kim_vopni (00:01.846)
Hi, Dr. Gargett, thank you so much for joining me today. I am really, really excited about speaking with you. I think you are doing amazing, amazing work in the world. So super excited to jump in. Thank you again for joining me.
caroline_gargett (00:15.768)
It's a pleasure and I'm really pleased to be able to spread the word a little bit on a topic that is quite taboo.
kim_vopni (00:22.442)
Yes, yes it is. And I've been working in this field for close to seven, actually closer to 18 years now. And word is getting out and it's starting to become a little bit less taboo, but we still have a long way to go. So can you share a bit about your background and what led you to this taboo area of pelvic organ prolapse?
caroline_gargett (00:46.128)
Well, the first thing is that, and probably one of the highlights of my career too, is that I discovered adult stem cells in the endometrium. This is the lining of the uterus that most of it, three quarters of it's shed every month and then it regrows. So very regenerative tissue and I sort of reasoned there had to be stem cells in there to manage that growth. I was interested in it for endometriosis actually.
caroline_gargett (01:15.42)
pelvic organ prolapse is that I was at an OBGYN seminar once on mesh in our department and the urogynecologist who was speaking was talking about mesh. This was back in 2005 when it was starting to become a big problem, vaginal mesh. And as I said, I know I have prolapse and it was for POP or prolapse and I thought, so I knew a little bit about it.
But I was absolutely staggered by the number of women who were affected. 25%. And then 50% of parous women when they reached menopause. I just thought this was a disgrace. And something had to be done about it. And I decided there and then to use the mesenchymal stem cells that we'd found in endometrium. They're quite proliferative and had really good properties. And we'd have just found ways of purifying them. And I thought we were up.
The idea was, it came during the seminar, was to put those cells together with the mesh, I thought, or the already had mesh that was available, and they may improve that outcome. There's a big long story after that of what we've done, but you might ask me that later.
kim_vopni (02:30.899)
Yeah, that is so interesting. It's amazing what can come from sometimes networking and collaborating with other people or just listening to other conversations. We have these light bulb moments and I think that that was such an amazing one that you had during that talk. Just before we get into the weeds, which I really want to get into the weeds, but what is pelvic organ prolapse?
caroline_gargett (02:56.112)
Okay, so pelvic organ prolapse really is the descent of the pelvic organs, or it's really a herniation. And so the bladder, the uterus and the bowel can all start to fall into the vagina, and in fact they can come out. So that's really what pelvic organ prolapse is.
kim_vopni (03:16.146)
And what are the more common treatment options that we have available to us right now?
caroline_gargett (03:21.928)
Alright, so at the moment you would start with your pelvic floor muscle exercises. You would, after, if that isn't working too well or if the prolapse is more severe, then you would, they would try a pessary, which is kind of an intra-vaginal device that can sort of hold up an organ, maybe the bladder or something like that. And then the third option is reconstructive surgery.
Now reconstructive surgery is required by about 19% of all women, so it's a huge number of women that require it.
kim_vopni (03:56.846)
Mm-hmm. And people who have surgery, there's also a fairly high recurrence rate. What would you, what's your interpretation as to why we have those high failure or recurrence rates?
caroline_gargett (04:10.072)
Yeah, and that's true, about a third of native tissue repairs fail. And part of that, particularly in the menopausal women, part of that is really the tissues are weak from the birth injuries and also from aging and other factors that can cause them to weaken. And so they're not strong enough to hold up. The
those pelvic organs, the bladder, the bowel, the uterus. And so that's why they have to have multiple operations. And that's where MeSH came in. Ha ha. Yes.
kim_vopni (04:42.71)
Right, yeah, so I was just saying it was a perfect segue into mesh came along thinking that it's a structure coming in to reinforce and support tissue that may not be able to be, that maybe isn't as robust as needed. So can you talk a little bit about the mesh and sort of what happened, what was the result of starting to use mesh?
caroline_gargett (04:55.174)
Mm-hmm.
caroline_gargett (05:02.3)
That's right. So, you know, as I mentioned, there was a big need for something for the surgical repair. And so the urogynecologist used abdominal mesh to begin with. And they did it in a transvaginal, so they incisioned in the vagina and inserted it there. The thing is the vagina and abdominal wall are very different. The vagina is very elastic and
the time, you know, frequently. And so that's the problem is, at the time, no clinical trials had to be done. So they went straight in. And the problem was that the mesh that was used is very quite stiff. It doesn't match the biomechanical properties of vaginal tissue. So it sort of moves around and it can come out and be exposed in the vagina or it can
it can erode into the bladder or the bowel and that sort of has to be resected out. So then they're having lots of these smaller operations to kind of tidy it up.
