Autologous bone marrow-derived stem cell therapy for Asherman's syndrome and endometrial atrophy: A 5-year follow-up study

Singh, Neeta; Shekhar, Bhawani; Mohanty, Sujata; Kumar, Sunesh; Seth, Tulika; Girish, Bhavana

doi:10.4103/jhrs.jhrs_64_19

Cited by 24 publications

(31 citation statements)

References 20 publications

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“…In 2011, Nagori et al reported the rst case of AS treated with adult autologous SCs via intrauterine infusion for endometrial regeneration that resulted in conception after in vitro fertilization and embryo transfer (IVF-ET) (17). Eight clinical studies from six research centers have explored the effect of SCs in treating intrauterine adhesions and thin endometrium (17)(18)(19)(20)(21)(22)(23)(24), of which one was a case report and seven were prospective studies (Table 3). What distinguishes our study from other studies is the inclusion of patients.…”

Section: Discussionmentioning

confidence: 99%

“…These led us to further explore the use of stem cells to treat refractory thin endometrium (≤ 5.5mm) caused by AS in clinic. Compared with other existing clinical studies (17)(18)(19)(20)(21)(22)(23)(24), the characteristics of this study were that all patients included had no history of intrauterine adhesions at the time of enrollment, and endometrial thickness was still less than 5.5mm after traditional treatment and adjuvant treatment.…”

Section: Introductionmentioning

confidence: 99%

“…Loss of endometrial stem cells might be responsible for the regeneration failure and adhesion formation in patients with AS (13). Basic and clinical studies on the application of stem cells to treat intrauterine adhesions are well under way (14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24). Our team demonstrated that stem cells could restore injured endometrium and improve fertility of the endometrial injury mice, which was partially attributed to angiogenesis and proliferation and macrophage immunomodulation induced by SCs (25)(26)(27).…”

Section: Introductionmentioning

confidence: 99%

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Unresponsive Thin Endometrium Caused by Asherman Syndrome Treated With Umbilical Cord Mesenchymal Stem Cells: A Pilot Study

Zhang

Shi

Lin

et al. 2021

Preprint

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BackgroundUnresponsive thin endometrium caused by Asherman’s syndrome (AS) is the major cause of uterine infertility. However, current therapies are ineffective. This study is to evaluate the effect of transplantation with collagen scaffold/umbilical cord mesenchymal stem cells (CS/UC-MSCs) on this refractory disease.MethodsEighteen infertile women with unresponsive thin endometrium, whose frozen–thawed embryo transfers (FET) were cancelled due to reduced endometrial thickness (ET ≤ 5.5 mm), were enrolled in this before and after self-control prospective study. Hysteroscopic examination was performed to confirm no intrauterine adhesions, then ten million UC-MSCs loaded onto a CS were transplanted into the uterine cavity in two consecutive menstrual cycles. Then uterine cavity was assessed through hysteroscopy after two transplants. FET were performed in the following cycle. Pregnancy outcomes were followed-up. Endometrial thickness, uterine receptivity and endometrial angiogenesis, proliferation and hormone response were compared before and after treatment.ResultsSeventeen patients completed the study. No treatment-related serious adverse events occurred. Three months after transplantation, the average ET increased from 4.11 ± 1.01 mm to 5.87 ± 0.77 mm (P < 0.001). Three of 15 patients after FET got pregnant, of whom 2 gave birth successfully and 1 had a miscarriage at 25 weeks’ gestation. One of 2 patients without FET had a natural pregnancy at 36 weeks after transplantation. Immunohistochemical analysis showed increased micro-vessel density, upregulated expression of Ki67, estrogen receptor alfa and progesterone receptor, indicating an improvement in endometrial angiogenesis, proliferation, and response to hormones.ConclusionCS/UC-MSCs can promote the growth of unresponsive thin endometrium caused by AS, possibly through promoting endometrial proliferation and angiogenesis and enhancing the response of the endometrium to hormones.Trial RegistrationClinicalTrials.gov (NCT03724617). Registered 26 October 2018-prospectively registered, https://register.clinicaltrials.gov/

