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Song M, Ma L, Zhu Y, Gao H, Hu R. Umbilical cord mesenchymal stem cell-derived exosomes inhibits fibrosis in human endometrial stromal cells via miR-140-3p/FOXP1/Smad axis. Sci Rep 2024; 14:8321. [PMID: 38594471 PMCID: PMC11004014 DOI: 10.1038/s41598-024-59093-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 04/08/2024] [Indexed: 04/11/2024] Open
Abstract
Endometrial fibrosis is the histologic appearance of intrauterine adhesion (IUA). Emerging evidences demonstrated umbilical cord mesenchymal stem cell-derived exosomes (UCMSC-exo) could alleviate endometrial fibrosis. But the specific mechanism is not clear. In this study, we explored the effect of UCMSC-exo on endometrial fibrosis, and investigated the possible role of miR-140-3p/FOXP1/Smad axis in anti-fibrotic properties of UCMSC-exo. UCMSC-exo were isolated and identified. Transforming growth factor-β (TGF-β) was used to induce human endometrial stromal cell (HESC) fibrosis. Dual luciferase assay was performed to verify the relationship between miR-140-3p and FOXP1. The expressions of fibrotic markers, SIP1, and p-Smad2/p-Smad3 in HESCs stimulated with UCMSC-exo were detected by western blot. In addition, the effects of miR-140-3p mimic, miR-140-3p inhibitor and FOXP1 over-expression on endometrial fibrosis were assessed. The isolated UCMSC-exo had a typical cup-shaped morphology and could be internalized into HESCs. The expressions of fibrotic markers were significantly increased by TGF-β, which was reversed by UCMSC-exo. MiR-140-3p in UCMSC-exo ameliorated TGf-β-induced HESCs fibrosis. FOXP1 was identified as the direct target of miR-140-3p, which could inversely regulate miR-140-3p's function on HESCs fibrosis. Furthermore, we demonstrated that miR-140-3p in UCMSC-exo regulated Smad signal pathway to exert the anti-fibrotic effect in HESCs. The anti-fibrotic effect of UCMSC-derived exosomes against HESC fibrosis was at least partially achieved by miR-140-3p/FOXP1/Smad axis.
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Affiliation(s)
- Mengling Song
- Department of Reproductive Medicine, General Hospital of Ningxia Medical University (The First Clinical Medical College of Ningxia Medical University), 804 Shengli Street, Xingqing Square, Yinchuan, 750004, Ningxia, China.
| | - Lijun Ma
- Department of Human Anatomy, Histology and Embryology, School of Basic Medicine, Ningxia Medical University, Yinchuan, 750004, Ningxia, China
| | - Yongzhao Zhu
- Institute of Medical Sciences, General Hospital of Ningxia Medical University, Yinchuan, 750004, Ningxia, China
| | - Huimin Gao
- General Hospital of Ningxia Medical University (the First Clinical Medical College of Ningxia Medical University), Yinchuan, 750004, Ningxia, China
| | - Rong Hu
- Department of Reproductive Medicine, General Hospital of Ningxia Medical University (The First Clinical Medical College of Ningxia Medical University), 804 Shengli Street, Xingqing Square, Yinchuan, 750004, Ningxia, China.
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Zhu H, Li T, Xu P, Ding L, Zhu X, Wang B, Tang X, Li J, Zhu P, Wang H, Dai C, Sun H, Dai J, Hu Y. Effect of autologous bone marrow stem cells-scaffold transplantation on the ongoing pregnancy rate in intrauterine adhesion women: a randomized, controlled trial. SCIENCE CHINA. LIFE SCIENCES 2024; 67:113-121. [PMID: 37751064 DOI: 10.1007/s11427-023-2403-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 06/20/2023] [Indexed: 09/27/2023]
Abstract
Intrauterine adhesion is a major cause of female reproductive disorders. Although we and others uncontrolled pilot studies showed that treatment with autologous bone marrow stem cells made a few patients with severe intrauterine adhesion obtain live birth, no large sample randomized controlled studies on this therapeutic strategy in such patients have been reported so far. To verify if the therapy of autologous bone marrow stem cells-scaffold is superior to traditional treatment in moderate to severe intrauterine adhesion patients in increasing their ongoing pregnancy rate, we conducted this randomized controlled clinical trial. Totally 195 participants with moderate to severe intrauterine adhesion were screened and 152 of them were randomly assigned in a 1:1 ratio to either group with autologous bone marrow stem cells-scaffold plus Foley balloon catheter or group with only Foley balloon catheter (control group) from February 2016 to January 2020. The per-protocol analysis included 140 participants: 72 in bone marrow stem cells-scaffold group and 68 in control group. The ongoing pregnancy occurred in 45/72 (62.5%) participants in the bone marrow stem cells-scaffold group which was significantly higher than that in the control group (28/68, 41.2%) (RR=1.52, 95%CI 1.08-2.12, P=0.012). The situation was similar in live birth rate (bone marrow stem cells-scaffold group 56.9% (41/72) vs. control group 38.2% (26/68), RR=1.49, 95%CI 1.04-2.14, P=0.027). Compared with control group, participants in bone marrow stem cells-scaffold group showed more menstrual blood volume in the 3rd and 6th cycles and maximal endometrial thickness in the 6th cycle after hysteroscopic adhesiolysis. The incidence of mild placenta accrete was increased in bone marrow stem cells-scaffold group and no severe adverse effects were observed. In conclusion, transplantation of bone marrow stem cells-scaffold into uterine cavities of the participants with moderate to severe intrauterine adhesion increased their ongoing pregnancy and live birth rates, and this therapy was relatively safe.
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Affiliation(s)
- Hui Zhu
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210008, China
| | - Taishun Li
- Department of Biostatistics, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210008, China
| | - Peizhen Xu
- Department of Gynecology, Changzhou Maternal and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, 213004, China
| | - Lijun Ding
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210008, China
| | - Xianghong Zhu
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210008, China
| | - Bin Wang
- Clinical Center for Stem Cell Research, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210008, China
| | - Xiaoqiu Tang
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210008, China
| | - Juan Li
- Department of Hematology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210008, China
| | - Pengfeng Zhu
- Department of Gynecology, Changzhou Maternal and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, 213004, China
| | - Huiyan Wang
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210008, China
| | - Chenyan Dai
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210008, China
| | - Haixiang Sun
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210008, China.
| | - Jianwu Dai
- Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, Beijing, 100190, China.
| | - Yali Hu
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210008, China.
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Schmerold L, Martin C, Mehta A, Sobti D, Jaiswal AK, Kumar J, Feldberg I, Munro MG, Lee WC. A cost-effectiveness analysis of intrauterine spacers used to prevent the formation of intrauterine adhesions following endometrial cavity surgery. J Med Econ 2024; 27:170-183. [PMID: 38131367 DOI: 10.1080/13696998.2023.2298584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 12/20/2023] [Indexed: 12/23/2023]
Abstract
AIM To assess, from a United States (US) payer's perspective, the cost-effectiveness of gels designed to separate the endometrial surfaces (intrauterine spacers) placed following intrauterine surgery. MATERIALS AND METHODS A decision tree model was developed to estimate the cost-effectiveness of intrauterine spacers used to facilitate endometrial repair and prevent the formation (primary prevention) and reformation (secondary prevention) of intrauterine adhesions (IUAs) and associated pregnancy- and birth-related adverse outcomes. Event rates and costs were extrapolated from data available in the existing literature. Sensitivity analyses were conducted to corroborate the base case results. RESULTS In this model, using intrauterine spacers for adhesion prevention led to net cost savings for US payers of $2,905 per patient over a 3.5-year time horizon. These savings were driven by the direct benefit of preventing procedures associated with IUA formation ($2,162 net savings) and the indirect benefit of preventing pregnancy-related complications often associated with IUA formation ($3,002). These factors offset the incremental cost of intrauterine spacer use of $1,539 based on an assumed price of $1,800 and the related increase in normal deliveries of $931. Model outcomes were sensitive to the probability of preterm and normal deliveries. Budget impact analyses show overall cost savings of $19.96 per initial member within a US healthcare plan, translating to $20 million over a 5-year time horizon for a one-million-member plan. LIMITATIONS There are no available data on the effects of intrauterine spacers or IUAs on patients' quality of life. Resultingly, the model could not evaluate patients' utility related to treatment with or without intrauterine spacers and instead focused on costs and events avoided. CONCLUSION This analysis robustly demonstrated that intrauterine spacers would be cost-saving to healthcare payers, including both per-patient and per-plan member, through a reduction in IUAs and improvements to patients' pregnancy-related outcomes.
