Células-tronco no tratamento de mulheres com incontinência urinária de esforço
Data
2023-10-10
Autores
Souza, Rodrigo de Cerqueira 
Orientadores
Castro, Rodrigo de Aquino
Tipo
Tese de doutorado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Introdução: a terapia celular com células-tronco mesenquimais tem sido estudada no tratamento da incontinência urinária de esforço (IUE). Objetivo: Avaliar a viabilidade do uso de injeção periuretral de células-tronco mesenquimais autólogas derivadas de músculo (CTDM) e de medula óssea (CTMO) no tratamento de mulheres com IUE. Métodos: Mulheres com IUE foram selecionadas após avaliação geral e ginecológica; além de teste da tosse, teste do absorvente e questionário de qualidade de vida (I-QoL). Foram alocadas no grupo CTDM ou CTMO. As células foram injetadas via periuretal no terço médio da uretra. Após 12 meses foram reavaliadas. Resultados: Vinte e seis pacientes foram incluídas no estudo, divididas em dois grupos: CTMO (12 pacientes, 46,2%) e CTDM (14 pacientes, 53,8%). No grupo CTMO, 3 pacientes (25,0%) foram excluídas por alterações na cultura (duas com trissomia do cromossomo 5 e uma por senescência celular). No grupo CTDM, 3 pacientes (21,4%) foram retiradas por instabilidade genética (ganho de cromossomo X, trissomia do cromossomo 7 e tetraploidia), e houve perda de contato com 1 paciente. Após 12 meses, 6 pacientes do grupo CTDM apresentavam teste da tosse negativo, redução de 60%, considerada estatisticamente relevante (p=0,01). No grupo CTMO, a melhora do teste da tosse não foi significativa (p=0,526). Quanto ao teste do absorvente, o peso médio inicial do grupo CTMO de 16,4g ± 19,9 reduziu-se para 2,4g ± 3,0 após 12 meses, mas não houve significância estatística (p=0,159). O grupo CTDM, não apresentou redução no peso médio dos absorventes após 12 meses (p=0,389). Por fim, no I-QoL, o grupo CTDM tinha média inicial de 68,6 ± 14,4 pontos, e após 12 meses passou a 79,9 ± 19,4; mas este aumento de 11 pontos não teve significância estatística (p=0,284). Já o grupo CTMO mostrou aumento de apenas 4 pontos em média no I-QoL, indo dos 63,1 ± 17,4 pontos iniciais para 66,9 ± 21,4 após 12 meses (p=0,874). Considerou-se cura se teste do esforço com bexiga cheia negativo ou diminuição de pelo menos 50% de peso no teste do absorvente. Conclusões: Foram obtidas soluções contendo 10 milhões de células (CTDM e CTMO) para o tratamento da IUE em mulheres. Em cada grupo houve 3 culturas em que não se obtiveram células com qualidade suficiente para o tratamento. No grupo CTMO observou-se cura de 55,6% (5 pacientes) contra 70,0% (7 pacientes) no grupo CTDM, e não houve efeitos colaterais importantes.
