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Jin Y, Zhao W, Yang M, Fang W, Gao G, Wang Y, Fu Q. Cell-Based Therapy for Urethral Regeneration: A Narrative Review and Future Perspectives. Biomedicines 2023; 11:2366. [PMID: 37760808 PMCID: PMC10525510 DOI: 10.3390/biomedicines11092366] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 07/29/2023] [Accepted: 08/16/2023] [Indexed: 09/29/2023] Open
Abstract
Urethral stricture is a common urological disease that seriously affects quality of life. Urethroplasty with grafts is the primary treatment, but the autografts used in clinical practice have unavoidable disadvantages, which have contributed to the development of urethral tissue engineering. Using various types of seed cells in combination with biomaterials to construct a tissue-engineered urethra provides a new treatment method to repair long-segment urethral strictures. To date, various cell types have been explored and applied in the field of urethral regeneration. However, no optimal strategy for the source, selection, and application conditions of the cells is available. This review systematically summarizes the use of various cell types in urethral regeneration and their characteristics in recent years and discusses possible future directions of cell-based therapies.
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Affiliation(s)
- Yangwang Jin
- Department of Urology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Eastern Institute of Urologic Reconstruction, Shanghai Jiao Tong University, Shanghai 200233, China; (Y.J.)
| | - Weixin Zhao
- Wake Forest Institute for Regenerative Medicine, Winston Salem, NC 27157, USA
| | - Ming Yang
- Department of Urology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Eastern Institute of Urologic Reconstruction, Shanghai Jiao Tong University, Shanghai 200233, China; (Y.J.)
| | - Wenzhuo Fang
- Department of Urology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Eastern Institute of Urologic Reconstruction, Shanghai Jiao Tong University, Shanghai 200233, China; (Y.J.)
| | - Guo Gao
- Key Laboratory for Thin Film and Micro Fabrication of the Ministry of Education, School of Sensing Science and Engineering, School of Electronic Information and Electrical Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Ying Wang
- Department of Urology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Eastern Institute of Urologic Reconstruction, Shanghai Jiao Tong University, Shanghai 200233, China; (Y.J.)
| | - Qiang Fu
- Department of Urology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Eastern Institute of Urologic Reconstruction, Shanghai Jiao Tong University, Shanghai 200233, China; (Y.J.)
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Horiguchi A, Shinchi M, Ojima K, Hirano Y, Kushibiki T, Mayumi Y, Miyai K, Miura I, Iwasaki M, Suryaprakash V, Senthilkumar R, Preethy S, Katoh S, Abraham SJK. Engraftment of Transplanted Buccal Epithelial Cells onto the Urethrotomy Site, Proven Immunohistochemically in Rabbit Model; a Feat to Prevent Urethral Stricture Recurrence. Stem Cell Rev Rep 2023; 19:275-278. [PMID: 36306011 PMCID: PMC9823073 DOI: 10.1007/s12015-022-10466-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2022] [Indexed: 01/29/2023]
Affiliation(s)
- Akio Horiguchi
- Department of Urology, National Defence Medical College, Tokorozawa, Saitama Japan
| | - Masayuki Shinchi
- Department of Urology, National Defence Medical College, Tokorozawa, Saitama Japan
| | - Kenichiro Ojima
- Department of Urology, National Defence Medical College, Tokorozawa, Saitama Japan
| | - Yusuke Hirano
- Department of Urology, National Defence Medical College, Tokorozawa, Saitama Japan
| | - Toshihiro Kushibiki
- Department of Medical Engineering, National Defence Medical College, Tokorozawa, Saitama Japan
| | - Yoshine Mayumi
- Department of Medical Engineering, National Defence Medical College, Tokorozawa, Saitama Japan
| | - Kosuke Miyai
- Departmet of Basic Pathology, National Defence Medical College, Tokorozawa, Saitama Japan
| | - Ichiro Miura
- Department of Clinical Laboratory, Hokkaido Institutional Society, Obihiro Hospital, Obihiro, Hokkaido Japan ,Department of Human Pathology, Juntendo University, Tokyo, Japan
| | - Masaru Iwasaki
- Center for Advancing Clinical Research (CACR), University of Yamanashi -Faculty of Medicine, 1110, Shimokato, Chuo, Yamanashi 409-3898 Japan
| | - Vaddi Suryaprakash
- Department of Urology, Yashoda Hospitals, Raj Bhavan Rd, Matha Nagar, Somajiguda, Hyderabad, Telangana 500082 India
| | - Rajappa Senthilkumar
- The Fujio-Eiji Academic Terrain (FEAT), Nichi-In Centre for Regenerative Medicine (NCRM), PB 1262, Chennai, 600034 Tamil Nadu India
| | - Senthilkumar Preethy
- The Fujio-Eiji Academic Terrain (FEAT), Nichi-In Centre for Regenerative Medicine (NCRM), PB 1262, Chennai, 600034 Tamil Nadu India
| | - Shojiro Katoh
- Edogawa Evolutionary Lab of Science (EELS), 2-24-18, Higashi-Koiwa, Edogawa, Tokyo, 133-0052 Japan
| | - Samuel J. K. Abraham
