Abstract
Lower urinary tract symptoms can significantly impact quality of life. Current standard treatments are not always effective and are associated with complications and side effects. The discovery of stem cells led to research into cell-based therapies for treatment of disorders of voiding dysfunction. Bone marrow mesenchymal stem cells are particularly promising given their ability to differentiate into a variety of cell types. Recent studies have investigated bone marrow stem cells to treat a number of functional voiding pathologies including bladder outlet obstruction, neurogenic bladder, and stress urinary incontinence. Experiments in tissue regeneration have also attempted to create artificial bladders and urethras. The purpose of this article is to critically review the literature regarding the use of bone marrow mesenchymal stem cells in treatment of voiding dysfunction.
Similar content being viewed by others
Abbreviations
- BMSC:
-
Bone marrow mesenchymal stem cell
- BOO:
-
Bladder outlet obstruction
- LPP:
-
Leak point pressure
- MSC:
-
Mesenchymal stem cell
- SCI:
-
Spinal cord injury
- SUI:
-
Stress urinary incontinence
References
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
Hu TW, Wagner TH, Bentkover JD, Leblanc K, Zhou SZ, Hunt T. Costs of urinary incontinence and overactive bladder in the United States: a comparative study. Urology. 2004;63(3):461–5. doi:10.1016/j.urology.2003.10.037.
Weiner LP. Definitions and criteria for stem cells. Methods Mol Biol (Clifton, NJ). 2008;438:3–8. doi:10.1007/978-1-59745-133-8_1.
Dominici M, Le Blanc K, Mueller I, Slaper-Cortenbach I, Marini F, Krause D, et al. Minimal criteria for defining multipotent mesenchymal stromal cells. The international society for cellular therapy position statement. Cytotherapy. 2006;8(4):315–7. doi:10.1080/14653240600855905.
Caplan AI. Adult mesenchymal stem cells for tissue engineering versus regenerative medicine. J Cell Physiol. 2007;213(2):341–7. doi:10.1002/jcp.21200.
Gilbert SM, Lai J, Saigal CS, Gore JL. Downstream complications following urinary diversion. J Urol. 2013;190(3):916–22. doi:10.1016/j.juro.2013.03.026.
Atala A, Bauer SB, Soker S, Yoo JJ, Retik AB. Tissue-engineered autologous bladders for patients needing cystoplasty. Lancet. 2006;367(9518):1241–6. doi:10.1016/s0140-6736(06)68438-9.
Joseph DB, Borer JG, De Filippo RE, Hodges SJ, McLorie GA. Autologous cell seeded biodegradable scaffold for augmentation cystoplasty: phase II study in children and adolescents with spina bifida. J Urol. 2014;191(5):1389–95. doi:10.1016/j.juro.2013.10.103. This follow up to the original Atala et al. study demonstrates that there is still much to learn about tissue regeneration. The trial failed to reproduce the results of the original study, and the complication rates of autologous engineered bladders was too high to be considered a safe alternative for now.
Adamowicz J, Juszczak K, Bajek A, Tworkiewicz J, Nowacki M, Marszalek A, et al. Morphological and urodynamic evaluation of urinary bladder wall regeneration: muscles guarantee contraction but not proper function—a rat model research study. Transplant Proc. 2012;44(5):1429–34. doi:10.1016/j.transproceed.2012.01.144.
Sharma AK, Bury MI, Marks AJ, Fuller NJ, Meisner JW, Tapaskar N, et al. A nonhuman primate model for urinary bladder regeneration using autologous sources of bone marrow-derived mesenchymal stem cells. Stem Cells (Dayton, Ohio). 2011;29(2):241–50. doi:10.1002/stem.568.
Raya-Rivera A, Esquiliano DR, Yoo JJ, Lopez-Bayghen E, Soker S, Atala A. Tissue-engineered autologous urethras for patients who need reconstruction: an observational study. Lancet. 2011;377(9772):1175–82. doi:10.1016/s0140-6736(10)62354-9.
