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Liu M, Wang Y, Gao G, Zhao WX, Fu Q. Stem Cell Application for Stress Urinary Incontinence: From Bench to Bedside. Curr Stem Cell Res Ther 2023; 18:17-26. [PMID: 35249506 DOI: 10.2174/1574888x17666220304213057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 11/29/2021] [Accepted: 12/21/2021] [Indexed: 11/22/2022]
Abstract
Stress urinary incontinence (SUI) is a common urinary system disease worldwide. Nowadays, medical therapy and surgery can control the symptoms and improve the life quality of patients. However, they might also bring about complications as the standard therapy fails to address the underlying problem of urethral sphincter dysfunction. Recent advances in cell technology have aroused interest in the use of autologous stem cell therapy to restore the ability of urinary control. The present study reviewed several types of stem cells for the treatment of SUI in the experimental and clinical stages.
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Affiliation(s)
- Meng Liu
- Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China.,Shanghai Eastern Institute of Urologic Reconstruction, Shanghai Jiao Tong University, Shanghai 200233, China
| | - Ying Wang
- Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China.,Shanghai Eastern Institute of Urologic Reconstruction, Shanghai Jiao Tong University, Shanghai 200233, China
| | - Guo Gao
- Department of Instrument Science and Engineering, School of Electronic Information and Electrical Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Wei-Xin Zhao
- Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina 27157, USA
| | - Qiang Fu
- Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China.,Shanghai Eastern Institute of Urologic Reconstruction, Shanghai Jiao Tong University, Shanghai 200233, China
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2
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Seval MM, Koyuncu K. Current status of stem cell treatments and innovative approaches for stress urinary incontinence. Front Med (Lausanne) 2022; 9:1073758. [PMID: 36530893 PMCID: PMC9755676 DOI: 10.3389/fmed.2022.1073758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 11/14/2022] [Indexed: 01/06/2024] Open
Abstract
Stem cells are capable of self-renewal, differentiation, and the promotion of the release of chemokines and progenitor cells essential for tissue regeneration. Stem cells have the potential to develop into specialized cells if given the right conditions, to self-renew and maintain themselves, to generate a large number of new differentiated cells if injured, and to either generate new tissues or repair existing ones. In the last decade, it has become clear that treating lower urinary tract dysfunction with the patient's own adult stem cells is an effective, root-cause method. Regenerative medicine is predicated on the idea that a damaged rhabdosphincter can be repaired, leading to enhanced blood flow and improved function of the sphincter's exterior (striated) and internal (smooth) muscles. Stem cell therapy has the potential to cure stress urinary incontinence according to preclinical models. In contrast, stem cell treatment has not been licensed for routine clinical usage. This article reviews the current state of stem cell for stres urinary incontinence research and recommends future avenues to facilitate practical uses of this potential therapy modality.
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Affiliation(s)
- Mehmet Murat Seval
- Department of Obstetrics and Gynecology, Ankara University School of Medicine, Ankara, Turkey
| | - Kazibe Koyuncu
- Department of Obstetrics and Gynecology, Medicana Hospital, Istanbul, Turkey
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3
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Maene A, Deniz G, Bouland C, Lagneaux L, Philippart P, Buxant F. Suburethral implantation of autologous regenerative cells for female stress urinary incontinence management: Results of a pilot study. Eur J Obstet Gynecol Reprod Biol 2022; 278:38-44. [PMID: 36113285 DOI: 10.1016/j.ejogrb.2022.08.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 08/23/2022] [Accepted: 08/30/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To assess the feasibility and the safety of treating female stress urinary incontinence (SUI) with suburethral implantation of a mixture of the stromal vascular fraction from adipose tissue and leukocyte-and platelet-rich-fibrin. METHODS Patients with SUI were treated with a mixture of stromal vascular fraction and leukocyte-and platelet-rich fibrin. The stromal vascular fraction was obtained from enzymatic digestion of autologous adipose-tissue and added to an leukocyte-and platelet-rich-fibrin membrane. The mixture was transvaginally implanted into the suburethral area. A fraction of the Stromal vascular fraction sample was used for cellular characterization. Patients were followed for 9 months. Every 3 months, the patients were clinically evaluated with a cough- stress test and a validated-questionnaire. An MRI was performed preoperatively and 3 months after the procedure to assess tissue changes. RESULTS Ten patients received the surgical procedure. The validated-questionnaire revealed a subjective SUI improvement in nine patients 3 months after the operation and in seven patients 9 months after the operation. Eight, six, and four patients achieved a negative cough-stress test 3, 6 and 9 months post-injection, respectively. Flow cytometric analysis of stromal vascular fraction cell phenotypes revealed predominantly mesenchymal and endothelial cell heterogeneity. In total, we injected 0,18 × 106 to 13,6 × 106 cells. No adverse events were observed peri- or postoperatively. CONCLUSION These preliminary results suggest that the suburethral implantation of a combination of SVF and l-PRF is a feasible and safe modality for treating female SUI. However, evidence is lacking and further research are needed to clarify the respective roles of SVF and l-PRF in female SUI treatment.
