Stem Cell Therapy for Premature Ovarian Failure

There is still a long way to go from basic research to clinical application, but this is also a process that every new technology must go through.

There is no dispute that the ovaries are the central organ of femininity.

Premature ovarian failure is the enemy of middle-aged and elderly women. It will change color upon hearing it, and even cause some series of physical and psychological problems. Conventional clinical treatment of premature ovarian failure, such as estrogen-progesterone replacement, ovulation induction therapy, immunotherapy and ovarian transplantation, only has a certain palliative effect, and there is no radical cure. Long-term use of these drugs will also bring many side effects: For example, immunosuppression can cause changes in immune cells and immune function; excessive use of hormones also increases the risk of gynecological tumors and cardiovascular and cerebrovascular diseases.

Animal experiments emerge in endlessly

The use of stem cells to treat premature ovarian failure seems very popular now. We can use pubmed to search bone marrow mesenchymal stem cells, umbilical cord blood stem cells, umbilical cord mesenchymal stem cells, amniotic fluid stem cells, uterine membrane stem cells, fat stem cells and even skin mesenchymal stem cells. A series of papers, including exosomes derived from stem cells, also came to join in the fun. This is the case in the field of scientific research now. Under the guidance of the SCI banner, we pay attention to hot spots, especially the universal hot spot - mesenchymal stem cells. In the past two years, there has been a rush to use microRNA, and now there is a rush to use exosomes. For liver cirrhosis, lung injury, and burns, everyone uses exosomes.

Most of these published papers use animal models: ovarian injury by radiotherapy and chemotherapy, autoimmune injury and aging animals. The experimental results in these animal models are exciting, hormone levels, follicle numbers at all levels, and animal weight have all been improved. The number of apoptotic cells in the ovary also decreased significantly.

In fact, there are many causes of premature ovarian failure in modern society: environmental pollution, psychological stress, lack of exercise, iatrogenic factors and autoimmune disorders are the main culprits, and in many cases genetic factors are mixed with other factors, it is difficult to use animal models Perfectly simulated, this is our question: In actual clinical application, can it really achieve as good a curative effect as in animal experiments?

The clinical effect is questionable

In order to answer this question, we first analyze the general mechanism of stem cell therapy for premature ovarian failure: 1) Immunomodulation, reducing disordered inflammatory factors; 2) Secreting paracrine factors, saving the three main types of cells in the half-dead ovary; 3) Improve tissue microcirculation, so that nutrients can be transported to each unit; 4) Improve the state of large organs such as heart, liver, lung and kidney, reduce free radicals and other harmful factors, and improve endocrine.

In general, whether it is autologous bone marrow, dental pulp, fat and uterine stem cells, or allogeneic umbilical cord blood, umbilical cord, amniotic fluid and amniotic membrane stem cells, they will not survive for too long after the reinfusion. Days later, they are all cleared away by the body's powerful immune system, leaving only paracrine factors. In this way, we can draw the following conclusion: at least this ovary is worth saving, but if the mood is too depressed, the ovarian failure is too serious, the immune attack is too severe, any stem cell injection is useless!

Therefore, it is very important to choose the right target in order to achieve better curative effect in the treatment of premature ovarian failure with stem cells , otherwise it will severely damage the confidence of the fragile stem cells. First of all, we need to analyze the cause of the disease. If it is genetic, don’t try it. If you are depressed, you should see a psychiatrist. If it is drug-induced, you should stop taking the medicine. It is possible that patients with premature ovarian failure can only improve basic signs such as hot and cold after receiving stem cells, and the hormone level and menstrual status will not change at all. Those who are still young, still have basic follicles, and those whose autoimmunity has passed the acute stage, can try using stem cells again.

Finally, let’s talk about the method. Intravenous infusion of stem cells is actually the most common treatment for premature ovarian failure because it is easy to operate. But the problem is that the stem cells that can reach the ovarian lesions are also rare, and most of them are trapped by the lungs and kidneys and die in the peripheral circulation. Therefore, local ovarian injection guided by transvaginal B-ultrasound has become an effective means of clinical stem cell therapy for premature ovarian failure. At the same time, patients must have sufficient determination and the full cooperation of gynecologists to do this well.

It is commendable that the combination of stem cells and biomaterials has become a good way to treat premature ovarian failure and solve many problems. The team of Dai Jianwu of the Chinese Academy of Sciences has designed and developed an injectable smart collagen scaffold material for the regeneration of ovarian function, which has been successful. In January 2018, the subject successfully gave birth to a baby boy at Nanjing Drum Tower Hospital. The collagen scaffold material combined with stem cells not only utilizes the paracrine effect of stem cells, but also combines transplanted stem cells to keep them in the damaged area to the greatest extent, avoiding the proliferation of cells .

There is still a long way to go from basic research to clinical application, but this is also a process that every new technology must go through. Stem cell therapy for premature ovarian failure may become a reality in the near future. In the near future, stem cells will officially enter clinical application as drugs, and the entire regenerative medicine industry will also usher in huge opportunities.