Autologous Adipose Stem Cell Therapy for Urinary Incontinence
In a recent study, patients were treated with autologous adipose stem cells combined with bovine collagen gel for female stress urinary incontinence (SUI). The cells were obtained from subcutaneous fat tissue, and expanded in the laboratory for three weeks. Urinary incontinence affects around 35% of women age 18 years and older. The symptoms include urgency and involuntary loss of urine with physical exertion or coughing. The prevalence of SUI increases with age. For patients who have had little response to medications and therapy, autologous stem cells therapy is an option.
How Stem Cells Work
Stem cell therapy is the wave of the future. Stem cells have the ability to divide into many forms of tissue in a process called differentiation. Adipose stem cells are also called mesenchymal stem cells (MSCs). Autologous means the stem cells come from the patient. Stem cells rush to the injured, degenerated, or damage area and start the healing process. Sometimes, however, your body’s own stem cells cannot reach the area of injury, so using stem cells harvested and concentrated works.
In a process called differentiation, stem cells give rise to other specialized cells. The cells usually go through many stages, and then become more specialized at each step. Scientists are just now understanding stem cell function. The signals omitted inside and outside the cells trigger each step of this differentiation process. Internal signals are controlled mainly by genes, which are interspersed across long individual strands of DNA. External cells include chemicals secreted by other cells, as well as certain molecules. The interaction of signals during the differentiation process cause the DNA to acquire epigenetic marks that are passed on through cell division.
Collection, Isolation, and Expansion of the Stem Cells
Tissue engineering or regenerative medicine is an attractive treatment for regenerating sphincter muscle tissue. In the clinical study, patients diagnosed with SUI were evaluated using several questionnaires and stress tests. The fat was collected from the study participants’ lower abdomens. This involved administration of a local anesthetic to numb the skin and deeper tissues. A small incision was made, and a special solution was inserted to help dislodge the cells. Around 300 milliliters of fat cells were obtained, and blood was taken to use in the processing procedure.
The isolation and expansion of the adipose-derived stem cells is done in a laboratory. The cell isolation, expansion, karyotyping, and mycoplasma testing are performed, and the adipose tissue was minced into small pieces along with collagenase. The tissue is placed in a centrifuge (spinning device), which separates red blood cells and other blood components from the stem cells. After the cells are expanded in a special solution.
Results of Clinical Studies
In the clinical study, the stem cells were injected transurethrally via a special scope and under local anesthesia. The injections were given under the urinary mucosa. The patients were evaluated at 3, 6, and 12 months after the injections via vaginal ultrasonography, a gynecological exam, a cough test, standardized questionnaires, a 24-hour pad test, and urodynamic evaluations.
At the 6-month follow-up, only 20% of patients had a negative cough test with full bladder. However, at the 12-month follow-up, 80% had negative cough tests. Overall, all 5 study participants had some type of improvement in SUI. This study demonstrated much efficacy of the cell-based injection therapy.
In an Austrian study, led by Dr. Strasser from the Medical University of Innsbruck, stem cell injections with collagen were used to treat 63 women with stress incontinence. While this study used stem cells from muscle tissue, the cells were injected into the women’s urinary sphincters and surrounding area using ultrasound-guidance. In this study, around 78% of patients were completely continent.
- Kuismanen K, Sartoneva R, Haimi S, et al. (2014). Autologous Adipose Stem Cells in Treatment of Female Stress Urinary Incontinence: Results of a Pilot Study. Stem Cell Transitional Medicine, 3(8), 936-941.
- Strasser, H. The Lancet, June 30, 2007; vol 369: pp 2179-2186. Novara, G. The Lancet, June 30, 2007; vol 369: pp 2139-2140