EndMT: New findings on the origin of myofibroblasts in endometrial fibrosis of intrauterine adhesions

Background Intrauterine adhesion (IUA) is one of the leading causes of infertility and the main clinical challenge is the high recurrence rate. The key to solving this dilemma lies in elucidating the mechanisms of endometrial fibrosis. The aim of our team is to study the mechanism underlying intrauterine adhesion fibrosis and the origin of fibroblasts in the repair of endometrial fibrosis. Methods Our experimental study involving an animal model of intrauterine adhesion and detection of fibrosis-related molecules. The levels of molecular factors related to the endothelial-to-mesenchymal transition (EndMT) were examined in a rat model of intrauterine adhesion using immunofluorescence, immunohistochemistry, qPCR and Western blot analyses. Main outcome measures are levels of the endothelial marker CD31 and the mesenchymal markers alpha-smooth muscle actin (α-SMA) and vimentin. Results Immunofluorescence co-localization of CD31 and a-SMA showed that 14 days after moulding, double positive cells for CD31 and a-SMA could be clearly observed in the endometrium. Decreased CD31 levels and increased α-SMA and vimentin levels indicate that EndMT is involved in intrauterine adhesion fibrosis. Conclusions Endothelial cells promote the emergence of fibroblasts via the EndMT during the endometrial fibrosis of intrauterine adhesions.

Effectiveness of treatment of the Asherman’s syndrome in women of reproductive age. Case report

The most urgent problem of modern gynecology is not just the treatment of intrauterine adhesive disease in fertile women, but the prevention of its recurrence. The lack of a systematic approach to management create grounds for searching for remedies with maximum anti-relapse effectiveness, minimum frequency of side effects. The purpose of the review is to consider the effectiveness of various types of treatment of intrauterine adhesions in women of reproductive age.

Hysteroscopic evaluation of uterine cavity in women with unexplained infertility

Objective: To detect missed uterine abnormalities on primary work up in unexplained infertile women. Study design: An observational study was performed in the outpatient infertility clinic of Beni-Suef University Hospitals. It included 100 women with unexplained infertility. Diagnostic office hysteroscopy was done for all participants. Women were grouped according to the infertility type and compared as regards uterine abnormalities detected. Results: Uterine abnormalities were detected by hysteroscopy in 29% of women. No significant difference was found regarding the hysteroscopic findings between primary and secondary infertility groups. However, uterine polyp cases were detected more in women with primary infertility (55.5% /18). A significant difference in intrauterine adhesions between both groups being detected only in secondary infertility group (p value =0.006). Conclusion: Outpatient preliminary and routine diagnostic office hysteroscopy may be a beneficial part of a primary and secondary infertility workup.

The Latest Developments in Immunomodulation of Mesenchymal Stem Cells in the Treatment of Intrauterine Adhesions, Both Allogeneic and Autologous

Intrauterine adhesion (IUA) is an endometrial fibrosis disease caused by repeated operations of the uterus and is a common cause of female infertility. In recent years, treatment using mesenchymal stem cells (MSCs) has been proposed by many researchers and is now widely used in clinics because of the low immunogenicity of MSCs. It is believed that allogeneic MSCs can be used to treat IUA because MSCs express only low levels of MHC class I molecules and no MHC class II or co-stimulatory molecules. However, many scholars still believe that the use of allogeneic MSCs to treat IUA may lead to immune rejection. Compared with allogeneic MSCs, autologous MSCs are safer, more ethical, and can better adapt to the body. Here, we review recently published articles on the immunomodulation of allogeneic and autologous MSCs in IUA therapy, with the aim of proving that the use of autologous MSCs can reduce the possibility of immune rejection in the treatment of IUAs.