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Efficacy of antimicrobial agents delivered to hernia meshes using an adaptable thermo-responsive hyaluronic acid-based coating

  • B. Pérez-Köhler
  • F. Linardi
  • G. Pascual
  • J. M. Bellón
  • D. Eglin
  • O. GuillaumeEmail author
Original Article



Mesh-related infection is a critical outcome for patients with hernia defect stabilized with synthetic or biological meshes. Even though bioactive meshes loaded with antibiotics or antiseptics are slowly emerging in the market, the available solutions still lack versatility. Here, we proposed a polymer solution, i.e., hyaluronic acid-poly(N-isopropylacrylamide) (HApN), which forms a hydrogel to be used as coating for meshes only when it reaches body temperature.


We assessed how the gelation of HApN was influenced by the incorporation of different antibiotic and antiseptic formulations, and how this gel can be used to coat several mesh types. The impact of the coating on the elastic behavior of a macroporous mesh was tested under cyclic elongation condition. Finally, we selected two different coating formulations, one based on antibiotics (gentamicin + rifampicin) and one based on antiseptic (chlorhexidine) and tested in vitro their antimicrobial efficacies.


HApN can be used as carrier for different antimicrobial agents, without having a strong influence on its gelation behavior. Porous or dense meshes can be coated with this polymer, even though the stability was not optimal on macroporous meshes such as Optilene when pores are too large. HApN loaded with drugs inhibited in vitro the growth of several Gram-positive and Gram-negative bacteria.


Compared to the available technologies developed to endow meshes with antibacterial activity, the proposed HApN offers further versatility with potential to prevent mesh-related infection in hernioplasty.


Antibacterial Coating Hernia mesh Hydrogel Infection Thermo-responsive 



This work was supported by a Research Grant from the European Hernia Society in 2019 and Grant SAF2017-89481-P from the Spanish Ministry of Science, Innovation and Universities.

Compliance with ethical standards

Conflict of interest

The author declares that they have no competing interests.

Ethical approval

For this type of study ethical approval is not required.

Human and animal rights

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

In this study, no patient care was involved.

Supplementary material

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Supplementary file1 (TIF 3601 kb)
10029_2019_2096_MOESM2_ESM.docx (13 kb)
Supplementary file2 (DOCX 12 kb)

Supplementary file3 (WMV 85348 kb)


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Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Medicine and Medical Specialities, Faculty of Medicine and Health SciencesUniversity of AlcaláMadridSpain
  2. 2.AO Research Institute DavosDavosSwitzerland
  3. 3.Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health SciencesUniversity of AlcaláMadridSpain
  4. 4.Biomedical Networking Research Centre On BioengineeringBiomaterials and Nanomedicine (CIBER-BBN)MadridSpain
  5. 5.Ramón y Cajal Health Research Institute (IRYCIS)MadridSpain

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