Our findings indicate that birth injury in ewes leads to disruptions in collagen structure, smooth muscle cells, and elastin content within vaginal tissue. However, treatment with AV-ALG-Hyd combined with SUSD2+ eMSC following simulated injury appeared to reverse these changes. Tissue analysis showed a trend of increased α-Smooth Muscle Actin (αSMA) expression in the hydrogel + eMSC group at 90 days, suggesting potential benefits in preserving smooth muscle integrity. Additionally, elastin levels were maintained at both 30 and 90 days across all groups, highlighting the positive effects of AV-ALG-Hyd and eMSC in supporting tissue elasticity. Our ongoing assessments are looking at measurement of differential gene expression in Vegfa, Pdgfrb, Fgf1, Fgf2, Pecam, Ki67, Fibulin5, Timp1, Timp2, Mmp9, Cdh1, Icam1, Col1a1, Col3a1 as well as gene associated with innate and adaptive immune response Cd80, Arg1, Cd68, Nlrp3, Mrc1, Il4r, Il3r, Cd19, Cd4Il2, Il23ccl5, Cd40.