- Center for Advancing Clinical Research (CACR), University of Yamanashi -Faculty of Medicine, 1110, Shimokato, Chuo, Yamanashi 409-3898 Japan ,Edogawa Evolutionary Lab of Science (EELS), 2-24-18, Higashi-Koiwa, Edogawa, Tokyo, 133-0052 Japan ,The Mary-Yoshio Translational Hexagon (MYTH), Nichi-In Centre for Regenerative Medicine (NCRM), PB 1262, Chennai, 600034 Tamil Nadu India ,Division of Research & Development, JBM Inc, Tokyo, Japan ,Antony- Xavier Interdisciplinary Scholastics (AXIS), GN Corporation Co. Ltd, 3-8, Wakamatsu, Kofu, Yamanashi, 400-0866 Japan ,University of Yamanashi - School of Medicine, Chuo, Japan
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Abraham SJ. Editorial Comment to Ability of photocurable gelatin to prevent stricture recurrence after urethral dilation in rabbits. Int J Urol 2021; 29:175-176. [PMID: 34753202 DOI: 10.1111/iju.14742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Samuel Jk Abraham
- Center for Advancing Clinical Research, School of Medicine, University of Yamanashi, Chuo, Japan.,Mary-Yoshio Translational Hexagon, Nichi-In Center for Regenerative Medicine, Chennai, India.,Antony-Xavier Interdisciplinary Scholastics, GN Corporation, Kofu, Japan
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Hughes M, Blakely S, Nikolavsky D. Advancements in transurethral management of urethral stricture disease. Curr Opin Urol 2021; 31:504-510. [PMID: 34175872 DOI: 10.1097/mou.0000000000000913] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To explore and report the recent evolution of transurethral management of urethral stricture disease. RECENT FINDINGS In recent years, new promising techniques in the transurethral management of urethral stricture disease have emerged including adjuvant therapies to direct vision internal urethrotomy, regenerative therapy with buccal mucosa cells and minimally invasive transurethral urethroplasty procedures that avoid skin incisions. SUMMARY Although further work is needed, the expanding field of transurethral therapies for urethral stricture disease demonstrates early promising results through a variety of modalities.
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Affiliation(s)
- Michael Hughes
- SUNY Upstate Medical University, Department of Urology, Syracuse, New York, USA
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Horiguchi A, Ojima K, Shinchi M, Kushibiki T, Mayumi Y, Miyai K, Katoh S, Takeda M, Iwasaki M, Prakash VS, Balamurugan M, Rajmohan M, Preethy S, Abraham SJK. Successful engraftment of epithelial cells derived from autologous rabbit buccal mucosal tissue, encapsulated in a polymer scaffold in a rabbit model of a urethral stricture, transplanted using the transurethral approach. Regen Ther 2021; 18:127-132. [PMID: 34189194 PMCID: PMC8203727 DOI: 10.1016/j.reth.2021.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 05/06/2021] [Accepted: 05/15/2021] [Indexed: 11/19/2022] Open
Abstract
Background A pilot study reported an autologous buccal mucosal cell transplant in humans through the trans-urethral route using the buccal epithelium expanded and encapsulated in scaffold-hybrid approach to urethral stricture (BEES-HAUS), a minimally invasive approach to treat urethral stricture. Although successful outcomes were achieved in that study, for further validation, it is essential to prove that the transplanted buccal epithelium was engrafted over the urothelium through histological examination of the urethra, harvested post-transplant, which is infeasible in humans. Herein, we report the successful creation of an animal model of urethral stricture and the engraftment of epithelial cells derived from autologous buccal mucosal tissue, encapsulated in a thermo-reversible gelation polymer (TGP) scaffold, transplanted by trans-urethral route. Methods An animal model of urethral stricture was created in Japanese white male rabbits using electro-coagulation. Buccal tissue was harvested from the rabbits and subjected to enzyme digestion, followed by 5-7 days of in vitro culture in conventional two-dimensional (2D) culture and in a 3D platform of thermo-reversible gelation polymer (3D-TGP) culture. The cells harvested from the groups were mixed and encapsulated and transplanted with TGP, by transurethral catheterization. Fourteen days later, the urethra was harvested and subjected to histological examination. The buccal biopsy tissue, cells after digestion and cells post-culture were also subjected to histological examination. Urethrogram and endoscopy images were recorded at different time points. Results The stricture was successfully created, with the coagulated area markedly stenosed. Histological staining of the cells after in vitro processing showed that the cells grew with native epithelial and rounded cell morphology in 3D-TGP while they differentiated into fibroblast like-cells in 2D culture. Histological staining of the urethral tissue after transplantation revealed the engraftment of the transplanted buccal mucosal cells, with stratified squamous epithelium over the specialized stratified urothelium in the urethrotomy site. Conclusion We used histology to prove the successful engraftment of TGP-encapsulated buccal mucosal epithelial cells in an animal model of urethral injury with healing of the injured tissue. The model of urethral stricture and cell therapy, using a transurethral approach, recapitulates the previously reported BEES-HAUS approach and lays the foundation for larger multi-centric translational clinical studies.
