Adipose Stem Cells: Potential Option for Female SUI

Yael Waknine

July 09, 2014

Urethral injection of patient-derived adipose stem cells (ASCs) and collagen may represent a viable alternative to surgery in women with stress urinary incontinence (SUI), according to a pilot study published online July 1 in Stem Cells Translational Medicine.

Although insertion of a suburethral sling remains the curative "gold standard" for female SUI, the procedure is not always effective. The 5 women recruited for this study had significant independent multiple risk factors for sling failure, including being overweight, having mixed incontinence, having a history of failed continence surgery, or having intrinsic sphincter deficiency.

"Tissue engineering offers an attractive method to regenerate sphincter muscle," write Kirsi Kuismanen, MD, from the Department of Obstetrics and Gynaecology and the Science Center, Tampere University Hospital, Finland, and colleagues. Adipose stem cells are more readily available than those derived from skeletal muscle or bone marrow and have been used more extensively in different surgical applications, they note.

The researchers obtained ASCs for treatment from a small sample (0.3 - 0.5 dL) of lower abdominal subcutaneous fat and augmented them via laboratory methods during a 3-week period. Injections of ASCs plus bovine collagen (2), as well as of ASCs in saline (2), were well-tolerated under local anesthesia.

At 6 months, 1 woman passed the cough stress test; at 1 year, 3 successfully achieved this primary endpoint. Two patients considered themselves cured, and all demonstrated subjective improvement from baseline on validated questionnaires.

According to Michael Safir, MD, from the Southern California Center for Advanced Urology in West Hills, the upswing in efficacy is particularly intriguing, given that most injection-based therapies currently in use show continence deterioration over time.

Although ASCs' regenerative capacity has traditionally been associated with plasticity, the authors attribute their therapeutic effects to the secretion of bioactive molecules with wide-ranging beneficial effects on immunomodulation, cell growth and differentiation, angiogenesis, chemoattraction, scarring, and apoptosis.

"While cellular differentiation and expansion may indeed be the source of improved continence over time, the study population (5 patients) is too small to conclude this effect," Dr. Safir explained to Medscape Medical News.

"Also, the presence of added collagen in the substrate, a substance which has been used as an injectable to improve continence, confounds any determination as to the continence improvement solely due to the stem cells," he added.

"Still, the potential to render patients continent with their own cells utilizing an injection under local anesthesia is an exciting finding, and I am hopeful that larger studies will validate the efficacy of stem cell therapy for this purpose," Dr. Safir concluded.

"Tissue engineering techniques hold the potential to provide an efficient treatment for SUI in the future, but more research is needed to reach this goal," the authors concur, noting in particular the need for a more suitable stem-cell carrier: when combined with ASCs, the bovine collagen became more liquid, which may have negatively affected overall therapeutic efficacy.

The study was supported by the Pirkanmaa Hospital District. The authors and Dr. Safir have disclosed no relevant financial relationships.

Stem Cells Trans Med. Published online July 1, 2014. Abstract

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