Supplementary Data PDF file - 189K, supplementary data showing: a. Primers used for RT-PCR analysis of human prostate tissue and cell lines b. Primer pairs used for detection of human EP3 isoforms c. RT-PCR analysis of human EP3 isoforms present in malignant and benign human prostate cell lines

Abstract PGE2 has been implicated in prostate cancer tumorigenesis. We hypothesized that abnormal prostaglandin receptor (EPR) expression may contribute to prostate cancer growth. Twenty-six archived radical prostatectomy specimens were evaluated by immunohistochemistry (IHC) and Western blotting for the expression of EP1, EP2, EP3, and EP4. As a corollary, EPR expression in one normal (PZ-HPV7) and four prostate cancer cell lines (CA-HPV10, LNCaP, PC3, and Du145) were assessed by Western blotting. Prostate cancer and normal cell growth were compared in vitro after EPR blockade, siRNA EPR knockdown, or overexpression. EP1, EP2, EP3, and EP4 receptors were detected by IHC in all areas of benign tissue within the clinical prostate cancer specimens. In areas of prostate cancer, EP4 and EP2 were overexpressed in 85% (22 of 26) and 75% (18 of 24) and EP3 expression was reduced in all (26 of 26, 100%) specimens (P < 0.05 vs. benign tissue). EP1 showed no specific differential expression pattern. Increased EP4 and reduced EP3 was confirmed by Western blotting in fresh clinical specimens and in prostate cancer cell lines (CA-HPV10, LNCaP, PC3, and Du145) compared with the normal prostate cell line (PZ-HPV7). EP2 and EP4 siRNA knockdown resulted in reduced in vitro growth and metastasis-related gene expression (MMP9 and Runx2) of prostate cancer lines, and in vitro migration was inhibited by EP4 antagonists. As a corollary, EP3-overexpressing PC3 cells displayed impaired growth in vitro. Human prostate cancer is associated with EP4 and EP2 overexpression and reduced EP3 expression. These data suggest that targeting specific EPR may represent a novel therapeutic approach for prostate cancer. Mol Cancer Res; 11(4); 427–39. ©2013 AACR.

Abstract INTRODUCTION AND OBJECTIVES: Prostaglandin E2 (PGE2) has been implicated in prostate cancer (CaP) growth. The cellular effects of PGE2 are mediated through the G protein-coupled receptors EPR1-4. We have previously shown increased EP4 expression in CaP clinical radical prostatectomy specimens compared with benign prostate tissue. In order to determine whether EP4 plays a functional role in CaP growth, we derived stable EP4 knockdown (KD) clones from the murine RM1 cell line and evaluated in vitro growth and in vivo tumorigenesis. METHODS: Stable knockdown of the EP4 gene in mouse CaP RM1 cells was achieved by lentiviral infection with EP4 shRNA particles (Santa Cruz Biotech). Of the 5 randomly selected clones derived from puromycin resistant single cells, EP4 knockdown was confirmed in 2 clones (2B3 and 1F5) by RT-PCR. These 2 clones were further assessed for in vitro cell growth by direct cell counting, soft agar colony formation and in vitro directed cell migration. In vivo tumorigenesis was assessed by injecting 25 x 103 cells suspended in 0.1 ml of Matrigel into the flank region of syngeneic B6 mice. Tumor size was measured twice weekly, and the mice were sacrificed at the end of the 3rd week. Controls were wild type (wt) and non-targeting shRNA infected (nTG) RM1 cells. RESULTS: Clones 2B3 and 1F5 had selectively reduced EP4 mRNA (RT-PCR) with preserved EP1-3 mRNA levels and hence were used for further study. EP4 KD cells (clones 1F5 and 2B3) exhibited significantly (p<0.01) reduced in vitro growth, colony formation (p<0.01) and in vitro directed migration (p<0.05) compared with that of wt RM1 and nTG controls. Mean tumor weights (gm) from a representative experiment of 4 (n=8 animals per group): 1F5: 0.03 ± 0.04; 2B3: 0.80 ± 0.1 gm; both p<0.001 vs wt RM1: 1.27 ± 0.31 and nTG: 1.25±0.26). Reduced EP4 expression and normal expression of EP1, EP2 and EP3 in tumor tissue derived from 2B3 and 1F5 cells were further confirmed by IHC. The proportion of animals developing tumors after in vivo implantation of stable EP4 knockdown cells from clones 2B3 and 1F5 were also reduced (55% and 27%, respectively) compared with WT (100%) and nTG (87%) controls. IHC of in tumors derived from 1F5 and 2B3 cells also revealed reduced expression of MMP9 and VEGF compared with WT and nTG controls. CONCLUSIONS: shRNA knockdown of the EP4 gene in murine CaP RM1 cells significantly reduced subsequent in vivo tumorigenesis with reduced tumor number and tumor weight, colony formation, migration, and expression of the metastasis-related genes MMP9 and VEGF. These findings show that EP4 knockdown inhibits in vivo CaP growth associated with reduced metastasis-related gene expression and suggests a novel therapeutic target for CaP. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 1208. doi:1538-7445.AM2012-1208

