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Zhu J, Xu HN, Lin T, Xia ZJ. Silencing of cysteine and serine rich nuclear protein 1 inhibits apoptosis, senescence and collagen degradation in human-derived vaginal fibroblasts in response to oxidative stress or DNA damage. Exp Cell Res 2024; 440:114139. [PMID: 38908423 DOI: 10.1016/j.yexcr.2024.114139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 05/24/2024] [Accepted: 06/19/2024] [Indexed: 06/24/2024]
Abstract
Pelvic organ prolapse (POP) is a group of diseases caused by extracellular matrix (ECM) degradation in pelvic supportive tissues. Cysteine and serine rich nuclear protein 1 (CSRNP1) is involved in cell proliferation and survival regulation, and reportedly facilitates collagen breakdown in human chondrocytes. The present study aimed to probe the effect of CSRNP1 on collagen metabolism in human-derived vaginal fibroblasts. High expression of CSRNP1 was found in POP patient-derived vaginal fibroblasts in comparison to normal-derived vaginal fibroblasts. Following functional experiments revealed that CSRNP1 overexpression led to proliferation inhibition, apoptosis and collagen degradation in normal vaginal fibroblasts. In line with this, silencing of CSRNP1 inhibited hydrogen peroxide (H2O2)-triggered apoptosis, ROS generation and collagen loss in normal vaginal fibroblasts. Silencing of CSRNP1 also reduced the expression of cell senescence markers p21 and γ-H2Ax (the histone H2Ax phosphorylated at Ser139), as well as curbed collagen breakdown in normal vaginal fibroblasts caused by a DNA damage agent etoposide. Transcriptomic analysis of vaginal fibroblasts showed that differentially expressed genes affected by CSRNP1 overexpression were mainly enriched in the Wnt signaling pathway. Treatment with a Wnt pathway inhibitor DKK1 blocked CSRNP1 knockdown-caused collagen deposition. Mechanistically, CSRNP1 was identified to be a target of Snail family transcriptional repressor 2 (SNAI2). Forced expression of CSRNP1 reversed the anti-apoptotic, anti-senescent and anti-collagen loss effects of SNAI2 in normal vaginal fibroblasts exposed to H2O2 or etoposide. Our study indicates that the SNAI2/CSRNP1 axis may be a key driver in POP progression, which provides a potential therapeutic strategy for POP.
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Affiliation(s)
- Jing Zhu
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China; Department of Obstetrics and Gynecology, Maternity & Child care Center of Qinhuangdao, Qinhuangdao, Hebei, People's Republic of China
| | - Hai-Nan Xu
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Te Lin
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Zhi-Jun Xia
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China.
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2
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Xu LM, Yu XX, Zhang N, Chen YS. Exosomes from umbilical cord mesenchymal stromal cells promote the collagen production of fibroblasts from pelvic organ prolapse. World J Stem Cells 2024; 16:708-727. [PMID: 38948096 PMCID: PMC11212552 DOI: 10.4252/wjsc.v16.i6.708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 03/23/2024] [Accepted: 04/22/2024] [Indexed: 06/25/2024] Open
Abstract
BACKGROUND Pelvic organ prolapse (POP) involves pelvic organ herniation into the vagina due to pelvic floor tissue laxity, and vaginal structure is an essential factor. In POP, the vaginal walls exhibit abnormal collagen distribution and decreased fibroblast levels and functions. The intricate etiology of POP and the prohibition of transvaginal meshes in pelvic reconstruction surgery present challenges in targeted therapy development. Human umbilical cord mesenchymal stromal cells (hucMSCs) present limitations, but their exosomes (hucMSC-Exo) are promising therapeutic tools for promoting fibroblast proliferation and extracellular matrix remodeling. AIM To investigate the effects of hucMSC-Exo on the functions of primary vaginal fibroblasts and to elucidate the underlying mechanism involved. METHODS Human vaginal wall collagen content was assessed by Masson's trichrome and Sirius blue staining. Gene expression differences in fibroblasts from patients with and without POP were assessed via RNA sequencing (RNA-seq). The effects of hucMSC-Exo on fibroblasts were determined via functional experiments in vitro. RNA-seq data from fibroblasts exposed to hucMSC-Exo and microRNA (miRNA) sequencing data from hucMSC-Exo were jointly analyzed to identify effective molecules. RESULTS In POP, the vaginal wall exhibited abnormal collagen distribution and reduced fibroblast 1 quality and quantity. Treatment with 4 or 6 μg/mL hucMSC-Exo suppressed inflammation in POP group fibroblasts, stimulated primary fibroblast growth, and elevated collagen I (Col1) production in vitro. High-throughput RNA-seq of fibroblasts treated with hucMSC-Exo and miRNA sequencing of hucMSC-Exo revealed that abundant exosomal miRNAs downregulated matrix metalloproteinase 11 (MMP11) expression. CONCLUSION HucMSC-Exo normalized the growth and function of primary fibroblasts from patients with POP by promoting cell growth and Col1 expression in vitro. Abundant miRNAs in hucMSC-Exo targeted and downregulated MMP11 expression. HucMSC-Exo-based therapy may be ideal for safely and effectively treating POP.
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Affiliation(s)
- Lei-Mei Xu
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200011, China
- Department of Gynecology, Shanghai Key Laboratory of Female Reproductive Endocrine-related Diseases, Shanghai 200011, China
| | - Xin-Xin Yu
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200011, China
| | - Ning Zhang
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200011, China
| | - Yi-Song Chen
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200011, China.
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3
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Xu LM, Yu XX, Zhang N, Chen YS. Exosomes from umbilical cord mesenchymal stromal cells promote the collagen production of fibroblasts from pelvic organ prolapse. World J Stem Cells 2024; 16:707-726. [DOI: 10.4252/wjsc.v16.i6.707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 03/23/2024] [Accepted: 04/22/2024] [Indexed: 06/25/2024] Open
Abstract
BACKGROUND Pelvic organ prolapse (POP) involves pelvic organ herniation into the vagina due to pelvic floor tissue laxity, and vaginal structure is an essential factor. In POP, the vaginal walls exhibit abnormal collagen distribution and decreased fibroblast levels and functions. The intricate etiology of POP and the prohibition of transvaginal meshes in pelvic reconstruction surgery present challenges in targeted therapy development. Human umbilical cord mesenchymal stromal cells (hucMSCs) present limitations, but their exosomes (hucMSC-Exo) are promising therapeutic tools for promoting fibroblast proliferation and extracellular matrix remodeling.
AIM To investigate the effects of hucMSC-Exo on the functions of primary vaginal fibroblasts and to elucidate the underlying mechanism involved.
METHODS Human vaginal wall collagen content was assessed by Masson’s trichrome and Sirius blue staining. Gene expression differences in fibroblasts from patients with and without POP were assessed via RNA sequencing (RNA-seq). The effects of hucMSC-Exo on fibroblasts were determined via functional experiments in vitro. RNA-seq data from fibroblasts exposed to hucMSC-Exo and microRNA (miRNA) sequencing data from hucMSC-Exo were jointly analyzed to identify effective molecules.
RESULTS In POP, the vaginal wall exhibited abnormal collagen distribution and reduced fibroblast 1 quality and quantity. Treatment with 4 or 6 μg/mL hucMSC-Exo suppressed inflammation in POP group fibroblasts, stimulated primary fibroblast growth, and elevated collagen I (Col1) production in vitro. High-throughput RNA-seq of fibroblasts treated with hucMSC-Exo and miRNA sequencing of hucMSC-Exo revealed that abundant exosomal miRNAs downregulated matrix metalloproteinase 11 (MMP11) expression.
CONCLUSION HucMSC-Exo normalized the growth and function of primary fibroblasts from patients with POP by promoting cell growth and Col1 expression in vitro. Abundant miRNAs in hucMSC-Exo targeted and downregulated MMP11 expression. HucMSC-Exo-based therapy may be ideal for safely and effectively treating POP.
