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Pelvic organ prolapse (POP) is a hidden women’s health disorder that impacts 1 in 4 women across all age groups. Surgical intervention has been the only treatment option, often involving non-degradable meshes, with variable results. However, recent reports have highlighted the adverse effects of meshes in the long term, which involve unacceptable rates of erosion, chronic infection and severe pain related to mesh shrinkage. Therefore, there is an urgent unmet need to fabricate of new class of biocompatible meshes for the treatment of POP. This review focuses on the causes for the downfall of commercial meshes, and discusses the use of emerging technologies such as electrospinning and 3D printing to design new meshes. Furthermore, we discuss the impact and advantage of nano-/microstructured alternative meshes over commercial meshes with respect to their tissue integration performance. Considering the key challenges of current meshes, we discuss the potential of cell-based tissue engineering strategies to augment the new class of meshes to improve biocompatibility and immunomodulation. Finally, this review highlights the future direction in designing the new class of mesh to overcome the hurdles of foreign body rejection faced by the traditional meshes, in order to have safe and effective treatment for women in the long term.

Modulating how macrophages sense mechanical cues offers a novel strategy to control fibrosis around implanted biomaterials. We term this approach ‘mechano-immunotherapy’, which involves the desensitization of immune mechanosensory pathways to control the host response. Here, we use RN-1734 (RN), a model small molecule to demonstrate the proof-of-concept that pharmacologically disrupting macrophage mechanosensation can mitigate fibrosis. In vitro, RN reduced calcium influx and pro-inflammatory cytokine secretion in J774. a2 macrophages. These effects were strictly context-dependent with efficacy observed only in macrophages on high-stiffness (10% w/v) GelMA hydrogels, with no significant impact on those in softer (5% w/v) hydrogels. In vivo, RN selectively attenuated fibrotic capsule formation around implanted electrospun scaffolds but not smooth hydrogels. Notably, despite hydrogels releasing ∼6-fold more drug than scaffolds, fibrosis was reduced only in the scaffold group, suggesting that therapeutic efficacy is driven by the inhibition of high mechanosensory input rather than the loaded drug concentration alone. Spatial transcriptomics revealed that macrophages acted as the primary mechanosensors at the tissue-implant interface. Unsupervised global principal component analysis revealed that RN acted predominantly on early day 3 macrophages. The strongest effect was observed in surface-adhered mechanosensitive macrophages, where RN treatment enhanced their M2-like phenotype and promoted their dispersal from clustered aggregates into broader distribution within the scaffold. This redistribution was accompanied by a marked reduction in the recruitment of interstitial macrophages from the surrounding tissue, which were enriched for matrix-forming gene signatures. Together, these findings suggest that pharmacological desensitization of immune mechanosensors may represent a promising, context-specific approach to improve biomaterial integration. [Display omitted] •Mechanosensation drives macrophage responses that cause implant fibrosis.•TRPV4 inhibitor RN-1734 suppresses stiffness-dependent inflammation.•Macrophages treated with RN-1734 reprogrammed toward reparative, anti-fibrotic states.•RN-1734 disperses surface-adhered macrophages and reduces matrix-forming populations.

Mitigating the foreign body response (FBR) to implantable medical devices (IMDs) is critical for successful long‐term clinical deployment. The FBR is an inevitable immunological reaction to IMDs, resulting in inflammation and subsequent fibrotic encapsulation. Excessive fibrosis may impair IMDs function, eventually necessitating retrieval or replacement for continued therapy. Therefore, understanding the implant design parameters and their degree of influence on FBR is pivotal to effective and long lasting IMDs. This review gives an overview of FBR as well as anti‐FBR strategies. Furthermore, we highlight recent advances in biomimetic approaches to resist FBR, focusing on their characteristics and potential biomedical applications.