Background. Eicosanoids are generally recognized to exert potent immunomodulatory properties, including effects on T cell, antigen-presenting cell (APC), and dendritic cell (DC) maturation and function. Since DC maturation and function may also be regulated by store-operated calcium entry (SOCE), we hypothesized that the effects of eicosanoids on DC function may in part be regulated through changes in intracellular calcium.Methods. DC derived from the bone marrow of male Balb/ ByJ mice cultured for 7 d in the presence of granulocyte macrophage colony stimulating factor (GMCSF) and interleukin-4 (IL-4) were used to study the effects of eicosanoids on SOCE and the resulting Ca(2+) mobilization.Results. The 5-lipoxygenase (5-LO) products leukotriene B4 (LTB(4)) and LTD(4), but not LTC(4), depleted Ca(2+) from DC endoplasmic reticulum stores. The specificity of LTB(4) and LTD(4) on Ca(2+) store-depletion was confirmed by the ability of the specific receptor antagonists, LY25583 and MK571, respectively, to abrogate Ca(2+) store depletion. RT-PCR demonstrated DC receptors for LTB(4) (BLT(1) and BLT(2)) and the cysteinyl-LTs (CysLT(1), CysLT(2), and GPR17). We also detected transient receptor potential canonical (TRPC) 1, 2, 4, and 6 and stromal interaction molecule 1 (STIM1) on CD11c D DCs, suggesting these proteins also participate in DC SOCE. In contrast, the cyclooxygenase (CO) metabolite PGE(2) had no effect on DC Ca(2+) mobilization.Conclusions. To our knowledge, these are the first observations of distinct effects of eicosanoids on DC Ca2+ mobilization, which may have important implications for the regulation of DC maturation at sites of immune and non-immune inflammation. Published by Elsevier Inc.

Abstract INTRODUCTION AND OBJECTIVE: Prostaglandin E2 (PGE2) acts through a series of distinct prostanoid receptors, EPR 1-4. Since PGE2 is implicated in prostate cancer (CaP) tumorigenesis and metastasis, we hypothesized that EP receptor expression may influence CaP growth. METHODS: 27 consecutive radical prostatectomy specimens were assessed by immunohistochemistry (IHC) for EPR expression and compared with normal human prostate epithelium (NP) from the same specimen as control. As a corollary, the expression of EP receptors in both normal (PrEC, PWR1E and PZ-HPV7) and CaP cells (LNCaP, PC3 and CA-HPV10) were assessed by RT-PCR and Western blot. The functional significance of EPR was assessed by growth of malignant and benign cell lines in vitro after siRNA EPR knockdown. All studies were approved by the local institutional review board (IRB) and all in vitro experiments performed a minimum of 3 times. RESULTS: EP1, EP2, EP3 and EP4 receptors were detected by IHC in all NP clinical specimens. Compared with NP, EP4 and EP2 were over-expressed in 74% (20/27) and 63% (17/27) of CaP specimens, respectively; in contrast, EP3 expression was reduced in 93% (25/27) clinical samples (Figure). EP1 showed no specific differential expression pattern. Western blot showed increased EP4 but reduced EP3 in CaP lines (CA-HPV10, LNCaP and PC3) compared with NP lines; EP2 and EP4 knockdown significantly suppressed whereas EP3 knockdown stimulated in vitro growth of CA-HPV10 vs PZ-HPV7 cells. Expression of Runx 2 and MMP9, (known to contribute to CaP metastatic potential) was also reduced after EP2 and EP4 knockdown in CaP cells. CONCLUSION: We observed EP4 and EP2 over-expression and reduced EP3 expression in 27 consecutive resected CaP specimens and in 6 representative cell lines. These observations were corroborated by the effects of EP4, EP2 and EP3 knockdown on tumor cell growth in vitro. These data suggest that EP receptor subtypes may regulate CaP growth which may represent a novel therapeutic approach. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 345.

