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Zhao S, Fang M, Li Y, Wang F, Li H, Wang L. Fabrication and in vitro investigation of hyperbranched poly-lysine-grafted warp knitted polypropylene sling for potential treatment of stress urinary incontinence. Biomater Sci 2023; 11:6504-6523. [PMID: 37577866 DOI: 10.1039/d3bm00943b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
Polypropylene (PP) sling implantation is the most commonly performed procedure for women with stress urinary incontinence (SUI). However, concerns have arisen regarding complications caused by slings, including the common issue of erosion, which can be attributed to various factors such as the body's response and bacterial contamination. To address these concerns, we have developed a rectangular mesh self-locking edge sling with a large pore size and lightweight design. Promising results have been obtained from preliminary in vivo mechanical reliability tests, including uniaxial tensile tests. In comparative in vitro fixed load tensile tests and simulated Tension-free Vaginal Tape (TVT) and Transobturator Vaginal Tape inside-out (TVT-O) technique tests using commercial slings, our sling demonstrated less transverse wrinkling. Both slings achieved an effective porosity of over 45% under the TVT technique. However, the commercial sling experienced a significant reduction in effective porosity during the TVT-O technique, whereas our sling maintained a stable effective porosity with minimal wrinkling. Furthermore, we successfully developed cationic hydration rejection-driven antibacterial-anti-fouling coatings on the surface of our sling by grafting hyperbranched poly-lysine (HBPL) mediated by polynorepinephrine. The HBPL coating imparts a positive charge and hydrophilicity to the sling, resulting in elevated bactericidal activity and reducing protein adhesion. An optimal grafting concentration of 20 mg mL-1 was selected, confirming the stability and biocompatibility of the sling coating. This coating is expected to reduce the likelihood of postoperative erosion. Overall, our research represents significant advancements in improving the safety and performance of PP slings for stress urinary incontinence, potentially leading to a reduction in complications following surgery.
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Affiliation(s)
- Shuying Zhao
- Key Laboratory of Textile Science & Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai, China.
- Key Laboratory of Textile Industry for Biomedical Textile Materials and Technology, Donghua University, Shanghai, China
| | - Meiqi Fang
- Key Laboratory of Textile Science & Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai, China.
- Key Laboratory of Textile Industry for Biomedical Textile Materials and Technology, Donghua University, Shanghai, China
| | - Yan Li
- Key Laboratory of Textile Science & Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai, China.
- Key Laboratory of Textile Industry for Biomedical Textile Materials and Technology, Donghua University, Shanghai, China
| | - Fujun Wang
- Key Laboratory of Textile Science & Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai, China.
- Key Laboratory of Textile Industry for Biomedical Textile Materials and Technology, Donghua University, Shanghai, China
| | - Hao Li
- Shanghai Hongyu Medical Technology Co., Ltd, Shanghai, China
| | - Lu Wang
- Key Laboratory of Textile Science & Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai, China.
- Key Laboratory of Textile Industry for Biomedical Textile Materials and Technology, Donghua University, Shanghai, China
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2
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Ouzin M, Kogler G. Mesenchymal Stromal Cells: Heterogeneity and Therapeutical Applications. Cells 2023; 12:2039. [PMID: 37626848 PMCID: PMC10453316 DOI: 10.3390/cells12162039] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/06/2023] [Accepted: 08/08/2023] [Indexed: 08/27/2023] Open
Abstract
Mesenchymal stromal cells nowadays emerge as a major player in the field of regenerative medicine and translational research. They constitute, with their derived products, the most frequently used cell type in different therapies. However, their heterogeneity, including different subpopulations, the anatomic source of isolation, and high donor-to-donor variability, constitutes a major controversial issue that affects their use in clinical applications. Furthermore, the intrinsic and extrinsic molecular mechanisms underlying their self-renewal and fate specification are still not completely elucidated. This review dissects the different heterogeneity aspects of the tissue source associated with a distinct developmental origin that need to be considered when generating homogenous products before their usage for clinical applications.
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Affiliation(s)
- Meryem Ouzin
- Institute for Transplantation Diagnostics and Cell Therapeutics, University Hospital Düsseldorf, 40225 Düsseldorf, Germany;
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3
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Ren J, Murray R, Wong CS, Qin J, Chen M, Totsika M, Riddell AD, Warwick A, Rukin N, Woodruff MA. Development of 3D Printed Biodegradable Mesh with Antimicrobial Properties for Pelvic Organ Prolapse. Polymers (Basel) 2022; 14:polym14040763. [PMID: 35215676 PMCID: PMC8877663 DOI: 10.3390/polym14040763] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 01/31/2022] [Accepted: 02/03/2022] [Indexed: 01/10/2023] Open
Abstract
To address the increasing demand for safe and effective treatment options for pelvic organ prolapse (POP) due to the worldwide ban of the traditional polypropylene meshes, this study introduced degradable polycaprolactone (PCL)/polyethylene glycol (PEG) composite meshes fabricated with melt-electrowriting (MEW). Two PCL/PEG mesh groups: 90:10 and 75:25 (PCL:PEG, wt%) were fabricated and characterized for their degradation rate and mechanical properties, with PCL meshes used as a control. The PCL/PEG composites showed controllable degradation rates by adjusting the PEG content and produced mechanical properties, such as maximal forces, that were higher than PCL alone. The antibacterial properties of the meshes were elicited by coating them with a commonly used antibiotic: azithromycin. Two dosage levels were used for the coating: 0.5 mg and 1 mg per mesh, and both dosage levels were found to be effective in suppressing the growth of S. aureus bacteria. The biocompatibility of the meshes was assessed using human immortalized adipose derived mesenchymal stem cells (hMSC). In vitro assays were used to assess the cell viability (LIVE/DEAD assay), cell metabolic activity (alamarBlue assay) and cell morphology on the meshes (fluorescent and electron microscopy). The cell attachment was found to decrease with increased PEG content. The freshly drug-coated meshes showed signs of cytotoxicity during the cell study process. However, when pre-released for 14 days in phosphate buffered saline, the initial delay in cell attachment on the drug-coated mesh groups showed full recovery at the 14-day cell culture time point. These results indicated that the PCL/PEG meshes with antibiotics coating will be an effective anti-infectious device when first implanted into the patients, and, after about 2 weeks of drug release, the mesh will be supporting cell attachment and proliferation. These meshes demonstrated a potential effective treatment option for POP that may circumvent the issues related to the traditional polypropylene meshes.
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Affiliation(s)
- Jiongyu Ren
- Centre for Biomedical Technologies, Queensland University of Technology (QUT), Brisbane, QLD 4000, Australia; (J.R.); (M.C.)
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology (QUT), Brisbane, QLD 4000, Australia
| | - Rebecca Murray
- Herston Biofabrication Institute, Metro North Health, Brisbane, QLD 4029, Australia; (R.M.); (N.R.)
- Australian Institute for Bioengineering and Nanotechnology, The University of Queensland, Brisbane, QLD 4072, Australia
- Redcliffe Hospital, Metro North Health, Redcliffe, QLD 4020, Australia; (A.D.R.); (A.W.)
| | - Cynthia S. Wong
- Aikenhead Centre for Medical Discovery (ACMD), St Vincent’s Hospital, Melbourne, VIC 3065, Australia;
| | - Jilong Qin
- Centre for Immunology and Infection Control, School of Biomedical Sciences, Queensland University of Technology, Brisbane, QLD 4000, Australia; (J.Q.); (M.T.)
| | - Michael Chen
- Centre for Biomedical Technologies, Queensland University of Technology (QUT), Brisbane, QLD 4000, Australia; (J.R.); (M.C.)
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology (QUT), Brisbane, QLD 4000, Australia
- Herston Biofabrication Institute, Metro North Health, Brisbane, QLD 4029, Australia; (R.M.); (N.R.)
| | - Makrina Totsika
- Centre for Immunology and Infection Control, School of Biomedical Sciences, Queensland University of Technology, Brisbane, QLD 4000, Australia; (J.Q.); (M.T.)
| | - Andrew D. Riddell
- Redcliffe Hospital, Metro North Health, Redcliffe, QLD 4020, Australia; (A.D.R.); (A.W.)
- Northside Clinical Unit, School of Clinical Medicine, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Andrea Warwick
- Redcliffe Hospital, Metro North Health, Redcliffe, QLD 4020, Australia; (A.D.R.); (A.W.)
| | - Nicholas Rukin
- Herston Biofabrication Institute, Metro North Health, Brisbane, QLD 4029, Australia; (R.M.); (N.R.)
- Redcliffe Hospital, Metro North Health, Redcliffe, QLD 4020, Australia; (A.D.R.); (A.W.)
| | - Maria A. Woodruff
- Centre for Biomedical Technologies, Queensland University of Technology (QUT), Brisbane, QLD 4000, Australia; (J.R.); (M.C.)
