Retrospective analysis of autologous bone marrow mesenchymal stem cells as adjuvant therapy in recurrent intrauterine adhesions

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Abstract

Objectives

We aimed to retrospectively analyze the efficacy and safety of autologous bone marrow mesenchymal stem cells (BM-MSCs) as adjuvant therapy for intrauterine adhesion (IUA) and endometrial repair.

Methods

Patients enrolled at Shengjing Hospital Affiliated to China Medical University from January 2017 to January 2020 for the treatment of infertility who diagnosed with recurrent IUA as confirmed by hysteroscopy were included. BM-MSC was isolated from the patient’s own bone marrow collected before and preserved. The patients were admitted to the hospital for hysteroscopic transcervical resection of adhesions in the early proliferative phase of the menstrual cycle, given the first intrauterine perfusion of BM-MSCs on the same day of surgery and after surgery for the second and third perfusion on the fifth day of the menstrual cycle.After the third perfusion and improvement in the menstrual cycle, the patients were followed up once a year, for up to two years.

Result

All patients had menstrual bleeding and significantly increased menstrual flow during three rounds of perfusions with MSC compared to before treatment. However, this effect was reversed and there was no significant difference between the menstrual flow 1 year after treatment vs before treatment. The IUA scores after three rounds of treatment as well as one and two years after treatments were significantly lower compared to before surgery. No IUA recurrence was observed during the 2 year follow-up. Endometrial thickness had significantly increased during treatment. During the 2 year follow-up period, one patient conceived naturally. One patient was successfully implanted after in vitro fertilization and embryo transfer.

Conclusion

Intrauterine perfusion of autologous BM-MSCs, assisted by adhesiolysis, was effective in preventing postoperative IUA recurrence and partially improved the reproductive prognosis.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00404-025-07952-5.

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Most cited references 31

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The considerable therapeutic potential of human multipotent mesenchymal stromal cells (MSC) has generated markedly increasing interest in a wide variety of biomedical disciplines. However, investigators report studies of MSC using different methods of isolation and expansion, and different approaches to characterizing the cells. Thus it is increasingly difficult to compare and contrast study outcomes, which hinders progress in the field. To begin to address this issue, the Mesenchymal and Tissue Stem Cell Committee of the International Society for Cellular Therapy proposes minimal criteria to define human MSC. First, MSC must be plastic-adherent when maintained in standard culture conditions. Second, MSC must express CD105, CD73 and CD90, and lack expression of CD45, CD34, CD14 or CD11b, CD79alpha or CD19 and HLA-DR surface molecules. Third, MSC must differentiate to osteoblasts, adipocytes and chondroblasts in vitro. While these criteria will probably require modification as new knowledge unfolds, we believe this minimal set of standard criteria will foster a more uniform characterization of MSC and facilitate the exchange of data among investigators.

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Mesenchymal stem cells.

Shinn-Zong Lin, Dah-Ching Ding, Woei-Cherng Shyu (2010)

Stem cells have two features: the ability to differentiate along different lineages and the ability of self-renewal. Two major types of stem cells have been described, namely, embryonic stem cells and adult stem cells. Embryonic stem cells (ESC) are obtained from the inner cell mass of the blastocyst and are associated with tumorigenesis, and the use of human ESCs involves ethical and legal considerations. The use of adult mesenchymal stem cells is less problematic with regard to these issues. Mesenchymal stem cells (MSCs) are stromal cells that have the ability to self-renew and also exhibit multilineage differentiation. MSCs can be isolated from a variety of tissues, such as umbilical cord, endometrial polyps, menses blood, bone marrow, adipose tissue, etc. This is because the ease of harvest and quantity obtained make these sources most practical for experimental and possible clinical applications. Recently, MSCs have been found in new sources, such as menstrual blood and endometrium. There are likely more sources of MSCs waiting to be discovered, and MSCs may be a good candidate for future experimental or clinical applications. One of the major challenges is to elucidate the mechanisms of differentiation, mobilization, and homing of MSCs, which are highly complex. The multipotent properties of MSCs make them an attractive choice for possible development of clinical applications. Future studies should explore the role of MSCs in differentiation, transplantation, and immune response in various diseases.

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Author and article information

Contributors

Guang-Wei Wang:

ORCID: http://orcid.org/0000-0002-8337-4520

Wanggw1@sj-hospital.org

Journal

Journal ID (nlm-ta): Arch Gynecol Obstet

Journal ID (iso-abbrev): Arch Gynecol Obstet

Title: Archives of Gynecology and Obstetrics

Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )

ISSN (Print): 0932-0067

ISSN (Electronic): 1432-0711

Publication date (Electronic): 7 February 2025

Publication date PMC-release: 7 February 2025

Publication date (Print): 2025

Volume: 311

Issue: 3

Pages: 789-799

Affiliations

[1 ]Department of Obstetrics and Gynaecology, Shengjing Hospital Affiliated to China Medical University, ( https://ror.org/0202bj006) Shenyang, 110004 China

[2 ]Department of Pathophysiology, College of Basic Medical Science, China Medical University, ( https://ror.org/00v408z34) Taichung, China

[3 ]Shenyang Cell Therapy Engineering Technology R&D Center Co., Ltd, Shenyang, China

Author information

Guang-Wei Wang http://orcid.org/0000-0002-8337-4520

Article

Publisher ID: 7952

DOI: 10.1007/s00404-025-07952-5

PMC ID: 11919936

PubMed ID: 39918733

SO-VID: b7481014-ba2f-4f9b-9d6f-96da359dc378

License:

Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.

History

Date received : 26 June 2024

Date accepted : 10 January 2025

Custom metadata

ScienceOpen disciplines: Obstetrics & Gynecology

Keywords: amenorrhea,bone marrow mesenchymal stem cells,intrauterine adhesions,infertility,stem cell harvest

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ScienceOpen disciplines: Obstetrics & Gynecology

Keywords: amenorrhea, bone marrow mesenchymal stem cells, intrauterine adhesions, infertility, stem cell harvest

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Retrospective analysis of autologous bone marrow mesenchymal stem cells as adjuvant therapy in recurrent intrauterine adhesions

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Abstract

Objectives

Methods

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Conclusion

Supplementary Information

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Advocacy for Maternal and Women’s Health

Most cited references 31

Minimal criteria for defining multipotent mesenchymal stromal cells. The International Society for Cellular Therapy position statement.

Mesenchymal stem cells.

Assessment of menstrual blood loss using a pictorial chart.

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