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González Enguita C, Garranzo García-Ibarrola M, Tufet I Jaumont JJ, Garde García H, González López R, Quintana Franco LM, Torres Zambrano GM, García-Arranz M. Cell Therapy in the Treatment of Female Stress Urinary Incontinence: Current Status and Future Proposals. Life (Basel) 2024; 14:861. [PMID: 39063615 PMCID: PMC11278173 DOI: 10.3390/life14070861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Revised: 07/01/2024] [Accepted: 07/02/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Stress urinary incontinence (SUI) is a common condition with a significant impact on the quality of life of female patients. The limitations of current treatment strategies have prompted the exploration of new effective and minimally invasive alternative approaches, including cell therapy. METHODS A literature search was conducted to update the current clinical status of stem cell therapy in the management of female stress urinary incontinence. RESULTS Over thirty clinical studies have been designed to assess the feasibility, safety and efficacy of cell therapy for female SUI. Despite differences in cell types and protocols, the overall treatment procedures were similar. Standard subjective and objective assessment tools, and follow-up periods ranged from 6 weeks to 6 years have been used. Cell injection has shown to be a safe therapy in the treatment of female SUI. However, the results from more recent randomized trials have shown less promising results than expected in restoring continence. Heterogeneous research methodologies using different cell types and doses make it difficult to draw conclusions about effectiveness. Several key points remain that need to be further explored in future clinical trials. CONCLUSION To advance in the development of cell therapy, it is essential to know the mechanisms involved to be able to direct it properly, its efficacy and the durability of the injected cells. Rigorous and homogenized preclinical and clinical studies that demonstrate its scope and improve its application are necessary for validation in the treatment of female SUI.
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Affiliation(s)
- Carmen González Enguita
- Urology Department, Hospital Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain; (J.J.T.I.J.); (H.G.G.); (R.G.L.); (L.M.Q.F.)
| | - María Garranzo García-Ibarrola
- Urology Department, Hospital Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain; (J.J.T.I.J.); (H.G.G.); (R.G.L.); (L.M.Q.F.)
| | - Jaime Jorge Tufet I Jaumont
- Urology Department, Hospital Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain; (J.J.T.I.J.); (H.G.G.); (R.G.L.); (L.M.Q.F.)
| | - Héctor Garde García
- Urology Department, Hospital Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain; (J.J.T.I.J.); (H.G.G.); (R.G.L.); (L.M.Q.F.)
| | - Raquel González López
- Urology Department, Hospital Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain; (J.J.T.I.J.); (H.G.G.); (R.G.L.); (L.M.Q.F.)
| | - Luis Miguel Quintana Franco
- Urology Department, Hospital Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain; (J.J.T.I.J.); (H.G.G.); (R.G.L.); (L.M.Q.F.)
| | | | - Mariano García-Arranz
- Instituto Investigaión Sanitaria Fundación Jiménez Díaz (IIS-FJD), 28040 Madrid, Spain;
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Raffo G, Sappia D, Dominici D, Rozenbaum M, García J, Lavigne M, Correa M. Endoscopic implantation of autologous myoblasts for stress urinary incontinence and evaluation of its efficacy in sphincterotomized rabbits. Actas Urol Esp 2023; 47:588-597. [PMID: 37355207 DOI: 10.1016/j.acuroe.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/02/2023] [Accepted: 05/03/2023] [Indexed: 06/26/2023]
Abstract
INTRODUCTION Stress urinary incontinence (SUI) is one of the health problems with more impact on patients' lives. The aim of the present work was to develop a therapy for SUI using tissue engineering by isolation and culture of autologous myoblasts (CAM) followed by endoscopic implantation. We also evaluated the efficacy of this therapy in a rabbit model of incontinence after sphincterotomy. MATERIALS AND METHODS We used healthy male New Zealand rabbits. The animals were first bled to obtain platelet-poor plasma (PPP) and biopsied for myoblast isolation. Post-sphincterotomy, they were divided into two groups: the treatment group (including animals that received CAM resuspended in PPP) and the control group (including animals receiving only PPP). The leak-point pressure (LPP) was used to measure continence in both groups at different time points. The results were evaluated with hierarchical linear regression models. Histological evaluation of the rabbits' sphincters was also performed at the end of follow-up. RESULTS No statistically significant differences were observed between the baseline LPP values of each group. The post-sphincterotomy values of both groups were below 50% of the baseline value, which was a mandatory condition for incontinence. The post-implantation values of the treatment group were higher than 50% of the baseline value, which led us to assume continence recovery. A statistically significant difference was observed in the LPP values between the two treatment groups (p=0.003). Histological study revealed interconnected islands formed by muscle fibers in the treatment group, and connective tissue surrounding the urethral lumen and inflammatory infiltrate in the control group. DISCUSSION AND CONCLUSIONS The implantation of CAM significantly improved LPP values in the treatment group, and the improvement remained throughout the evaluation period. It may be associated with the consistency of the implant and its stability at the injection site. Longer follow-up studies and human clinical investigations are required to consider CAM implantation as an alternative treatment for stress urinary incontinence.
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Affiliation(s)
- G Raffo
- Servicio de Urología, Policlínica Privada Paz, Tandil, Argentina
| | - D Sappia
- Clínica Veterinaria Sappia, Tandil, Argentina
| | - D Dominici
- División Bioingeniería, Laboratorio Craveri, Buenos Aires, Argentina.
| | - M Rozenbaum
- División Bioingeniería, Laboratorio Craveri, Buenos Aires, Argentina
| | - J García
- Servicio de Diagnóstico Veterinario de la Facultad de Ciencias Veterinarias de Tandil, Tandil, Argentina
| | - M Lavigne
- División Bioingeniería, Laboratorio Craveri, Buenos Aires, Argentina
| | - M Correa
- División Bioingeniería, Laboratorio Craveri, Buenos Aires, Argentina
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Schmid FA, Prange JA, Kozomara M, Betschart C, Sousa RA, Steinke N, Hunziker M, Lehner F, Veit M, Grossmann R, Landsmann A, Hötker AM, Boss A, Mohr-Haralampieva D, Eberli D. Transurethral injection of autologous muscle precursor cells for treatment of female stress urinary incontinence: a prospective phase I clinical trial. Int Urogynecol J 2023; 34:2197-2206. [PMID: 37042972 PMCID: PMC10506953 DOI: 10.1007/s00192-023-05514-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 02/18/2023] [Indexed: 04/13/2023]
Abstract
INTRODUCTION AND HYPOTHESIS The purpose was to investigate the safety and feasibility of transurethral injections of autologous muscle precursor cells (MPCs) into the external urinary sphincter (EUS) to treat stress urinary incontinence (SUI) in female patients. METHODS Prospective and randomised phase I clinical trial. Standardised 1-h pad test, International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI-SF), urodynamic study, and MRI of the pelvis were performed at baseline and 6 months after treatment. MPCs gained through open muscle biopsy were transported to a GMP facility for processing and cell expansion. The final product was injected into the EUS via a transurethral ultrasound-guided route. Primary outcomes were defined as any adverse events (AEs) during follow-up. Secondary outcomes were functional, questionnaire, and radiological results. RESULTS Ten female patients with SUI grades I-II were included in the study and 9 received treatment. Out of 8 AEs, 3 (37.5%) were potentially related to treatment and treated conservatively: 1 urinary tract infection healed with antibiotics treatment, 1 dysuria and 1 discomfort at biopsy site. Functional urethral length under stress was 25 mm at baseline compared with 30 mm at 6 months' follow-up (p=0.009). ICIQ-UI-SF scores improved from 7 points at baseline to 4 points at follow-up (p=0.035). MRI of the pelvis revealed no evidence of tumour or necrosis, whereas the diameter of the EUS muscle increased from 1.8 mm at baseline to 1.9 mm at follow-up (p=0.009). CONCLUSION Transurethral injections of autologous MPCs into the EUS for treatment of SUI in female patients can be regarded as safe and feasible. Only a minimal number of expected and easily treatable AEs were documented.
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Affiliation(s)
- Florian A Schmid
- University Hospital Zurich, Department of Urology, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Jenny A Prange
- University Hospital Zurich, Department of Urology, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Marko Kozomara
- University Hospital Zurich, Department of Urology, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Cornelia Betschart
- University Hospital Zurich, Department of Gynecology, University of Zurich, Zurich, Switzerland
| | - Rosa A Sousa
- University Hospital Zurich, Department of Urology, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Nicolas Steinke
- University Hospital Zurich, Department of Urology, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Manuela Hunziker
- University Hospital Zurich, Department of Urology, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Fabienne Lehner
- University Hospital Zurich, Department of Urology, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Markus Veit
- University Hospital Zurich, Department of Urology, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Regina Grossmann
- University Hospital Zurich, Clinical Trial Center, University of Zurich, Zurich, Switzerland
| | - Anna Landsmann
- University Hospital Zurich, Institute of Diagnostic and Interventional Radiology, University of Zurich, Zurich, Switzerland
| | - Andreas M Hötker
- University Hospital Zurich, Institute of Diagnostic and Interventional Radiology, University of Zurich, Zurich, Switzerland
| | - Andreas Boss
- University Hospital Zurich, Institute of Diagnostic and Interventional Radiology, University of Zurich, Zurich, Switzerland
| | - Deana Mohr-Haralampieva
- University Hospital Zurich, Department of Urology, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Daniel Eberli
- University Hospital Zurich, Department of Urology, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland.
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Kibschull M, Nguyen TTN, Chow T, Alarab M, Lye SJ, Rogers I, Shynlova O. Differentiation of patient-specific void urine-derived human induced pluripotent stem cells to fibroblasts and skeletal muscle myocytes. Sci Rep 2023; 13:4746. [PMID: 36959367 PMCID: PMC10036466 DOI: 10.1038/s41598-023-31780-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 03/17/2023] [Indexed: 03/25/2023] Open
Abstract
Cell-based therapy is a major focus for treatment of stress urinary incontinence (SUI). However, derivation of primary cells requires tissue biopsies, which often have adverse effects on patients. A recent study used human induced pluripotent stem cells (iPSC)-derived smooth muscle myocytes for urethral sphincter regeneration in rats. Here, we establish a workflow using iPSC-derived fibroblasts and skeletal myocytes for urethral tissue regeneration: (1) Cells from voided urine of women were reprogrammed into iPSC. (2) The iPSC line U1 and hESC line H9 (control) were differentiated into fibroblasts expressing FSP1, TE7, vinculin, vimentin, αSMA, fibronectin and paxillin. (3) Myogenic differentiation of U1 and H9 was induced by small molecule CHIR99021 and confirmed by protein expression of myogenic factors PAX7, MYOD, MYOG, and MF20. Striated muscle cells enriched by FACS expressed NCAM1, TITIN, DESMIN, TNNT3. (4) Human iPSC-derived fibroblasts and myocytes were engrafted into the periurethral region of RNU rats. Injected cells were labelled with ferric nanoparticles and traced by Prussian Blue stain, human-specific nuclear protein KU80, and human anti-mitochondria antibody. This workflow allows the scalable derivation, culture, and in vivo tracing of patient-specific fibroblasts and myocytes, which can be assessed in rat SUI models to regenerate urethral damages and restore continence.
