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BACKGROUND: Vaginoplasty is a surgical solution to multiple disorders, including Mayer-Rokitansky-Küster-Hauser syndrome and Male-to-Female gender dysphoria. Using non-vaginal tissues for these reconstructions is associated with many complications and autologous vaginal tissue may not be sufficient. The potential of tissue engineering for vaginoplasty was studied through a systematic bibliography search. Cell type, biomaterial and signalling factors were analyzed by investigating advantages, disadvantages, complications and research quantity. SEARCH METHODS: A systematic search was performed in Medline, EMBASE, Web of Science and Scopus until March 8, 2022. Term combinations for tissue engineering, guided tissue regeneration, regenerative medicine and tissue scaffold were applied, together with vaginoplasty and neovagina. The snowball method on references and a Google Scholar search on the first 200 hits were performed. Original studies on human and/or animal subjects, that met the inclusion (reconstruction of vaginal tissue; tissue engineering method) and no exclusion criteria (not available as full text; written in foreign language; non-original study article; genital surgery other than neovagina reconstruction; vaginal reconstruction with autologous or allogenic tissue without tissue engineering or scaffold) were assessed. The STROBE checklist, Newcastle Ottawa Scale and Gold Standard Publication Checklist were used to evaluate article quality and bias. OUTCOMES: A total of 31 out of 1569 articles were included. Data extraction was based on cell origin and type, biomaterial nature and composition, host specy, number of hosts and controls, neovagina size, replacement fraction and signalling factors. An overview of used tissue engineering methods for neovagina formation was created, showing high variance of cell type, biomaterial and signalling factors and topics were rarely covered multiple times. Autologous vaginal cells and Extracellular Matrix-based biomaterials showed preferential properties and stem cells carry potential. However, quality confirmation of orthotopic cell-seeded Acellular Vaginal Matrix by clinical trials is needed as well as exploration of signalling factors for vaginoplasty. IMPACT STATEMENT: Autologous cells prevent complications and compatibility issues like healthy cell destruction, whereas stem cells prevent cross-talk and rejection (but need confirmation testing beyond animal trials). Natural (orthotopic) ECM biomaterials have great preferential properties that encourage future research and signalling factors for vascularization are important for tissue engineering full-size neovagina.

Traditionally tissue samples are analysed using protein or enzyme specific stains on serial sections to build up a picture of the distribution of components contained within them. In this study we investigated the potential of multivariate curve resolution-alternating least squares (MCR-ALS) to deconvolute 2nd derivative spectra of Fourier transform infrared (FTIR) microscopic images measured in transflectance mode of goat and human paraffin embedded intervertebral disc (IVD) tissue sections, to see if this methodology can provide analogous information to that provided by immunohistochemical stains and bioassays but from a single section. MCR-ALS analysis of non-degenerate and enzymatically in vivo degenerated goat IVDs reveals five matrix components displaying distribution maps matching histological stains for collagen, elastin and proteoglycan (PG), as well as immunohistochemical stains for collagen type I and II. Interestingly, two components exhibiting characteristic spectral and distribution profiles of proteoglycans were found, and relative component/tissue maps of these components (labelled PG1 and PG2) showed distinct distributions in non-degenerate versus mildly degenerate goat samples. MCR-ALS analysis of human IVD sections resulted in comparable spectral profiles to those observed in the goat samples, highlighting the inter species transferability of the presented methodology. Multivariate FTIR image analysis of a set of 43 goat IVD sections allowed the extraction of semi-quantitative information from component/tissue gradients taken across the IVD width of collagen type I, collagen type II, PG1 and PG2. Regional component/tissue parameters were calculated and significant correlations were found between histological grades of degeneration and PG parameters (PG1: p = 0.0003, PG2: p < 0.0001); glycosaminoglycan (GAG) content and PGs (PG1: p = 0.0055, PG2: p = 0.0001); and MRI T2* measurements and PGs (PG1: p = 0.0021, PG2: p < 0.0001). Additionally, component/tissue parameters for collagen type I and II showed significant correlations with total collagen content (p = 0.0204, p = 0.0127). In conclusion, the presented findings illustrate, that the described multivariate FTIR imaging approach affords the necessary chemical specificity to be considered an important tool in the study of IVD degeneration in goat and human IVDs.

Objective: The use of knitted, polypropylene meshes for the surgical treatment of pelvic organ prolapse (POP) is frequently accompanied by severe complications. Looking for alternatives, we studied the potential of three different electrospun matrices in supporting the adhesion, proliferation, and matrix deposition of POP and non-POP fibroblasts, the most important cells to produce extracellular matrix (ECM), in vitro. Study design: We electrospun three commonly used medical materials: nylon; poly (lactide-co-glycolide) blended with poly-caprolactone (PLGA/PCL); and poly-caprolactone blended with gelatin (PCL/Gelatin). The matrices were characterized for their microstructure, hydrophilicity, and mechanical properties. We seeded POP and non-POP fibroblasts from patients with POP and we determined cellular responses and ECM deposition. Results: All matrices had >65% porosity, homogenous microstructures, and close to sufficient tensile strength for pelvic floor repair: 15.4 ± 3.3 MPa for Nylon; 12.4 ± 1.6 MPa for PLGA/PCL; and 3.5 ± 0.9 MPa for PCL/Gelatin. Both the POP and non-POP cells adhered to the electrospun matrices; they proliferated well and produced ample ECM. Overall, the best in vitro performance appeared to be on nylon, presumably because this was the most hydrophilic material with the thinnest fibers. Conclusion: Electrospun nanofibrous matrices show feasible mechanical strength and great biocompatibility for POP and non-POP fibroblasts to produce their ECM in vitro and, thus, may be candidates for a new generation of implants for pelvic floor repair. Further studies on electrospun nanofibrous matrices should focus on mechanical and immunological conditions that would be presented in vivo. Neurourol. Urodynam. 36:565–573, 2017.

Biomechanical properties of healthy and degenerated nucleus pulposus (NP) are thought to be important for future regenerative strategies for intervertebral disc (IVD) repair. However, which properties are pivotal as design criteria when developing NP replacement materials is ill understood. Therefore, we determined and compared segmental biomechanics and NP viscoelastic properties in normal and mildly degenerated discs. In eight goats, three lumbar IVDs were chemically degenerated using chondroitinase ABC (CABC), confirmed with radiography and MRI after euthanasia 12 weeks post-operative. Neutral zone (NZ) stiffness and range of motion (ROM) were determined sagitally, laterally, and rotationally for each spinal motion segment (SMS) using a mechanical testing device. NPs were isolated for oscillatory shear experiments; elastic and viscous shear moduli followed from the ratio between shear stress and strain. Water content was quantified by weighing before and after freeze-drying. Disc height on radiographs and signal intensity on MRI decreased (6% and 22%, respectively, p

Polylactides are commonly praised for their excellent mechanical properties (e.g. a high modulus and yield strength). In combination with their bioresorbability and biocompatibility, they are considered prime candidates for application in load-bearing biomedical implants. Unfortunately, however, their long-term performance under static load is far from impressive. In a previous in vivo study on degradable polylactide spinal cages in a goat model it was observed that, although short-term mechanical and real-time degradation experiments predicted otherwise, the implants failed prematurely under the specified loads. In this chapter we demonstrate that this premature failure is attributed to the time-dependent character of the material used. The phenomenon is common to all polymers, and finds its origin in stress-activated segmental molecular mobility leading to a steady rate of plastic flow. The main conclusion is that knowledge of the instantaneous strength of a polymeric material is insufficient to predict its long-term performance.