The Latest Developments in Immunomodulation of Mesenchymal Stem Cells in the Treatment of Intrauterine Adhesions, Both Allogeneic and Autologous.

Jia-Ming Chen,Qi-Yang Shi,Shu Lin,Qiao-Yi Huang,Wei-Hong Chen,Yun-Xia Zhao

doi:10.3389/fimmu.2021.785717

Abstract

Intrauterine adhesion (IUA) is an endometrial fibrosis disease caused by repeated operations of the uterus and is a common cause of female infertility. In recent years, treatment using mesenchymal stem cells (MSCs) has been proposed by many researchers and is now widely used in clinics because of the low immunogenicity of MSCs. It is believed that allogeneic MSCs can be used to treat IUA because MSCs express only low levels of MHC class I molecules and no MHC class II or co-stimulatory molecules. However, many scholars still believe that the use of allogeneic MSCs to treat IUA may lead to immune rejection. Compared with allogeneic MSCs, autologous MSCs are safer, more ethical, and can better adapt to the body. Here, we review recently published articles on the immunomodulation of allogeneic and autologous MSCs in IUA therapy, with the aim of proving that the use of autologous MSCs can reduce the possibility of immune rejection in the treatment of IUAs.

Highlights

Intrauterine adhesion (IUA), known as Asherman syndrome, is condition involving endometrial fibrosis caused by damage to the basal layer of the uterus, leading to partial or full adhesion of the uterine cavity [1, 2]
Immune rejection is very common in allogeneic transplantation and is one of the top five causes of death in patients undergoing allogeneic transplantation [134]
Some scholars have proposed that allogeneic mesenchymal stem cells can still trigger immune rejection

Summary

INTRODUCTION

Intrauterine adhesion (IUA), known as Asherman syndrome, is condition involving endometrial fibrosis caused by damage to the basal layer of the uterus, leading to partial or full adhesion of the uterine cavity [1, 2]. Research has shown [19] that Mycobacterium tuberculosis infection of the uterine cavity can lead to focal ulceration, necrosis, or bleeding of the endometrial tissue, while destruction of the endometrium can cause partial or complete IUA. Another important reason is the insufficient endometrial blood perfusion [20]. The causes of microecological imbalance may be related to the long-term use of antibiotics, frequent sexual intercourse, vaginal flushing, and decreased estrogen These factors greatly increase the incidence of uterine inflammation. Studies have shown [31] that collagen scaffolds loaded with human umbilical cord mesenchymal stem cells can promote endometrial structural reconstruction and functional recovery (Table 1)

Background of Mesenchymal Stem Cells

Results

CONCLUSION AND PROSPECTIVE