OBJECTIVE
To evaluate the changes in the gene expression of proinflammatory cytokine TNF-α of monocytes in the patients with pelvic organ prolapse after the polypropylene mesh implant installation in comparison with the patients with the same diagnosis who underwent reconstructive surgical interventions on the pelvic floor organs using their own (native) tissues.
MATERIAL AND METHODS
A prospective cohort study with participation of 60 patients operated on for pelvic organ prolapse from 12 to 24 months ago was conducted. Two groups were formed: group 1 — 40 patients after polypropylene mesh prosthesis placement; group 2 — 20 patients after genital prolapse surgery using native surgery techniques. Subgroup 1a included 20 patients with implant-associated complications (erosion of the vaginal mucosa, n=20) according to the inclusion criteria, subgroup 1b — 20 patients without implant-associated complications. Blood monocytes from the patients of the examined groups were isolated, cultured and their viability under different conditions was assessed. The gene expression of proinflammatory cytokine TNF-α in monocytes differentiated into macrophages, M1-like and M2-like cells and undifferentiated monocytes in the presence of the mesh prosthesis material was evaluated.
RESULTS
Polypropylene mesh prosthesis does not affect the viability of monocytes, their proinflammatory balance, i.e. this material is bioinert and does not potentiate inflammation in the tissues adjacent to it. In patients with polypropylene mesh prosthesis, the relative level of TNF-α gene expression of monocytes as well as macrophages is significantly lower than in patients without endoprosthesis.
CONCLUSION
Polypropylene mesh prosthesis is a bioinert material with high biocompatibility in in vitro experiments, but it can induce the phenomenon of «depletion» of proinflammatory macrophage population (M1) and their insufficient function in female patients due to prolonged stimulation in vivo. Thus, the use of polypropylene mesh prostheses may have a systemic effect on the patient, which requires further investigation.