Examination of the foreign body response to biomaterials by nonlinear intravital microscopy


Implanted biomaterials often fail because they elicit a foreign body response (FBR) and concomitant fibrotic encapsulation. To design clinically relevant interference approaches, it is crucial to first examine the FBR mechanisms. Here, we report the development and validation of infrared-excited nonlinear microscopy to resolve the three-dimensional (3D) organization and fate of 3D-electrospun scaffolds implanted deep into the skin of mice and the following step-wise FBR process. We observed that immigrating myeloid cells (predominantly macrophages of the M1 type) engaged and became immobilized along the scaffold/tissue interface, before forming multinucleated giant cells. Both macrophages and giant cells locally produced vascular endothelial growth factor (VEGF), which initiated and maintained an immature neovessel network, followed by the formation of a dense collagen capsule two- to four-weeks post-implantation. Elimination of the macrophage/giant-cell compartment, by clodronate and/or neutralization of VEGF by VEGF Trap, significantly diminished giant-cell accumulation, neovascularization and fibrosis. Our findings identify macrophages and giant cells as incendiaries of the fibrotic encapsulation of engrafted biomaterials via VEGF release and neovascularization, and therefore as targets for therapy.

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Figure 1: Higher harmonic multiphoton microscopy of 3D-printed mPCL-CaP fibres in vitro.
Figure 2: | Generation and characterization of an in vivo model to study the FBR by longitudinal intravital imaging.
Figure 3: Dynamics of infiltrate cells of the FBR monitored by intravital microscopy.
Figure 4: Neovessel development and collagen deposition in the scaffold-elicited FBR monitored by intravital microscopy.
Figure 5: Therapeutic targeting of the FBR by macrophage and VEGF depletion.
Figure 6: Long-term efficacy of macrophage- and VEGF-depletion treatment.
Figure 7: FBR and late-stage scarring mediated by macrophages, giant cells and neovessels.


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We thank M. Starbuck, C. Johnston, Y. Xiaoqing, R. Jimenez and J. Douglas for histological processing of the samples; and E. De Juan Pardo for the manufacturing of the mPCL-CaP scaffolds. E.D. was supported by the Cancer Prevention and Research Institute of Texas (RP140482) and the Prostate Cancer Foundation (16YOUN24). P.F. was supported by the Netherlands Science Organization (NWO-VICI 918.11.626), the European Research Council (ERC-CoG DEEPINSIGHT, Project No. 617430) and the Cancer Genomics Center, The Netherlands. This work was further supported by the National Health and Medical Research Council (NHMRC Project Grant 1082313), the National Breast Cancer Foundation (NBCF IN-15-047) and the Worldwide Cancer Research (WWCR 15-11563) to B.M.H. and D.W.H. and the German Research Foundation (DFG HO 5068/1-1) to B.M.H. The Genitourinary Cancers Program of the CCSG shared resources at the MD Anderson Cancer Center was supported by the National Institute of Health/National Cancer Institute award number P30 CA016672.

Author information




E.D., B.M.H., S.A., D.W.H. and P.F. designed the research. E.D., B.M.H., S.A., S.F. and D.W.H. performed the research. E.D., S.F., D.W.H. and P.F. analysed the data. E.D., B.M.H., D.W.H. and P.F. wrote the paper.

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Correspondence to Eleonora Dondossola or Peter Friedl.

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The authors declare no competing financial interests.

Supplementary information

Supplementary Information

Supplementary figures and video captions. (PDF 13926 kb)

Video 1

Kinetics of infiltrate cells at day 4 post-scaffold implantation. (AVI 5426 kb)

Video 2

Kinetics of infiltrate cells at day 7 post-scaffold implantation. (AVI 12122 kb)

Video 3

Kinetics of infiltrate cells at day 10 post-scaffold implantation. (AVI 15468 kb)

Video 4

Cytoplasmic dynamics of scaffold-associated giant cells. (AVI 1036 kb)

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Dondossola, E., Holzapfel, B., Alexander, S. et al. Examination of the foreign body response to biomaterials by nonlinear intravital microscopy. Nat Biomed Eng 1, 0007 (2017). https://doi.org/10.1038/s41551-016-0007

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