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology (QUT), Brisbane, QLD 4000, Australia
- Correspondence:
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4
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Diallo MN, Mayeur O, Lecomte-Grosbras P, Patrouix L, Witz JF, Lesaffre F, Rubod C, Cosson M, Brieu M. Simulation of the mobility of the pelvic system: influence of fascia between organs. Comput Methods Biomech Biomed Engin 2021; 25:1073-1087. [PMID: 34783611 DOI: 10.1080/10255842.2021.2001460] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The mobility of pelvic organs is the result of an equilibrium called Pelvic Static characterizing the balance between the properties and geometries of organs, suspensions and support system. Any imbalance in this complex system can cause of pelvic static disorder. Genital prolapse is a common hypermobility pathology which is complex, multi factorial and its surgical management has high rate of complications. The use of 3 D numerical models and simulation enables the role of the various suspension structures to be objectively studied and quantified. Fascias are connective tissues located between organs. Although their role are described as important in various descriptions of pelvic statics, their influence and role has never been quantitatively objectified. This article presents a refine Finite Element (FE) model for a better understanding of biomechanical contribution of inter-organ fascia. The model is built from MRI images of a young volunteer, the mechanical properties derived from literature data to take into account the age of the patient and new experimental results have enabled an order of magnitude of the mechanical properties of the fascias to be defined. The FE results allows to quantify the biomechanical role of the fascia on pelvic mobility quantified by an analysis of dynamic MRI images and a local mapping of the gap between calculated and measured displacements. This improved numerical model integrating the fascias makes it possible to describe pelvic mobilities with a gap of 1 mm between numerical simulations and measurements, whereas without taking them into account this gap locally reaches 20 mm.
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Affiliation(s)
- Mouhamadou Nassirou Diallo
- CNRS, Centrale Lille, UMR 9013 - LaMcube - Laboratoire de Mécanique, Multiphysique, Multiéchelle, University of Lille, Lille, France
| | - Olivier Mayeur
- CNRS, Centrale Lille, UMR 9013 - LaMcube - Laboratoire de Mécanique, Multiphysique, Multiéchelle, University of Lille, Lille, France
| | - Pauline Lecomte-Grosbras
- CNRS, Centrale Lille, UMR 9013 - LaMcube - Laboratoire de Mécanique, Multiphysique, Multiéchelle, University of Lille, Lille, France
| | - Laurent Patrouix
- CNRS, Centrale Lille, UMR 9013 - LaMcube - Laboratoire de Mécanique, Multiphysique, Multiéchelle, University of Lille, Lille, France
| | - Jean François Witz
- CNRS, Centrale Lille, UMR 9013 - LaMcube - Laboratoire de Mécanique, Multiphysique, Multiéchelle, University of Lille, Lille, France
| | - François Lesaffre
- CNRS, Centrale Lille, UMR 9013 - LaMcube - Laboratoire de Mécanique, Multiphysique, Multiéchelle, University of Lille, Lille, France
| | - Chrystle Rubod
- CNRS, Centrale Lille, UMR 9013 - LaMcube - Laboratoire de Mécanique, Multiphysique, Multiéchelle, University of Lille, Lille, France.,Service de chirurgie gynécologique - CHU Lille, Lille, France
| | - Michel Cosson
- CNRS, Centrale Lille, UMR 9013 - LaMcube - Laboratoire de Mécanique, Multiphysique, Multiéchelle, University of Lille, Lille, France.,Service de chirurgie gynécologique - CHU Lille, Lille, France
| | - Mathias Brieu
- CNRS, Centrale Lille, UMR 9013 - LaMcube - Laboratoire de Mécanique, Multiphysique, Multiéchelle, University of Lille, Lille, France.,Department of Mechanical Engineering, College Engineering, Computer Science and Technology, California State University, Los Angeles, Long Angeles, CA, USA
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5
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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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6
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Morch A, Doucède G, Lecomte-Grosbras P, Brieu M, Rubod C, Cosson M. Pelvic organ prolapse meshes: Can they preserve the physiological behavior? J Mech Behav Biomed Mater 2021; 120:104569. [PMID: 34058600 DOI: 10.1016/j.jmbbm.2021.104569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 11/24/2020] [Accepted: 05/02/2021] [Indexed: 10/21/2022]
Abstract
Implants for the cure of female genital prolapse still show numerous complications cases that sometimes have dramatic consequences. These implants must be improved to provide physiological support and restore the normal functionalities of the pelvic area. Besides the trend towards lighter meshes, a better understanding of the in vivo role and impact of the mesh implantation is required. This work investigates the mechanical impact of meshes after implantation with regards to the behavior of the native tissues. Three meshes were studied to assess their mechanical and biological impact on the native tissues. An animal study was conducted on rats. Four groups (n = 17/group) underwent surgery. Rats were implanted on the abdominal wall with one of the three polypropylene knitted mesh (one mesh/group). The last group served as control and underwent the same surgery without any mesh implantation. Post-operative complications, contraction, mechanical rigidities, and residual deformation after cyclic loading were collected. Non-parametric statistical comparisons were performed (Kruskal-Wallis) to observe potential differences between implanted and control groups. Mechanical characterization showed that one of the three meshes did not alter the mechanical behavior of the native tissues. On the contrary, the two others drastically increased the rigidities and were also associated with clinical complications. All of the meshes seem to reduce the geometrical lengthening of the biological tissues that comes with repetitive loads. Mechanical aspects might play a key role in the compatibility of the mesh in vivo. One of the three materials that were implanted during an animal study seems to provide better support and adapt more properly to the physiological behavior of the native tissues.
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Affiliation(s)
- Annie Morch
- Univ. Lille, CNRS, Centrale Lille, UMR 9013- LaMcube - Laboratoire de Mécanique, Multiphysique, Multi-échelle, F-59000, Lille, France
| | - Guillaume Doucède
- Service de Chirurgie gynécologique - CHU Lille, F-59000, Lille, France; Université de Lille - Faculté de Lille, F-59000, Lille, France
| | - Pauline Lecomte-Grosbras
- Univ. Lille, CNRS, Centrale Lille, UMR 9013- LaMcube - Laboratoire de Mécanique, Multiphysique, Multi-échelle, F-59000, Lille, France
| | - Mathias Brieu
- Univ. Lille, CNRS, Centrale Lille, UMR 9013- LaMcube - Laboratoire de Mécanique, Multiphysique, Multi-échelle, F-59000, Lille, France; California State University - Los Angeles, College Engineering - Computer Science, and Technology, Dept. Mechanical Engineering, United States
| | - Chrystèle Rubod
- Univ. Lille, CNRS, Centrale Lille, UMR 9013- LaMcube - Laboratoire de Mécanique, Multiphysique, Multi-échelle, F-59000, Lille, France; Service de Chirurgie gynécologique - CHU Lille, F-59000, Lille, France; Université de Lille - Faculté de Lille, F-59000, Lille, France
| | - Michel Cosson
- Univ. Lille, CNRS, Centrale Lille, UMR 9013- LaMcube - Laboratoire de Mécanique, Multiphysique, Multi-échelle, F-59000, Lille, France; Service de Chirurgie gynécologique - CHU Lille, F-59000, Lille, France; Université de Lille - Faculté de Lille, F-59000, Lille, France.
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7
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Paul K, Darzi S, Werkmeister JA, Gargett CE, Mukherjee S. Emerging Nano/Micro-Structured Degradable Polymeric Meshes for Pelvic Floor Reconstruction. NANOMATERIALS (BASEL, SWITZERLAND) 2020; 10:E1120. [PMID: 32517067 PMCID: PMC7353440 DOI: 10.3390/nano10061120] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/29/2020] [Accepted: 06/02/2020] [Indexed: 02/07/2023]
Abstract
Pelvic organ prolapse (POP) is a hidden women's health disorder that impacts 1 in 4 women across all age groups. Surgical intervention has been the only treatment option, often involving non-degradable meshes, with variable results. However, recent reports have highlighted the adverse effects of meshes in the long term, which involve unacceptable rates of erosion, chronic infection and severe pain related to mesh shrinkage. Therefore, there is an urgent unmet need to fabricate of new class of biocompatible meshes for the treatment of POP. This review focuses on the causes for the downfall of commercial meshes, and discusses the use of emerging technologies such as electrospinning and 3D printing to design new meshes. Furthermore, we discuss the impact and advantage of nano-/microstructured alternative meshes over commercial meshes with respect to their tissue integration performance. Considering the key challenges of current meshes, we discuss the potential of cell-based tissue engineering strategies to augment the new class of meshes to improve biocompatibility and immunomodulation. Finally, this review highlights the future direction in designing the new class of mesh to overcome the hurdles of foreign body rejection faced by the traditional meshes, in order to have safe and effective treatment for women in the long term.
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Affiliation(s)
- Kallyanashis Paul
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton 3168, Australia; (K.P.); (S.D.); (J.A.W.); (C.E.G.)
- Department of Obstetrics and Gynaecology, Monash University, Clayton 3168, Australia
| | - Saeedeh Darzi
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton 3168, Australia; (K.P.); (S.D.); (J.A.W.); (C.E.G.)
| | - Jerome A. Werkmeister
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton 3168, Australia; (K.P.); (S.D.); (J.A.W.); (C.E.G.)
- Department of Obstetrics and Gynaecology, Monash University, Clayton 3168, Australia
| | - Caroline E. Gargett
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton 3168, Australia; (K.P.); (S.D.); (J.A.W.); (C.E.G.)
- Department of Obstetrics and Gynaecology, Monash University, Clayton 3168, Australia
| | - Shayanti Mukherjee
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton 3168, Australia; (K.P.); (S.D.); (J.A.W.); (C.E.G.)