Li CL, Liao WB, Yang SX, Song C, Li YW, Xiong YH, et al. Urethral reconstruction using bone marrow mesenchymal stem cell- and smooth muscle cell-seeded bladder acellular matrix. Transplant Proc. 2013;45(9):3402–7. doi:10.1016/j.transproceed.2013.07.055.
Kanno Y, Mitsui T, Sano H, Kitta T, Moriya K, Nonomura K. Contribution of bone marrow-derived mesenchymal stem cells to the morphological changes in the bladder after partial outlet obstruction: a preliminary study. Int J Urol Off J Jpn Urol Assoc. 2014. doi:10.1111/iju.12406.
Tanaka ST, Martinez-Ferrer M, Makari JH, Wills ML, Thomas JC, Adams MC, et al. Recruitment of bone marrow derived cells to the bladder after bladder outlet obstruction. J Urol. 2009;182(4 Suppl):1769–74. doi:10.1016/j.juro.2009.02.081.
Woo LL, Tanaka ST, Anumanthan G, Pope JC, Thomas JC, Adams MC, et al. Mesenchymal stem cell recruitment and improved bladder function after bladder outlet obstruction: preliminary data. J Urol. 2011;185(3):1132–8. doi:10.1016/j.juro.2010.10.033.
Lee HJ, Won JH, Doo SH, Kim JH, Song KY, Lee SJ, et al. Inhibition of collagen deposit in obstructed rat bladder outlet by transplantation of superparamagnetic iron oxide-labeled human mesenchymal stem cells as monitored by molecular magnetic resonance imaging (MRI). Cell Transplant. 2012;21(5):959–70. doi:10.3727/096368911x627516.
Song YS, Lee HJ, Doo SH, Lee SJ, Lim I, Chang KT, et al. Mesenchymal stem cells overexpressing hepatocyte growth factor (HGF) inhibit collagen deposit and improve bladder function in rat model of bladder outlet obstruction. Cell Transplant. 2012;21(8):1641–50. doi:10.3727/096368912x637488.
Nishijima S, Sugaya K, Miyazato M, Kadekawa K, Oshiro Y, Uchida A, et al. Restoration of bladder contraction by bone marrow transplantation in rats with underactive bladder. Biomed Res (Tokyo, Jpn). 2007;28(5):275–80.
Dayanc M, Kibar Y, Ural AU, Onguru O, Yildiz O, Irkilata HC, et al. The histopathologic, pharmacologic and urodynamic results of mesenchymal stem cell’s injection into the decompensated rabbit’s bladder. Stem Cell Rev. 2012;8(4):1245–53. doi:10.1007/s12015-012-9393-4.
Soler R, Füllhase C, Hanson A, Campeau L, Santos C, Andersson K-E. Stem cell therapy ameliorates bladder dysfunction in an animal model of Parkinson disease. J Urol. 2012;187(4):1491–7. doi:10.1016/j.juro.2011.11.079.
Campeau L, Soler R, Sittadjody S, Pareta R, Nomiya M, Zarifpour M, et al. Effects of allogeneic bone marrow derived mesenchymal stromal cell therapy on voiding function in a rat model of Parkinson disease. J Urol. 2014;191(3):850–9. doi:10.1016/j.juro.2013.08.026.
Park WB, Kim SY, Lee SH, Kim HW, Park JS, Hyun JK. The effect of mesenchymal stem cell transplantation on the recovery of bladder and hindlimb function after spinal cord contusion in rats. BMC Neurosci. 2010;11:119. doi:10.1186/1471-2202-11-119.
Dai G, Liu X, Zhang Z, Yang Z, Dai Y, Xu R. Transplantation of autologous bone marrow mesenchymal stem cells in the treatment of complete and chronic cervical spinal cord injury. Brain Res. 2013;1533:73–9. doi:10.1016/j.brainres.2013.08.016.