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Affiliation(s)
- Anne Maene
- Université Libre de Bruxelles, Medicine Faculty, route de Lennik 808, 1070 Brussels, Belgium.
| | - Gulcan Deniz
- Departments of Gynecology and Obstetrics, IRIS South Hospital, rue Jean-Paquot 63, 1050 Brussels, Belgium
| | - Cyril Bouland
- Université Libre de Bruxelles, Medicine Faculty, route de Lennik 808, 1070 Brussels, Belgium; Departement of Stomatology and maxillofacial Surgery, CHU Saint-Pierre, 322 Rue Haute, 1000 Brussels, Belgium; Laboratory of Clinical Cell Therapy, Jules Bordet Institute, Université Libre de Bruxelles, campus Erasme, Route de Lennik 808, 1070 Brussels, Belgium
| | - Laurence Lagneaux
- Laboratory of Clinical Cell Therapy, Jules Bordet Institute, Université Libre de Bruxelles, campus Erasme, Route de Lennik 808, 1070 Brussels, Belgium
| | - Pierre Philippart
- Université Libre de Bruxelles, Medicine Faculty, route de Lennik 808, 1070 Brussels, Belgium; Departement of Stomatology and maxillofacial Surgery, IRIS south Hospital, rue Docteur Huet, 1070 Brussels, Belgium
| | - Fréderic Buxant
- Departments of Gynecology and Obstetrics, IRIS South Hospital, rue Jean-Paquot 63, 1050 Brussels, Belgium
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Teraoka S, Honda M, Makishima K, Shimizu R, Tsounapi P, Yumioka T, Iwamoto H, Li P, Morizane S, Hikita K, Hisatome I, Takenaka A. Early effects of an adipose-derived stem cell sheet against detrusor underactivity in a rat cryo-injury model. Life Sci 2022; 301:120604. [DOI: 10.1016/j.lfs.2022.120604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 04/21/2022] [Accepted: 04/27/2022] [Indexed: 11/25/2022]
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5
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Zhang Y, Guo S, Wang C, Liu X, Liu Y, Shang H, Yang P, Wang L, Zhai J, Li X, Jia Y. Acupuncture for prostatectomy incontinence: study protocol for a multicenter single-blind randomized parallel controlled trial. Trials 2022; 23:9. [PMID: 34983588 PMCID: PMC8725553 DOI: 10.1186/s13063-021-05805-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 11/06/2021] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Urinary incontinence is a common complication post radical prostatectomy. Acupuncture is considered an effective treatment for post-prostatectomy incontinence (PPI), but the evidence is still limited. We propose to evaluate the effectiveness of acupuncture in a rigorously conducted trial. METHODS Twenty hospitals will recruit 340 participants with urinary incontinence after radical prostatectomy in China from April 2021 to April 2022. Participants will be randomly allocated to acupuncture or sham acupuncture with a 1:1 ratio using computerized simple random sampling. The study plan consists of 1-week baseline, 6-week treatment, and 18-week follow-up. Eighteen 30-min sessions of acupuncture or sham acupuncture treatment will be provided between weeks 1 and 6. The primary outcome is the change in the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI-SF) score at the week 6 from the baseline. Secondary outcomes include the change in volume of urine leakage at weeks 4 and 6 from a baseline measured using the 1-h pad test; 72-h incontinence episode frequency based on a 72-h voiding diary; change in the Expanded prostate cancer Index Composite scale (EPIC-26); change in the Self-Rating Anxiety Scale; weekly consumption of pads; and the severity of urinary incontinence based on a 72-h bladder diary and self-assessment of the therapeutic effect. The safety of acupuncture will also be assessed. DISCUSSION This trial will help to identify whether acupuncture is effective for PPI, and, if so, whether it exerts a therapeutic rather than a placebo effect. TRIAL REGISTRATION www.Chictr.org.cn ChiCTR2100042500 . Retrospectively registered on 22 January 2021.
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Affiliation(s)
- Yao Zhang
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Shanqi Guo
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Chaoran Wang
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Xiaodi Liu
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yan Liu
- Key Laboratory of Chinese Internal Medicine of Ministry of Education, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Hongcai Shang
- Key Laboratory of Chinese Internal Medicine of Ministry of Education, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Peiying Yang
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Liang Wang
- Tianjin Medical University General Hospital, Tianjin, China
| | - Jingbo Zhai
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Xiaojiang Li
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Yingjie Jia
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
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6
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Ding DC, Li PC. Stem-cell therapy in stress urinary incontinence: A review. Tzu Chi Med J 2022. [DOI: 10.4103/tcmj.tcmj_145_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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7
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El-Kadiry AEH, Rafei M, Shammaa R. Cell Therapy: Types, Regulation, and Clinical Benefits. Front Med (Lausanne) 2021; 8:756029. [PMID: 34881261 PMCID: PMC8645794 DOI: 10.3389/fmed.2021.756029] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 11/01/2021] [Indexed: 12/12/2022] Open
Abstract
Cell therapy practices date back to the 19th century and continue to expand on investigational and investment grounds. Cell therapy includes stem cell- and non-stem cell-based, unicellular and multicellular therapies, with different immunophenotypic profiles, isolation techniques, mechanisms of action, and regulatory levels. Following the steps of their predecessor cell therapies that have become established or commercialized, investigational and premarket approval-exempt cell therapies continue to provide patients with promising therapeutic benefits in different disease areas. In this review article, we delineate the vast types of cell therapy, including stem cell-based and non-stem cell-based cell therapies, and create the first-in-literature compilation of the different "multicellular" therapies used in clinical settings. Besides providing the nuts and bolts of FDA policies regulating their use, we discuss the benefits of cell therapies reported in 3 therapeutic areas-regenerative medicine, immune diseases, and cancer. Finally, we contemplate the recent attention shift toward combined therapy approaches, highlighting the factors that render multicellular therapies a more attractive option than their unicellular counterparts.
