间充质干细胞外泌体多靶点修复女性压力性 尿失禁的研究进展

Research Advances in Mesenchymal Stem Cell-Derived Exosomes for Multi-Target Repair of Female Stress Urinary Incontinence

摘要: 压力性尿失禁(stress urinary incontinence, SUI)是影响女性健康的常见盆底功能障碍性疾病，其病理机制涉及尿道括约肌退变与纤维化、盆底支持组织细胞外基质代谢失衡、神经损伤及盆底微环境破坏等多重环节。间充质干细胞来源的外泌体(mesenchymal stem cell-derived exosomes, MSC-Exos)作为一种新型无细胞治疗范式，具有低免疫原性、多靶点调控及工程化可塑性等优势，可通过激活肌卫星细胞再生、调节基质金属蛋白酶及其抑制剂平衡、递送脑源性神经营养因子及促再生miRNA、诱导微血管新生、重塑炎症与氧化还原稳态等多种机制，协同修复压力性尿失禁的多重病理损伤，为其无细胞再生治疗提供了理论依据与新策略。

Abstract: Stress urinary incontinence (SUI) is a common pelvic floor dysfunction affecting women’s health, and its pathological mechanisms involve multiple links, including degeneration and fibrosis of the urethral sphincter, metabolic imbalance of the extracellular matrix in pelvic floor supportive tissues, nerve injury, and disruption of the pelvic floor microenvironment. Mesenchymal stem cell-derived exosomes (MSC-Exos), as a novel cell-free therapeutic paradigm, possess advantages such as low immunogenicity, multi-target regulation, and engineering plasticity. They can synergistically repair the multiple pathological lesions of SUI through various mechanisms, including activating muscle satellite cell regeneration, modulating the balance between matrix metalloproteinases and their inhibitors, delivering brain-derived neurotrophic factor and pro-regenerative miRNAs, inducing microvascular angiogenesis, and remodeling inflammatory and redox homeostasis, thereby providing a theoretical basis and novel strategy for cell-free regenerative therapy of stress urinary incontinence.