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Affiliation(s)
| | | | | | | | | | | | | | - Malcolm G Munro
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Dan J, Cao Y. Yangmo decoction versus hyaluronic acid gel in women with intrauterine re-adhesion after hysteroscopic adhesiolysis: a retrospective efficacy and safety analysis. BMC Womens Health 2023; 23:480. [PMID: 37689637 PMCID: PMC10493015 DOI: 10.1186/s12905-023-02598-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 08/10/2023] [Indexed: 09/11/2023] Open
Abstract
BACKGROUND Hysteroscopic adhesiolysis is the preferred primary method for intrauterine adhesion. However, there is about a 60% of chance of re-adhesion after surgery. The objectives of the study were to evaluate the efficacy and safety of Yangmo decoction as a secondary treatment in preventing intrauterine re-adhesion against those of hyaluronic acid gel. METHODS Women received oral Yangmo decoction (YD cohort, n = 105) or intrauterine hyaluronic acid gel (HA cohort, n = 125) or did not receive secondary re-adhesion prevention treatments (EP cohort, n = 165) after hysteroscopic adhesiolysis for 6 months. In addition, all women have received 3 mg of oral estrogen and 20 mg oral progesterone combination after hysteroscopic adhesiolysis for 3 months. Intrauterine re-adhesion after hysteroscopic adhesiolysis after 6 months with or without secondary treatment(s) was detected using hysteroscopy. The extent of the cavity, type of adhesion, and the menstrual pattern were included to define the American Fertility Society classification of intrauterine re-adhesions (AFS) score. RESULTS Fewer numbers of women suffered from intrauterine re-adhesion after hysteroscopic adhesiolysis in the YD cohort than those of the HA (15(14%) vs. 40(32%), p = 0.0019) and the EP (15(14%) vs. 58(35%). p = 0.0001) cohorts. Among women who developed intrauterine re-adhesion, AFS score was fewer for women of the YD cohort than those of HA (2(2-1) vs. 4(4-3), p < 0.001) and the EP (2(2-1) vs. 4(4-4), p < 0.001) cohorts. AFS score after surgery was fewer for women of the HA cohort than those of the EP cohort (p < 0.05). Higher numbers of women of the YD cohort retained pregnancies after 6-months of treatment than those of the HA (55(52%) vs. 45(36%), p = 0.0161) and EP (55(52%) vs. 35(21%), p < 0.0001) cohorts. Among women who develop re-adhesion, 10(10%) women of the YD cohort only had successful pregnancies. CONCLUSIONS Yangmo decoction for 6 months after hysteroscopic adhesiolysis can reduce AFS score, prevent intrauterine re-adhesion, and increases the chances of successful pregnancies of women. LEVEL OF EVIDENCE IV. TECHNICAL EFFICACY Stage 5.
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Affiliation(s)
- Jiaxin Dan
- Department of Gynecology of Jinshan Campus, the First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Yi Cao
- Department of Gynecology of Jinshan Campus, the First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China.
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D'Urso V, Gulino FA, Incognito GG, Cimino M, Dilisi V, Di Stefano A, Gulisano M, Cannone F, Capriglione S, Palumbo M. Hysteroscopic Findings and Operative Treatment: All at Once? J Clin Med 2023; 12:4232. [PMID: 37445266 DOI: 10.3390/jcm12134232] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 06/01/2023] [Accepted: 06/20/2023] [Indexed: 07/15/2023] Open
Abstract
Hysteroscopy is considered not only a diagnostic instrument but also a therapeutic tool for many uterine pathologies. In the early 1990s, advances in technology and techniques made hysteroscopy less painful and invasive, allowing to increase in the number of gynecological procedures performed in an ambulatory setting without significant patient discomfort and with potentially significant cost savings. This is the so-called "office hysteroscopy" or "see-and-treat hysteroscopy", whose spread has permitted the decrease of the number of procedures performed in the operating room with the benefit of obviating the need for anesthesia and dilatation of the cervical canal.
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Affiliation(s)
- Valentina D'Urso
- Department of General Surgery and Medical Surgical Specialties, University of Catania, 95123 Catania, Italy
| | - Ferdinando Antonio Gulino
- Department of Obstetrics and Gynaecology, Azienda di Rilievo Nazionale e di Alta Specializzazione (ARNAS) Garibaldi Nesima, 95124 Catania, Italy
| | - Giosuè Giordano Incognito
- Department of General Surgery and Medical Surgical Specialties, University of Catania, 95123 Catania, Italy
| | - Monia Cimino
- Department of General Surgery and Medical Surgical Specialties, University of Catania, 95123 Catania, Italy
| | - Valentina Dilisi
- Department of General Surgery and Medical Surgical Specialties, University of Catania, 95123 Catania, Italy
| | - Alessandra Di Stefano
- Department of General Surgery and Medical Surgical Specialties, University of Catania, 95123 Catania, Italy
| | - Marianna Gulisano
- Department of General Surgery and Medical Surgical Specialties, University of Catania, 95123 Catania, Italy
| | - Francesco Cannone
- Department of Obstetrics and Gynaecology, Azienda di Rilievo Nazionale e di Alta Specializzazione (ARNAS) Garibaldi Nesima, 95124 Catania, Italy
| | - Stella Capriglione
- Department of Obstetrics and Gynecology, Ospedale "Santa Maria Alla Gruccia" Piazza del Volontariato 2, 52025 Montevarchi, Italy
| | - Marco Palumbo
- Department of General Surgery and Medical Surgical Specialties, University of Catania, 95123 Catania, Italy
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CRC Therapy Identifies Indian Hedgehog Signaling in Mouse Endometrial Epithelial Cells and Inhibition of Ihh-KLF9 as a Novel Strategy for Treating IUA. Cells 2022; 11:cells11244053. [PMID: 36552817 PMCID: PMC9776583 DOI: 10.3390/cells11244053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 11/26/2022] [Accepted: 12/01/2022] [Indexed: 12/23/2022] Open
Abstract
Intrauterine adhesion (IUA) causes menstrual disturbance and infertility. There is no effective treatment available for moderate to severe IUA cases. Stem cell-based therapy has been investigated for treating IUA but is limited in clinical applications due to issues including the precise induction of differentiation, tumorigenesis, and unclear molecular mechanisms. In our recent study, we isolated and expanded the long-term cultures of conditional reprogrammed (CR) mouse endometrial epithelial cells. Treating IUA mice with these CR cells (CRCs) restored the morphology and structure of the endometrium and significantly improved the pregnancy rate. In this study, our data with high-throughput sequencing, CRISPR knockout Ihh-/-CRCs, and transplantation identified for the first time that the Indian hedgehog (Ihh) gene plays a critical role in the regulation of endometrial epithelial cell proliferation. We also found that aberrant activated Ihh-krüppel-like factor 9 (KLF9) signaling contributes to the inhibition of normal progesterone receptor (PR) function in IUA mice. Thus, we hypothesized that inhibition of the Ihh-KLF9 pathway may be a novel strategy to treat IUA. Our data demonstrated that treatment with the hedgehog signaling inhibitor Vismodegib restored the morphology, structure, and microenvironment of the endometrium, and greatly improved the pregnancy rate in IUA mice. This study suggests a promising application of hedgehog inhibitors as a targeted drug in the IUA clinic.
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Zhang B, Wu S, Zhao X, Tan L, Xu D. Treatment of septate uterus. ZHONG NAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF CENTRAL SOUTH UNIVERSITY. MEDICAL SCIENCES 2022; 47:1487-1494. [PMID: 36481626 PMCID: PMC10930620 DOI: 10.11817/j.issn.1672-7347.2022.220501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Indexed: 12/13/2022]
Abstract
Although there is insufficient evidence supporting the link between septate uterus and infertility, there are many studies demonstrated the effect of spetal incision on pregnancy in women diagnosed with septate uterus associated with infertility. Hysteroscopic metroplasty can significantly improve the reproductive performance of those with septate uterus. Some Müllerian malformations can be healed by surgery. The accurate diagnosis and appropriate therapeutic approch are fundamental for successful treatment. Any attempt at surgical correction of uterine abnormalities must be aimed at preserving or improving reproductive function. Among congenital uterine anomalies, septate uterus is the most amenable to simple hysteroscopic treatment. The resection of the septum is performed as standard treatment worldwide.
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Affiliation(s)
- Baiyu Zhang
- Jiangwan Research Institute, Central South University, Changsha Jiangwan Maternity Hospital, Changsha 410008.
| | - Susu Wu
- Department of Gynecology, Third Xiangya Hospital, Central South University, Changsha 410013, China.
| | - Xingping Zhao
- Department of Gynecology, Third Xiangya Hospital, Central South University, Changsha 410013, China
| | - Lin Tan
- Jiangwan Research Institute, Central South University, Changsha Jiangwan Maternity Hospital, Changsha 410008.
| | - Dabao Xu
- Department of Gynecology, Third Xiangya Hospital, Central South University, Changsha 410013, China.
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Jin J, Yang QQ, Zhou YL. Non-Viral Delivery of Gene Therapy to the Tendon. Polymers (Basel) 2022; 14:polym14163338. [PMID: 36015594 PMCID: PMC9415435 DOI: 10.3390/polym14163338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/07/2022] [Accepted: 07/18/2022] [Indexed: 01/19/2023] Open
Abstract
The tendon, as a compact connective tissue, is difficult to treat after an acute laceration or chronic degeneration. Gene-based therapy is a highly efficient strategy for diverse diseases which has been increasingly applied in tendons in recent years. As technology improves by leaps and bounds, a wide variety of non-viral vectors have been manufactured that attempt to have high biosecurity and transfection efficiency, considered to be a promising treatment modality. In this review, we examine the unwanted biological barriers, the categories of applicable genes, and the introduction and comparison of non-viral vectors. We focus on lipid-based nanoparticles and polymer-based nanoparticles, differentiating between them based on their combination with diverse chemical modifications and scaffolds.