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Affiliation(s)
- Abed El-Hakim El-Kadiry
- Laboratory of Thrombosis and Hemostasis, Montreal Heart Institute, Research Center, Montreal, QC, Canada
- Department of Biomedical Sciences, Université de Montréal, Montreal, QC, Canada
| | - Moutih Rafei
- Department of Pharmacology and Physiology, Université de Montréal, Montreal, QC, Canada
- Department of Microbiology, Infectious Diseases and Immunology, Université de Montréal, Montreal, QC, Canada
- Molecular Biology Program, Université de Montréal, Montreal, QC, Canada
- Department of Microbiology and Immunology, McGill University, Montreal, QC, Canada
| | - Riam Shammaa
- Canadian Centre for Regenerative Therapy, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
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Adamowicz J, Kluth LA, Pokrywczynska M, Drewa T. Tissue Engineering and Its Potential to Reduce Prostate Cancer Treatment Sequelae-Narrative Review. Front Surg 2021; 8:644057. [PMID: 34722618 PMCID: PMC8551715 DOI: 10.3389/fsurg.2021.644057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 07/19/2021] [Indexed: 01/08/2023] Open
Abstract
Tissue engineering offers the possibility to overcome limitations of current management for postprostatectomy incontinence and ED. Developed in recent years biotechnological feasibility of mesenchymal stem cell isolation, in vitro cultivation and implantation became the basis for new cell-based therapies oriented to induce regeneration of adult tissue. The perspective to offer patients suffering from post-prostatectomy incontinence or erectile dysfunction minimal invasive one-time procedure utilizing autologous stem cell transplantation is desired management.
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Affiliation(s)
- Jan Adamowicz
- Chair of Urology, Department of Regenerative Medicine, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Luis Alex Kluth
- Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Marta Pokrywczynska
- Chair of Urology, Department of Regenerative Medicine, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Tomasz Drewa
- Chair of Urology, Department of Regenerative Medicine, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
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Durante J, Manassero F, Fidecicchi T, Tognarelli A, Di Vico T, Faviana P, Selli C. Autologous fascial slings remain viable at long-term follow-up: a post cystectomy case report. BMC Urol 2021; 21:122. [PMID: 34496811 PMCID: PMC8424806 DOI: 10.1186/s12894-021-00884-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 08/17/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Autologous fascial slings (AFS) have been used for a very long time in the treatment of female stress urinary incontinence, but the introduction of synthetic mesh slings placed either retropubicallyor trans-obturator has decreased the need to harvest the autologous rectus muscle fascia, thus reducing invasiveness and operative time. However AFS are still indicated in complicated cases and re-interventions, and the FDA has underlined safety concerns over the use of surgical meshes for the transvaginal repair of prolapsed pelvic organs. CASE PRESENTATION A 76-year-old woman with muscle-invasivebladder cancer underwent radical cystectomy 16 years after retropubic positioning of an autologous rectus muscle fascial sling for SUI, with complete symptom resolution. The sling was easily identified and removed en bloc with the bladder and urethra, providing an opportunity to histologicallyevaluate the autologous fascial graft after its long permanence in the new position. Histopathological examination demonstrated increased fibroblastic proliferation and formation of capillaries. A slight separation and an increased waviness of the connective fibers were both evident. An increased vascularity was also apparent, including transverse vessels, with clusters of vessels. A relative inflammatory reaction was present in over 300 cells/10 HPF. All these characteristics indicated viable connective tissue. CONCLUSIONS AFS remain a valuable surgical option for both primary and recurrent SUI in women, showing high cure rates and low complications in the long-term. The present case, to the best of our knowledge, presents the longest follow-up period of an autologous rectus muscle fascia placed retropubically and its histological evaluation documents characteristics which support its mechanical strength and viability.
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Affiliation(s)
- Jacopo Durante
- Department of Translational Research and New Technologies in Medicine and Surgery, Section of Urology, University of Pisa, via Paradisa 2, 56126, Pisa, Italy.