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Affiliation(s)
- M Kibschull
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, 25 Orde St, Suite 6-1017, Toronto, ON, M5T 3H7, Canada
| | - T T N Nguyen
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, 25 Orde St, Suite 6-1017, Toronto, ON, M5T 3H7, Canada
| | - T Chow
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, 25 Orde St, Suite 6-1017, Toronto, ON, M5T 3H7, Canada
- Department of Physiology, University of Toronto, Toronto, Canada
| | - M Alarab
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, Canada
- Division of Urogynecology and Reconstructive Pelvic Surgery, Mount Sinai Hospital, Toronto, Canada
| | - S J Lye
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, 25 Orde St, Suite 6-1017, Toronto, ON, M5T 3H7, Canada
- Department of Physiology, University of Toronto, Toronto, Canada
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, Canada
| | - I Rogers
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, 25 Orde St, Suite 6-1017, Toronto, ON, M5T 3H7, Canada
- Department of Physiology, University of Toronto, Toronto, Canada
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, Canada
| | - O Shynlova
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, 25 Orde St, Suite 6-1017, Toronto, ON, M5T 3H7, Canada.
- Department of Physiology, University of Toronto, Toronto, Canada.
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, Canada.
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Exosome biopotentiated hydrogel restores damaged skeletal muscle in a porcine model of stress urinary incontinence. NPJ Regen Med 2022; 7:58. [PMID: 36175423 PMCID: PMC9523025 DOI: 10.1038/s41536-022-00240-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 08/05/2022] [Indexed: 11/28/2022] Open
Abstract
Urinary incontinence afflicts up to 40% of adult women in the United States. Stress urinary incontinence (SUI) accounts for approximately one-third of these cases, precipitating ~200,000 surgical procedures annually. Continence is maintained through the interplay of sub-urethral support and urethral sphincter coaptation, particularly during activities that increase intra-abdominal pressure. Currently, surgical correction of SUI focuses on the re-establishment of sub-urethral support. However, mesh-based repairs are associated with foreign body reactions and poor localized tissue healing, which leads to mesh exposure, prompting the pursuit of technologies that restore external urethral sphincter function and limit surgical risk. The present work utilizes a human platelet-derived CD41a and CD9 expressing extracellular vesicle product (PEP) enriched for NF-κB and PD-L1 and derived to ensure the preservation of lipid bilayer for enhanced stability and compatibility with hydrogel-based sustained delivery approaches. In vitro, the application of PEP to skeletal muscle satellite cells in vitro drove proliferation and differentiation in an NF-κB-dependent fashion, with full inhibition of impact on exposure to resveratrol. PEP biopotentiation of collagen-1 and fibrin glue hydrogel achieved sustained exosome release at 37 °C, creating an ultrastructural “bead on a string” pattern on scanning electron microscopy. Initial testing in a rodent model of latissimus dorsi injury documented activation of skeletal muscle proliferation of healing. In a porcine model of stress urinary incontinence, delivery of PEP-biopotentiated collagen-1 induced functional restoration of the external urethral sphincter. The histological evaluation found that sustained PEP release was associated with new skeletal muscle formation and polarization of local macrophages towards the regenerative M2 phenotype. The results provided herein serve as the first description of PEP-based biopotentiation of hydrogels implemented to restore skeletal muscle function and may serve as a promising approach for the nonsurgical management of SUI.
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Bilhar APM, Bortolini MAT, Sé AB, Feitosa SM, Zanoteli E, Castro RA. Long-term effects of muscle-derived stem cell therapy on the regeneration of the urethra of female rats. Int Urogynecol J 2022; 33:965-975. [PMID: 33655365 DOI: 10.1007/s00192-021-04708-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 01/31/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The aim was to analyze the long-term effects of muscle-derived stem cells (MDSCs) therapy in traumatized urethras of female rats regarding messenger ribonucleic acid (mRNA) expression of collagens 1 and 3, Ngf and Ki67; and the mRNA and protein expression of Myh11 and Myh2. METHODS Muscle-derived stem cells were injected into the tail vein of rats 3 days after trauma by vaginal distention. Urethras were analyzed from 30 animals divided into three groups: control without injury or treatment, trauma (30 days post-injury), and MDSC (30 days post-injury who received MDSC therapy). Real-time quantitative polymerase chain reaction (RT-qPCR) and immunohistochemistry were performed. The Kruskal-Wallis and ANOVA tests were used with p < 0.05 indicating significance. RESULTS We detected increased Myh11 and Myh2 mRNA expression in the trauma group compared with the control group (p = 0.03 and p = 0.04 respectively). Ki67 and Col1a1 genes were overexpressed in the MDSC group compared with both the trauma (p = 0.02 and p = 0.008 respectively) and the control group (p = 0.01 and p = 0.03 respectively). Col3a1 gene was upregulated in the MDSC compared with the control group (p = 0.03). Ngf mRNA level was lower in the MDSC group than in the trauma group (p = 0.002). Myh11, Myh2, and Desmin proteins were overexpressed in the MDSC compared with the trauma group (1.5-fold, p = 0.01; 1.5-fold, p = 0.04; 1.3-fold, p = 0.01 respectively). CONCLUSIONS Muscle-derived stem cell therapy may have had long-term structural and molecular effects on the injured urethra of female rats, particularly on markers of cell proliferation, neural growth factor, extracellular matrix, and muscle content. This study suggests that MDSC therapy acted mainly to produce urethral sphincter regeneration marked by increased immunohistochemical expression of the proteins desmin, smooth muscle Myh11, and skeletal muscle Myh2.
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Affiliation(s)
- Andreisa P M Bilhar
- Department of Gynecology, Universidade Federal de São Paulo, São Paulo, Brazil
- Department of Gynecology, Maternidade Escola Assis Chateaubriand, Universidade Federal do Ceará, Fortaleza, Brazil
| | - Maria A T Bortolini
- Department of Gynecology, Universidade Federal de São Paulo, São Paulo, Brazil.
| | - Alexandre B Sé
- Department of Gynecology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Suellen M Feitosa
- Department of Gynecology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Edmar Zanoteli
- Department of Neurology, Universidade de São Paulo, São Paulo, Brazil
| | - Rodrigo A Castro
- Department of Gynecology, Universidade Federal de São Paulo, São Paulo, Brazil
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Wu YR, Shen D, Zhang YQ, Cui ZY, Yang WZ. Efficacy evaluation of Lattice Carbon Dioxide Laser Therapy in the treatment of postmenopausal patients with mild to moderate stress urinary incontinence. Pak J Med Sci 2021; 37:1989-1993. [PMID: 34912431 PMCID: PMC8613011 DOI: 10.12669/pjms.37.7.4077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/04/2021] [Accepted: 06/05/2021] [Indexed: 11/15/2022] Open
Abstract
Objectives To investigate the efficacy and postoperative complications of lattice carbon dioxide laser in the treatment of postmenopausal patients with mild to moderate stress urinary incontinence. Methods A total of 30 postmenopausal female patients with mild to moderate stress urinary incontinence, recruited from the Affiliated Hospital of Hebei University from September to November 2019, were selected as the study subjects and treated with lattice carbon dioxide laser therapy. Treatment was given at intervals of one month. The degree of urinary incontinence, the urinary incontinence questionnaire (ICI-Q-SF) score, and the urinary incontinence quality of life scale (I-QOL)) Score, surgical satisfaction, one hour pad test and postoperative complications before treatment and after each treatment of all patients were respectively recorded and compared. Results Compared with those before treatment, the grade of urinary incontinence and ICI-Q-SF scores of these 30 patients after each treatment were lower, and their I-QOL scores were higher. The difference of one hour urine pad test was statistically significant (P<0.05), but the follow-up data of three months after the third treatment was close to that of one month after the first treatment. The satisfaction rate of these 30 patients was 76.67% (23/30). After treatment, only one patient presented vaginal itching discomfort on the first day after surgery and the symptoms disappeared three days later. No obvious complications occurred in the other 29 patients. Conclusion The treatment of mild and moderate postmenopausal patients with stress urinary incontinence with lattice carbon dioxide laser can effectively reduce the incidence of incontinence and improve the quality of life.
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Affiliation(s)
- Ya-Ru Wu
- Ya-ru Wu, Department of Urology, Affiliated Hospital of Hebei University, Baoding, Hebei, 071030, P. R. China
| | - Dan Shen
- Dan Shen, Department of Urology, Affiliated Hospital of Hebei University, Baoding, Hebei, 071030, P. R. China
| | - Yan-Qiao Zhang
- Yan-qiao Zhang, Department of Urology, Affiliated Hospital of Hebei University, Baoding, Hebei, 071030, P. R. China
| | - Zhen-Yu Cui
- Zhen-yu Cui, Department of Urology, Affiliated Hospital of Hebei University, Baoding, Hebei, 071030, P. R. China
| | - Wen-Zeng Yang
- Wen-zeng Yang Department of Urology, Affiliated Hospital of Hebei University, Baoding, Hebei, 071030, P. R. China
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Schmid FA, Williams JK, Kessler TM, Stenzl A, Aicher WK, Andersson KE, Eberli D. Treatment of Stress Urinary Incontinence with Muscle Stem Cells and Stem Cell Components: Chances, Challenges and Future Prospects. Int J Mol Sci 2021; 22:3981. [PMID: 33921532 PMCID: PMC8069473 DOI: 10.3390/ijms22083981] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/09/2021] [Accepted: 04/10/2021] [Indexed: 02/06/2023] Open
Abstract
Urinary incontinence (UI) is a major problem in health care and more than 400 million people worldwide suffer from involuntary loss of urine. With an increase in the aging population, UI is likely to become even more prominent over the next decades and the economic burden is substantial. Among the different subtypes of UI, stress urinary incontinence (SUI) is the most prevalent and focus of this review. The main underlying causes for SUI are pregnancy and childbirth, accidents with direct trauma to the pelvis or medical treatments that affect the pelvic floor, such as surgery or irradiation. Conservative approaches for the treatment of SUI are pelvic physiotherapy, behavioral and lifestyle changes, and the use of pessaries. Current surgical treatment options include slings, colposuspensions, bulking agents and artificial urinary sphincters. These treatments have limitations with effectiveness and bear the risk of long-term side effects. Furthermore, surgical options do not treat the underlying pathophysiological causes of SUI. Thus, there is an urgent need for alternative treatments, which are effective, minimally invasive and have only a limited risk for adverse effects. Regenerative medicine is an emerging field, focusing on the repair, replacement or regeneration of human tissues and organs using precursor cells and their components. This article critically reviews recent advances in the therapeutic strategies for the management of SUI and outlines future possibilities and challenges.
