4. Effect of GLP-2 Coated Vaginal Expansion Sleeves (VES) in a Rat Model

Background

Vaginal atresia is the congenital absence of the vaginal canal. Current treatments include at-home dilation therapy and surgical vaginoplasty. In our previous studies we have created a novel vaginal expansion sleeve (VES) that progressively elongated and retained vaginal expansion with only minor procedural intervention. This study aims to further explore the effect of the VES device on vaginal lengthening utilizing Glucagon-like peptide 2 (GLP-2). GLP-2 is known to promote intestinal tissue proliferation however the research exploring GLP-2′s role in non-intestinal tissues including female reproductive tissue is sparse.

Methods

The VES is a cylindrical, spring-like device with resin caps. Each VES was cut to 1.3x the current vaginal canal length, coated with 50µg GLP-2 via cross-linking with polyvinyl alcohol, inserted into the vaginal canals of 4 Sprague Dawley rats, and anchored with nonabsorbable sutures. Each week, the sleeves were removed and replaced with a serially longer VES over three weeks measuring 1.3x the current length of the vaginal canal. Rats were monitored for another 2 weeks to assess for any decrease in vaginal length. Vaginal lengths were measured prior to initial VES insertion and weekly during the 5-week trial.

Results

Serial deployment of GLP-2 coated VES devices resulting in an increase in vaginal length from 26.25 ± 0.96 mm to 35.5 ± 3.11 mm (p< 0.001, week 5). Histologically, diffuse vaginal wall thinning with preservation of the epithelial, mucosal, and muscular layers was seen. Mild to moderate inflammation was also noted as evidenced by intraepithelial and and subepithelial lymphoid infiltrate.

Conclusions

The serial implantation of GLP-2 VES resulted in significant and retained expansion of the rat vagina comparable to the previous non-GLP-2 VES with both rounds of devices producing an average vaginal length of 35.5 mm with retained tissue architecture. The GLP-2 VES suggests a minimally invasive alternative for vaginal atresia treatment.