| Summary: | 博士 === 東海大學 === 生命科學系 === 98 === Introduction and hypothesis
The current status of using synthetic meshes to augment the effectiveness of reconstructive pelvic surgery for repairing pelvic organ prolapse (POP) does not meet the clinical expectation due to newly onset bothersome complications such as vaginal mesh erosion. We hypothesize it may be beneficial to develop a tissue-engineered fascia-equivalent with absorbable scaffold and autologous progenitor/stem cells that can be transplanted during operation and contribute to tissue regeneration by forming appropriate connective tissue.
Methods
Human vaginal fibroblasts (HVFs) from 10 patients undergoing vaginal hysterectomy were characterized in vitro in regard to their cell morphology, collagen contents, proliferation potential and the occupying ability of polypropylene mesh on co-culture. Subsequently, we used eligible HVFs and the absorbable PLGA mesh to fabricate a fascia-equivalent in vitro and evaluated the histological outcomes after the subcutaneous transplantation of it in experimental nude mice. Meanwhile, a controlled implantation of surgical meshes without cell-seeding was conducted in the same animals for comparison.
Results
The cultured HVFs were classified into groups with either high (n=6) or low (n=4) cellular collagen I/III ratios. HVFs of high ratios expressed better cell proliferation potential and occupying ability of mesh on co-culture than those of low ratios, and the difference is statistically significant (p < 0.05). It took about six weeks for most of HVFs with high collagen I/III ratios to fully occupy the mesh under normal co-culture condition. However, by using tissue-engineering techniques, the fabrication time of a HVFs-seeded scaffold with high cellularity could be shortened to within five days. The subsequent transplantation of the scaffold resulted in the formation of a well-organized fascia-like tissue with DiI-labeled HVFs could still be traced up to 12 weeks after. In contrast, the controlled implantation of surgical meshes without cell-seeding resulted in inferior outcomes that somehow reflected the current clinical experience.
Conclusions
We suggest that the analysis of cellular collagen I/III ratios may be a novel method for identifying HVFs eligible for a potential therapeutic application. Our findings also support the promise of using tissue-engineering techniques for treatment of POP in the future.
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