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Affiliation(s)
- Florian A. Schmid
- Department of Urology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland;
| | - J. Koudy Williams
- Institute of Regenerative Medicine, Wake Forest University School of Medicine, Winston Salem, NC 27101, USA; (J.K.W.); (K.-E.A.)
| | - Thomas M. Kessler
- Department of Neuro-Urology, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland;
| | - Arnulf Stenzl
- Department of Urology, University Hospital Tubingen, University of Tubingen, 72076 Tubingen, Germany; (A.S.); (W.K.A.)
| | - Wilhelm K. Aicher
- Department of Urology, University Hospital Tubingen, University of Tubingen, 72076 Tubingen, Germany; (A.S.); (W.K.A.)
| | - Karl-Erik Andersson
- Institute of Regenerative Medicine, Wake Forest University School of Medicine, Winston Salem, NC 27101, USA; (J.K.W.); (K.-E.A.)
| | - Daniel Eberli
- Department of Urology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland;
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Magnetic targeting of super-paramagnetic iron oxide nanoparticle labeled myogenic-induced adipose-derived stem cells in a rat model of stress urinary incontinence. NANOMEDICINE-NANOTECHNOLOGY BIOLOGY AND MEDICINE 2020; 30:102281. [PMID: 32763385 DOI: 10.1016/j.nano.2020.102281] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 06/23/2020] [Accepted: 07/26/2020] [Indexed: 12/31/2022]
Abstract
Cell-based injectable therapy utilizing stem cells is a promising approach for the treatment of stress urinary incontinence (SUI). Applying a magnetically controlled cell delivery approach has enormous potential to enhance cell retention capability within the specified site. To assess the therapeutic efficacy of cellular magnetic targeting, we applied an external magnetic force to target an adipose-derived stem cell based therapy in a rat model of SUI. The results revealed that magnetic attraction of transplanted cells under the magnetic field was generated by cell uptake of superparamagnetic iron oxide nanoparticles in vitro. More importantly, magnetic targeting improved the retention rate of transplanted cells and facilitated the restoration of sphincter structure and function in a rat SUI model according to the results of histological examination and urodynamic testing. Therefore, magnetically guided targeting strategy might be a potential therapy method for treatment of SUI.
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Thurner M, Deutsch M, Janke K, Messner F, Kreutzer C, Beyl S, Couillard-Després S, Hering S, Troppmair J, Marksteiner R. Generation of myogenic progenitor cell-derived smooth muscle cells for sphincter regeneration. Stem Cell Res Ther 2020; 11:233. [PMID: 32532320 PMCID: PMC7291744 DOI: 10.1186/s13287-020-01749-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/15/2020] [Accepted: 05/28/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Degeneration of smooth muscles in sphincters can cause debilitating diseases such as fecal incontinence. Skeletal muscle-derived cells have been effectively used in clinics for the regeneration of the skeletal muscle sphincters, such as the external anal or urinary sphincter. However, little is known about the in vitro smooth muscle differentiation potential and in vivo regenerative potential of skeletal muscle-derived cells. METHODS Myogenic progenitor cells (MPC) were isolated from the skeletal muscle and analyzed by flow cytometry and in vitro differentiation assays. The differentiation of MPC to smooth muscle cells (MPC-SMC) was evaluated by immunofluorescence, flow cytometry, patch-clamp, collagen contraction, and microarray gene expression analysis. In vivo engraftment of MPC-SMC was monitored by transplanting reporter protein-expressing cells into the pyloric sphincter of immunodeficient mice. RESULTS MPC derived from human skeletal muscle expressed mesenchymal surface markers and exhibit skeletal myogenic differentiation potential in vitro. In contrast, they lack hematopoietic surface marker, as well as adipogenic, osteogenic, and chondrogenic differentiation potential in vitro. Cultivation of MPC in smooth muscle differentiation medium significantly increases the fraction of alpha smooth muscle actin (aSMA) and smoothelin-positive cells, while leaving the number of desmin-positive cells unchanged. Smooth muscle-differentiated MPC (MPC-SMC) exhibit increased expression of smooth muscle-related genes, significantly enhanced numbers of CD146- and CD49a-positive cells, and in vitro contractility and express functional Cav and Kv channels. MPC to MPC-SMC differentiation was also accompanied by a reduction in their skeletal muscle differentiation potential. Upon removal of the smooth muscle differentiation medium, a major fraction of MPC-SMC remained positive for aSMA, suggesting the definitive acquisition of their phenotype. Transplantation of murine MPC-SMC into the mouse pyloric sphincter revealed engraftment of MPC-SMC based on aSMA protein expression within the host smooth muscle tissue. CONCLUSIONS Our work confirms the ability of MPC to give rise to smooth muscle cells (MPC-SMC) with a well-defined and stable phenotype. Moreover, the engraftment of in vitro-differentiated murine MPC-SMC into the pyloric sphincter in vivo underscores the potential of this cell population as a novel cell therapeutic treatment for smooth muscle regeneration of sphincters.
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Affiliation(s)
- Marco Thurner
- Innovacell Biotechnologie AG, Mitterweg 24, 6020, Innsbruck, Austria.
- Daniel Swarovski Research Laboratory (DSL), Visceral Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria.
| | - Martin Deutsch
- Innovacell Biotechnologie AG, Mitterweg 24, 6020, Innsbruck, Austria
| | - Katrin Janke
- Innovacell Biotechnologie AG, Mitterweg 24, 6020, Innsbruck, Austria
| | - Franka Messner
- Daniel Swarovski Research Laboratory (DSL), Visceral Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Christina Kreutzer
- Institute of Experimental Neuroregeneration, Spinal Cord Injury and Tissue Regeneration Center Salzburg (SCI-TReCS), Paracelsus Medical University, Salzburg, Austria
- Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Stanislav Beyl
- Department of Pharmacology and Toxicology, University of Vienna, Vienna, Austria
| | - Sébastien Couillard-Després
- Institute of Experimental Neuroregeneration, Spinal Cord Injury and Tissue Regeneration Center Salzburg (SCI-TReCS), Paracelsus Medical University, Salzburg, Austria
- Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Steffen Hering
- Department of Pharmacology and Toxicology, University of Vienna, Vienna, Austria
| | - Jakob Troppmair
- Daniel Swarovski Research Laboratory (DSL), Visceral Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
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11
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Barakat B, Franke K, Schakaki S, Hijazi S, Hasselhof V, Vögeli TA. Stem cell applications in regenerative medicine for stress urinary incontinence: A review of effectiveness based on clinical trials. Arab J Urol 2020; 18:194-205. [PMID: 33029431 PMCID: PMC7473152 DOI: 10.1080/2090598x.2020.1750864] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Objective To evaluate the current state, therapeutic benefit and safety of urethral injection of autologous stem cells for the treatment stress urinary incontinence (SUI). Materials and methods A selective database search of PubMed, the Excerpta Medica dataBASE (EMBASE), Cochrane Library and Google Scholar was conducted to validate the effectiveness of stem cell-based therapy. The search included clinical trials published up until 4 January 2020, written in English, and included cohorts of women and men who had received stem cell-based therapy for SUI. The search used the following keywords in various combinations: ‘stem cell therapy’, ‘cell-based therapy for SUI’, ‘regenerative medicine for SUI’, and ‘tissue engineering’. The success rates were assessed according to cough test, urodynamics, pad tests, and International Consultation on Incontinence Questionnaire-Urinary Incontinence. The primary endpoint was continence rate to measure objectively the effect of the treatment. Results We identified four clinical trials using local injections of adipose-derived stem cells (ADSCs), 11 trails with muscle-derived stem cells (MDSCs), and two trails with human umbilical cord blood stem cells (HUCBs) and total nucleated cells (TNCs). The median improvement rate of intrinsic sphincter deficiency after ADSCs, MDSCs, TNCs, HUCBs injections were 88%, 77%, 89%, 36% (improvement rate: 1–2 pads) at a mean (range) follow-up of 6 (1–72) months. The cell sources, methods of cell processing, cell number, and implantation techniques differed considerably between studies. Most of the periurethral injections were at the 3, 5, 7, and 9 o’clock positions and for submucosa were at the 4, 6, and 8 o’clock positions. No significant postoperative complications were reported. Conclusion Despite many challenges in stem cell-based therapy for treating SUI, it appears to provide, in both male and female patients, acceptable functional results with minimal side-effects and complications. In the future, more clinical trials should be funded in order to optimise stem cell-based therapy and evaluate long-term outcomes. Abbreviations ADSC: adipose-derived stem cell; BMSCs: bone marrow-derived mesenchymal stem cell; CLPP: cough leak-point pressure; FPL: functional profile length; HUCB: human umbilical cord blood stem cell; ICIQ-(QOL)(SF)(UI): International Consultation on Incontinence Questionnaire (Quality of life) (-Urinary incontinence Short Form) (-Urinary Incontinence); IIQ-7: Incontinence Impact Questionnaire-short form; I-QOL: Incontinence quality of life questionnaire; ISD: intrinsic urinary sphincter deficiency; MDSC: muscle-derived stem cell; MUCP: maximum urethral closure pressure; NR: not reported; Pdet-max: maximum detrusor pressure; PVR: post-void residual urine volume; Qmax: maximum urinary flow; QOL: quality of life; RP: radical prostatectomy; TNC: total nucleated cell; (S)UI: (stress) urinary incontinence; UDSCs: urine-derived stem cells; UTUS: upper tract ultrasonography; VLPP: Valsalva leak-point pressure
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Affiliation(s)
- Bara Barakat
- Department of Urology and Pediatric Urology, Hospital Viersen, Viersen, Germany
| | - Knut Franke
- Department of Urology and Pediatric Urology, Hospital Viersen, Viersen, Germany
| | - Samer Schakaki
- Department of Urology, Hospital Osnabrück, Osnabruck, Germany
| | - Sameh Hijazi
- Department of Urology, Hospital Ibbenbüren, Ibbenbüren, Germany
| | | | - Thomas-Alexander Vögeli
- Department of Urology and Pediatric Urology, Universityhospital RWTH Aachen, Aachen, Germany
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12
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Regenerative medicine and injection therapies in stress urinary incontinence. Nat Rev Urol 2020; 17:151-161. [PMID: 31974507 DOI: 10.1038/s41585-019-0273-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2019] [Indexed: 02/06/2023]
Abstract
Stress urinary incontinence (SUI) is a common and bothersome condition. Anti-incontinence surgery has high cure rates, but concerns about mesh tapes have resulted in the resurgence of surgical procedures that involve increased abdominopelvic dissection and morbidity. Injection therapy with urethral bulking agents or stem cell formulations have been developed as minimally invasive alternatives. Many synthetic and biological bulking agents have been trialled, but several have been discontinued owing to safety concerns. The use of Macroplastique and Contigen has the largest evidence base, but, overall, success rates seem to be similar between the various agents and positive outcomes are poorly sustained for more than 6 months. Furthermore, subjective cure rates, although initially high, also deteriorate over time. The available data consistently demonstrate manifestly poorer outcomes for injection therapies than for surgery. Stem cell treatments are thought to functionally regenerate the urethral sphincter in patients with suspected intrinsic sphincter deficiency. Autologous adipose and muscle-derived stem cells seem to be the intuitive cell source, as they are comparatively abundant, can be harvested and cause minimal donor site morbidity. To date, only a few small clinical studies have been reported and most data are derived from animal models. The success rates of stem cell injection therapies seem to be comparable with those of bulking agents.
