham, Gynemesh PS had a negative impact on the metabolism of both collagen and elastin-favoring catabolic reactions, whereas UltraPro induced an increase only in elastin degradation. Restorelle had the least impact. As compared with sham, the degradation of collagen and elastin in the vagina implanted with Gynemesh PS was increased with a simultaneous increase in active matrix metalloproteinase (MMP)-1, -8, -13, and total MMP-2 and -9 (all P < .05). The degradation of elastin (tropoelastin and mature elastin) was increased in the UltraPro-implanted vagina with a concomitant increase of MMP-2, and -9 (all P < .05). Collagen subtype ratio III/I was increased in Gynemesh PS and UltraPro perpendicular groups (P < .05).
  
  
  CONCLUSIONS
  Following implantation with the heavier, less porous, and stiffer mesh, Gynemesh PS, the degradation of vaginal collagen and elastin exceeded synthesis, most likely as a result of increased activity of MMPs, resulting in a structurally compromised tissue.
authors.affiliation: Department of Obstetrics and Gynecology, Magee-Womens Research Institute, School of Medicine, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Rui
authors.initials: R
authors.lastname: Liang
authors.affiliation: Department of Obstetrics and Gynecology, Magee-Womens Research Institute, School of Medicine, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Wenjun
authors.initials: W
authors.lastname: Zong
authors.affiliation: Department of Obstetrics and Gynecology, Magee-Womens Research Institute, School of Medicine, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Stacy
authors.initials: S
authors.lastname: Palcsey
authors.affiliation: Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Steven
authors.initials: S
authors.lastname: Abramowitch
authors.affiliation: Department of Obstetrics and Gynecology, Magee-Womens Research Institute, School of Medicine, University of Pittsburgh, Pittsburgh, PA. Electronic address: moalpa@mail.magee.edu.
authors.forename: Pamela A
authors.initials: PA
authors.lastname: Moalli
mesh_terms: D000818:Animals; D015153:Blotting, Western; D003094:Collagen / Q000378:metabolism*; D024042:Collagen Type I / Q000378:metabolism; D024061:Collagen Type III / Q000378:metabolism; D004549:Elastin / Q000378:metabolism*; D004591:Electrophoresis, Polyacrylamide Gel; D005109:Extracellular Matrix / Q000378:metabolism*; D005260:Female; D008253:Macaca mulatta; D020781:Matrix Metalloproteinase 1 / Q000378:metabolism; D053509:Matrix Metalloproteinase 13 / Q000378:metabolism; D020778:Matrix Metalloproteinase 2 / Q000378:metabolism; D020784:Matrix Metalloproteinase 8 / Q000378:metabolism; D020780:Matrix Metalloproteinase 9 / Q000378:metabolism; D011126:Polypropylenes; D011347:Procollagen / Q000378:metabolism; D013526:Surgical Mesh / Q000009:adverse effects*; D014333:Tropoelastin / Q000378:metabolism; D014596:Uterine Prolapse / Q000601:surgery*; D014621:Vagina / Q000378:metabolism*
chemical_list: D024042:Collagen Type I; D024061:Collagen Type III; D011126:Polypropylenes; D011347:Procollagen; D014333:Tropoelastin; D003094:Collagen; D004549:Elastin; D053509:Matrix Metalloproteinase 13; D020778:Matrix Metalloproteinase 2; D020784:Matrix Metalloproteinase 8; D020780:Matrix Metalloproteinase 9; D020781:Matrix Metalloproteinase 1
keywords: collagen and elastin; matrix metalloproteinases; rhesus macaque; synthetic mesh; vagina