Lymphocytes, long regarded as central actors of adaptive immunity, are increasingly recognized as key regulators of the foreign body response (FBR) to biomaterials. Their presence shapes the chronic phases of inflammation, fibrosis, angiogenesis, and regenerative outcomes after implantation. This review summarizes the roles of T cells, B cells, and natural killer (NK) cells in biomaterial-associated immune responses, with a particular focus on protein adsorption, antigen recognition, cytokine secretion, and downstream interactions with macrophages, fibroblasts, and endothelial cells. Evidence indicates that T-cell polarization into Th1/Th17 subsets promotes pro-inflammatory reactions, while Th2 and regulatory T cells (Tregs) support constructive remodeling and resolution. B cells contribute through antibody production and cytokine release, which may foster fibrosis or support debris clearance. NK cells serve as early stress sensors, releasing cytotoxic mediators and pro-angiogenic factors that influence vascularization and tissue repair. Collectively, lymphocytes are pivotal but underexplored players in biomaterial integration. Incorporating lymphocyte biology into material design and surface modification strategies offers promising avenues to guide immune cascades toward predictable and regenerative outcomes.

During the foreign body response (FBR), macrophages fuse to form foreign body giant cells (FBGCs). Modulation of FBGC formation can prevent biomaterial degradation and loss of therapeutic efficacy. However, the microenvironmental cues that dictate FBGC formation are poorly understood with conflicting reports. Here, we identified molecular and cellular factors involved in driving FBGC formation in vitro . Macrophages demonstrated distinct fusion competencies dependent on monocyte differentiation. The transition from a proinflammatory to a reparative microenvironment, characterised by specific cytokine and growth factor programmes, accompanied FBGC formation. Toll-like receptor signalling licensed the formation of FBGCs containing more than 10 nuclei but was not essential for cell-cell fusion to occur. Moreover, the fibroblast-macrophage crosstalk influenced FBGC development, with the fibroblast secretome inducing macrophages to secrete more PDGF, which enhanced large FBGC formation. These findings advance our understanding as to how a specific and timely combination of cellular and microenvironmental factors is required for an effective FBR, with monocyte differentiation and fibroblasts being key players.

Granulocytes, long considered short-lived effector cells, are increasingly recognized as key modulators of the foreign body response (FBR) to biomaterials and determinants of regenerative outcomes. This review summarizes current evidence on the roles of neutrophils, basophils, and eosinophils in biomaterial-associated inflammation and tissue remodeling. Particular focus is placed on protein adsorption, cytokine release, and downstream effects across diverse biomaterial classes, including bone substitutes, collagen scaffolds, titanium, magnesium, and synthetic polymers. Neutrophils dominate the acute phase through reactive oxygen species, proteases, and neutrophil extracellular traps, which can either support remodeling or drive fibrosis and implant failure. Basophils, though rare, release histamine and Th2 cytokines, enhancing angiogenesis but also contributing to fibrotic encapsulation. Eosinophils are recruited in material-dependent patterns, releasing cytotoxic granules and pro-regenerative mediators, thereby functioning as double-edged regulators of degradation, fibrosis, and vascularization. Overall, granulocytes act as critical, though often overlooked, determinants of biomaterial integration. Incorporating granulocyte biology into biomaterial design-through modulation of surface chemistry, protein adsorption, and degradation kinetics- offers a promising path to guide inflammatory cascades toward constructive remodeling, angiogenesis, and predictable clinical performance.

Tissue repair/regeneration, after implantation or injury, involves comprehensive physiological processes wherein immune responses play a crucial role to enable tissue restoration, amidst the immune cells early‐stage response to tissue damages. These cells break down extracellular matrix, clear debris, and secret cytokines to orchestrate regeneration. However, the immune response can also lead to abnormal tissue healing or scar formation if not well directed. This review first introduces the general immune response post injury, with focus on the major immune cells including neutrophils, macrophages, and T cells. Next, a variety of implant‐mediated immunomodulation strategies to regulate immune response through physical, chemical, and biological cues are discussed. At last, various scaffold‐facilitated regenerations of different tissue types, such as, bone, cartilage, blood vessel, and nerve system, by harnessing the immunomodulation are presented. Therefore, the most recent data in biomaterials and immunomodulation is presented here in a bid to shape expert perspectives, inspire researchers to go in new directions, and drive development of future strategies focusing on targeted, sequential, and dynamic immunomodulation elicited by implants. Implant‐mediated immunomodulation represents an emerging research topic in the field of tissue engineering, and is a new promising direction to achieve better tissue regeneration. The underlying mechanism of immune response and its influence on tissue repair, immunomodulatory strategies, recent in vivo applications of implant‐based immunomodulation to improve tissue regeneration are summarized, and current challenges and future prospect are also discussed.