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Affiliation(s)
- Lei-Mei Xu
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200011, China
- Department of Gynecology, Shanghai Key Laboratory of Female Reproductive Endocrine-related Diseases, Shanghai 200011, China
| | - Xin-Xin Yu
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200011, China
| | - Ning Zhang
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200011, China
| | - Yi-Song Chen
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200011, China
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4
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Wang Y, Wen Y, Kim K, Wu H, Zhang J, Dobberfuhl AD, Chen B. Functional outcome of the anterior vaginal wall in a pelvic surgery injury rat model after treatment with stem cell-derived progenitors of smooth muscle cells. RESEARCH SQUARE 2024:rs.3.rs-4172308. [PMID: 38946968 PMCID: PMC11213168 DOI: 10.21203/rs.3.rs-4172308/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
Background Stem-cell-derived therapy is a promising option for tissue regeneration. Human iPSC-derived progenitors of smooth muscle cells (pSMCs) have limited proliferation and differentiation, which may minimize the risk of in vivo tumor formation while restoring smooth muscle cell deficiencies. Up to 30 % of women who suffer from recurrence of vaginal prolapse after prolapse surgery are faced with reoperation. Therefore, there is an unmet need for therapies that can restore vaginal tissue function. We hypothesize that human pSMCs can restore vaginal function in a vaginal-injury rat model. Methods Female immune-compromised RNU rats were divided into 5 groups: intact controls (n=12), VSHAM (surgery + saline injection, n=33), and cell-injection group (surgery + cell injection using three patient pSMCs lines, n=14/cell line). The surgery, similar to what is done in vaginal prolapse surgery, involved ovariectomy, urethrolysis, and vagina injury. The vagina, urethra, bladder dome and trigone were harvested 10 weeks after surgery (5 weeks after injection). Organ bath myography was performed to evaluate the contractile function of vagina, and smooth muscle thickness was examined by tissue immunohistochemistry. Collagen I, collagen III, and elastin mRNA and protein expressions in tissues were assessed. Results When compared to the VSHAM group, cell-injection groups showed significantly increased vaginal smooth muscle contractions induced by carbachol (groups A and C) and by KCl (group C), and significantly higher collagen I protein expression in the vagina (groups A and B). Elastin mRNA and protein expressions in the vagina did not correlate with injection group. In the urethra, mRNA expressions of collagen I, collagen III, and elastin were all significantly higher in the cell-injection groups compared to the VSHAM group. Collagen I protein expression of the urethra was also higher in the cell-injection group compared to the VSHAM group. Elastin protein expression in the urethra did not correlate with injection group. Conclusions Human iPSC-derived pSMCs improved contractile function of the post-surgery vagina. Additionally, pSMC injection modulated collagen I, collagen III and elastin mRNA and protein expressions in the vagina and urethra. These findings suggest that pSMCs may be a possible therapy for vaginal prolapse recurrence after surgical intervention.
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Affiliation(s)
| | - Yan Wen
- Stanford University School of Medicine
| | - Kayla Kim
- Stanford University School of Medicine
| | - Hugo Wu
- Stanford University School of Medicine
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5
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Maljaars L, Gudde A, Oosthuysen A, Roovers JP, Guler Z. The Regenerative Capacity of Tissue-Engineered Amniotic Membranes. ACS APPLIED BIO MATERIALS 2024; 7:1441-1448. [PMID: 38391263 PMCID: PMC10951947 DOI: 10.1021/acsabm.3c00765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 02/24/2024]
Abstract
Scaffolds can be introduced as a source of tissue in reconstructive surgery and can help to improve wound healing. Amniotic membranes (AMs) as scaffolds for tissue engineering have emerged as promising biomaterials for surgical reconstruction due to their regenerative capacity, biocompatibility, gradual degradability, and availability. They also promote fetal-like scarless healing and provide a bioactive matrix that stimulates cell adhesion, migration, and proliferation. The aim of this study was to create a tissue-engineered AM-based implant for the repair of vesicovaginal fistula (VVF), a defect between the bladder and vagina caused by prolonged obstructed labor. Layers of AMs (with or without cross-linking) and electrospun poly-4-hydroxybutyrate (P4HB) (a synthetic, degradable polymer) scaffold were joined together by fibrin glue to produce a multilayer scaffold. Human vaginal fibroblasts were seeded on the different constructs and cultured for 28 days. Cell proliferation, cell morphology, collagen deposition, and metabolism measured by matrix metalloproteinase (MMP) activity were evaluated. Vaginal fibroblasts proliferated and were metabolically active on the different constructs, producing a distributed layer of collagen and proMMP-2. Cell proliferation and the amount of produced collagen were similar across different groups, indicating that the different AM-based constructs support vaginal fibroblast function. Cell morphology and collagen images showed slightly better alignment and organization on the un-cross-linked constructs compared to the cross-linked constructs. It was concluded that the regenerative capacity of AM does not seem to be affected by mechanical reinforcement with cross-linking or the addition of P4HB and fibrin glue. An AM-based implant for surgical repair of internal organs requiring load-bearing functionality can be directly translated to other types of surgical reconstruction of internal organs.
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Affiliation(s)
- Lennart Maljaars
- Department
of Obstetrics and Gynecology, Amsterdam
UMC location University of Amsterdam, Meibergdreef 9, 1105
AZ Amsterdam, The
Netherlands
- Amsterdam
Reproduction and Development research institute, Meibergdreef 9, 1105
AZ Amsterdam, The
Netherlands
| | - Aksel Gudde
- Department
of Obstetrics and Gynecology, Amsterdam
UMC location University of Amsterdam, Meibergdreef 9, 1105
AZ Amsterdam, The
Netherlands
- Amsterdam
Reproduction and Development research institute, Meibergdreef 9, 1105
AZ Amsterdam, The
Netherlands
| | - Anel Oosthuysen
- Cardiovascular
Research Unit, University of Cape Town, Anzio Road, Observatory, 7925 Cape Town, South Africa
| | - Jan-Paul Roovers
- Department
of Obstetrics and Gynecology, Amsterdam
UMC location University of Amsterdam, Meibergdreef 9, 1105
AZ Amsterdam, The
Netherlands
- Amsterdam
Reproduction and Development research institute, Meibergdreef 9, 1105
AZ Amsterdam, The
Netherlands
| | - Zeliha Guler
- Department
of Obstetrics and Gynecology, Amsterdam
UMC location University of Amsterdam, Meibergdreef 9, 1105
AZ Amsterdam, The
Netherlands
- Amsterdam
Reproduction and Development research institute, Meibergdreef 9, 1105
AZ Amsterdam, The
Netherlands
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6
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van Velthoven MJJ, Gudde AN, van der Kruit M, van Loon MPC, Rasing L, Wagener FADTG, Roovers JP, Guler Z, Kouwer PHJ. An Improved Understanding of the Pathophysiology of Pelvic Organ Prolapse: A 3D In Vitro Model under Static and Mechanical Loading Conditions. Adv Healthc Mater 2024; 13:e2302905. [PMID: 38219051 DOI: 10.1002/adhm.202302905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 12/22/2023] [Indexed: 01/15/2024]
Abstract
The suboptimal outcomes of pelvic organ prolapse (POP) surgery illustrate the demand for improved therapies. However, their development is hampered by the limited knowledge on the cellular pathophysiology of POP. Current investigations, that are limited to tissues and 2D in vitro models, provide highly inconclusive results on how the extracellular matrix (ECM) metabolism and fibroblasts are affected in POP. This study uses a physiologically relevant 3D in vitro model to investigate the cellular pathophysiology of POP by determining the differences between POP and non-POP fibroblasts on ECM metabolism, proliferation, and fibroblast-to-myofibroblast (FMT) transition. This model, based on the synthetic and biomimetic polyisocyanide hydrogel, enables the incorporation of mechanical loading, which simulates the forces exerted on the pelvic floor. Under static conditions, 3D cultured POP fibroblasts are less proliferative, undergo FMT, and exhibit lower collagen and elastin contents compared to non-POP fibroblasts. However, under mechanical loading, the differences between POP and non-POP fibroblasts are less pronounced. This study contributes to the development of more comprehensive models that can accurately mimic the POP pathophysiology, which will aid in an enhanced understanding and may contribute to improved therapies in the future.
