Supramolecular Fibrous Hydrogel Augmentation of Uterosacral Ligament Suspension for Treatment of Pelvic Organ Prolapse
Supramolecular Fibrous Hydrogel Augmentation of Uterosacral Ligament Suspension for Treatment of Pelvic Organ Prolapse
复制标题
DOI：
10.1002/adhm.202300086
复制
发表时间：
2023-05-31
影响因子：
10
通讯作者：
Caliari，Steven R.
中科院分区：
文献类型：
--
作者：
Miller，Beverly;Wolfe，Wiley;Caliari，Steven R.
子宫骶韧带悬吊术(USLS)是治疗盆腔器官脱垂(POP)的常用手术方法。然而，相对较高的失败率高达40%，这突显了临床上对补充治疗策略的强烈需求，例如生物材料增强。在这里，描述了在最近建立的大鼠模型中使用可注射纤维水凝胶复合材料对USLS的第一次水凝胶生物材料增强。超分子组装的透明质酸(HA)水凝胶纳米纤维包裹在可降解的基质金属蛋白酶(MMPs)水凝胶中，形成了一种可注射的支架，表现出良好的生物相容性和血液相容性。水凝胶可以被成功地输送并定位到USLS手术的缝合部位，在那里它会在六周内逐渐降解。经产妇USLS模型术后24周的原位力学测试显示，完整的子宫骶韧带(USL)修复的极限载荷(失效载荷)为1.70±0.36 N，USLS修复的极限载荷为0.89±0.28 N，USLS+水凝胶(USLS+H)修复的最大载荷为1.37±0.31 N(n=0.8)。这些结果表明，与标准的USLS相比，水凝胶复合材料显著改善了组织衰竭所需的负荷，即使在水凝胶降解之后也是如此，并且这种基于水凝胶的方法可以潜在地降低与USLS程序相关的高失败率。
Uterosacral ligament suspension (USLS) is a common surgical treatment for pelvic organ prolapse (POP). However, the relatively high failure rate of up to 40% underscores a strong clinical need for complementary treatment strategies, such as biomaterial augmentation. Herein, the first hydrogel biomaterial augmentation of USLS in a recently established rat model is described using an injectable fibrous hydrogel composite. Supramolecularly‐assembled hyaluronic acid (HA) hydrogel nanofibers encapsulated in a matrix metalloproteinase (MMP)‐degradable HA hydrogel create an injectable scaffold showing excellent biocompatibility and hemocompatibility. The hydrogel can be successfully delivered and localized to the suture sites of the USLS procedure, where it gradually degrades over six weeks. In situ mechanical testing 24 weeks post‐operative in the multiparous USLS rat model shows the ultimate load (load at failure) to be 1.70 ± 0.36 N for the intact uterosacral ligament (USL), 0.89 ± 0.28 N for the USLS repair, and 1.37 ± 0.31 N for the USLS + hydrogel (USLS+H) repair (n= 8). These results indicate that the hydrogel composite significantly improves load required for tissue failure compared to the standard USLS, even after the hydrogel degrades, and that this hydrogel‐based approach can potentially reduce the high failure rate associated with USLS procedures.