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The Bioengineered Uterus: A Possible Future

  • Mats HellströmEmail author
  • Mats Brännström
Chapter

Abstract

Customized grafts that include a scaffold populated with the patient’s own cells could become a major advantage in the field of uterus transplantation since it may overcome problematic donor issues and negative side effects from immunosuppression. So far, bioengineering was only utilized to personalize bone structure grafts and less complex organs for clinical use. However, recent tissue engineering protocols developed in animal experiments now include solid tissues and whole organs that were decellularized to create suitable scaffolds for using autologous stem cells in the reconstruction phase. Furthermore, several studies have shown that stratified uterine-like tissues can successfully be created in vitro either from various collagen-derived hydrogels or from decellularized uterine tissues populated with primary cells of the uterus and mesenchymal stem cells. When patches of these constructs were assessed in rodent models, that carried uteri with defect uterine walls, they stimulated regeneration and significantly improved fertility outcomes. Hence, partial uterus repair using a bioengineered construct could potentially become an effective treatment routine to cure infertility or fetal morbidity caused by severe uterus scarring or malformations. However, improved protocols are still needed that will support the construction of a transplantable bioengineered whole uterus. These large constructs must be constructed to enable vascular anastomosis and must facilitate successful implantation and fetal development. Once these objectives are met, this donor option could become a future clinical reality in a uterus transplantation setting.

Abbreviations

3D

Three-dimensional

ECM

Extracellular matrix

ES

Embryonic stem (cells)

GFP

Green fluorescent protein

HHP

High hydrostatic pressure

iPS

Induced pluripotent stem (cells)

MSCs

Mesenchymal stem cells

SDS

Sodium dodecyl sulfate

STAT3

Signal transducer and activator of transcription 3

UTx

Uterus transplantation

Notes

Acknowledgements

The authors report no conflict of interest. The work was supported by Wilhelm and Martina Lundgren research foundation, Hjalmar Svensson research foundation, Adlerbertska research foundation, the Swedish Government LUA grant, Wallenberg Foundation and the Swedish Science Research Council (Vetenskapsrådet; Grant No. 116008).

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© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Laboratory for Transplantation and Regenerative MedicineInstitute of Clinical Science, Sahlgrenska Academy, University of GothenburgGothenburgSweden
  2. 2.Department of Obstetrics and GynecologyInstitute of Clinical Science, Sahlgrenska Academy, University of GothenburgGothenburgSweden
  3. 3.Department of Obstetrics and GynecologySahlgrenska Academy, University of Gothenburg, Sahlgrenska University HospitalGothenburgSweden
  4. 4.Stockholm IVF-EUGINStockholmSweden

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