ArticleMaterials today. Bio2026
Adipose-derived extracellular vesicles miR-423-5p targets SMAD3 to reverse endometrial fibrosis in a porcine model of intrauterine adhesion: insights from single-cell sequencing.
Article in Materials today. Bio, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Intrauterine adhesion (IUA), a fibrotic cause of female infertility, lacks effective therapies due to high recurrence following surgical intervention. Extracellular vesicles derived from mesenchymal stem cells (MSC-EVs) show promise in small-animal models, yet clinical translation is hindered by poor retention and the absence of large-animal validation. To address this, we developed a thermosensitive chitosan hydrogel (GelCT) as an EV carrier for autologous adipose MSC-EV delivery in a porcine IUA model. EVs-GelCT significantly attenuated fibrosis, restored endometrial architecture, and enhanced vascularization. Single-cell transcriptomics revealed that EVs remodel fibroblast subpopulations, specifically suppressing pro-fibrotic F2 (ECM-reparative) and F3 (inflammation-associated) clusters. Integrated miRNA profiling identified miR-423-5p as a functional EV cargo that directly targets SMAD3 3'UTR, thereby inhibiting TGF-β/Smad signaling. This first-in-porcine demonstration establishes the miR-423-5p/SMAD3 axis as a therapeutically actionable mechanism for IUA, advancing EV-based strategies from proof of concept to clinical translation.
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