Stem Cell Applications in Intrauterine Adhesion Management

Intrauterine adhesions are fibrotic sequelae of endometrial injury that compromise female fertility and reproductive health globally. Surgical separation remains the standard management but is often hampered by high rates of recurrence and limited functional restoration of the uterine lining. Stem cell–based strategies have emerged as promising alternatives, leveraging the regenerative potential of mesenchymal stem cells (MSCs), endometrial side-population cells and organoids to promote endometrial repair, modulate fibrosis and restore vascularisation. Approaches range from cell transplantation to biomimetic scaffolds and paracrine modulation, with ongoing optimisation of cell source, delivery vehicle and microenvironmental cues. Comprehensive understanding of endometrial niche dynamics and controlled engineering of cell–matrix interactions are key to translating these therapies into reliable clinical options for patients with Asherman’s syndrome and severe intrauterine adhesions.

Research from Nature Portfolio

Recent studies have employed single-cell transcriptomics to map the endometrial niche in patients with severe intrauterine scarring, revealing loss of epithelial progenitors, aberrant activation of pro-fibrotic and pro-inflammatory pathways, and disruption of Wnt and Notch signalling networks. The identification of syndrome-associated cell populations and their intercommunication provides a framework for refining stem cell interventions, informing the selection of cell types and preconditioning regimens to enhance engraftment, suppress fibrogenesis and restore a receptive endometrial microenvironment.

Stem Cell Applications in Intrauterine Adhesion Management publication trend

The graph below shows the total number of articles in stem cell applications in intrauterine adhesion management across all publications each year (not limited to Nature Index journals).

Technical terms

Intrauterine adhesion (IUA): Fibrous scar tissue forming within the uterine cavity following endometrial injury, leading to menstrual disturbances and infertility.

Mesenchymal stem cell (MSC): Multipotent stromal cell capable of differentiating into mesenchymal lineages and secreting paracrine factors that modulate repair.

Organoid: Three-dimensional, multicellular in vitro construct that recapitulates key structural and functional features of native tissue.

Biomimetic scaffold: Engineered matrix designed to emulate the extracellular environment, supporting cell attachment, proliferation and tissue morphogenesis.

References

1. Biomimicking trilayer scaffolds with controlled estradiol release for uterine tissue regeneration. Exploration (2024).
2. Decoding the endometrial niche of Asherman’s Syndrome at single-cell resolution. Nature Communications (2023).
3. Mechanisms of Regeneration and Fibrosis in the Endometrium. Annual Review of Cell and Developmental Biology (2023).
4. Endometrial organoids: a reservoir of functional mitochondria for uterine repair. Theranostics (2024).
5. Allogeneic cell therapy using umbilical cord MSCs on collagen scaffolds for patients with recurrent uterine adhesion: a phase I clinical trial. Stem Cell Research & Therapy (2018).
6. The management of Asherman syndrome: a review of literature. Reproductive Biology and Endocrinology (2013).
7. Stem Cell-Like Properties of the Endometrial Side Population: Implication in Endometrial Regeneration. PLOS ONE (2010).