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Yuan L, Cao J, Hu M, Xu D, Li Y, Zhao S, Yuan J, Zhang H, Huang Y, Jin H, Chen M, Liu D. Bone marrow mesenchymal stem cells combined with estrogen synergistically promote endometrial regeneration and reverse EMT via Wnt/β-catenin signaling pathway. Reprod Biol Endocrinol 2022; 20:121. [PMID: 35971112 PMCID: PMC9377128 DOI: 10.1186/s12958-022-00988-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 08/02/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intrauterine adhesion (IUA) is a clinical disease characterized by the uterine cavity occlusion caused by the damage of the endometrial basal layer. Bone marrow mesenchymal stem cells (BMSCs) transplantation have the potential to promote endometrial regeneration mainly through paracrine ability. Estrogen is an indispensable and important factor in the repair of endometrial damage, which has been reported as a promising and adjunctive therapeutic application for stem cell transplantation therapy. This study aims to investigate the synergistic effect of BMSCs and estrogen on improving the endometrial regeneration and restoring the endometrium morphology in a dual damage model of IUA in rabbits and the underlying molecular mechanisms. METHODS BMSCs were isolated and identified by adipogenic and osteogenic differentiation and flow cytometry assays. The rabbit IUA animal model was established by a dual damage method of mechanical curettage and lipopolysaccharide infection. Additionally, we investigated the therapeutic impact of both BMSCs and estrogen either separately or in combination in a rabbit model. The retention of PKH26-labeled BMSCs was observed by vivo fluorescence imaging.The number of endometrial glands and the degree of fibrosis were observed by H&E and Masson staining respectively. Western blotting, Immunohistochemistry and immunofluorescence staining were performed to detect biomarkers related to endometrial epithelium, endometrial fibrosis and EMT. Finally, the protein expression of core molecules of Wnt/β-catenin pathway was detected by Western blotting. RESULTS PKH26-labeled fluorescence results revealed that BMSCs appeared and located in the endometrial glands and extracellular matrix area when orthotopic transplanted into the uterine cavity. Histological assays showed that remarkably increasing the number of endometrial glands and decreasing the area of endometrial fibrosis in the BMSCs combined with estrogen treatment group. Moreover, downregulated expression of fibrosis markers (fibronectin, CollagenI, a-SMA) and interstitial markers (ZEB1, Vimentin, N-cadherin), as well as upregulated E-cadherin expression were found in the combined group. Further study of in vivo staining revealed that fluorescence intensity of CK7 was stronger in the combined group than that of direct BMSCs intrauterine transplantation, while vimentin showed the opposite results. Moreover, the protein levels of β-catenin, Axin2, C-myc, CycinE of Wnt/β-catenin signaling pathway increased in the BMSCs combined with estrogen group than in the other treatment groups. CONCLUSION BMSCs combined with estrogen can promote the differentiation of stem cells into endometrial epithelial cells to facilitate the regeneration of damaged endometrium. The potential mechanism of the synergistic effect may inhibit the occurrence of EMT by activating the Wnt/β-catenin signaling pathway.
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Affiliation(s)
- Liwei Yuan
- Department of Gynecology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
- College of Clinical Medicine, Ningxia Medical University, Yinchuan, Ningxia, China
| | - Jia Cao
- Department of Beijing National Biochip Research Center Sub-Center in Ningxia, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Mingyue Hu
- Department of Gynecology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
- College of Clinical Medicine, Ningxia Medical University, Yinchuan, Ningxia, China
| | - Dabao Xu
- Department of Gynecology, Third Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Yan Li
- Department of Gynecology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
- Key Laboratory of Ministry of Education for Fertility Preservation and Maintenance, Ningxia Medical University, Yinchuan, Ningxia, China
| | - Shiyun Zhao
- Department of Gynecology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
- College of Clinical Medicine, Ningxia Medical University, Yinchuan, Ningxia, China
| | - Juanjuan Yuan
- Department of Gynecology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
- College of Clinical Medicine, Ningxia Medical University, Yinchuan, Ningxia, China
| | - Huixing Zhang
- Department of Gynecology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
- College of Clinical Medicine, Ningxia Medical University, Yinchuan, Ningxia, China
| | - Yani Huang
- Department of Gynecology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
- College of Clinical Medicine, Ningxia Medical University, Yinchuan, Ningxia, China
| | - He Jin
- Department of Gynecology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
- College of Clinical Medicine, Ningxia Medical University, Yinchuan, Ningxia, China
| | - Meixia Chen
- Department of Gynecology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
- College of Clinical Medicine, Ningxia Medical University, Yinchuan, Ningxia, China
| | - Dan Liu
- Department of Gynecology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China.
- Key Laboratory of Ministry of Education for Fertility Preservation and Maintenance, Ningxia Medical University, Yinchuan, Ningxia, China.
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Efficacy of hyaluronic acid on the prevention of intrauterine adhesion and the improvement of fertility: A meta-analysis of randomized trials. Complement Ther Clin Pract 2022; 47:101575. [DOI: 10.1016/j.ctcp.2022.101575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/20/2022] [Accepted: 03/21/2022] [Indexed: 12/23/2022]
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11
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Sun D, Mao X, Zhang A, Gao B, Huang H, Burjoo A, Xu D, Zhao X. Pregnancy Patterns Impact Live Birth Rate for Patients With Intrauterine Adhesions After Hysteroscopic Adhesiolysis: A Retrospective Cohort Study. Front Physiol 2022; 13:822845. [PMID: 35360249 PMCID: PMC8963734 DOI: 10.3389/fphys.2022.822845] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 02/22/2022] [Indexed: 11/13/2022] Open
Abstract
Objective The pregnancy patterns and other factors of live birth for patients with intrauterine adhesions (IUAs) were identified by analyzing the clinical features of pre-, intra-, and post-hysteroscopic adhesiolysis (HA). Design A total of 742 patients with IUAs who wanted to become pregnant underwent HA from January 2017 to May 2018 at the Third Xiangya Hospital of Central South University. The patient follow-up period was 2 years post-HA. A logistic regression was performed to analyze the clinical characteristics associated with a live birth for patients with IUAs. Pre-operative clinical indicators included age, gravidity, parity, abortion, IUA recurrence, menstrual patterns, disease course. Intraoperative clinical features assessed in the last operation were uterine cavity length, IUA appearance, IUA area, number of visible uterine cornua, number of visible tubal ostia, AFS scores. Pregnancy patterns were post-hysteroscopic adhesiolysis features. Results Among the 742 IUA patients, 348 (46.9%) had a live birth and 394 (53.1%) did not. A bivariate and binary logistic regression analysis showed that IUA patients’ pregnancy patterns, age, number of visible tubal ostia noted by a second-look hysteroscopy, and American Fertility Society (AFS) scores were significantly related to the live birth rate (P < 0.05). Conclusions Pregnancy patterns, age, number of visible tubal ostia, and AFS scores were significantly related to the live birth rate and may be considered potential predictors of the live birth rate in IUA patients. The indications of assisted reproductive technology (ART) might be a better choice for patients with recurrent IUAs.
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Affiliation(s)
- Dan Sun
- Department of Gynecology, Third Xiangya Hospital of Central South University, Changsha, China
| | - Xuetao Mao
- Department of Gynecology, Third Xiangya Hospital of Central South University, Changsha, China
| | - Aiqian Zhang
- Department of Gynecology, Third Xiangya Hospital of Central South University, Changsha, China
| | - Bingsi Gao
- Department of Gynecology, Third Xiangya Hospital of Central South University, Changsha, China
| | - Huan Huang
- Department of Gynecology, Third Xiangya Hospital of Central South University, Changsha, China
| | - Arvind Burjoo
- Department of Obstetrics and Gynaecology, Bruno Cheong Hospital, Central Flacq, Mauritius
| | - Dabao Xu
- Department of Gynecology, Third Xiangya Hospital of Central South University, Changsha, China
| | - Xingping Zhao
- Department of Gynecology, Third Xiangya Hospital of Central South University, Changsha, China
- *Correspondence: Xingping Zhao,
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12
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Ma J, Zhan H, Li W, Zhang L, Yun F, Wu R, Lin J, Li Y. Recent trends in therapeutic strategies for repairing endometrial tissue in intrauterine adhesion. Biomater Res 2021; 25:40. [PMID: 34819167 PMCID: PMC8611984 DOI: 10.1186/s40824-021-00242-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 10/31/2021] [Indexed: 12/25/2022] Open
Abstract
Intrauterine adhesion (IUA) is a common gynaecological disease that develops from infection or trauma. IUA disease may seriously affect the physical and mental health of women of childbearing age, which may lead to symptoms such as hypomenorrhea or infertility. Presently, hysteroscopic transcervical resection of adhesion (TCRA) is the principal therapy for IUAs, although its function in preventing the recurrence of adhesion and preserving fertility is limited. Pharmaceuticals such as hormones and vasoactive agents and the placement of nondegradable stents are the most common postoperative adjuvant therapy methods. However, the repair of injured endometrium is relatively restricted due to the different anatomical structures of the endometrium. Recently, the treatment outcome of IUAs has improved with the advancement of hysteroscopic techniques. In particular, the application of bioactive scaffolds combined with tissue engineering technology has proven to have high therapeutic potential or endometrial repair in IUA treatment. Herein, this review has summarized past therapeutic strategies, including postoperative adjuvant therapy, cell or therapeutic molecular delivery therapy methods and bioactive scaffold-based tissue engineering methods. Therefore, this review presented the recent therapeutic strategies for repairing endometrium treatment and pointed out the issues of clinical concern to provide alternative methods for the management of IUAs.