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13
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Kaufman MR. Contemporary application of autologous muscle-derived cells for urinary sphincter regeneration. World J Urol 2019; 38:2095-2099. [DOI: 10.1007/s00345-019-03018-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 11/07/2019] [Indexed: 12/24/2022] Open
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15
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Rehailia-Blanchard A, He MY, Rancoule C, Guillaume É, Guy JB, Vial N, Nivet A, Orliac H, Chargari C, Magné N. [Medical prevention and treatment of radiation-induced urological and nephrological complications]. Cancer Radiother 2019; 23:151-160. [PMID: 30898418 DOI: 10.1016/j.canrad.2018.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 05/09/2018] [Accepted: 05/30/2018] [Indexed: 02/02/2023]
Abstract
Abdominal and pelvic irradiations play a major place in the management of patients with cancer and present a risk of acute and late side effects. Radiation-induced lesions can affect kidney or urological structures. These side effects can have an impact in the quality of life of patients. The aim of this article is to describe the physiopathology, the symptomatology, and the principles of management of radiation-induced nephropathy, uretheritis, cystitis, and urethritis.
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Affiliation(s)
- A Rehailia-Blanchard
- Département de radiothérapie, institut de cancérologie Lucien-Neuwirth, 108 bis, rue Albert-Raimond, 42270 Saint-Priest en Jarez, France.
| | - M Y He
- Département de radiothérapie, institut de cancérologie Lucien-Neuwirth, 108 bis, rue Albert-Raimond, 42270 Saint-Priest en Jarez, France; Oncology departement, affiliated hospital of Guizhou medical university, 550004 China
| | - C Rancoule
- Département de radiothérapie, institut de cancérologie Lucien-Neuwirth, 108 bis, rue Albert-Raimond, 42270 Saint-Priest en Jarez, France
| | - É Guillaume
- Département de radiothérapie, institut de cancérologie Lucien-Neuwirth, 108 bis, rue Albert-Raimond, 42270 Saint-Priest en Jarez, France
| | - J-B Guy
- Département de radiothérapie, institut de cancérologie Lucien-Neuwirth, 108 bis, rue Albert-Raimond, 42270 Saint-Priest en Jarez, France
| | - N Vial
- Département de radiothérapie, institut de cancérologie Lucien-Neuwirth, 108 bis, rue Albert-Raimond, 42270 Saint-Priest en Jarez, France
| | - A Nivet
- Département de radiothérapie, CHU de Limoges, 2, avenue Martin-Luther-King, 87000 Limoges, France
| | - H Orliac
- Département de radiothérapie, CHU de Limoges, 2, avenue Martin-Luther-King, 87000 Limoges, France
| | - C Chargari
- Département de radiothérapie, Gustave-Roussy Cancer Campus, 114, rue Édouard-Vaillant, 94805 Villejuif, France; Inserm, U1030, 114, rue Édouard-Vaillant, 94805 Villejuif , France; Université Paris Sud, université Paris-Saclay, 94270 Le Kremlin-Bicêtre, France; Institut de recherche biomédicale des armées, D19, 91220 Brétigny-sur-Orge, France
| | - N Magné
- Département de radiothérapie, institut de cancérologie Lucien-Neuwirth, 108 bis, rue Albert-Raimond, 42270 Saint-Priest en Jarez, France
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16
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Gallo F, Ninotta G, Schenone M, Cortese P, Giberti C. Advances in stem cell therapy for male stress urinary incontinence. Expert Opin Biol Ther 2019; 19:293-300. [PMID: 30709326 DOI: 10.1080/14712598.2019.1578343] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Among the several options that have been proposed in recent years for the management of male stress urinary incontinence (SUI), stem cell therapy represents a new frontier in treatment. The aim of this paper is to update the current status of stem cell therapy in animal and human studies for the management of iatrogenic male SUI. AREAS COVERED A literature review was conducted based on MEDLINE/PubMed searches for English articles using a combination of the following keywords: stem cell therapy, urinary incontinence, prostatectomy, regenerative medicine, mesenchymal stem cells. EXPERT OPINION The few studies reported in the literature have demonstrated short-term safety and promising results of stem cell therapy in treating male SUI. However, many aspects need to be clarified before stem cell therapy can be introduced into daily urologic practice. In fact, important issues such as the limitations of these studies in terms of small sample sizes and short follow-ups, the incomplete knowledge of the mechanism of action of stem cells, the technical details regarding the delivery method and the best sources of stem cells, the safety risks regarding genomic or epigenetic changes and potential immune reactions in the longer term need to be identified in more stringent clinical trials.
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Affiliation(s)
- Fabrizio Gallo
- a Department of Surgery, Division of Urology , San Paolo Hospital , Savona , Italy
| | - Gaetano Ninotta
- a Department of Surgery, Division of Urology , San Paolo Hospital , Savona , Italy
| | - Maurizio Schenone
- a Department of Surgery, Division of Urology , San Paolo Hospital , Savona , Italy
| | - Pierluigi Cortese
- a Department of Surgery, Division of Urology , San Paolo Hospital , Savona , Italy
| | - Claudio Giberti
- a Department of Surgery, Division of Urology , San Paolo Hospital , Savona , Italy
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17
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Autologous Muscle-Derived Cells for Urinary Sphincter Regeneration: Where are we now? CURRENT BLADDER DYSFUNCTION REPORTS 2018. [DOI: 10.1007/s11884-018-0486-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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18
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Burdzinska A, Dybowski B, Zarychta-Wiśniewska W, Kulesza A, Butrym M, Zagozdzon R, Graczyk-Jarzynka A, Radziszewski P, Gajewski Z, Paczek L. Intraurethral co-transplantation of bone marrow mesenchymal stem cells and muscle-derived cells improves the urethral closure. Stem Cell Res Ther 2018; 9:239. [PMID: 30241573 PMCID: PMC6151032 DOI: 10.1186/s13287-018-0990-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 07/16/2018] [Accepted: 08/23/2018] [Indexed: 01/08/2023] Open
Abstract
Background Cell therapy constitutes an attractive alternative to treat stress urinary incontinence. Although promising results have been demonstrated in this field, the procedure requires further optimization. The most commonly proposed cell types for intraurethral injections are muscle derived cells (MDCs) and mesenchymal stem/stromal cell (MSCs). The aim of this study was to evaluate the effects of MDC-MSC co-transplantation into the urethra. Methods Autologous transplantation of labeled MDCs, bone marrow MSCs or co-transplantation of MDC-MSC were performed in aged multiparous female goats (n = 6 in each group). The mean number of cells injected per animal was 29.6 × 106(± 4.3 × 106). PBS-injected animals constituted the control group (n = 5). Each animal underwent urethral pressure profile (UPP) measurements before and after the injection procedure. The maximal urethral closure pressure (MUCP) and functional area (FA) of UPPs were calculated. The urethras were collected at the 28th or the 84th day after transplantation. The marker fluorochrome (DID) was visualized and quantified using in vivo imaging system in whole explants. Myogenic differentiation of the graft was immunohistochemically evaluated. Results The grafted cells were identified in all urethras collected at day 28 regardless of injected cell type. At this time point the strongest DID-derived signal (normalized to the number of injected cells) was noted in the co-transplanted group. There was a distinct decline in signal intensity between day 28 and day 84 in all types of transplantation. Both MSCs and MDCs contributed to striated muscle formation if transplanted directly to the external urethral sphincter. In the MSC group those events were rare. If cells were injected into the submucosal region they remained undifferentiated usually packed in clearly distinguishable depots. The mean increase in MUCP after transplantation in comparison to the pre-transplantation state in the MDC, MSC and MDC-MSC groups was 12.3% (± 11.2%, not significant (ns)), 8.2% (± 9.6%, ns) and 24.1% (± 3.1%, p = 0.02), respectively. The mean increase in FA after transplantation in the MDC, MSC and MDC-MSC groups amounted to 17.8% (± 15.4%, ns), 15.2% (± 12.9%, ns) and 17.8% (± 2.5%, p = 0.04), respectively. Conclusions The results suggest that MDC-MSC co-transplantation provides a greater chance of improvement in urethral closure than transplantation of each population alone.
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Affiliation(s)
- Anna Burdzinska
- Department of Immunology, Transplantology and Internal Diseases, Medical University of Warsaw, Nowogrodzka 59, 02-006, Warsaw, Poland
| | - Bartosz Dybowski
- Department of Urology, Medical University of Warsaw, Warsaw, Poland
| | - Weronika Zarychta-Wiśniewska
- Department of Immunology, Transplantology and Internal Diseases, Medical University of Warsaw, Nowogrodzka 59, 02-006, Warsaw, Poland
| | - Agnieszka Kulesza
- Department of Immunology, Transplantology and Internal Diseases, Medical University of Warsaw, Nowogrodzka 59, 02-006, Warsaw, Poland
| | - Marta Butrym
- Department of Immunology, Transplantology and Internal Diseases, Medical University of Warsaw, Nowogrodzka 59, 02-006, Warsaw, Poland.,Division of Dermatology and Venereology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Radoslaw Zagozdzon
- Department of Clinical Immunology, Medical University of Warsaw, Warsaw, Poland.,Department of Bioinformatics, Institute of Biochemistry and Biophysics, Polish Academy of Sciences, Warsaw, Poland
| | | | | | - Zdzislaw Gajewski
- Department of Large Animal Diseases with Clinic, Veterinary Research Centre and Center for Biomedical Research, Faculty of Veterinary Medicine, Warsaw University of Life Sciences (WULS - SGGW), Warsaw, Poland
| | - Leszek Paczek
- Department of Immunology, Transplantology and Internal Diseases, Medical University of Warsaw, Nowogrodzka 59, 02-006, Warsaw, Poland. .,Department of Bioinformatics, Institute of Biochemistry and Biophysics, Polish Academy of Sciences, Warsaw, Poland.
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19
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Bilhar AP, Bortolini MA, Sé AB, Feitosa SM, Salerno GR, Zanoteli E, Simões MJ, Castro RA. Molecular and immunohistochemical analysis of the urethra of female rats after induced trauma and intravenous therapy with muscle derived stem cells. Neurourol Urodyn 2018; 37:2151-2159. [DOI: 10.1002/nau.23567] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Accepted: 02/26/2018] [Indexed: 01/17/2023]
Affiliation(s)
| | | | - Alexandre B. Sé
- Department of Gynecology; Federal University of São Paulo; São Paulo Brazil
| | - Suellen M. Feitosa
- Department of Gynecology; Federal University of São Paulo; São Paulo Brazil
| | | | - Edmar Zanoteli
- Department of Neurology; University of São Paulo; São Paulo Brazil
| | - Manuel J. Simões
- Department of Gynecology; Federal University of São Paulo; São Paulo Brazil
| | - Rodrigo A. Castro
- Department of Gynecology; Federal University of São Paulo; São Paulo Brazil
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20
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Vinarov A, Atala A, Yoo J, Slusarenco R, Zhumataev M, Zhito A, Butnaru D. Cell therapy for stress urinary incontinence: Present-day frontiers. J Tissue Eng Regen Med 2017; 12:e1108-e1121. [PMID: 28482121 DOI: 10.1002/term.2444] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 01/28/2017] [Accepted: 05/03/2017] [Indexed: 01/16/2023]
Abstract
Stress urinary incontinence (SUI) significantly diminishes the quality of patients' lives. Currently available surgical and nonsurgical therapies remain far from ideal. At present, advances in cellular technologies have stirred growing interest in the use of autologous cell treatments aimed to regain urinary control. The objective was to conduct a review of the literature and analyse preclinical and clinical studies dedicated to various cell therapies for SUI, assessing their effectiveness, safety, and future prospects. A systematic literature search in PubMed was conducted using the following key terms: "stem," "cell," "stress," "urinary," and "incontinence." A total of 32 preclinical studies and 15 clinical studies published between 1946 and December 2014 were included in the review. Most preclinical trials have used muscle-derived stem cells and adipose-derived stem cells. However, at present, the application of other types of cells, such as human amniotic fluid stem muscle-derived progenitor cells and bone marrow mesenchymal stromal cells, is becoming more extensive. While the evidence shows that these therapies are effective and safe, further work is required to standardize surgical techniques, as well as to identify indications for their use, doses and number of doses. Future research will have to focus on clinical applications of cell therapies; namely, it will have to determine indications for their use, doses of cells, optimal surgical techniques and methods, attractive cell sources, as well as to develop clinically relevant animal models and make inroads into understanding the mechanisms of SUI improvement by cell therapies.
