Mezenkimal Kök Hücrelerin Erkek İnfertilitesindeki Rolü
Özet
İnfertilite, Dünya çapında çiftlerin yaklaşık %15'ini etkileyen önemli bir halk sağlığı sorunudur ve bu vakaların %50-60'ına erkek faktörü eşlik etmektedir. Sigara, alkol, genetik faktörler, Y kromozomu mikrodelesyonları, yüksek reaktif oksijen türleri (ROS) kaynaklı oksidatif stres, kanser tedavileri ve testis torsiyonu erkek infertilitesinin temel nedenleri arasında yer almaktadır. Günümüzde yaygın olarak kullanılan yardımcı üreme teknikleri (YÜT), fonksiyonel gametleri bulunmayan veya çocukluk çağında gonadotoksik tedavilere maruz kalmış hastalar için yetersiz kalabilmektedir. Bu noktada, rejeneratif tıp ve kök hücre teknolojileri kısırlık tedavisinde yeni bir umut kapısı aralamaktadır. Sahip oldukları yüksek çoğalma, kendi kendini yenileme ve parakrin faktörler salgılama yetenekleri sayesinde mezenkimal kök hücreler (MKH), hasarlı testis dokularının iyileştirilmesinde kritik bir rol oynamaktadır. Kemik iliği, göbek kordonu ve yağ dokusu gibi çeşitli kaynaklardan izole edilen MKH'lerin, retinoik asit ve belirli büyüme faktörleri eşliğinde in vitro ortamda germ hücrelerine farklılaşabildiği gösterilmiştir. Deneysel çalışmalar, transplante edilen MKH'lerin veya bunların koşullu ortamlarının (sekretom), oksidatif stresi ve apoptozu azaltarak, sperm motilitesini artırarak ve testis nişini destekleyerek spermatogenezi geri döndürebildiğini ortaya koymaktadır. Sonuç olarak MKH'ler, erkek infertilitesinin hücresel düzeyde tedavisinde güçlü ve yenilikçi bir terapötik alternatif sunmaktadır.
Infertility is a major global public health issue affecting approximately 15% of couples worldwide, with a male factor contributing to 50-60% of cases. The primary causes of male infertility include smoking, alcohol consumption, genetic factors, Y chromosome microdeletions, oxidative stress induced by high reactive oxygen species (ROS), cancer therapies, and testicular torsion. Although assisted reproductive technologies (ART) are widely utilized today, they remain insufficient for patients lacking functional gametes or those who underwent gonadotoxic treatments during childhood. In this regard, regenerative medicine and stem cell technologies offer a new beacon of hope for infertility treatment. Due to their high proliferation, self-renewal capacities, and secretome profile, mesenchymal stem cells (MSCs) play a critical role in healing damaged testicular tissues. Isolated from various sources such as bone marrow, umbilical cord, and adipose tissue, MSCs have been shown to differentiate into germ-like cells in vitro when treated with retinoic acid and specific growth factors. Experimental studies demonstrate that transplanted MSCs or their conditioned media can restore spermatogenesis by reducing oxidative stress and apoptosis, improving sperm motility, and enhancing the testicular niche. Consequently, MSCs provide a powerful and innovative therapeutic alternative for the cellular-level treatment of male infertility.
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