A comprehensive evaluation of spontaneous pelvic organ prolapse in rhesus macaques as an ideal model for the study of human pelvic organ prolapse

Galvanic Cell-Stimulated Mesenchymal Stem Cell Mesh for Enhanced Pelvic Organ Prolapse Treatment

Implantation of a mesh loaded with mesenchymal stem cells (MSCs) is a common approach for the treatment of pelvic organ prolapse (POP). The mesh provides effective support to pelvic floor, enhancing muscle contraction of pelvic organs while reducing inflammation. In this study, a fully degradable mesh is designed for the treatment of POP, utilizing MSCs stimulated by a galvanic battery-powered electric field. The bioelectronic mesh consists of two parts: a galvanic cell film and a porous hydrogel loaded with MSCs. The battery film has a flexible substrate, on which Zinc and Molybdenum film electrodes form a galvanic cell that discharges at up to 1.2 V, stimulating cell proliferation and migration of the MSCs pre-loaded in the hydrogel. The hydrogel provides anchoring and growth sites for the MSCs. The bioelectronic mesh elevates the production of elasticity-related and healing-related factors, enhancing the strength and elasticity of the pelvic tissue and promoting tissue regeneration for POP repair. Compared to traditional stem cell therapy, the local stimulation strategy significantly reduces inflammation in pelvic tissues. In addition, the bioelectronic mesh completely degrades after in vivo application, which avoids risks caused by surgical removal, demonstrating good biocompatibility in the implanted mesh.

Extracellular Vesicles from Adipose-Derived Mesenchymal Stem Cells Combined with PEG Hydrogel Alleviate Maternal Simulated Birth Injury in a Rat Model

Pelvic organ prolapse (POP) is a common and distressing condition affecting women, particularly those with a history of vaginal delivery. The impact of extracellular vesicles derived from adipose-derived mesenchymal stem cells (ADSC-EVs) on pelvic floor tissue injury remains unclear. Due to their short half-life and rapid clearance in vivo, ADSC-EVs lose efficacy quickly. To address this, an injectable tetra-PEG hydrogel to encapsulate ADSC-EVs (PEG@EVs) is developed. The hydrogel is formed by tetra-PEG-NH2 and tetra-PEG-NHS through an ammonolysis reaction, leading to the formation of amide bonds within seconds. Vaginal wall tissue from POP patients shows disruption in the extracellular matrix, lipid peroxidation, and inflammation. In vitro, ADSC-EVs significantly reduce H₂O₂-induced oxidative stress, lipid oxidation, and apoptosis, while enhancing the expression of Nrf2 and its downstream targets-CAT, NQO1, HO-1, and SOD2. ADSC-EVs also upregulate GPX4 and SLC7A11, reducing mitochondrial damage and mitigating ferroptosis. The Nrf2 inhibitor ML385 reverses these protective effects. In a rat model of childbirth injury, PEG@EVs treatment promotes Nrf2 nuclear translocation, induces the M1-to-M2 macrophage conversion, reduces inflammation, and stimulates collagen deposition, thereby accelerating vaginal wall repair. The findings of this study may serve as a foundation for early targeted intervention in POP, representing a promising therapeutic approach.

Recombinant Humanized Collagen: A Promising Treatment for Pelvic Organ Prolapse via Enhanced Fibroblast Function and Angiogenesis

INTRODUCTION AND HYPOTHESIS

The treatment of pelvic organ prolapse (POP) presents significant challenges. It is important to explore safer and more effective treatment modalities. Recombinant humanized collagen (rhCol) is a promising biomaterial with excellent biocompatibility and pro-regenerative properties. Therefore, this study aims to evaluate the potential applications of rhCol in POP treatment.

METHODS

Vaginal wall tissues were collected from three non-POP and five POP patients to analyze extracellular matrix (ECM) changes via histological staining. Primary fibroblasts isolated from POP vaginal tissues were treated with rhCol III. Cell proliferation, migration, senescence, and ECM synthesis were assessed. A simulated birth injury (SBI) rat model was used to evaluate ECM remodeling following rhCol injection into the vaginal wall. Additionally, the angiogenic potential of rhCol III was examined in vivo and in vitro.

