Abstract
Stress urinary incontinence (SUI) is highly prevalent and associated with a reduced quality of life. An intact rhabdosphincter at the mid-urethra is mandatory to maintain urinary continence. Adult stem cell injection therapy for the regenerative repair of an impaired sphincter is currently at the forefront of incontinence research. The implanted cells will fuse with muscle and release trophic factors promoting nerve and muscle integration. Hereby, we review the use of mesenchymal stem cell therapy for SUI and the experience with the development of muscle-derived stem cells.
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References
Atala A (2004) Tissue engineering and regenerative medicine: concepts for clinical application. Rejuvenation Res 7:15–31
Atala A (2009) Regenerative medicine and tissue engineering in urology. Urol Clin North Am 36:199–209, viii-ix
Beauchamp JR, Morgan JE, Pagel CN, Partridge TA (1999) Dynamics of myoblast transplantation reveal a discrete minority of precursors with stem cell-like properties as the myogenic source. J Cell Biol 144:1113–1122
Bent AE, Tutrone RT, McLennan MT, Lloyd LK, Kennelly MJ, Badlani G (2001) Treatment of intrinsic sphincter deficiency using autologous ear chondrocytes as a bulking agent. Neurourol Urodyn 20:157–165
Brivanlou AH, Gage FH, Jaenisch R, Jessell T, Melton D, Rossant J (2003) Stem cells. Setting standards for human embryonic stem cells. Science 300:913–916
Cannon TW, Lee JY, Somogyi G, Pruchnic R, Smith CP, Huard J, Chancellor MB (2003) Improved sphincter contractility after allogenic muscle-derived progenitor cell injection into the denervated rat urethra. Urology 62:958–963
Carr LK, Steele D, Steele S, Wagner D, Pruchnic R, Jankowski R, Erickson J, Huard J, Chancellor MB (2008) 1-year follow-up of autologous muscle-derived stem cell injection pilot study to treat stress urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct 19:881–883
Chancellor MB, Perkin H, Yoshimura N (2005) Recent advances in the neurophysiology of stress urinary incontinence. Scand J Urol Nephrol 39:21–24
Chancellor MB, Yokoyama T, Tirney S, Mattes CE, Ozawa H, Yoshimura N, de Groat WC, Huard J (2000) Preliminary results of myoblast injection into the urethra and bladder wall: a possible method for the treatment of stress urinary incontinence and impaired detrusor contractility. Neurourol Urodyn 19:279–287
Chermansky CJ, Tarin T, Kwon DD, Jankowski RJ, Cannon TW, de Groat WC, Huard J, Chancellor MB (2004) Intraurethral muscle-derived cell injections increase leak point pressure in a rat model of intrinsic sphincter deficiency. Urology 63:780–785
Chrouser KL, Fick F, Goel A, Itano NB, Sweat SD, Lightner DJ (2004) Carbon coated zirconium beads in beta-glucan gel and bovine glutaraldehyde cross-linked collagen injections for intrinsic sphincter deficiency: continence and satisfaction after extended follow-up. J Urol 171:1152–1155
Corcos J, Beaulieu S, Donovan J, Naughton M, Gotoh M (2002) Quality of life assessment in men and women with urinary incontinence. J Urol 168:896–905
Corcos J, Loutochin O, Campeau L, Eliopoulos N, Bouchentouf M, Blok B, Galipeau J (2010) Bone marrow mesenchymal stromal cell therapy for external urethral sphincter restoration in a rat model of stress urinary incontinence. Neurourol Urodyn 30:447–455
de Groat WC (1998) Anatomy of the central neural pathways controlling the lower urinary tract. Eur Urol 34(Suppl 1):2–5
de Groat WC (2006) Integrative control of the lower urinary tract: preclinical perspective. Br J Pharmacol 147(Suppl 2):S25–S40
DeLancey JO (1994) Structural support of the urethra as it relates to stress urinary incontinence: the hammock hypothesis. Am J Obstet Gynecol 170:1713–20, discussion 1720-3
Dezawa M, Ishikawa H, Itokazu Y, Yoshihara T, Hoshino M, Takeda S, Ide C, Nabeshima Y (2005) Bone marrow stromal cells generate muscle cells and repair muscle degeneration. Science 309:314–317