- Department of Obstetrics and Gynaecology, Monash University, Clayton 3168, Australia
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8
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Gargett CE, Gurung S, Darzi S, Werkmeister JA, Mukherjee S. Tissue engineering approaches for treating pelvic organ prolapse using a novel source of stem/stromal cells and new materials. Curr Opin Urol 2020; 29:450-457. [PMID: 31008783 DOI: 10.1097/mou.0000000000000634] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE OF REVIEW Nondegradable transvaginal polypropylene meshes for treating pelvic organ prolapse (POP) are now generally unavailable or banned. In this review, we summarize recent developments using tissue engineering approaches combining alternate degradable scaffolds with a novel source of mesenchymal stem/stromal cells from human endometrium (eMSC). RECENT FINDINGS Tissue engineering constructs comprising immunomodulatory, reparative eMSC and biomimetic materials with nanoarchitecture are a promising approach for vaginal repair and improving outcomes of POP surgery. Culture expansion of eMSC that maintains them (and other MSC) in the undifferentiated state has been achieved using a small molecule transforming growth factor-β receptor inhibitor, A83-01. The mechanism of action of A83-01 has been determined and its suitability for translation into the clinic explored. Novel blends of electrospun synthetic and natural polymers combined with eMSC shows this approach promotes host cell infiltration and slows biomaterial degradation that has potential to strengthen the vaginal wall during healing. Improving the preclinical ovine transvaginal surgical model by adapting the human clinical POP-Quantification system for selection of multiparous ewes with vaginal wall weakness enables assessment of this autologous eMSC/nanobiomaterial construct. SUMMARY A tissue engineering approach using autologous eMSC with degradable nanobiomaterials offers a new approach for treating women with POP.
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Affiliation(s)
- Caroline E Gargett
- The Ritchie Centre.,Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Shanti Gurung
- Centre for Reproductive Health, Hudson institute of Medical Research
| | - Saeedeh Darzi
- The Ritchie Centre.,Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Jerome A Werkmeister
- The Ritchie Centre.,Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Shayanti Mukherjee
- The Ritchie Centre.,Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
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9
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Ai FF, Mao M, Zhang Y, Kang J, Zhu L. The in vivo biocompatibility of titanized polypropylene lightweight mesh is superior to that of conventional polypropylene mesh. Neurourol Urodyn 2019; 39:96-107. [PMID: 31584215 DOI: 10.1002/nau.24159] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 08/23/2019] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To evaluate the histological response to and changes in the biomechanical properties of titanized polypropylene lightweight mesh and conventional polypropylene mesh at 1 and 12 weeks following implantation in the sheep vagina. METHODS We compared a titanized polypropylene lightweight mesh (TiLOOP Mesh) to a conventional polypropylene mesh (Gynemesh PS) in a sheep vagina model. Explants were harvested after 1 and 12 weeks (n = 6/mesh type/time point) for histological observation. After 12 weeks, mesh-tissue complex specimens were biomechanically assessed by a uniaxial tension system. RESULTS One week after implantation, there was no significant difference in the inflammatory response between the two groups. Twelve weeks after implantation, the TiLOOP light mesh elicited a lower inflammatory response than was observed for the Gynemesh PS (1.44 ± 0.61 vs 2.05 ± 0.80, P = .015). Twelve weeks after implantation, the collagen I/III ratio was lower in the TiLOOP light mesh group than in the Gynemesh PS group (9.41 ± 5.06 vs 15.21 ± 8.21, P = .019). The messenger RNA expression levels of the inflammatory factors interleukin 10 and tumor necrosis factor α were lower in the TiLOOP Mesh group than in the Gynemesh PS group at both 1 and 12 weeks (P < .05). There were no significant differences in any of the evaluated biomechanical characteristics between the two meshes (P > .05). CONCLUSION Although the titanized polypropylene lightweight mesh induces slightly less tissue reactivity and has better in vivo biocompatibility, further studies should be conducted including the complications and the success rate of pelvic organ prolapse in patients before recommending it in pelvic floor reconstruction.
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Affiliation(s)
- Fang-Fang Ai
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.,Department of Obstetrics and Gynecology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Meng Mao
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Ye Zhang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Jia Kang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Lan Zhu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
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10
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Landmarks in vaginal mesh development: polypropylene mesh for treatment of SUI and POP. Nat Rev Urol 2019; 16:675-689. [PMID: 31548731 DOI: 10.1038/s41585-019-0230-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2019] [Indexed: 01/03/2023]
Abstract
Vaginal meshes used in the treatment of stress urinary incontinence (SUI) and pelvic organ prolapse (POP) have produced highly variable outcomes, causing life-changing complications in some patients while providing others with effective, minimally invasive treatments. The risk:benefit ratio when using vaginal meshes is a complex issue in which a combination of several factors, including the inherent incompatibility of the mesh material with some applications in pelvic reconstructive surgeries and the lack of appropriate regulatory approval processes at the time of the premarket clearance of these products, have contributed to the occurrence of complications caused by vaginal mesh. Surgical mesh used in hernia repair has evolved over many years, from metal implants to knitted polymer meshes that were adopted for use in the pelvic floor for treatment of POP and SUI. The evolution of the material and textile properties of the surgical mesh was guided by clinical feedback from hernia repair procedures, which were also being modified to obtain the best outcomes with use of the mesh. Current evidence shows how surgical mesh fails biomechanically when used in the pelvic floor and materials with improved performance can be developed using modern material processing and tissue engineering techniques.
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11
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Emmerson S, Mukherjee S, Melendez-Munoz J, Cousins F, Edwards SL, Karjalainen P, Ng M, Tan KS, Darzi S, Bhakoo K, Rosamilia A, Werkmeister JA, Gargett CE. Composite mesh design for delivery of autologous mesenchymal stem cells influences mesh integration, exposure and biocompatibility in an ovine model of pelvic organ prolapse. Biomaterials 2019; 225:119495. [PMID: 31606680 DOI: 10.1016/j.biomaterials.2019.119495] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 08/20/2019] [Accepted: 09/11/2019] [Indexed: 12/21/2022]
Abstract
The widespread use of synthetic transvaginal polypropylene mesh for treating Pelvic Organ Prolapse (POP) has been curtailed due to serious adverse effects highlighted in 2008 and 2011 FDA warnings and subsequent legal action. We are developing new synthetic mesh to deliver endometrial mesenchymal stem cells (eMSC) to improve mesh biocompatibility and restore strength to prolapsed vaginal tissue. Here we evaluated knitted polyamide (PA) mesh in an ovine multiparous model using transvaginal implantation and matched for the degree of POP. Polyamide mesh dip-coated in gelatin and stabilised with 0.5% glutaraldehyde (PA/G) were used either alone or seeded with autologous ovine eMSC (eMSC/PA/G), which resulted in substantial mesh folding, poor tissue integration and 42% mesh exposure in the ovine model. In contrast, a two-step insertion protocol, whereby the uncoated PA mesh was inserted transvaginally followed by application of autologous eMSC in a gelatin hydrogel onto the mesh and crosslinked with blue light (PA + eMSC/G), integrated well with little folding and no mesh exposure. The autologous ovine eMSC survived 30 days in vivo but had no effect on mesh integration. The stiff PA/G constructs provoked greater myofibroblast and inflammatory responses in the vaginal wall, disrupted the muscularis layer and reduced elastin fibres compared to PA + eMSC/G constructs. This study identified the superiority of a two-step protocol for implanting synthetic mesh in cellular compatible composite constructs and simpler surgical application, providing additional translational value.
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Affiliation(s)
- S Emmerson
- Ritchie Centre, Hudson Institute of Medical Research, 27-31 Wright Street, Clayton, Melbourne, Australia; Department of Obstetrics and Gynaecology, Monash University, Wellington Road, Clayton, Melbourne, Australia
| | - S Mukherjee
- Ritchie Centre, Hudson Institute of Medical Research, 27-31 Wright Street, Clayton, Melbourne, Australia; Department of Obstetrics and Gynaecology, Monash University, Wellington Road, Clayton, Melbourne, Australia
| | | | - F Cousins
- Ritchie Centre, Hudson Institute of Medical Research, 27-31 Wright Street, Clayton, Melbourne, Australia
| | - S L Edwards
- CSIRO Manufacturing, Research Way, Clayton, Melbourne, Australia
| | - P Karjalainen
- Monash Health, Centre Road, Moorabbin, Melbourne, Australia
| | - M Ng
- Singapore Bioimaging Consortium, 1 Agency for Science, Technology and Research (A*STAR), 1 Biopolis Way, Singapore
| | - K S Tan
- Ritchie Centre, Hudson Institute of Medical Research, 27-31 Wright Street, Clayton, Melbourne, Australia
| | - S Darzi
- Ritchie Centre, Hudson Institute of Medical Research, 27-31 Wright Street, Clayton, Melbourne, Australia; Department of Obstetrics and Gynaecology, Monash University, Wellington Road, Clayton, Melbourne, Australia
| | - K Bhakoo
- Singapore Bioimaging Consortium, 1 Agency for Science, Technology and Research (A*STAR), 1 Biopolis Way, Singapore
| | - A Rosamilia
- Department of Obstetrics and Gynaecology, Monash University, Wellington Road, Clayton, Melbourne, Australia; Monash Health, Centre Road, Moorabbin, Melbourne, Australia
| | - J A Werkmeister
- Ritchie Centre, Hudson Institute of Medical Research, 27-31 Wright Street, Clayton, Melbourne, Australia; Department of Obstetrics and Gynaecology, Monash University, Wellington Road, Clayton, Melbourne, Australia
| | - C E Gargett
- Ritchie Centre, Hudson Institute of Medical Research, 27-31 Wright Street, Clayton, Melbourne, Australia; Department of Obstetrics and Gynaecology, Monash University, Wellington Road, Clayton, Melbourne, Australia.
