间充质干细胞靶向治疗早发性卵巢功能不全的现状及前景

The Current Status and Prospects of Mesenchymal Stem Cells in Targeted Therapy for Premature Ovarian Insufficiency

早发性卵巢功能不全(premature ovarian insufficiency,POI)既往又称卵巢早衰(premature ovarian failure,POF),是一种复杂的内分泌疾病,常见于40岁以下的女性。其特点是卵巢功能在40岁前停止,对女性生理及心理均有较大影响,最大的影响是导致不孕。目前可用于治疗POI的方法有限,而且往往效果不佳。干细胞移植是近年来国内外学者研究较多的一种新的治疗POI的方法,特别是对于有生育需求的POI女性来说,干细胞疗法是最终的治疗选择。迄今为止,用于POI治疗的最成熟的干细胞是间充质干细胞(mesenchymal stem cells,MSCs),其有效性已得到临床前和临床研究的证实,组织工程和干细胞治疗策略已成为恢复卵巢功能和改善POI女性生活质量的有前途的方法。该综述旨在全面综述POI的研究现状,重点阐述不同来源的MSCs用于治疗POI的临床应用进展及发展前景,包括骨髓来源、脐带来源、脂肪来源及经血来源的MSCs通过微创、靶向治疗后的效果,以及不同来源的MSCs对卵巢功能恢复的比较。此外,该文还讨论了模拟自然卵巢微环境并支持卵巢细胞、卵泡生长和成熟的生物材料及支架的开发,且强调了与组织工程和基于干细胞的POI治疗相关的挑战和伦理考虑,并提出了解决这些问题的潜在方案。

POI(premature ovarian insufficiency),also previously known as POF(premature ovarian failure),is a complex endocrine disease,which is common in women under 40 years old.Its characteristic is that the ovarian function stops before the age of 40,which has a greater impact on the female's physiology and psychology,and the biggest influence is to lead to infertility.At present,the methods that can be used to treat POI are limited,and the effect is often not good.Stem cell transplantation is a new method for the treatment of POI studied by scholars at home and abroad in recent years.Especially for female with POI in need of reprodution,stem cell therapy is the ultimate choice.To date,the most mature stem cell therapy for POI therapy is MSCs(mesenchymal stem cells),and its efficacy has been confirmed by preclinical and clinical studies.Tissue engineering and stem cell therapy strategies have become promising methods to restore ovarian function and improve the quality of life of female with POI.This review aims to comprehensively review the research status of POI,focusing on the progress and development prospect of MSCs from different sources for clinical application to treat POI,which includes efficacy of MSCs derived from bone marrow,umbilical cord,adipose and menstrual blood after minimally invasive targeted therapy,and the comparison of ovarian function recovery between different sources of MSCs.Additionally,this paper discusses the development of biomaterials and scaffolds that mimic the natural ovarian microenvironment and support the growth and maturation of ovarian cells and follicles.Furthermore,the review highlights the challenges and ethical considerations associated with tissue engineering and stem cell-based therapies for POI,and proposes potential solutions to address these issues.