UH Urology Institute - Fall 2017
ADONIS HIJAZ, MD
Director of Female Pelvic Surgery at UH Cleveland Medical Center; Associate Professor of Urology, Case Western Reserve University School of Medicine
While common treatments for female stress urinary incontinence (SUI) – including the mid-urethral sling procedure – are effective, Adonis Hijaz, MD, Director of Female Pelvic Surgery at UH Cleveland Medical Center, believes there are better solutions that encompass the full understanding of the pathophysiology of urinary incontinence.
Dr. Hijaz chose his area of specialty to help improve the quality of life for the growing number of patients with pelvic floor disorders. Early on in his career, while completing a fellowship at The Cleveland Clinic Foundation, Dr. Hijaz did a research project on the use of stem cell therapy for incontinence. That work was the springboard for more than a decade of cutting-edge research on SUI.
“SUI is a complicated, multifactorial disease that happens to women in their early lives and increases in prevalence as they advance in age,” he says. “There are multiple components to the disease, including loss of ligament support of the urethra, weakness of the sphincter and decrease in tissue support around the urethra and in the vagina.”
Earlier work on stem cell therapy for SUI involved injecting the stem cells around the urethra, with the hope and understanding that the cells would grow, multiply and create new sphincter muscles. But Dr. Hijaz and others discovered that the healing process is active rather than passive: Stem cells are bioactive, secreting small proteins called cytokines that aid in tissue repair.
“Our recent understanding is that when we inject the stem cells to treat stress incontinence in small animal models, they recover the injury that has led to incontinence through a release of chemokine – bioactive molecules,” says Dr. Hijaz.
Animal model studies conducted by Dr. Hijaz have shown that vaginal distension injuries injected with human mesenchymal stem cells (hMSCs) recover in about four days, compared to natural recovery of two to three weeks. (Results were published in the Sept. 9, 2015, issue of the International Urogynecology Journal.) This led Dr. Hijaz to the understanding that for stem cells to work most effectively, they need to be used in an acute setting.
“Stem cell therapy should move from treating a disease that’s well established in a 40- or 50-year-old woman to using it at the time of delivery when the injury is still active and recovering,” says Dr. Hijaz. He has developed a proposal for a clinical trial to profile patients with persistent post-partum incontinence and intervene with stem cell therapy at the time of recovery, while the injury is active.
In addition, Dr. Hijaz is researching the use of hMSCs in older women with established stress incontinence. He postulates that injecting stem cells in a “cold environment” – one that’s not actively repairing itself – is not as effective. His proposal for this patient population is to co-inject the stem cells with a bioactive molecule that anchors the cells to the area of injection and activates them to result in recovery.
“My hope is that my research will ultimately help patients who seek to improve their quality of life,” says Dr. Hijaz. “That’s what I focus on. That’s what I want to see for all female patients.”