Release date: 2017-09-08

Intrauterine adhesions, also known as Asherman syndrome, is a common endometrial injury disease that occurs between the intrauterine and cervical canal and the cervical canal after multiple factors cause endometrial damage to the lining of the cervix and the cervix. Formed by sticking to each other. For example, artificial abortion or spontaneous abortion curettage produces intrauterine adhesions. Intrauterine adhesions are often accompanied by one or more symptoms such as menstrual reduction, amenorrhea, repeated abortion, infertility, and abnormal placental formation.

With the frequent intrauterine operation and the popularity of hysteroscopic surgery, the incidence and detection rate of intrauterine adhesions have increased year by year, becoming the second leading cause of female secondary infertility [1]. Because intrauterine adhesions affect the implantation and growth of embryos, even mild intrauterine adhesions can trigger primary or secondary infertility. The latest statistics show that 20% to 40% of infertility in China is caused by female endometrial damage [2]. Severe endometrial damage leads to severe uterine adhesions and was once thought to be a "critical disease" leading to infertility.

The purpose of clinical treatment is to restore the normal morphology of the uterine cavity, prevent adhesion recurrence, repair the damaged endometrium, and restore normal reproductive function. Currently, traditional treatment strategies for intrauterine adhesions include intrauterine adhesion separation, prevention of re-adhesion, repair of the endometrium, and postoperative evaluation. However, traditional treatment methods such as hysteroscopic surgery, intrauterine device, uterine balloon stent, bio-gel, estrogen, etc. have clinical limitations. Especially for patients with severe or extensive endometrial damage, endometrial regeneration and functional recovery have become a clinically difficult problem [3].

With the extensive research of stem cells in the field of regenerative medicine, stem cells provide new ideas for the treatment of intrauterine adhesions, and significant progress has been made in clinical research. With the further development of the research, future stem cells are expected to solve the thorny problem of clinical treatment of intrauterine adhesions, and overcome the "endiac disease" that leads to infertility.

Progress in stem cell therapy for intrauterine adhesions

Stem cells have been used in clinical research to treat intrauterine adhesions for many years, and research cases are increasing year by year. The endometrium is a dynamic, circulating, regenerative tissue that generates new blood vessels by utilizing local endothelial cells in adjacent blood vessels or releasing bone marrow endothelial progenitor cells in peripheral blood. A large body of evidence indicates that there are adult stem cell populations in human endometrium. Not only endogenous endometrial stem/progenitor cells can activate endometrial regeneration in patients with intrauterine adhesions, but stem cell transplantation can also be used for endometrial regeneration [4] ].

In 2011, a case published in the journal J Hum Reprod Sci. used autologous bone marrow stem cells to achieve endometrial regeneration. Patients with intrauterine adhesions were successfully conceived after receiving stem cell therapy.

In this case, a patient with severe intrauterine adhesions was treated with a 6-month intrauterine device after a curettage to promote endometrial development. However, this treatment has not been effective. Finally, the research team used autologous stem cell therapy for treatment.

They first extracted autologous stem cells from the patient's bone marrow and used immunomagnetic beads to separate stem cells that produce endometrial blood vessels. These stem cells are transplanted into the endometrial cavity under ultrasound guidance after curettage, and patients are given periodic hormone therapy. After treatment, the patient underwent intermittent endometrial testing. It was found that after receiving stem cell treatment, the patient's endometrial thickness increased by 8 mm and a good blood vessel was formed. Through IVF technology, the patient successfully conceived.

This case shows that stem cell therapy is expected to be an effective treatment for intrauterine adhesions, but more clinical trials are needed to verify.

In 2014, another case in J Hum Reprod Sci. evaluated the effectiveness of autologous stem cell transplantation in the treatment of intrauterine adhesions [6].

Six patients with refractory intrauterine adhesions underwent standard treatment failure, received mononuclear stem cell transplantation, and received oral exogenous estrogen therapy, and were tested for endometrial thickness after 3, 6 and 9 months of treatment. The results showed that after receiving stem cell transplantation, the endometrial thickness of 6 patients was significantly higher than that before treatment, and 5 of them recovered the menstrual cycle and the endometrial regeneration was good. This case shows that autologous stem cell transplantation is a promising treatment for intrauterine adhesions.

Then share two domestic cases. The research team of the People's Liberation Army Naval General Hospital also reported a case of autologous mesenchymal stem cell transplantation for the treatment of intrauterine adhesions in the American Journal of Obstetrics and Gynecology. The patient underwent stem cell transplantation after undergoing hysteroscopic uterine adhesion separation combined with periodic hormone replacement therapy. The researchers transplanted autologous mesenchymal stem cells into the patient's endometrium under ultrasound guidance and given a three-month periodic hormone therapy. Ultrasound evaluation revealed that the patient recovered partially after endometrium after stem cell transplantation.

The Center for Regenerative Medicine of the Chinese Academy of Sciences and the Nanjing Gulou Hospital have cooperated for 10 years in the field of intrauterine adhesion stem cell therapy, and have carried out a large number of basic and animal experiments. After the success of the animal test, in 2013, the research team carried out a clinical study of endometrial regeneration in Nanjing Gulou Hospital, using patients with autologous bone marrow stem cells or umbilical cord mesenchymal stem cells to functionalize the severely damaged endometrium. repair. To date, 13 patients with severe intrauterine adhesions to infertility have successfully conceived and delivered through this clinical trial. A total of 14 healthy babies were born.

Outlook

Scientific research has confirmed that mesenchymal stem cells can effectively repair the endometrium of patients with intrauterine adhesions and improve fertility. In recent years, in addition to bone marrow-derived mesenchymal stem cells, more and more studies have begun to use placenta or umbilical cord mesenchymal stem cells. Placental mesenchymal stem cells are not only rich in source, easy to collect, separate and proliferate, and have no foreign body rejection, which is an ideal medical resource.

Stem cell transplantation has brought about a breakthrough in the treatment of intrauterine adhesions, and has successfully helped some infertile patients achieve their fertility desires. At present, there is still a lot of research at home and abroad. Boya Holding Group is working with a number of top three hospitals to conduct clinical research on stem cell therapy for intrauterine adhesions through the Wu Jieping Foundation. I believe that in the future, stem cells will make greater progress in the treatment of intrauterine adhesions.

references

[1] Research progress of stem cells in the treatment of intrauterine adhesions, International Journal of Obstetrics and Gynecology 2014, Issue 06

[2] Yangguang.com: Chinese Academy of Sciences Stem Cell Endometrial Regeneration Technology Birth Baby gathers in Nanjing

[3] Progress in the treatment of intrauterine adhesions, Journal of Reproductive Medicine 2015-01

[4] Taylor HS. Endometrial cells derived from donor stem cells in bone marrow transplant recipients. JAMA 2004;292:81-5.

[5]Endometrial regeneration using autologous adult stem cells followed by conception by in vitrofertilization in a patient of severe Asherman's syndrome, DOI:10.4103/0974-1208.82360

[6]Autologous stem cell transplantation in refractory Asherman's syndrome: A novel cell based therapy.DOI:10.4103/0974-1208.138864

Source: Boya stem cells (micro signal benboyalife)

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