Role and mechanism of mesenchymal stem cells in endometrial receptivity remodeling

Wang Zhao-di, Liu Xian-bao, Lv Liang-Zhen, Li Lu-Hao, Ren Jia-Jie, Zhu Hui, Jiang Bei, Chang Zhuo
In: Frontiers in Cell and Developmental Biology · 2026 · vol. 14 , pp. 1724597 · doi:10.3389/fcell.2026.1724597 · PMID:41909132 · PMC13017818 · W7135080103
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

Mesenchymal stem cells enhance endometrial receptivity through differentiation, angiogenesis, immunomodulation, and extracellular matrix remodeling, showing promise in treating infertility and improving pregnancy rates.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-11 ⓘ

This narrative review examines how mesenchymal stem cells (MSCs) may restore endometrial receptivity (ER) by summarizing evidence on preclinical and clinical studies across infertility contexts, including intrauterine adhesions and thin endometrium. The authors synthesize mechanisms whereby MSCs improve ER through potential differentiation into endometrial-like cells, paracrine-driven angiogenesis (e.g., VEGF), immunomodulation via induction of Treg cells and M2 macrophages, and extracellular matrix remodeling, while also noting translational barriers such as challenges in standardization and long-term safety. As part of the review, they discuss MSC source-dependent properties and identification methods (surface markers like CD73/CD90/CD105, morphology, and differentiation assays), emphasizing that culture conditions and passage number can alter cell characteristics. The paper is centrally about endometriosis? No—this review is not centrally about endometriosis or adenomyosis; it focuses on MSC mechanisms in endometrial receptivity and regeneration, with endometriosis/adenomyosis not explicitly discussed in the provided text.

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Abstract

Endometrial receptivity (ER) is a pivotal determinant of successful embryo implantation, and its dysfunction is a major cause of infertility and recurrent implantation failure. Mesenchymal stem cells (MSCs) have emerged as a promising therapeutic strategy due to their multipotency, self-renewal capacity, and potent paracrine activity. This review elucidates the multifaceted mechanisms through which MSCs enhance ER, including direct differentiation into endometrial cells, promotion of angiogenesis via secretion of factors like VEGF, immunomodulation by inducing Treg cells and M2 macrophages, and remodeling of the extracellular matrix. Crucially, we highlight emerging clinical evidence; for instance, in a recent clinical trial, intrauterine infusion of umbilical cord-derived MSCs in women with intrauterine adhesions significantly increased endometrial thickness from a mean of 4.2 ± 0.5 mm to 6.8 ± 0.7 mm and improved the clinical pregnancy rate to 38.5%. Furthermore, we discuss ongoing clinical trials and future directions, such as the development of engineered MSC-derived exosomes and biomaterial-scaffold combinations. Despite challenges in standardization and long-term safety, MSC-based therapy represents a novel and potent approach for regenerating dysfunctional endometrium, offering new hope for refractory infertility.

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Condition tags

infertility

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