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Affiliation(s)
- Melissa J J van Velthoven
- Institute for Molecules and Materials, Radboud University, Heyendaalseweg 135, Nijmegen, 6525 AJ, The Netherlands
- Department of Urology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Geert Grooteplein Zuid 28, Nijmegen, 6525 GA, The Netherlands
| | - Aksel N Gudde
- Department of Obstetrics and Gynecology, Amsterdam University Medical Center, location AMC, Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands
- Reproductive Biology Laboratory, Amsterdam Reproduction and Development, Amsterdam University Medical Center, location AMC, Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands
| | - Marit van der Kruit
- Institute for Molecules and Materials, Radboud University, Heyendaalseweg 135, Nijmegen, 6525 AJ, The Netherlands
- Department of Urology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Geert Grooteplein Zuid 28, Nijmegen, 6525 GA, The Netherlands
| | - Malou P C van Loon
- Institute for Molecules and Materials, Radboud University, Heyendaalseweg 135, Nijmegen, 6525 AJ, The Netherlands
- Department of Urology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Geert Grooteplein Zuid 28, Nijmegen, 6525 GA, The Netherlands
| | - Lissy Rasing
- Institute for Molecules and Materials, Radboud University, Heyendaalseweg 135, Nijmegen, 6525 AJ, The Netherlands
- Department of Urology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Geert Grooteplein Zuid 28, Nijmegen, 6525 GA, The Netherlands
| | - Frank A D T G Wagener
- Department of Dentistry-Orthodontics and Craniofacial Biology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Philips van Leydenlaan 25, Nijmegen, 6525 EX, The Netherlands
| | - Jan-Paul Roovers
- Department of Obstetrics and Gynecology, Amsterdam University Medical Center, location AMC, Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands
- Reproductive Biology Laboratory, Amsterdam Reproduction and Development, Amsterdam University Medical Center, location AMC, Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands
| | - Zeliha Guler
- Department of Obstetrics and Gynecology, Amsterdam University Medical Center, location AMC, Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands
- Reproductive Biology Laboratory, Amsterdam Reproduction and Development, Amsterdam University Medical Center, location AMC, Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands
| | - Paul H J Kouwer
- Institute for Molecules and Materials, Radboud University, Heyendaalseweg 135, Nijmegen, 6525 AJ, The Netherlands
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7
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Jin X, Hu Q, Qin M, Yin Y, Xia Z. SOCS3, Transcriptionally Activated by NR4A1, Induces Apoptosis and Extracellular Matrix Degradation of Vaginal Fibroblasts in Pelvic Organ Prolapse. Balkan Med J 2024; 41:105-112. [PMID: 38229336 PMCID: PMC10913121 DOI: 10.4274/balkanmedj.galenos.2023.2023-10-60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 12/07/2023] [Indexed: 01/18/2024] Open
Abstract
Background Pelvic organ prolapse (POP) is a common gynecological chronic disorder. Human vaginal fibroblasts (HVFs) that maintain the integrity of vaginal wall tissues are essential for keeping pelvic organs in place. Apoptosis and the degradation of the extracellular matrix in HVFs contribute to the progression of POP. The cytokine signal transduction inhibitor 3 (SOCS3) exerts significant regulatory effects on cell signal transduction pathways, thereby affecting various pathological processes. Aims To explore the role and mechanism of SOCS3 on HVFs in the context of POP. Study Design In vitro cell lines and human-sample study. Methods Anterior vaginal wall tissues were obtained from POP or non-POP patients for the analysis of SOCS3 expression. HVFs were isolated from the vaginal tissues of POP patients, and SOCS3 was either overexpressed or knocked down in HVFs via lentivirus infection. Subsequently, the biological function and mechanism of SOCS3 in HVFs were investigated. Results SOCS3 was highly expressed in the vaginal tissues of POP patients compared to non-POP patients. Functionally, the overexpression of SOCS3 suppressed cell viability while promoting cell apoptosis in HVFs. The overexpression of SOCS3 also accelerated extracellular matrix degradation (decreasing collagen I, collagen III, and elastin, and increasing MMP2 and MMP9). In terms of mechanism, NR4A1 transcriptionally activated SOCS3 by binding to its promoter. Furthermore, rescue experiments revealed that SOCS3 knockdown hindered NR4A1 overexpression-induced cell apoptosis and extracellular matrix degradation in HVFs. Conclusion SOCS3 mediated the apoptotic and extracellular matrix degradation effects of NR4A1 on HVFs, underlining that the restraining of the SOCS3 expression may be a promising strategy for POP treatment.
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Affiliation(s)
- Xin Jin
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Qing Hu
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Meiying Qin
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yitong Yin
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Zhijun Xia
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
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8
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Guler Z, Kaestner LA, Vodegel E, Ras L, Jeffrey S, Roovers JP. Two-Year Preclinical Evaluation of Long-Term Absorbable Poly-4-hydroxybutyrate Scaffold for Surgical Correction of Pelvic Organ Prolapse. Int Urogynecol J 2024; 35:713-722. [PMID: 38430238 PMCID: PMC11024044 DOI: 10.1007/s00192-023-05720-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 12/14/2023] [Indexed: 03/03/2024]
Abstract
INTRODUCTION AND HYPOTHESIS Fully absorbable implants may be an alternative to permanent meshes in the correction pf pelvic organ prolapse (POP) as they may reduce adverse events by promoting tissue regeneration and collagen metabolism. This study was aimed at evaluating the long-term host and biomechanical response to a fully absorbable poly-4-hydroxybutyrate (P4HB) scaffold in comparison with polypropylene (PP) mesh. METHODS Poly-4-hydroxybutyrate scaffold (n = 16) and PP mesh (n = 16) were surgically implanted in the posterior vaginal wall of parous female Dohne Merino sheep. Vaginal explants were evaluated in terms of gross necropsy, host response (immune response, collagen deposition, tissue regeneration), biomechanics, and degradation of P4HB at 12 and 24 months post-implantation. RESULTS Gross necropsy revealed no infection or fluid collection using P4HB or PP. At 12 months, exposures were observed with both P4HB (3 out of 8) and PP (4 out of 8), whereas at 24 months, exposures were observed only with PP (4 out of 8). The tensile stiffness of the P4HB explants was maintained over time despite complete absorption of P4HB. The collagen amount of the vaginal tissue after P4HB implantation increased over time and was significantly higher than PP at 24 months. P4HB scaffolds exhibited significantly lower myofibroblast differentiation than PP meshes at 24 months. CONCLUSIONS The P4HB scaffold allowed for gradual load transfer to the vaginal wall and resulted in mechanically self-sufficient tissue. P4HB scaffold had a more favorable host response than PP mesh, with higher collagen content, lower myofibroblastic differentiation, and no exposures at 24 months. P4HB scaffolds have potential as an alternative to permanent implants in treating POP.
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Affiliation(s)
- Zeliha Guler
- Department of Obstetrics and Gynaecology, Amsterdam UMC - location AMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands.
| | - Lisa Ann Kaestner
- Department of Urology, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Eva Vodegel
- Department of Obstetrics and Gynaecology, Amsterdam UMC - location AMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
| | - Lamees Ras
- Department of Obstetrics and Gynecology, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Stephen Jeffrey
- Department of Obstetrics and Gynecology, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Jan Paul Roovers
- Department of Obstetrics and Gynaecology, Amsterdam UMC - location AMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
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9
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Quiles MT, Rodríguez-Contreras A, Guillem-Marti J, Punset M, Sánchez-Soto M, López-Cano M, Sabadell J, Velasco J, Armengol M, Manero JM, Arbós MA. Effect of Functionalization of Texturized Polypropylene Surface by Silanization and HBII-RGD Attachment on Response of Primary Abdominal and Vaginal Fibroblasts. Polymers (Basel) 2024; 16:667. [PMID: 38475352 DOI: 10.3390/polym16050667] [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: 01/16/2024] [Revised: 02/24/2024] [Accepted: 02/26/2024] [Indexed: 03/14/2024] Open
Abstract
Soft tissue defects, such as incisional hernia or pelvic organ prolapse, are prevalent pathologies characterized by a tissue microenvironment rich in fragile and dysfunctional fibroblasts. Precision medicine could improve their surgical repair, currently based on polymeric materials. Nonetheless, biomaterial-triggered interventions need first a better understanding of the cell-material interfaces that truly consider the patients' biology. Few tools are available to study the interactions between polymers and dysfunctional soft tissue cells in vitro. Here, we propose polypropylene (PP) as a matrix to create microscale surfaces w/wo functionalization with an HBII-RGD molecule, a fibronectin fragment modified to include an RGD sequence for promoting cell attachment and differentiation. Metal mold surfaces were roughened by shot blasting with aluminum oxide, and polypropylene plates were obtained by injection molding. HBII-RGD was covalently attached by silanization. As a proof of concept, primary abdominal and vaginal wall fasciae fibroblasts from control patients were grown on the new surfaces. Tissue-specific significant differences in cell morphology, early adhesion and cytoskeletal structure were observed. Roughness and biofunctionalization parameters exerted unique and combinatorial effects that need further investigation. We conclude that the proposed model is effective and provides a new framework to inform the design of smart materials for the treatment of clinically compromised tissues.
