Treatment strategies for intrauterine adhesion: focus on the exosomes and hydrogels

Fengling Wu; Ningjing Lei; Shenyu Yang; Junying Zhou; Mengyu Chen; Cheng Chen; Luojie Qiu; Ruixia Guo; Yong Li; Lei Chang

doi:10.3389/fbioe.2023.1264006

Treatment strategies for intrauterine adhesion: focus on the exosomes and hydrogels

Front Bioeng Biotechnol. 2023 Aug 31:11:1264006. doi: 10.3389/fbioe.2023.1264006. eCollection 2023.

Authors

Fengling Wu^#¹, Ningjing Lei^#², Shenyu Yang³, Junying Zhou¹, Mengyu Chen¹, Cheng Chen⁴, Luojie Qiu¹, Ruixia Guo¹, Yong Li⁵, Lei Chang¹

Affiliations

¹ Department of Obstetrics and Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
² School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, Henan, China.
³ Medical 3D Printing Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
⁴ Department of Gynaecology and Obstetrics, Chongqing General Hospital, Chongqing, China.
⁵ St George and Sutherland Clinical Campuses, School of Clinical Medicine, UNSW Sydney, Kensington, NSW, Australia.

^# Contributed equally.

Abstract

Intrauterine adhesion (IUA), also referred to as Asherman Syndrome (AS), results from uterine trauma in both pregnant and nonpregnant women. The IUA damages the endometrial bottom layer, causing partial or complete occlusion of the uterine cavity. This leads to irregular menstruation, infertility, or repeated abortions. Transcervical adhesion electroreception (TCRA) is frequently used to treat IUA, which greatly lowers the prevalence of adhesions and increases pregnancy rates. Although surgery aims to disentangle the adhesive tissue, it can exacerbate the development of IUA when the degree of adhesion is severer. Therefore, it is critical to develop innovative therapeutic approaches for the prevention of IUA. Endometrial fibrosis is the essence of IUA, and studies have found that the use of different types of mesenchymal stem cells (MSCs) can reduce the risk of endometrial fibrosis and increase the possibility of pregnancy. Recent research has suggested that exosomes derived from MSCs can overcome the limitations of MSCs, such as immunogenicity and tumorigenicity risks, thereby providing new directions for IUA treatment. Moreover, the hydrogel drug delivery system can significantly ameliorate the recurrence rate of adhesions and the intrauterine pregnancy rate of patients, and its potential mechanism in the treatment of IUA has also been studied. It has been shown that the combination of two or more therapeutic schemes has broader application prospects; therefore, this article reviews the pathophysiology of IUA and current treatment strategies, focusing on exosomes combined with hydrogels in the treatment of IUA. Although the use of exosomes and hydrogels has certain challenges in treating IUA, they still provide new promising directions in this field.

Keywords: 3D printing; exosome; hydrogel; intrauterine adhesion; treatment.

Publication types

Review

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This work was supported by Henan Provincial Medical Science and Technology Research Plan Joint Provincial and Ministry Youth Project (No. SB201902013), Scientific and Technological Project of Henan Province (No. 192102310069), Henan Province University Major Research Project (22A320055), Henan Province Colleges and Universities Innovative Talent Support Program (No. 21HASTIT044), Henan Medical Education Research Project (No. Wjlx2020062), Henan Youth Talent Promotion Project (No. 2020HYTP052), Henan Province Young and Middle-aged Health Science and Technology Innovative Talent Training Project (No. YXKC2020039), Central Plains Youth Top Talent Project (ZYYCYU202012169), Young and middle-aged subject leader of Henan Provincial Health Commission (HNSWJW-2022001).