But then there was about the 10 to 20 percent of women who had really terrible problems and for them I would have thought they would have had severely compromised vaginal tissue and function and probably really their lives ruined as a result. And then that's what led to the litigations and the withdrawal of that mesh. So
The problem was there were no clinical trials. And I don't think, because it's a device, and I don't know that the rules were at the time that you needed to have clinical trials for devices. So, but it's changed now. Yeah.
kim_vopni (06:42.766)
What's the reason for that?
kim_vopni (06:57.778)
Yeah, yeah, yeah. Yeah, it's so many people suffered as a result. And yet at the same time, there was also some who did have success with it. And that's where now the mesh is still used. It's a different type of mesh. Do I understand that correctly?
caroline_gargett (07:16.096)
That's a really important point is that a lot of women were really helped with the mesh, even those earlier meshes which were much more heavy designs and they did improve them over time. But in Australia here we can't use any mesh trans-vaginally so it has to be an abdominal operation.
And of course, you know, the vagina is really at the bottom of the pelvis. It's a long way down and a lot of tissue to get through. So it's sort of more of a major operation. Yes.
kim_vopni (07:40.949)
Uh-huh.
kim_vopni (07:48.854)
Yeah. So that sort of then leads to other options. So there, you know, surgeries can fall short, pesteries may not work, exercise may not be successful. So we're looking at other options. And this is where this light bulb moment that you had is is bringing something really interesting to the table. So how what is your hope with this discovery of these mesenchymal cells and how it could potentially help in this situation?
caroline_gargett (08:19.252)
So basically we still think you need to have some support, some supporting material. And so we really started to develop a tissue engineering approach. And I was working with a surgeon, Anna Rosamilia, and then we tried just with a mesh available and honestly it wasn't very good. So we then went to a big research organisation in Australia called the Commonwealth.
Scientific and Industrial Research Organisation, or CYRO, where they had some material scientists. We went there and so it was a big collaboration between the material scientists and us. We actually made some non-degradable mesh out of what we'd call nylon and knitted it in a pattern quite similar to what was being used. We first made sure that the mechanical properties were the same as the vaginal tissue, human vaginal tissue.
So it was extremely soft and drapable. But as things progressed through the FDA warnings and the companies withdrawing their mesh and the litigations, we knew that we had to go for the degradable type mesh material. At the same time I recruited Dr. Shayanti Mukherjee who's a bioengineer. So together with her, she's now...
leading that work of developing degradable materials. So she does what's called electro spinning and makes these nanofibers or nanofibre meshes and that they resemble in a way like the connective tissue more that the pores are very, very small but the cells can actually get in. Whereas the pores of the...
non-degradable mesh were quite large and I think, yeah, so it's just a completely different approach. They do degrade and you have to choose a material or a polymer that will take a long time to degrade and the cells then will recruit tissue stem cells. They'll promote growth of vessels and that's what really helps the tissue get stronger because it can support new tissue.
caroline_gargett (10:44.072)
The cells also have anti-inflammatory properties, so they dampen down their body's response to a foreign body because the body wants to remove it by the immune system and the inflammatory system. And they also reduce fibrosis, which is another big problem because some of the early measures that caused all the problem in women sort of healed as kind of like a big scar.
kim_vopni (10:55.242)
Mm-hmm.
caroline_gargett (11:11.12)
as the back of the vagina as you can imagine that would be awful you know and that's the type of thing we're doing now so we're really looking at degradable long-term degradable meshes together with our cells because we've found in our animal studies that that really seems to work the cells everything's required the cells are required and this new type of biomaterials help too
kim_vopni (11:37.378)
So if I understand correctly, and I have a clarifying question as well, being degradable, it's degradable over time. So during the time that it is degrading, we have other tissue because of the stem cell piece that is also creating new, more robust, resilient tissue. Is that accurate?
caroline_gargett (11:56.136)
That's right, it does three things really. It'll promote influx of other tissue progenitors that might be there to perhaps grow and heal that area. It promotes growth of new blood vessels and that really helps a lot, vascularized tissue, and even in that regeneration, and also just preventing that fibrosis. And dampening down the immune response and the inflammatory response.
quite considerably actually and so I think that then stops the tissue from being like painful or yeah.
kim_vopni (12:33.25)
Right. So how long would that, when you say a delayed degradation, how long would that be approximately?