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Affiliation(s)
- Maria Teresa Quiles
- General Surgery Research Unit, Vall d'Hebron Research Institute (VHIR), Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
- Department of Basic Sciences, School of Medicine and Health Sciences, Universitat Internacional de Catalunya (UIC), Josep Trueta, s/n, 08195 Sant Cugat del Vallés, Spain
| | - Alejandra Rodríguez-Contreras
- Biomaterials, Biomechanics and Tissue Engineering Group (BBT), Department Materials Science and Engineering, Universitat Politècnica de Catalunya-Barcelona Tech (UPC), Escola d'Enginyeria de Barcelona Est (EEBE), Campus Diagonal-Besòs, Av. Eduard Maristany, 16, 08019 Barcelona, Spain
- Department Materials Science and Engineering, Universitat Politècnica de Catalunya-Barcelona Tech (UPC), Escola d'Enginyeria de Barcelona Est (EEBE), Campus Diagonal-Besòs, Av. D'Eduard Maristany, 16, 08019 Barcelona, Spain
- Networking Research Centre of Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Institute of Health Carlos III, 28029 Madrid, Spain
| | - Jordi Guillem-Marti
- Biomaterials, Biomechanics and Tissue Engineering Group (BBT), Department Materials Science and Engineering, Universitat Politècnica de Catalunya-Barcelona Tech (UPC), Escola d'Enginyeria de Barcelona Est (EEBE), Campus Diagonal-Besòs, Av. Eduard Maristany, 16, 08019 Barcelona, Spain
- Department Materials Science and Engineering, Universitat Politècnica de Catalunya-Barcelona Tech (UPC), Escola d'Enginyeria de Barcelona Est (EEBE), Campus Diagonal-Besòs, Av. D'Eduard Maristany, 16, 08019 Barcelona, Spain
- Networking Research Centre of Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Institute of Health Carlos III, 28029 Madrid, Spain
| | - Miquel Punset
- Biomaterials, Biomechanics and Tissue Engineering Group (BBT), Department Materials Science and Engineering, Universitat Politècnica de Catalunya-Barcelona Tech (UPC), Escola d'Enginyeria de Barcelona Est (EEBE), Campus Diagonal-Besòs, Av. Eduard Maristany, 16, 08019 Barcelona, Spain
- Department Materials Science and Engineering, Universitat Politècnica de Catalunya-Barcelona Tech (UPC), Escola d'Enginyeria de Barcelona Est (EEBE), Campus Diagonal-Besòs, Av. D'Eduard Maristany, 16, 08019 Barcelona, Spain
| | - Miguel Sánchez-Soto
- Department Materials Science and Engineering, Universitat Politècnica de Catalunya-Barcelona Tech (UPC), Escola d'Enginyeria de Barcelona Est (EEBE), Campus Diagonal-Besòs, Av. D'Eduard Maristany, 16, 08019 Barcelona, Spain
| | - Manuel López-Cano
- General Surgery Research Unit, Vall d'Hebron Research Institute (VHIR), Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
- Abdominal Wall Surgery Unit, Department of General Surgery, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona (UAB), Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Jordi Sabadell
- General Surgery Research Unit, Vall d'Hebron Research Institute (VHIR), Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
- Urogynecology and Pelvic Floor Unit, Department of Gynecology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona (UAB), Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Janice Velasco
- Department of Surgery, Hospital San Rafael, Germanes Hospitalàries, Passeig de la Vall d'Hebron, 107, 08035 Barcelona, Spain
| | - Manuel Armengol
- General Surgery Research Unit, Vall d'Hebron Research Institute (VHIR), Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
- Department of General Surgery, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona (UAB), Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Jose Maria Manero
- Biomaterials, Biomechanics and Tissue Engineering Group (BBT), Department Materials Science and Engineering, Universitat Politècnica de Catalunya-Barcelona Tech (UPC), Escola d'Enginyeria de Barcelona Est (EEBE), Campus Diagonal-Besòs, Av. Eduard Maristany, 16, 08019 Barcelona, Spain
- Department Materials Science and Engineering, Universitat Politècnica de Catalunya-Barcelona Tech (UPC), Escola d'Enginyeria de Barcelona Est (EEBE), Campus Diagonal-Besòs, Av. D'Eduard Maristany, 16, 08019 Barcelona, Spain
- Networking Research Centre of Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Institute of Health Carlos III, 28029 Madrid, Spain
| | - Maria Antònia Arbós
- General Surgery Research Unit, Vall d'Hebron Research Institute (VHIR), Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
- Department of Basic Sciences, School of Medicine and Health Sciences, Universitat Internacional de Catalunya (UIC), Josep Trueta, s/n, 08195 Sant Cugat del Vallés, Spain
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10
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Liu X, Su M, Wei L, Zhang J, Wang W, Hao Q, Lin X, Wang L. Single-cell analysis of uterosacral ligament revealed cellular heterogeneity in women with pelvic organ prolapse. Commun Biol 2024; 7:159. [PMID: 38326542 PMCID: PMC10850063 DOI: 10.1038/s42003-024-05808-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 01/11/2024] [Indexed: 02/09/2024] Open
Abstract
Pelvic organ prolapse (POP) markedly affects the quality of life of women, including significant financial burden. Using single-cell RNA sequencing, we constructed a transcriptional profile of 30,452 single cells of the uterosacral ligament in POP and control samples, which has never been constructed before. We identified 10 major cell types, including smooth muscle cells, endothelial cells, fibroblasts, neutrophils, macrophages, monocytes, mast cells, T cells, B cells, and dendritic cells. We performed subpopulation analysis and pseudo-time analysis of POP primary cells, and explored differentially expressed genes. We verified previous cell clusters of human neutrophils of uterosacral ligaments. We found a significant reduction in receptor-ligand pairs related to ECM and cell adhesion between fibroblasts and endothelial cells in POP. The transcription factors related to the extracellular matrix, development, and immunity were identified in USL. Here we provide insight into the molecular mechanisms of POP and valuable information for future research directions.
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Affiliation(s)
- Xiaochun Liu
- Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, 030032, Taiyuan, China.
| | - Minna Su
- Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, 030032, Taiyuan, China
| | - Lingyun Wei
- Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, 030032, Taiyuan, China
| | - Jia Zhang
- Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, 030032, Taiyuan, China
| | - Wenzhen Wang
- Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, 030032, Taiyuan, China
| | - Qian Hao
- Taiyuan Health School, 030012, Taiyuan, China
| | - Xiling Lin
- Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, 030032, Taiyuan, China
| | - Lili Wang
- Taiyuan University of Technology, 030024, Taiyuan, China
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11
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Wu X, Zhang F, Mao X, Xu F, Ding X, Sun X, Wang J. The mechanism of adipose mesenchymal stem cells to stabilize the immune microenvironment of pelvic floor injury by regulating pyroptosis and promoting tissue repair. Mater Today Bio 2024; 24:100910. [PMID: 38204481 PMCID: PMC10776425 DOI: 10.1016/j.mtbio.2023.100910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 11/19/2023] [Accepted: 12/09/2023] [Indexed: 01/12/2024] Open
Abstract
Pelvic organ prolapse (POP) has a high incidence rate among Chinese women. Repeated mechanical stimulation is an important factor causing POP, but the injury mechanism has not yet been elucidated. The purpose of this study is to explore the related mechanisms of pelvic floor supporting tissue damage caused by mechanical force and the application of stem cell therapy. First, we obtained vaginal wall and sacral ligament tissue samples from clinical patients for examination. Pelvic floor support tissues of POP patients displayed high expression of inflammation and immune disorders. Then, we constructed a rat model of childbirth injury. In vivo and in vitro experiments investigated the key mechanism of pelvic floor support tissue injury caused by mechanical force. We discovered that after mechanical force, a large number of reactive oxygen species (ROS) and macrophages rapidly accumulated in pelvic floor tissues. ROS stimulated macrophages to produce NLRP3 inflammatory complex, induced the release of interleukin (IL-1β) and pyroptosis and exacerbated the inflammatory state of damaged tissues, persisting chronic inflammation of fibroblasts in supporting tissues, thus causing the pelvic floor's extracellular matrix (ECM) collagen metabolic disorder. Resultingly impeding the repair process, thereby causing the onset and progression of the disease. Through their paracrine ability, we discovered that adipose mesenchymal stem cells (ADSCs) could inhibit this series of pathological processes and promote tissue repair, asserting a good therapeutic effect. Simultaneously, to overcome the low cell survival rate and poor therapeutic effect of directly injecting cells, we developed a ROS-responsive PVA@COLI hydrogel with ADSCs. The ROS-scavenging properties of the gel could reshape the site of inflammation injury, enhance cell survival, and play a role in subsequent treatment. The findings of this study could serve as a basis for early, targeted intervention therapy for POP and representing a promising approach.