Signal transducers and activators of transcription (STAT) were originally discovered as components of signal transduction pathways. Persistent aberrant activation of STAT3 is a feature of many malignancies including prostate cancer and pancreatic cancer. One consequence of persistently activated STAT3 in malignant cells is that they depend on it for survival; thus, STAT3 is an excellent molecular target for therapy. Previously, we reported that single-stranded oligonucleotides containing consensus STAT3 binding sequences (13410 and 13411) were more effective for inducing apoptosis in prostate cancer cells than antisense STAT3 oligonucleotides. Control oligonucleotides (scrambled sequences) had no effect. Here, we report that authentic STAT3 binding sequences, identified from published literature, were more effective for inducing apoptosis in prostate cancer cells and pancreatic cancer cells than was oligonucleotide 13410. Moreover, the authentic STAT3 binding sequences showed differing efficacies in the malignant cell lines depending on whether the canonical STAT3 binding sequence was truncated at the 5′ or the 3′ end. Finally, expression of one STAT3-regulated gene was decreased following treatment, suggesting that STAT3 may regulate the same set of genes in the two types of cancer. We conclude that truncating the 5′ end left intact enough of the canonical STAT3 binding site for effective hybridization to the genome, whereas truncation of the 3′ end, which is outside the canonical binding site, may have affected binding of required cofactors essential for STAT3 activity, thereby reducing the capacity of this modified oligonucleotide to induce apoptosis. Additional experiments to answer this hypothesis are under way. [Mol Cancer Ther 2008;7(6):1543–50]

UNLABELLED:Male infertility as a result of spinal cord injury (SCI) is associated with abnormal semen qualities including low sperm counts and poor sperm motility and morphology. Clinical studies suggest that reactive oxygen species (ROS)-related events might contribute to abnormal sperm functions after SCI. The current study examined whether impaired sperm functions after SCI can be ameliorated by an antioxidant, vitamin E. Vitamin E feeding of spinal cord transected (SCX) rats during the acute (maintenance) and chronic (restoration) phases of the injury partially preserved sperm viability and mitochondrial potential; similar effects were only seen in spinal cord contused (SCC) rats during the chronic phase. A beneficial effect of vitamin E on sperm motility, however, was only observed in SCX rats during the chronic phase of the injury. These results suggest that ROS-related events might account for some of the effects of cord injury on sperm functions, depending on the extent of injury and time postinjury. Furthermore, we found that sperm heads from SCC and SCX rats were less condensed compared to those from sham control rats. Such effects were attenuated by vitamin E, suggesting that ROS-related events may also contribute to abnormal sperm morphology after SCI. Partial restoration of male accessory gland weights in those rats fed vitamin E further suggests its beneficial effects on the functions of these glands.CONCLUSION:Vitamin E feeding attenuated some of the effects of spinal cord injury on sperm functions and male accessory glands in the rat. These results support a role of ROS-related events in deterioration of semen quality after cord injury. Further understanding of the underlying mechanisms for effects of vitamin E on sperm functions and male accessory glands will provide scientific rationale for the use of vitamin E or other antioxidant as therapeutic means to preserve sperm functions and semen quality in SCI men.

Our previous observations of changes in the expression of cAMP-dependent genes and the cAMP-responsive element modulator (CREM) in rat testicular cells after spinal cord injury (SCI) implied abnormal cAMP signaling as one of the mechanisms underlying the effects of SCI on spermatogenesis. It was postulated that such effects might contribute to abnormal sperm function after SCI. In this study, we examined this possibility. In spinal cord-contused (SCC) and -transected (SCX) rats, impaired sperm motility was accompanied by an increase in sperm cAMP content. Treatment of SCX rats with exogenous testosterone or follicle-stimulating hormone resulted in a further decrease in sperm motility, whereas sperm cAMP either increased or remained unchanged. These effects differed from those in sham control rats that received identical treatments. Results of these experiments also demonstrated that impaired sperm motility in SCC and SCX rats was accompanied by decreases in sperm viability and mitochondrial potential, thus suggesting a possible link between these changes. We concluded that impaired sperm motility after SCI was associated with decreases in sperm viability and mitochondrial potential. These effects occurred in the face of elevated sperm cAMP content and changes in its regulation, suggesting that altered cAMP signaling events might contribute to impairment of sperm motility and perhaps other sperm functions after SCI.

