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Seifalian A, Digesu A, Khullar V. The use of animal models in preclinical investigations for the development of a surgical mesh for pelvic organ prolapse. Int Urogynecol J 2024; 35:741-758. [PMID: 38358519 PMCID: PMC11052796 DOI: 10.1007/s00192-024-05741-3] [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: 08/17/2023] [Accepted: 01/20/2024] [Indexed: 02/16/2024]
Abstract
INTRODUCTION AND HYPOTHESIS Polypropylene (PP) mesh for the treatment of pelvic organ prolapse (POP) has raised substantial concerns over long-term complications, leading to its ban in multiple countries. In response, emerging materials are being explored as alternatives for prolapse surgery. Preclinical animal models have historically played a pivotal role in validating medical devices, prior to clinical trials. Successful translation of these materials necessitates the identification of suitable animal models that replicate the female human pelvis and its biomechanical properties. Preclinical in vivo testing assesses the safety of surgical mesh and treatment efficacy in preventing POP recurrence. METHODS The research critically reviews animal models used for preclinical pelvic mesh testing over the last decade and proposes a promising model for future preclinical studies. RESULTS Rats were the most common mammal used for toxicity and biocompatibility investigations through abdominal implantation. Although non-human primates serve as a gold standard for efficacy testing, ethical considerations limit their use owing to their close biological and cognitive resemblance to humans. Consequently, sheep were the most preferred large animal model owing to their reproductive system similarities and propensity for spontaneous POP following parity. CONCLUSION The study contributes valuable insights into the selection of appropriate animal models for preclinical pelvic mesh testing, offering guidance that is crucial for enhancing the safety and efficacy of novel surgical interventions in the treatment of POP.
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Affiliation(s)
- Amelia Seifalian
- Department of Urogynaecology, Imperial College London, London, UK.
| | - Alex Digesu
- Department of Urogynaecology, Imperial College London, London, UK
| | - Vikram Khullar
- Department of Urogynaecology, Imperial College London, London, UK
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Wu X, Jia Y, Sun X, Wang J. Acceleration of pelvic tissue generation by overexpression of basic fibroblast growth factor in stem cells. Connect Tissue Res 2022; 63:256-268. [PMID: 33627007 DOI: 10.1080/03008207.2021.1895130] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Pelvic organ prolapse (POP) is a common debilitating condition affecting approximately 30-40% of women. The FDA issued a warning about polypropylene mesh used for pelvic floor repair due to erosion, exposure and other complications and banned it in 2019. The application of stem cell therapy and growth factors has strongly promoted the development of pelvic tissue engineering. PURPOSE we intend to address the issues of direct application of growth factors, the side effects of long-term exogenous treatment, and the directional differentiation of stem cells. Methods: we evaluated the paracrine effects and directional differentiation of adipose mesenchymal stem cells through stable overexpression of basic fibroblast growth factor (bFGF). RESULTS we found that the modified stem cells could continuously and stably release bFGF in the initial stage and could spontaneously differentiate into fibroblasts with a high differentiation efficiency in the later stage. CONCLUSION following ADSCs are designed to continuously release controllable levels of growth factors during the control period of repair, taking advantage of the paracrine function of stem cells to accelerate cell growth and extracellular matrix (ECM) reconstruction during the early stage of stem cell implantation, and then stem cells are differentiated into target tissues-fibroblasts to accelerate the reconstruction of pelvic floor tissues, this study demonstrated the strong therapeutic potential of this approach for pelvic tissue engineering. ABBREVIATIONS POP: Pelvic organ prolapse; ADSCs: Adipose-derived stem cells; bFGF: Basic fibroblast growth factor; BMSCs: Bone marrow-derived mesenchymal stem cells; HUVECs: Human umbilical vein endothelial cells; EMSCs: Endometrial mesenchymal stem cells; VEGF: Vascular endothelial growth factor; PDGF: Platelet-derived growth factor ECM: Extracellular matrix; IGF: Insulin-like growth factor; HGF: Hepatocyte growth factor; EGF: Epidermal growth factor; BMP-2: Bone morphogenetic protein 2; FBR: Foreign body reaction.