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Affiliation(s)
- Xiaotong Wu
- Department of Obstetrics and Gynecology, Peking University People's Hospital, 100044, Beijing, China
- Beijing Key Laboratory of Female Pelvic Floor Disorders, 100044, Beijing, China
| | - Fengshi Zhang
- Department of Orthopedics and Trauma, Peking University People's Hospital, 100044, Beijing, China
| | - Xiaolin Mao
- College of Materials Science and Engineering, Beijing University of Chemical Technology, 100029, Beijing, China
| | - Fujian Xu
- College of Materials Science and Engineering, Beijing University of Chemical Technology, 100029, Beijing, China
| | - Xiaokang Ding
- College of Materials Science and Engineering, Beijing University of Chemical Technology, 100029, Beijing, China
| | - Xiuli Sun
- Department of Obstetrics and Gynecology, Peking University People's Hospital, 100044, Beijing, China
- Beijing Key Laboratory of Female Pelvic Floor Disorders, 100044, Beijing, China
| | - Jianliu Wang
- Department of Obstetrics and Gynecology, Peking University People's Hospital, 100044, Beijing, China
- Beijing Key Laboratory of Female Pelvic Floor Disorders, 100044, Beijing, China
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12
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Sartoneva R, Paakinaho K, Hannula M, Kuismanen K, Huhtala H, Hyttinen J, Miettinen S. Ascorbic Acid 2-Phosphate Releasing Supercritically Foamed Porous Poly-L-Lactide-Co-ε-Caprolactone Scaffold Enhances the Collagen Production of Human Vaginal Stromal Cells: A New Approach for Vaginal Tissue Engineering. Tissue Eng Regen Med 2024; 21:81-96. [PMID: 37907765 PMCID: PMC10764701 DOI: 10.1007/s13770-023-00603-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 09/17/2023] [Accepted: 09/24/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND The reconstructive surgery of vaginal defects is highly demanding and susceptible to complications, especially in larger defects requiring nonvaginal tissue grafts. Thus, tissue engineering-based solutions could provide a potential approach to the reconstruction of vaginal defects. METHODS Here, we evaluated a novel porous ascorbic acid 2-phosphate (A2P)-releasing supercritical carbon dioxide foamed poly-L-lactide-co-ε-caprolactone (scPLCLA2P) scaffold for vaginal reconstruction with vaginal epithelial (EC) and stromal (SC) cells. The viability, proliferation, and phenotype of ECs and SCs were evaluated in monocultures and in cocultures on d 1, d 7 and d 14. Furthermore, the collagen production of SCs on scPLCLA2P was compared to that on scPLCL without A2P on d 14. RESULTS Both ECs and SCs maintained their viability on the scPLCLA2P scaffold in mono- and coculture conditions, and the cells maintained their typical morphology during the 14-d culture period. Most importantly, the scPLCLA2P scaffolds supported the collagen production of SCs superior to plain scPLCL based on total collagen amount, collagen I and III gene expression results and collagen immunostaining results. CONCLUSION This is the first study evaluating the effect of A2P on vaginal tissue engineering, and the results are highly encouraging, indicating that scPLCLA2P has potential as a scaffold for vaginal tissue engineering.
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Affiliation(s)
- Reetta Sartoneva
- Faculty of Medicine and Health Technology (MET), Tampere University, Arvo Ylpön Katu 34, 33520, Tampere, Finland.
- Tays Research Services, Wellbeing Services County of Pirkanmaa, Tampere University Hospital, Arvo Ylpön Katu 34, 33520, Tampere, Finland.
- Department of Obstetrics and Gynaecology, Seinäjoki Central Hospital, Seinäjoki, Finland.
| | - Kaarlo Paakinaho
- Faculty of Medicine and Health Technology (MET), Tampere University, Arvo Ylpön Katu 34, 33520, Tampere, Finland
- Tays Research Services, Wellbeing Services County of Pirkanmaa, Tampere University Hospital, Arvo Ylpön Katu 34, 33520, Tampere, Finland
| | - Markus Hannula
- Faculty of Medicine and Health Technology (MET), Tampere University, Arvo Ylpön Katu 34, 33520, Tampere, Finland
- Tays Research Services, Wellbeing Services County of Pirkanmaa, Tampere University Hospital, Arvo Ylpön Katu 34, 33520, Tampere, Finland
| | - Kirsi Kuismanen
- Tays Research Services, Wellbeing Services County of Pirkanmaa, Tampere University Hospital, Arvo Ylpön Katu 34, 33520, Tampere, Finland
- Department of Obstetrics and Gynaecology, Tampere University Hospital, Tampere, Finland
| | - Heini Huhtala
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | - Jari Hyttinen
- Faculty of Medicine and Health Technology (MET), Tampere University, Arvo Ylpön Katu 34, 33520, Tampere, Finland
- Tays Research Services, Wellbeing Services County of Pirkanmaa, Tampere University Hospital, Arvo Ylpön Katu 34, 33520, Tampere, Finland
| | - Susanna Miettinen
- Faculty of Medicine and Health Technology (MET), Tampere University, Arvo Ylpön Katu 34, 33520, Tampere, Finland
- Tays Research Services, Wellbeing Services County of Pirkanmaa, Tampere University Hospital, Arvo Ylpön Katu 34, 33520, Tampere, Finland
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13
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Yu Y, Ma M, Zhou Q. The relationship between vaginal microenvironment and pelvic dysfunctional diseases in Chinese women: a systematic review and meta-analysis. Int Urogynecol J 2023; 34:2849-2858. [PMID: 37650904 DOI: 10.1007/s00192-023-05635-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 07/31/2023] [Indexed: 09/01/2023]
Abstract
OBJECTIVE The aim of this review is to synthesize existing evidence on the combined effects of the vaginal microenvironment on pelvic dysfunctional diseases. METHODS This systematic review was conducted in accordance with the PRISMA guidelines. The PubMed, Embase, Cochrane Library, Web of Science, Wanfang, and China Knowledge Network (CNKI) databases were systematically searched up to January 2023 using the following MeSH terms: "pelvic organ prolapse", "stress urinary incontinence" and "vaginal microenvironment", "microenvironment", "vaginal cleanliness", "vaginitis", "lactobacillus" and other related keywords. Study methods were limited to case-control studies or cross-sectional studies. Quality assessment was performed using the Newcastle-Ottawa scale, and meta-analysis of the included literature was performed using Review Manager 5.3. RESULTS A total of eight articles were included in this systematic review (SR) and meta-analysis (MA), which involved a total of 7298 study participants. The pooled results of this meta-analysis showed that the vaginal microenvironment (number of vaginal lactobacilli, leukorrhea cleanliness, and presence of vaginitis) were all statistically significantly associated with pelvic dysfunctional diseases in Chinese women. CONCLUSION This review indicates that the vaginal microenvironment has an impact on the development of PFD in Chinese women. TRIAL REGISTRATION The protocol of this systematic review (SR) and meta-analysis (MA) has been registered in PROSPERO databases with the Registration number of CRD42023407251.
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Affiliation(s)
- Ye Yu
- The First Clinical College of Medicine, Chongqing Medical University / The First Hospital of Chongqing Medical University, 1 Youyi Road, Yuanjiagang, Yuzhong District, Chongqing, 400010, China
| | - MingRong Ma
- The First Clinical College of Medicine, Chongqing Medical University / The First Hospital of Chongqing Medical University, 1 Youyi Road, Yuanjiagang, Yuzhong District, Chongqing, 400010, China
| | - Qin Zhou
- The First Clinical College of Medicine, Chongqing Medical University / The First Hospital of Chongqing Medical University, 1 Youyi Road, Yuanjiagang, Yuzhong District, Chongqing, 400010, China.
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14
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Gudde AN, van Velthoven MJJ, Kouwer PHJ, Roovers JPWR, Guler Z. Injectable polyisocyanide hydrogel as healing supplement for connective tissue regeneration in an abdominal wound model. Biomaterials 2023; 302:122337. [PMID: 37793268 DOI: 10.1016/j.biomaterials.2023.122337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 09/07/2023] [Accepted: 09/23/2023] [Indexed: 10/06/2023]
Abstract
In pelvic organ prolapse (POP) patients, the uterus, bladder and/or rectum descends into vagina due to weakened support tissues. High recurrence rates after POP surgery suggest an urgent need for improved surgical outcomes. Our aim is to promote connective tissue healing that results in stimulated tissue support functions by surgically applying a hydrogel functionalized with biological cues. We used known vaginal wound healing promoting factors (basic fibroblast growth factor, β-estradiol, adipose-derived stem cells) in the biomimetic and injectable polyisocyanide (PIC) hydrogel, which in itself induces regenerative vaginal fibroblast behavior. The regenerative capacity of injected PIC hydrogel, and the additional pro-regenerative effects of these bioactive factors was evaluated in abdominal wounds in rabbits. Assessment of connective tissue healing (tensile testing, histology, immunohistochemistry) revealed that injection with all PIC formulations resulted in a statistically significant stiffness and collagen increase over time, in contrast to sham. Histological evaluation indicated new tissue growth with moderate to mild immune activity at the hydrogel - tissue interface. The results suggest that PIC injection in an abdominal wound improves healing towards regaining load-bearing capacity, which encourages us to investigate application of the hydrogel in a more translational vaginal model for POP surgery in sheep.