This article provides a thorough overview of the available resorbable biomaterials appropriate for producing replacements for damaged tissues. In addition, their various properties and application possibilities are discussed as well. Biomaterials are fundamental components in tissue engineering (TE) of scaffolds and play a critical role. They need to exhibit biocompatibility, bioactivity, biodegradability, and non-toxicity, to ensure their ability to function effectively with an appropriate host response. With ongoing research and advancements in biomaterials for medical implants, the objective of this review is to explore recently developed implantable scaffold materials for various tissues. The categorization of biomaterials in this paper includes fossil-based materials (e.g., PCL, PVA, PU, PEG, and PPF), natural or bio-based materials (e.g., HA, PLA, PHB, PHBV, chitosan, fibrin, collagen, starch, and hydrogels), and hybrid biomaterials (e.g., PCL/PLA, PCL/PEG, PLA/PEG, PLA/PHB PCL/collagen, PCL/chitosan, PCL/starch, and PLA/bioceramics). The application of these biomaterials in both hard and soft TE is considered, with a particular focus on their physicochemical, mechanical, and biological properties. Furthermore, the interactions between scaffolds and the host immune system in the context of scaffold-driven tissue regeneration are discussed. Additionally, the article briefly mentions the concept of in situ TE, which leverages the self-renewal capacities of affected tissues and highlights the crucial role played by biopolymer-based scaffolds in this strategy.

In recent years, a variety of biomaterial implantable devices has been developed. Of particular significance to pharmaceutical sciences is the progress made on the development of drug/implantable device combination products. However, the clinical application of these devices is still a critical issue due to the host response, which results from both the tissue trauma during implantation and the presence of the device in the body. Accordingly, the in vivo functionality and durability of any implantable device can be compromised by the body response to the foreign material. Numerous strategies to overcome negative body reactions have been reported. The aim of this review is to outline some key issues of biomaterial/tissue interactions such as foreign body response and biocompatibility and biocompatibility assessment. In addition, general approaches used to overcome the in vivo instability of implantable devices are presented, including (a) biocompatible material coatings, (b) steroidal and nonsteroidal anti-inflammatory drugs, and (c) angiogenic drugs. In particular, strategies to overcome host response to glucose biosensors are summarized.

The sustained reliability of invasive brain-computer interface (BCI) electrodes is fundamentally constrained by progressive interface destabilization, a process driven by the dynamic foreign body response (FBR). Given the intricate, time-dependent evolution of the FBR, the establishment of long-term stable neural interfaces necessitates the deployment of sophisticated material architectures capable of intercepting core regulatory mechanisms across distinct pathological phases. This review synthesizes bio-inspired and functional material design strategies, systematically examining their capacity to actively modulate the FBR in a stage-specific manner. Specifically, these approaches are engineered to attenuate acute inflammatory cascades, which is hypothesized to impede detrimental glial scarring—while establishing robust biological barriers resilient to chronic biofouling and infection. Furthermore, by mitigating material degradation and micromotion-induced fretting, these strategies are associated with preserved the functional integrity of the interface over extended periods. By consolidating the theoretical principles, recent advancements, and persisting challenges associated with these material paradigms, this work aims to delineate a forward-looking framework for the development of ultra-durable BCI electrodes, thereby accelerating the clinical translation of neural interface technologies. [Display omitted] •Propose a new paradigm of “time-phase specificity design” for neural interfaces.•Regulate acute inflammation and chronic biofouling through biomimetic materials.•Utilize self-healing and flexible structures to achieve long-term stability.•Addressing engineering conflicts and challenges in multifunctional coupling.•Provide a forward-looking framework for the development of ultra-durable brain-computer interfaces.