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12
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Powers SA, Burleson LK, Hannan JL. Managing female pelvic floor disorders: a medical device review and appraisal. Interface Focus 2019; 9:20190014. [PMID: 31263534 DOI: 10.1098/rsfs.2019.0014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2019] [Indexed: 02/07/2023] Open
Abstract
Pelvic floor disorders (PFDs) will affect most women during their lifetime. Sequelae such as pelvic organ prolapse, stress urinary incontinence, chronic pain and dyspareunia significantly impact overall quality of life. Interventions to manage or eliminate symptoms from PFDs aim to restore support of the pelvic floor. Pessaries have been used to mechanically counteract PFDs for thousands of years, but do not offer a cure. By contrast, surgically implanted grafts or mesh offer patients a more permanent resolution but have been in wide use within the pelvis for less than 30 years. In this perspective review, we provide an overview of the main theories underpinning PFD pathogenesis and the animal models used to investigate it. We highlight the clinical outcomes of mesh and grafts before exploring studies performed to elucidate tissue level effects and bioengineering considerations. Considering recent turmoil surrounding transvaginal mesh, the role of pessaries, an impermanent method, is examined as a means to address patients with PFDs.
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Affiliation(s)
- Shelby A Powers
- Department of Physiology, Brody School of Medicine, East Carolina University, 600 Moye Boulevard, Mailstop 634, Greenville, NC 27834-4354, USA
| | - Lindsey K Burleson
- Department of Physiology, Brody School of Medicine, East Carolina University, 600 Moye Boulevard, Mailstop 634, Greenville, NC 27834-4354, USA
| | - Johanna L Hannan
- Department of Physiology, Brody School of Medicine, East Carolina University, 600 Moye Boulevard, Mailstop 634, Greenville, NC 27834-4354, USA
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13
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Mukherjee S, Darzi S, Paul K, Werkmeister JA, Gargett CE. Mesenchymal stem cell-based bioengineered constructs: foreign body response, cross-talk with macrophages and impact of biomaterial design strategies for pelvic floor disorders. Interface Focus 2019; 9:20180089. [PMID: 31263531 PMCID: PMC6597526 DOI: 10.1098/rsfs.2018.0089] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2019] [Indexed: 02/06/2023] Open
Abstract
An excessive foreign body response (FBR) has contributed to the adverse events associated with polypropylene mesh usage for augmenting pelvic organ prolapse surgery. Consequently, current biomaterial research considers the critical role of the FBR and now focuses on developing better biocompatible biomaterials rather than using inert implants to improve the clinical outcomes of their use. Tissue engineering approaches using mesenchymal stem cells (MSCs) have improved outcomes over traditional implants in other biological systems through their interaction with macrophages, the main cellular player in the FBR. The unique angiogenic, immunomodulatory and regenerative properties of MSCs have a direct impact on the FBR following biomaterial implantation. In this review, we focus on key aspects of the FBR to tissue-engineered MSC-based implants for supporting pelvic organs and beyond. We also discuss the immunomodulatory effects of the recently discovered endometrial MSCs on the macrophage response to new biomaterials designed for use in pelvic floor reconstructive surgery. We conclude with a focus on considerations in biomaterial design that take into account the FBR and will likely influence the development of the next generation of biomaterials for gynaecological applications.
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Affiliation(s)
- Shayanti Mukherjee
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria 3168, Australia.,Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria 3168, Australia.,CSIRO Manufacturing, Clayton, Victoria 3168, Australia
| | - Saeedeh Darzi
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria 3168, Australia
| | - Kallyanashis Paul
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria 3168, Australia.,Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria 3168, Australia
| | - Jerome A Werkmeister
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria 3168, Australia.,Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria 3168, Australia.,CSIRO Manufacturing, Clayton, Victoria 3168, Australia
| | - Caroline E Gargett
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria 3168, Australia.,Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria 3168, Australia
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14
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Roman S, Mangir N, Hympanova L, Chapple CR, Deprest J, MacNeil S. Use of a simple in vitro fatigue test to assess materials used in the surgical treatment of stress urinary incontinence and pelvic organ prolapse. Neurourol Urodyn 2018; 38:107-115. [DOI: 10.1002/nau.23823] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 08/27/2018] [Indexed: 01/04/2023]
Affiliation(s)
- Sabiniano Roman
- Department of Materials Science and Engineering, Kroto Research Institute; University of Sheffield; Sheffield United Kingdom
| | - Naside Mangir
- Department of Materials Science and Engineering, Kroto Research Institute; University of Sheffield; Sheffield United Kingdom
- Royal Hallamshire Hospital; Sheffield United Kingdom
| | - Lucie Hympanova
- Department of Development and Regeneration, KU Leuven; University of Leuven; Leuven Belgium
- Third Faculty of Medicine, Institute for the Care of the Mother and Child; Charles University; Prague Czech Republic
| | | | - Jan Deprest
- Department of Development and Regeneration, KU Leuven; University of Leuven; Leuven Belgium
| | - Sheila MacNeil
- Department of Materials Science and Engineering, Kroto Research Institute; University of Sheffield; Sheffield United Kingdom
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15
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Darzi S, Deane JA, Nold CA, Edwards SE, Gough DJ, Mukherjee S, Gurung S, Tan KS, Vashi AV, Werkmeister JA, Gargett CE. Endometrial Mesenchymal Stem/Stromal Cells Modulate the Macrophage Response to Implanted Polyamide/Gelatin Composite Mesh in Immunocompromised and Immunocompetent Mice. Sci Rep 2018; 8:6554. [PMID: 29700360 PMCID: PMC5919927 DOI: 10.1038/s41598-018-24919-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 03/28/2018] [Indexed: 01/09/2023] Open
Abstract
The immunomodulatory properties of human endometrial mesenchymal stem cells (eMSC) have not been well characterised. Initial studies showed that eMSC modulated the chronic inflammatory response to a non-degradable polyamide/gelatin mesh in a xenogeneic rat skin wound repair model, but the mechanism remains unclear. In this study, we investigated the immunomodulatory effect of eMSC on the macrophage response to polyamide/gelatin composite mesh in an abdominal subcutaneous wound repair model in C57BL6 immunocompetent and NSG (NOD-Scid-IL2Rgammanull) immunocompromised mice to determine whether responses differed in the absence of an adaptive immune system and NK cells. mCherry lentivirus-labelled eMSC persisted longer in NSG mice, inducing longer term paracrine effects. Inclusion of eMSC in the mesh reduced inflammatory cytokine (Il-1β, Tnfα) secretion, and in C57BL6 mice reduced CCR7+ M1 macrophages surrounding the mesh on day 3 and increased M2 macrophage marker mRNA (Arg1, Mrc1, Il10) expression at days 3 and 7. In NSG mice, these effects were delayed and only observed at days 7 and 30 in comparison with controls implanted with mesh alone. These results show that the differences in the immune status in the two animals directly affect the survival of xenogeneic eMSC which leads to differences in the short-term and long-term macrophage responses to implanted meshes.
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Affiliation(s)
- S Darzi
- The Ritchie Centre, Hudson Institute of Medical Research, 27-31 Wright Street, Clayton, Victoria, 3168, Australia.,Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, 3168, Australia
| | - J A Deane
- The Ritchie Centre, Hudson Institute of Medical Research, 27-31 Wright Street, Clayton, Victoria, 3168, Australia.,Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, 3168, Australia
| | - C A Nold
- The Ritchie Centre, Hudson Institute of Medical Research, 27-31 Wright Street, Clayton, Victoria, 3168, Australia
| | - S E Edwards
- CSIRO Manufacturing, Bayview Avenue, Clayton, Victoria, 3169, Australia
| | - D J Gough
- The Ritchie Centre, Hudson Institute of Medical Research, 27-31 Wright Street, Clayton, Victoria, 3168, Australia
| | - S Mukherjee
- The Ritchie Centre, Hudson Institute of Medical Research, 27-31 Wright Street, Clayton, Victoria, 3168, Australia
| | - S Gurung
- The Ritchie Centre, Hudson Institute of Medical Research, 27-31 Wright Street, Clayton, Victoria, 3168, Australia.,Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, 3168, Australia
| | - K S Tan
- The Ritchie Centre, Hudson Institute of Medical Research, 27-31 Wright Street, Clayton, Victoria, 3168, Australia
| | - A V Vashi
- CSIRO Manufacturing, Bayview Avenue, Clayton, Victoria, 3169, Australia
| | - J A Werkmeister
- The Ritchie Centre, Hudson Institute of Medical Research, 27-31 Wright Street, Clayton, Victoria, 3168, Australia.,Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, 3168, Australia.,CSIRO Manufacturing, Bayview Avenue, Clayton, Victoria, 3169, Australia
| | - C E Gargett
- The Ritchie Centre, Hudson Institute of Medical Research, 27-31 Wright Street, Clayton, Victoria, 3168, Australia. .,Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, 3168, Australia.
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16
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Stem cell therapy in Asherman syndrome and thin endometrium: Stem cell- based therapy. Biomed Pharmacother 2018; 102:333-343. [PMID: 29571018 DOI: 10.1016/j.biopha.2018.03.091] [Citation(s) in RCA: 104] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 03/06/2018] [Accepted: 03/15/2018] [Indexed: 12/17/2022] Open
Abstract
The endometrium is one of the essential components of the uterus. The endometrium of human is a complex and dynamic tissue, which undergoes periods of growth and turn over during any menstrual cycle. Stem cells are initially undifferentiated cells that display a wide range of differentiation potential with no distinct morphological features. Stem cell therapy method recently has become a novel procedure for treatment of tissue injury and fibrosis in response to damage. Currently, there is massive interest in stem cells as a novel treatment method for regenerative medicine and more specifically for the regeneration of human endometrium disorder like Asherman syndrome (AS) and thin endometrium. AS also known as intrauterine adhesion (IUA) is a uterine disorder with the aberrant creation of adhesions within the uterus and/or cervix. Patients with IUA are significantly associated with menstrual abnormalities and suffer from pelvic pain. In addition, IUA might prevent implantation of the blastocyst, impair the blood supply to the uterus and early fetus, and finally result in the recurrent miscarriage or infertility in the AS patients. It has been evidenced that the transplantation of different stem cells with a diverse source in the endometrial zone had effects on endometrium such as declined the fibrotic area, an elevated number of glands, stimulated angiogenesis, the enhanced thickness of the endometrium, better formed tissue construction, protected gestation, and improved pregnancy rate. This study presents a summary of the investigations that indicate the key role of stem cell therapy in regeneration and renovation of defective parts.