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Affiliation(s)
- Aksel N Gudde
- Department of Obstetrics and Gynecology, Amsterdam University Medical Center-location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands; Amsterdam Reproduction and Development, Amsterdam University Medical Center-location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Melissa J J van Velthoven
- Department of Urology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Geert Grooteplein Zuid 28, 6525 GA, Nijmegen, the Netherlands; Institute for Molecules and Materials, Radboud University, Heyendaalseweg 135, 6525 AJ, Nijmegen, the Netherlands
| | - Paul H J Kouwer
- Institute for Molecules and Materials, Radboud University, Heyendaalseweg 135, 6525 AJ, Nijmegen, the Netherlands
| | - Jan-Paul W R Roovers
- Department of Obstetrics and Gynecology, Amsterdam University Medical Center-location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands; Amsterdam Reproduction and Development, Amsterdam University Medical Center-location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Zeliha Guler
- Department of Obstetrics and Gynecology, Amsterdam University Medical Center-location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands; Amsterdam Reproduction and Development, Amsterdam University Medical Center-location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.
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15
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Wu J, Yao H, Yu L, Li H, Zuo Y, Liu W, Zhang C, Fu C, Liu M. A novel 3D printed type II silk fibroin/polycaprolactone mesh for the treatment of pelvic organ prolapse. Biomater Sci 2023; 11:7203-7215. [PMID: 37750690 DOI: 10.1039/d3bm01158e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
Pelvic organ prolapse (POP) is one of the common diseases in middle-aged and elderly women, caused by weakened pelvic floor muscle ligament tissue support. Pelvic floor reconstruction with mesh implantation has been proven to be an effective treatment for POP. However, traditional non-degradable and inflexible pelvic floor implantation meshes have been associated with pain, vaginal infections, and the need for additional surgeries. In this study, novel meshes with pre-designed structures were fabricated with solution-based electrohydrodynamic printing (EHDP) technology, using a series of polycaprolactone/silk fibroin composites as bioinks. The PCL/SF mesh mechanical performances were particularly enhanced with the addition of silk II, leading it to obtain higher adaptability with soft tissue repair. The mesh containing SF showed more robust degradation performance in the in vitro degradation assay. Furthermore, biocompatibility tests conducted on mouse embryonic fibroblasts (NIH/3T3) revealed enhanced cell affinity. Finally, the biocompatibility and tissue repair properties of PCL/SF mesh were verified through the implantation of meshes in the muscle defect site of mice. The results demonstrated that the 3D printed PCL/SF mesh prepared by EHDP exhibits superior mechanical properties, biocompatibility, biodegradability, as well as ligament and muscle fiber repair ability. The novel implantable meshes are promising for curing POP.
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Affiliation(s)
- Jingya Wu
- Department of Gynecology, Zhuhai People's Hospital (Zhuhai Hospital Affiliated with Jinan University), Zhuhai, 519050, China.
| | - Hai Yao
- Center for Peak of Excellence on Biological Science and Food Engineering, National University of Singapore (Suzhou) Research Institute, Suzhou, 215004, China.
| | - Lili Yu
- Center for Peak of Excellence on Biological Science and Food Engineering, National University of Singapore (Suzhou) Research Institute, Suzhou, 215004, China.
| | - Huawen Li
- Department of Gynecology, Zhuhai People's Hospital (Zhuhai Hospital Affiliated with Jinan University), Zhuhai, 519050, China.
| | - Yan Zuo
- Department of Gynecology, Zhuhai People's Hospital (Zhuhai Hospital Affiliated with Jinan University), Zhuhai, 519050, China.
| | - Wenjun Liu
- Department of Research and Development, Zhejiang Zhongwei Medical Research Center, Hangzhou, 310018, China
| | - Chunye Zhang
- Center for Peak of Excellence on Biological Science and Food Engineering, National University of Singapore (Suzhou) Research Institute, Suzhou, 215004, China.
| | - Caili Fu
- Center for Peak of Excellence on Biological Science and Food Engineering, National University of Singapore (Suzhou) Research Institute, Suzhou, 215004, China.
| | - Mubiao Liu
- Department of Gynecology, Zhuhai People's Hospital (Zhuhai Hospital Affiliated with Jinan University), Zhuhai, 519050, China.
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16
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Gudde A, van Velthoven MJJ, Türkel B, Kouwer PHJ, Roovers JPWR, Guler Z. Vaginal Fibroblast Behavior as a Function of Stiffness Changes in a Polyisocyanide Hydrogel for Prolapse Repair. ACS APPLIED BIO MATERIALS 2023; 6:3759-3767. [PMID: 37589427 PMCID: PMC10521013 DOI: 10.1021/acsabm.3c00433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 08/03/2023] [Indexed: 08/18/2023]
Abstract
There is an urgent need for improved outcomes in the treatment of pelvic organ prolapse (POP). Success of primary surgery relies on the load bearing capacity of plicated connective tissue underneath the vaginal wall, which is compromised due to an altered vaginal fibroblast function and collagen composition. There is an important factor in connective tissue repair that relates to changes in stiffness of the vaginal fibroblast microenvironment, which influences cell activity through cellular mechanosensing. The aim of this study is to investigate the effect of stiffness changes on vaginal fibroblast functions that relate to connective tissue healing in prolapse repair. The substrate stiffness was controlled by changing the polymer concentration in the fibrous and strongly biomimetic polyisocyanide (PIC) hydrogel. We analyzed stiffness during cell culture and assessed the consequential fibroblast proliferation, morphology, collagen deposition, and contraction. Our results show that increasing stiffness coincides with vaginal fibroblast alignment, promotes collagen deposition, and inhibits PIC gel contraction. These findings suggest that the matrix stiffness directly influences vaginal fibroblast functionality. Moreover, we observed a buildup in stiffness and collagen, with an enhanced fibroblast and collagen organization on the PIC-substrate, which indicate an enhanced structural integrity of the hydrogel-cell construct. An improved tissue structure during healing is relevant in the functional repair of POP. Therefore, this study encourages future research in the use of PIC gels as a supplement in prolapse surgery, whereby the hydrogel stiffness should be considered.
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Affiliation(s)
- Aksel
N. Gudde
- Department
of Obstetrics and Gynecology, Amsterdam
University Medical Center−location AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Reproductive
Biology Laboratory, Amsterdam Reproduction and Development, Amsterdam University Medical Center−location
AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Melissa J. J. van Velthoven
- Department
of Urology, Radboud Institute for Molecular
Life Sciences, Radboud University Medical Centre, Geert Grooteplein Zuid 28, 6525 GA Nijmegen, The Netherlands
- Institute
for Molecules and Materials, Radboud University, Heyendaalseweg 135, 6525 AJ Nijmegen, The Netherlands
| | - Betül Türkel
- Department
of Obstetrics and Gynecology, Amsterdam
University Medical Center−location AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Reproductive
Biology Laboratory, Amsterdam Reproduction and Development, Amsterdam University Medical Center−location
AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Paul H. J. Kouwer
- Institute
for Molecules and Materials, Radboud University, Heyendaalseweg 135, 6525 AJ Nijmegen, The Netherlands
| | - Jan-Paul W. R. Roovers
- Department
of Obstetrics and Gynecology, Amsterdam
University Medical Center−location AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Reproductive
Biology Laboratory, Amsterdam Reproduction and Development, Amsterdam University Medical Center−location
AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Zeliha Guler
- Department
of Obstetrics and Gynecology, Amsterdam
University Medical Center−location AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Reproductive
Biology Laboratory, Amsterdam Reproduction and Development, Amsterdam University Medical Center−location
AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
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17
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Vodegel EV, Guler Z, Ras L, Mackova K, Groeneveld ACHM, Bezuidenhout D, Deprest J, Jeffery ST, Roovers JPWR. Vaginal changes after ovariectomy in ewes: A large animal model for genitourinary syndrome of menopause. Int J Gynaecol Obstet 2023; 162:1042-1049. [PMID: 37151087 DOI: 10.1002/ijgo.14816] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 03/29/2023] [Accepted: 04/12/2023] [Indexed: 05/09/2023]
Abstract
OBJECTIVE To evaluate the effect of iatrogenic menopause on the physiology of the vagina of the ewe and to evaluate if vaginal changes in ewes can be translated to women with genitourinary syndrome of menopause (GSM). METHODS Preclinical research with Dohne Merino ewes. Iatrogenic menopause was induced by bilateral ovariectomy (OVX). Animals were randomized for surgery, blinded for allocation and outcome assessment. Differences between groups were determined by linear regression analyses at 5 months after OVX. Outcome measures were vaginal epithelial thickness, pH, vaginal maturation value, vaginal maturation index, epithelial glycogen accumulation, content of elastin fibers, collagen, and vascularity. RESULTS OVX ewes (n = 20) showed epithelial thinning of the vaginal wall from 146 μm to 47 μm (mean, P < 0.001). Furthermore, epithelial glycogen accumulation and vascularity of the vaginal wall significantly decreased (43% and 23%, respectively) as compared with the control group (no intervention; n = 5). No significant differences were found for other outcome measures. CONCLUSION This study established the ewe as a suitable large animal model for GSM. Furthermore, the similar relevant outcomes in humans and ewes hold great value for future translational research for the evaluation and optimization of different treatment modalities for GSM.