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Affiliation(s)
- Andrey Vinarov
- Research Institute for Uronephrology and Reproductive Health, Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Anthony Atala
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - James Yoo
- Wake Forest Institute for Regenerative Medicine, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Roman Slusarenco
- Research Institute for Uronephrology and Reproductive Health, Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Marat Zhumataev
- Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Alexey Zhito
- Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Denis Butnaru
- Institute for Regenerative Medicine, Sechenov First Moscow State Medical University, Moscow, Russian Federation
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Hejbøl EK, Sellathurai J, Nair PD, Schrøder HD. Injectable scaffold materials differ in their cell instructive effects on primary human myoblasts. J Tissue Eng 2017; 8:2041731417717677. [PMID: 28717506 PMCID: PMC5502935 DOI: 10.1177/2041731417717677] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 06/06/2017] [Indexed: 12/15/2022] Open
Abstract
Scaffolds are materials used for delivery of cells for regeneration of tissues. They support three-dimensional organization and improve cell survival. For the repair of small skeletal muscles, injections of small volumes of cells are attractive, and injectable scaffolds for delivery of cells offer a minimally invasive technique. In this study, we examined in vitro the cell instructive effects of three types of injectable scaffolds, fibrin, alginate, and poly(lactic-co-glycolic acid)-based microparticles on primary human myoblasts. The myoblast morphology and progression in the myogenic program differed, depending on the type of scaffold material. In alginate gel, the cells obtained a round morphology, they ceased to proliferate, and entered quiescence. In the fibrin gels, differentiation was promoted, and myotubes were observed within a few days in culture, while poly(lactic-co-glycolic acid)-based microparticles supported prolonged proliferation. Myoblasts released from the alginate and fibrin gels were studied, and cells released from these scaffolds had retained the ability to proliferate and differentiate. Thus, the study shows that human myogenic cells combined with injectable scaffold materials are guided into different states depending on the choice of scaffold. This opens for in vivo experiments, including testing of the significance of the cell state on regeneration potential of primary human myoblasts.
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Affiliation(s)
- Eva Kildall Hejbøl
- Institute of Clinical Research, SDU Muscle Research Cluster, University of Southern Denmark, Odense, Denmark
| | - Jeeva Sellathurai
- Institute of Clinical Research, SDU Muscle Research Cluster, University of Southern Denmark, Odense, Denmark
| | - Prabha Damodaran Nair
- Division of Tissue Engineering and Regeneration Technologies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | - Henrik Daa Schrøder
- Institute of Clinical Research, SDU Muscle Research Cluster, University of Southern Denmark, Odense, Denmark.,Department of Pathology, Odense University Hospital, Odense, Denmark
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Abstract
Myoblasts are defined as stem cells containing skeletal muscle cell precursors. A decade of experimental work has revealed many properties of myoblasts, including the stability of resulting hybrid myofibers without immune suppression, the persistence of transgene expression, and the lack of tumorigenicity. Early phase clinical trials also showed that myoblast-based therapy is a promising approach for many intractable clinical conditions, including both muscle-related and non-muscle-related diseases. The potential application of myoblast therapy may be in the treatment of genetic muscle diseases, cardiomyocyte damaged heart diseases, and urinary incontinence. This review will provide an overview of myoblast biology, along with discussion of the potential application in clinical medicine. In addition, problems in current myoblast therapy and possible future improvements will be addressed.
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Affiliation(s)
- Zhongmin Liu
- Heart Center, Shanghai East Hospital, Tongji University, Shanghai 200120, China
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Shinohara M, Sumino Y, Sato F, Kiyono T, Hashimoto N, Mimata H. Tumor necrosis factor-alpha inhibits differentiation of myogenic cells in human urethral rhabdosphincter. Int J Urol 2017; 24:461-467. [DOI: 10.1111/iju.13330] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 02/03/2017] [Indexed: 01/08/2023]
Affiliation(s)
- Mayuka Shinohara
- Department of Oncological Science (Urology); Oita University Faculty of Medicine; Yufu Oita Japan
| | - Yasuhiro Sumino
- Department of Oncological Science (Urology); Oita University Faculty of Medicine; Yufu Oita Japan
| | - Fuminori Sato
- Department of Oncological Science (Urology); Oita University Faculty of Medicine; Yufu Oita Japan
| | - Tohru Kiyono
- Division of Carcinogenesis and Cancer Prevention; National Cancer Center Research Institute; Tokyo Japan
| | - Naohiro Hashimoto
- Department of Regenerative Medicine Institute; National Center for Geriatrics and Gerontology; Obu Aichi Japan
| | - Hiromitsu Mimata
- Department of Oncological Science (Urology); Oita University Faculty of Medicine; Yufu Oita Japan
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Giberti C, Gallo F, Schenone M, Cortese P, Ninotta G. Stem Cell Therapy for Male Urinary Incontinence. Urol Int 2016; 90:249-52. [PMID: 23221307 DOI: 10.1159/000342415] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Among the medical and surgical options which have been proposed in the last years for the management of male stress urinary incontinence (SUI), stem cell therapy represents a new frontier treatment. The aim of this paper is to update the current status of stem cell therapy in animal and human studies for the management of iatrogenic male SUI. MATERIAL AND METHODS A PubMed review of the literature on stem cell therapy for the treatment of male SUI was performed. RESULTS Regarding animal studies, bone marrow-, muscle- and adipose-derived stem cells have been widely studied, showing regeneration of the urethral sphincter and recovery of the damaged pelvic nerves. With regard to human studies, only four papers are available in the literature using muscle- and adipose-derived stem cells which reported a significant improvement in sphincteric function and incontinence with no severe side effects. CONCLUSIONS In spite of these promising results, further studies are needed with longer follow-ups and larger numbers of patients in order to clarify the potential role of stem cell therapy for the treatment of male SUI.
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Affiliation(s)
- C Giberti
- Department of Surgery, Division of Urology, San Paolo Hospital, Savona, Italy
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Rottmar M, Haralampieva D, Salemi S, Eberhardt C, Wurnig MC, Boss A, Eberli D. Magnetization Transfer MR Imaging to Monitor Muscle Tissue Formation during Myogenic in Vivo Differentiation of Muscle Precursor Cells. Radiology 2016; 281:436-443. [PMID: 27152553 DOI: 10.1148/radiol.2016152330] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To determine whether magnetization transfer (MT) magnetic resonance (MR) imaging may serve as a quantitative measure of the degree of fiber formation during differentiation of muscle precursor cells into engineered muscle tissue as a potential noninvasive monitoring tool in mice. Materials and Methods The study was approved by the local ethics committee (no. StV 01/2008) and the local Veterinary Office (license no. 99/2013). Human muscle progenitor cells (hMPCs) derived from rectus abdominis muscles were subcutaneously injected into CD-1 nude mice (CD-1 nude mice, Crl:CD1-Foxn1nu; Charles River Laboratories, Wilmington, Mass) for development of muscle tissue. The mice underwent MR imaging examinations at 4.7 T at days 1, 3, 7, 14, 21, and 28 after cell transplantation by using a gradient-echo sequence with an MT prepulse and systematic variation of the off-resonance frequency (50-37 500 Hz) at an amplitude of 800°. Direct saturation was estimated from a Bloch equation simulation. The MT ratio (MTR) was correlated to immunohistochemistry findings, Western blot results, and results of myography. Data were analyzed by using one-way or two-way analysis of variance with the Sidak or Tukey multiple comparisons test. Results In the reference skeletal muscle, highest MT was found for 2500 Hz off-resonance frequency with an MTR ± standard deviation of 57.5% ± 3.5. The developing muscle tissue exhibited increasing MT values during the 28 days of myogenic in vivo differentiation and did not reach the values of native skeletal muscle. Mean values of MTR (2500 Hz) for hMPCs were 27.6% ± 6.3 (day 1), 24.7% ± 8.7 (day 3), 28.2% ± 5.7 (day 7), 35.9% ± 5.0 (day 14), 37.0% ± 7.9 (day 21), and 39.9% ± 8.1 (day 28). The results from MT MR imaging correlated qualitatively well with muscle tissue expression of specific skeletal markers, as well as muscle contractility. Conclusion MT MR imaging may be used to noninvasively monitor the process of myogenic in vivo differentiation of hMPCs as a biomarker of the quantity and quality of muscle fiber formation. © RSNA, 2016 Online supplemental material is available for this article.
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Affiliation(s)
- Markus Rottmar
- From the Institute of Diagnostic and Interventional Radiology (M.R., C.E., M.C.W., A.B.) and Department of Urology (M.R., D.H., S.S., D.E.), University Hospital Zurich, Rämistrasse 100, CH-8091 Zurich, Switzerland; and Laboratory for Biointerfaces, Empa, Swiss Federal Laboratories for Materials Science and Technology, St Gallen, Switzerland (M.R.)
| | - Deana Haralampieva
- From the Institute of Diagnostic and Interventional Radiology (M.R., C.E., M.C.W., A.B.) and Department of Urology (M.R., D.H., S.S., D.E.), University Hospital Zurich, Rämistrasse 100, CH-8091 Zurich, Switzerland; and Laboratory for Biointerfaces, Empa, Swiss Federal Laboratories for Materials Science and Technology, St Gallen, Switzerland (M.R.)
| | - Souzan Salemi
- From the Institute of Diagnostic and Interventional Radiology (M.R., C.E., M.C.W., A.B.) and Department of Urology (M.R., D.H., S.S., D.E.), University Hospital Zurich, Rämistrasse 100, CH-8091 Zurich, Switzerland; and Laboratory for Biointerfaces, Empa, Swiss Federal Laboratories for Materials Science and Technology, St Gallen, Switzerland (M.R.)
| | - Christian Eberhardt
- From the Institute of Diagnostic and Interventional Radiology (M.R., C.E., M.C.W., A.B.) and Department of Urology (M.R., D.H., S.S., D.E.), University Hospital Zurich, Rämistrasse 100, CH-8091 Zurich, Switzerland; and Laboratory for Biointerfaces, Empa, Swiss Federal Laboratories for Materials Science and Technology, St Gallen, Switzerland (M.R.)
| | - Moritz C Wurnig
- From the Institute of Diagnostic and Interventional Radiology (M.R., C.E., M.C.W., A.B.) and Department of Urology (M.R., D.H., S.S., D.E.), University Hospital Zurich, Rämistrasse 100, CH-8091 Zurich, Switzerland; and Laboratory for Biointerfaces, Empa, Swiss Federal Laboratories for Materials Science and Technology, St Gallen, Switzerland (M.R.)
| | - Andreas Boss
- From the Institute of Diagnostic and Interventional Radiology (M.R., C.E., M.C.W., A.B.) and Department of Urology (M.R., D.H., S.S., D.E.), University Hospital Zurich, Rämistrasse 100, CH-8091 Zurich, Switzerland; and Laboratory for Biointerfaces, Empa, Swiss Federal Laboratories for Materials Science and Technology, St Gallen, Switzerland (M.R.)
| | - Daniel Eberli
- From the Institute of Diagnostic and Interventional Radiology (M.R., C.E., M.C.W., A.B.) and Department of Urology (M.R., D.H., S.S., D.E.), University Hospital Zurich, Rämistrasse 100, CH-8091 Zurich, Switzerland; and Laboratory for Biointerfaces, Empa, Swiss Federal Laboratories for Materials Science and Technology, St Gallen, Switzerland (M.R.)