Yazdani SO, Hafizi M, Zali AR, Atashi A, Ashrafi F, Seddighi AS, et al. Safety and possible outcome assessment of autologous Schwann cell and bone marrow mesenchymal stromal cell co-transplantation for treatment of patients with chronic spinal cord injury. Cytotherapy. 2013;15(7):782–91. doi:10.1016/j.jcyt.2013.03.012.
Melville JL, Katon W, Delaney K, Newton K. Urinary incontinence in US women: a population-based study. Arch Intern Med. 2005;165(5):537–42. doi:10.1001/archinte.165.5.537.
Zou XH, Zhi YL, Chen X, Jin HM, Wang LL, Jiang YZ, et al. Mesenchymal stem cell seeded knitted silk sling for the treatment of stress urinary incontinence. Biomaterials. 2010;31(18):4872–9. doi:10.1016/j.biomaterials.2010.02.056.
Madjar S, Sharma AK, Waltzer WC, Frischer Z, Secrest CL. Periurethral mass formations following bulking agent injection for the treatment of urinary incontinence. J Urol. 2006;175(4):1408–10. doi:10.1016/s0022-5347(05)00679-8.
Gunetti M, Tomasi S, Giammò A, Boido M, Rustichelli D, Mareschi K, et al. Myogenic potential of whole bone marrow mesenchymal stem cells in vitro and in vivo or usage in urinary incontinence. PLoS ONE. 2012;7(9):e45538. doi:10.1371/journal.pone.0045538. This unique study characterises the interaction between BMSC and muscle cells. It appears that BMSC serves as a promoter cell rather than differentiate into muscle cells after injection into perineal tissue. This is particularly significant as better understanding of basic cell biology and behaviour is key to utilising stem cells in tissue regeneration.
Corcos J, Loutochin O, Campeau L, Eliopoulos N, Bouchentouf M, Blok B, et al. Bone marrow mesenchymal stromal cell therapy for external urethral sphincter restoration in a rat model of stress urinary incontinence. Neurourol Urodyn. 2011;30(3):447–55. doi:10.1002/nau.20998.
Du X-W, Wu H-L, Zhu Y-F, Hu J-B, Jin F, Lv R-P, et al. Experimental study of therapy of bone marrow mesenchymal stem cells or muscle-like cells/calcium alginate composite gel for the treatment of stress urinary incontinence. Neurourol Urodyn. 2013;32(3):281–6. doi:10.1002/nau.22291.
Peters KM, Dmochowski RR, Carr LK, Robert M, Kaufman MR, Sirls LT, et al. Autologous muscle derived cells for treatment of stress urinary incontinence in women. J Urol. 2014;192(2):469–76. doi:10.1016/j.juro.2014.02.047. Although this study does not describe using BMSC per se, it is the largest clinical trial to date utilizing stem cell therapy in voiding dysfunction. Not only are the results promising, the study also demonstrate relative long-term safety (12 months).
Cruz M, Dissaranan C, Cotleur A, Kiedrowski M, Penn M, Damaser M. Pelvic organ distribution of mesenchymal stem cells injected intravenously after simulated childbirth injury in female rats. Obstet Gynecol Int. 2012;2012:612946. doi:10.1155/2012/612946.
Trainor N, Pietak A, Smith T. Rethinking clinical delivery of adult stem cell therapies. Nat Biotechnol. 2014;32(8):729–35. doi:10.1038/nbt.2970.
Compliance with Ethics Guidelines
Conflict of Interest
Alice Yu and Lysanne Campeau each declare no potential conflicts of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Author information
Authors and Affiliations
Corresponding author
Additional information
This article is part of the Topical Collection on Regenerative Medicine
Rights and permissions
About this article
Cite this article
Yu, A., Campeau, L. Bone Marrow Mesenchymal Stem Cell Therapy for Voiding Dysfunction. Curr Urol Rep 16, 49 (2015). https://doi.org/10.1007/s11934-015-0516-8
Published:
DOI: https://doi.org/10.1007/s11934-015-0516-8