E-Posters-10018

10018_Adelstein
Pdf Summary
This study aimed to evaluate the role of extracellular matrix (ECM) proteoglycans in the inflammatory response to pelvic floor mesh in women undergoing mesh removal. Tissue specimens from women with symptomatic pelvic floor mesh complications undergoing removal were compared to control specimens from women with prolapse or incontinence undergoing surgery. The results showed that the mesh types included slings, abdominal implants, and vaginal implants. Indications for removal were urinary obstruction, pain, and erosion/exposure. Compared to control tissues, the symptomatic mesh cases exhibited strong staining of hyaluronan (HA) and versican, an HA-binding protein associated with inflammation and elastin breakdown, adjacent to mesh fibers. HA was enriched throughout the explant case specimen ECM. Giant cells that were in contact with the mesh were negative for HA, but the ECM between other inflammatory cells was rich in HA. Occasionally, alpha-SMA-positive cells co-localized with versican in a fibrous capsule surrounding the mesh fibers. Nerves associated with the mesh fibers and located within the fibrous capsule stained strongly for versican. The researchers concluded that the tissue in women with symptomatic mesh complications demonstrated changes in ECM, suggesting inflammatory changes that may contribute to the development of pelvic floor mesh complications. Co-localization of alpha-SMA with versican and HA around the mesh suggests that some of the capsule cells around mesh fibers differentiated into myofibroblasts. The accumulation of versican and HA around nerves near the mesh fibers may offer a possible mechanism for pain by direct mechanical pressure on nerve sheaths and merits further investigation. These findings suggest that changes in the ECM involving versican, HA, and myofibroblast formation play a role in the inflammatory response to pelvic floor mesh.
Keywords
extracellular matrix
proteoglycans
inflammatory response
pelvic floor mesh
mesh removal
symptomatic complications
hyaluronan
versican
myofibroblasts
nerve sheaths