Unveiling the Pathological Landscape of Intrauterine Adhesion: Mechanistic Insights and Exosome-Biomaterial Therapeutic Innovations
Zhimin Qin,1,* Qicheng Yu,2,* Yan Long1 1Department of Obstetrics and Gynecology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People’s Republic of China; 2Emergency Department of Xuanwu Hospital, Capital Medical University, Beijing, 100053, Peopl...
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Dove Medical Press
2025-08-01
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| author | Qin Z Yu Q Long Y |
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| description | Zhimin Qin,1,* Qicheng Yu,2,* Yan Long1 1Department of Obstetrics and Gynecology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People’s Republic of China; 2Emergency Department of Xuanwu Hospital, Capital Medical University, Beijing, 100053, People’s Republic of China*These authors contributed equally to this workCorrespondence: Yan Long, Department of Obstetrics and Gynecology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People’s Republic of China, Email longyan_doc@163.comAbstract: Intrauterine adhesion (IUA) is a fibrotic disorder caused by endometrial injury, characterized by structural damage and functional impairment of the endometrium, which severely impacts female reproductive health. The core pathology of IUA revolves around aberrant fibrosis, driven by intricate interactions among inflammation, epithelial-mesenchymal transition (EMT), and dysregulated cellular processes such as autophagy and ferroptosis. Inflammation acts as a pivotal initiator, directly activating fibrotic pathways or inducing EMT, thereby exacerbating fibrosis. Recent studies highlight the dual roles of autophagy and ferroptosis in IUA progression, where their dysregulation either mitigates or aggravates fibrotic outcomes, underscoring the complexity of its pathogenesis. Current treatments, such as transcervical resection of adhesions (TCRA), offer short-term anatomical restoration but fail to address high recurrence rates and insufficient endometrial regeneration. Exosomes have emerged as a promising cell-free therapeutic strategy, leveraging their bioactive cargo to modulate fibrosis, inflammation, and EMT. However, research on exosome-based therapies for IUA remains limited, particularly in targeting autophagy, ferroptosis, and their integration with biomaterials. Biomaterial-assisted exosome delivery systems, such as hydrogels and scaffolds, enhance therapeutic efficacy by enabling sustained release and localized action. Despite preclinical progress, clinical translation faces challenges, including standardized protocols and long-term safety validation. This review synthesizes the pathological mechanisms of IUA, explores the therapeutic potential of exosomes and biomaterials, and discusses future directions to bridge the gap between mechanistic insights, therapeutic strategy development and clinical applications.Keywords: intrauterine adhesion, pathological mechanism, exosomes, biomaterials |
| format | Article |
| id | doaj-art-e6e6e431a4a247909c5e35dcf558f3fd |
| institution | DOAJ |
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| language | English |
| publishDate | 2025-08-01 |
| publisher | Dove Medical Press |
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| series | International Journal of Nanomedicine |
| spelling | doaj-art-e6e6e431a4a247909c5e35dcf558f3fd2025-08-20T02:56:31ZengDove Medical PressInternational Journal of Nanomedicine1178-20132025-08-01Volume 20Issue 196679694105461Unveiling the Pathological Landscape of Intrauterine Adhesion: Mechanistic Insights and Exosome-Biomaterial Therapeutic InnovationsQin Z0Yu Q1Long Y2Department of Obstetrics and GynecologyEmergency DepartmentDepartment of Obstetrics and GynecologyZhimin Qin,1,* Qicheng Yu,2,* Yan Long1 1Department of Obstetrics and Gynecology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People’s Republic of China; 2Emergency Department of Xuanwu Hospital, Capital Medical University, Beijing, 100053, People’s Republic of China*These authors contributed equally to this workCorrespondence: Yan Long, Department of Obstetrics and Gynecology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People’s Republic of China, Email longyan_doc@163.comAbstract: Intrauterine adhesion (IUA) is a fibrotic disorder caused by endometrial injury, characterized by structural damage and functional impairment of the endometrium, which severely impacts female reproductive health. The core pathology of IUA revolves around aberrant fibrosis, driven by intricate interactions among inflammation, epithelial-mesenchymal transition (EMT), and dysregulated cellular processes such as autophagy and ferroptosis. Inflammation acts as a pivotal initiator, directly activating fibrotic pathways or inducing EMT, thereby exacerbating fibrosis. Recent studies highlight the dual roles of autophagy and ferroptosis in IUA progression, where their dysregulation either mitigates or aggravates fibrotic outcomes, underscoring the complexity of its pathogenesis. Current treatments, such as transcervical resection of adhesions (TCRA), offer short-term anatomical restoration but fail to address high recurrence rates and insufficient endometrial regeneration. Exosomes have emerged as a promising cell-free therapeutic strategy, leveraging their bioactive cargo to modulate fibrosis, inflammation, and EMT. However, research on exosome-based therapies for IUA remains limited, particularly in targeting autophagy, ferroptosis, and their integration with biomaterials. Biomaterial-assisted exosome delivery systems, such as hydrogels and scaffolds, enhance therapeutic efficacy by enabling sustained release and localized action. Despite preclinical progress, clinical translation faces challenges, including standardized protocols and long-term safety validation. This review synthesizes the pathological mechanisms of IUA, explores the therapeutic potential of exosomes and biomaterials, and discusses future directions to bridge the gap between mechanistic insights, therapeutic strategy development and clinical applications.Keywords: intrauterine adhesion, pathological mechanism, exosomes, biomaterialshttps://www.dovepress.com/unveiling-the-pathological-landscape-of-intrauterine-adhesion-mechanis-peer-reviewed-fulltext-article-IJNIntrauterine adhesionPathological mechanismExosomesBiomaterials |
| spellingShingle | Qin Z Yu Q Long Y Unveiling the Pathological Landscape of Intrauterine Adhesion: Mechanistic Insights and Exosome-Biomaterial Therapeutic Innovations International Journal of Nanomedicine Intrauterine adhesion Pathological mechanism Exosomes Biomaterials |
| title | Unveiling the Pathological Landscape of Intrauterine Adhesion: Mechanistic Insights and Exosome-Biomaterial Therapeutic Innovations |
| title_full | Unveiling the Pathological Landscape of Intrauterine Adhesion: Mechanistic Insights and Exosome-Biomaterial Therapeutic Innovations |
| title_fullStr | Unveiling the Pathological Landscape of Intrauterine Adhesion: Mechanistic Insights and Exosome-Biomaterial Therapeutic Innovations |
| title_full_unstemmed | Unveiling the Pathological Landscape of Intrauterine Adhesion: Mechanistic Insights and Exosome-Biomaterial Therapeutic Innovations |
| title_short | Unveiling the Pathological Landscape of Intrauterine Adhesion: Mechanistic Insights and Exosome-Biomaterial Therapeutic Innovations |
| title_sort | unveiling the pathological landscape of intrauterine adhesion mechanistic insights and exosome biomaterial therapeutic innovations |
| topic | Intrauterine adhesion Pathological mechanism Exosomes Biomaterials |
| url | https://www.dovepress.com/unveiling-the-pathological-landscape-of-intrauterine-adhesion-mechanis-peer-reviewed-fulltext-article-IJN |
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