Stem cell therapy for voiding and erectile dysfunction

Abstract

Voiding dysfunction comprises a variety of disorders, including stress urinary incontinence and overactive bladder, and affects millions of men and women worldwide. Erectile dysfunction (ED) also decreases quality of life for millions of men, as well as for their partners. Advanced age and diabetes are common comorbidities that can exacerbate and negatively impact upon the development of these disorders. Therapies that target the pathophysiology of these conditions to halt progression are not currently available. However, stem cell therapy could fill this therapeutic void. Stem cells can reduce inflammation, prevent fibrosis, promote angiogenesis, recruit endogenous progenitor cells, and differentiate to replace damaged cells. Adult multipotent stem cell therapy, in particular, has shown promise in case reports and preclinical animal studies. Stem cells have also enabled advances in urological tissue engineering by facilitating ex vivo construction of bladder wall and urethral tissue (using a patient's own cells) prior to transplantation. More recent studies have focused on bioactive factor secretion and homing of stem cells. In the future, clinicians are likely to utilize allogeneic stem cell sources, intravenous systemic delivery, and ex vivo cell enhancement to treat voiding dysfunction and ED.

Histopathological effects of mesenchymal stem cells in ratswith bladder and posterior urethral injuries

“…Their results are quite successful (9). Wang et al showed in their experimental study on rabbits that combined fibrin glue and MSC treatment in repairing urethral injury may improve neovascularization and smooth muscle formation (10). We did not find a study evaluating the histopathologic effects of mesenchymal stem cell therapy on uroepithelial wound healing.…”

The potential role of stem cells in the treatment of urinary incontinence

“…ASCs are the most well-studied and well-understood cell type in the field of stem cell therapy and, thus far, are the only stem cell type that have been investigated for urologic applications Goldman et al 2012;Vaegler et al 2012;Kim et al 2013]. Over the past decade, ASCs have been identified throughout the body and are thought to act as tissue-specific progenitors that repair damage and restore function locally.…”

“…Currently, four broad categories describe the diversity of stem cells being investigated in regenerative medicine: ESCs, stem cells derived from placenta or amniotic fluid (AFPS), induced pluripotent stem cells (IPSC), and adult stem cells (ASC) [Martin, 1981;Thomson et al 1998;Goldman et al 2012;Vaegler et al 2012;Kim et al 2013]. ESCs are stem cells isolated from an early stage embryo [Thomson et al 1998].…”

“…To date, none of the standard therapies focus on halting disease progression or reversing existing injury. Regenerative medicine concepts have emerged as an exciting means of fulfilling this therapeutic void by restoring and maintaining normal function via direct effects on injured or dysfunctional tissues [Furuta et al 2007;Wang et al 2011;Goldman et al 2012;Vaegler et al 2012]. Over the past decade, the use of stem cells has shown promise for a host of urologic disorders including applications in lower urinary tract dysfunction, ureteral and bladder trauma, erectile dysfunction, and renal disease [Al-Awqati and Oliver, 2002;Chermansky et al 2004b ;Bivalacqua et al 2007;Zhuo et al 2013].…”

“…Stem cells are classically thought to improve tissue repair via multilineage differentiation and self-renewal [Vaegler et al 2012;Kim et al 2013]. Stem cells may also exert a therapeutic effect via the secretion of bioactive factors that have antiapoptotic, antiscarring, neovascularization, and immunomodulatory effects on innate tissues and can direct innate stem and progenitor cells to the area of injury [Gnecchi et al 2008].…”