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Zwaans BM, Chancellor MB, Lamb LE. Modeling and Treatment of Radiation Cystitis. Urology 2016; 88:14-21. [DOI: 10.1016/j.urology.2015.11.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 09/15/2015] [Accepted: 11/01/2015] [Indexed: 10/22/2022]
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Frudinger A, Pfeifer J, Paede J, Kolovetsiou-Kreiner V, Marksteiner R, Halligan S. Autologous skeletal-muscle-derived cell injection for anal incontinence due to obstetric trauma: a 5-year follow-up of an initial study of 10 patients. Colorectal Dis 2015; 17:794-801. [PMID: 25773013 DOI: 10.1111/codi.12947] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Accepted: 01/27/2015] [Indexed: 01/01/2023]
Abstract
AIM Our aim was to determine whether the benefits of autologous skeletal-muscle-derived cell injection to treat obstetric anal incontinence are sustained at 5 years. METHOD An observational study was performed of 10 women suffering from obstetric anal incontinence refractory to non-surgical therapy. Autologous skeletal-muscle-derived cells were injected into the external sphincter defect under ultrasound guidance. Incontinence diaries and quality of life questionnaires were obtained pre-implantation and annually after implantation for 5 years. Anal physiology testing was performed before implantation and at 1, 2 and 5 years after implantation. The end-points included were adverse events, Wexner incontinence scores, incontinence episodes, anal squeeze pressures and quality of life over 5 years. An independent statistician used multilevel linear regression to analyse changes in repeated measures over time. Any skewed distributions were log transformed prior to analysis. RESULTS No procedure-related adverse events occurred and haematological and biochemical parameters were normal during the 5-year period. There were sustained significant improvements in the Wexner incontinence score and reduced frequency of defaecation and number of incontinence episodes (all comparisons P < 0.001). Anal resting and squeeze pressures showed sustained improvement (all P < 0.001) and quality of life improved overall (P < 0.001), including all submeasures studied (P < 0.001). CONCLUSION Autologous skeletal-muscle-derived cells to treat obstetric anal incontinence resulted in sustained improvement in incontinence episodes, physiological measurements of anal function and quality of life at 5 years.
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Affiliation(s)
- A Frudinger
- Department of Obstetrics and Gynaecology, Medical University of Graz, Graz, Austria
| | - J Pfeifer
- General Surgery, Medical University of Graz, Graz, Austria
| | - J Paede
- B-K Medical, Quickborn, Germany
| | | | | | - S Halligan
- Centre for Medical Imaging, University College London, London, UK
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Chung E. Stem-cell-based therapy in the field of urology: a review of stem cell basic science, clinical applications and future directions in the treatment of various sexual and urinary conditions. Expert Opin Biol Ther 2015; 15:1623-32. [DOI: 10.1517/14712598.2015.1075504] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Alwaal A, Hussein AA, Lin CS, Lue TF. Prospects of stem cell treatment in benign urological diseases. Korean J Urol 2015; 56:257-65. [PMID: 25874038 PMCID: PMC4392024 DOI: 10.4111/kju.2015.56.4.257] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 02/23/2015] [Indexed: 12/15/2022] Open
Abstract
Stem cells (SCs) are undifferentiated cells that are capable of self-renewal and differentiation and that therefore contribute to the renewal and repair of tissues. Their capacity for division, differentiation, and tissue regeneration is highly dependent on the surrounding environment. Several preclinical and clinical studies have utilized SCs in urological disorders. In this article, we review the current status of SC use in benign urological diseases (erectile dysfunction, Peyronie disease, infertility, and urinary incontinence), and we summarize the results of the preclinical and clinical trials that have been conducted.
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Affiliation(s)
- Amjad Alwaal
- Department of Urology, University of California, San Francisco, CA, USA
- Department of Urology, King Abdul Aziz University, Jeddah, Saudi Arabia
| | - Ahmed A. Hussein
- Department of Urology, University of California, San Francisco, CA, USA
- Department of Urology, Cairo University, Cairo, Egypt
| | - Ching-Shwun Lin
- Department of Urology, University of California, San Francisco, CA, USA
| | - Tom F. Lue
- Department of Urology, University of California, San Francisco, CA, USA
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Mesenchymal stromal cells for sphincter regeneration. Adv Drug Deliv Rev 2015; 82-83:123-36. [PMID: 25451135 DOI: 10.1016/j.addr.2014.10.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Revised: 09/29/2014] [Accepted: 10/15/2014] [Indexed: 02/06/2023]
Abstract
Stress urinary incontinence (SUI), defined as the involuntary loss of considerable amounts of urine during increased abdominal pressure (exertion, effort, sneezing, coughing, etc.), is a severe problem to the individuals affected and a significant medical, social and economic challenge. SUI is associated with pelvic floor debility, absence of detrusor contraction, or a loss of control over the sphincter muscle apparatus. The pathology includes an increasing loss of muscle cells, replacement of muscular tissue with fibrous tissue, and general aging associated processes of the sphincter complex. When current therapies fail to cure or improve SUI, application of regeneration-competent cells may be an alternative therapeutic option. Here we discuss different aspects of the biology of mesenchymal stromal cells, which are relevant to their clinical applications and for regenerating the sphincter complex. However, there are reports in favor of and against cell-based therapies. We therefore summarize the potential and the risks of cell-based therapies for the treatment of SUI.
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Hakim L, De Ridder D, Van der Aa F. Slings for urinary incontinence and the application of cell-based therapy. Adv Drug Deliv Rev 2015; 82-83:22-30. [PMID: 25463774 DOI: 10.1016/j.addr.2014.11.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 10/15/2014] [Accepted: 11/08/2014] [Indexed: 02/08/2023]
Abstract
The most commonly used technique for the treatment of stress urinary incontinence (SUI) in women is the suburethral polypropylene sling, using either a retropubic or transobturator tape approach This treatment results in a cure rate of over 80%, based on both subjective and objective evaluations. Biological slings have been largely abandoned due to lack of efficacy. Despite the high success rates, 10-20% of women remain incontinent. Cell-based therapy might offer solutions for the future both for the primary setting as for the treatment of failures. Preclinical studies suggest that stem cells (SC) can enhance the recovery of damaged tissue either by direct integration and replacement of damaged tissue (differentiation) or by secreting factors that influence host response mechanisms (paracrine effect). The clinical data to date do not allow strong efficacy conclusions, except that SC therapy seems to be safe in the short term. Most published studies use autologous cells. Allogeneic cell sources need to be investigated as well to allow ready-to-use solutions in the future. Most importantly, we need better insight into the mechanisms of action. We need more basic stem cell research, better acute and chronic animal models, better investigational tools and more efforts using tissue engineering approach.
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Gopinath C, Ponsaerts P, Wyndaele JJ. Cell-Based Therapies in Lower Urinary Tract Disorders. Cell Transplant 2014; 24:1679-86. [PMID: 25291710 DOI: 10.3727/096368914x685050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Cell-based therapy for the bladder has its beginnings in the 1990s with the successful isolation and culture of bladder smooth muscle cells. Since then, several attempts have been made to artificially implant native cell types and stem cell-derived cells into damaged bladders in the form of single-cell injectables or as grafts seeded onto artificial extracellular matrix. We critically examined in the literature the types of cells and their probable role as an alternative to non-drug-based, non-bowel-based graft replacement therapy in disorders of the urinary bladder. The limitations and plausible improvements to these novel therapies have also been discussed, keeping in mind an ideal therapy that could suit most bladder abnormalities arising out of varied number of disorders. In conclusion, muscle-derived cell types have consistently proven to be a promising therapy to emerge in the coming decade. However, tissue-engineered constructs have yet to prove their success in preclinical and long-term clinical setting.
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Effect of myogenic stem cells on the integrity and histomorphology of repaired transected external anal sphincter. Int Urogynecol J 2014; 26:251-6. [PMID: 25253391 DOI: 10.1007/s00192-014-2496-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 08/24/2014] [Indexed: 01/30/2023]
Abstract
INTRODUCTION AND HYPOTHESIS The objective was to evaluate the effect of myogenic stem cells on histological properties and the volume of striated muscle of the external anal sphincter after transection and repair. METHODS Histological analysis was performed on the external anal sphincters of 40 young female rats euthanized at 7 or 90 days after transection and repair and randomization to injection of either phosphate buffered solution (PBS) or myogenic stem cells (SC) at the transection site. Sphincter complexes, previously evaluated for neurophysiological function, were processed for histology and analyzed for possible disruption, amount of inflammation, and volume of striated muscle. The relationship between the muscular disruption and contractile force of sphincters was evaluated. RESULTS Disruption was seen in 100 % of sphincters 7 days after repair for both SC and control animals. Eighty-nine percent of controls and 78% of SC-administered animals had intact sphincters at 90 days. Significant inflammatory infiltrate was seen in repaired anal sphincters for both the PBS and the SC groups at 7 days, and persisted at 90 days, with no difference between treatment groups. Striated muscle volume increased from 7 to 90 days for both control and SC-administered animals. Although there was no difference in volume between treatments, there was substantial temporal improvement in contractile force generation of the sphincters receiving SC compared with those receiving PBS. CONCLUSION In this animal model, administration of myogenic stem cells to transected/repaired anal sphincters did not alter the amount of inflammation nor the volume of striated muscle, suggesting that stem cells might improve contractile function through other cellular processes.
