In the Mangera et al.  study various natural and synthetic scaffold materials, potentially applicable for tissue engineering purposes, were carefully compared. Primarily these materials were investigated for their suitability, when seeded with cultured oral fibroblasts, as an in vivo tissue-engineering approach to treat, by restoring the pelvic floor tissue structure, women with pelvic organ prolapse or those with stress urinary incontinence (SUI). Two potential candidate biodegradable scaffold materials were identified to treat these women’s pathological conditions, synthetic poly(L) lactic acid (PLA) and natural small intestinal submucosa (SIS), as they supported good cell attachment and proliferation, and had biomechanical features of the native pelvic floor.
The effectiveness of PLA and SIS as scaffold materials in other tissue engineering areas has been documented since the 1990s, e.g. to obtain a tissue-engineered bladder [2,3]. Recent advances in the preparation of synthetic polymeric scaffolds have shown that electrospun polyethylene terephthalate and polyurethane, given their fibrous microarchitecture similar to extracellular matrix (ECM), can favourably support cell adhesion/growth without the need of co-acting them with ECM-derived proteins [4,5].
Among the complex problems, from bench-to-bedside, concerning the biomechanical and dynamic requirements of a tissue-engineered structure to treat SUI, the main one is its potential for a quick and durable response to the neuronal mechanisms involved in the urinary continence guarding reflex towards sudden increases in intra-abdominal pressure. Indeed, the pontine storage centre-dependent spinal glutamatergic signalling induces the activation of sacral Onuf’s nucleus pudendal motoneurones, that, in turn, promote the acetylcholine-supported stimulation of pelvic floor striated muscle/urethral rhabdosphincter nicotinic receptors, thus efficaciously supporting the ‘guarding reflex’ [6–8].
Presumably the Authors , in the course of experimentation, have taken into consideration the response of their tissue-engineered structure to such guarding reflex-related neuromuscular mechanisms; however, this was not discussed in their article.
Surgical Semeiotics, University of Parma, Parma, Italy
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