Characterization of the T Cell Response to Polypropylene Mesh in Women with Complications

Abstract Background Polypropylene mesh is widely used for surgical treatment of pelvic organ prolapse and stress urinary incontinence. While these surgeries demonstrate favorable functional and anatomical outcomes, their use has been limited by complications, the two most common being exposure and pain. Growing evidence suggests T lymphocytes play a critical role in regulating the host response to biomaterials. Objectives To define and characterize the T cell response and correlate the response to collagen deposition in fibrotic capsules in mesh tissue complexes removed for the complications of pain versus exposure. Study Design Patients who were scheduled to undergo a surgical excision of mesh for pain or exposure at Magee-Women’s Hospital were offered enrollment. Forty- two mesh-vagina tissue complexes were removed for the primary complaint of exposure (n=24) versus pain (n=18). Twenty-one patients agreed to have an additional vaginal biopsy away from the site of mesh and served as control tissue. T cells were examined via immunofluorescent labeling for cell surface markers CD4+ (T helper), CD8+ (cytotoxic) and foxp3 (T regulatory cell). Frozen sections were stained with HE P=0.01) but not exposure (P>0.7). Conclusion T cells appear to play a critical role in the long-term host response to mesh and may be a central pathway leading to complications. The complexity of this response warrants further investigation and has the potential to broaden our understanding of mesh biology and clinical outcomes.