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Affiliation(s)
- Akio Horiguchi
- Department of Urology, National Defence Medical College, Tokorozawa, Saitama, Japan
| | - Kenichiro Ojima
- Department of Urology, National Defence Medical College, Tokorozawa, Saitama, Japan
| | - Masayuki Shinchi
- Department of Urology, National Defence Medical College, Tokorozawa, Saitama, Japan
| | - Toshihiro Kushibiki
- Department of Medical Engineering, National Defence Medical College, Tokorozawa, Saitama, Japan
| | - Yoshine Mayumi
- Department of Medical Engineering, National Defence Medical College, Tokorozawa, Saitama, Japan
| | - Kosuke Miyai
- Department of Basic Pathology, National Defence Medical College, Tokorozawa, Saitama, Japan
| | - Shojiro Katoh
- Edogawa Evolutionary Lab of Science (EELS), 2-24-18, Higashi-Koiwa, Edogawa, Tokyo, 133-0052, Japan
- Edogawa Hospital, 2-24-18, Higashi-Koiwa, Edogawa, Tokyo, 133-0052, Japan
| | - Masayuki Takeda
- Department of Urology, Yamanashi University-Faculty of Medicine, 1110, Shimokato, Chuo, Yamanashi, 409-3898, Japan
| | - Masaru Iwasaki
- Center for Advancing Clinical Research (CACR), University of Yamanashi -Faculty of Medicine, 1110, Shimokato, Chuo, Yamanashi, 409-3898, Japan
| | - Vaddi Surya Prakash
- Department of Urology, Yashoda Hospitals, Raj Bhavan Rd, Matha Nagar, Somajiguda, Hyderabad, Telangana, 500082, India
| | - Madasamy Balamurugan
- The Fujio-Eiji Academic Terrain (FEAT), Nichi-In Centre for Regenerative Medicine (NCRM), PB 1262, Chennai, 600034, Tamil Nadu, India
| | | | | | - Samuel JK. Abraham
- Center for Advancing Clinical Research (CACR), University of Yamanashi -Faculty of Medicine, 1110, Shimokato, Chuo, Yamanashi, 409-3898, Japan
- JBM Inc., 3-1-14, Higashi-Koiwa, Edogawa, Tokyo, 133-0052, Japan
- The Mary-Yoshio Translational Hexagon (MYTH), Nichi-In Centre for Regenerative Medicine (NCRM), PB 1262, Chennai, 600034, Tamil Nadu, India
- The Antony-Xavier Interdisciplinary Scholastics (AXIS), GN Corporation Co. Ltd., 3-8, Wakamatsu, Kofu, Yamanashi, 400-0866, Japan
- Corresponding author. University of Yamanashi, School of Medicine, 3-8, Wakamatsu, Kofu, Yamanashi, 400-0866. Japan.
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Mershon JP, Baradaran N. Recurrent Anterior Urethral Stricture: Challenges and Solutions. Res Rep Urol 2021; 13:237-249. [PMID: 34012927 PMCID: PMC8128502 DOI: 10.2147/rru.s198792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 04/14/2021] [Indexed: 12/05/2022] Open
Abstract
Recurrent male anterior urethral stricture disease is a complex surgical challenge that should be managed by reconstructive urologists with experience in stricture management. Diagnosis of recurrence requires both anatomic narrowing and patient symptoms identified on validated questionnaires, with limited role for intervention in asymptomatic treatment “failures”. Endoscopic management has a very specific role in recurrence, and the choice of technique for urethroplasty depends on pre-operative urethrography and cystoscopy. Surgical success depends on addressing patient concerns, complete stricture excision, tissue quality optimization, and the use of multi-stage repair when indicated. Augmentation with genital skin flaps and/or grafts is often required, with buccal mucosa as the ideal graft source if local tissue is compromised. Salvage options including urinary diversion and perineal urethrostomy must also be considered in debilitated patients with severe disease or repeated treatment failures. Unique patient populations including patients with hypospadias and lichen sclerosis are among the highest risk for repeated recurrence and require special care in surgical technique, graft selection, and post-operative management.
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Affiliation(s)
| | - Nima Baradaran
- The Ohio State University Department of Urology, Columbus, OH, USA
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Zuckerman JM, Nikolavsky D. Is regenerative medicine the future of urology? World J Urol 2020; 38:2073-2074. [DOI: 10.1007/s00345-020-03371-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Abstract
Urethral stricturing is a narrowing of the urethral lumen as a result of ischaemic spongiofibrosis. The main challenge of currently available treatment options is recurrence of the stricture. Recent advancements in the treatment of urethral strictures mainly came from the fields of regenerative medicine and tissue engineering. Research efforts have primarily focused on decreasing the recurrence of stricture after internal urethrotomy and constructing tissue-engineered urethral substitutes to improve clinical outcomes of urethroplasty surgeries. The aim of this article is to review the most recent advancements in the management of urethral stricture disease in men.
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Affiliation(s)
- Naside Mangir
- Department of Functional and Reconstructive Urology, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF, UK
| | - Christopher Chapple
- Department of Functional and Reconstructive Urology, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF, UK
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