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Drake MJ, Williams J, Bijos DA. Voiding dysfunction due to detrusor underactivity: an overview. Nat Rev Urol 2014; 11:454-64. [PMID: 25002201 DOI: 10.1038/nrurol.2014.156] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Detrusor underactivity (DUA) is defined as a voiding contraction of reduced strength and/or duration, which prolongs urination and/or prevents complete emptying of the bladder within a 'normal' period of time. This issue is associated with voiding and postmicturition urinary symptoms, and can predispose to urinary infections and acute urinary retention. The aetiology of DUA is influenced by multiple factors, including ageing, bladder outlet obstruction, neurological disease, and autonomic denervation. The true prevalence of this condition remains unknown, as most data come from referral populations. Urodynamic testing is used to diagnose the condition, either by assessing the relationship between bladder pressures and urinary flow, or by interrupting voiding to measure detrusor pressure change under isovolumetric conditions. Current treatments for DUA have poor efficacy and tolerability, and often fail to improve quality of life; muscarinic receptor agonists, in particular, have limited efficacy and frequent adverse effects. Bladder emptying might be achieved through Valsalva straining, and intermittent or indwelling catheterization, although sacral nerve stimulation can reduce dependency on catheterization. Novel stem-cell-based therapies have been attempted; however, new drugs that increase contractility are currently largely conceptual, and the complex pathophysiology of DUA, difficulty achieving organ specificity of treatment, the limited availability of animal models, and the subjective nature of current outcome measures must be addressed to facilitate the development of such agents.
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Affiliation(s)
- Marcus J Drake
- Urology Department, University of Bristol and Bristol Urological Institute, Southmead Hospital, Bristol, Avon BS10 5NB, UK
| | - Jonathan Williams
- Urology Department, University of Bristol and Bristol Urological Institute, Southmead Hospital, Bristol, Avon BS10 5NB, UK
| | - Dominika A Bijos
- Urology Department, University of Bristol and Bristol Urological Institute, Southmead Hospital, Bristol, Avon BS10 5NB, UK
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Chung E. Underactive Bladder and Detrusor Underactivity: a Review of Pathophysiology and Management Strategies for This Poorly Understood Bladder Syndrome. CURRENT BLADDER DYSFUNCTION REPORTS 2014. [DOI: 10.1007/s11884-014-0248-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Chen W, Xie M, Yang B, Bharadwaj S, Song L, Liu G, Yi S, Ye G, Atala A, Zhang Y. Skeletal myogenic differentiation of human urine-derived cells as a potential source for skeletal muscle regeneration. J Tissue Eng Regen Med 2014; 11:334-341. [DOI: 10.1002/term.1914] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 03/11/2014] [Accepted: 04/20/2014] [Indexed: 12/27/2022]
Affiliation(s)
- Wei Chen
- Wake Forest Institute for Regenerative Medicine; Wake Forest School of Medicine; Winston-Salem NC USA
- Department of Urology, Xinqiao Hospital; Third Military Medical University; Chongqing People's Republic of China
| | - Minkai Xie
- Wake Forest Institute for Regenerative Medicine; Wake Forest School of Medicine; Winston-Salem NC USA
- Department of Urology; Shanghai Jiaotong University Affiliated Sixth People's Hospital; Shanghai People's Republic of China
- Shanghai Oriental Institute for Urologic Reconstruction; Shanghai People's Republic of China
| | - Bin Yang
- Wake Forest Institute for Regenerative Medicine; Wake Forest School of Medicine; Winston-Salem NC USA
- Department of Urology, Shanghai Tenth People's Hospital; Tongji University School of Medicine; Shanghai People's Republic of China
| | - Shantaram Bharadwaj
- Wake Forest Institute for Regenerative Medicine; Wake Forest School of Medicine; Winston-Salem NC USA
| | - Lujie Song
- Wake Forest Institute for Regenerative Medicine; Wake Forest School of Medicine; Winston-Salem NC USA
- Department of Urology; Shanghai Jiaotong University Affiliated Sixth People's Hospital; Shanghai People's Republic of China
- Shanghai Oriental Institute for Urologic Reconstruction; Shanghai People's Republic of China
| | - Guihua Liu
- Wake Forest Institute for Regenerative Medicine; Wake Forest School of Medicine; Winston-Salem NC USA
| | - Shanhong Yi
- Department of Urology, Xinqiao Hospital; Third Military Medical University; Chongqing People's Republic of China
| | - Gang Ye
- Department of Urology, Xinqiao Hospital; Third Military Medical University; Chongqing People's Republic of China
| | - Anthony Atala
- Wake Forest Institute for Regenerative Medicine; Wake Forest School of Medicine; Winston-Salem NC USA
| | - Yuanyuan Zhang
- Wake Forest Institute for Regenerative Medicine; Wake Forest School of Medicine; Winston-Salem NC USA
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Wang Y, Fu Q, Zhao RY, Deng CL. Muscular tubes of urethra engineered from adipose-derived stem cells and polyglycolic acid mesh in a bioreactor. Biotechnol Lett 2014; 36:1909-16. [PMID: 24930094 DOI: 10.1007/s10529-014-1554-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 05/08/2014] [Indexed: 12/17/2022]
Abstract
We have explored the feasibility of using adipose-derived stem cells (ADSCs) and polyglycolic acid (PGA) for constructing muscular tubes of urethra in a bioreactor. With the induction of by 5-azacytidine, ADSCs were found to acquire a myoblast phenotype. Here we seeded ADSCs in a PGA mesh to construct the cell-PGA complex that was cultured statically for 1 week. Afterwards, the cell-PGA complex was subjected to extension stimulation in a bioreactor for 5 weeks. A muscular tube of urethra was formed after 6 weeks. Histological examination showed differentiated ADSCs and collagenous fibers had orientated well. This study demonstrates that tissue engineering of urethra tissues in vitro by using a bioreactor leads to tissue maturation and the differentiation of ADSCs. This novel technique could provide an effective approach for urethra tissue engineering.
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Affiliation(s)
- Ying Wang
- Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Yi Shan Road 600, Shanghai, 200233, China
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Vaegler M, DaSilva L, Benz K, Amend B, Mollenhauer J, Aicher W, Stenzl A, Sievert KD. Zellbasierte Therapie der Belastungsinkontinenz. Urologe A 2014; 53:354-61. [DOI: 10.1007/s00120-013-3353-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Aicher WK, Hart ML, Stallkamp J, Klünder M, Ederer M, Sawodny O, Vaegler M, Amend B, Sievert KD, Stenzl A. Towards a Treatment of Stress Urinary Incontinence: Application of Mesenchymal Stromal Cells for Regeneration of the Sphincter Muscle. J Clin Med 2014; 3:197-215. [PMID: 26237258 PMCID: PMC4449674 DOI: 10.3390/jcm3010197] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 01/16/2014] [Accepted: 01/17/2014] [Indexed: 02/07/2023] Open
Abstract
Stress urinary incontinence is a significant social, medical, and economic problem. It is caused, at least in part, by degeneration of the sphincter muscle controlling the tightness of the urinary bladder. This muscular degeneration is characterized by a loss of muscle cells and a surplus of a fibrous connective tissue. In Western countries approximately 15% of all females and 10% of males are affected. The incidence is significantly higher among senior citizens, and more than 25% of the elderly suffer from incontinence. When other therapies, such as physical exercise, pharmacological intervention, or electrophysiological stimulation of the sphincter fail to improve the patient’s conditions, a cell-based therapy may improve the function of the sphincter muscle. Here, we briefly summarize current knowledge on stem cells suitable for therapy of urinary incontinence: mesenchymal stromal cells, urine-derived stem cells, and muscle-derived satellite cells. In addition, we report on ways to improve techniques for surgical navigation, injection of cells in the sphincter muscle, sensors for evaluation of post-treatment therapeutic outcome, and perspectives derived from recent pre-clinical studies.
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Affiliation(s)
- Wilhelm K Aicher
- KFO273, Department of Urology, University of Tuebingen Hospital, Tuebingen 72076, Germany.
| | - Melanie L Hart
- KFO273, Department of Urology, University of Tuebingen Hospital, Tuebingen 72076, Germany.
| | - Jan Stallkamp
- FRAUNHOFER Institute, Klinikum Mannhein, Mannheim 68167, Germany.
| | - Mario Klünder
- Department for Systems Dynamics, University of Stuttgart, Stuttgart 70569, Germany.
| | - Michael Ederer
- Department for Systems Dynamics, University of Stuttgart, Stuttgart 70569, Germany.
| | - Oliver Sawodny
- Department for Systems Dynamics, University of Stuttgart, Stuttgart 70569, Germany.
| | - Martin Vaegler
- KFO273, Department of Urology, University of Tuebingen Hospital, Tuebingen 72076, Germany.
| | - Bastian Amend
- KFO273, Department of Urology, University of Tuebingen Hospital, Tuebingen 72076, Germany.
- Department of Urology, University of Tuebingen Hospital, Tuebingen 72076, Germany.
| | - Karl D Sievert
- KFO273, Department of Urology, University of Tuebingen Hospital, Tuebingen 72076, Germany.
- Department of Urology, University of Tuebingen Hospital, Tuebingen 72076, Germany.
| | - Arnulf Stenzl
- KFO273, Department of Urology, University of Tuebingen Hospital, Tuebingen 72076, Germany.
- Department of Urology, University of Tuebingen Hospital, Tuebingen 72076, Germany.
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Abstract
Congenital abnormalities and acquired disorders can lead to organ damage or loss of tissue within the genitourinary tract. For reconstructive purposes, tissue-engineering efforts are currently underway for virtually every type of tissue and organ within the urinary tract. Tissue engineering incorporates the fields of cell transplantation, materials science and engineering for the purpose of creating functional replacement tissue. This article reviews some of the principles of tissue engineering and some of the applications of these principles to the genitourinary tract.
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Affiliation(s)
- Anthony Atala
- Wake Forest Institute for Regenerative Medicine, Wake Forest University School of Medicine, Medical Center Blvd., Winston Salem, NC 27157, USA.
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Hajiabbas M, Mashayekhan S, Nazaripouya A, Naji M, Hunkeler D, Rajabi Zeleti S, Sharifiaghdas F. Chitosan-gelatin sheets as scaffolds for muscle tissue engineering. ARTIFICIAL CELLS NANOMEDICINE AND BIOTECHNOLOGY 2013; 43:124-32. [DOI: 10.3109/21691401.2013.852101] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Bisson A, Fréret M, Drouot L, Jean L, Le Corre S, Gourcerol G, Doucet C, Michot F, Boyer O, Lamacz M. Restoration of anal sphincter function after myoblast cell therapy in incontinent rats. Cell Transplant 2013; 24:277-86. [PMID: 24143883 DOI: 10.3727/096368913x674053] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Fecal incontinence (FI) remains a socially isolating condition with profound impact on quality of life for which autologous myoblast cell therapy represents an attractive treatment option. We developed an animal model of FI and investigated the possibility of improving sphincter function by intrasphincteric injection of syngeneic myoblasts. Several types of anal cryoinjuries were evaluated on anesthetized Fischer rats receiving analgesics. The minimal lesion yielding sustainable anal sphincter deficiency was a 90° cryoinjury of the sphincter, repeated after a 24-h interval. Anal sphincter pressure was evaluated longitudinally by anorectal manometry under local electrostimulation. Myoblasts were prepared using a protocol mimicking a clinical-grade process and further transduced with a GFP-encoding lentiviral vector before intrasphincteric injection. Experimental groups were uninjured controls, cryoinjured + PBS, and cryoinjured + myoblasts (different doses or injection site). Myoblast injection was well tolerated. Transferred myoblasts expressing GFP integrated into the sphincter and differentiated in situ into dystrophin-positive mature myofibers. Posttreatment sphincter pressures increased over time. At day 60, pressures in the treated group were significantly higher than those of PBS-injected controls and not significantly different from those of normal rats. Longitudinal follow-up showed stability of the therapeutic effect on sphincter function over a period of 6 months. Intrasphincteric myoblast injections at the lesion borders were equally as effective as intralesion administration, but an injection opposite to the lesion was not. These results provide proof of principle for myoblast cell therapy to treat FI in a rat model. This strategy is currently being evaluated in humans in a randomized double-blind placebo-controlled clinical trial.
