Abstract
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.
Highlights
The endometrium is both unique and fascinating in its ability to undergo regular cycles of growth, followed by vasoconstriction, hypoxia, cell death, tissue desquamation, shedding, followed by scar-less wound healing and regeneration, with angiogenesis serving an essential role [1,2,3,4]
While the process of endometrial repair is overall efficient, significant insults to the regenerating layer of endometrium can result in endometrial pathologies such as intrauterine adhesions or endometrial atrophy, clinically presenting as oligomenorrhea/amenorrhea, infertility, and pregnancy loss [6]
These patients are typically referred to fertility clinics, the issues are most frequently encountered by infertility specialists
Summary
The endometrium is both unique and fascinating in its ability to undergo regular cycles of growth, followed by vasoconstriction, hypoxia, cell death, tissue desquamation, shedding, followed by scar-less wound healing and regeneration, with angiogenesis serving an essential role [1,2,3,4]. While the process of endometrial repair is overall efficient, significant insults to the regenerating layer of endometrium can result in endometrial pathologies such as intrauterine adhesions or endometrial atrophy, clinically presenting as oligomenorrhea/amenorrhea, infertility, and pregnancy loss [6]. These patients are typically referred to fertility clinics, the issues are most frequently encountered by infertility specialists. Asherman’s Syndrome (AS) represents the most notable and well-characterized clinical condition associated with endometrial dysfunction and resulting intrauterine adhesions. Endometrial cells in AS lose their responsiveness to estrogen and progesterone, suggesting a functional deficit in addition to the physical impact of adhesions [5]
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