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17
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Vashaghian M, Zaat SJ, Smit TH, Roovers JP. Biomimetic implants for pelvic floor repair. Neurourol Urodyn 2017; 37:566-580. [PMID: 28799675 DOI: 10.1002/nau.23367] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 05/15/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND Polypropylene implants are used for the reconstructive surgery of urogynaecological disorders like pelvic organ prolapse, but severe complications associated with their use have been reported. There is evidence that surface properties and a difference in mechanical stiffness between the implant and the host tissue contribute to these adverse events. Electrospinning is an innovative engineering alternative that provides a biomimetic microstructure for implants, resulting in a different mechano-biological performance. AIM The main objective of this review is to inform about the potential of electrospun matrices as an alternative modality for pelvic floor repair. METHODS Publications with the following studies of electrospun matrices were reviewed: (i) the technique; (ii) in vitro use for soft tissue engineering; (iii) in vivo use for reconstruction of soft tissues in animals; and (iv) clinical use in humans. RESULTS Electrospun matrices provide a synthetic mimic of natural extracellular matrix (ECM), favoring cellular attachment, proliferation and matrix deposition, through which a proper, low-inflammatory tissue-implant interaction can be established. Electrospun sheets can also be created with sufficient mechanical strength and stiffness for usage in prolapse surgery. CONCLUSION Electrospun matrices mimic the structural topography of the extracellular matrix and can be functionalized for better biological performance. As such, they have great potential for the next generation of urogynecological implants. However, their long-term safety and efficacy must still be established in vivo.
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Affiliation(s)
- Mahshid Vashaghian
- Department of Obstetrics & Gynaecology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Sebastianus J Zaat
- Department of Medical Microbiology, Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Theodoor H Smit
- Department of Medical Biology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Jan-Paul Roovers
- Department of Obstetrics & Gynaecology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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18
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Experimental study of the mechanical behavior of an explanted mesh: The influence of healing. J Mech Behav Biomed Mater 2017; 65:190-199. [DOI: 10.1016/j.jmbbm.2016.07.033] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 07/22/2016] [Accepted: 07/27/2016] [Indexed: 11/17/2022]
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19
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The effect of fabric structure on the mechanical properties of warp knitted surgical mesh for hernia repair. J Mech Behav Biomed Mater 2016; 66:77-86. [PMID: 27838593 DOI: 10.1016/j.jmbbm.2016.10.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 10/24/2016] [Accepted: 10/26/2016] [Indexed: 11/23/2022]
Abstract
Surgical mesh is being used for healing hernia, pelvic organ prolapse, skull injuries and urinary incontinence. In this research the effect of fabric structure on the mechanical properties of warp knitted surgical meshes in comparison to abdominal fascia has been investigated. For this purpose, warp knitted surgical mesh with five different structures (Tricot, Pin-hole-net, quasi-Sandfly, Sandfly and quasi-Marquissite) were produced using polypropylene monofilament. Thereafter, their mechanical properties such as uniaxial tensile behavior in various directions (wale-wise (90°), course-wise (0°) and diagonal (45°)), bending resistance and crease recovery were analyzed. The meshes demonstrated different elastic modulus in various directions, which can be attributed to the pore shape (pore angle) and underlap angle in the structure of mesh. Except Pin-hole-net mesh, other produced meshes exhibited better level of orthotropy in comparison to abdominal fascia. The most flexible mesh in both wale-wise and course-wise directions was quasi-Sandfly and thereafter quasi-Marquissite. Tricot and Pin-hole-net manifested the highest crease recovery in wale-wise and coursewise directions respectively. The most desirable mesh in terms of porosity was quasi-Marquissite mesh. Overall, the quasi-Marquissite mesh was selected as the most suitable surgical mesh considering all advantages and disadvantages of each produced mesh in this study.
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20
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Emmerson SJ, Gargett CE. Endometrial mesenchymal stem cells as a cell based therapy for pelvic organ prolapse. World J Stem Cells 2016; 8:202-215. [PMID: 27247705 PMCID: PMC4877564 DOI: 10.4252/wjsc.v8.i5.202] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 12/23/2015] [Accepted: 02/16/2016] [Indexed: 02/07/2023] Open
Abstract
Pelvic organ prolapse (POP) occurs when the pelvic organs (bladder, bowel or uterus) herniate into the vagina, causing incontinence, voiding, bowel and sexual dysfunction, negatively impacting upon a woman’s quality of life. POP affects 25% of all women and results from childbirth injury. For 19% of all women, surgical reconstructive surgery is required for treatment, often augmented with surgical mesh. The surgical treatment fails in up to 30% of cases or results in adverse effects, such as pain and mesh erosion into the bladder, bowel or vagina. Due to these complications the Food and Drug Administration cautioned against the use of vaginal mesh and several major brands have been recently been withdrawn from market. In this review we will discuss new cell-based approaches being developed for the treatment of POP. Several cell types have been investigated in animal models, including a new source of mesenchymal stem/stromal cells (MSC) derived from human endometrium. The unique characteristics of endometrial MSC, methods for their isolation and purification and steps towards their development for good manufacturing practice production will be described. Animal models that could be used to examine the potential for this approach will also be discussed as will a rodent model showing promise in developing an endometrial MSC-based therapy for POP. The development of a preclinical large animal model for assessing tissue engineering constructs for treating POP will also be mentioned.
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21
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Vashaghian M, Ruiz-Zapata AM, Kerkhof MH, Zandieh-Doulabi B, Werner A, Roovers JP, Smit TH. Toward a new generation of pelvic floor implants with electrospun nanofibrous matrices: A feasibility study. Neurourol Urodyn 2016; 36:565-573. [DOI: 10.1002/nau.22969] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 01/19/2016] [Indexed: 11/10/2022]
Affiliation(s)
- Mahshid Vashaghian
- Department of Orthopedic Surgery; VU University Medical Center, MOVE Research Institute; Amsterdam The Netherlands
- Department of Oral Cell Biology; ACTA-University of Amsterdam and VU University, MOVE Research Institute; Amsterdam The Netherlands
| | - Alejandra M. Ruiz-Zapata
- Department of Orthopedic Surgery; VU University Medical Center, MOVE Research Institute; Amsterdam The Netherlands
| | - Manon H. Kerkhof
- Department of Obstetrics and Gynaecology; VU University Medical Center; Amsterdam The Netherlands
| | - Behrouz Zandieh-Doulabi
- Department of Orthopedic Surgery; VU University Medical Center, MOVE Research Institute; Amsterdam The Netherlands
- Department of Oral Cell Biology; ACTA-University of Amsterdam and VU University, MOVE Research Institute; Amsterdam The Netherlands
| | - Arie Werner
- Department of Materials; ACTA-University of Amsterdam and VU University, MOVE Research Institute; Amsterdam The Netherlands
| | - Jan Paul Roovers
- Department of Obstetrics and Gynecology; University of Amsterdam, Academic Medical Center; Amsterdam The Netherlands
| | - Theo H. Smit
- Department of Orthopedic Surgery; VU University Medical Center, MOVE Research Institute; Amsterdam The Netherlands
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22
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Gargett CE, Schwab KE, Deane JA. Endometrial stem/progenitor cells: the first 10 years. Hum Reprod Update 2015; 22:137-63. [PMID: 26552890 PMCID: PMC4755439 DOI: 10.1093/humupd/dmv051] [Citation(s) in RCA: 211] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 10/19/2015] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The existence of stem/progenitor cells in the endometrium was postulated many years ago, but the first functional evidence was only published in 2004. The identification of rare epithelial and stromal populations of clonogenic cells in human endometrium has opened an active area of research on endometrial stem/progenitor cells in the subsequent 10 years. METHODS The published literature was searched using the PubMed database with the search terms ‘endometrial stem cells and menstrual blood stem cells' until December 2014. RESULTS Endometrial epithelial stem/progenitor cells have been identified as clonogenic cells in human and as label-retaining or CD44+ cells in mouse endometrium, but their characterization has been modest. In contrast, endometrial mesenchymal stem/stromal cells (MSCs) have been well characterized and show similar properties to bone marrow MSCs. Specific markers for their enrichment have been identified, CD146+PDGFRβ+ (platelet-derived growth factor receptor beta) and SUSD2+ (sushi domain containing-2), which detected their perivascular location and likely pericyte identity in endometrial basalis and functionalis vessels. Transcriptomics and secretomics of SUSD2+ cells confirm their perivascular phenotype. Stromal fibroblasts cultured from endometrial tissue or menstrual blood also have some MSC characteristics and demonstrate broad multilineage differentiation potential for mesodermal, endodermal and ectodermal lineages, indicating their plasticity. Side population (SP) cells are a mixed population, although predominantly vascular cells, which exhibit adult stem cell properties, including tissue reconstitution. There is some evidence that bone marrow cells contribute a small population of endometrial epithelial and stromal cells. The discovery of specific markers for endometrial stem/progenitor cells has enabled the examination of their role in endometrial proliferative disorders, including endometriosis, adenomyosis and Asherman's syndrome. Endometrial MSCs (eMSCs) and menstrual blood stromal fibroblasts are an attractive source of MSCs for regenerative medicine because of their relative ease of acquisition with minimal morbidity. Their homologous and non-homologous use as autologous and allogeneic cells for therapeutic purposes is currently being assessed in preclinical animal models of pelvic organ prolapse and phase I/II clinical trials for cardiac failure. eMSCs and stromal fibroblasts also exhibit non-stem cell-associated immunomodulatory and anti-inflammatory properties, further emphasizing their desirable properties for cell-based therapies. CONCLUSIONS Much has been learnt about endometrial stem/progenitor cells in the 10 years since their discovery, although several unresolved issues remain. These include rationalizing the terminology and diagnostic characteristics used for distinguishing perivascular stem/progenitor cells from stromal fibroblasts, which also have considerable differentiation potential. The hierarchical relationship between clonogenic epithelial progenitor cells, endometrial and decidual SP cells, CD146+PDGFR-β+ and SUSD2+ cells and menstrual blood stromal fibroblasts still needs to be resolved. Developing more genetic animal models for investigating the role of endometrial stem/progenitor cells in endometrial disorders is required, as well as elucidating which bone marrow cells contribute to endometrial tissue. Deep sequencing and epigenetic profiling of enriched populations of endometrial stem/progenitor cells and their differentiated progeny at the population and single-cell level will shed new light on the regulation and function of endometrial stem/progenitor cells.
