An update on stem cell therapy for Asherman syndrome

• Published in: Journal of assisted reproduction and genetics 2020-07, Vol.37 (7), p.1511-1529
• Main Authors: Benor, Ariel, Gay, Steven, DeCherney, Alan
• Format: Article
• Language: English
• Subjects: Adipose tissue; Amniotic Fluid - cytology; Animals; Antimicrobial activity; Biomarkers - metabolism; Bone marrow; Cell culture; Cell differentiation; Cell therapy; Cell- and Tissue-Based Therapy - methods; Chemokines; Clinical trials; Endometrium; Endometrium - pathology; Endometrium - physiology; Epithelial-Mesenchymal Transition; Female; Fibrosis; Gynatresia - pathology; Gynatresia - therapy; Gynecology; Human Genetics; Humans; Immune system; Injection; Medicine; Medicine & Public Health; Menstruation; Menstruation - blood; Mesenchymal Stem Cells - physiology; Placenta - cytology; Pregnancy; Regeneration; Reproductive Medicine; Review; Stem Cell Transplantation; Stem cells; Umbilical cord; Umbilical Cord - cytology; Uterus; Uterus - cytology
• ISSN: 1058-0468; 1573-7330
• DOI: 10.1007/s10815-020-01801-x

The current treatment for Asherman syndrome is limited and not very effective. The aim of this review is to summarize the most recent evidence for stem cells in the treatment of Asherman syndrome. The advent of stem cell therapy has propagated experimentation on mice and humans as a novel treatment. The consensus is that the regenerative capacity of stem cells has demonstrated improved outcomes in terms of fertility and fibrosis in both mice and humans with Asherman syndrome. Stem cells have effects on tissue repair by homing to the injured site, recruiting other cells by secreting chemokines, modulating the immune system, differentiating into other types of cells, proliferating into daughter cells, and potentially having antimicrobial activity. The studies reviewed examine different origins and administration modalities of stem cells. In preclinical models, therapeutic systemic injection of stem cells is more effective than direct intrauterine injection in regenerating the endometrium. In conjunction, bone marrow-derived stem cells have a stronger effect on uterine regeneration than uterine-derived stem cells, likely due to their broader differentiation potency. Clinical trials have demonstrated the initial safety and effectiveness profiles of menstrual, bone marrow, umbilical cord, and adipose tissue-derived stem cells in resumption of menstruation, fertility outcomes, and endometrial regeneration.