Proof of concept project

A Fat Chance of Curing Faecal Incontinence

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  • Date Published

    March 2016

  • Principal Investigator

    Dr Richard Day, University College London

  • Co-Investigators

    Prof David Jayne, Leeds Teaching Hospital’s NHS Trust

    Dr Sabrina Falloon & Dr Nina Palmer, University College London

Summary

A Fat chance of Curing Faecal Incontinence is a bio-engineering project which addresses the need for improvements to the treatment of anal sphincter muscle failure resulting from obstetric trauma. Currently the muscle is repaired with stitches but the failure rate long term is around 50%.

Developed at University College London in conjunction with Leeds University Hospitals this work will investigate whether fat tissue from near the site of the anal sphincter can be harvested, refined and then used to bind the overlapping tissues of the muscle together to help the healing process and negate the need for stitches.

Better long-term outcomes following anterior sphincteroplasty might be achieved by improving the union that occurs between the overlapped muscle.

This might be attained through increased mechanical strength of the union with the use of prosthetic meshes or a reduction in tissue ischaemia by increasing vascularization. Given current concerns about prosthetic meshes in pelvic floor surgery, and the high risk of mesh infection in the anodermal region, the preferred strategy is to mitigate the effects of ischaemia on muscle repair.

Unprocessed autologous lipoaspirate has been used in other tissues to reduce scarring and increase vascularization, which is thought to relate to resident mesenchymal stem cells in the adipose tissue [1,2].

Large quantities of adipose tissue are accessible from the perianal fat adjacent to the anal sphincter complex and could be readily harvested during anterior sphincteroplasty.

We have previously shown purified populations of adipose-derived mesenchymal stem cells attach readily to the surface of TIPS microparticles [3]. Furthermore, TIPS microparticles have been proven to be retained at the site of intermuscular implantation in pre-clinical in vivo models.

Combining clinically ready TIPS microparticles with an adipose concentration system already in clinical use and applying this to an established surgical procedure could provide a novel and readily translatable biomedical engineering approach to improving continence.

It is hypothesised that refined adipose tissue containing mesenchymal stem cells isolated, mixed with TIPS microparticles, implanted and retained between the overlapped sphincter muscle will enhance union between the joined muscle, leading to improved clinical reproducibility and long-term outcomes.

[1] Huang et al. Ann Plast Surg. 2012;69(6):656-62.

[2] Pallua et al. J Plast Reconstr Aesthet Surg. 2014;67(8):1033-7.

[3] Parmar et al. Tissue Engineering Part C. 2015;21(4):404-12.

Aims

The aim of the pilot study is to establish the feasibility of developing a point-of-care product for the isolation, concentration, and targeted delivery of autologous cells from raw human lipoaspirates that can be retained between the overlapped sphincter muscle in order to facilitate quality healing.

Objectives

  • Devise a simple and efficient protocol for the preparation of refined and concentrated adipose tissue that can be combined TIPS microparticles with minimal sample handling in a closed processing system.
  • Determine whether cells present in the isolated adipose tissue bind to the surface of TIPS microparticles before delivery and if they do, whether the cells display multilineage potential in vitro.

Incontinence Management & PRevention through Engineering and ScienceS