Signal transducers and activators of transcription (STATs) are involved in growth regulation of cells. They are usually activated by phosphorylation at specific tyrosine residues. In neoplastic cells, constitutive activation of STATs accompanies growth dysregulation and resistance to apoptosis through changes in gene expression, such as enhanced anti-apoptotic gene expression or reduced pro-apoptotic gene expression. Activated STAT3 is thought to play an important role in prostate cancer (PCA) progression. Because we are interested in how persistently-activated STAT3 changes the cellular phenotype to a malignant one in prostate cancer, we used expression vectors containing a gene for constitutively-activated STAT3, called S3c, into NRP-152 rat and BPH-1 human benign prostatic epithelial cells.

A healthy, asymptomatic 37-year-old woman was found to have elevated liver enzymes on routine examination. All other laboratory tests were within normal limits with the exception of elevated ferritin and total iron-binding capacity. The patient denied the use of oral contraceptives. Subsequent studies with ultrasound and CT scan revealed hepatic masses in both lobes. The patient was referred for possible resection or ablation of masses. Further studies with triple-phase CT scan of the liver, hepatobiliary scan, and Tc-99m sulfur colloid scan with SPECT revealed the typical appearance of focal nodular hyperplasia (FNH).

Although fluorescent dyes combined with flow cytometry have been used to confirm the viability of sperm in the past, methods to detect damage to spermatozoa following injury have been limited to use of dyes, which are often difficult to adequately compensate for in a single laser system.

Signal transducers and activators of transcription (STAT) were originally discovered as components of cytokine signal transduction pathways. Persistent activation of one of these transcription factors, STAT3, is a feature of many malignancies, including hormone-resistant prostate cancer. In this regard, malignant cells expressing persistently activated STAT3 become dependent on it for survival, thus rendering STAT3 a potential molecular target for therapy of hormone-resistant prostate cancer. Previously, we reported that antisense oligonucleotides specific for STAT3 were better at inducing apoptosis than inhibitors of JAK1 or JAK2, the upstream activating kinases of STAT3. Here, we report that novel single-stranded oligonucleotides, which putatively block STAT3-DNA binding, were better at inducing hormone-resistant prostate cancer apoptosis than antisense STAT3 oligonucleotides. We observed that the novel STAT3-inhibiting oligonucleotides induced apoptosis by a mitochondrial-dependent pathway involving the activation of caspase-3. Prostate cell lines not expressing persistently activated STAT3 did not become apoptotic after treatment with these same oligonucleotides. Scrambled-sequence control oligonucleotides had none of the effects of the active sequence oligonucleotides on any variable measured. Furthermore, the novel STAT3-inhibiting oligonucleotides, but not scrambled-sequence control oligonucleotide, significantly reduced the volume of s.c. DU145 tumors in vivo. Histologic examination of the tumors revealed no infiltrate of mononuclear or granulocytic cells, which would be indicative of evocation of a nonspecific immune response by the oligonucleotides. We conclude that single-stranded oligonucleotides based on the binding sequences of STAT3 are an additional strategy to design inhibitors for this molecular target and that these inhibitors should be useful as experimental therapeutics for hormone-resistant prostate cancer.

The determination of degree-of-sinter in P/M materials historically has been difficult. Past attempts have been subjective and lacked the quantitative results that could be used in correlation studies to improve properties or monitor manufacturing processes. An attempt is made to develop a test technique using quantitative microscopy to evaluate pore structures in pressed and sintered materials. For this initial phase of the study, a F-0005 material was sintered at times ranging from 5 to 45 minutes in the heating zone. Specimens were removed, prepared by metallographic methods, and tested using quantitative microscopy techniques. The preparation procedures and results of the testing are presented along with a brief historical background.

