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Implications of stem cells in Gynecology and Obstetrics

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Departmant of Gynecology and Obstetrics
Sohag school of medicine

For the PPT , the animated presentation, please contact me on : matrix_magic2009@yahoo.com

Presentation on stem cells and new emerging therapeutic techniques in the field of obstetrics and gynecology

Published in: Health & Medicine
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Implications of stem cells in Gynecology and Obstetrics

  1. 1. By: Ali Khalaf Ali M. Ali Emad Fathy Emad M. Qasem Omar Gaber Amr Ibrahim
  2. 2. • General look on stem cells. • Gynecology & Obstetrics; a source and a target. • Stem cells in the regenerative approaches to the urogenital tract. • Stem cells and Gynecological tumors. • A way to fight infertility; a reproductive biology point of view. • Genetic manipulation and fetal genetic therapy. • Ethical and religious aspects. Intended learning outcomes
  3. 3. • Definition • Classification • Sources •Properties • Important points
  4. 4. • undifferentiated cells. • retain the capacity for self-renewal. • Can differentiate into specialized cell types. Definition
  5. 5. Overview on stem cells: stem cell stem cell SELF-RENEWAL (copying) specialized cell e.g. muscle cell, nerve cell DIFFERENTIATION (specializing)
  6. 6. Overview on stem cells: 1 stem cell Self renewal - maintains the stem cell pool 4 specialized cells Differentiation - replaces dead or damaged cells throughout your life 1 stem cell
  7. 7. Classification of stem cells: • According to their potency: Progenitor cells MultipotentPluripotentTotipotent • Produce terminally differentiated or specialized cells. • Differentiate into more than 1 type of specialized cells. • Example:  Hematopoietic stem cells • From embryonic tissue layers; (ectoderm, endoderm and mesoderm). • Two types: Embryonic stem (ES) Embryonic Germ (EG) • Embryonic blastomeres. • From fertilization up to 8 cells stage • Give complete organism including extra embryonic tissue.
  8. 8. Classification of stem cells: • According to their potency: Fig. 1.
  9. 9. Classification of stem cells: • According to their Source: 1 Embryonic tissue source Big ethical Problem
  10. 10. Classification of stem cells: • According to their Source: 2 Extra embryonic source Collection methods Expansion media
  11. 11. Classification of stem cells: • According to their Source: 3 Adult source Limited time for differentiation
  12. 12. Classification of stem cells: muscles skin surface of the eye brain breast intestines (gut) bone marrow testicles Source of adult stem cells:
  13. 13. Important definitions: Stem cell engraftment: • This term indicates the homing of the transfused or transplanted stem cells into a specific target organ. • Their ability to be functional as evidenced by:  proliferation expression of differentiation markers. formation of specialized proteins or structure.
  14. 14. Rich resource in gynecology • Close contact with the main sources of promising stem cell types;  Embryonic stem cells (ES),  Umbilical cord blood stem cells (UCB)  Fetal stem cells. As a source:
  15. 15. Rich resource in gynecology Stem cells Treatment of gynecological tumors Regenerative medicine approaches HSC with high dose chemotherapy in treatment of different types of cancer Repair and replacement of: 1. Urinary sphincter. 2. Pelvic floor. 3. Uterus. 4. Ovaries. 5. Vagina.
  16. 16. 1. Treatment of Stress Urinary incontinence (SUI) • By Autologus stem or Urethral tract progenitor cells. • Aim : to restore and regenerate muscle content and function of sphincter. Regenerative medicine In the urogenital tract
  17. 17. 1. Treatment of Stress Urinary incontinence (SUI) Regenerative medicine In the urogenital tract Fig. 2.
  18. 18. 2. Bladder reconstruction: • Classic operation : Entero-cystoplasty. Regenerative medicine In the urogenital tract Fig.4
  19. 19. 2. Bladder reconstruction: • Modifications with stem cells: A. Using a cellular natural or synthetic biomaterials. E.g.: small intestinal submucosa, and bladder derived acellular matrix. Regenerative medicine In the urogenital tract
  20. 20. 2. Bladder reconstruction: • Modifications with stem cells: B. Implantation of scaffolds with autologus cells in vitro. E.g.: Collagen scaffolds or collagen coated polyglycolic acid (PGA) scaffolds. Regenerative medicine In the urogenital tract
  21. 21. 2. Bladder reconstruction: • Modifications with stem cells: B. Implantation of scaffolds Regenerative medicine In the urogenital tract Fig.4
  22. 22. 2. Bladder reconstruction: • Modifications with stem cells: C. Combined cystoplasty. Autologous stem cells sheet with de-epithelized pedicled smooth muscle segment. Regenerative medicine In the urogenital tract
  23. 23. Composite cystoplasty Fig.6. Regenerative medicine In the urogenital tract
  24. 24. 3. Pelvic floor prolapse (POP) and urinary incontinence (UI): Ordinary surgical methods:  Repair of the prolapsed bladder  Removal of the uterus (hysterectomy).  Closure of the vagina (vaginal obliteration). Regenerative medicine In the urogenital tract