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Affiliation(s)
- Eva V Vodegel
- Department of Obstetrics and Gynaecology, Amsterdam UMC Location University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, Netherlands
| | - Zeliha Guler
- Department of Obstetrics and Gynaecology, Amsterdam UMC Location University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, Netherlands
| | - Lamees Ras
- Department of Obstetrics and Gynaecology, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Katerina Mackova
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Institute for the Care of Mother and Child, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Anne C H M Groeneveld
- Department of Obstetrics and Gynaecology, Amsterdam UMC Location University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, Netherlands
| | - Deon Bezuidenhout
- Cardiovascular Research Unit, Cape Hearth Center, University of Cape Town, Cape Town, South Africa
| | - Jan Deprest
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Pelvic Floor Unit, University Hospitals KU Leuven, Leuven, Belgium
| | - Stephen T Jeffery
- Department of Obstetrics and Gynaecology, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Jan-Paul W R Roovers
- Department of Obstetrics and Gynaecology, Amsterdam UMC Location University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, Netherlands
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18
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van Velthoven MJJ, Gudde AN, Struijs F, Oosterwijk E, Roovers JP, Guler Z, Hooijmans CR, Kouwer PHJ. The Effect of Growth Factors on Vaginal Wound Healing: A Systematic Review and Meta-analysis. TISSUE ENGINEERING. PART B, REVIEWS 2023; 29:429-440. [PMID: 37051705 DOI: 10.1089/ten.teb.2022.0225] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
Surgical outcomes of pelvic organ prolapse (POP) surgery are poor, resulting in a 20% recurrence risk. Following the hypothesis that impaired wound healing is the main determinant of recurrent POP, growth factors have the potential to promote wound healing and may improve surgical outcomes. In this study, we systematically reviewed the effect of growth factors on vaginal wound healing in both in vitro and animal studies. For each independent comparison, the standardized mean difference and 95% CI were calculated using the Hedges' g correction. Of the 3858 retrieved studies, seven studies were included, of which six were included in meta-analysis (three in vitro studies and four in vivo studies). In vitro, basic fibroblast growth factor (bFGF) promotes proliferation, differentiation, and collagen types I and III production. Epidermal growth factor stimulates proliferation and connective tissue growth factor promotes Tenascin-C expression. These effects, however, are less pronounced in vivo; only bFGF slightly promotes collagen production. The review shows that growth factors, particularly bFGF, are able to promote vaginal wound healing in vitro. The uncertain in vivo findings suggest that preclinical models should be improved. The ultimate goal is to develop effective growth factor-supplemented therapies that improve surgical outcomes for POP.
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Affiliation(s)
- Melissa J J van Velthoven
- Institute of Molecules and Materials, Radboud University, Nijmegen, The Netherlands
- Department of Urology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Aksel N Gudde
- Department of Obstetrics and Gynecology and Amsterdam University Medical Center, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Frederique Struijs
- Institute of Molecules and Materials, Radboud University, Nijmegen, The Netherlands
- Department of Urology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Egbert Oosterwijk
- Department of Urology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jan-Paul Roovers
- Department of Obstetrics and Gynecology and Amsterdam University Medical Center, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Zeliha Guler
- Department of Obstetrics and Gynecology and Amsterdam University Medical Center, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Carlijn R Hooijmans
- Department of Anesthesiology, Pain and Palliative Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Paul H J Kouwer
- Institute of Molecules and Materials, Radboud University, Nijmegen, The Netherlands
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19
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Co-transplantation of two different cell populations: A novel step forward to address stress urinary incontinence (SUI). J Stem Cells Regen Med 2022; 18:27-28. [PMID: 36713796 PMCID: PMC9837697 DOI: 10.46582/jsrm.1802005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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20
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Rathnayake RAC, Yoon S, Zheng S, Clutter ED, Wang RR. Electrospun Silk Fibroin-CNT Composite Fibers: Characterization and Application in Mediating Fibroblast Stimulation. Polymers (Basel) 2022; 15:91. [PMID: 36616441 PMCID: PMC9824115 DOI: 10.3390/polym15010091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/19/2022] [Accepted: 12/20/2022] [Indexed: 12/28/2022] Open
Abstract
Electrospinning is a simple, low-cost, and highly efficient technique to generate desirable nano/microfibers from polymer solutions. Silk fibroin (SF), a biopolymer found in Bombyx mori cocoons, has attracted attention for various biomedical applications. In this study, functionalized CNT was incorporated in SF to generate biocomposite fibers by electrospinning. The electrospun (E-spun) fibers were well aligned with morphology mimicking the locally oriented ECM proteins in connective tissues. While as-spun fibers dissolved in water in just two minutes, ethanol vapor post-treatment promoted β-sheet formation leading to improved fiber stability in an aqueous environment (>14 days). The addition of a minute amount of CNT effectively improved the E-spun fiber alignment and mechanical strength while retained high biocompatibility and biodegradability. The fibers’ electrical conductivity increased by 13.7 folds and 21.8 folds, respectively, in the presence of 0.1 w% and 0.2 w% CNT in SF fibers. With aligned SF-CNT 0.1 % fibers as a cell culture matrix, we found electrical stimulation effectively activated fibroblasts from patients of pelvic organ prolapse (POP), a connective tissue disorder. The stimulation boosted the fibroblasts’ productivity of collagen III (COLIII) and collagen I (COLI) by 74 folds and 58 folds, respectively, and reduced the COLI to COLIII ratio favorable for tissue repair. The developed material and method offer a simple, direct, and effective way to remedy the dysfunctional fibroblasts of patients for personalized cell therapeutic treatment of diseases and health conditions associated with collagen disorder.
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Affiliation(s)
| | | | | | | | - Rong R. Wang
- Department of Chemistry, Illinois Institute of Technology, Chicago, IL 60616, USA
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21
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The Middle Compartment: Keystone or Cul De Sac? Dis Colon Rectum 2022; 65:1415-1417. [PMID: 36102875 DOI: 10.1097/dcr.0000000000002604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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22
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Li Y, Kong M, Wang J, Han P, Zhang N, Yang X, Wang J, Hu Y, Duo Y, Liu D. Exercise-induced circulating exosomes potentially prevent pelvic organ prolapse in clinical practice via inhibition of smooth muscle apoptosis. Heliyon 2022; 9:e12583. [PMID: 37077375 PMCID: PMC10106923 DOI: 10.1016/j.heliyon.2022.e12583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 11/14/2022] [Accepted: 12/15/2022] [Indexed: 12/26/2022] Open
Abstract
Background This study aimed to explore the potential mechanisms of exercise to prevent pelvic organ prolapse (POP) and search for diagnostic indictors for POP. Methods We used two clinical POP datasets with patients' information (GSE12852 and GSE53868), a dataset consisting of altered microRNA expression in circulating blood after exercise (GSE69717) for bioinformatic analysis and clinical diagnostic analysis, while a series of cellular experiments were conducted for preliminary mechanical validation. Results Our results show that AXUD1 is highly expressed in the smooth muscle of the ovary and is a key pathogenic gene in POP, while miR-133b is a key molecule in the regulation of POP by exercise-induced serum exosomes. The AUCs of AXUD1 for POP diagnosis were 0.842 and 0.840 in GSE12852 and GSE53868 respectively. At cut-off value = 9.627, the sensitivity and specificity of AXUD1 for predicating POP is 1.000 and 0.833 respectively for GSE53868, while at cut-off value = 3324.640, the sensitivity and specificity of AXUD1 for predicating POP is 0.941 and 0.812 separately for GSE12852. Analysis and experiments confirmed that miR-133b can directly regulate AXUD1. miR-133b mediated C2C12 myoblasts proliferation and inhibited hydrogen peroxide-induced apoptosis. Conclusions Our study proved that AXUD1 is a good clinical diagnostic indicator for POP and provided a theoretical basis for future prevention of POP through exercise and a potential target for intervention in muscle dysfunction.