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Affiliation(s)
- Xiaotong Wu
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, China.,Beijing Key Laboratory of Female Pelvic Floor Disorders, Beijing, China
| | - Yuanyuan Jia
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, China.,Beijing Key Laboratory of Female Pelvic Floor Disorders, Beijing, China
| | - Xiuli Sun
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, China.,Beijing Key Laboratory of Female Pelvic Floor Disorders, Beijing, China
| | - Jianliu Wang
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, China.,Beijing Key Laboratory of Female Pelvic Floor Disorders, Beijing, China
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Yang D, Zhang M, Liu K. Tissue engineering to treat pelvic organ prolapse. JOURNAL OF BIOMATERIALS SCIENCE-POLYMER EDITION 2021; 32:2118-2143. [PMID: 34313549 DOI: 10.1080/09205063.2021.1958184] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Pelvic organ prolapse (POP) is a frequent chronic illness, which seriously affects women's living quality. In recent years, tissue engineering has made superior progress in POP treatment, and biological scaffolds have received considerable attention. Nevertheless, pelvic floor reconstruction still faces severe challenges, including the construction of ideal scaffolds, the selection of optimal seed cells, and growth factors. This paper summarizes the recent progress of pelvic floor reconstruction in tissue engineering, and discusses the problems that need to be further considered and solved to provide references for the further development of this field.
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Affiliation(s)
- Deyu Yang
- Department of Biopharmaceutics, College of Food Science and Technology, Shanghai Ocean University, Shanghai, P.R. China
| | - Min Zhang
- Department of Biopharmaceutics, College of Food Science and Technology, Shanghai Ocean University, Shanghai, P.R. China
| | - Kehai Liu
- Department of Biopharmaceutics, College of Food Science and Technology, Shanghai Ocean University, Shanghai, P.R. China
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Ye M, Yu L, She Y, Wang S, Wang M, Zhao Q, Gu C, Bian L, Wen N, Gong J, Li L, Meng Y. Healing effects of a protein scaffold loaded with adipose-derived mesenchymal stem cells on radiation-induced vaginal injury in rats. J Int Med Res 2021; 48:300060520958826. [PMID: 33115306 PMCID: PMC7607296 DOI: 10.1177/0300060520958826] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Objectives Cervical cancer, the most common female cancer after breast cancer, is
typically treated using radiotherapy. However, pelvic radiotherapy can cause
irreversible damage to the vagina, seriously affecting patients’ quality of
life. In this study, protein scaffolds loaded with rat adipose-derived
mesenchymal stem cells (ADSCs) were implanted into irradiated tissue to
assess their healing potential. Methods We established a rat model of radiation-induced vaginal injury. Complexes
(consisting of protein scaffolds loaded with ADSCs) were implanted into
injury sites. Histological analysis were used to assess regeneration of the
vaginal epithelium. RNA sequencing was used to study the therapeutic
mechanism of the complexes. Results The complexes promoted vaginal epithelial cell regeneration, vaginal tissue
repair and improved vaginal stenosis and contracture. Compared with rats
transplanted with ADSCs, rats transplanted with complexes achieved better
therapeutic effects. Conclusions Protein scaffold-ADSC complexes had a beneficial therapeutic effect on
radiation-induced vaginal injury in rats and may serve as the basis of a
novel therapeutic approach for radiation dermatitis.