caroline_gargett (12:42.24)
So one of the ones that we've chosen, this is also where the 3D printing comes in, is PCL, or polycaprolactate, polycaprolactate, oh I'm not quite sure, this is Cheyenne's area. PCL, or she's got various, you can blend them as well.
kim_vopni (12:59.33)
Hehehehe
kim_vopni (13:05.934)
Mm-hmm.
caroline_gargett (13:09.024)
polycaprolactone, I think it is something like that anyway.
kim_vopni (13:11.69)
And is it over months or weeks or how long would it last?
caroline_gargett (13:16.361)
The PCL one, which is the one that we're 3D printing, that would be about two years. And I think you need something that lasts quite a long time. So it's very slow degradation because even the degradation sets off an immune, can set off inflammation too. So the products, as it degrades, so the slower it degrades and the more cells that infiltrate,
kim_vopni (13:23.029)
Oh wow.
kim_vopni (13:35.551)
Interesting.
caroline_gargett (13:43.592)
mesh, the better off it all is. So that kind of really becomes incorporated into the tissue and it's given strength.
kim_vopni (13:45.716)
Mm-hmm.
kim_vopni (13:51.95)
Interesting. Okay, so that's slowly degrading over time. We're rebuilding, we're working on dampening the immune response. And now you've mentioned 3D printing. So the creation of this mesh is using the mesenchymal cells in a 3D printing practice, is that correct?
caroline_gargett (14:10.812)
Yeah, well there's several things you can do. One, you can just 3D print the mesh. Okay, so and Shayanti and her...
no he's in our post-op but he was a PhD, Kelly-Ann Paul, they've made some, what I call, rational design of mesh. So with the 3D printer, you have to program it and set it up for the way they're printing. But you print layer upon layer, so it's like an inkjet, an inkjet printer that prints on paper. But this one, if you set it up in a pattern, it'll do a layer of the...
extruded polymer in a certain way and then you can go in various angles and build up say 50 layers thick.
which is what they've done and they've done various designs and they've really shown that certain designs are far better than others with the way the body responds to it. So yeah, it's really, I think, fantastic work that they're doing. So when it comes to the bioprinting, this is more challenging because you've got to actually put the cells like in a hydrogel and you can print that too through an inkjet printer.
kim_vopni (15:10.997)
Interesting.
caroline_gargett (15:28.488)
But the thing is, what's printable has to match what the cells will cope with. And temperature is a big issue. But they have 3D printed cells and this is where these bio inks come from. There's a huge lot of research being done around the world just in developing bio inks. Not necessarily for our work, but that's what we're trying to do as well that's suitable for our work.
one bio ink and they've been looking at a bit of other work as well. And so basically you could print your mesh and then you could print your cells on top or you could print them in between the layers as well I think. They're more complex but that's the sort of thing that they're aiming for.
kim_vopni (16:15.118)
Wow.
kim_vopni (16:19.426)
That is so fascinating. So bio inks are essentially taking human tissue then, and how are they made?
caroline_gargett (16:27.204)
Nah, I'll uh...
That's actually usually something synthetic and it might like the first one that Cheyenti produced was and Calliane was with aloe vera gel and alginate and alginate is used a lot in tissue engineering so you know it's a seaweed protein and then that mix forms a gel on its own and then they put the cells in that gel and they've actually printed those cells on
kim_vopni (16:32.52)
Okay.
kim_vopni (16:47.571)
Mm-hmm. Mm-hmm.
kim_vopni (16:51.47)
Got it.
caroline_gargett (16:58.89)
printed. But they've refined it a lot since then.
kim_vopni (17:03.838)
Okay. And sorry if I've missed this, but where then did the endometrial cells that you had found, where does that fit into the whole picture?
caroline_gargett (17:12.521)
Oh, right, so you could print them either on the mesh, on the surface of the mesh, or you could print them, which is what they did in the first experiment. I also think there may be that opportunity to print them between layers of the mesh.
So then, yeah, so it might be quite complex. You might need a couple of nozzles. Cause it's like an inkjet printer actually, yeah. And so it just goes back and forth. And the other word for it is melt electro writing. So it's like writing your mesh in these layers. I mean, that's one way. There's other, probably other ways as well that we're not, that I don't know, I don't have the knowledge of off that that could be used.
kim_vopni (17:36.366)
Mm-hmm.
kim_vopni (17:44.941)
Interesting.
