Enhancing exosome stability and delivery with natural polymers to prevent intrauterine adhesions and promote endometrial regeneration: a review.

Intrauterine adhesions (IUAs) are defined as the formation of fibrotic scar tissue within the uterine cavity. They can lead to a range of complications, including hypomenorrhea, amenorrhea, infertility, and recurrent pregnancy loss. Conventional methods of adhesiolysis frequently demonstrate high recurrence rates and suboptimal therapeutic outcomes. Moreover, conventional postoperative IUA prevention strategies (e.g., physical barriers and hormonal therapy) are ineffective and have adverse effects, emphasizing the need for new therapies. Natural polymers are ideal biomaterials for barrier membranes and drug delivery in uterine repair due to their safety, biodegradability, and compatibility. Exosomes, tiny cell-released vesicles containing healing factors (like miRNAs and proteins), help reduce inflammation and scarring while promoting tissue regeneration. Emerging evidence suggests that combining natural polymers with exosomes could provide a potential therapeutic approach for IUAs and endometrial regeneration. This review presents a comprehensive overview of the biological characteristics of natural polymers and exosomes, elucidating their mechanisms of action in endometrial repair. It also provides an in-depth analysis of the current research landscape pertaining to the combined delivery of natural polymers and exosomes in the prevention of IUAs and the promotion of endometrial regeneration.