| | - Francesca Manassero
- Department of Translational Research and New Technologies in Medicine and Surgery, Section of Urology, University of Pisa, via Paradisa 2, 56126, Pisa, Italy
| | - Tiziana Fidecicchi
- Department of Translational Research and New Technologies in Medicine and Surgery, Section of Urology, University of Pisa, via Paradisa 2, 56126, Pisa, Italy
| | - Alessio Tognarelli
- Department of Translational Research and New Technologies in Medicine and Surgery, Section of Urology, University of Pisa, via Paradisa 2, 56126, Pisa, Italy
| | - Tommaso Di Vico
- Department of Translational Research and New Technologies in Medicine and Surgery, Section of Urology, University of Pisa, via Paradisa 2, 56126, Pisa, Italy
| | - Pinuccia Faviana
- Department of Surgical, Medical, Molecular Pathology and Critical Area, Section of Pathology, University of Pisa, via Roma 67, 56124, Pisa, Italy
| | - Cesare Selli
- Department of Translational Research and New Technologies in Medicine and Surgery, Section of Urology, University of Pisa, via Paradisa 2, 56126, Pisa, Italy
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Okabe YT, Shimizu S, Suetake Y, Matsui-Hirai H, Hasegawa S, Takanari K, Toriyama K, Kamei Y, Yamamoto T, Mizuno M, Gotoh M. Biological characterization of adipose-derived regenerative cells used for the treatment of stress urinary incontinence. Int J Urol 2020; 28:115-124. [PMID: 33289131 DOI: 10.1111/iju.14408] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 09/27/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess the characteristics of adipose-derived regenerative cells, and provide supportive data explaining the mechanism of efficacy observed for the use of these cells in the treatment of stress urinary incontinence. METHODS Adipose tissues were harvested by abdominal liposuction from healthy donors and patients with stress urinary incontinence. Adipose-derived regenerative cells were isolated from tissues using the Celution system, and assessed for their characteristics and ability to differentiate into smooth muscle cells. RESULTS Adipose-derived regenerative cells isolated by the Celution system developed into fibroblastic colonies. Flow cytometric analysis of adipose-derived stem cell markers showed that adipose-derived regenerative cells were positive for CD34 and CD44, and negative for CD31. Immunofluorescence staining after differentiation showed that colony-forming cells were positive for alpha-smooth muscle actin, calponin and desmin, which are smooth muscle cell markers. A cytokine release assay showed that adherent cells secreted cytokines associated with angiogenesis, including vascular endothelial growth factor-A, angiopoietin-2 and placental growth factor. CONCLUSIONS Adipose-derived regenerative cells collected by the Celution system might have clonogenic capacity and an angiogenetic function. These properties might contribute to the mechanisms through which regenerative cell therapy by periurethral injection of autologous adipose-derived regenerative cells ameliorates stress urinary incontinence.
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Affiliation(s)
- Yuka Tsukagoshi Okabe
- Departments of, Department of, Advanced Medicine, Nagoya University Hospital, Nagoya, Aichi, Japan
| | - Shinobu Shimizu
- Departments of, Department of, Advanced Medicine, Nagoya University Hospital, Nagoya, Aichi, Japan
| | - Yukihiro Suetake
- Departments of, Department of, Advanced Medicine, Nagoya University Hospital, Nagoya, Aichi, Japan
| | - Hisako Matsui-Hirai
- Departments of, Department of, Advanced Medicine, Nagoya University Hospital, Nagoya, Aichi, Japan
| | - Shizuka Hasegawa
- Department of, Clinical Engineering, Nagoya University Hospital, Nagoya, Aichi, Japan
| | - Keisuke Takanari
- Department of Plastic and Reconstructive Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Kazuhiro Toriyama
- Department of Plastic and Reconstructive Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.,Department of Plastic and Reconstructive Surgery, Nagoya City University Hospital, Nagoya, Aichi, Japan
| | - Yuzuru Kamei
- Department of Plastic and Reconstructive Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Tokunori Yamamoto
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Masaaki Mizuno
- Departments of, Department of, Advanced Medicine, Nagoya University Hospital, Nagoya, Aichi, Japan
| | - Momokazu Gotoh
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
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Huang Z, Yang T, Shao L, Yang B, Yang S, Wang G, Li P, Li J. Regenerated Cell Therapy for Stress Urinary Incontinence: A Meta-Analysis. J INVEST SURG 2020; 34:1366-1376. [PMID: 33198535 DOI: 10.1080/08941939.2020.1805654] [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] [Indexed: 10/23/2022]
Abstract
PURPOSE To evaluate the efficacy and safety of regenerated cell therapy for stress urinary incontinence (UI) in humans. METHODS We searched articles from PubMed, Embase, and the Cochrane Library database published before February 24, 2020. Of 396 records identified, 23 articles on human clinical research met our criteria, including a total of 890 patients. Stata/SE12.0 software was used to analyze cure, efficiency (cure rate plus improvement rate), and complication rates. RESULTS No significant differences in cure rates and effective rates were observed for any cell type in males. However, in females, the myocytes with fibroblasts subgroup (82%) and nucleated cells with platelets subgroup (89%) exhibited significantly higher cure rates compared with the other two subgroups (25% and 36%). Pooled effective rates of myocytes and fibroblasts (92%) and nucleated cells with platelets (97%) were also higher compared with the other two subgroups (72% and 60%). Pooled complication rates were 23% and 26% in males and females, respectively, and there were some differences among subgroups. Although some studies reported postoperative complications, no serious complications were reported and most recovered within 1-2 weeks. CONCLUSIONS Limited studies have indicated the safety and effectiveness of regenerated cells for treating stress UI in the follow-up period, which may be an ideal method to treat stress UI in the future. Moreover, nucleated cells with platelets and myocytes with fibroblasts were markedly effective, but whether cell injection therapies elicit superior effects need further confirmation.