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Affiliation(s)
- Junyan Ma
- Zhejiang Provincial Key Laboratory for Precision Diagnosis & Treatment of Major Gynecological Diseases, Hangzhou, 310006, Zhejiang Province, China
| | - Hong Zhan
- Department of Gynecology and Obstetrics, Women' s Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, Zhejiang Province, China
| | - Wen Li
- Department of Gynecology and Obstetrics, Women' s Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, Zhejiang Province, China
| | - Liqi Zhang
- Department of Gynecology and Obstetrics, Women' s Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, Zhejiang Province, China
| | - Feng Yun
- Department of Gynecology and Obstetrics, Women' s Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, Zhejiang Province, China
| | - Ruijin Wu
- Department of Gynecology and Obstetrics, Women' s Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, Zhejiang Province, China.
| | - Jun Lin
- Department of Gynecology and Obstetrics, Women' s Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, Zhejiang Province, China.
| | - Yangyang Li
- Zhejiang Provincial Key Laboratory for Precision Diagnosis & Treatment of Major Gynecological Diseases, Hangzhou, 310006, Zhejiang Province, China.
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13
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Piriyev E, Schiermeier S, Römer T. Transcorporal septal dissection using the balloon technique in complete uterine septums, pre- and postoperative results. A follow up from 2007 to 2020. Eur J Obstet Gynecol Reprod Biol 2021; 265:125-129. [PMID: 34488038 DOI: 10.1016/j.ejogrb.2021.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/06/2021] [Accepted: 08/23/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The aim of the study is to show the pre- and postoperative results of transcorporal septal dissection using the balloon technique in complete uterine septums, which is a rare pathology. STUDY DESIGN It is a retrospective analysis. In this study 21 patients with a complete uterine septum were included. All patient underwent the transcorporal septal dissection using the balloon technique. Data analysis was based on patient history, surgical reports and telephone contact with the patients and supervising gynecologists. RESULTS 73% patients with a current desire to become pregnant managed to do so and 75% of them were able to give birth on time. One patient was pregnant at the time of the analysis. In 17 patients the results of the control hysteroscopy were available. In eight patients (47%) a normal cavity was found. In nine cases (53%) a residual septum of 1-2 cm was found, so that an operative hysteroscopy with a residual septum dissection was performed. The operative time was average 30.6 min in the group without laparoscopy and 56.8 min in the group with laparoscopy. CONCLUSION The transcorporal septum dissection using the balloon technique is a safe method with a good fertility outcome and requires an experienced surgeon.
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Affiliation(s)
- Elvin Piriyev
- University Witten-Herdecke, Department of Obstetrics and Gynecology, Academic Hospital Cologne, Weyertal University of Cologne, Germany.
| | - Sven Schiermeier
- Department of Obstetrics and Gynecology, University Witten-Herdecke, Marien-Hospital, Witten Marienplatz, 258452 Witten, Germany
| | - Thomas Römer
- Department of Obstetrics and Gynecology, Academic Hospital Cologne, Weyertal University of Cologne, Germany
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14
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de Miguel-Gómez L, Romeu M, Pellicer A, Cervelló I. Strategies for managing asherman's syndrome and endometrial atrophy: Since the classical experimental models to the new bioengineering approach. Mol Reprod Dev 2021; 88:527-543. [PMID: 34293229 DOI: 10.1002/mrd.23523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 06/11/2021] [Accepted: 06/30/2021] [Indexed: 11/07/2022]
Abstract
Endometrial function is essential for embryo implantation and pregnancy, but managing endometrial thickness that is too thin to support pregnancy or an endometrium of compromised functionality due to intrauterine adhesions is an ongoing challenge in reproductive medicine. Here, we review current and emerging therapeutic and experimental options for endometrial regeneration with a focus on animal models used to study solutions for Asherman's syndrome and endometrial atrophy, which both involve a damaged endometrium. A review of existing literature was performed that confirmed the lack of consensus on endometrial therapeutic options, though promising new alternatives have emerged in recent years (platelet-rich plasma, exosomes derived from stem cells, bioengineering-based techniques, endometrial organoids, among others). In the future, basic research using established experimental models of endometrial pathologies (combined with new high-tech solutions) and human clinical trials with large population sizes are needed to evaluate these emerging and new endometrial therapies.
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Affiliation(s)
- Lucía de Miguel-Gómez
- Fundación Instituto Valenciano de Infertilidad (FIVI), La Fe Health Research Institute, Valencia, Spain
- University of Valencia, Valencia, Spain
| | - Mónica Romeu
- Reproductive Medicine Research Group, La Fe Health Research Institute, La Fe University Hospital, Valencia, Spain
- Women's Health Area, Human Reproduction Unit, La Fe University Hospital, Valencia, Spain
| | | | - Irene Cervelló
- Fundación Instituto Valenciano de Infertilidad (FIVI), La Fe Health Research Institute, Valencia, Spain
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15
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Han X, Ma Y, Lu X, Li W, Xia E, Li TC, Zhang H, Huang X. Transplantation of Human Adipose Stem Cells Using Acellular Human Amniotic Membrane Improves Angiogenesis in Injured Endometrial Tissue in a Rat Intrauterine Adhesion Model. Cell Transplant 2021; 29:963689720952055. [PMID: 32838542 PMCID: PMC7784510 DOI: 10.1177/0963689720952055] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Endometrial injury resulting in intrauterine adhesion is associated with extensive damage to the regenerative basal layer of the endometrium and represents a major therapeutic challenge. Human adipose stem cells (hASCs) hold promise for future clinical use in the individualized therapy of injured endometrial tissue. Here, we observed that the use of the acellular human amniotic membrane (AHAM) significantly increased the expression of angiogenic factors, including angiogenin (ANG) and vascular endothelial growth factor (VEGF), in hASCs in vitro. The three-dimensional engineered hASC-AHAM grafts significantly increased the endometrial receptivity, as increased endometrial thickness, greater numbers of endometrial glands, and higher protein levels of leukemia inhibitory factor were observed in injured endometrial tissue that was treated with these grafts compared to those detected in injured endometrial tissue that was treated with AHAM alone. In addition, the hASC-AHAM grafts significantly increased the vascular density in the injured endometrial tissue in rats, when transplanted into an injured uterine cavity. Using the EGFP+-hASC-AHAM grafts for transplantation, we confirmed that the hASCs maintained higher protein levels of ANG and VEGF in the injured uterine cavity in vivo. The results of this study suggest that the ability of the engineered hASC-AHAM grafts to repair injured endometrial tissue may be associated with their ability to promote angiogenesis through the upregulated expression of angiogenic factors in hASCs. These findings may support individualized stem cell–based therapy for endometrial disease using bioartificial grafts.
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Affiliation(s)
- Xiao Han
- Hysteroscopic Center, Fuxing Hospital, Capital Medical University, Beijing, China
| | - Yuejiao Ma
- Department of Cell Biology, Municipal Laboratory for Liver Protection and Regulation of Regeneration, 12517Capital Medical University, Beijing, China
| | - Xin Lu
- Department of Cell Biology, Municipal Laboratory for Liver Protection and Regulation of Regeneration, 12517Capital Medical University, Beijing, China
| | - Weihong Li
- Department of Cell Biology, Municipal Laboratory for Liver Protection and Regulation of Regeneration, 12517Capital Medical University, Beijing, China
| | - Enlan Xia
- Hysteroscopic Center, Fuxing Hospital, Capital Medical University, Beijing, China
| | - Tin-Chiu Li
- Hysteroscopic Center, Fuxing Hospital, Capital Medical University, Beijing, China.,Assisted Conception Unit, Department of Obstetrics and Gynecology, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Haiyan Zhang
- Department of Cell Biology, Municipal Laboratory for Liver Protection and Regulation of Regeneration, 12517Capital Medical University, Beijing, China
| | - Xiaowu Huang
- Hysteroscopic Center, Fuxing Hospital, Capital Medical University, Beijing, China
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16
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Lee WL, Liu CH, Cheng M, Chang WH, Liu WM, Wang PH. Focus on the Primary Prevention of Intrauterine Adhesions: Current Concept and Vision. Int J Mol Sci 2021; 22:ijms22105175. [PMID: 34068335 PMCID: PMC8153321 DOI: 10.3390/ijms22105175] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/11/2021] [Accepted: 05/12/2021] [Indexed: 02/07/2023] Open
Abstract
Intrauterine adhesion (IUA), and its severe form Asherman syndrome (Asherman’s syndrome), is a mysterious disease, often accompanied with severe clinical problems contributing to a significant impairment of reproductive function, such as menstrual disturbance (amenorrhea), infertility or recurrent pregnancy loss. Among these, its correlated infertility may be one of the most challenging problems. Although there are many etiologies for the development of IUA, uterine instrumentation is the main cause of IUA. Additionally, more complicated intrauterine surgeries can be performed by advanced technology, further increasing the risk of IUA. Strategies attempting to minimize the risk and reducing its severity are urgently needed. The current review will expand the level of our knowledge required to face the troublesome disease of IUA. It is separated into six sections, addressing the introduction of the normal cyclic endometrial repairing process and its abruption causing the formation of IUA; the etiology and prevalence of IUA; the diagnosis of IUA; the classification of IUA; the pathophysiology of IUA; and the primary prevention of IUA, including (1) delicate surgical techniques, such as the use of surgical instruments, energy systems, and pre-hysteroscopic management, (2) barrier methods, such as gels, intrauterine devices, intrauterine balloons, as well as membrane structures containing hyaluronate–carboxymethylcellulose or polyethylene oxide–sodium carboxymethylcellulose as anti-adhesive barrier.