Mm-hmm.
kim_vopni (17:57.806)
Mm-hmm.
caroline_gargett (18:01.746)
So the cells could be separate from the mesh and we've done some work with that. Just with the nanofibers, we've just put them into an animal model and then put the cells on top in another hydrogel, like collagen or something, and they stay relatively put and then they act at the area where the mesh is.
kim_vopni (18:24.642)
So interesting.
caroline_gargett (18:25.172)
So it's a combination, that's why it's called tissue engineering, it's a combination of cells and material. And you have to put them together in a way and there's many different ways that that can be done. And one way is 3D printing and bio-printing. Bio-printing is when you add the cells.
kim_vopni (18:30.469)
Mm-hmm. Mm-hmm.
kim_vopni (18:42.15)
Right. And you mentioned a few times in your animal models. So you're currently testing this with animals? And what type of animal do you use?
caroline_gargett (18:52.488)
Yeah. We do.
We do mice and rats first because they're small and to test certain things. Then we really have got this what we call a pretty large animal pre-clinical model which is sheep and the sheep vagina is pretty very similar in size and structure to the human vagina. So it's a really good model to use. And we just do trans-vaginal surgery just...
We're just using patches first and then really needing to design and starting to design mesh with arms and things like that, so like the original meshes were, so they can be anchored somewhere. So at the moment we just had doing it in the vagina without that anchoring, apart from
kim_vopni (19:39.395)
Mm-hmm.
kim_vopni (19:46.398)
That's it, like I can, I'm visualizing the vagina of a mouse and how small that would be and how intricate that procedure would be. That's just fascinating.
caroline_gargett (19:52.164)
Mm. Yeah.
caroline_gargett (19:57.277)
Yeah, well we don't in the mice we don't do it in the vagina we do it on the on the back of the mice we just do it under the skin. Yeah because it's too small you're quite correct it's just too small.
kim_vopni (20:03.122)
Oh, okay, okay, got it. Right, okay. Yeah, okay. Yeah.
caroline_gargett (20:10.176)
And the thing is we did find different things when we went from mice or rats to sheep, because we've done one, we've published one sheep experiment with our polyamide or the nylon mesh, and we found it was much better to put the mesh in first, you know, it layered in, and then put the cells, we would drip the cells over the top, and then you can, with a blue light, it just cross-links it all
keeps the cells there and we overcame the problem. We actually recapitulated the erosion of mesh through the vagina initially. So that was really recapitulating the problem because our original way of putting the cells on the mesh made the mesh a bit stiff. So the stiffness of the mesh is so important.
kim_vopni (20:48.078)
Wow.
kim_vopni (21:03.356)
Yeah, yeah.
caroline_gargett (21:03.844)
is to be just like vagina and it has to drape, you know, rather than sit there like a five dollar note. Well, and what's a polymer? Our Australian dollars are polymer and if you put one of those in the vagina, it would sit up, it wouldn't lay on the tissue and that's the problem. That was the problem of the polypropylene mesh too. So yeah, so that's what the, I really think the large animal models are incredibly important.
kim_vopni (21:11.095)
Right, right.
kim_vopni (21:19.207)
Yeah, yes, yes.
kim_vopni (21:25.547)
Adjusting, okay.
caroline_gargett (21:32.456)
before you go into humans.
kim_vopni (21:34.378)
Yeah. So how long does that process takes, you know, from where you are now with the sheet vaginas? How long would it take until you could start applying this to potentially human trials?
caroline_gargett (21:40.942)
All right.
still a bit of a way away because we've in some ways we've started again because we've
doing the degradable measures. They've done a huge amount of sheep work here, and a lot of it's being analyzed at the moment. Also, we're preparing the cells in a way that keeps them undifferentiated. We have to expand them, because adult stem cells in a tissue are rare cells, so there's not many. And we expand those in culture, and then culture, they sort of lose their mesenchymal stem cell property. So we've developed a measure
kim_vopni (21:50.081)
Mm-hmm.
caroline_gargett (22:18.338)
method with a small molecule that keeps them undifferentiated and we've done a lot of analysing of that. So the cells are nearly ready. We're sort of in our last steps for the cells, probably about three or four years will be done with the cells and then the meshes are still being developed and then it's putting them together. So I think it might be more like five to ten years before we're ready.
kim_vopni (22:46.618)
Mm-hmm. Mm-hmm.
caroline_gargett (22:48.298)
slow and we have to really we have to do you know after the scandal of the mesh we really have to do a proper job and anyway there will have to be clinical trials so yeah.
kim_vopni (22:49.162)
Yes. Yeah.
