Annals of Biomedical Engineering

, Volume 44, Issue 5, pp 1773–1784 | Cite as

Tissue-Engineered External Anal Sphincter Using Autologous Myogenic Satellite Cells and Extracellular Matrix: Functional and Histological Studies

  • Abdol-Mohammad KajbafzadehEmail author
  • Majid Kajbafzadeh
  • Shabnam Sabetkish
  • Nastaran Sabetkish
  • Seyyed Mohammad Tavangar


The aim of the present study was to demonstrate the regaining histological characteristics of bioengineered external anal sphincters (EAS) in rabbit fecal incontinence model. The EAS of 16 rabbits were resected and decellularized. The decellularized scaffolds were transplanted to the terminal rectum following a period of 6 months of fecal incontinency (5 days after sterilization). The rabbits were divided into two groups: in group 1 (n = 8), myogenic satellite cells were injected into the transplanted sphincters. In group 2 (n = 8), the transplanted scaffolds remained in situ without cellular injection. The histological evaluation was performed with desmin, myosin, smooth muscle actin, CD31, and CD34 at 3-month intervals. The rabbits were followed for 2 years. Electromyography (EMG) with needle and electrical stimulation, pudendal and muscle electrical stimulation were also performed after 2 years of transplantation. At the time of biopsy, no evidence of inflammation or rejection was observed and the transplanted EAS appeared histologically and anatomically normal. The immunohistochemistry staining validated that the histological features of EAS was more satisfactory in group 1 in short-term follow-up. However, no statistically significant difference was detected between two groups in long-term follow-ups (p value > 0.05). In both groups, grafted EAS contracted in response to electrical signals delivered to the muscle and the pudendal nerve. However, more signals were detected in group 1 in EMG evaluation. In conclusion, bioengineered EAS with myogenic satellite cells can gain more satisfactory histological outcomes in short-term follow-ups with better muscle electrical stimulation outcomes.


External anal sphincter Fecal incontinence Decellularization Myogenic satellite cells Immunohistochemistry Bioengineering 



Fecal Incontinence


Decellularized external anal sphincter matrix


External anal sphincters


Extra cellular matrix





This study was co-founded by Tehran University of Medical Sciences. We are also highly grateful from Mrs. Safieh Lotfi for her precise editing of the manuscript.

Conflict of interest

None of the authors has direct or indirect commercial financial incentive associating with publishing the article and does not have any conflict of interest, and all have signed the Disclosure Form.

Supplementary material

10439_2015_1468_MOESM1_ESM.mp4 (3.2 mb)
Video 1: Perineal muscle stimulation with electrical muscle stimulator in rabbits of group 1 after 6 months of implantation (MP4 3236 kb)
10439_2015_1468_MOESM2_ESM.mp4 (5.9 mb)
Video 2: Perineal muscle stimulation with electrical muscle stimulator in rabbits of group 1 after 12 months of implantation (MP4 6061 kb)
10439_2015_1468_MOESM3_ESM.mp4 (3.2 mb)
Video 3: Perineal muscle stimulation with electrical muscle stimulator in rabbits of group 1 after 24 months of implantation (MP4 3322 kb)
10439_2015_1468_MOESM4_ESM.mp4 (2.3 mb)
Video 4: Perineal muscle stimulation with electrical muscle stimulator in rabbits of group 2 after 6 months of implantation (MP4 2309 kb)
10439_2015_1468_MOESM5_ESM.mp4 (6.1 mb)
Video 5: Perineal muscle stimulation with electrical muscle stimulator in rabbits of group 2 after 12 months of implantation (MP4 6280 kb)
10439_2015_1468_MOESM6_ESM.mp4 (3 mb)
Video 6: Perineal muscle stimulation with electrical muscle stimulator in rabbits of group 2 after 24 months of implantation (MP4 3090 kb)

Video 7: Pudendal nerve stimulation with electrical nerve stimulator in group 1 after 2 years of implantation (MPG 3309 kb)

Video 8: Pudendal nerve stimulation with electrical nerve stimulator in group 2, two years post operatively (MPG 3951 kb)


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Copyright information

© Biomedical Engineering Society 2015

Authors and Affiliations

  • Abdol-Mohammad Kajbafzadeh
    • 1
    Email author
  • Majid Kajbafzadeh
    • 2
  • Shabnam Sabetkish
    • 1
  • Nastaran Sabetkish
    • 1
  • Seyyed Mohammad Tavangar
    • 3
  1. 1.Pediatric Urology Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children’s Hospital Medical CenterTehran University of Medical SciencesTehranIslamic Republic of Iran
  2. 2.Sydney Medical SchoolThe University of Sydney SydneyAustralia
  3. 3.Department of Pathology, Shariati HospitalTehran University of Medical SciencesTehranIslamic Republic of Iran

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