Engineering biocompatible solutions for POP: eMSC-seeded and plasma-treated scaffolds.

Abstract

Introduction & Objectives: Pelvic Organ Prolapse (POP) remains a prevalent condition with limited durable and biocompatible surgical solutions. The withdrawal of synthetic polypropylene mesh due to concerns regarding risk of erosion has prompted the need for innovative bioengineered alternatives. This study evaluates two translational strategies to enhance poly-L-lactide-co-e-caprolactone (PLCL) vaginal implant integration and reduce complications: mesenchymal stem cell (MSC) augmentation and plasma polymer surface modification. Method(s): Human endometrial mesenchymal stem/stromal cells (eMSC; SUSD2+) were isolated, expanded, and seeded onto nanostructured PLCL scaffolds. An ovine vaginal repair model (Monash Animal Ethics Committee #MMCA-2018) was used to compare native repair, PLCL implants, and PLCL + eMSC constructs. Modified POP-Q scores were recorded pre-op and at 7, 30, and 90 days post-op. Tissue samples were analysed using histology, immunohistochemistry, scanning electron microscopy (SEM), and immunofluorescence to assess tissue integration, inflammation, ECM remodelling, and angiogenesis. For surface modification studies, PLCL scaffolds were treated with plasma polymerised allylamine and implanted into a separate ovine model. Groups included uncoated, freshly coated, and delayed implantation PLCL. Post-op tissue was harvested at day 7 and 30 for histological and SEM analysis. Result(s): Stem cell-seeded PLCL scaffolds showed improved integration, minimal inflammatory response, and enhanced collagen and elastin organisation compared to controls. eMSC constructs exhibited histological evidence of angiogenesis and tissue maturation, with limited smooth muscle disruption. Interestingly, eMSCs maintained SUSD2 expression over 90%, even after attaching to PLCL meshes, demonstrating excellent engraftment. Plasma-coated PLCL significantly reduced foreign body giant cell formation and promoted collagen preservation compared to uncoated scaffolds. Conclusion(s): eMSC-functionalised nanomeshes and plasma polymerisation represent synergistic strategies to enhance biocompatibility and host tissue integration of synthetic implants for POP repair. These advanced constructs mitigate chronic inflammation and foreign body reaction while supporting angiogenesis and ECM maintenance. This study supports further clinical development of stem cell-augmented and plasma-treated scaffolds as nextgeneration solutions for reconstructive pelvic floor surgery.