Drost AC, Weng S, Feil G, Schafer J, Baumann S, Kanz L, Sievert KD, Stenzl A, Mohle R (2009) In vitro myogenic differentiation of human bone marrow-derived mesenchymal stem cells as a potential treatment for urethral sphincter muscle repair. Ann NY Acad Sci 1176:135–143
Edwards RG (2007) A burgeoning science of embryological genetics demands a modern ethics. Reprod Biomed Online 15(Suppl 1):34–40
Ferrari G, Cusella-De Angelis G, Coletta M, Paolucci E, Stornaiuolo A, Cossu G, Mavilio F (1998) Muscle regeneration by bone marrow-derived myogenic progenitors. Science 279:1528–1530
Furuta A, Jankowski RJ, Pruchnic R, Yoshimura N, Chancellor MB (2007) The promise of stem cell therapy to restore urethral sphincter function. Curr Urol Rep 8:373–378
Hampel C, Wienhold D, Benken N, Eggersmann C, Thuroff JW (1997) Prevalence and natural history of female incontinence. Eur Urol 32(Suppl 2):3–12
Herschorn S, Carr LK, Birch C (2010) Autologous muscle-derived cells as therapy for stress urinary incontinence: a randomized blinded trial. Neurourol Urodyn 29:243–326
Herschorn S, Glazer AA (2000) Early experience with small volume periurethral polytetrafluoroethylene for female stress urinary incontinence. J Urol 163:1838–1842
Holroyd-Leduc JM, Straus SE (2004) Management of urinary incontinence in women: scientific review. JAMA, J Am Med Assoc 291:986–995
Hoshi A, Tamaki T, Tono K, Okada Y, Akatsuka A, Usui Y, Terachi T (2008) Reconstruction of radical prostatectomy-induced urethral damage using skeletal muscle-derived multipotent stem cells. Transplantation 85:1617–1624
Jack GS, Almeida FG, Zhang R, Alfonso ZC, Zuk PA, Rodriguez LV (2005) Processed lipoaspirate cells for tissue engineering of the lower urinary tract: implications for the treatment of stress urinary incontinence and bladder reconstruction. J Urol 174:2041–2045
Jankowski RJ, Deasy BM, Huard J (2002) Muscle-derived stem cells. Gene Ther 9:642–647
Jeffry L, Deval B, Birsan A, Soriano D, Darai E (2001) Objective and subjective cure rates after tension-free vaginal tape for treatment of urinary incontinence. Urology 58:702–706
Kaiho Y, Kamo I, Chancellor MB, Arai Y, de Groat WC, Yoshimura N (2007) Role of noradrenergic pathways in sneeze-induced urethral continence reflex in rats. Am J Physiol Ren Physiol 292:F639–F646
Kajbafzadeh AM, Elmi A, Payabvash S, Salmasi AH, Saeedi P, Mohamadkhani A, Sadeghi Z, Nikfarjam L (2008) Transurethral autologous myoblast injection for treatment of urinary incontinence in children with classic bladder exstrophy. J Urol 180:1098–1105
Kamo I, Cannon TW, Conway DA, Torimoto K, Chancellor MB, de Groat WC, Yoshimura N (2004) The role of bladder-to-urethral reflexes in urinary continence mechanisms in rats. Am J Physiol Ren Physiol 287:F434–F441
Kamo I, Kaiho Y, Canon TW, Chancellor MB, de Groat WC, Prantil RL, Vorp DA, Yoshimura N (2006) Functional analysis of active urethral closure mechanisms under sneeze induced stress condition in a rat model of birth trauma. J Urol 176:2711–2715
Kamo I, Torimoto K, Chancellor MB, de Groat WC, Yoshimura N (2003) Urethral closure mechanisms under sneeze-induced stress condition in rats: a new animal model for evaluation of stress urinary incontinence. Am J Physiol Regul Integr Comp Physiol 285:R356–65
Kang SB, Lee HN, Lee JY, Park JS, Lee HS (2008) Sphincter contractility after muscle-derived stem cells autograft into the cryoinjured anal sphincters of rats. Dis Colon Rectum 51:1367–1373
Kayigil O, Iftekhar Ahmed S, Metin A (1999) The coexistence of intrinsic sphincter deficiency with type II stress incontinence. J Urol 162:1365–1366
Kern S, Eichler H, Stoeve J, Kluter H, Bieback K (2006) Comparative analysis of mesenchymal stem cells from bone marrow, umbilical cord blood, or adipose tissue. Stem Cells 24:1294–1301
Kim SO, Na HS, Kwon D, Joo SY, Kim HS, Ahn Y (2011) Bone-marrow-derived mesenchymal stem cell transplantation enhances closing pressure and leak point pressure in a female urinary incontinence rat model. Urol Int 86:110–116
Kinebuchi Y, Aizawa N, Imamura T, Ishizuka O, Igawa Y, Nishizawa O (2010) Autologous bone-marrow-derived mesenchymal stem cell transplantation into injured rat urethral sphincter. Int J Urol, official journal of the Japanese Urological Association 17:359–368
