Cellular modelling in functional tissue engineering: review oriented for pelvic floor dysfunctions

Abstract

This paper aims to review the current strategies for pelvic floor dysfunctions (PFDs). PFDs, such as stress urinary incontinence, foecal incontinence and vaginal prolapse affect the quality of life in women, involve high healthcare costs, and pose poor long-term success rates. As the problem progresses the cells in the pelvic tissues are impaired. The rheological relations between PFD and the damage of the tissues is not yet well established, bringing out clinical repair interventions, instead of knowing the root problem. As a consequence, the verification of damage mechanisms in the pelvic structures should be observed at cellular scales to correlate with the macroscopic phenomenological pathologies, namely, the changes in the mechanical properties and on the geometric configuration of the pelvic structures. Cells sense mechanical stimuli and respond biochemically via mechanotransduction mechanisms. Therefore, investigations on the cell dynamics must be performed, considering the physical conditions inside the bioreactors, to shed insight into the active behaviour of the cells during the treatment. These investigations should establish the conditions that push a cell to or keep a cell in a desired state during a regenerative treatment. This paper reviews the use of human adult stem cells to regenerate the defective muscles, ligaments and connective tissues in the pelvic floor, focusing on the role of the computational models as an assistive technology for these emergent tissue engineering treatments. First, the pelvic floor anatomy and physiology is related with the kinematic and mechanical behaviour of those structures at the tissue and cell scales. After, the relevance of the regenerative treatments is discussed and the requirements for their application are summarised. Later, the developments on computational models are exposed and the main guidelines for regeneration of the pelvic cavity tissues are proposed.