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Kantartzis KL, Moalli PA. Stem Cell Therapy for Female Urinary Incontinence. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2013. [DOI: 10.1007/s13669-013-0049-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Sumino Y, Mimata H. Regenerative medicine as a new therapeutic strategy for lower urinary tract dysfunction. Int J Urol 2013; 20:670-5. [PMID: 23594124 DOI: 10.1111/iju.12137] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Accepted: 02/05/2013] [Indexed: 12/30/2022]
Abstract
The use of regenerative medicine for the treatment of organic and functional disorders intractable to conventional treatment has increased worldwide. This innovative medical field might particularly hold promise for the treatment of life-threatening diseases or healing of irreplaceable organs, such as the heart, liver and brain. Dysfunction of the urogenital tract and associated organs other than the kidney might not have immediate life-threatening implications; furthermore, the effectiveness of alternative therapy, such as enterocystoplasty for bladder cancer, has been shown. Therefore, most physicians or scientists do not give much importance to these disorders. However, urological disease has increased in developed societies in recent years. Furthermore, medical costs have also escalated. Disorders of the lower urinary tract, such as urinary disturbance or incontinence, can lead to other complications, impairing quality of life and ultimately increasing short- and long-term medical expenses. Regenerative medicine might hold potential solutions to these problems. Recent advances in urogenital regenerative medicine are reviewed in the present article, with particular reference to lower urinary tract reconstruction. The potential of regenerative medicine for the treatment of intractable lower urinary tract dysfunction compared with conventional treatment is also discussed.
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Affiliation(s)
- Yasuhiro Sumino
- Department of Urology, Oita University Faculty of Medicine, Oita, Japan
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Yoshimura N, Miyazato M, Sasaki K, Yokoyama H, Oguchi T, Chancellor MB, Funahashi Y. Gene therapy for lower urinary tract dysfunction. Int J Urol 2012; 20:56-63. [DOI: 10.1111/j.1442-2042.2012.03226.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Accepted: 10/05/2012] [Indexed: 11/28/2022]
Affiliation(s)
- Naoki Yoshimura
- Department of Urology; University of Pittsburgh School of Medicine; Pittsburgh; Pennsylvania; USA
| | - Minoru Miyazato
- Department of Urology; University of Pittsburgh School of Medicine; Pittsburgh; Pennsylvania; USA
| | - Katsumi Sasaki
- Department of Urology; University of Pittsburgh School of Medicine; Pittsburgh; Pennsylvania; USA
| | - Hitoshi Yokoyama
- Department of Urology; University of Pittsburgh School of Medicine; Pittsburgh; Pennsylvania; USA
| | - Tomohiko Oguchi
- Department of Urology; University of Pittsburgh School of Medicine; Pittsburgh; Pennsylvania; USA
| | - Michael B Chancellor
- Department of Urology; Oakland University William Beaumont School of Medicine; Royal Oak; Michigan; USA
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Lee JY, Piao S, Kim IG, Byun SS, Hwang JH, Hong SH, Kim SW, Hwang TK, Lee JY. Effect of human muscle-derived stem cells on cryoinjured mouse bladder contractility. Urology 2012; 80:224.e7-11. [PMID: 22748891 DOI: 10.1016/j.urology.2012.03.037] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2011] [Revised: 02/29/2012] [Accepted: 03/29/2012] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To investigate the effect of human muscle-derived stem cells (hMDSCs) on ameliorating impaired detrusor contractility in a cryoinjured bladder murine model. METHODS The hMDSCs were isolated and cultured by modified preplate technique, and only CD34-positive hMDSCs were extracted by Mini-MACS kits. Isolated hMDSCs were prelabeled with PKH26 and injected into the cryoinjured bladder to observe the pattern and characteristics. The nude mice were subdivided into three groups: normal group (N), cryoinjury bladder group with saline injection (C), and hMDSCs injection group after cryoinjury (M). At 2 weeks after injecting hMDSCs, we compared the contractility of bladder muscle strip stimulated by electrical field stimulation (EFS), acetylcholine (Ach.), and adenosine triphosphate (ATP), and the bladder smooth muscle tissue was examined by immunohistochemistry. RESULTS The contractile powers of bladder muscle strip in the C group were more decreased than the N group after EFS, Ach, and ATP treatment (P < .05). The bladder contractility of the M group was more increased than in the C group (P < .05), but was lower than the N group after EFS and Ach treatment. However, there was no significant difference of contractile power between the C and M groups after ATP stimulation. In immunohistochemical staining, the thickness of the bladder smooth muscle layer in the M group was significantly increased compared with the C group, and PKH26-labeled implanted cells were positive for smooth muscle cell differentiation marker (α-SMA) in the injected region. CONCLUSION hMDSCs injection increased cholinergic bladder contractile power but not the purinergic component of bladder contraction after cryoinjury.
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Affiliation(s)
- Ji Young Lee
- Department of Urology, College of Medicine, Catholic University of Korea, Seoul, Korea
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Eberli D, Aboushwareb T, Soker S, Yoo JJ, Atala A. Muscle Precursor Cells for the Restoration of Irreversibly Damaged Sphincter Function. Cell Transplant 2012; 21:2089-98. [DOI: 10.3727/096368911x623835] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Multiple modalities, including injectable bulking agents and surgery, have been used to treat stress urinary incontinence. However, none of these methods is able to fully restore normal striated sphincter muscle function. In this study, we explored the possibility of achieving functional recovery of the urinary sphincter muscle using autologous muscle precursor cells (MPCs) as an injectable, cell-based therapy. A canine model of striated urinary sphincter insufficiency was created by microsurgically removing part of the sphincter muscle in 24 dogs. Autologous MPCs were obtained, expanded in culture, and injected into the damaged sphincter muscles of 12 animals. The animals were followed for up to 6 months after injection, and urodynamic studies, functional organ bath studies, ultrastructural and histological examinations were performed. Animals receiving MPC injections demonstrated sphincter pressures of approximately 80% of normal values, while the pressures in the control animals without cells dropped and remained at 20% of normal values. Histological analysis indicated that the implanted cells survived and formed tissue, including new innervated muscle fibers, within the injected region of the sphincter. These results indicate that autologous muscle precursor cells may be able to restore otherwise irreversibly damaged urinary sphincter function clinically.
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Affiliation(s)
- Daniel Eberli
- Department of Urology and Wake Forest Institute for Regenerative Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Tamer Aboushwareb
- Department of Urology and Wake Forest Institute for Regenerative Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Shay Soker
- Department of Urology and Wake Forest Institute for Regenerative Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - James J. Yoo
- Department of Urology and Wake Forest Institute for Regenerative Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Anthony Atala
- Department of Urology and Wake Forest Institute for Regenerative Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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Lane FL, Jacobs S. Stem cells in gynecology. Am J Obstet Gynecol 2012; 207:149-56. [PMID: 22464292 DOI: 10.1016/j.ajog.2012.01.045] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2011] [Revised: 01/12/2012] [Accepted: 01/31/2012] [Indexed: 12/14/2022]
Abstract
Stem cell based therapies hold promise for the obstetrician and gynecologist. This article reviews the history of stem cells and some of their current applications in gynecology. Currently, mesenchymal and muscle-derived stem cells are being explored for the treatment of urinary and anal incontinence. Potential stem cell treatments include fistula repair, vaginal tissue engineering, and graft material enhancement. Published animal and human pilot studies demonstrate improved histologic and functional outcomes in those receiving stem cells. Transplanted cells may improve function by local engraftment, trophic factors, or modulation of inflammation. Further clinical and safety studies are needed before clinical application.
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Craig JB, Lane FL, Nistor G, Motakef S, Pham QA, Keirstead H. Allogenic myoblast transplantation in the rat anal sphincter. Female Pelvic Med Reconstr Surg 2012; 16:205-8. [PMID: 22453342 DOI: 10.1097/spv.0b013e3181ec1edd] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVES : To determine the feasibility of injecting rat myoblasts into the intact anal sphincter as a potential treatment for anal incontinence, and to detect transferred myoblast survival and integration. STUDY DESIGN : A pilot study using nonpregnant female Sprague Dawley rodents of 8 to 10 weeks of age. A biopsy of skeletal muscle was harvested from a study animal and recovered myoblasts were expanded in vitro over 10 days. Myoblasts were then tagged with a cytomegalovirus promoter to transduce green fluorescent protein (GFP) into the myoblasts. The cell aspirate was injected directly into the intact external anal sphincter using an electromyographic guidance. The animals received 1.5 or 4.5 × 10 cells of GFP-labeled myoblasts, dividing the dose between three injection sites. The remaining in vitro myoblasts were still viable 28 days post-harvest. Ten days after transplantation the anal sphincter complex was surgically extracted. RESULTS : The presence of GFP-labeled myoblasts was confirmed within the external anal sphincter. CONCLUSIONS : This demonstrates that myoblasts can be successfully extracted, cultivated in vitro, transplanted and will integrate into the host tissue.
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Affiliation(s)
- Jocelyn B Craig
- From the *Division of Urogynecology, Department of Obstetrics and Gynecology, and †Department of Anatomy and Neurobiology, Reeve-Irvine Research Center, University of California-Irvine, Orange, CA
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Kang MR, Yang G, Charisse K, Epstein-Barash H, Manoharan M, Li LC. An orthotopic bladder tumor model and the evaluation of intravesical saRNA treatment. J Vis Exp 2012:4207. [PMID: 22872227 DOI: 10.3791/4207] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
We present a novel method for treating bladder cancer with intravesically delivered small activating RNA (saRNA) in an orthotopic xenograft mouse bladder tumor model. The mouse model is established by urethral catheterization under inhaled general anesthetic. Chemical burn is then introduced to the bladder mucosa using intravesical silver nitrate solution to disrupt the bladder glycosaminoglycan layer and allows cells to attach. Following several washes with sterile water, human bladder cancer KU-7-luc2-GFP cells are instilled through the catheter into the bladder to dwell for 2 hours. Subsequent growth of bladder tumors is confirmed and monitored by in vivo bladder ultrasound and bioluminescent imaging. The tumors are then treated intravesically with saRNA formulated in lipid nanoparticles (LNPs). Tumor growth is monitored with ultrasound and bioluminescence. All steps of this procedure are demonstrated in the accompanying video.
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Affiliation(s)
- Moo Rim Kang
- Department of Urology and Helen Diller Comprehensive Cancer Center, University of California-San Francisco
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