Fibroblast Matrix Implants - A Better Alternative for Incisional Hernia Repair?

Abstract Background: The standard surgical procedure for abdominal hernia repair with conventional prosthetic mesh still results in a high recurrence rate. In the present study, we propose a Fibroblast Matrix Implant (FMI), which is a Poly-L-lactic acid (PLLA) scaffold coated with three-dimensional (3D) collagen (matrix) and seeded with fibroblasts, as an alternative to conventional prosthetic mesh for hernia repair. Methods: The matrix was seeded with fibroblasts (cellularized) and treated with a Conditioned Medium (CM) of human Umbilical Cord Mesenchymal Stem Cells (hUC-MSC). Fibroblast proliferation and collagen secretion were assessed and compared between the treated group and the untreated group (without CM hUC-MSC) 24 hours after seeding onto the matrix (n=3). To study the matrices in vivo, male Sprague Dawley rats were used as hernia models. The hernia was surgically created and repaired with four different grafts (n=3), including a commercial mesh (mesh group), a matrix without cells (cell-free group), a matrix seeded with fibroblasts (FMI group), and a matrix seeded with fibroblasts and cultured in medium enriched with 1 % CM hUC-MSC (FMI-CM group). Results: In vitro examination showed that the fibroblasts’ proliferation on the matrices (treated group) did not differ significantly compared to the untreated group. CM hUC-MSC was able to promote the collagen synthesis of the fibroblasts, resulting in a higher collagen concentration compared to the control group. Furthermore, the in vivo study showed that the matrices allowed fibroblast growth and supported cell functionality for at least 1 month after implantation. The highest number of fibroblasts was observed in the FMI group at the 14-day endpoint, but at the 28-day endpoint, the FMI-CM group had the highest. Collagen production and neovascularization were observed in all groups without any significant difference between the groups. Conclusions: FMI combined with CM hUC-MSC may serve as a better option for hernia repair, providing adequate reinforcement and promoting greater scar formation, which in turn should reduce hernia recurrence.