Adipose Derived Stem Cells for the Tissue Engineering of the Lower Urinary Tract. Implications for the Treatment of Stress Urinary Incontinence and Bladder Reconstruction

Hypothesis / aims of study Loss of urethral support and atrophy of the intrinsic sphincter mechanism can result in SUI. Minimally invasive therapies for SUI offer injection of bulking materials into the periurethral tissues to improve urethral resistance. These therapies have had low success rates due to material migration, breakdown, and antigenicity. These bulking therapies only provide mass to the incontinent urethra, and they overlook the need for functional smooth muscle required to provide coaptation and contraction of the urethra. Bladder disease affects 400 million persons worldwide with gastrointestinal tissue being the gold standard when tissue is required for urinary diversion or augmentation; however, its use is associated with long-term complications. An easily obtainable source of healthy smooth muscle would be very useful in genitourinary tissue engineering. Ideally, these cells would be autologous. We have recently demonstrated that adipose derived stem cells (ADSC) are an autologous source of pluripotent cells. ADSCs are abundant in adipose tissue, amenable to harvesting under local anesthesia, and phenotypically similar to mesenchymal stem cells. In addition, ADSCs have been shown to differentiate into adipogenic, chrondrogenic, osteogenic, neurogenic and myogenic lineages. We investigated the ability of human ADSCs to be delivered to and survive within the bladder and urethral smooth muscle over extended periods of time. In addition, we investigated a tissue-engineered bladder generated from SMCs differentiated from ADSCs.