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Affiliation(s)
- Wen-Ling Lee
- Department of Medicine, Cheng-Hsin General Hospital, Taipei 112, Taiwan;
- Department of Nursing, Oriental Institute of Technology, Taipei 220, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan; (C.-H.L.); (M.C.); (W.-H.C.)
| | - Chia-Hao Liu
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan; (C.-H.L.); (M.C.); (W.-H.C.)
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei 112, Taiwan
| | - Min Cheng
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan; (C.-H.L.); (M.C.); (W.-H.C.)
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei 112, Taiwan
| | - Wen-Hsun Chang
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan; (C.-H.L.); (M.C.); (W.-H.C.)
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei 112, Taiwan
- Department of Nursing, Taipei Veterans General Hospital, Taipei 112, Taiwan
| | - Wei-Min Liu
- Department of Obstetrics and Gynecology, Taipei Medical University Hospital, Taipei 110, Taiwan;
| | - Peng-Hui Wang
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan; (C.-H.L.); (M.C.); (W.-H.C.)
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei 112, Taiwan
- Female Cancer Foundation, Taipei 104, Taiwan
- Department of Medical Research, China Medical University Hospital, Taichung 404, Taiwan
- Correspondence: ; Tel.: +886-2-28757566
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Nir A, Mor M, Yekutiel M, Eisenberg N, Smorgick N. Postpartum retained products of conception: Is it possible to avoid postpartum curettage? Int J Gynaecol Obstet 2021; 156:231-235. [PMID: 33811338 DOI: 10.1002/ijgo.13696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/24/2021] [Accepted: 03/25/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Removal of retained products of conception (RPOC) by suction curettage or hysteroscopy may be required in the postpartum period, possibly causing intrauterine adhesions. We investigated whether rates of suction curettage, hysteroscopy, and postoperative intrauterine adhesions have changed over time. METHODS Parturients considered at risk for RPOC were followed in a specialized postpartum clinic with sequential ultrasound scans. We compared the rates of women requiring surgical procedures for RPOC removal and rates of postoperative intrauterine adhesions between two 2-years periods: 2011-2012 ("early period") and 2016-2017 ("late period"). RESULTS The overall rates of women requiring a surgical procedure for removal of RPOC did not differ between the early and late periods (38/762 [5.0%] vs 41/732 [5.6%], respectively, P = 0.595). However, removal of RPOC by suction curettage decreased significantly over time whereas removal by hysteroscopy increased (P = 0.022). Intrauterine adhesions were diagnosed in 7 of 38 women (18.4%) who underwent a surgical procedure for RPOC removal in the early period, but none of the patients operated on in the late period developed intrauterine adhesions (P = 0.004). CONCLUSION Removal of RPOC in postpartum women may be completed by hysteroscopy in most cases, significantly reducing the need for postpartum curettage and the rates of postoperative intrauterine adhesions.
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Affiliation(s)
- Arava Nir
- Department of Obstetrics and Gynecology, Shamir (Assaf Harofe) Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Matan Mor
- Department of Obstetrics and Gynecology, Shamir (Assaf Harofe) Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Matar Yekutiel
- Department of Obstetrics and Gynecology, Shamir (Assaf Harofe) Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Neta Eisenberg
- Department of Obstetrics and Gynecology, Shamir (Assaf Harofe) Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Noam Smorgick
- Department of Obstetrics and Gynecology, Shamir (Assaf Harofe) Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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18
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Zhang S, Sun Y, Jiang D, Chen T, Liu R, Li X, Lu Y, Qiao L, Pan Y, Liu Y, Lin J. Construction and Optimization of an Endometrial Injury Model in Mice by Transcervical Ethanol Perfusion. Reprod Sci 2021; 28:693-702. [PMID: 32939736 DOI: 10.1007/s43032-020-00296-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 08/10/2020] [Indexed: 10/23/2022]
Abstract
This study aimed to establish a stable animal model of intrauterine adhesion (IUA) using a minimally invasive method that recapitulates the clinicopathologic characteristics of IUA. Mice were randomly divided into groups based on the ethanol treatment time (the EtOH-10 s, EtOH-20 s, EtOH-40 s, EtOH-1 min, and sham operation groups), and after the cervix was relaxed with phloroglucinol, the uterine horn was perfused with 95% ethanol through the cervix to induce endometrial injury. Eight days after the procedure, routine biochemical assays were performed to assess liver and kidney function; HE and Masson staining were used to assess uterine morphology and fibrosis; and immunohistochemistry was performed to evaluate the expression of CD31 and F4/80 in the endometrium. Furthermore, the fertility of mice in the EtOH-40 s group and the sham operation group was compared. As expected, the ethanol treatment time was positively correlated with the degree of uterine damage and kidney dysfunction in mice. In particular, the endometria of mice in the EtOH-40 s group were significantly thinner than those of mice in the sham operation group and exhibited severe necrosis, glandular loss, incomplete epithelial and glandular epithelial cell structure, severe tissue fibrosis, an activated inflammatory response, and a significant decrease in the number of fetuses, consistent with the clinical characteristics of severe IUA. In conclusion, this study resulted in successful establishment, by a minimally invasive transcervical ethanol perfusion technique, of a mouse model of endometrial injury, which could support an in-depth study of IUA pathogenesis and further promote the development of IUA therapies.
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Affiliation(s)
- Shenghui Zhang
- The Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, 453100, China
- Stem Cell and Biotherapy Technology Research Center, College of Life Science and Technology, Xinxiang Medical University, Xinxiang, 453003, China
| | - Yuliang Sun
- Stem Cell and Biotherapy Technology Research Center, College of Life Science and Technology, Xinxiang Medical University, Xinxiang, 453003, China
- College of Biomedical Engineering, Xinxiang Medical University, Xinxiang, 453003, China
| | - Dongli Jiang
- Stem Cell and Biotherapy Technology Research Center, College of Life Science and Technology, Xinxiang Medical University, Xinxiang, 453003, China
- School of International Education of Xinxiang Medical University, Xinxiang, 453003, China
| | - Tongtong Chen
- Stem Cell and Biotherapy Technology Research Center, College of Life Science and Technology, Xinxiang Medical University, Xinxiang, 453003, China
| | - Ruihong Liu
- Stem Cell and Biotherapy Technology Research Center, College of Life Science and Technology, Xinxiang Medical University, Xinxiang, 453003, China
- College of Biomedical Engineering, Xinxiang Medical University, Xinxiang, 453003, China
| | - Xinyi Li
- Stem Cell and Biotherapy Technology Research Center, College of Life Science and Technology, Xinxiang Medical University, Xinxiang, 453003, China
| | - Yilin Lu
- Stem Cell and Biotherapy Technology Research Center, College of Life Science and Technology, Xinxiang Medical University, Xinxiang, 453003, China
| | - Liang Qiao
- Stem Cell and Biotherapy Technology Research Center, College of Life Science and Technology, Xinxiang Medical University, Xinxiang, 453003, China
| | - Ying Pan
- The Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, 453100, China.
| | - Yanli Liu
- Stem Cell and Biotherapy Technology Research Center, College of Life Science and Technology, Xinxiang Medical University, Xinxiang, 453003, China.
| | - Juntang Lin
- Stem Cell and Biotherapy Technology Research Center, College of Life Science and Technology, Xinxiang Medical University, Xinxiang, 453003, China
- College of Biomedical Engineering, Xinxiang Medical University, Xinxiang, 453003, China
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19
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van Wessel S, Hamerlynck T, Schutyser V, Tomassetti C, Wyns C, Nisolle M, Verguts J, Colman R, Weyers S, Bosteels J. Anti-adhesion Gel versus No gel following Operative Hysteroscopy prior to Subsequent fertility Treatment or timed InterCourse (AGNOHSTIC), a randomised controlled trial: protocol. Hum Reprod Open 2021; 2021:hoab001. [PMID: 33623830 PMCID: PMC7886624 DOI: 10.1093/hropen/hoab001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 01/09/2021] [Indexed: 12/29/2022] Open
Abstract
STUDY QUESTIONS Does the application of anti-adhesion gel, compared to no gel, following operative hysteroscopy to treat intrauterine pathology in women wishing to conceive increase the chance of conception leading to live birth? WHAT IS KNOWN ALREADY Intrauterine adhesions (IUAs) following operative hysteroscopy may impair reproductive success in women of reproductive age. Anti-adhesion barrier gels may decrease the occurrence of IUAs, but the evidence on their effectiveness to improve reproductive outcomes is sparse and of low quality. STUDY DESIGN SIZE DURATION This multicentre, parallel group, superiority, blinded and pragmatic randomised controlled trial is being carried out in seven participating centres in Belgium. Recruitment started in April 2019. Women will be randomly allocated to treatment with anti-adhesion gel (intervention group) or no gel (control group). Sterile ultrasound gel will be applied into the vagina as a mock-procedure in both treatment arms. The patient, fertility physician and gynaecologist performing the second-look hysteroscopy are unaware of the allocated treatment. Power analysis, based on a target improvement of 15% in conception leading to live birth using anti-adhesion gel, a power of 85%, a significance level of 5%, and a drop-out rate of 10%, yielded a number of 444 patients to be randomised. The baseline rate of conception leading to live birth in the control group is expected to be 45%. PARTICIPANTS/MATERIALS SETTING METHODS Women of reproductive age (18-47 years), wishing to conceive (spontaneously or by fertility treatment) and scheduled for operative hysteroscopy to treat intrauterine pathology (endometrial polyps, myomas with uterine cavity deformation, uterine septa, IUAs or retained products of conception) are eligible for recruitment. Women may try to conceive from 3 to 6 weeks after receiving allocated treatment with follow-up ending at 30 weeks after treatment. If the woman fails to conceive within this timeframe, a second-look hysteroscopy will be scheduled within 2-6 weeks to check for IUAs. The primary endpoint is conception leading to live birth, measured at 30 weeks after randomisation. The secondary endpoints are time to conception, clinical pregnancy, miscarriage and ectopic pregnancy rates, measured at 30 weeks after receiving allocated treatment. The long-term follow-up starts when the patient is pregnant and she will be contacted every trimester. STUDY FUNDING/COMPETING INTERESTS This work is funded by the Belgian Healthcare Knowledge Centre (KCE). The anti-adhesion gel is supplied at no cost by Nordic Pharma and without conditions. Dr. Tomassetti reports grants and non-financial support from Merck SA, non-financial support from Ferring SA, personal fees and non-financial support from Gedeon-Richter, outside the submitted work. None of the other authors have a conflict of interest.
