间充质干细胞及细胞外囊泡修复子宫内膜损伤

Mesenchymal stem cells and extracellular vesicles in repair of endometrial injury

背景:子宫内膜损伤是育龄期女性常见的良性疾病,严重影响女性的生育和生殖健康。近年来,间充质干细胞及其分泌的细胞外囊泡作为一种新的治疗策略,在子宫内膜损伤修复中备受关注。目的:综述间充质干细胞及其细胞外囊泡在子宫内膜损伤治疗中的应用,全面介绍子宫内膜损伤的发病机制、治疗效果,探讨间充质干细胞及细胞外囊泡治疗子宫内膜损伤的潜力与挑战,以期为进一步的基础和临床研究提供理论依据。方法:检索中国知网和中华医学全文数据库的中文文献,检索词为“间充质干细胞,间充质干细胞来源细胞外囊泡,外泌体,子宫内膜损伤,宫腔粘连,Asherman综合征”;检索PubMed数据库中的英文文献,英文检索词为“mesenchymal stem cells,extracellular vesicles derived from mesenchymal stem cells,exosome,endometrial injury,intrauterine adhesion,Asherman’s syndrome”,通过人工阅读的方法,排除重复文献或与子宫内膜损伤不相关的文献,最终纳入87篇文献。结果与结论:间充质干细胞及其细胞外囊泡能够通过多种分子机制参与子宫内膜损伤的修复,如抗纤维化、促进血管生成和细胞增殖、细胞归巢、免疫调节、内膜容受性调节等,细胞和动物实验已取得大量研究成果,临床研究的初步结果也取得了一定的疗效,包括增加子宫内膜厚度、改善月经量和生育能力。但是,间充质干细胞及其细胞外囊泡治疗子宫内膜损伤的应用研究仍面临着困难和挑战。在治疗过程中,需要进一步提高间充质干细胞及其细胞外囊泡的质量和稳定性,明确其在细胞增殖、迁移、分化等过程中的调控作用。此外,还需开展大规模、多中心的临床试验,以验证间充质干细胞及其细胞外囊泡在子宫内膜损伤修复中的长期安全性和有效性,并确定最佳的治疗剂量和给药途径。随着科学技术的进步和生物工程材料的辅助应用,未来有望解决上述难题,开发出疗效更好、安全性更高的治疗手段。

BACKGROUND:Endometrial injury is a common benign disease in women of reproductive age,which seriously affects their fertility and reproductive health.In recent years,mesenchymal stem cells and their secreted extracellular vesicles,as a new therapeutic strategy,have received much attention in the repair of endometrial injury.OBJECTIVE:To review the application of mesenchymal stem cells and their secreted extracellular vesicles in the treatment of endometrial injury,to comprehensively understand the therapeutic mechanism and efficacy of endometrial injury,and to discuss the potential and challenges of the application of mesenchymal stem cells and their secreted extracellular vesicles in the treatment of endometrial injury,in order to provide theoretical basis for further basic and clinical research.METHODS:Literature searches were conducted in the China National Knowledge Infrastructure(CNKI),Chinese Medical Full-text Database,and PubMed electronic databases using search terms“mesenchymal stem cells,extracellular vesicles derived from mesenchymal stem cells,exosome,endometrial injury,intrauterine adhesion,Asherman’s syndrome”in Chinese and English.Articles were selected through manual screening to exclude duplicates and irrelevant studies,resulting in the inclusion of 87 articles.RESULTS AND CONCLUSION:Mesenchymal stem cells and their secreted extracellular vesicles can participate in endometrial damage repair through a variety of molecular mechanisms,such as anti-fibrosis,promoting angiogenesis and cell proliferation,cell homing,immune regulation,and endometrial receptibility regulation.A large number of research results have been achieved in cell and animal experiments,and preliminary results of clinical studies have also achieved certain curative effects,including increased endometrial thickness,improved menstrual volume and fertility.However,difficulty and challenges persist in the application of mesenchymal stem cells and their secreted extracellular vesicles for endometrial injury treatment.During treatment,it is necessary to enhance the quality and stability of mesenchymal stem cells and their secreted extracellular vesicles,as well as clarifying their roles in processes such as cell proliferation,migration,and differentiation.Moreover,large-scale multicenter clinical trials are needed to validate the long-term safety and efficacy of mesenchymal stem cells and their secreted extracellular vesicles in endometrial repair,and to determine optimal dosages and administration routes.Continuous advancements in scientific technologies and the auxiliary application of bioengineering materials offer hope for developing more effective and safer therapeutic methods for endometrial injury treatment and the above problems will be solved in the future.