{"title":"Cellular regenerative therapy in stress urinary incontinence: new frontiers?-a narrative review.","authors":"Karl-Erik Andersson, Koudy Williams","doi":"10.21037/tau-22-682","DOIUrl":null,"url":null,"abstract":"<p><strong>Background and objective: </strong>Even if treatment with stem cells has been shown to be safe and effective in many patients with stress urinary incontinence (SUI), there is still room for improvement using other regenerative medicine alternatives. Since the beneficial effects of stem cells are probably mediated by secretion of factors rather than by the cells themselves there is a good rationale for further exploring the therapeutic effects of the secretome and/or its components. However, homing factors such as stromal derived growth factor 1 (SDF-1; CXCL12), stimulation of stem cell growth and stem cell mobilization <i>in vivo</i> using low intensity shock wave therapy (Li-ESWT) or regenerative electrical stimulation (RES), are also promising approaches.</p><p><strong>Methods: </strong>A literature search was performed based on PubMed, Scopus and Google Scholar. The search criteria included original basic science articles, systematic reviews and randomized control trials. All studies were published between 2000 and 2023. Selected, peer-reviewed studies were further analyzed to identify those of relevance. Keywords searched included: \"female stress incontinence\", \"homing factors\", \"CXCL12\", \"secretome\", \"low intensity shockwave therapy\" and \"regenerative electrical stimulation\". The peer-reviewed publications on the key word subjects that contained a novel addition to the existing body of literature were included.</p><p><strong>Key content and findings: </strong>There is evidence from studies on non-human primates (NHPs) with experimental urinary sphincter injury that CXCL12 can restore sphincter structure and function. Studies with homing factors in human patients with SUI are still to be performed. A large number of clinical studies on the use of secretome or secretome products from mesenchymal stem cells (MSCs) on indications other than human SUI are already available. However, controlled clinical trials on patients with SUI, have to the best of our knowledge, not yet been performed. Also, RES has not been studied in patients with SUI. In contrast, there is clinical evidence that Li-ESWT may improve female SUI.</p><p><strong>Conclusions: </strong>Treatment with homing factors, MSC secretome/secretome components, Li-ESWT and RES are promising frontiers in the treatment of human SUI caused by sphincter damage.</p>","PeriodicalId":23270,"journal":{"name":"Translational andrology and urology","volume":"13 8","pages":"1709-1716"},"PeriodicalIF":1.9000,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11399031/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Translational andrology and urology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.21037/tau-22-682","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2023/7/24 0:00:00","PubModel":"Epub","JCR":"Q4","JCRName":"ANDROLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Background and objective: Even if treatment with stem cells has been shown to be safe and effective in many patients with stress urinary incontinence (SUI), there is still room for improvement using other regenerative medicine alternatives. Since the beneficial effects of stem cells are probably mediated by secretion of factors rather than by the cells themselves there is a good rationale for further exploring the therapeutic effects of the secretome and/or its components. However, homing factors such as stromal derived growth factor 1 (SDF-1; CXCL12), stimulation of stem cell growth and stem cell mobilization in vivo using low intensity shock wave therapy (Li-ESWT) or regenerative electrical stimulation (RES), are also promising approaches.
Methods: A literature search was performed based on PubMed, Scopus and Google Scholar. The search criteria included original basic science articles, systematic reviews and randomized control trials. All studies were published between 2000 and 2023. Selected, peer-reviewed studies were further analyzed to identify those of relevance. Keywords searched included: "female stress incontinence", "homing factors", "CXCL12", "secretome", "low intensity shockwave therapy" and "regenerative electrical stimulation". The peer-reviewed publications on the key word subjects that contained a novel addition to the existing body of literature were included.
Key content and findings: There is evidence from studies on non-human primates (NHPs) with experimental urinary sphincter injury that CXCL12 can restore sphincter structure and function. Studies with homing factors in human patients with SUI are still to be performed. A large number of clinical studies on the use of secretome or secretome products from mesenchymal stem cells (MSCs) on indications other than human SUI are already available. However, controlled clinical trials on patients with SUI, have to the best of our knowledge, not yet been performed. Also, RES has not been studied in patients with SUI. In contrast, there is clinical evidence that Li-ESWT may improve female SUI.
Conclusions: Treatment with homing factors, MSC secretome/secretome components, Li-ESWT and RES are promising frontiers in the treatment of human SUI caused by sphincter damage.
背景与目的:尽管干细胞治疗已被证明对许多压力性尿失禁(SUI)患者安全有效,但使用其他再生医学替代方法仍有改进的余地。由于干细胞的有益作用可能是由分泌因子而非细胞本身介导的,因此有充分理由进一步探索分泌组和/或其成分的治疗效果。然而,基质衍生生长因子1(SDF-1;CXCL12)等归原因子、使用低强度冲击波疗法(Li-ESWT)或再生电刺激(RES)在体内刺激干细胞生长和干细胞动员也是很有前景的方法:方法:根据PubMed、Scopus和Google Scholar进行文献检索。搜索标准包括原始基础科学文章、系统综述和随机对照试验。所有研究均发表于 2000 年至 2023 年之间。我们进一步分析了经同行评审的精选研究,以确定其中的相关性。搜索的关键词包括"女性压力性尿失禁"、"归巢因子"、"CXCL12"、"分泌组"、"低强度冲击波疗法 "和 "再生电刺激"。主要内容和研究结果:对实验性尿道括约肌损伤的非人灵长类动物(NHPs)的研究表明,CXCL12 可以恢复括约肌的结构和功能。在人类 SUI 患者中使用归巢因子的研究仍有待进行。关于间充质干细胞(MSCs)分泌物或分泌物产品用于人类 SUI 以外适应症的大量临床研究已经问世。不过,据我们所知,针对 SUI 患者的对照临床试验尚未进行。此外,RES 也未在 SUI 患者中进行过研究。相反,有临床证据表明,Li-ESWT 可以改善女性 SUI:结论:使用归巢因子、间充质干细胞分泌体/分泌体成分、Li-ESWT 和 RES 治疗因括约肌损伤引起的人类 SUI 是很有前途的前沿疗法。
期刊介绍:
ranslational Andrology and Urology (Print ISSN 2223-4683; Online ISSN 2223-4691; Transl Androl Urol; TAU) is an open access, peer-reviewed, bi-monthly journal (quarterly published from Mar.2012 - Dec. 2014). The main focus of the journal is to describe new findings in the field of translational research of Andrology and Urology, provides current and practical information on basic research and clinical investigations of Andrology and Urology. Specific areas of interest include, but not limited to, molecular study, pathology, biology and technical advances related to andrology and urology. Topics cover range from evaluation, prevention, diagnosis, therapy, prognosis, rehabilitation and future challenges to urology and andrology. Contributions pertinent to urology and andrology are also included from related fields such as public health, basic sciences, education, sociology, and nursing.