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Affiliation(s)
- Ziye Huang
- The Department of Urology, Kunming Medical University and The Second Affiliated Hospital, Kunming, P. R. China
| | - Tongxin Yang
- The Department of Urology, Kunming Medical University and The Second Affiliated Hospital, Kunming, P. R. China
| | - Lishi Shao
- The Department of Imageology, Kunming Medical University and The Second Affiliated Hospital, Kunming, P. R. China
| | - Bowei Yang
- The Department of Urology, Kunming Medical University and The Second Affiliated Hospital, Kunming, P. R. China
| | - Shunhang Yang
- The Department of Urology, Kunming Medical University and The Second Affiliated Hospital, Kunming, P. R. China
| | - Guang Wang
- The Department of Urology, Kunming Medical University and The Second Affiliated Hospital, Kunming, P. R. China
| | - Pei Li
- The Department of Urology, Kunming Medical University and The Second Affiliated Hospital, Kunming, P. R. China
| | - Jiongming Li
- The Department of Urology, Kunming Medical University and The Second Affiliated Hospital, Kunming, P. R. China
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Abstract
Stem cells are capable of self-renewal and differentiation into a range of cell types and promote the release of chemokines and progenitor cells necessary for tissue regeneration. Mesenchymal stem cells are multipotent progenitor cells with enhanced proliferation and differentiation capabilities and less tumorigenicity than conventional adult stem cells; these cells are also easier to acquire. Bladder dysfunction is often chronic in nature with limited treatment modalities due to its undetermined pathophysiology. Most treatments focus on symptom alleviation rather than pathognomonic changes repair. The potential of stem cell therapy for bladder dysfunction has been reported in preclinical models for stress urinary incontinence, overactive bladder, detrusor underactivity, and interstitial cystitis/bladder pain syndrome. Despite these findings, however, stem cell therapy is not yet available for clinical use. Only one pilot study on detrusor underactivity and a handful of clinical trials on stress urinary incontinence have reported the effects of stem cell treatment. This limitation may be due to stem cell function loss following ex vivo expansion, poor in vivo engraftment or survival after transplantation, or a lack of understanding of the precise mechanisms of action underlying therapeutic outcomes and in vivo behavior of stem cells administered to target organs. Efficacy comparisons with existing treatment modalities are also needed for the successful clinical application of stem cell therapies. This review describes the current status of stem cell research on treating bladder dysfunction and suggests future directions to facilitate clinical applications of this promising treatment modality, particularly for bladder dysfunction.
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Barakat B, Franke K, Schakaki S, Hijazi S, Hasselhof V, Vögeli TA. Stem cell applications in regenerative medicine for stress urinary incontinence: A review of effectiveness based on clinical trials. Arab J Urol 2020; 18:194-205. [PMID: 33029431 PMCID: PMC7473152 DOI: 10.1080/2090598x.2020.1750864] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Objective To evaluate the current state, therapeutic benefit and safety of urethral injection of autologous stem cells for the treatment stress urinary incontinence (SUI). Materials and methods A selective database search of PubMed, the Excerpta Medica dataBASE (EMBASE), Cochrane Library and Google Scholar was conducted to validate the effectiveness of stem cell-based therapy. The search included clinical trials published up until 4 January 2020, written in English, and included cohorts of women and men who had received stem cell-based therapy for SUI. The search used the following keywords in various combinations: ‘stem cell therapy’, ‘cell-based therapy for SUI’, ‘regenerative medicine for SUI’, and ‘tissue engineering’. The success rates were assessed according to cough test, urodynamics, pad tests, and International Consultation on Incontinence Questionnaire-Urinary Incontinence. The primary endpoint was continence rate to measure objectively the effect of the treatment. Results We identified four clinical trials using local injections of adipose-derived stem cells (ADSCs), 11 trails with muscle-derived stem cells (MDSCs), and two trails with human umbilical cord blood stem cells (HUCBs) and total nucleated cells (TNCs). The median improvement rate of intrinsic sphincter deficiency after ADSCs, MDSCs, TNCs, HUCBs injections were 88%, 77%, 89%, 36% (improvement rate: 1–2 pads) at a mean (range) follow-up of 6 (1–72) months. The cell sources, methods of cell processing, cell number, and implantation techniques differed considerably between studies. Most of the periurethral injections were at the 3, 5, 7, and 9 o’clock positions and for submucosa were at the 4, 6, and 8 o’clock positions. No significant postoperative complications were reported. Conclusion Despite many challenges in stem cell-based therapy for treating SUI, it appears to provide, in both male and female patients, acceptable functional results with minimal side-effects and complications. In the future, more clinical trials should be funded in order to optimise stem cell-based therapy and evaluate long-term outcomes. Abbreviations ADSC: adipose-derived stem cell; BMSCs: bone marrow-derived mesenchymal stem cell; CLPP: cough leak-point pressure; FPL: functional profile length; HUCB: human umbilical cord blood stem cell; ICIQ-(QOL)(SF)(UI): International Consultation on Incontinence Questionnaire (Quality of life) (-Urinary incontinence Short Form) (-Urinary Incontinence); IIQ-7: Incontinence Impact Questionnaire-short form; I-QOL: Incontinence quality of life questionnaire; ISD: intrinsic urinary sphincter deficiency; MDSC: muscle-derived stem cell; MUCP: maximum urethral closure pressure; NR: not reported; Pdet-max: maximum detrusor pressure; PVR: post-void residual urine volume; Qmax: maximum urinary flow; QOL: quality of life; RP: radical prostatectomy; TNC: total nucleated cell; (S)UI: (stress) urinary incontinence; UDSCs: urine-derived stem cells; UTUS: upper tract ultrasonography; VLPP: Valsalva leak-point pressure
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Affiliation(s)
- Bara Barakat
- Department of Urology and Pediatric Urology, Hospital Viersen, Viersen, Germany
| | - Knut Franke
- Department of Urology and Pediatric Urology, Hospital Viersen, Viersen, Germany
| | - Samer Schakaki
- Department of Urology, Hospital Osnabrück, Osnabruck, Germany
| | - Sameh Hijazi
- Department of Urology, Hospital Ibbenbüren, Ibbenbüren, Germany