RESULTS

POP patient tissues and fibroblasts exhibited lower expression levels of type I and III collagen compared to non-POP samples. At a 1 mg/ml concentration, rhCol III promoted fibroblast proliferation and migration, reduced cellular senescence, and enhanced ECM synthesis. In the vaginal wall, the expression of COL1A1 and COL3A1 in the rhCol group was significantly higher than that in the SBI group, with a marked increase in the levels of CD31, CD34, and VEGFA. Furthermore, rhCol III improved the proliferation, migration, and tubule formation capacities of HUVECs.

CONCLUSIONS

rhCol III may promote ECM remodeling in an injured vaginal wall by restoring fibroblast function and stimulating angiogenesis, offering a novel biomaterial-based strategy for POP treatment.

The therapeutic potential of PX-478 in a murine model of pelvic organ prolapse

BACKGROUND

Pelvic organ prolapse (POP), characterised by the downward displacement of pelvic organs, is a prevalent disorder that affects adult women. This study explored the therapeutic potential of PX-478, a selective hypoxia-inducible factor-1α (HIF-1α) inhibitor, in a murine POP model.

METHODS

A murine POP model was established through ovariectomy, mimicking oestrogen deprivation. Fifteen C57BL/6J mice were randomly assigned to control, POP, and PX-478 groups. PX-478, targeting HIF-1α, was administered intravaginally. The analysis of fibroblasts, macrophage and inflammation was performed through Masson staining, immunofluorescence, and ELISA. Collagen distribution was assessed using Sirius Red staining. Expression levels of matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMP-1) were determined through immunohistochemistry and western blot. Fibroblast proliferation and apoptosis were evaluated by CCK-8 assay and flow cytometry.

RESULTS

PX-478 treatment significantly reduced vaginal length, indicating a therapeutic effect on POP severity. Masson staining revealed reduced fibrotic changes and collagen disruption in PX-478-treated mice. Immunofluorescence showed increased fibroblast markers (Vimentin, α-SMA) and collagen fibres by PX-478. Sirius Red staining indicated PX-478 mitigated damage to Type I and Type III collagen fibres. PX-478 significantly reduced MMP-2 and MMP-9 expression while increased TIMP-1. In macrophages, PX-478 decreased M1 and M2 markers (CD80, CD206) and IL-18 secretion. Fibroblasts exhibited increased proliferation, reduced apoptosis, and altered MMP/TIMP expression under PX-478 influence.

CONCLUSION

PX-478 demonstrates a therapeutic potential in the mice POP model. It reduces vaginal length, attenuates fibrosis, and modulates collagen synthesis. Its immunomodulation is evident through reduced M1 and M2 macrophages and suppressed IL-18 secretion.

Puerarin-Loaded Electrospun Patches with Anti-Inflammatory and Pro-Collagen Synthesis Properties for Pelvic Floor Reconstruction

Pelvic organ prolapse (POP) is one of the most common pelvic floor dysfunction disorders worldwide. The weakening of pelvic connective tissues initiated by excessive collagen degradation is a leading cause of POP. However, the patches currently used in the clinic trigger an unfavorable inflammatory response, which often leads to implantation failure and the inability to simultaneously reverse progressive collagen degradation. Therefore, to overcome the present challenges, a new strategy is applied by introducing puerarin (Pue) into poly(l-lactic acid) (PLLA) using electrospinning technology. PLLA improves the mechanical properties of the patch, while Pue offers intrinsic anti-inflammatory and pro-collagen synthesis effects. The results show that Pue is released from PLLA@Pue in a sustained manner for more than 20 days, with a total release rate exceeding 80%. The PLLA@Pue electrospun patches also show good biocompatibility and low cytotoxicity. The excellent anti-inflammatory and pro-collagen synthesis properties of the PLLA@Pue patch are demonstrated both in vitro in H2O2-stimulated mouse fibroblasts and in vivo in rat abdominal wall muscle defects. Therefore, it is believed that this multifunctional electrospun patch integrating anti-inflammatory and pro-collagen synthesis properties can overcome the limitations of traditional patches and has great prospects for efficient pelvic floor reconstruction.