Review
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Stem Cells. May 26, 2016; 8(5): 202-215
Published online May 26, 2016. doi: 10.4252/wjsc.v8.i5.202
Endometrial mesenchymal stem cells as a cell based therapy for pelvic organ prolapse
Stuart J Emmerson, Caroline E Gargett
Stuart J Emmerson, Caroline E Gargett, the Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria 3168, Australia
Stuart J Emmerson, Caroline E Gargett, Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria 3168, Australia
Author contributions: Emmerson SJ contributed to the acquisition of data, analysis and interpretation of data, drafting, writing the article and approved the final version; Gargett CE contributed to the conception and design of the study, critical revision related to the important intellectual content, editing and approval of the final version.
Conflict-of-interest statement: The authors have no conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Caroline E Gargett, PhD, Associate Professor, the Ritchie Centre, Hudson Institute of Medical Research, 27-31 Wright Street, Melbourne, Victoria 3168, Australia. caroline.gargett@hudson.org.au
Telephone: +61-3-85722795 Fax: +61-3-95947439
Received: October 30, 2015
Peer-review started: November 4, 2015
First decision: November 30, 2015
Revised: December 23, 2015
Accepted: February 14, 2016
Article in press: February 16, 2016
Published online: May 26, 2016
Abstract

Pelvic organ prolapse (POP) occurs when the pelvic organs (bladder, bowel or uterus) herniate into the vagina, causing incontinence, voiding, bowel and sexual dysfunction, negatively impacting upon a woman’s quality of life. POP affects 25% of all women and results from childbirth injury. For 19% of all women, surgical reconstructive surgery is required for treatment, often augmented with surgical mesh. The surgical treatment fails in up to 30% of cases or results in adverse effects, such as pain and mesh erosion into the bladder, bowel or vagina. Due to these complications the Food and Drug Administration cautioned against the use of vaginal mesh and several major brands have been recently been withdrawn from market. In this review we will discuss new cell-based approaches being developed for the treatment of POP. Several cell types have been investigated in animal models, including a new source of mesenchymal stem/stromal cells (MSC) derived from human endometrium. The unique characteristics of endometrial MSC, methods for their isolation and purification and steps towards their development for good manufacturing practice production will be described. Animal models that could be used to examine the potential for this approach will also be discussed as will a rodent model showing promise in developing an endometrial MSC-based therapy for POP. The development of a preclinical large animal model for assessing tissue engineering constructs for treating POP will also be mentioned.

Keywords: Endometrium, Mesenchymal stem cells, Endometrial mesenchymal stem cells, Pelvic organ prolapse, Mesh, Tissue engineering, Regenerative medicine

Core tip: Pelvic organ prolapse is the herniation of pelvic organs into the vaginal cavity and affects approximately 25% of all women. Traditional mesh-augmented surgical treatments cause complications such as pain and mesh erosion. A tissue engineering approach using endometrial mesenchymal stem cells seeded on new composite mesh show promise in animal models through their modulation of the chronic inflammatory response and promotion of physiological and biomechanically compliant neotissue.