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Affiliation(s)
- Mingxia Ye
- Medical School of Chinese PLA, Department of Obstetrics and Gynecology The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Ling Yu
- Department of Obstetrics and Gynecology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yujia She
- Department of Obstetrics and Gynecology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Shufang Wang
- Blood Transfusion Department, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Min Wang
- Medical School of Chinese PLA, Department of Obstetrics and Gynecology The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Qingdong Zhao
- Medical School of Chinese PLA, Department of Obstetrics and Gynecology The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Chenglei Gu
- The Eighth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Lihua Bian
- Department of Obstetrics and Gynecology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Na Wen
- Medical School of Chinese PLA, Department of Obstetrics and Gynecology The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Jing Gong
- Anzhen Hospital Affiliated to Capital Medical University, Beijing, China
| | - Lian Li
- Department of Obstetrics and Gynecology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yuanguang Meng
- Department of Obstetrics and Gynecology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
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Abstract
Mesenchymal stem cells (MSCs), also referred to as multipotent stromal cells or mesenchymal stromal cells, are present in multiple tissues and capable of differentiating into diverse cell lineages, holding a great promise in developing cell-based therapy for a wide range of conditions. Pelvic floor disorders (PFDs) is a common degenerative disease in women and may diminish a woman's quality of life at any age. Since the treatments for this disease are limited by the high rates of recurrence and surgical complications, seeking an ideal therapy in the restoration of pelvic floor function is an urgent issue at present. Herein, we summarize the cell sources of MSCs used for PFDs and discuss the potential mechanisms of MSCs in treating PFDs. Specifically, we also provide a comprehensive review of current preclinical and clinical trials dedicated to investigating MSC-based therapy for PFDs. The novel therapy has presented promising therapeutic effects which include relieving the symptoms of urinary or fecal incontinence, improving the biological properties of implanted meshes and promoting the injured tissue repair. Nevertheless, MSC-based therapies for PFDs are still experimental and the unstated issues on their safety and efficacy should be carefully addressed before their clinical applications.
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Cheng J, Zhao ZW, Wen JR, Wang L, Huang LW, Yang YL, Zhao FN, Xiao JY, Fang F, Wu J, Miao YL. Status, challenges, and future prospects of stem cell therapy in pelvic floor disorders. World J Clin Cases 2020; 8:1400-1413. [PMID: 32368533 PMCID: PMC7190946 DOI: 10.12998/wjcc.v8.i8.1400] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 03/30/2020] [Accepted: 04/08/2020] [Indexed: 02/05/2023] Open
Abstract
Pelvic floor disorders (PFDs) represent a group of common and frequently-occurring diseases that seriously affect the life quality of women, generally including stress urinary incontinence and pelvic organ prolapse. Surgery has been used as a treatment for PFD, but almost 30% of patients require subsequent surgery due to a high incidence of postoperative complications and high recurrence rates. Therefore, investigations of new therapeutic strategies are urgently needed. Stem cells possess strong multi-differentiation, self-renewal, immunomodulation, and angiogenesis abilities and they are able to differentiate into various cell types of pelvic floor tissues and thus provide a potential therapeutic approach for PFD. Recently, various studies using different autologous stem cells have achieved promising results by improving the pelvic ligament and muscle regeneration and conferring the tissue elasticity and strength to the damaged tissue in PFD, as well as reduced inflammatory reactions, collagen deposition, and foreign body reaction. However, with relatively high rates of complications such as bladder stone formation and wound infections, further studies are necessary to investigate the role of stem cells as maintainers of tissue homeostasis and modulators in early interventions including therapies using new stem cell sources, exosomes, and tissue-engineering combined with stem cell-based implants, among others. This review describes the types of stem cells and the possible interaction mechanisms in PFD treatment, with the hope of providing more promising stem cell treatment strategies for PFD in the future.
