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Effect of gelatin methacryloyl hydrogel on healing of the guinea pig vaginal wall with or without mesh augmentation

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Abstract

Introduction and hypothesis

The aims of this study were to evaluate the effectiveness of gelatin methacryloyl as an adjunct to anterior vaginal wall injury with or without vaginal mesh compared with traditional repair with suture.

Methods

Virginal cycling Hartley strain guinea pigs (n = 60) were randomized to undergo surgical injury and repair using either polyglactin 910 suture or gelatin methacryloyl for epithelium re-approximation or anterior colporrhaphy with mesh augmentation using either polyglactin 910 suture or gelatin methacryloyl for mesh fixation and epithelium re-approximation. Noninjured controls (n = 5) were also evaluated. After 4 days, 4 weeks, or 3 months, tissues were analyzed by hematoxylin & eosin in addition to immunolabeling for macrophages, leukocytes, smooth muscle, and fibroblasts.

Results

Surgical injury repaired with suture was associated with increased inflammation and vessel density compared with gelatin methacryloyl. Vimentin and α-smooth muscle actin expression were increased with gelatin methacryloyl at 4 days (p = 0.0026, p = 0.0272). There were no differences in changes in smooth muscle or overall histomorphology after 3 months between the two closure techniques. Mesh repair with suture was also associated with increased inflammation and vessel density relative to gelatin methacryloyl. Quantification of collagen content by picrosirius red staining revealed increased thick collagen fibers throughout the implanted mesh with gelatin methacryloyl compared with suture at 4 weeks (0.62 ± 0.01 μm2 vs 0.55 ± 0.01, p = 0.018). Even at the long-term time point of 3 months, mesh repair with suture resulted in a profibrotic encapsulation of the mesh fibers, which was minimal with gelatin methacryloyl. Smooth muscle density was suppressed after mesh implantation returning to baseline levels at 3 months regardless of fixation with suture or gelatin methacryloyl.

Conclusions

These results suggest that gelatin methacryloyl might be a safe alternative to suture for epithelium re-approximation and anchoring of prolapse meshes to the vagina and may improve chronic inflammation in the vaginal wall associated with mesh complications.

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Financial support

This work was supported by NIH AG028048, Dedman’s Scholar grant from the University of Texas Southwestern Medical Center.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390-9032, USA

    Lindsey A. Jackson, R. Ann Word & Maria Florian-Rodriguez

  2. Cecil H and Ida Green Center for Reproductive Biological Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Haolin Shi, Jesus Acevedo, R. Ann Word & Maria Florian-Rodriguez

  3. Department of Chemical Engineering, University of California Los Angeles, Los Angeles, CA, USA

    Sohyung Lee & Nasim Annabi

Authors
  1. Lindsey A. Jackson
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  2. Haolin Shi
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  3. Jesus Acevedo
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  4. Sohyung Lee
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  5. Nasim Annabi
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  6. R. Ann Word
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  7. Maria Florian-Rodriguez
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Contributions

L. Jackson: data collection or management, data analysis, manuscript writing/editing; H. Shi: data collection or management, data analysis, manuscript writing/editing; J. Acevedo: data collection or management, data analysis, manuscript writing/editing; S. Lee: data analysis, manuscript writing/editing; N. Annabi: protocol/project development, data analysis, manuscript writing/editing; A. Word: protocol/project development, data analysis, manuscript writing/editing; M. Florian-Rodriguez: protocol/project development, data collection or management, data analysis, manuscript writing/editing.

Corresponding author

Correspondence to Maria Florian-Rodriguez.

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Supplementary Information

Supplementary Table 1

(DOCX 14 kb)

Supplementary Figure 1

Effect of suture or GelMA on smooth muscle and fibroblasts in the vaginal wall after anterior colporrhaphy with mesh. Sections from tissues repaired with suture at a 4 weeks or b 3 months or c GelMA at 4 week or d 3 months were double labeled with anti-SMA (red) and anti-vimentin (green) antibodies as described in Materials and methods. Quantification of smooth muscle area is presented in panels e (muscularis) and f (lamina propria). *p < 0.05 compared with noninjured controls. Epi epithelium, M muscularis, LP lamina propria, EUS external urethral sphincter, Ca profibrotic capsule

Supplementary Figure 2

Effect of suture or GelMA on vimentin expression in the vaginal wall after anterior colporrhaphy with mesh. Quantification of vimentin positive area in a anterior vaginal wall muscularis or b lamina propria. *p < 0.05 compared with noninjured controls

Supplementary Figure 3

Impact of suture or GelMA on total collagen content in the vaginal wall after anterior colporrhaphy with mesh. Sections stained with picrosirius red from tissues of a noninjured controls or after anterior colporrhaphy repaired with mesh and b suture or c GelMA at 4 weeks post-procedure. Note that collagen fibers surrounding suture are not aligned (b) relative to the more aligned fibers surrounding GelMA (c). Black circles mesh pores, EUS external urethral sphincter, Epi vaginal epithelium, M muscularis, LP lamina propria

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Jackson, L.A., Shi, H., Acevedo, J. et al. Effect of gelatin methacryloyl hydrogel on healing of the guinea pig vaginal wall with or without mesh augmentation. Int Urogynecol J 33, 2223–2232 (2022). https://doi.org/10.1007/s00192-021-05031-2

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  • DOI: https://doi.org/10.1007/s00192-021-05031-2

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