kim_vopni (23:01.11)
Right, right, right, right. And in reading all the things that you're up to, one of the other things that you have is what you're calling a smart pessary. And I just think like, how, where are you finding the time to do all this amazing stuff? But can you tell us, was that something that came about as part of this journey with the stem cells? Was it something you had thought of before or where does it fit into the whole?
caroline_gargett (23:11.769)
All right.
caroline_gargett (23:26.64)
In actual fact it wasn't me that thought about it but it's a PhD student in our OBGYN department. I don't even supervise him. He's very entrepreneurial and he, so his idea is that to have a pessary that also stimulates the muscles.
the pelvic floor muscles at the same time. So then he's called me and Anna-Rosa Millie are in, because she's got to conduct the trials and questionnaires and all that type of thing. So I guess what's happening is that we've got a nucleus of people, of researchers here where we are at the Hudson, with the work that we've done bringing in Shayanti and bioengineers into the group, and she runs her own group now.
over in the OBGYN department and students who get good ideas, that was his light bulb moment, then they've got us to talk to and so you know they can more quickly develop things. So that's really how that came about. So yes, so I think that's what happens, you get this critical mass.
kim_vopni (24:26.305)
Mm-hmm.
kim_vopni (24:34.126)
Mm-hmm.
kim_vopni (24:37.867)
Yeah.
kim_vopni (24:41.354)
Yeah. And so is that in development now currently, or is there a model available or it's kind of the prototype?
caroline_gargett (24:44.796)
It is. It's very early prototypes and he's just got some funding that he's working on and there's a student working on it as well.
kim_vopni (24:50.102)
Okay.
kim_vopni (24:55.818)
Right, right. Interesting. Yeah, there's a couple, there's two other, one in Canada and one in the US who are making some headway with regards to innovation in the pessary space. Also with 3D printing and looking at individual anatomy and being able to make some customizations and that type of thing. So that's super interesting.
caroline_gargett (25:07.038)
Alright. Mm-hmm.
caroline_gargett (25:12.589)
Oh yes. Yep.
caroline_gargett (25:18.524)
Yes, and that's what you can do with 3D printing. You can off of the CT scans or you can actually match it to the using the engineering principles. You can actually design it so it's a perfect match. So initially that's not what Ritesh is doing. It would just be size of the pessary initially.
kim_vopni (25:35.746)
Yeah.
kim_vopni (25:43.254)
Right, right.
caroline_gargett (25:45.672)
But you know, that could be a possibility later down the track.
kim_vopni (25:49.002)
Yeah, yeah. And so I'm assuming he, and you may not know this, I don't know given that it's his kind of project he's working on now, but is, would the stimulation of the pelvic floor muscles be from e-STIM maybe that's incorporated into the pessary, or what would actually be contributing to the muscle function?
caroline_gargett (26:08.156)
Yeah, and that's probably the part I can't really tell you about because he's still got some IP issues there. But yeah, so he's doing something in the pessary that makes it able to stimulate.
kim_vopni (26:13.378)
Fair enough, yeah.
kim_vopni (26:18.794)
Yeah, yeah, fair enough. Okay. And when you think about, so what we've kind of been focusing on here is, is more the from a surgical correction perspective, is there any applicability to any of, uh, and back to your work here, any applicability from a prevention? So there's, you know, PRP and PRF is being used for stem cell therapy in the face and joints and vaginas everywhere. So is there,
Is these mesenchymal cells something we could be potentially using from a prevention or maintenance perspective as well?
caroline_gargett (26:52.857)
Yes, we do and we have a project in that area too because really the cause of prolapse really is vaginal birth.
particularly if you have forceps for example. And then if you happen to cough a lot or if you have constipation and you strain a lot on the toilet. And there's other things that come into play as well. So we're very keen on prevention because that's really the source of the problem. So the idea is that we were going to use the woman's own cells, possibly from the placenta or the endometrial ones,
kim_vopni (27:20.27)
Great, yep.
caroline_gargett (27:31.222)
can isolate too from the placenta, the ones that are in the maternal, the mother's part of the placenta, and they're actually derived from the endometrial mesenchymal stem cells. So the idea is then in the postpartum period, so before sometime around the time that they go back for the checkup to the obstetrician that we might inject them into the areas that are needed.
muscles, it could be the vagina wall. I'm not sure about the ligaments because that's fairly high up, but maybe they'd have a scan first and then you could be able to see. But this is, yeah, so the patient part, we've still got a bit of work to do, but we definitely have tried just inject, we've developed a sheep model, an anorak model of birth injury.