Introduction: cell therapy with mesenchymal stem cells has been evaluated in the treatment of urinary stress incontinence (SUI). Objective: To evaluate the feasibility of the use of periurethral injection of autologous mesenchymal stem cells derived from muscle (MDSC) and bone marrow (BMSC) in the treatment of women with SUI. Methods: Women with SUI were selected after anamnesis and general and gynecological physical examination; in addition to cough test, pad test and quality of life questionnaire (I-QoL). They were allocated in the MDSC or BMSC group. The cells were injected into the middle urethra. After 12 months, they were reevaluated with the same tests. Results: Twenty-six patients were included in the study, divided into two groups: BMSC (12 patients, 46.2%) and MDSC (14 patients, 53.8%). In the BMSC group, 3 patients (25.0%) were excluded by changes in cell culture (two with trisomy 5 and one by cellular senescence - the latter included in the MDSC group). In the MDSC group, 3 patients (21.4%) were removed due to genetic instability (X chromosome gain, trisomy 7 and tetraploidia), and there was loss of contact with 1 patient. After 12 months, 6 patients in the MDSC group had a negative cough test, a reduction of 60%, considered statistically relevant (p=0.01). In the BMSC group, the improvement in the cough test was not significant (p=0.526). In the pad test, the mean initial weight of the BMSC group of 16.4g ± 19.9 was reduced to 2.4g +/- 3.0 after 12 months, but there was no statistical significance (p=0.159). The MDSC group showed no reduction in the average weight of pads after 12 months (p=0.389). Finally, in the I-QoL, the MDSC group had an initial average of 68.6 ± 14.4 points, and after 12 months it increased to 79.9 ± 19.4; this 11-point increase was not statistically significant (p=0.284). The BMSC group showed an increase of only 4 points on average in the I-QoL, going from 63.1 ± 17.4 points at the beginning to 66.9 ± 21.4 after 12 months (p=0.874). The cure was considered if the stress test with full bladder was negative or if there was a decrease of at least 50% in weight in pad test. Conclusions: solutions containing 10 million cells were obtained for the treatment of SUI. In each group there were 3 cultures in which cells with sufficient quality for the treatment were not obtained. In the BMSC group, a cure rate of 55.6% (5 patients) was observed against 70.0% (7 patients) of the MDSC group. There were no major side effects.
Introduction: cell therapy with mesenchymal stem cells has been evaluated in the treatment of urinary stress incontinence (SUI). Objective: To evaluate the feasibility of the use of periurethral injection of autologous mesenchymal stem cells derived from muscle (MDSC) and bone marrow (BMSC) in the treatment of women with SUI. Methods: Women with SUI were selected after anamnesis and general and gynecological physical examination; in addition to cough test, pad test and quality of life questionnaire (I-QoL). They were allocated in the MDSC or BMSC group. The cells were injected into the middle urethra. After 12 months, they were reevaluated with the same tests. Results: Twenty-six patients were included in the study, divided into two groups: BMSC (12 patients, 46.2%) and MDSC (14 patients, 53.8%). In the BMSC group, 3 patients (25.0%) were excluded by changes in cell culture (two with trisomy 5 and one by cellular senescence - the latter included in the MDSC group). In the MDSC group, 3 patients (21.4%) were removed due to genetic instability (X chromosome gain, trisomy 7 and tetraploidia), and there was loss of contact with 1 patient. After 12 months, 6 patients in the MDSC group had a negative cough test, a reduction of 60%, considered statistically relevant (p=0.01). In the BMSC group, the improvement in the cough test was not significant (p=0.526). In the pad test, the mean initial weight of the BMSC group of 16.4g ± 19.9 was reduced to 2.4g +/- 3.0 after 12 months, but there was no statistical significance (p=0.159). The MDSC group showed no reduction in the average weight of pads after 12 months (p=0.389). Finally, in the I-QoL, the MDSC group had an initial average of 68.6 ± 14.4 points, and after 12 months it increased to 79.9 ± 19.4; this 11-point increase was not statistically significant (p=0.284). The BMSC group showed an increase of only 4 points on average in the I-QoL, going from 63.1 ± 17.4 points at the beginning to 66.9 ± 21.4 after 12 months (p=0.874). The cure was considered if the stress test with full bladder was negative or if there was a decrease of at least 50% in weight in pad test. Conclusions: solutions containing 10 million cells were obtained for the treatment of SUI. In each group there were 3 cultures in which cells with sufficient quality for the treatment were not obtained. In the BMSC group, a cure rate of 55.6% (5 patients) was observed against 70.0% (7 patients) of the MDSC group. There were no major side effects.
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Citação
SOUZA, Rodrigo de Cerqueira. Células-tronco no tratamento de mulheres com incontinência urinária de esforço. 2023. 145 f. Tese (Doutorado em Ginecologia) - Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP). São Paulo, 2023.