| | | | - Thomas-Alexander Vögeli
- Department of Urology and Pediatric Urology, Universityhospital RWTH Aachen, Aachen, Germany
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14
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Whiting D, Hamdoon M, Sriprasad S. Stem cell therapy for stress urinary incontinence. JOURNAL OF CLINICAL UROLOGY 2020. [DOI: 10.1177/2051415819841957] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Stress urinary incontinence is the involuntary loss of urine on effort or physical exertion. It is a highly prevalent condition affecting both men and women. Treatment is performed in a step-wise approach involving conservative measures, such as weight loss and pelvic floor exercises, medical treatment with duloxetine and a variety of surgical treatment options. However, recent restrictions in the use of synthetic mesh and tape have limited the surgical treatment options, leading to the need for new and novel treatment for stress urinary incontinence. Stem cell therapy is a developing medical field and offers the potential to restore normal physiological function of the urethral sphincter. The effectiveness of stem cell therapy in stress urinary incontinence has been demonstrated in pre-clinical studies, leading to its evaluation in several clinical studies. This review assesses the current evidence for the safety and efficacy of stem cell treatment for patients with stress urinary incontinence who have failed conservative and/or medical management and have not undergone previous surgical treatment for stress urinary incontinence.Evidence Level: Not applicable
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Affiliation(s)
- D Whiting
- Department of Urology, Darent Valley Hospital, United Kingdom
| | - M Hamdoon
- Department of Urology, Darent Valley Hospital, United Kingdom
| | - S Sriprasad
- Department of Urology, Darent Valley Hospital, United Kingdom
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15
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Chermansky C, Mitsogiannis I, Abrams P, Apostolidis A. Stem cells and lower urinary tract dysfunction: Has its potential finally reached clinical maturity? ICI‐RS2018. Neurourol Urodyn 2019; 38 Suppl 5:S134-S141. [DOI: 10.1002/nau.24069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 05/10/2019] [Indexed: 12/31/2022]
Affiliation(s)
| | - Iraklis Mitsogiannis
- 2nd Department of UrologySismanogleio General HospitalNational and Kapodistrian University of AthensAthens Greece
| | - Paul Abrams
- Bristol Urological InstituteUniversity of BristolBristol UK
| | - Apostolos Apostolidis
- 2nd Department of Urology, Papageorgiou General HospitalAristotle University of ThessalonikiThessaloniki Greece
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16
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Andia I, Maffulli N, Burgos-Alonso N. Stromal vascular fraction technologies and clinical applications. Expert Opin Biol Ther 2019; 19:1289-1305. [PMID: 31544555 DOI: 10.1080/14712598.2019.1671970] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Introduction: The heterogeneous pool of cells found in the stromal vascular fraction of adipose tissue (SVF) and the purified mesenchymal stromal/stem cells (ASCs) isolated from this pool have increasingly been used as therapeutic tools in regenerative medicine.Areas covered: As SVF and ASCs are different, and should be used in different manners according to various clinical and biological indications, we reviewed the current literature, and focused on the clinical use of SVF to appraise the main medical fields for development. Both enzymatic digestion and mechanical disruption have been used to obtain SVF for non-homologous use. The safety and/or benefits of SVF have been examined in 71 clinical studies in various contexts, mainly musculoskeletal conditions, wound healing, urogenital, and cardiovascular and respiratory diseases. The use of SVF as a therapy remains experimental, with few clinical trials.Expert opinion: SVF provides a cellular and molecular microenvironment for regulation of ASC' activities under different clinical conditions. SVF may enhance angiogenesis and neovascularization in wound healing, urogenital and cardiovascular diseases. In joint conditions, therapeutic benefits may rely on paracrine immune-modulatory and anti-inflammatory mechanisms. Novel point of care methods are emerging to refine SVF in ways that meet the regulatory requirements for minimal manipulation.
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Affiliation(s)
- Isabel Andia
- Regenerative Medicine Laboratory, BioCruces Bizkaia Health Research Institute, Cruces University Hospital, Barakaldo, Spain
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, University of Salerno School of Medicine and Dentistry, Salerno, Italy.,Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Natalia Burgos-Alonso
- Preventive Medicine and Public Health Department, University of the Basque Country, Faculty of Medicine and Odontology, UPV/EHU, Leioa, Bizkaia, Spain
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17
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Gallo F, Ninotta G, Schenone M, Cortese P, Giberti C. Advances in stem cell therapy for male stress urinary incontinence. Expert Opin Biol Ther 2019; 19:293-300. [PMID: 30709326 DOI: 10.1080/14712598.2019.1578343] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Among the several options that have been proposed in recent years for the management of male stress urinary incontinence (SUI), stem cell therapy represents a new frontier in treatment. The aim of this paper is to update the current status of stem cell therapy in animal and human studies for the management of iatrogenic male SUI. AREAS COVERED A literature review was conducted based on MEDLINE/PubMed searches for English articles using a combination of the following keywords: stem cell therapy, urinary incontinence, prostatectomy, regenerative medicine, mesenchymal stem cells. EXPERT OPINION The few studies reported in the literature have demonstrated short-term safety and promising results of stem cell therapy in treating male SUI. However, many aspects need to be clarified before stem cell therapy can be introduced into daily urologic practice. In fact, important issues such as the limitations of these studies in terms of small sample sizes and short follow-ups, the incomplete knowledge of the mechanism of action of stem cells, the technical details regarding the delivery method and the best sources of stem cells, the safety risks regarding genomic or epigenetic changes and potential immune reactions in the longer term need to be identified in more stringent clinical trials.