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Affiliation(s)
- Caroline E Gargett
- The Ritchie Centre, Hudson Institute of Medical Research, 27-31 Wright Street, Clayton 3168, Victoria, Australia Department of Obstetrics and Gynaecology, Monash University, Monash Medical Centre, 246 Clayton Road, Clayton 3168, Victoria, Australia
| | - Kjiana E Schwab
- The Ritchie Centre, Hudson Institute of Medical Research, 27-31 Wright Street, Clayton 3168, Victoria, Australia
| | - James A Deane
- The Ritchie Centre, Hudson Institute of Medical Research, 27-31 Wright Street, Clayton 3168, Victoria, Australia Department of Obstetrics and Gynaecology, Monash University, Monash Medical Centre, 246 Clayton Road, Clayton 3168, Victoria, Australia
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23
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Todros S, Pavan PG, Natali AN. Biomechanical properties of synthetic surgical meshes for pelvic prolapse repair. J Mech Behav Biomed Mater 2015; 55:271-285. [PMID: 26615384 DOI: 10.1016/j.jmbbm.2015.10.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 10/26/2015] [Accepted: 10/27/2015] [Indexed: 12/27/2022]
Abstract
Synthetic meshes are widely used for surgical repair of different kind of prolapses. In the light of the experience of abdominal wall repair, similar prostheses are currently used in the pelvic region, to restore physiological anatomy after organ prolapse into the vaginal wall, that represent a recurrent dysfunction. For this purpose, synthetic meshes are surgically positioned in contact with the anterior and/or posterior vaginal wall, to inferiorly support prolapsed organs. Nonetheless, while mesh implantation restores physiological anatomy, it is often associated with different complications in the vaginal region. These potentially dangerous effects induce the surgical community to reconsider the safety and efficacy of mesh transvaginal placement. For this purpose, the evaluation of state-of-the-art research may provide the basis for a comprehensive analysis of mesh compatibility and functionality. The aim of this work is to review synthetic surgical meshes for pelvic organs prolapse repair, taking into account the mechanics of mesh material and structure, and to relate them with pelvic and vaginal tissue biomechanics. Synthetic meshes are currently available in different chemical composition, fiber and textile conformations. Material and structural properties are key factors in determining mesh biochemical and mechanical compatibility in vivo. The most significant results on vaginal tissue and surgical meshes mechanical characterization are here reported and discussed. Moreover, computational models of the pelvic region, which could support the surgeon in the evaluation of mesh performances in physiological conditions, are recalled.
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Affiliation(s)
- S Todros
- Department of Industrial Engineering, Centre for Mechanics of Biological Materials, University of Padova, via Marzolo 9, I-35131 Padova, Italy.
| | - P G Pavan
- Department of Industrial Engineering, Centre for Mechanics of Biological Materials, University of Padova, via Marzolo 9, I-35131 Padova, Italy
| | - A N Natali
- Department of Industrial Engineering, Centre for Mechanics of Biological Materials, University of Padova, via Marzolo 9, I-35131 Padova, Italy
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Morch A, Pouseele B, Doucède G, Witz JF, Lesaffre F, Brieu M, Cosson M, Rubod C. Influence of healing time on the mechanical properties of an implanted mesh. Comput Methods Biomech Biomed Engin 2015; 18 Suppl 1:2004-5. [DOI: 10.1080/10255842.2015.1069598] [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]
Affiliation(s)
- A. Morch
- LML, CNRS, UMR 8107, Villeneuve d’Ascq, France
- Université Lille Nord de France, Villeneuve d’Ascq, France
- Ecole Centrale de Lille, Villeneuve d’Ascq, France
| | | | - G. Doucède
- LML, CNRS, UMR 8107, Villeneuve d’Ascq, France
- Jeanne de Flandres, CHRU, Lille, France
- Université Lille Nord de France, Villeneuve d’Ascq, France
| | - J.-F. Witz
- LML, CNRS, UMR 8107, Villeneuve d’Ascq, France
- Université Lille Nord de France, Villeneuve d’Ascq, France
| | - F. Lesaffre
- LML, CNRS, UMR 8107, Villeneuve d’Ascq, France
- Université Lille Nord de France, Villeneuve d’Ascq, France
- Ecole Centrale de Lille, Villeneuve d’Ascq, France
| | - M. Brieu
- LML, CNRS, UMR 8107, Villeneuve d’Ascq, France
- Université Lille Nord de France, Villeneuve d’Ascq, France
- Ecole Centrale de Lille, Villeneuve d’Ascq, France
| | - M. Cosson
- LML, CNRS, UMR 8107, Villeneuve d’Ascq, France
- Jeanne de Flandres, CHRU, Lille, France
- Université Lille Nord de France, Villeneuve d’Ascq, France
| | - C. Rubod
- LML, CNRS, UMR 8107, Villeneuve d’Ascq, France
- Jeanne de Flandres, CHRU, Lille, France
- Université Lille Nord de France, Villeneuve d’Ascq, France
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25
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Mechanical biocompatibility of highly deformable biomedical materials. J Mech Behav Biomed Mater 2015; 48:100-124. [DOI: 10.1016/j.jmbbm.2015.03.023] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Revised: 03/22/2015] [Accepted: 03/24/2015] [Indexed: 12/20/2022]
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Schenke-Layland K, Brucker SY. Prospects for regenerative medicine approaches in women's health. J Anat 2015; 227:781-5. [PMID: 26173979 PMCID: PMC4694118 DOI: 10.1111/joa.12336] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2015] [Indexed: 01/26/2023] Open
Abstract
Novel regenerative strategies, stem cell‐based therapies or the development of advanced human cell‐based in vitro‐manufactured preclinical test systems offer great potential to generate advances in clinical practice in the field of women's health. This review aims to provide a brief overview of the current advances in the field.
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Affiliation(s)
- Katja Schenke-Layland
- Department of Women's Health, Research Institute for Women's Health, University Hospital of the Eberhard Karls University, Tübingen, Germany.,Department of Cell and Tissue Engineering, Fraunhofer Institute for Interfacial Engineering and Biotechnology (IGB), Stuttgart, Germany.,Department of Medicine/Cardiology, Cardiovascular Research Laboratories, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Sara Y Brucker
- Department of Women's Health, Research Institute for Women's Health, University Hospital of the Eberhard Karls University, Tübingen, Germany.,Department of Women's Health, University Women's Hospital of the Eberhard Karls University, Tübingen, Germany
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27
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Maurer MM, Röhrnbauer B, Feola A, Deprest J, Mazza E. Prosthetic Meshes for Repair of Hernia and Pelvic Organ Prolapse: Comparison of Biomechanical Properties. MATERIALS 2015. [PMCID: PMC5455575 DOI: 10.3390/ma8052794] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This study aims to compare the mechanical behavior of synthetic meshes used for pelvic organ prolapse (POP) and hernia repair. The analysis is based on a comprehensive experimental protocol, which included uniaxial and biaxial tension, cyclic loading and testing of meshes in dry conditions and embedded into an elastomer matrix. Implants are grouped as POP or hernia meshes, as indicated by the manufacturer, and their stiffness in different loading configurations, area density and porosity are compared. Hernia meshes might be expected to be stiffer, since they are implanted into a stiffer tissue (abdominal wall) than POP meshes (vaginal wall). Contrary to this, hernia meshes have a generally lower secant stiffness than POP meshes. For example, DynaMesh PRS, a POP mesh, is up to two orders of magnitude stiffer in all tested configurations than DynaMesh ENDOLAP, a hernia mesh. Additionally, lighter, large pore implants might be expected to be more compliant, which was shown to be generally not true. In particular, Restorelle, the lightest mesh with the largest pores, is less compliant in the tested configurations than Surgipro, the heaviest, small-pore implant. Our study raises the question of defining a meaningful design target for meshes in terms of mechanical biocompatibility.
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Affiliation(s)
- Manfred M. Maurer
- Institute of Mechanical Systems, ETH Zurich, Leonhardstrasse 21, Zurich 8092, Switzerland; E-Mails: (B.R.); (E.M.)
