| 1. |
- Al-Saqi, Shahla Hamza
(författare)
-
New approaches to treat women’s urogenital problems
- 2014
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Women’s urogenital problems adversely affect their quality of life. In this thesis, I address tw oof such urogenital problems: namely, postmenopausal vaginal atrophy (VA) and stress urinary incontinence (SUI). In the first two studies of this thesis, an intravaginal oxytocin gel(Vagitocin) was used for the treatment of VA in double-blinded randomized controlled trials. The hypothesis was that oxytocin could serve as an alternative to local estrogen treatments for postmenopausal VA particularly for women, whom estrogens are contraindicated for use by any means, including by local administrations. Breast cancer survivors and other hormone-dependent cancer patients form the core of this group. Oxytocin improved both the subjective symptoms of VA (i.e., dryness, irritation, itching, dyspareunia and postcoital bleeding), including the most bothersome symptom, and the objective features of VA. We observed an increase in the percentage of superficial cells in the vaginal mucosa, an increased maturation value, a decreased vaginal pH and decreased vaginal atrophic scores, as evaluated by a histopathology. Furthermore, oxytocin had no influence on the endometrial lining of the uterus, as evaluated by both ultrasound and endometrial biopsy, and we did not observe any serious side effects. In conclusion, oxytocin induced remarkable clinical and laboratory improvements in postmenopausal VA without inducing any serious adverse effects. Thus, oxytocin (Vagitocin), as a non-estrogenic compound, may be a good alternative treatment for postmenopausal VA, particularly in women who cannot or do not wish to use estrogen-containing products. Traditional treatments for SUI are not always effective. Therefore, we developed a clinical expansion protocol of mesenchymal stem cells (MSCs). The hypothesis is that MSCs can be injected into the defective sphincter urethrae in order to improve its function by restoring the structure and, eventually, maintaining the continence. We isolated MSCs from the minimally invasive source adipose tissue (Ad) and expanded and stored the MSCs in clinical grade culture and cryopreservation media. We showed that, after isolation and expansion, Ad-MSCs had a stable morphology and shorter population doubling time than standard bone-marrow-derived MSCs (BM-MSCs). Furthermore, Ad-MSCs sustained their surface marker characteristic salong five passages and were able to differentiate into both bone and fat lineages. In the last study, we showed that Ad-MSCs could be successfully cryopreserved and thawed in a clinical grade serum- and xeno-free cryoprotectant medium. This is important because such cryopreservation allows Ad-MSCs to be held on the shelf until their planned use(s). The Ad-MSCs exhibited a stable morphology, and they preserved their surface marker characteristics and differentiation potentials into bone and fat lineages. In conclusion, we believe that autologous Ad-MSCs, when cultured and cryopreserved in the described clinical grade media, can be successfully tested for their ability to improve women’s SUI in the future.
|
|
| 2. |
- Al-Saqi, Shahla Hamza, et al.
(författare)
-
Oxytocin improves cytological and histological profiles of vaginal atrophy in postmenopausal women
- 2016
-
Ingår i: Post Reproductive Health. - : SAGE Publications. - 2053-3691 .- 2053-3705. ; 22:1, s. 25-33
-
Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To investigate if topical oxytocin can reverse vaginal atrophy, as assessed by cytological and histological examination of the vaginal mucosal epithelium, in postmenopausal women after 12 weeks of treatment as compared to placebo.STUDY DESIGN: Sixty-eight postmenopausal women diagnosed with vaginal atrophy were randomized for this multicenter, double-blinded, placebo-controlled trial. Thirty-three women received 600 IU vagitocin, an oxytocin containing gel, and 35 women received a placebo gel intravaginally. The dose was 600 IU daily for the first two weeks and thereafter 600 IU twice a week for 10 weeks. All participant women underwent four visits and a subgroup of 20 women had a further fifth visit. Vaginal smears for cytological evaluation were collected at all visits. Vaginal biopsies were taken in 20 women before and after 12 weeks of treatment for histological analysis. In these women a vaginal smear was also collected after 14 weeks.RESULTS: The increase in the percentage of superficial cells between 0 and 2 weeks was significantly greater after treatment with vagitocin in comparison with placebo (p = 0.04). The difference in the maturation value between 0 and 12 weeks was significantly higher in the vagitocin than in the placebo group (p = 0.01). The reduction in the scores of atrophy was according to the histological investigation significantly greater in the vagitocin group than in the placebo group at 12 weeks (p < 0.04).CONCLUSION: Daily intravaginal treatment with vagitocin 600 IU improves expressions of vaginal atrophy as recorded by cytological investigation of vaginal smears and histological analysis of vaginal biopsies. Treatment twice weekly seems to be less effective regarding the increase in superficial cells.
|
|
