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Secretome engineering is an emerging frontier: PD-MSCs primed to secrete high hepatocyte-growth-factor engage Wnt/-catenin signalling to tighten endothelial barriers and foster follicular growth [183], while an estrogen-responsive PD-MSC secretome rescues cyclophosphamide-induced POI, restores circadian clock genes and curbs granulosa-cell apoptosis, suggesting cell-free formulations could combine ovarian repair with systemic chronoprotection [20]