Hellström Mats, Bandstein Sara, Brännström Mats
Laboratory for Transplantation and Regenerative Medicine, Department of Obstetrics and Gynecology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
, Kvinnokliniken, Blå stråket 6, 413 45, Göteborg, Sweden.
Ann Biomed Eng. 2017 Jul;45(7):1718-1730. doi: 10.1007/s10439-016-1776-2. Epub 2016 Dec 19.
The recent successful births following live donor uterus transplantation are proof-of-concept that absolute uterine factor infertility is a treatable condition which affects several hundred thousand infertile women world-wide due to a dysfunctional uterus. This strategy also provides an alternative to gestational surrogate motherhood which is not practiced in most countries due to ethical, religious or legal reasons. The live donor surgery involved in uterus transplantation takes more than 10 h and is then followed by years of immunosuppressive medication to prevent uterine rejection. Immunosuppression is associated with significant adverse side effects, including nephrotoxicity, increased risk of serious infections, and diabetes. Thus, the development of alternative approaches to treat absolute uterine factor infertility would be desirable. This review discusses tissue engineering principles in general, but also details strategies on how to create a bioengineered uterus that could be used for transplantation, without risky donor surgery and any need for immunosuppression. We discuss scaffolds derived from decellularized organs/tissues which may be recellularized using various types of autologous somatic/stem cells, in particular for uterine tissue engineering. It further highlights the hurdles that lay ahead in developing an alternative to an allogeneic source for uterus transplantation.
近期活体供体子宫移植后成功分娩证明了一个概念，即绝对子宫因素不孕症是一种可治疗的疾病，全球有数十万不孕女性受子宫功能障碍影响。这种策略也为妊娠代孕提供了一种替代方案，由于伦理、宗教或法律原因，大多数国家并未实行代孕。子宫移植所涉及的活体供体手术耗时超过10小时，术后还需多年服用免疫抑制药物以防止子宫排斥。免疫抑制会带来显著的不良副作用，包括肾毒性、严重感染风险增加以及糖尿病。因此，开发治疗绝对子宫因素不孕症的替代方法是可取的。本综述总体讨论了组织工程原理，还详细阐述了如何创建可用于移植的生物工程子宫的策略，无需进行有风险的供体手术且无需任何免疫抑制。我们讨论了源自脱细胞器官/组织的支架，这些支架可使用各种类型的自体体细胞/干细胞进行重新细胞化，特别是用于子宫组织工程。它还进一步强调了在开发子宫移植异体来源替代方案方面面临的障碍。
