Status, challenges, and future prospects of stem cell therapy in pelvic floor disorders

Abstract

Pelvic floor disorders (PFDs) represent a group of common and frequently-occurring diseases that seriously affect the life quality of women, generally including stress urinary incontinence and pelvic organ prolapse. Surgery has been used as a treatment for PFD, but almost 30% of patients require subsequent surgery due to a high incidence of postoperative complications and high recurrence rates. Therefore, investigations of new therapeutic strategies are urgently needed. Stem cells possess strong multi-differentiation, self-renewal, immunomodulation, and angiogenesis abilities and they are able to differentiate into various cell types of pelvic floor tissues and thus provide a potential therapeutic approach for PFD. Recently, various studies using different autologous stem cells have achieved promising results by improving the pelvic ligament and muscle regeneration and conferring the tissue elasticity and strength to the damaged tissue in PFD, as well as reduced inflammatory reactions, collagen deposition, and foreign body reaction. However, with relatively high rates of complications such as bladder stone formation and wound infections, further studies are necessary to investigate the role of stem cells as maintainers of tissue homeostasis and modulators in early interventions including therapies using new stem cell sources, exosomes, and tissue-engineering combined with stem cell-based implants, among others. This review describes the types of stem cells and the possible interaction mechanisms in PFD treatment, with the hope of providing more promising stem cell treatment strategies for PFD in the future.

Keywords: Pelvic floor disorders, Pelvic organ prolapse, Stress urinary incontinence, Mesenchymal stem cells, Stem cell therapy

Core tip: Recently, various studies using different autologous mesenchymal stem cells (MSCs) have achieved promising results showing that: (1) MSCs can undergo transdifferentiation into different cell types of the pelvic floor tissues and improve collagen secretion and neovascularization with induction by a series of cytokines; and (2) MSCs can deliver bioactive molecules to the site of injury to promote angiogenesis by enhancing the migration and proliferation of tissue-specific progenitor cells and inhibiting apoptosis and fibrosis through promoting tissue cell proliferation and collagen synthesis, and inhibiting inflammation by recruiting macrophages and leukocytes, thus improving the connective or neuromuscular tissues in pelvic floor disorders.