Abstract
Asherman’s syndrome (AS) is characterized by intrauterine adhesion or fibrosis resulting from damage to the endometrium, often leading to amenorrhea, infertility, or recurrent pregnancy loss. Although various therapeutic strategies for AS have been proposed, the options remain limited. New strategies such as bone marrow-derived mesenchymal stem cell (BM-MSC) therapy aim to potentiate the intrinsic capacity of endometrial regeneration. However, BM-MSC therapy has not been widely adopted mainly because it involves invasive and expensive procedures such as bone marrow biopsy and cell storing. On the other hand, platelet-rich plasma (PRP) is considered safe and affordable because it involves the less invasive procedure of blood collection from peripheral veins to produce PRP. To assess the effectiveness of human PRP infusion for endometrial regeneration, we established a murine model of injury-induced AS and evaluated endometrial morphology, expression of fibrosis-related factors, implantation sites (IS), and pregnancy outcomes associated with human PRP treatment. We found that treatment with human PRP was associated with improved endometrial morphology, reduced degree of fibrosis, and down-regulated expression of fibrosis-related factors in murine model of AS. Furthermore, human PRP treatment was associated with a higher number of IS and live-births. Our results suggest that human PRP treatment may become a valuable strategy to promote the regeneration of damaged endometrium and thus improve fertility and pregnancy outcomes in clinical practice.
Highlights
The human endometrium undergoes cyclic regeneration and breakdown during the reproductive years of a woman’s life (Chan and Gargett, 2006; Masuda et al, 2010)
To evaluate the potential pharmacologic use of human platelet-rich plasma (PRP) in the clinical setting, we developed a murine model of Asherman’s syndrome (AS) and conducted histological, biological, and functional analysis to investigate whether human PRP administration could restore endometrial function and improve pregnancy outcomes
These results indicated that PRP promoted the recovery of endometrial structure and inhibited fibrosis after uterine horn injury
Summary
The human endometrium undergoes cyclic regeneration and breakdown during the reproductive years of a woman’s life (Chan and Gargett, 2006; Masuda et al, 2010). The basal layer is the source of endometrial reconstruction, giving rise to the new functional layer at monthly intervals (Chan and Gargett, 2006). There has been a growing interest in developing mesenchymal stem cell (MSC) therapy for refractory endometrium, as the presence of endometrial stem cells in the human endometrium is thought to play a role in endometrial regeneration (Mouhayar and Sharara, 2017). Bone marrow-derived MSC (BM-MSC) therapy has been shown to promote the reconstruction of murine and human endometrium (Gargett and Healy, 2011; Cervello et al, 2015; Mouhayar and Sharara, 2017). It is desirable to identify alternative treatment strategies that are safe, cost effective, and convenient for the patients
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