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +41-44-6339228; Fax: +41-44-6321145
| | - Barbara Röhrnbauer
- Institute of Mechanical Systems, ETH Zurich, Leonhardstrasse 21, Zurich 8092, Switzerland; E-Mails: (B.R.); (E.M.)
| | - Andrew Feola
- Center for Surgical Technologies, Faculty of Medicine, Universitair Ziekenhuis “Gasthuisberg” Leuven, Katholieke Universiteit Leuven, Leuven 3000, Belgium; E-Mails: (A.F.); (J.D.)
| | - Jan Deprest
- Center for Surgical Technologies, Faculty of Medicine, Universitair Ziekenhuis “Gasthuisberg” Leuven, Katholieke Universiteit Leuven, Leuven 3000, Belgium; E-Mails: (A.F.); (J.D.)
| | - Edoardo Mazza
- Institute of Mechanical Systems, ETH Zurich, Leonhardstrasse 21, Zurich 8092, Switzerland; E-Mails: (B.R.); (E.M.)
- Empa—Swiss Federal Laboratories for Materials Science and Technology, Überlandstrasse 129, Dübendorf 8600, Switzerland
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28
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Mutlu L, Hufnagel D, Taylor HS. The endometrium as a source of mesenchymal stem cells for regenerative medicine. Biol Reprod 2015; 92:138. [PMID: 25904012 DOI: 10.1095/biolreprod.114.126771] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 04/09/2015] [Indexed: 12/21/2022] Open
Abstract
Stem cell therapies have opened new frontiers in medicine with the possibility of regenerating lost or damaged cells. Embryonic stem cells, induced pluripotent stem cells, hematopoietic stem cells, and mesenchymal stem cells have been used to derive mature cell types for tissue regeneration and repair. However, the endometrium has emerged as an attractive, novel source of adult stem cells that are easily accessed and demonstrate remarkable differentiation capacity. In this review, we summarize our current understanding of endometrial stem cells and their therapeutic potential in regenerative medicine.
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Affiliation(s)
- Levent Mutlu
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
| | - Demetra Hufnagel
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
| | - Hugh S Taylor
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
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29
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Edwards S, Ulrich D, White J, Su K, Rosamilia A, Ramshaw J, Gargett C, Werkmeister J. Temporal changes in the biomechanical properties of endometrial mesenchymal stem cell seeded scaffolds in a rat model. Acta Biomater 2015; 13:286-94. [PMID: 25462845 DOI: 10.1016/j.actbio.2014.10.043] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 09/18/2014] [Accepted: 10/28/2014] [Indexed: 12/24/2022]
Abstract
Use of synthetic clinical meshes in pelvic organ prolapse (POP) repair can lead to poor mechanical compliance in vivo, as a result of a foreign body reaction leading to excessive scar tissue formation. Seeding mesh with mesenchymal stem cells (MSCs) prior to implantation may reduce the foreign body reaction and lead to improved biomechanical properties of the mesh-tissue complex. This study investigates the influence of seeding human endometrial mesenchymal stem cells (eMSCs) on novel gelatin-coated polyamide scaffolds, to identify differences in scaffold/tissue biomechanical properties and new tissue growth following up to 90 days' implantation, in a subcutaneous rat model of wound repair. Scaffolds were subcutaneously implanted, either with or without eMSCs, in immunocompromised rats and following 7, 30, 60 and 90 days were removed and assessed for their biomechanical properties using uniaxial tensile testing. Following 7, 30 and 90 days' implantation scaffolds were assessed for tissue ingrowth and organization using histological staining and scanning electron microscopy. The eMSCs were associated with altered collagen growth and organization around the mesh filaments of the scaffold, affecting the physiologically relevant tensile properties of the scaffold-tissue complex, in the toe region of the load-elongation curve. Scaffolds seeded with eMSCs were significantly less stiff on initial stretching than scaffolds implanted without eMSCs. Collagen growth and organization were enhanced in the long-term in eMSC-seeded scaffolds, with improved fascicle formation and crimp configuration. Results suggest that neo-tissue formation and remodelling may be enhanced through seeding scaffolds with eMSCs.
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Marfia G, Navone SE, Di Vito C, Ughi N, Tabano S, Miozzo M, Tremolada C, Bolla G, Crotti C, Ingegnoli F, Rampini P, Riboni L, Gualtierotti R, Campanella R. Mesenchymal stem cells: potential for therapy and treatment of chronic non-healing skin wounds. Organogenesis 2015; 11:183-206. [PMID: 26652928 PMCID: PMC4879897 DOI: 10.1080/15476278.2015.1126018] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 11/20/2015] [Accepted: 11/23/2015] [Indexed: 12/16/2022] Open
Abstract
Wound healing is a complex physiological process including overlapping phases (hemostatic/inflammatory, proliferating and remodeling phases). Every alteration in this mechanism might lead to pathological conditions of different medical relevance. Treatments for chronic non-healing wounds are expensive because reiterative treatments are needed. Regenerative medicine and in particular mesenchymal stem cells approach is emerging as new potential clinical application in wound healing. In the past decades, advance in the understanding of molecular mechanisms underlying wound healing process has led to extensive topical administration of growth factors as part of wound care. Currently, no definitive treatment is available and the research on optimal wound care depends upon the efficacy and cost-benefit of emerging therapies. Here we provide an overview on the novel approaches through stem cell therapy to improve cutaneous wound healing, with a focus on diabetic wounds and Systemic Sclerosis-associated ulcers, which are particularly challenging. Current and future treatment approaches are discussed with an emphasis on recent advances.
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Affiliation(s)
- Giovanni Marfia
- Fondazione IRCCS Ca’Granda Ospedale Maggiore Policlinico; University of Milan; Neurosurgery Unit; Laboratory of Experimental Neurosurgery and Cell Therapy; Milan, Italy
| | - Stefania Elena Navone
- Fondazione IRCCS Ca’Granda Ospedale Maggiore Policlinico; University of Milan; Neurosurgery Unit; Laboratory of Experimental Neurosurgery and Cell Therapy; Milan, Italy
| | - Clara Di Vito
- University of Milan; Department of Medical Biotechnology and Translational Medicine; LITA-Segrate; Milan, Italy
| | - Nicola Ughi
- Division of Rheumatology; Istituto Gaetano Pini; Milan Italy; Department of Clinical Science & Community Health; University of Milan; Milan, Italy
| | - Silvia Tabano
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico; University of Milan; Division of Pathology; Milan, Italy
| | - Monica Miozzo
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico; University of Milan; Division of Pathology; Milan, Italy
| | | | - Gianni Bolla
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico; University of Milan; Milan, Italy
| | - Chiara Crotti
- Division of Rheumatology; Istituto Gaetano Pini; Milan Italy; Department of Clinical Science & Community Health; University of Milan; Milan, Italy
| | - Francesca Ingegnoli
- Division of Rheumatology; Istituto Gaetano Pini; Milan Italy; Department of Clinical Science & Community Health; University of Milan; Milan, Italy
| | - Paolo Rampini
- Fondazione IRCCS Ca’Granda Ospedale Maggiore Policlinico; University of Milan; Neurosurgery Unit; Laboratory of Experimental Neurosurgery and Cell Therapy; Milan, Italy
| | - Laura Riboni
- University of Milan; Department of Medical Biotechnology and Translational Medicine; LITA-Segrate; Milan, Italy
| | - Roberta Gualtierotti
- Division of Rheumatology; Istituto Gaetano Pini; Milan Italy; Department of Clinical Science & Community Health; University of Milan; Milan, Italy
| | - Rolando Campanella
- Fondazione IRCCS Ca’Granda Ospedale Maggiore Policlinico; University of Milan; Neurosurgery Unit; Laboratory of Experimental Neurosurgery and Cell Therapy; Milan, Italy
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Maurer M, Röhrnbauer B, Feola A, Deprest J, Mazza E. Mechanical biocompatibility of prosthetic meshes: A comprehensive protocol for mechanical characterization. J Mech Behav Biomed Mater 2014; 40:42-58. [DOI: 10.1016/j.jmbbm.2014.08.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 07/29/2014] [Accepted: 08/10/2014] [Indexed: 11/27/2022]
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Su K, Edwards SL, Tan KS, White JF, Kandel S, Ramshaw JA, Gargett CE, Werkmeister JA. Induction of endometrial mesenchymal stem cells into tissue-forming cells suitable for fascial repair. Acta Biomater 2014; 10:5012-5020. [PMID: 25194931 DOI: 10.1016/j.actbio.2014.08.031] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 08/15/2014] [Accepted: 08/27/2014] [Indexed: 12/16/2022]
Abstract
Pelvic organ prolapse is a major hidden burden affecting almost one in four women. It is treated by reconstructive surgery, often augmented with synthetic mesh. To overcome the growing concerns of using current synthetic meshes coupled with the high risk of reoperation, a tissue engineering strategy has been developed, adopting a novel source of mesenchymal stem cells. These cells are derived from the highly regenerative endometrial lining of the uterus (eMSCs) and will be delivered in vivo using a new gelatin-coated polyamide scaffold. In this study, gelatin properties were optimized by altering the gelatin concentration and extent of crosslinking to produce the desired gelation and degradation rate in culture. Following cell seeding of uncoated polyamide (PA) and gelatin-coated meshes (PA+G), the growth rate of eMSCs on the PA+G scaffolds was more than that on the PA alone, without compromising cell shape. eMSCs cultured on the PA+G scaffold retained their phenotype, as demonstrated by W5C5/SUSD2 (eMSC-specific marker) immunocytochemistry. Additionally, eMSCs were induced to differentiate into smooth muscle cells (SMC), as shown by immunofluorescence for smooth muscle protein 22 and smooth muscle myosin heavy chain. eMSCs also differentiated into fibroblast-like cells when treated with connective tissue growth factor with enhanced detection of Tenascin-C and collagen type I as well as new tissue formation, as seen by Masson's trichrome. In summary, it was demonstrated that the PA+G scaffold is an appropriate platform for eMSC delivery, proliferation and differentiation into SMC and fibroblasts, with good biocompatibility and the capacity to regenerate neo-tissue.