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Affiliation(s)
- Fabrizio Gallo
- a Department of Surgery, Division of Urology , San Paolo Hospital , Savona , Italy
| | - Gaetano Ninotta
- a Department of Surgery, Division of Urology , San Paolo Hospital , Savona , Italy
| | - Maurizio Schenone
- a Department of Surgery, Division of Urology , San Paolo Hospital , Savona , Italy
| | - Pierluigi Cortese
- a Department of Surgery, Division of Urology , San Paolo Hospital , Savona , Italy
| | - Claudio Giberti
- a Department of Surgery, Division of Urology , San Paolo Hospital , Savona , Italy
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18
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Urethral Bulking and Salvage Techniques for Post-Prostatectomy Incontinence. CURRENT BLADDER DYSFUNCTION REPORTS 2019. [DOI: 10.1007/s11884-019-00499-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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19
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Gotoh M, Yamamoto T, Shimizu S, Matsukawa Y, Kato M, Majima T, Takai S, Funahashi Y, Toriyama K. Treatment of male stress urinary incontinence using autologous adipose-derived regenerative cells: Long-term efficacy and safety. Int J Urol 2018; 26:400-405. [PMID: 30557919 DOI: 10.1111/iju.13886] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 11/21/2018] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To investigate the long-term efficacy and safety of periurethral injection of autologous adipose-derived regenerative cells for the treatment of post-prostatectomy stress urinary incontinence. METHODS A total of 13 patients with persistent stress urinary incontinence after prostate surgery (radical prostatectomy, 10 patients; holmium laser enucleation of the prostate, three patients) underwent periurethral injection of adipose-derived regenerative cells and were followed up for >4 years. A 24-h pad test was carried out for four consecutive days in each evaluation period, and changes in the mean daily leakage volume during the 4 days from baseline to 60 months after treatment were evaluated. RESULTS The mean follow-up period was 69 months (range 55-72 months). The mean leakage volume/24 h in all patients changed from 260.7 g to 152.7 g. Urinary incontinence progressively improved up to 12 months after treatment in 10 patients, who maintained improvement up to the final assessment, with the mean daily leakage volume decreasing from 281.5 g to 119.0 g (reduction rate 57.7%). The other three patients showed no improvement at 1 year and at the final assessment. After the perioperative period, significant adverse events or prostate-specific antigen increase were not observed during long-term follow up. CONCLUSIONS The present findings suggest that periurethral injection of autologous adipose-derived regenerative cells is a safe and feasible treatment modality with long-term efficacy for patients with male stress urinary incontinence caused by urethral sphincter deficiency.
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Affiliation(s)
- Momokazu Gotoh
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Tokunori Yamamoto
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Shinobu Shimizu
- Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya, Aichi, Japan
| | - Yoshihisa Matsukawa
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Masashi Kato
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Tsuyoshi Majima
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Shun Takai
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Yasuhito Funahashi
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Kazuhiro Toriyama
- Department of Plastic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
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20
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Aragón IM, Imbroda BH, Lara MF. Cell Therapy Clinical Trials for Stress Urinary Incontinence: Current Status and Perspectives. Int J Med Sci 2018; 15:195-204. [PMID: 29483809 PMCID: PMC5820847 DOI: 10.7150/ijms.22130] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 11/22/2017] [Indexed: 12/11/2022] Open
Abstract
Stress urinary incontinence (SUI) affects 200 million people worldwide. Standard therapies often provide symptomatic relief, but without targeting the underlying etiology, and show tremendous patient-to-patient variability, limited success and complications associated with the procedures. We review in this article the latest clinical trials performed to treat SUI using cell-based therapies. These therapies, despite typically including only a small number of patients and short term evaluation of results, have proven to be feasible and safe. However, there is not yet a consensus for the best cell source to be used to treat SUI and not all patients may be suitable for these therapies. Therefore, more clinical trials should be promoted recruiting large number of patients and evaluating long term results.
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Affiliation(s)
- Isabel María Aragón
- Department of Urology, Virgen de la Victoria University Hospital, Campus Universitario de Teatinos, Málaga, Spain
| | - Bernardo Herrera Imbroda
- Department of Urology, Virgen de la Victoria University Hospital, Campus Universitario de Teatinos, Málaga, Spain
| | - María Fernanda Lara
- Department of Urology, Virgen de la Victoria University Hospital, Campus Universitario de Teatinos, Málaga, Spain
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21
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Toyserkani NM, Jørgensen MG, Tabatabaeifar S, Jensen CH, Sheikh SP, Sørensen JA. Concise Review: A Safety Assessment of Adipose-Derived Cell Therapy in Clinical Trials: A Systematic Review of Reported Adverse Events. Stem Cells Transl Med 2017; 6:1786-1794. [PMID: 28722289 PMCID: PMC5689766 DOI: 10.1002/sctm.17-0031] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 06/09/2017] [Indexed: 12/14/2022] Open
Abstract
The popularity of adipose-derived cell therapy has increased over the last decade, and the number of studies published annually is growing. However, concerns regarding safety in the setting of previous malignancy or the use of allogeneic cells have been raised. We therefore aimed to systematically review all clinical studies using adipose-derived cell therapy to identify reported adverse events with a special focus on risk of thromboembolic, immunological, and oncological safety concerns. Our systematic search resulted in 70 included studies involving more than 1,400 patients that were treated with adipose-derived cell therapy. Safety assessment method was not described in 32 of the included studies. For studies involving systemic or cardiac administration, one case of pulmonary thromboembolism and cases of both myocardial and cerebral infarctions were described. In the setting of allogeneic cell therapy studies, where the production of specific antibodies toward donor cells was examined, it was noted that 19%-34% of patients develop antibodies, but the consequence of this is unknown. With regard to oncological safety, only one case of breast cancer recurrence was identified out of 121 patients. Adipose-derived cell therapy has so far shown a favorable safety profile, but safety assessment description has, in general, been of poor quality, and only adverse events that are looked for will be found. We encourage future studies to maintain a strong focus on the safety profile of cell therapy, so its safeness can be confirmed. Stem Cells Translational Medicine 2017;6:1786-1794.