Kleinert S, Horton R (2008) Retraction—autologous myoblasts and fibroblasts versus collagen [corrected] for treatment of stress urinary incontinence in women: a [corrected] randomised controlled trial. Lancet 372:789–790
Kwon D, Kim Y, Pruchnic R, Jankowski R, Usiene I, de Miguel F, Huard J, Chancellor MB (2006) Periurethral cellular injection: comparison of muscle-derived progenitor cells and fibroblasts with regard to efficacy and tissue contractility in an animal model of stress urinary incontinence. Urology 68:449–454
Lee JY, Cannon TW, Pruchnic R, Fraser MO, Huard J, Chancellor MB (2003) The effects of periurethral muscle-derived stem cell injection on leak point pressure in a rat model of stress urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct 14:31–7, discussion 37
Lee JY, Paik SY, Yuk SH, Lee JH, Ghil SH, Lee SS (2004) Long term effects of muscle-derived stem cells on leak point pressure and closing pressure in rats with transected pudendal nerves. Mol Cells 18:309–313
Levy R, Muller N (2006) Urinary incontinence: economic burden and new choices in pharmaceutical treatment. Adv Ther 23:556–573
Lin Y, Yan Z, Liu L, Qiao J, Jing W, Wu L, Chen X, Li Z, Tang W, Zheng X, Tian W (2006) Proliferation and pluripotency potential of ectomesenchymal cells derived from first branchial arch. Cell Prolif 39:79–92
Lo B, Zettler P, Cedars MI, Gates E, Kriegstein AR, Oberman M, Reijo Pera R, Wagner RM, Wuerth MT, Wolf LE, Yamamoto KR (2005) A new era in the ethics of human embryonic stem cell research. Stem Cells 23:1454–1459
Maher CF, O’Reilly BA, Dwyer PL, Carey MP, Cornish A, Schluter P (2005) Pubovaginal sling versus transurethral Macroplastique for stress urinary incontinence and intrinsic sphincter deficiency: a prospective randomised controlled trial. BJOG 112:797–801
McGuire EJ, Lytton B, Pepe V, Kohorn EI (1976) Stress urinary incontinence. Obstet Gynecol 47:255–264
Milsom I, Ekelund P, Molander U, Arvidsson L, Areskoug B (1993) The influence of age, parity, oral contraception, hysterectomy and menopause on the prevalence of urinary incontinence in women. J Urol 149:1459–1462
Nilsson CG, Kuuva N, Falconer C, Rezapour M, Ulmsten U (2001) Long-term results of the tension-free vaginal tape (TVT) procedure for surgical treatment of female stress urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct 12(Suppl 2):S5–S8
Norton P, Brubaker L (2006) Urinary incontinence in women. Lancet 367:57–67
Oshima H, Payne TR, Urish KL, Sakai T, Ling Y, Gharaibeh B, Tobita K, Keller BB, Cummins JH, Huard J (2005) Differential myocardial infarct repair with muscle stem cells compared to myoblasts. Mol Ther 12:1130–1141
Pannek J, Brands FH, Senge T (2001) Particle migration after transurethral injection of carbon coated beads for stress urinary incontinence. J Urol 166:1350–1353
Papa Petros PE (1994) Tissue reaction to implanted foreign materials for cure of stress incontinence. Am J Obstet Gynecol 171:1159
Peroni D, Scambi I, Pasini A, Lisi V, Bifari F, Krampera M, Rigotti G, Sbarbati A, Galie M (2008) Stem molecular signature of adipose-derived stromal cells. Exp Cell Res 314:603–615
Pittenger MF, Mackay AM, Beck SC, Jaiswal RK, Douglas R, Mosca JD, Moorman MA, Simonetti DW, Craig S, Marshak DR (1999) Multilineage potential of adult human mesenchymal stem cells. Science 284:143–147
Qu Z, Balkir L, van Deutekom JC, Robbins PD, Pruchnic R, Huard J (1998) Development of approaches to improve cell survival in myoblast transfer therapy. J Cell Biol 142:1257–1267
Rezapour M, Ulmsten U (2001) Tension-free vaginal tape (TVT) in women with mixed urinary incontinence—a long-term follow-up. Int Urogynecol J Pelvic Floor Dysfunct 12(Suppl 2):S15–S18
Rodriguez LV, Alfonso Z, Zhang R, Leung J, Wu B, Ignarro LJ (2006) Clonogenic multipotent stem cells in human adipose tissue differentiate into functional smooth muscle cells. Proc Natl Acad Sci USA 103:12167–12172
