Vagina reconstruction by decellularization of healthy human vaginal tissue

Abstract When a healthy, full-size vagina is absent due to a disorder, various neovagina creation methods are available. Sometimes dilation or stretching of the vagina cavity is sufficient, but generally intestinal or dermal graft tissue is required. However, different inherent tissue properties cause complications. Therefore, when a body part is lost, it should be replaced by a similar material. The use of organ-specific acellular vaginal tissue carries great potential, as the similar architecture and matrix composition make it fit for vagina regeneration. We developed an optimized decellularization protocol for human vaginal tissue and determined suitability as tissue-mimicking scaffold for vagina reconstruction. Histological examination confirmed the preservation of structural features and minimal cellular residue was seen during fluorescence microscopy, DNA and RNA quantification and fragment-length examination. Biomechanical testing showed decreased (P<0,05) strain at rupture (23%), tensile stress (55%) and elastic modulus (68%) after decellularization. Fluorescence microscopy revealed preserved Fibronectin-I/II/III and Laminin-I/II, while Collagen-I and Ficolin-2B were decreased but mostly retained. The absence of cellular residue, minimally altered biomechanical ECM properties and mostly preserved structural proteins, appear to make our decellularized human vaginal matrix a suitable tissue-mimicking scaffold for vagina transplantation when tissue survival through vascularization and innervation are accomplished in the future.