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Affiliation(s)
- Navid Mohamadpour Toyserkani
- Department of Plastic SurgeryOdense University HospitalOdenseDenmark
- The Danish Centre for Regenerative Medicine Odense University HospitalDenmark
- Clinical Institute, Odense University HospitalOdenseDenmark
| | - Mads Gustaf Jørgensen
- Department of Plastic SurgeryOdense University HospitalOdenseDenmark
- The Danish Centre for Regenerative Medicine Odense University HospitalDenmark
- Clinical Institute, Odense University HospitalOdenseDenmark
| | - Siavosh Tabatabaeifar
- Department of Plastic SurgeryOdense University HospitalOdenseDenmark
- Clinical Institute, Odense University HospitalOdenseDenmark
| | - Charlotte Harken Jensen
- The Danish Centre for Regenerative Medicine Odense University HospitalDenmark
- Laboratory of Molecular and Cellular Cardiology, Department of Clinical Biochemistry and Pharmacology, Odense University HospitalOdenseDenmark
| | - Søren Paludan Sheikh
- The Danish Centre for Regenerative Medicine Odense University HospitalDenmark
- Laboratory of Molecular and Cellular Cardiology, Department of Clinical Biochemistry and Pharmacology, Odense University HospitalOdenseDenmark
- Institute of Molecular Medicine, University of Southern DenmarkOdense CDenmark
| | - Jens Ahm Sørensen
- Department of Plastic SurgeryOdense University HospitalOdenseDenmark
- The Danish Centre for Regenerative Medicine Odense University HospitalDenmark
- Clinical Institute, Odense University HospitalOdenseDenmark
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22
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Amend B, Kelp A, Vaegler M, Klünder M, Frajs V, Klein G, Sievert KD, Sawodny O, Stenzl A, Aicher WK. Precise injection of human mesenchymal stromal cells in the urethral sphincter complex of Göttingen minipigs without unspecific bulking effects. Neurourol Urodyn 2016; 36:1723-1733. [PMID: 27935100 DOI: 10.1002/nau.23182] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 11/09/2016] [Indexed: 12/12/2022]
Abstract
AIM To investigate if injection of cells in the urethral sphincter complex causes unspecific bulking effects. METHODS Human mesenchymal stromal cells were isolated, expanded, and characterized. For transurethral injection, cells were labeled with the fluorescent dye PKH26 and in magnetic resonance imaging associated experiments with superparamagnetic particles. Aliquots of cells in 250 µL solvent were injected under vision in the urethral sphincter of immuno-suppressed Göttingen minipigs. Sphincteric closure pressure was recorded by standard and high-definition urethral pressure profilometry prior to and after cell injection. The animals were sacrificed after surgery or after 3 weeks, 3, 6, or 12 months of follow-up. The localisation of the injected cells was explored by histochemistry. Sham-treated animals served as controls. RESULTS PKH26-labeled cells survive injections in sphincter tissue samples by Williams cystoscopic injection needle well. In our animal study, the cellular depots were detected in the submucosa or in deeper zones of the sphincter, depending of the length of the injection needle (4-8 mm). Adverse effects associated with injection of cells or solvent such as a noteworthy bleeding, incontinence, or obstruction, were not recorded (n = 96 minipigs). However, a transient infiltration of macrophages was detected 3 weeks after cell injection. Changes in the urethral pressure profiles were not observed in cell-treated (n = 72) compared to sham-treated animals (n = 24). CONCLUSIONS Injection of small aliquots of cells to investigate cell therapies in minipigs is a feasible and safe procedure, and it does not bias the intrinsic urethral wall pressure.
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Affiliation(s)
- Bastian Amend
- Department of Urology, University of Tübingen Hospital, Tübingen, Germany
| | - Alexandra Kelp
- Department of Urology, University of Tübingen Hospital, Tübingen, Germany
| | - Martin Vaegler
- Department of Urology, University of Tübingen Hospital, Tübingen, Germany
| | - Mario Klünder
- Institute for Systems Dynamics, University of Stuttgart, Stuttgart, Germany
| | - Viktoria Frajs
- Department of Urology, University of Tübingen Hospital, Tübingen, Germany
| | - Gerd Klein
- Department of Medicine II, University of Tübingen Hospital, Tübingen, Germany
| | | | - Oliver Sawodny
- Institute for Systems Dynamics, University of Stuttgart, Stuttgart, Germany
| | - Arnulf Stenzl
- Department of Urology, University of Tübingen Hospital, Tübingen, Germany
| | - Wilhelm K Aicher
- Department of Urology, University of Tübingen Hospital, Tübingen, Germany
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