Regenerative Medicine Strategies for Treating Neurogenic Bladder

Abstract

Neurogenic bladder is a general term encompassing various neurologic dysfunctions of the bladder and the external urethral sphincter. These can be caused by damage or disease. Therapeutic management options can be conservative, minimally invasive, or surgical. The current standard for surgical management is bladder augmentation using intestinal segments. However, because intestinal tissue possesses different functional characteristics than bladder tissue, numerous complications can ensue, including excess mucus production, urinary stone formation, and malignancy. As a result, investigators have sought after alternative solutions. Tissue engineering is a scientific field that uses combinations of cells and biomaterials to encourage regeneration of new, healthy tissue and offers an alternative approach for the replacement of lost or deficient organs, including the bladder. Promising results using tissue-engineered bladder have already been obtained in children with neurogenic bladder caused by myelomeningocele. Human clinical trials, governed by the Food and Drug Administration, are ongoing in the United States in both children and adults to further evaluate the safety and efficacy of this technology. This review will introduce the principles of tissue engineering and discuss how it can be used to treat refractory cases of neurogenic bladder.

Microscopic evaluation of transdifferentiation of Wharton’s jelly stem cells to urothelium

“…La ingeniería tisular es una rama de la investigación, que en las últimas décadas ha desarrollado grandes avances en el tratamiento de diversas patologías (1). Los tratamientos convencionales son insuficientes e incluso en algunos casos generan importantes complicaciones para el mismo paciente.…”

“…Actualmente, los tratamientos de cirugía urológica reconstructiva especialmente de vejiga, están enfocados a la utilización de segmentos de tejidos gastrointestinales, ya sea para el reemplazo o la reparación de la vejiga (1)(2)(3). La utilización de implantes de tejidos gastrointestinales en el sistema urinario disminuye sin embargo la tolerancia de estos tejidos al contacto con la orina y produce graves riesgos tales como producción excesiva de moco, urolitiasis, trastornos metabólicos y malignización (1)(2)(3). De este modo, la ingeniería tisular se presenta como una alternativa viable y prometedora en el tratamiento de pacientes que requieran reemplazo o reparación de la vejiga urinaria.…”

“…De este modo, la ingeniería tisular se presenta como una alternativa viable y prometedora en el tratamiento de pacientes que requieran reemplazo o reparación de la vejiga urinaria. La mayoría de los sustitutos vesicales desarrollados hasta el momento se basan en la utilización de cultivos autólogos de células uroteliales (1). En este sentido, se ha descrito, la escasa capacidad proliferativa de estas células in vitro, lo cual dificulta la creación de tejidos artificiales vesicales.…”

Whyever bladder tissue engineering clinical applications still remain unusual even though many intriguing technological advances have been reached?

“…As pivotal tools to properly develop tissue engineering organs, different bioreactors can provide, just regarding bladder mechanical properties (wall elasticity, compliance pertinent various filling pressure, etc), suitable mechanical stimulations in cell culture chambres, thus favourably affecting both urothelial and smooth muscle cell growth together with the endothelial cell layer development in blood vessels (39,40).…”

Positive Results of Transplantation of Multi-Component Composite Material Containing Allogeneic Mesenchymal Stem Cells After Cystectomy in a Rabbit

“…In vivo предпринят удачный опыт замещения МП у 14 собак выращенным in vitro неоцистисом [14]. После удачного экспери-мента на лабораторных животных сгенерирован-ный in vitro резервуар успешно трансплантирован человеку [21].…”