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Verdi J, Tan A, Shoae-Hassani A, Seifalian AM. Endometrial stem cells in regenerative medicine. J Biol Eng 2014; 8:20. [PMID: 25097665 PMCID: PMC4121626 DOI: 10.1186/1754-1611-8-20] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Accepted: 06/30/2014] [Indexed: 01/14/2023] Open
Abstract
First described in 2004, endometrial stem cells (EnSCs) are adult stem cells isolated from the endometrial tissue. EnSCs comprise of a population of epithelial stem cells, mesenchymal stem cells, and side population stem cells. When secreted in the menstrual blood, they are termed menstrual stem cells or endometrial regenerative cells. Mounting evidence suggests that EnSCs can be utilized in regenerative medicine. EnSCs can be used as immuno-modulatory agents to attenuate inflammation, are implicated in angiogenesis and vascularization during tissue regeneration, and can also be reprogrammed into induced pluripotent stem cells. Furthermore, EnSCs can be used in tissue engineering applications and there are several clinical trials currently in place to ascertain the therapeutic potential of EnSCs. This review highlights the progress made in EnSC research, describing their mesodermal, ectodermal, and endodermal potentials both in vitro and in vivo.
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Affiliation(s)
- Javad Verdi
- Centre for Nanotechnology and Regenerative Medicine, UCL Division of Surgery & Interventional Science, University College London (UCL), London NW3 2QG, UK ; Applied Cell Sciences Department, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Aaron Tan
- Centre for Nanotechnology and Regenerative Medicine, UCL Division of Surgery & Interventional Science, University College London (UCL), London NW3 2QG, UK ; UCL Medical School, University College London (UCL), London, UK
| | - Alireza Shoae-Hassani
- Applied Cell Sciences Department, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Alexander M Seifalian
- Centre for Nanotechnology and Regenerative Medicine, UCL Division of Surgery & Interventional Science, University College London (UCL), London NW3 2QG, UK ; Royal Free London NHS Foundation Trust Hospital, London, UK
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Influence of reproductive status on tissue composition and biomechanical properties of ovine vagina. PLoS One 2014; 9:e93172. [PMID: 24709913 PMCID: PMC3977844 DOI: 10.1371/journal.pone.0093172] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 02/28/2014] [Indexed: 12/02/2022] Open
Abstract
Objective To undertake a comprehensive analysis of the biochemical tissue composition and passive biomechanical properties of ovine vagina and relate this to the histo-architecture at different reproductive stages as part of the establishment of a large preclinical animal model for evaluating regenerative medicine approaches for surgical treatment of pelvic organ prolapse. Methods Vaginal tissue was collected from virgin (n = 3), parous (n = 6) and pregnant sheep (n = 6; mean gestation; 132 d; term = 145 d). Tissue histology was analyzed using H+E and Masson's Trichrome staining. Biochemical analysis of the extracellular matrix proteins used a hydroxyproline assay to quantify total collagen, SDS PAGE to measure collagen III/I+III ratios, dimethylmethylene blue to quantify glycosaminoglycans and amino acid analysis to quantify elastin. Uniaxial tensiometry was used to determine the Young's modulus, maximum stress and strain, and permanent strain following cyclic loading. Results Vaginal tissue of virgin sheep had the lowest total collagen content and permanent strain. Parous tissue had the highest total collagen and lowest elastin content with concomitant high maximum stress. In contrast, pregnant sheep had the highest elastin and lowest collagen contents, and thickest smooth muscle layer, which was associated with low maximum stress and poor dimensional recovery following repetitive loading. Conclusion Pregnant ovine vagina was the most extensible, but the weakest tissue, whereas parous and virgin tissues were strong and elastic. Pregnancy had the greatest impact on tissue composition and biomechanical properties, compatible with significant tissue remodeling as demonstrated in other species. Biochemical changes in tissue protein composition coincide with these altered biomechanical properties.
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Ulrich D, Edwards SL, Su K, Tan KS, White JF, Ramshaw JA, Lo C, Rosamilia A, Werkmeister JA, Gargett CE. Human endometrial mesenchymal stem cells modulate the tissue response and mechanical behavior of polyamide mesh implants for pelvic organ prolapse repair. Tissue Eng Part A 2014; 20:785-98. [PMID: 24083684 PMCID: PMC3926142 DOI: 10.1089/ten.tea.2013.0170] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 09/25/2013] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Pelvic organ prolapse (POP) is defined as the descent of one or more of the pelvic structures into the vagina and includes uterine, vaginal vault, and anterior or posterior vaginal wall prolapse. The treatment of POP may include implantation of a synthetic mesh. However, the long-term benefit of mesh surgery is controversial due to complications such as mesh exposure or pain. The aim of this study was to use a tissue engineering (TE) approach to assess the in vivo biological and biomechanical behavior of a new gelatin/polyamide mesh, seeded with a novel source of mesenchymal stem cells in a subcutaneous rat model of wound repair. METHODS W5C5-enriched human endometrial mesenchymal stem cells (eMSC) were seeded onto meshes (gelatin-coated polyamide knit) at 100,000 cells/cm². Meshes, with or without cells were subcutaneously implanted dorsally in immunocompromised rats for 7, 30, 60, and 90 days. Flow cytometry was used to detect DiO labeled cells after explantation. Immunohistochemical assessment of foreign body reaction and tissue integration were conducted. Total collagen and the levels of collagens type III and type I were determined. Uniaxial tensiometry was performed on explanted meshes, originally seeded with and without cells, at days 7 and 90. RESULTS Implanted meshes were well tolerated, with labeled cells detected on the mesh up to 14 days postimplantation. Meshes with cells promoted significantly more neovascularization at 7 days (p<0.05) and attracted fewer macrophages at 90 days (p<0.05). Similarly, leukocyte infiltration was significantly lower in the cell-seeded meshes at 90 days (p<0.05). Meshes with cells were generally less stiff than those without cells, after 7 and 90 days implantation. CONCLUSION The TE approach used in this study significantly reduced the number of inflammatory cells around the implanted mesh and promoted neovascularization. Seeding with eMSC exerts an anti-inflammatory effect and promotes wound repair with new tissue growth and minimal fibrosis, and produces mesh with greater extensibility. Cell seeding onto polyamide/gelatin mesh improves mesh biocompatibility and may be an alternative option for future treatment of POP.
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Affiliation(s)
- Daniela Ulrich
- The Ritchie Centre, Monash Institute of Medical Research, Clayton, Victoria, Australia
- Department of Obstetrics and Gynaecology, Monash Medical Centre, Monash University, Clayton, Victoria, Australia
| | | | - Kai Su
- Materials Science Engineering, CSIRO, Clayton, Victoria, Australia
| | - Ker Sin Tan
- The Ritchie Centre, Monash Institute of Medical Research, Clayton, Victoria, Australia
| | - Jacinta F. White
- Materials Science Engineering, CSIRO, Clayton, Victoria, Australia
| | | | - Camden Lo
- The Ritchie Centre, Monash Institute of Medical Research, Clayton, Victoria, Australia
| | - Anna Rosamilia
- Department of Obstetrics and Gynaecology, Monash Medical Centre, Monash University, Clayton, Victoria, Australia
| | | | - Caroline E. Gargett
- The Ritchie Centre, Monash Institute of Medical Research, Clayton, Victoria, Australia
- Department of Obstetrics and Gynaecology, Monash Medical Centre, Monash University, Clayton, Victoria, Australia
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36
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Ulrich D, Muralitharan R, Gargett CE. Toward the use of endometrial and menstrual blood mesenchymal stem cells for cell-based therapies. Expert Opin Biol Ther 2013; 13:1387-400. [PMID: 23930703 DOI: 10.1517/14712598.2013.826187] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Bone marrow is a widely used source of mesenchymal stem cells (MSCs) for cell-based therapies. Recently, endometrium - the highly regenerative lining of the uterus - and menstrual blood have been identified as more accessible sources of MSCs. These uterine MSCs include two related cell types: endometrial MSCs (eMSCs) and endometrial regenerative cells (ERCs). AREAS COVERED The properties of eMSCs and ERCs and their application in preclinical in vitro and in vivo studies for pelvic organ prolapse, heart disorders and ischemic conditions are reviewed. Details of the first clinical Phase I and Phase II studies will be provided. EXPERT OPINION The authors report that eMSCs and ERCs are a readily available source of adult stem cells. Both eMSCs and ERCs fulfill the key MSC criteria and have been successfully used in preclinical models to treat various diseases. Data on clinical trials are sparse. More research is needed to determine the mechanism of action of eMSCs and ERCs in these regenerative medicine models and to determine the long-term benefits and any adverse effects after their administration.
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Affiliation(s)
- Daniela Ulrich
- Monash University, Monash Institute of Medical Research, The Ritchie Centre , 27-31 Wright Street, PO Box 5418, Clayton, Melbourne, 3168 , Australia
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