Chen Xian, Chen Mingye, Liu Meng, Qi Lingbin, Liu Zhiqiang, Chen Cong, Liang Binfa, Yang Xiaobing, Zhang Tao, Li Yuye, Lian Ruochun
Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproductive Medicine and Genetics, Shenzhen Zhongshan Obstetrics and Gynecology Hospital, Shenzhen, China.
Guangdong Engineering Technology Research Center of Reproductive Immunology for Peri-implantation, Shenzhen, China.
Front Immunol. 2025 May 15;16:1528522. doi: 10.3389/fimmu.2025.1528522. eCollection 2025.
Chronic endometritis (CE) has been widely recognized as a potential cause of infertility, however, access to effective treatment is a formidable challenge due to the rudimentary understanding of the pathogenesis of persistent CE. Here, we aimed to analyze the impact of platelet-rich plasma (PRP) treatment on pregnancy outcomes and the endometrial microenvironment in patients with persistent CE.
A total of 89 infertility patients were selected, including 56 non-CE (as the control group) and 33 persistent CE. The persistent CE patients received an intrauterine infusion of PRP four times before embryo transfer. Immunohistochemistry staining and transcriptomic sequencing were used to investigate the uterine-specific role of PRP in patients with persistent CE.
The implantation rate and clinical pregnancy rate were significantly increased in the cured CE group compared to the non-cured CE group. After PRP treatment, the proportions of endometrial CD8 T cells, CD56 NK cells, Foxp3 Treg cells, and T-bet Th1 cells were significantly decreased in patients with persistent CE. Specifically, DEG analysis showed that genes implicated in endometrial receptivity-related and antimicrobial were upregulated and genes involved in the immune response processes were downregulated in cured CE patients after PRP treatment. Functional enrichment analysis suggested that the effects of changes in leukocyte chemotaxis-related genes played a critical role in the endometrial immune environment.
Autologous PRP treatment has been shown as a potentially successful therapy for improving pregnancy outcomes by reconstructing the uterine local immune microenvironment to improve endometrial receptivity in patients with persistent CE.
慢性子宫内膜炎（CE）已被广泛认为是不孕症的一个潜在原因，然而，由于对持续性CE发病机制的认识尚浅，获得有效的治疗是一项艰巨的挑战。在此，我们旨在分析富血小板血浆（PRP）治疗对持续性CE患者妊娠结局和子宫内膜微环境的影响。
共选取89例不孕症患者，其中56例非CE患者（作为对照组）和33例持续性CE患者。持续性CE患者在胚胎移植前接受4次宫腔内PRP输注。采用免疫组织化学染色和转录组测序研究PRP在持续性CE患者子宫中的特定作用。
与未治愈的CE组相比，治愈的CE组着床率和临床妊娠率显著提高。PRP治疗后，持续性CE患者子宫内膜CD8 T细胞、CD56 NK细胞、Foxp3调节性T细胞和T-bet Th?1细胞的比例显著降低。具体而言，差异基因分析显示，PRP治疗后治愈的CE患者中，与子宫内膜容受性相关和抗菌相关的基因上调，而参与免疫反应过程的基因下调。功能富集分析表明，白细胞趋化相关基因变化的影响在子宫内膜免疫环境中起关键作用。
自体PRP治疗已被证明是一种潜在成功的治疗方法，可通过重建子宫局部免疫微环境来提高持续性CE患者的子宫内膜容受性，从而改善妊娠结局。
