Abstract
Cellular therapy is an emerging field in clinical and personalised medicine. Many adult mesenchymal stem/progenitor cells (MSC) or pluripotent derivatives are being assessed simultaneously in preclinical trials for their potential treatment applications in chronic and degenerative human diseases. Endometrial mesenchymal stem/progenitor cells (eMSC) have been identified as clonogenic cells that exist in unique perivascular niches within the uterine endometrium. Compared with MSC isolated from other tissue sources, such as bone marrow and adipose tissue, eMSC can be extracted through less invasive methods of tissue sampling, and they exhibit improvements in potency, proliferative capacity, and control of culture-induced differentiation. In this review, we summarize the potential cell therapy and tissue engineering applications of eMSC in pelvic organ prolapse (POP), emphasising their ability to exert angiogenic and strong immunomodulatory responses that improve tissue integration of novel surgical constructs for POP and promote vaginal tissue healing.
Highlights
Pelvic organ prolapse (POP) is a common urogynaecological disorder that affects one in four women across all age groups, or over 50% of postmenopausal parous women with a history of vaginal birth [1,2]
The adverse events associated with use of PP mesh in pelvic reconstructive surgery has been attributed to a lack of biomechanical compatibility of synthetic mesh with the unique dynamics of vaginal tissue, which in turn is associated with an exaggerated foreign body response that results in chronic fibrosis [10]
This study demonstrated that a simpler two step procedure of inserting uncoated polyamide (PA) mesh followed by the application of autologous Endometrial mesenchymal stem/progenitor cells (eMSC) in a gelatin hydrogel crosslinked in situ with blue light drastically improved tissue–mesh integration and resulted in no cases of mesh erosion [72]
Summary
Pelvic organ prolapse (POP) is a common urogynaecological disorder that affects one in four women across all age groups, or over 50% of postmenopausal parous women with a history of vaginal birth [1,2]. Urogynaecologists have implemented polypropylene (PP) mesh to augment POP surgery in an attempt to reduce the risk of anatomical failure. This mesh comprised synthetic, non-degradable macroporous monofilament fibres that caused serious adverse events in some women when implanted vaginally; including infection, retraction, exposure, and erosion [8]. Tissue engineered surgical constructs consisting of endometrial mesenchymal stem cells (eMSC), combined with mesh, have demonstrated improved surgical outcomes in pre-clinical models of POP surgery, with a more favourable immune response and improved biomechanical properties of vaginal tissue [11]. Other significant risk factors include the use of forceps, and other gynaecological procedures such as hysterectomy for other clinical indications [5,14,15]
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