caroline_gargett (28:31.282)
the cells and to me that's much simpler than making a tissue engineering complex and that's where the hydrogels come in again or the bio inks, just a good injectable gel to inject them. So that is it and we've got, I think there's one publication and there's another one in the sheep model that's coming out relatively well. It's been hopefully this year.
kim_vopni (28:47.628)
Mm-hmm.
kim_vopni (29:02.526)
Yeah, it must be so hard with all of the, you know, our brains work fast and our ideas come fast and then the research is so slow to come. I can imagine how challenging it would be to sit and wait, hurry up and wait, as they say. But yeah, that is so fascinating. And I think I've often thought about what could we be doing in those early weeks, whether you've had vaginal birth or cesarean, but especially vaginal birth to help support the tissues, to help support the muscles.
caroline_gargett (29:15.217)
and
caroline_gargett (29:23.21)
Yes.
kim_vopni (29:30.694)
even with regards to prolapse, when I started learning about PRP and the vampire facials and all the things that people were using here, I kept thinking, what about the vagina? And then I started to see the O-Shot and now all these other therapists, sexual wellness doctors and regenerative medicine doctors who are using it for all sorts of practices. And I just think it's fascinating.
caroline_gargett (29:35.838)
Yeah.
caroline_gargett (29:51.488)
Mm, that's rough.
caroline_gargett (29:55.86)
That's right. I mean we haven't gone down the PRP route. We've used, there's a lot of growth factors and things that would promote angiogenesis, which is growth of blood vessels. But I think you'd have to give it on a regular basis.
what we're trying to do is using the cells is that hopefully some of them might incorporate or they really help the tissue itself, get the stem cells of the tissue itself, their own mesenchymal stem cells, to proliferate and just generate thicker and better tissue, so especially in the vagina and perhaps the pelvic floor muscles because they get overstretched as well. That's a big problem really.
kim_vopni (30:35.842)
Right, right, right.
caroline_gargett (30:46.918)
And you know, the vagina appears to have healed, but I think it can't really have healed sufficiently so that, you know, after the next birth and the next birth and then the aging and coughing and things like that, you get prolapse. So yeah, so that's where I think we need to sort of really focus on.
kim_vopni (31:12.575)
And if somebody had nerve damage from a vaginal birth or maybe even from a surgery or an accident and that was interfering with the capacity of the muscle, so the muscle is now losing tone and what have you, is that something again that could potentially come in and play a role in helping that aspect, that part of the muscle?
caroline_gargett (31:24.946)
time.
caroline_gargett (31:32.58)
Yeah, well, there's a lot of people looking at nerve because it grows very slowly and to get it reconnected properly back. If it's inflamed and that, cells would help with that type of thing. So that may be where it would help because things don't work very well when there's inflammation, not regeneration. We haven't done anything with nerves.
kim_vopni (31:54.21)
Right, right.
caroline_gargett (32:00.724)
But there's a lot of work in many different fields looking at that type of thing. But that would be the hope I think, is if we attacked it early or we treated early before the nerve is no good at all anymore. It does depend what's happened to it, whether it's been deprived of oxygen, as that baby's head's coming down, the nerve is so squashed.
that it doesn't recover. But that's where I think the cells would be very good, because if they're not yet dead. Ha ha.
Then I think they work and there's definitely in heart disease when they inject mesenchymal stem cells into the heart. They can do it in what they call the penumbra region. You know the heart attack's only small but it just spreads and in that prevents that spread. So I think it could work quite well with the pelvic floor muscles in that way.
kim_vopni (32:59.382)
Hmm, interesting.
kim_vopni (33:05.794)
Right, right. This is so fascinating and I really want the research to hurry up. So I will be watching closely, but thank you so much for your time and for this amazing work that you're doing and forwarding the options that people have for really debilitating conditions like prolapse. So thank you so much.
caroline_gargett (33:12.785)
I'm crying.
caroline_gargett (33:25.331)
Amen.
caroline_gargett (33:28.556)
Thank you to yourself, I've enjoyed talking with you. And also, it's really important to get the message out there, isn't it? Yeah, and people talking.
kim_vopni (33:36.49)
Yeah, yeah, absolutely. It's how the next, it'll change for the next generation is the more we talk and the more information we share. Yeah. Yes, exactly. Yeah, yeah. Thank you, Professor Garrett.
caroline_gargett (33:42.556)
Yes, I agree. I agree. You'll actually be able to say the word vagina, which some people just don't get. So there you go. Okay, bye bye.
