An in vivo analysis of Miromesh—a novel porcine liver prosthetic created by perfusion decellularization

Clayton C Petro,Ajita S Prabhu,Lijia Liu,Arnab Majumder,James M Anderson,Michael J Rosen

doi:10.1016/j.jss.2015.10.009

Clayton C Petro, Ajita S Prabhu + Show 4 more

Open Access

https://doi.org/10.1016/j.jss.2015.10.009

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Abstract

BackgroundBioprosthetics derived from human or porcine dermis and intestinal submucosa have dense, homogenous, aporous collagen structures that potentially limit cellular penetration, undermining the theoretical benefit of a “natural” collagen scaffold. We hypothesized that Miromesh—a novel prosthetic derived from porcine liver by perfusion decellularization—provides a more optimal matrix for tissue ingrowth. MethodsThirty rats underwent survival surgery that constituted the creation of a 4 × 1 cm abdominal defect and simultaneous bridged repair. Twenty rats were bridged with Miromesh, and 10 rats were bridged with non–cross-linked porcine dermis (Strattice). Ten Miromesh and all 10 Strattice were rinsed in vancomycin solution and inoculated with 104 colony-forming units of green fluorescent protein–labeled Staphylococcus aureus (GFP-SA) after implantation. Ten Miromesh controls were neither soaked nor inoculated. No animals received systemic antibiotics. All animals were euthanized at 90 d and underwent an examination of their gross appearance before being sectioned for quantitative bacterial culture and histologic grading. A pathologist scored specimens (0–4) for cellular infiltration, acute inflammation, chronic inflammation, granulation tissue, foreign body reaction, and fibrous capsule formation. ResultsAll but one rat repaired with Strattice survived until the 90-d euthanization. All quantitative bacterial cultures for inoculated specimens were negative for GFP-SA. Of nine Strattice explants, none received a cellular infiltration score >0, consistent with a poor tissue–mesh interface observed grossly. Of 10 Miromesh explants also inoculated with GFP-SA, seven of 10 demonstrated cellular infiltration with an average score of +2.7 ± 0.8, whereas sterile Miromesh implants received an average score of 0.8 ± 1.0. Two inoculated Miromesh implants demonstrated acute inflammation and infection on histology. ConclusionsA prosthetic generated from porcine liver by perfusion decellularization provides a matrix for superior cellular infiltration compared with non–cross-linked porcine dermis.

Highlights

The use of prosthetic reinforcement for all but the smallest of ventral hernia repairs has consistently produced lower recurrence rates [1e3]
Half of the rats bridged with Miromesh and all those bridged with Strattice were rinsed with vancomycin solution (10 mg/mL for 15 min) and inoculated with 104 colony-forming units (CFU) of green fluorescent proteinelabeled Staphylococcus aureus (GFP-SA)
There were no instances of repair failure at the meshetissue suture line resulting in hernia “recurrence” or evisceration

Summary

Introduction

The use of prosthetic reinforcement for all but the smallest of ventral hernia repairs has consistently produced lower recurrence rates [1e3]. The extracellular matrix proteins retained after decellularization of human or animal tissue theoretically provide a “natural” collagen scaffold for tissue ingrowth. Bioprosthetics derived from human or porcine dermis and intestinal submucosa have dense, homogenous, aporous collagen structures that potentially limit cellular penetration, undermining the theoretical benefit of a “natural” collagen scaffold. Of nine Strattice explants, none received a cellular infiltration score >0, consistent with a poor tissueemesh interface observed grossly. Of 10 Miromesh explants inoculated with GFP-SA, seven of 10 demonstrated cellular infiltration with an average score of þ2.7 Æ 0.8, whereas sterile Miromesh implants received an average score of 0.8 Æ 1.0. Conclusions: A prosthetic generated from porcine liver by perfusion decellularization provides a matrix for superior cellular infiltration compared with nonecross-linked porcine dermis.

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