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Affiliation(s)
- S van Wessel
- Women’s Clinic, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - T Hamerlynck
- Women’s Clinic, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - V Schutyser
- Centre for Reproductive Medicine, University Hospital Brussels, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - C Tomassetti
- Department of Obstetrics and Gynaecology, Leuven University Fertility Centre, University Hospital Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - C Wyns
- Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Avenue Hippocrate 10, 1200 Brussels, Belgium
| | - M Nisolle
- Département de Gynécologie-Obstétrique, CHU Site, CHR Citadelle, Boulevard du Douzième de Ligne 1, 4000 Liège, Belgium
| | - J Verguts
- Department of Obstetrics and Gynaecology, Jessa Hospital, Stadsomvaart 11, 3500 Hasselt, Belgium
| | - R Colman
- Biostatitics Unit, Department of Public Health and Primary Care, Ghent University, C. Heymanslaan 10, 9000 Gent, Belgium
| | - S Weyers
- Women’s Clinic, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - J Bosteels
- Women’s Clinic, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium
- Department of Gynaecology, Imelda Hospital, Imeldalaan 9, 2820 Bonheiden, Belgium
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20
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Bai X, Liu J, Yuan W, Liu Y, Li W, Cao S, Yu L, Wang L. Therapeutic Effect of Human Amniotic Epithelial Cells in Rat Models of Intrauterine Adhesions. Cell Transplant 2021; 29:963689720908495. [PMID: 32223314 PMCID: PMC7444214 DOI: 10.1177/0963689720908495] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
As a refractory fibrosis disease, intrauterine adhesions (IUAs) is defined as
fibrosis of the physiological endometrium. Although hysteroscopic adhesiolysis
is widely recommended as an effective treatment, prognosis and recurrence remain
poor in severe cases. Recently, stem cell therapy has been promoted as a
promising treatment for IUAs. The ability of human amniotic epithelial cells
(hAECs), emerging as a new candidate for stem cell therapy, to treat IUAs has
not been demonstrated. To study the potential effects of hAECs on IUAs, we
created an IUA rat model using mechanical injury and injected cultured primary
hAECs into the rats’ uteri. Next, we observed the morphological structure of
endometrial thickness and glands using hematoxylin and eosin staining, and we
detected extracellular-matrix collagen deposition using Masson staining. In
addition, we performed immunohistochemical staining and reverse-transcription
polymerase chain reaction (RT-PCR) to investigate potential fibrosis molecules
and angiogenesis factors 7 d after hAECs transplantation. Finally, we detected
estrogen receptor (ER) and growth factors via RT-PCR to verify the molecular
mechanism underlying cell therapy. In the IUA rat models, endometrial thickness
and endometrial glands proliferated and collagen deposition decreased
significantly after hAEC transplantation. We found that during the recovery of
injured endometrium, the crucial fibrosis marker transforming growth factor-β
(TGF-β) was regulated and angiogenesis occurred in the endometrial tissue with
the up-regulation of vascular endothelial growth factor. Furthermore, hAECs were
shown to promote ER expression in the endometrium and regulate the inflammatory
reaction in the uterine microenvironment. In conclusion, these results
demonstrated that hAEC transplantation could inhibit the progression of fibrosis
and promote proliferation and angiogenesis in IUA rat models. The current study
suggests hAECs as a novel stem cell candidate in the treatment of severe
IUA.
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Affiliation(s)
- Xuechai Bai
- Department of Gynecology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Jia Liu
- Institute of Genetics and Regenerative Biology, College of Life Sciences, Hangzhou, People's Republic of China.,Shanghai iCELL Biotechnology Co Ltd, Shanghai, People's Republic of China
| | - Weixin Yuan
- Institute of Genetics and Regenerative Biology, College of Life Sciences, Hangzhou, People's Republic of China
| | - Yang Liu
- Department of Gynecology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Wei Li
- Department of Gynecology, Ningbo Yinzhou People's Hospital, Ningbo, People's Republic of China
| | - Siyu Cao
- Department of Gynecology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Luyang Yu
- Institute of Genetics and Regenerative Biology, College of Life Sciences, Hangzhou, People's Republic of China.,College of Life Sciences-iCell Biotechnology Regenerative Biomedicine Laboratory, Hangzhou, People's Republic of China
| | - Liang Wang
- Department of Gynecology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
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21
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Cheng M, Chang WH, Yang ST, Huang HY, Tsui KH, Chang CP, Lee WL, Wang PH. Efficacy of Applying Hyaluronic Acid Gels in the Primary Prevention of Intrauterine Adhesion after Hysteroscopic Myomectomy: A Meta-Analysis of Randomized Controlled Trials. Life (Basel) 2020; 10:life10110285. [PMID: 33203159 PMCID: PMC7697815 DOI: 10.3390/life10110285] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 11/12/2020] [Accepted: 11/13/2020] [Indexed: 12/15/2022] Open
Abstract
Intrauterine adhesion (IUA), which mainly occurs after intrauterine surgery or an inflammatory process, is an important but often neglected condition in women of reproductive age. The presentation of IUA varies greatly, ranging from symptom-free to severe, with amenorrhea or infertility. With much advanced development of intrauterine instruments, more intrauterine diseases can be successfully cured by hysteroscopic surgery. Among these, submucosal myoma is one of the best examples. Submucosal myomas are often related to abnormal bleeding, anemia, and possible infertility or miscarriage. However, submucosal myoma after hysteroscopic myomectomy may be complicated by IUA in various grades of severity, and its incidence and prevalence might be nearly one-quarter to one-third of patients, suggesting an urgent need for efforts to decrease the risk of developing IUA after hysteroscopic myomectomy. Many strategies have been reported to be useful for this purpose, and intrauterine application of anti-adhesive gels, such as polyethylene oxide–sodium carboxymethylcellulose (PEO-NaCMC) or auto-crosslinked hyaluronic acid (ACHA), has become increasingly popular in routine clinical practice. This meta-analysis is aimed at investigating the effect of ACHA on the primary prevention of IUA formation after hysteroscopic myomectomy. A pooled analysis of three studies (hysteroscopic surgeries for fibroids, polyps, and septum) including 242 women showed that using PEO-NaCMC or ACHA gel decreased the IUA rate with an odds ratio (OR) of 0.364 (95% confidence interval (CI) 0.189–0.703, p = 0.03). Pooled analysis of two studies that limited the use of ACHA in 119 women showed that the application of ACHA gel for the primary prevention of IUA in patients after hysteroscopic myomectomy led to a statistically significant reduction of the development of IUA postoperatively (OR 0.285, 95% CI 0.116–0.701, p = 0.006). All of this suggests that the use of ACHA gel in patients after hysteroscopic myomectomy could significantly reduce de novo IUA, although more evidence is needed.
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Affiliation(s)
- Min Cheng
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei 112, Taiwan; (M.C.); (W.-H.C.); (S.-T.Y.); (C.-P.C.)
- Institute of Clinical Medicine, National Yang-Ming University, Taipei 112, Taiwan;
- Department of Obstetrics and Gynecology, National Yang-Ming University, Taipei 112, Taiwan
| | - Wen-Hsun Chang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei 112, Taiwan; (M.C.); (W.-H.C.); (S.-T.Y.); (C.-P.C.)
- Institute of Clinical Medicine, National Yang-Ming University, Taipei 112, Taiwan;
- Department of Nursing, Taipei Veterans General Hospital, Taipei 112, Taiwan
| | - Szu-Ting Yang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei 112, Taiwan; (M.C.); (W.-H.C.); (S.-T.Y.); (C.-P.C.)
- Institute of Clinical Medicine, National Yang-Ming University, Taipei 112, Taiwan;
- Department of Obstetrics and Gynecology, National Yang-Ming University, Taipei 112, Taiwan
| | - Hsin-Yi Huang
- Biostatics Task Force, Taipei Veterans General Hospital, Taipei 112, Taiwan;
| | - Kuan-Hao Tsui
- Institute of Clinical Medicine, National Yang-Ming University, Taipei 112, Taiwan;
- Department of Obstetrics and Gynecology, National Yang-Ming University, Taipei 112, Taiwan
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan
- Department of Pharmacy and Master Program, College of Pharmacy and Health Care, Tajen University, Pingtung County 907, Taiwan
| | - Chia-Pei Chang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei 112, Taiwan; (M.C.); (W.-H.C.); (S.-T.Y.); (C.-P.C.)