Sakamoto K, Sharma S, Wheeler JS (2007) Long-term subjective continence status and use of alternative treatments by women with stress urinary incontinence after collagen injection therapy. World J Urol 25:431–433
Sampselle CM, Miller JM, Mims BL, Delancey JO, Ashton-Miller JA, Antonakos CL (1998) Effect of pelvic muscle exercise on transient incontinence during pregnancy and after birth. Obstet Gynecol 91:406–412
Schroder HD, Reske-Nielsen E (1983) Fiber types in the striated urethral and anal sphincters. Acta Neuropathol 60:278–282
Seale P, Asakura A, Rudnicki MA (2001) The potential of muscle stem cells. Dev Cell 1:333–342
Sharifi-Aghdas F (2005) Surgical management of stress urinary incontinence. Urol J 2:175–182
Strasser H, Marksteiner R, Margreiter E, Mitterberger M, Pinggera GM, Frauscher F, Fussenegger M, Kofler K, Bartsch G (2007) Transurethral ultrasonography-guided injection of adult autologous stem cells versus transurethral endoscopic injection of collagen in treatment of urinary incontinence. World J Urol 25:385–392
Sweat SD, Lightner DJ (1999) Complications of sterile abscess formation and pulmonary embolism following periurethral bulking agents. J Urol 161:93–96
Sweeney DD, Chancellor MB (2005) Treatment of stress urinary incontinence with duloxetine hydrochloride. Rev urol 7:81–86
Tamaki T, Uchiyama Y, Okada Y, Ishikawa T, Sato M, Akatsuka A, Asahara T (2005) Functional recovery of damaged skeletal muscle through synchronized vasculogenesis, myogenesis, and neurogenesis by muscle-derived stem cells. Circulation 112:2857–2866
Ward KL, Hilton P (2004) A prospective multicenter randomized trial of tension-free vaginal tape and colposuspension for primary urodynamic stress incontinence: two-year follow-up. Am J Obstet Gynecol 190:324–331
Wu Y, Chen L, Scott PG, Tredget EE (2007) Mesenchymal stem cells enhance wound healing through differentiation and angiogenesis. Stem Cells 25:2648–2659
Yiou R, Yoo JJ, Atala A (2003) Restoration of functional motor units in a rat model of sphincter injury by muscle precursor cell autografts. Transplantation 76:1053–1060
Yokoyama T, Pruchnic R, Lee JY, Chuang YC, Jumon H, Yoshimura N, de Groat WC, Huard J, Chancellor MB (2001) Autologous primary muscle-derived cells transfer into the lower urinary tract. Tissue Eng 7:395–404
Yokoyama T, Yoshimura N, Dhir R, Qu Z, Fraser MO, Kumon H, de Groat WC, Huard J, Chancellor MB (2001) Persistence and survival of autologous muscle derived cells versus bovine collagen as potential treatment of stress urinary incontinence. J Urol 165:271–276
Zeng X, Jack GS, Zhang R (2006) Treatment of SUI using adipose derived stem cells: restoration of urethral function. J Urol 175:291
Zhao W, Zhang C, Jin C, Zhang Z, Kong D, Xu W, Xiu Y (2010) Periurethral injection of autologous adipose-derived stem cells with controlled-release nerve growth factor for the treatment of stress urinary incontinence in a rat model. Eur Urol 59:e1–e4
Zuk PA, Zhu M, Ashjian P, De Ugarte DA, Huang JI, Mizuno H, Alfonso ZC, Fraser JK, Benhaim P, Hedrick MH (2002) Human adipose tissue is a source of multipotent stem cells. Mol Biol Cell 13:4279–4295
Zuk PA, Zhu M, Mizuno H, Huang J, Futrell JW, Katz AJ, Benhaim P, Lorenz HP, Hedrick MH (2001) Multilineage cells from human adipose tissue: implications for cell-based therapies. Tissue Eng 7:211–228
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Chancellor MB is the consultant and patent holder of technology licensed to Cook MyoSite, no conflicts of interest for Wang HJ and Chuang YC.
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This manuscript is an extended version of the Ulf Ulmsten lecture given by Dr. Michael Chancellor at the joint IUGA/ICS meeting in August 2010 in Toronto, Canada.
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Wang, HJ., Chuang, YC. & Chancellor, M.B. Development of cellular therapy for the treatment of stress urinary incontinence. Int Urogynecol J 22, 1075–1083 (2011). https://doi.org/10.1007/s00192-011-1432-1
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DOI: https://doi.org/10.1007/s00192-011-1432-1