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23
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Maljaars LP, Bendaoud S, Kastelein AW, Guler Z, Hooijmans CR, Roovers JPWR. Application of amniotic membranes in reconstructive surgery of internal organs-A systematic review and meta-analysis. J Tissue Eng Regen Med 2022; 16:1069-1090. [PMID: 36333859 PMCID: PMC10099938 DOI: 10.1002/term.3357] [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: 05/16/2022] [Accepted: 10/20/2022] [Indexed: 11/08/2022]
Abstract
Amniotic membrane (AM) has great potential as a scaffold for tissue regeneration in reconstructive surgery. To date, no systematic review of the literature has been performed for the applications of AM in wound closure of internal organs. Therefore, in this systematic review and meta-analysis, we summarize the literature on the safety and efficacy of AM for the closure of internal organs. A systematic search was performed in MEDLINE-PubMed database and OVID Embase to retrieve human and controlled animal studies on wound closure of internal organs. The Cochrane Risk of Bias tool for randomized clinical trials and the SYRCLE risk of bias tool for animal studies were used. Meta-analyses (MAs) were conducted for controlled animal studies to assess efficacy of closure, mortality and complications in subjects who underwent surgical wound closure in internal organs with the application of AM. Sixty references containing 26 human experiments and 36 animal experiments were included. The MAs of the controlled animal studies showed comparable results with regard to closure, mortality and complications, and suggested improved mechanical strength and lower inflammation scores after AM application when compared to standard surgical closure techniques. This systematic review and MAs demonstrate that the application of AM to promote wound healing of internal organs appears to be safe, efficacious, and feasible.
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Affiliation(s)
- Lennart P Maljaars
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, location University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Reproduction and Development research institute, Amsterdam, The Netherlands
| | - Sohayla Bendaoud
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, location University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Reproduction and Development research institute, Amsterdam, The Netherlands
| | - Arnoud W Kastelein
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, location University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Reproduction and Development research institute, Amsterdam, The Netherlands
| | - Zeliha Guler
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, location University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Reproduction and Development research institute, Amsterdam, The Netherlands
| | - Carlijn R Hooijmans
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jan-Paul W R Roovers
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, location University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Reproduction and Development research institute, Amsterdam, The Netherlands
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24
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Verhorstert K, Gudde A, Weitsz C, Bezuidenhout D, Roovers JP, Guler Z. Absorbable Electrospun Poly-4-hydroxybutyrate Scaffolds as a Potential Solution for Pelvic Organ Prolapse Surgery. ACS APPLIED BIO MATERIALS 2022; 5:5270-5280. [PMID: 36315937 PMCID: PMC9682484 DOI: 10.1021/acsabm.2c00691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Women with pelvic organ prolapse (POP) have bothersome complaints that significantly affect their quality of life. While native tissue repair is associated with high recurrence rates, polypropylene knitted implants have caused specific implant-related adverse events that have detrimental, often irreversible, effects. We hypothesize that surgical outcome can be improved with a tissue-engineered solution using an absorbable implant that mimics the natural extracellular matrix (ECM) structure, releases estrogen, and activates collagen metabolism by fibroblasts as the main regulators of wound healing. To this aim, we produced electrospun poly-4-hydroxybutyrate (P4HB) scaffolds and biofunctionalized them with estradiol (E2). The cell-implant interactions relevant for POP repair were assessed by seeding primary POP vaginal fibroblasts isolated from patients on electrospun P4HB scaffolds with 1%, 2%, or 5% E2 and without E2. To test our hypothesis on whether ECM mimicking structures should improve regeneration, electrospun P4HB was compared to knitted P4HB implants. We evaluated vaginal fibroblast proliferation, ECM deposition, and metabolism by quantification of collagen, elastin, and matrix metalloproteinases and by gene expression analysis for 28 days. We established effective E2 drug loading with a steady release over time. Significantly higher cell proliferation, collagen-, and elastin deposition were observed on electrospun P4HB scaffolds as compared to knitted P4HB. For this study, physical properties of the scaffolds were more determinant on the cell response than the release of E2. These results indicate that making these electrospun P4HB scaffolds E2-releasing appears to be technically feasible. In addition, electrospun P4HB scaffolds promote the cellular response of vaginal fibroblasts and further studies are merited to assess if their use results in improved surgical outcomes in case of POP repair.
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Affiliation(s)
- Kim Verhorstert
- Department
of Obstetrics and Gynecology, Amsterdam
UMC, University of Amsterdam, Meibergdreef 9, 1105
AZAmsterdam, The Netherlands,Amsterdam
Reproduction and Development Research Institute, Meibergdreef 9, 1105
AZAmsterdam, The Netherlands
| | - Aksel Gudde
- Department
of Obstetrics and Gynecology, Amsterdam
UMC, University of Amsterdam, Meibergdreef 9, 1105
AZAmsterdam, The Netherlands,Amsterdam
Reproduction and Development Research Institute, Meibergdreef 9, 1105
AZAmsterdam, The Netherlands
| | - Carmen Weitsz
- Cardiovascular
Research Unit, Department of Surgery, University
of Cape Town, 203 Chris Barnard Building, Anzio Road, Observatory7925Cape Town, South Africa
| | - Deon Bezuidenhout
- Cardiovascular
Research Unit, Department of Surgery, University
of Cape Town, 203 Chris Barnard Building, Anzio Road, Observatory7925Cape Town, South Africa
| | - Jan-Paul Roovers
- Department
of Obstetrics and Gynecology, Amsterdam
UMC, University of Amsterdam, Meibergdreef 9, 1105
AZAmsterdam, The Netherlands,Amsterdam
Reproduction and Development Research Institute, Meibergdreef 9, 1105
AZAmsterdam, The Netherlands
| | - Zeliha Guler
- Department
of Obstetrics and Gynecology, Amsterdam
UMC, University of Amsterdam, Meibergdreef 9, 1105
AZAmsterdam, The Netherlands,Amsterdam
Reproduction and Development Research Institute, Meibergdreef 9, 1105
AZAmsterdam, The Netherlands,
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25
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Mesenchymal stem cell transplantation improves biomechanical properties of vaginal tissue following full-thickness incision in aged rats. Stem Cell Reports 2022; 17:2565-2578. [DOI: 10.1016/j.stemcr.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 11/06/2022] Open
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26
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Gudde AN, van Velthoven MJJ, Roovers JPWR, Kouwer PHJ, Guler Z. Polyisocyanides as a substrate to trigger vaginal fibroblast functioning in an in vitro model for prolapse repair. BIOMATERIALS ADVANCES 2022; 141:213104. [PMID: 36116187 DOI: 10.1016/j.bioadv.2022.213104] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 08/10/2022] [Accepted: 08/31/2022] [Indexed: 06/15/2023]
Abstract
Pelvic organ prolapse (POP) is the descent of the bladder, uterus, and/or rectum into the vagina. POP is associated with altered vaginal fibroblast functionality and connective tissue composition in the vaginal wall. The results of surgical intervention are poor, which may be related to the lack of true restoration of the connective tissue. An innovative treatment addresses tissue repair after surgery by the introduction of a bioactive supplement that enhances the healing process through collagen and elastin deposition. As a novel strategy, we first studied the effects in an in vitro model. Here, we investigate how the presence of cell binding GRGDS (RGD) peptides on the highly biomimetic polyisocyanide (PIC) gel facilitates and promotes the function of primary vaginal fibroblasts isolated from a POP patient. Fibroblast function was analyzed in terms of morphology, proliferation, and extracellular matrix (ECM) deposition and remodeling. RGD modification of the gel facilitated cell spread and proliferation. Quantitative outcomes of the ECM content indicated increased production of collagen and elastin by fibroblasts on gels with the highest RGD density. The in vitro results suggest that PIC-RGD hydrogel application may translate into improved connective tissue healing in the pelvic floor, which is essential for its use as a regeneration promoting additive in surgery.
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Affiliation(s)
- Aksel N Gudde
- Department of Obstetrics and Gynecology, Amsterdam University Medical Center-location AMC, Meibergdreef 9, 1105, AZ, Amsterdam, the Netherlands; Amsterdam Reproduction and Development, Amsterdam University Medical Center-location AMC, Meibergdreef 9, 1105, AZ, Amsterdam, the Netherlands
| | - Melissa J J van Velthoven
- Institute for Molecular Life Sciences, Radboud University, Geert Grooteplein Zuid 28, 6525, GA, Nijmegen, the Netherlands; Institute for Molecules and Materials, Radboud University, Heyendaalseweg 135, 6525, AJ, Nijmegen, the Netherlands
| | - Jan-Paul W R Roovers
- Department of Obstetrics and Gynecology, Amsterdam University Medical Center-location AMC, Meibergdreef 9, 1105, AZ, Amsterdam, the Netherlands; Amsterdam Reproduction and Development, Amsterdam University Medical Center-location AMC, Meibergdreef 9, 1105, AZ, Amsterdam, the Netherlands
| | - Paul H J Kouwer
- Institute for Molecules and Materials, Radboud University, Heyendaalseweg 135, 6525, AJ, Nijmegen, the Netherlands.
| | - Zeliha Guler
- Department of Obstetrics and Gynecology, Amsterdam University Medical Center-location AMC, Meibergdreef 9, 1105, AZ, Amsterdam, the Netherlands; Amsterdam Reproduction and Development, Amsterdam University Medical Center-location AMC, Meibergdreef 9, 1105, AZ, Amsterdam, the Netherlands.
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