BACKGROUND:STAT3 phosphorylation is associated with the neoplastic state in many types of cancer, including prostate cancer. We investigated the role of IL-6 signaling and phosphorylation of STAT3 in 2 rat prostatic epithelial lines. NRP-152 and NRP-154 cells were derived from the same rat prostate, yet the NRP-152 cells are not tumorigenic while the NRP-154 cells are tumorigenic. These lines are believed to represent 2 of the stages in the development of prostate cancer, hyperplasia and neoplasia. Differences in signaling pathways should play a role in the 2 phenotypes, hyperplastic and neoplastic.METHODS:We looked at the phosphorylation state of STAT3 by intracellular flow cytometry, using phospho-specific antibodies to STAT3. We used the same method to examine IL-6 production by the cell lines. We also measured apoptosis by binding of fluorescent annexin V to the cells.RESULTS:Although both cells lines made IL-6 constitutively, phosphorylated-STAT3 was present in untreated NRP-154 cells, but not in NRP-152 cells. Treatment with dexamethasone inhibited the IL-6 production of NRP-152 cells, but enhanced that of NRP-154 cells. Treatment with the JAK2 inhibitor AG490 induced apoptosis in NRP-152, but not NRP-154 cells.CONCLUSIONS:We conclude from these experiments that STAT3 activity plays a role in the phenotype of NRP-154 cell, but not NRP-152 cells. The significance of alternative IL-6 signaling pathways in the different phenotypes of the 2 cell lines is discussed.

The development of cancer cachexia has been linked to cytokines related to interleukin6 (IL-6). We examined the kinetics of IL-6, IL-11, oncostatinM (OSM) and leukaemia inhibitory factor (LIF) induction in the splenocytes of tumour-bearing mice. Using a lung carcinoma line, which grows in C57BL/6J mice, we observed that when the tumour grew and cachexia was observed, the splenocytes produced IL-6, IL-11, and OSM, but not LIF. Cytokine expression was observed within 1 week (day 3 for IL-6 and IL-11, and day 1 for OSM) of administration of tumour cells, and was observed in splenocytes without tumour metastases to the spleen. Cytokine expression preceded cachexia (determined by changes in serum triglyceride levels and decrease in epididymal fat-pad weights) development by over 1 week. Exogenous administration of IL-11 resulted in the accelerated onset of cachexia, compared to control protein treatment, but without an effect on the tumour burden. In vivo treatment with a neutralizing dose of anti-OSM antibody inhibited the triglyceride dysregulation only until the synthesis of IL-6 and IL-11 began in the spleen (day 3). Afterward, IL-6 and IL-11 induced lipid catabolism in the absence of functional OSM. We conclude from the data described above that cachexia developed due to a systemic cytokine response induced by a tumour burden, and that IL-6-like cytokines contributed independently to lipid hypercatabolism in the aetiology of cancer cachexia.

Myeloma is a neoplasm thought to "home" to bone marrow. However, evidence for bone-marrow-specific receptors or adhesion molecules expressed on myeloma cells is scanty. Initial myeloma expansion is thought to be due to IL-6 and/or related cytokines. Previous determinations of cytokine expression in bone marrow were performed on bone marrow stromal lines; these findings may not reflect the constitutive pattern of expression in situ. Intracytoplasmic staining for IL-6-like cytokines revealed constitutive expression of some factors in the bone marrow of normal mice, but not spleens. Spleens of myeloma-transplanted SCID mice expressed IL-6-like cytokines, indicative of induction of expression by myeloma. Some cytokines expressed in bone marrow induced myeloma proliferation in the presence of dexamethasone, demonstrating dependence of the myeloma on these cytokines. Our data imply that, rather than "homing" to bone marrow, myeloma cells proliferated within marrow cavities more than in other organs because of growth factors constitutively expressed by bone marrow cells. As myeloma progressed, we observed the induction of growth factor expression in spleen cells. Furthermore, because cytokines other than IL-6 may induce myeloma cell proliferation, therapy aimed at neutralizing IL-6 may not be the most effective method to treat this disease. These findings have implications for both the pathophysiology and therapy of multiple myeloma.