- Institute of Clinical Medicine, National Yang-Ming University, Taipei 112, Taiwan;
- Department of Obstetrics and Gynecology, National Yang-Ming University, Taipei 112, Taiwan
| | - Wen-Ling Lee
- Institute of Clinical Medicine, National Yang-Ming University, Taipei 112, Taiwan;
- Department of Medicine, Cheng-Hsin General Hospital, Taipei 112, Taiwan
- Department of Nursing, Oriental Institute of Technology, New Taipei City 220, Taiwan
- Correspondence: (W.-L.L.); (P.-H.W.); Tel.: +886-2-2873-4400 (W.-L.L.); +886-2-2875-7566 (P.-H.W.)
| | - Peng-Hui Wang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei 112, Taiwan; (M.C.); (W.-H.C.); (S.-T.Y.); (C.-P.C.)
- Institute of Clinical Medicine, National Yang-Ming University, Taipei 112, Taiwan;
- Department of Obstetrics and Gynecology, National Yang-Ming University, Taipei 112, Taiwan
- Cancer Female Foundation, Taipei 104, Taiwan
- Department of Medical Research, China Medical University Hospital, Taichung 404, Taiwan
- Correspondence: (W.-L.L.); (P.-H.W.); Tel.: +886-2-2873-4400 (W.-L.L.); +886-2-2875-7566 (P.-H.W.)
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Peng J, Li M, Zeng H, Zeng Z, Huang J, Liang X. Intrauterine infusion of platelet-rich plasma is a treatment method for patients with intrauterine adhesions after hysteroscopy. Int J Gynaecol Obstet 2020; 151:362-365. [PMID: 32816322 PMCID: PMC7756367 DOI: 10.1002/ijgo.13353] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 05/19/2020] [Accepted: 08/18/2020] [Indexed: 11/16/2022]
Abstract
Objective To evaluate the efficacy of an intrauterine infusion of platelet‐rich plasma (PRP) in patients with intrauterine adhesions (IUAs). Methods A retrospective study was conducted from April 2018 to December 2019 to compare the efficacy of intrauterine infusion of PRP with balloon for patients with IUAs. All patients had moderate or severe IUAs, including 28 patients with intrauterine infusion of PRP (group A), 22 patients with intrauterine balloon (group B), and 20 patients with both intrauterine infusion of PRP and balloon in the first operative hysteroscopy. American Fertility Society (AFS) score and rates of chemical pregnancy were compared. Results The AFS score decreased with an average of 5.18 ± 3.93, 4.91 ± 4.39, and 5.15 ± 3.17 comparing the third hysteroscopy with the first operative hysteroscopy in group A, group B, and group C, respectively. No significant differences were found among these groups (P=0.734). The rates of chemical pregnancy were 40.0% in group A, 38.9% in group B, and 33.3% in group C without significant differences (P=0.944). Conclusion There were no significant differences between intrauterine infusion of PRP and balloon. PRP is a treatment method for IUAs. There were no significant differences between intrauterine infusion of platelet‐rich plasma and a balloon, and platelet‐rich plasma is a treatment for intrauterine adhesions.
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Affiliation(s)
- Jintao Peng
- Reproductive Medicine Research Center, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Manzhao Li
- Reproductive Medicine Research Center, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Haitao Zeng
- Reproductive Medicine Research Center, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhi Zeng
- Reproductive Medicine Research Center, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jiana Huang
- Reproductive Medicine Research Center, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiaoyan Liang
- Reproductive Medicine Research Center, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Crosslinked Hyaluronic Acid Gels for the Prevention of Intrauterine Adhesions after a Hysteroscopic Myomectomy in Women with Submucosal Myomas: A Prospective, Randomized, Controlled Trial. Life (Basel) 2020; 10:life10050067. [PMID: 32429137 PMCID: PMC7280993 DOI: 10.3390/life10050067] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/10/2020] [Accepted: 05/13/2020] [Indexed: 01/12/2023] Open
Abstract
Intrauterine adhesion (IUA), fibrosis, and scarring resulting from damage to the endometrium is a rare but serious clinical disease, contributing to a significant impairment of reproductive function. Uterine instrumentation, especially that of a hysteroscopic myomectomy, has become the main cause of IUA. Therefore, a prospective randomized controlled study to assess the effectiveness and short-term safety of the use of hyaluronic acid gels in the prevention of IUA after a hysteroscopic myomectomy and an evaluation of the characteristics of IUA observed at follow-up are presented here. A total of 70 patients were analyzed at the end of 16 March 2020. The results show that the incidence of IUA in women who underwent a hysteroscopic myomectomy is 21.4% (15/70), overall. Women treated with hyaluronic acid gels have a statistically significantly lower incidence of IUAs than non-treated women (12.8% vs. 39.1%, p = 0.012). In addition, women in the anti-adhesive gel treatment group had a dramatically reduced severity of IUA than women in the no-treatment group (p = 0.002). Further analysis shows that the International Federation of Gynecology and Obstetrics (FIGO) classification type and the use of anti-adhesive gels are independent factors associated with moderate and severe degrees of IUA formation. The results here highlight the significant therapeutic benefits of the application of hyaluronic acid gels in women undergoing a hysteroscopic myomectomy, especially for those patients with a uterine myoma classified as FIGO type 2. Since the risk of IUA after a hysteroscopic myomectomy is high, especially for patients who have not received prophylactic anti-adhesive gels, the application of hyaluronic acid gels as a prevention strategy is highly recommended. More studies are encouraged to confirm our observation.
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Zhang Z, Li S, Deng J, Yang S, Xiang Z, Guo H, Xi H, Sang M, Zhang W. Aspirin inhibits endometrial fibrosis by suppressing the TGF‑β1‑Smad2/Smad3 pathway in intrauterine adhesions. Int J Mol Med 2020; 45:1351-1360. [PMID: 32323728 PMCID: PMC7138280 DOI: 10.3892/ijmm.2020.4506] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 01/24/2020] [Indexed: 01/07/2023] Open
Abstract
Intrauterine adhesions (IUAs) represent one of the most common diseases in women of reproductive age. Patients with moderate‑to‑severe IUA can experience a decrease in normal menstrual patterns, amenorrhea and even infertility. At present, the first‑line treatment strategies for IUAs in the clinical practice are hysteroscopic transuterine resection of adhesion and postoperative adjuvant therapy, including oestrogen. However, a high recurrence rate of IUAs remains. In recent years, studies have demonstrated that aspirin combined with oestrogen may significantly prevent the postoperative disease recurrence rate, improve endometrial receptivity and improve the conception rate by increasing endometrial blood supply and angiogenesis more effectively. The TGF‑β1‑Smad2/Smad3 pathway is one of the important mechanisms involved in endometrial fibrosis. However, whether aspirin can inhibit endometrial fibrosis through the TGF‑β1‑Smad2/Smad3 pathway to prevent postoperative re‑adhesion remains to be elucidated. The results of the present study suggested that aspirin inhibits endometrial fibrosis by suppressing the TGF‑β1‑Smad2/Smad3 pathway, which may provide new hypotheses for the mechanism of action of aspirin in the treatment of IUAs.
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Affiliation(s)
- Zihui Zhang
- Department of Obstetrics and Gynaecology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, Hubei 441000, P.R. China
| | - Shuang Li
- Department of Obstetrics and Gynaecology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, Hubei 441000, P.R. China
| | - Jie Deng
- Department of Obstetrics and Gynaecology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, Hubei 441000, P.R. China
| | - Shaorong Yang
- Department of Pathology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, Hubei 441000, P.R. China
| | - Ziwu Xiang
- Department of Pathology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, Hubei 441000, P.R. China
| | - Hongyan Guo
- Department of Obstetrics and Gynaecology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, Hubei 441000, P.R. China
| | - Hongli Xi
- Department of Obstetrics and Gynaecology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, Hubei 441000, P.R. China
| | - Ming Sang
- Department of Obstetrics and Gynaecology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, Hubei 441000, P.R. China
| | - Wei Zhang
- Department of Obstetrics and Gynaecology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, Hubei 441000, P.R. China
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Zheng F, Xin X, He F, Liu J, Cui Y. Meta-analysis on the use of hyaluronic acid gel to prevent intrauterine adhesion after intrauterine operations. Exp Ther Med 2020; 19:2672-2678. [PMID: 32256748 PMCID: PMC7086218 DOI: 10.3892/etm.2020.8483] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 01/06/2020] [Indexed: 12/27/2022] Open
Abstract
Intrauterine adhesion (IUA) is a severe complication that occurs following abortion, and hyaluronic acid gel has been used to prevent IUA following intrauterine operation. The present study aimed to systematically evaluate the efficacy of hyaluronic acid gel in preventing IUA following intrauterine operation. In the current study, a literature search was performed using PubMed, Cochrane Library and EMbase databases for randomized controlled clinical trials that used hyaluronic acid gel as an adjuvant therapy following intrauterine operation. The terms 'hyaluronic acid', 'intrauterine adhesions', 'Asherman's syndrome', 'IUA', 'dilatation and curettage', 'abortion' and 'hysteroscopic' were used to search for articles published online before July 31, 2018. RevMan 5.3 software was used to analyze the indicators of uterine cavity adhesion formation and pregnancy rates following intrauterine operation. A total of seven randomized controlled clinical studies were included, consisting of 952 patients who underwent intrauterine operation. The meta-analysis indicated that the use of hyaluronic acid gel reduced the incidence of IUA [relative risk (RR)=0.42; 95% confidence interval (CI)=0.30-0.57; P<0.001] and the score for IUA after an intrauterine operation (mean difference=-1.29; 95%=-1.73 to -0.84; P<0.001). A subgroup analysis revealed that the preventive effect of hyaluronic acid gel on IUA was not affected by the type of intrauterine operation, namely abortion (RR=0.40; 95% CI=0.26-0.62; P<0.001) and hysteroscopy (RR=0.44; 95% CI=0.28-0.68; P<0.001). The preventive effect of hyaluronic acid gel on IUA was also not affected by primary disorders/diseases including the following: Abortion (RR=0.48; 95% CI=0.29-0.78; P=0.003); IUA (RR=0.38; 95% CI=0.21-0.67; P<0.001) and submucosal myoma of the uterus, endometrial polyps or mediastinum uterus (RR=0.40; 95% CI=0.18-0.90; P=0.03). Hyaluronic acid gel improved pregnancy rates after intrauterine operations (RR=1.94; 95% CI=1.46-2.60; P<0.001). In conclusion, hyaluronic acid gel was indicated to significantly reduce the incidence of IUA following intrauterine operation, regardless of the type of intrauterine operation or the presence of primary diseases. Treatment with hyaluronic acid gel was also revealed to increase pregnancy rates following intrauterine operation.