  25. 25. 3. Pelvic floor prolapse (POP) and urinary incontinence (UI): • Biomaterial of synthetic and natural polymers fibers to strength matrix. • With stem cells used to strengthen and reconstruct muscles of pelvic floor. Regenerative medicine In the urogenital tract
  26. 26. 3. Uterine reconstruction (endometrial): • Treatment of women with uterine factor infertility. • Engraftment of stem cells (from bone marrow source) could produce endometrial tissue regeneration. Regenerative medicine In the urogenital tract
  27. 27. Regenerative medicine In the urogenital tract • EnSCs as a promising source of stem cells (Autologous stem cells). • In treatment of critical limb ischaemia, liver cirrhosis , type I diabetes.
  28. 28. Regenerative medicine In the urogenital tract • EnSCs as a promising source of stem cells (Autologous stem cells). Fig.7.
  29. 29. 4. Vaginal reconstruction: • Treatment of vaginal agenesis. • Ordinary Surgical methods; reconstruction with large intestine or skin. • Stem cells technique using autologous expanded cells from small vaginal biopsy. Regenerative medicine In the urogenital tract
  30. 30. Gynecological theories Stem cells and endometriosis • Retrograde menstrual blood stem cells (undifferentiated endometrial stem cells) • thought to be the etiological factor of both primary disease and its progression to distant sites.
  31. 31. Gynecological tumors • Embryonal rest theory of cancer: • It was Postulated that cancer might arise from embryonic like cells. • Evidence is that cancer cells express embryonic stem cell markers as; OCT-4
  32. 32. Gynecological tumors Treatment of gynecological tumors 1. Hematopoietic stem cell (HSC) • Treatment of solid tumors including gynecological. • High dose chemotherapy. • Followed by autologous HSC transplantation. • Adjunctive treatment with different growth factors.
  33. 33. Cancer vaccine-therapy • Tumor cells can escape the immune control through; 1. Secretion of immuno-suppressive factors. 2. Induction of immune tolerance. 3. Selection of resistant neoplastic clones.
  34. 34. Cancer vaccination • Vaccine production Fig. 5.
  35. 35. Reproductive biology Stem cells and treatment of infertility • In many ovarian and testicular disorders, they help understanding differentiation and functioning of the gonads. • Extra-gonadal source of germ cells (from bone marrow).
  36. 36. Reproductive biology • several clinical trials regarding EnSCs are underway, Using them in In Vitro fertilization. • Improving Implantation Rates
  37. 37. Genetic manipulation • New trials in treatment of some genetic diseases as; 1. α-thalassemi. 2. Mucopolusaccharidosis (MPS). 3. Β-thalassemia. 4. Sickle cell anemia. 5. Muscular dystrophies. 6. Osteogenesis Imperfecta (OI).
  38. 38. Methods of Intra-uterine fetal therapy • IUSCT • Engraftment of stem cells in embryo to decrease permanent organ damage and improving survival. Genetic manipulation
  39. 39. Allogenic approaches • Normal genetic cells transplanted in diseased fetus. • Mostly Paternal cells. • Avoidance of breastfeeding. Autologous approaches • Cells taken from embryo itself. • Gene transfer techniques. • Reintroduction to fetus. Genetic manipulation
  40. 40. • Stem cells figures: www.eurostemcell.org/files/IntroducingStemCellsFINAL_Jan2012.ppt • Classification of cells: www.bioline.org.br/pdf?mf06028 • Stem cell therapies in obstetrics and gynecology, Royal college of obstetricians & gynecologists , May 2013, https://www.rcog.org.uk/en/guidelines-research- services/guidelines/sip38/ • Pelvic floor prolapse ordinary surgery methods: http://www.webmd.com/urinary-incontinence-oab/tc/pelvic-organ-prolapse- surgery • Pelvic floor prolapse (POP) and urinary incontinence (UI) stem cell repair: http://articles.chicagotribune.com/2013-06-03/news/chi-tms-mayo- prolapse_1_pelvic-organ-prolapse-regenerative-medicine-own-cells • stem cell-based treatments for gynecological solid tumors : http://www.europeanreview.org/wp/wp-content/uploads/160.pdf • Stem cells and endometriosis: http://cdn.intechopen.com/pdfs-wm/36763.pdf • Genetic manipulation of stem cells : http://omicsonline.org/genetic- manipulation-of-stem-cells-2161-0932.S6-001.pdf
  41. 41. • Endometrial stem cells in regenerative medicine : http://www.jbioleng.org/content/8/1/20 • Role of Stem Cells in Improving Implantation Rates in ICSI Patients : https://clinicaltrials.gov/ct2/show/NCT01649752
  42. 42. • Fig. 1. : http://en.wikipedia.org/wiki/Stem_cell • Fig. 2. : http://www.medscape.com/viewarticle/735539 • Fig. 3. : http://www.europeanurology.com/uploads/europeanurology.com/eur_article s/S0302-2838(07)00033-4/assets/gr1.jpg • Fig. 4. : http://www.mccormick.northwestern.edu/images/news/2013/03/bone- marrow-cells-synthetic-scaffold-used-in-bladder-regeneration-main.jpg • Fig.5. : http://cvi.asm.org/content/18/1/23/F1.large.jpg . • Fig.6. : http://openi.nlm.nih.gov/detailedresult.php?img=3098455_gr2&req=4 . • Fig.7. : http://www.jbioleng.org/content/8/1/20/figure/F1

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