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Unresponsive Thin Endometrium Caused by Asherman Syndrome Treated With Umbilical Cord Mesenchymal Stem Cells: A Pilot Study

Zhang

Shi

Lin

et al. 2021

Preprint

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“…However, whether hormone treatment, following by the stem cell transplantation, played a major role in the combination therapy was proposed. Here, according to the selection criteria, all the patients enrolled in trails have received hysteroscopic adhesiolysis and hormone therapy previously, but has unsuccessful treatment outcome [ 21 – 23 ]. More importantly, every patient serves as their own control before and after transplanting stem cells.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, we found there is no between-study heterogeneity in 3-month follow-up and 9-month follow-up groups, but the heterogeneity became most obvious in the 6-month follow-up group, suggesting that the time effect may be one of the reasons affecting endometrial recovery. However, in this condition, the increase of endometrial thickness is prominent when compared with the nonstem cell treatment period [ 17 , 23 ]. Taken together, these studies support the generalisability of the observed beneficial effects of stem cell therapy in AS syndrome patients.…”

Section: Discussionmentioning

confidence: 99%

Clinical Efficacy and Safety of Stem Cell-Based Therapy in Treating Asherman Syndrome: A System Review and Meta-Analysis

Zhao

Luo

Zhang

et al. 2020

Stem Cells International

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Asherman’s Syndrome (AS) is an uncommon, acquired, and refractory gynecological disorder. Current treatment was still limited, and stem cell-based therapy has been proposed as a novel strategy for management of AS. Here, we conducted a meta-analysis of self-controlled clinical trials to assess the effectiveness and safety of stem cell-based therapy in Asherman syndrome patients who have failed in conventional treatment. We systematically searched PubMed, Embase, Cochrane, and Web of Science database (published up to October 3, 2020). Our main evaluation outcomes were menses improvement, endometrial thickness changes, pregnancy outcome, and side effects. All analyses were performed by using RevMan5.4 software. 427 studies were identified, eight of which were eligible and included in our analysis. Stem cell combined hormone therapy achieved a higher likelihood of improving menstruation (risk ratio [RR] 22.43, 95% CI: 8.03 to 62.68, P < 0.00001 ), an enhancement of pregnancy outcome (risk ratio [RR] 11.1, 95% CI: 3.58 to 34.38, P < 0.0001 ), and a mean increase of 3-month endometrial thickness (standardized mean difference [SMD] 2.43, 95% CI: 1.72 to 3.13, P < 0.00001 ). Subgroup analysis also indicated that 6-month and 9-month endometrial thickness increased significantly with the stem cell-based treatment. Moreover, no obvious and severe adverse reactions were observed during the process of stem cell therapy. There were 3 patients (3.57%) reported with lost appetite, mild gastritis, vomiting, or abdominal cramps, whereas, these symptoms relieved subsequently. This meta-analysis systematically reviewed and synthesized the outcomes of stem cell-based therapy in treating Asherman syndrome, which suggest that stem cell and hormone combination therapy was safe and more effective in improving menstruation duration, pregnancy outcome, and endometrial thickness. However, further trials with large sample sizes are needed to establish more solid evidence for administrating this therapy in clinic.

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Mechanistic insights into intrauterine adhesions

Zhao,

2024

Semin Immunopathol

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Autologous bone marrow-derived stem cell therapy for Asherman's syndrome and endometrial atrophy: A 5-year follow-up study

Cited by 24 publications

References 20 publications

Unresponsive Thin Endometrium Caused by Asherman Syndrome Treated With Umbilical Cord Mesenchymal Stem Cells: A Pilot Study

Unresponsive Thin Endometrium Caused by Asherman Syndrome Treated With Umbilical Cord Mesenchymal Stem Cells: A Pilot Study

Clinical Efficacy and Safety of Stem Cell-Based Therapy in Treating Asherman Syndrome: A System Review and Meta-Analysis

Mechanistic insights into intrauterine adhesions

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