Decidual and Endometrial Multipotent Mesenchymal Stromal Cells: Emerging Therapeutic and Clinical Approaches for Intrauterine Adhesion Repair

Abstract

Intrauterine adhesion (IUA), a prevalent cause of female infertility and recurrent pregnancy loss, is characterized by endometrial trauma and progressive fibrosis. Current treatment modalities, including hysteroscopic adhesiolysis and hormone decidual multipotent mesenchymal stromal cells (DMSCs), a unique subset of stromal cells derived from the endometrium, exhibit strong multipotent differentiation capabilities, immunomodulatory properties, and low immunogenicity. These features enable DMSCs to facilitate endometrial regeneration, restore intrauterine immune homeostasis, and attenuate fibrosis, offering a compelling therapeutic strategy for IUA. Recent preclinical studies have demonstrated promising regenerative outcomes, yet the clinical application of DMSCs remains constrained by challenges such as limited cell availability, variability in therapeutic efficacy, and concerns regarding long-term safety. This review provides a comprehensive overview of the current progress in DMSC-based therapy for IUA, highlights its mechanistic advantages, and discusses critical obstacles and future directions for successful clinical translation.