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Review
. 2023 Aug 31:11:1264006.
doi: 10.3389/fbioe.2023.1264006. eCollection 2023.

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

Fengling Wu #  1 , Ningjing Lei #  2 , Shenyu Yang  3 , Junying Zhou  1 , Mengyu Chen  1 , Cheng Chen  4 , Luojie Qiu  1 , Ruixia Guo  1 , Yong Li  5 , Lei Chang  1
Affiliations
Review

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

Fengling Wu et al. Front Bioeng Biotechnol. .

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.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Schematic description of an overview of exosomes and hydrogel in the treatment of IUA. Exosomes are loaded on hydrogels and the mixture is injected into the uterine cavity to continuously release exosomes at the injured site to play a therapeutic role. The potential mechanisms of treatment in IUA are described: (a) anti-inflammatory, (b) promotion of angiogenesis, and (c) promotion of endometrial cell proliferation.
FIGURE 2
FIGURE 2
The model diagram of exosomes combined with hydrogels therapy for IUA is as follows: (A). After the endometrial and stroma were damaged, inflammatory cells infiltrated, collagen fibers replaced normal tissues, the number of glands and blood vessels was reduced and bacteria polluted; (B). After the injection of exosomes and hydrogels, the uterus began to repair, and endometrial progenitor cells migrated to the injured site and differentiated into epithelial cells and stromal cells, and inflammatory cells played an anti-inflammatory role to promote tissue repair and increase angiogenesis; (C). Uterine cavity returned to normal.
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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).