Review articleAdipose-Derived Mesenchymal Stem Cells: A Promising Tool in the Treatment of pre mature ovarian failure
Introduction
Premature ovarian failure (POF) is among the most common diseases in women. This term refers to a condition in which the follicles in ovaries are destroyed or inactivated (Hoek et al., 1997; Kovanci & Schutt, 2015). Evidence with regards to the exact prevalence of POF do not exist yet. Almost 1% of women younger than 40 are estimated to be affected by spontaneous POF. Although particular information are lacking, the incidence of iatrogenic POF is increasing, which is concerning. As a result of increased survival rates following malignant diseases, more women now experience the long-term effects of treatments in this regard, including radiotherapy and chemotherapy (Maclaran & Panay, 2011).
Although the causes of ovarian failure have not been precisely identified, factors such as surgery, radiation or chemotherapy, genetic and chromosomal abnormalities, environmental factors (chemical agents, viruses, etc.), metabolic damage of ovarian autoimmunity (type 1 diabetes, galactosemia, deficiency of 17-OH and OH-21, etc.), endometriosis, and polycystic ovary syndrome are involved in the development of ovarian failure (Komorowska, 2016). Ovarian failure occurs with symptoms such as amenorrhea or infertility. However, comorbidities including hypotension, axillary and genital hair loss, hyperpigmentation or vitiligo (related to autoimmune adrenal insufficiency, thyroid enlargement, and exophthalmos can also be symptoms of ovarian failure (Ahonen et al., 1990; Betterle et al., 2002; Betterle & Volpato, 1998).
One of the recent treatment options for ovarian failure is the use of ADMSCs. Adipose tissue is totally available and is in fact a rich source for stem cells which possess multipotent characteristics that are proper for application in regenerative medicine and tissue engineering (Parhizkar et al., 2021). These are the reasons why ADMSCs have become popular among researchers (Bunnell et al., 2008).
Obtaining ADMSCs could be performed on adipose tissue using liposuction, washing, collagenase digestion, and centrifugation. The advantages of employing adipose stem cells over bone marrow cells include less invasion, facile application, and abundance of this tissue in the body (Aghlmandi et al., 2021). Reproduction, migration, and ADMSC differentiation can be regulated using estrogen. In this review, the causes of POF, effective treatment strategies, and the effect of Adipose-Derived Mesenchymal Stem Cell transplantation for the treatment of premature ovarian failure are reviewed.
Section snippets
Etiology of POF
Follicogenesis is a regular process in which primary follicles first develop into secondary follicles, and then into antral follicles, following which ovulation occurs. If this natural process changes, it will lead to POF. There exist three cell types in ovarian follicles, including oocytes, granulosa cells, and theca cells. Receptors for luteinizing hormone and follicle-stimulating hormone (FSH) exist on theca and granulosa cells, respectively, which are vital to follicle growth and
Diagnosis
Doctors may face the condition (POF) by examining young women who struggle to get pregnant or experience secondary amenorrhea. In this case, to make the diagnosis, determining whether there exist any menopausal symptoms might be beneficial. Assessments of the medical history of POF patients typically show a normal age of menarche and usual menstrual cycles, which are followed either by oligomenorrhea or sudden amenorrhea. Some cases might also show secondary loss of menses when they stop taking
Current treatments
There are several treatments for POF, but none are definite because of the complexity of POF. Overall, some of the best recent treatments for POF include exercise and diet, hormone replacement therapy, donor oocytes, use of androgens, biochemical hormones, dehydroepiandrosterone, Melatonin and cell therapy (Table3) (Sheikhansaria et al., 2018).
Stem cell therapy is particularly significant among the aforesaid treatments, since MSCs as multipotent somatic stem cells are capable of differentiating
Mesenchymal stem cells
Due to their availability and poor immunogenicity, mesenchymal stem cells (MSCs) are potent candidates for regeneration-related purposes (Aghebati-Maleki et al., 2019; Jahanbani et al., 2020). Adipose tissue, cord blood, and bone are rich in these cells (Izadpanah et al., 2020). POF was treated through the application of rat umbilical cord-derived MSCs by Wang et al. in 2013. Moreover, enhanced levels of sex hormones, restored function of ovaries, and reduced apoptosis of cumulus cells were
Conclusion
Ovarian failure causes complications that can lead to infertility, though they have not been determined precisely yet and require further study. One of the most effective treatments in this regard is the application of stem cells, which have received a lot of attention due to possessing unique self-renewal and proliferative features. Also, treatment with stem cells does not have the side effects of other treatments, such as hormone therapy. Therefore, it is a valuable treatment option. Among
Funding
This study was supported by Research Vice- Chancellor at Tabriz University of Medical Sciences, Iran [Grant No. 68037].
Declaration of Competing Interest
The authors report no declarations of interest.
Acknowledgments
This study was supported by Immunology Research Center, Tabriz University of Medical Sciences, Iran.
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