间充质干细胞治疗宫内粘连和子宫内膜异位症：潜力、机制和未来方向

摘要(中文译文)

宫腔粘连（IUA）和子宫内膜异位症是损害子宫内膜功能和生育能力的衰弱性妇科疾病。宫腔粘连通常由基底层子宫内膜的医源性创伤引起，导致纤维化和不孕；而子宫内膜异位症以子宫内膜异位生长为特征，引发慢性炎症、疼痛和生育力低下。目前的治疗方法，如宫腔粘连的手术粘连松解术和子宫内膜异位症的激素抑制治疗，往往无法解决潜在的病理机制，包括异常纤维化、炎症级联反应和组织再生受损。近年来，间充质干细胞（MSCs）已成为一种有前景的治疗方法。其治疗效益主要通过旁分泌作用介导，调节免疫反应、促进组织修复并减轻炎症和纤维化。近期研究进一步凸显了间充质干细胞来源外泌体（MSC-Exos）作为无细胞替代方案的潜力。在本综述中，我们全面总结了来自动物模型和临床研究的当前证据，涉及间充质干细胞及间充质干细胞来源外泌体在治疗宫腔粘连和子宫内膜异位症中的应用，重点关注其治疗潜力、作用机制和未来方向。我们还讨论了剩余挑战及克服这些挑战的有前景策略，从而将基于间充质干细胞的疗法定位为子宫内膜修复和疾病管理的变革性选择。

Abstract

Intrauterine adhesions (IUA) and endometriosis are debilitating gynecological disorders that impair endometrial function and fertility. IUA, typically caused by iatrogenic trauma to the basal endometrium, leads to fibrosis and infertility, whereas endometriosis, characterized by ectopic endometrial growth, induces chronic inflammation, pain, and subfertility. Current treatments, such as surgical adhesiolysis for IUA and hormonal suppression for endometriosis, frequently fail to address underlying pathological mechanisms, including aberrant fibrosis, inflammatory cascades, and impaired tissue regeneration. Recently, mesenchymal stem cells (MSCs) have emerged as a promising therapeutic approach. Their therapeutic benefits are mediated primarily through paracrine actions, which modulate immune responses, promote tissue repair, and attenuate inflammation and fibrosis. Recent studies have further highlighted the potential of MSC-derived exosomes (MSC-Exos) as a cell-free alternative. In this review, we comprehensively summarize current evidence from animal models and clinical studies on the application of MSCs and MSC-Exos in treating IUA and endometriosis, focusing on their therapeutic potential, mechanisms of action, and future directions. We also discuss remaining challenges and promising strategies to overcome them, thereby positioning MSC-based therapies as transformative options for endometrial restoration and disease management.

如何引用

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