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Affiliation(s)
- Fei Zheng
- Department of Obstetrics and Gynecology, Yiwu Maternity and Children Hospital, Jinhua, Zhejiang 322000, P.R. China
| | - Xin Xin
- Department of Obstetrics and Gynecology, Benxi Central Hospital, Benxi, Liaoning 117000, P.R. China
| | - Fei He
- Department of Obstetrics and Gynecology, Yiwu Maternity and Children Hospital, Jinhua, Zhejiang 322000, P.R. China
| | - Jianyong Liu
- Department of Obstetrics and Gynecology, Yiwu Maternity and Children Hospital, Jinhua, Zhejiang 322000, P.R. China
| | - Yuechong Cui
- Department of Human Health and Human Services, Yiwu Maternity and Children Hospital, Jinhua, Zhejiang 322000, P.R. China
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Mao X, Tao Y, Cai R, Zhang J, Gao H, Chen Q, Kuang Y, Zhang S. Cross-linked hyaluronan gel to improve pregnancy rate of women patients with moderate to severe intrauterine adhesion treated with IVF: a randomized controlled trial. Arch Gynecol Obstet 2019; 301:199-205. [PMID: 31883044 DOI: 10.1007/s00404-019-05368-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 10/30/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate whether the cross-linked hyaluronan (cHA) gel can improve the clinical pregnancy rate of patients with moderate to severe intrauterine adhesion (IUA) who underwent operative hysteroscopy followed by embryo transfer. METHODS Women with moderate to severe IUA desiring to undergo embryo transfer were recruited in this randomized controlled trial. The patients were randomized on the day of receiving hysteroscopy. The control group received standard hysteroscopy, while cHA gel was applied to the treatment group at the end of hysteroscopy and 5-7 days after operation. All patients were expected to undergo in vitro fertilization (IVF)/intracytoplasmic sperm injection and frozen-thawed embryo transfer (FET). RESULTS A total of 306 patients were enrolled in this study, of which 202 were assigned to the treatment group and 104 to the control group. Both the clinical pregnancy rate (26.3% [49/186] vs. 15.3% [13/85], P = 0.045), the implantation rate (17.7% [57/322] vs. 9.8% [15/153], P = 0.025), and the endometrial thickness on the day of embryo transfer (7.97 ± 1.37 vs. 7.50 ± 0.60 mm, P < 0.001) were significantly higher in the treatment group compared to the control group. In addition, histological assessment of the paired endometrial tissues collected before and after operation revealed a relatively higher number of tubular glands after operation (15.1 ± 13.2 vs. 28.8 ± 30.4, P = 0.166). CONCLUSIONS To conclude, the application of cHA gel in patients with moderate to severe IUA during hysteroscopy can improve the quality of endometrium and uterine receptivity and consequently enhance the clinical pregnancy rate after IVF/CSI and FET.
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Affiliation(s)
- Xiaoyan Mao
- Department of Assisted Reproduction, The Ninth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yu Tao
- Department of Assisted Reproduction, The Ninth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Renfei Cai
- Department of Assisted Reproduction, The Ninth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jie Zhang
- Department of Assisted Reproduction, The Ninth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hongyuan Gao
- Department of Assisted Reproduction, The Ninth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qiuju Chen
- Department of Assisted Reproduction, The Ninth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yanping Kuang
- Department of Assisted Reproduction, The Ninth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shaozhen Zhang
- Department of Assisted Reproduction, The Ninth People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Fei Z, Xin X, Fei H, Yuechong C. Meta-analysis of the use of hyaluronic acid gel to prevent intrauterine adhesions after miscarriage. Eur J Obstet Gynecol Reprod Biol 2019; 244:1-4. [PMID: 31731019 DOI: 10.1016/j.ejogrb.2019.10.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 10/09/2019] [Accepted: 10/17/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Intrauterine adhesions are a severe complication after miscarriage. Hyaluronic acid gel has been used to prevent intrauterine adhesions after miscarriage. OBJECTIVE To systematically evaluate the efficacy of adjuvant therapy with hyaluronic acid gel to prevent intrauterine adhesions after miscarriage. SEARCH STRATEGY The Cochrane Library, Embase and PubMed databases were searched for articles published before 31 July 2018 using the terms: ('hyaluronic acid gel' or 'gel') and ('dilatation and curettage' or 'D&C' or 'abortion' or 'miscarriage' or 'hysteroscopic') and ('intrauterine adhesions' or 'Asherman syndrome' or 'IUA' or 'endometrial injury' or 'intrauterine adhesion'). SELECTION CRITERIA Randomized controlled trials of hyaluronic acid gel therapy after miscarriage. DATA COLLECTION AND ANALYSIS Four studies were included in the meta-analysis (625 patients in total). Dichotomous outcomes were expressed as relative risk (RR) with 95 % confidence intervals (CI). Continuous variables were expressed as standardized mean differences (SMD). MAIN RESULTS Hyaluronic acid gel reduced the intrauterine adhesion scores after miscarriage (SMD -0.68, 95 % CI -1.08~-0.28; p = 0.0008) and the incidence of postoperative intrauterine adhesions after miscarriage (RR 0.44, 95 % CI 0.29~0.67; p = 0.0001). Subgroup analysis found that hyaluronic acid gel reduced the incidence of moderate and severe intrauterine adhesions after miscarriage (RR 0.18, 95 % CI: 0.07~0.47; p = 0.0004), but had no effect on the incidence of mild intrauterine adhesions (RR 0.77, 95 % CI 0.42~1.19; p = 0.19). Hyaluronic acid gel also improved the pregnancy rate after miscarriage (RR 1.94, 95 % CI 1.46~2.60; p < 0.00001). CONCLUSION Hyaluronic acid gel significantly reduced the incidence of moderate and severe intrauterine adhesions and significantly improved the pregnancy rate after miscarriage.
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Affiliation(s)
- Zheng Fei
- Department of Obstetrics and Gynaecology, Yiwu Maternity and Children Hospital, Jinhua, China
| | - Xin Xin
- Department of Obstetrics and Gynaecology, Benxi Central Hospital, Benxi, China
| | - He Fei
- Department of Obstetrics and Gynaecology, Yiwu Maternity and Children Hospital, Jinhua, China
| | - Cui Yuechong
- Department of Human Health and Human Services, Yiwu Maternity and Children's Hospital, Jinhua, China.
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Margaux Becker V, Silver S, Seufert R, Muensterer OJ. The Association of Appendectomy, Adhesions, Tubal Pathology, and Female Infertility. JSLS 2019; 23:JSLS.2018.00099. [PMID: 30846898 PMCID: PMC6400250 DOI: 10.4293/jsls.2018.00099] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background and Objectives The aim of the study was to investigate a potential association between previous childhood appendectomy, tube pathology, and female infertility. Methods We reviewed patients seeking care at the fertility clinic of our university medical center between 2006 and 2016. The history of previous appendectomy was extracted from hospital documentation and by telephone follow-up. Tubal patency was assessed by diagnostic laparoscopy and chromopertubation. Results In our study cohort (N = 237), 24.9% (n = 59) had a history of previous appendectomy. Previous appendectomy, therefore, was about 3-fold more prevalent in women seeking fertility treatment than in the general population. Patients with previous appendectomy had more intra-abdominal adhesions (P < .001) and patients with adhesions tended to have compromised tubal patency (P = .05). However, there was no direct correlation between a previous appendectomy and tube pathology (P = .727). Conclusion Because previous appendectomy was associated with intra-abdominal adhesions, and these were in turn associated with tube pathology, but appendectomy was not directly associated with compromised tubal patency, previous appendectomy may indirectly affect female fertility through mechanisms other than direct tubal obstruction. This is one of the largest study analyzing laparoscopic chromopertubation in association with previous childhood appendectomy.
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Affiliation(s)
- Victoria Margaux Becker
- Department of Pediatric Surgery, University Medical Center of the Johannes Gutenberg University Mainz, Germany
| | - Saskia Silver
- Department of Pediatric Surgery, University Medical Center of the Johannes Gutenberg University Mainz, Germany
| | - Rudolf Seufert
- Department of Obstetrics and Gynecology, University Medical Center of the Johannes Gutenberg University Mainz, Germany
| | - Oliver J Muensterer
- Department of Pediatric Surgery, University Medical Center of the Johannes Gutenberg University Mainz, Germany
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