**4.2 Cell source**

There are two general types of stem cells potentially useful for therapeutic treatment, embryonic stem cells (ESCs) and adult stem cells **(Novara and Artibani, 2007).** The practical use of ESCs has ethical limitations inherent to cell harvesting from fetal tissue and histocompatibility problems. **(Edwards, 2007)**. In contrast, adult stem cells have no significant ethical issues related to their use and have more limited differentiation potential which makes them safer. Tissues engineering therapies are based on autologous multipotent stem cells, of which bone marrow stromal cells are most often used. The bone marrow stromal cells contain mesenchymal stem cells (MSCs) that are capable of differentiating into into adipogenic, osteogenic, chondrogenic and myogenic cells **(Pittenger et al, 1999; Ferrari et al, 1998; Prockop, 1997; Dezawa et al, 2005),** However, bone marrow compartment usage has significant limitations due to its painful nature which usually require general or spinal

Futuristic Concept in Management

myofibrils **(Mitterberger et al, 2008).** 

fibroblasts **(Kwon et al, 2006).**

cells **(Jankowski et al, 2008)** 

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also may improve neurogenic bladder dysfunction in animal models by reconstitution of damaged peripheral nerve cells (eg, Schwann cells, perineum) and vascular cells (eg, vascular smooth muscle cells, pericytes, endothelial cells) **(Nitta et al, 2010)**. For the treatment of SUI myoblasts have been injected to the striated urinary sphincter of a pig model. The animals have shown an increase in urethral pressure profile and muscular

1. MDSCs that are derived from the incontinent patient (autologous cell transplantation) will not cause an immunogenic or allergic reaction **(Yokoyama et al, 2001a; Lee et al, 2004).**  2. MDSCs are uniquely different from fibroblasts and smooth muscle cells since MDSCs will fuse to form post-mitotic multinucleated myotubes. This limits persistent expansion and risk of obstruction that may occur with other cell sources such as

3. MDSCs form contractile myotubes and myofibers that become innervated into the host muscle by activating the intrinsic nerve regeneration and formation of neuromuscular junctions. Therefore, they can not only serve as a bulking agent, but they are also physiologically capable of improving urethral sphincter function **(Chancellor et al,** 

Mitterberger M et al. and Strasser H et al. reported biopsy in the right or left upper limb (biceps muscle) to obtain 0.32 to 2 cm3 of muscle tissue (figure 11). At the same time, 250 mL of blood were drawn for autologous serum **(Mitterberger et al, 2008; Strasser et al, 2007b).**

Fig. 11. Diagram showing autologous stem cell injection therapy for SUI. Autologous stem cells are obtained with a biopsy of tissue, the cells are dissociated and expanded in culture, and the expanded cells are implanted into the same host. MDSCs = muscle derived stem

Advantages of MDSCs injection therapy over conventional treatments for SUI:

**2000; Yokoyama et al, 2001b; Huard et al, 2002; Hoshi et al, 2008).** 

**4.3 Isolation of muscle-derived stem cells in humans** 

anesthesia, and low number of (MSCs) are obtained **(Pittenger et al. 1999**). Muscle derived stem cells (MDCs) and adipose derived stem cells (ADSCs) are advantageous because they can be easily obtained in large quantities under local anesthesia **(Rodríguez et al,. 2006; Strem et al, 2005).** 