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Affiliation(s)
- Juan Cheng
- Department of Obstetrics and Gynecology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of MOE, West China Second University Hospital, West China Campus, Sichuan University, Chengdu 610041, Sichuan Province, China
- Deep Underground Space Medical Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Zhi-Wei Zhao
- West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Ji-Rui Wen
- West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Ling Wang
- Deep Underground Space Medical Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Li-Wei Huang
- West China School of Stomatology Medicine, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Yan-Lin Yang
- West China School of Medicine/West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Feng-Nian Zhao
- West China School of Medicine/West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Jing-Yue Xiao
- West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Fei Fang
- West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Jiang Wu
- Deep Underground Space Medical Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Ya-Li Miao
- Department of Obstetrics and Gynecology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of MOE, West China Second University Hospital, West China Campus, Sichuan University, Chengdu 610041, Sichuan Province, China
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Jia YY, Zhou JY, Chang Y, An F, Li XW, Xu XY, Sun XL, Xiong CY, Wang JL. Effect of Optimized Concentrations of Basic Fibroblast Growth Factor and Epidermal Growth Factor on Proliferation of Fibroblasts and Expression of Collagen: Related to Pelvic Floor Tissue Regeneration. Chin Med J (Engl) 2018; 131:2089-2096. [PMID: 30127219 PMCID: PMC6111681 DOI: 10.4103/0366-6999.239301] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background: Fibroblasts were the main seed cells in the studies of tissue engineering of the pelvic floor ligament. Basic fibroblast growth factor (bFGF) and epidermal growth factor (EGF) were widely studied but at various concentrations. This study aimed to optimize the concentrations of combined bFGF and EGF by evaluating their effects on proliferation and collagen secretion of fibroblasts. Methods: Fibroblasts were differentiated from rat adipose mesenchymal stem cells (ADSCs). Flow cytometry and immunohistochemistry were used for cell identification. The growth factors were applied at concentrations of 0, 1, 10, and 100 ng/ml as three groups: (1) bFGF alone, (2) EGF alone, and (3) bFGF mixed with EGF. Cell proliferation was evaluated by Cell Counting Kit-8 assays. Expression of Type I and III collagen (Col-I and Col-III) mRNAs was evaluated by real-time quantitative reverse transcription-polymerase chain reaction. Statistical analysis was performed with SPSS software and GraphPad Prism using one-way analysis of variance and multiple t-test. Results: ADSCs were successfully isolated from rat adipose tissue as identified by expression of typical surface markers CD29, CD44, CD90, and CD45 in flow cytometry. Fibroblasts induced from ADSC, compared with ADSCs, were with higher mRNA expression levels of Col I and Col III (F = 1.29, P = 0.0390). bFGF, EGF, and the mixture of bFGF with EGF can enhanced fibroblasts proliferation, and the concentration of 10 ng/ml of the mixture of bFGF with EGF displayed most effectively (all P < 0.05). The expression levels of Col-I and Col-III mRNAs in fibroblasts displayed significant increases in the 10 ng/ml bFGF combined with EGF group (all P < 0.05). Conclusions: The optimal concentration of both bFGF and EGF to promote cell proliferation and collagen expression in fibroblasts was 10 ng/ml at which fibroblasts grew faster and secreted more Type I and III collagens into the extracellular matrix, which might contribute to the stability of the pelvic floor microenvironment.
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Affiliation(s)
- Yuan-Yuan Jia
- Department of Obstetrics and Gynecology, Peking University People's Hospital; Beijing Key Laboratory of Female Pelvic Floor Disorders, Beijing 100044, China
| | - Jing-Yi Zhou
- Department of Obstetrics and Gynecology, Peking University People's Hospital; Beijing Key Laboratory of Female Pelvic Floor Disorders, Beijing 100044, China
| | - Yue Chang
- Department of Obstetrics and Gynecology, Peking University People's Hospital; Beijing Key Laboratory of Female Pelvic Floor Disorders, Beijing 100044, China
| | - Fang An
- Department of Obstetrics and Gynecology, Peking University People's Hospital; Beijing Key Laboratory of Female Pelvic Floor Disorders, Beijing 100044, China
| | - Xiao-Wei Li
- Department of Obstetrics and Gynecology, Peking University People's Hospital; Beijing Key Laboratory of Female Pelvic Floor Disorders, Beijing 100044, China
| | - Xiao-Yue Xu
- Department of Obstetrics and Gynecology, Peking University People's Hospital; Beijing Key Laboratory of Female Pelvic Floor Disorders, Beijing 100044, China
| | - Xiu-Li Sun
- Department of Obstetrics and Gynecology, Peking University People's Hospital; Beijing Key Laboratory of Female Pelvic Floor Disorders, Beijing 100044, China
| | - Chun-Yang Xiong
- Department of Mechanics and Bioengineering, College of Engineering, Peking University, Beijing 100871, China
| | - Jian-Liu Wang
- Department of Obstetrics and Gynecology, Peking University People's Hospital; Beijing Key Laboratory of Female Pelvic Floor Disorders, Beijing 100044, China
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