Strug Michael, Aghajanova Lusine
Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, School of Medicine, Stanford University, Sunnyvale, CA 94087, USA.
J Pers Med. 2021 Dec 14;11(12):1364. doi: 10.3390/jpm11121364.
The uterus is a homeostatic organ, unwavering in the setting of monthly endometrial turnover, placental invasion, and parturition. In response to ovarian steroid hormones, the endometrium autologously prepares for embryo implantation and in its absence will shed and regenerate. Dysfunctional endometrial repair and regeneration may present clinically with infertility and abnormal menses. Asherman's syndrome is characterized by intrauterine adhesions and atrophic endometrium, which often impacts fertility. Clinical management of infertility associated with abnormal endometrium represents a significant challenge. Endometrial mesenchymal stem cells (MSC) occupy a perivascular niche and contain regenerative and immunomodulatory properties. Given these characteristics, mesenchymal stem cells of endometrial and non-endometrial origin (bone marrow, adipose, placental) have been investigated for therapeutic purposes. Local administration of human MSC in animal models of endometrial injury reduces collagen deposition, improves angiogenesis, decreases inflammation, and improves fertility. Small clinical studies of autologous MSC administration in infertile women with Asherman's Syndrome suggested their potential to restore endometrial function as evidenced by increased endometrial thickness, decreased adhesions, and fertility. The objective of this review is to highlight translational and clinical studies investigating the use of MSC for endometrial dysfunction and infertility and to summarize the current state of the art in this promising area.
子宫是一个稳态器官，在每月的子宫内膜更新、胎盘植入和分娩过程中保持稳定。子宫内膜会对卵巢甾体激素作出反应，自动为胚胎着床做好准备，若缺乏这些激素，子宫内膜就会脱落并再生。功能失调的子宫内膜修复和再生在临床上可能表现为不孕和月经异常。阿谢曼综合征的特征是宫腔粘连和子宫内膜萎缩，这往往会影响生育能力。与子宫内膜异常相关的不孕症的临床管理是一项重大挑战。子宫内膜间充质干细胞（MSC）占据血管周围微环境，具有再生和免疫调节特性。鉴于这些特性，已对子宫内膜来源和非子宫内膜来源（骨髓、脂肪、胎盘）的间充质干细胞进行了治疗目的的研究。在子宫内膜损伤动物模型中局部施用人类MSC可减少胶原蛋白沉积、改善血管生成、减轻炎症并提高生育能力。对患有阿谢曼综合征的不孕女性进行自体MSC给药的小型临床研究表明，它们有恢复子宫内膜功能的潜力，表现为子宫内膜厚度增加、粘连减少和生育能力提高。本综述的目的是强调研究MSC用于子宫内膜功能障碍和不孕症的转化研究和临床研究，并总结这一有前景领域的当前技术水平。