A human myeloma line was used to create a model of human multiple myeloma in vivo that would reproduce the pathophysiology of the disease, including the cachexia associated with cancer. Unirradiated severe combined immunodeficient (SCID) mice were used as surrogate hosts for in vivo experiments that allowed the effects of autocrine (human) verus paracrine (murine) cytokines on the development of myeloma to be studied. Serum levels of human paraprotein increased over time and with the number of cells transplanted. Transplanted mice developed major syndromes, cachexia and paralysis (due to invasion of bones by myeloma cells), associated with multiple myeloma. Analyses of serum samples obtained from transplanted mice revealed that when the mice were terminal, total serum protein decreased on average by 20%, whereas serum triglycerides decreased on average by 50%. These data indicate the mice were cachectic, which was confirmed by necropsy. The mice had low but measurable levels of both human and murine interleukin (IL)-6, soluble IL-6 receptor, and murine IL-10 in their sera. The presence of these cytokines and the IL-6 receptor in sera are also characteristics of human myeloma in patients. Since human cells do not respond to murine IL-6, it was possible to demonstrate clearly the importance of autocrine IL-6 in establishing myeloma in situ. By reproducing both the hallmarks of a cancer as well as the accompanying paraneoplastic syndromes, this model should be useful in designing more effective therapies for both the primary cancer as well as the accompanying secondary diseases.

BACKGROUNDOur objective was to perform a prospective, randomized, double blinded study of cefprozil and penicillin therapy to eradicate group A beta-hemolytic streptococci (GABHS) in children who were bacteriologic failures after receiving a standard 10-day course of penicillin treatment for GABHS pharyngitis.METHODSChildren and adolescents 2 to 18 years of age were eligible for the study. From 3 to 7 days after completing oral penicillin therapy for pharyngitis caused by GABHS, the study was explained, informed consent was obtained, a history and physical examination were completed and a throat culture was performed. Children with throat cultures positive for GABHS were randomized to receive either cefprozil or penicillin for 10 days. Children who were bacteriologic failures after administration of the first study drug were crossed over to receive the alternate drug.RESULTSOf 180 enrolled children 66 (37%) had throat cultures positive for GABHS. Seventeen were excluded from the study, leaving 49 who completed the protocol. Of the 49 participants 26 received cefprozil initially whereas 23 received penicillin. GABHS were eradicated from the pharynx of 73% of children who received cefprozil as the first antibiotic compared with 39% of penicillin recipients (chi square, 5.748, 0.01 < P < 0.025). After crossover of failures, the final efficacy rate for cefprozil was 65% compared with 36.7% for penicillin (chi square, 5.523, 0.01 < P < 0.025).CONCLUSIONSCefprozil was more effective than penicillin in treating children who were bacteriologic failures after a standard 10-day course of oral penicillin.

We have previously reported superior survival after one level of hemorrhagic shock in germ-free (GF) rats compared with germ-bearing (GB) rats. The objective of this study was to determine the effect of the GF state on survival at different degrees of hemorrhagic shock. GF and GB rats were bled to a mean arterial blood pressure of 30 mmHg. Shock was terminated after 10, 20, 40, or 80% of the maximum shed blood volume was reabsorbed spontaneously. Both shock time and time to decompensation were significantly longer in GF rats (p < .05). Comparative survival was greater for GF rats at most levels of shock (p < .01). This superiority in survival was greatest at moderate shock levels and decreased at severe shock levels. There may be several reasons for the increased tolerance of GF animals to hemorrhagic shock such as metabolic or immunologic variations. It is hard to avoid the fact, however, that the most notable difference between the GF and GB rat is the presence or absence of bacteria.

Large ventral hernias are a difficult surgical problem. Previous attempts to repair large defects in the abdominal wall with prostheses have been associated with recurrences and infection. A filamentous polylactic acid-carbon tissue mesh is a possible alternative prosthesis. We evaluated and compared polylactic acid-carbon mesh and Marlex mesh in repairing a large defect of the abdominal wall in a rat model. The polylactic acid-carbon mesh led to as strong a repair as Marlex mesh for the same time periods postoperatively; furthermore, no infection was noted with the former, whereas a 5.3 percent incidence of infection was noted with Marlex mesh. One mesh disruption was also noted with Marlex mesh. Polylactic acid-carbon mesh was found to have a more marked fibrotic response and a lesser inflammatory response. Polylactic acid-carbon mesh, therefore, appears to be more biocompatible, with more fibrosis, less inflammatory reaction, and equal strength to Marlex mesh. It is therefore a more appropriate synthetic material for a large ventral herniorrhaphy.