Background: Keloids represent the dysregulation of cutaneous wound healing caused by aberrant fibroblast activities. Adipose-derived stem cells have been recognized as a promising treatment for keloids. However, the molecular mechanisms have not been fully elucidated. Objectives: to explicitly demonstrate the relationship between adipose-derived stem cells alleviating keloids and alterations of Col-1, Col-3, CTGF, and P-4-HB. Methods: Skin biopsies were obtained from 10 keloid patients and 9 healthy volunteers. Fibroblasts isolated from all samples were divided into two groups, one co-cultured with adipose-derived stem cells and the other grown independently. We compared the wound-healing rates, fibroblast survival rates, apoptosis rates, mRNA expressions, and protein levels of Col-1, Col-3, CTGF, and P-4-HB between separated groups. Results: We found no significant differences between normal fibroblasts and keloid fibroblasts in terms of wound-healing rate, survival rate, or apoptosis rate at the baseline. With adipose-derived stem cells, wound-healing rate and survival rate of normal fibroblasts were promoted, whereas in keloid fibroblasts, they were reduced. The apoptosis rate of normal fibroblasts and keloid fibroblasts were restrained, with the restraint in keloid fibroblasts being more evident. The protein levels of Col-3, CTGF, and P-4-HB were lower in keloid fibroblasts co-cultured with adipose-derived stem cells than in normal fibroblasts under similar conditions. Conclusions: Adipose-derived stem cells strongly suppressed keloid fibroblasts' proliferative and invasive behavior. However, adipose-derived stem cells negatively regulated keloid fibroblast apoptosis. Adipose-derived stem cells can be a potential keloid therapy worth further investigation.

Among approaches for the treatment of cutaneous squamous cell carcinoma (cSCC), complete surgical removal at the primary tumor site should be the first-line treatment when tumor characteristics (size, location, and number) allow. 1 Mohs micrographic surgery (MMS) is the gold standard for the treatment of cSCC, with a cure rate of 96%-99%. 2 Wide local excision (WLE) is another type of treatment with a cure rate of 90%-97%, and it can be used when MMS is not available or indicated. 3 No difference was found in the 5-year cure rate between MMS and WLE. 4 WLE with an interpolation flap was used F I G U R E 1 Forearm and leg rotational interpolation flap for three cases with cSCC. (A-C) Case 1 before and after WLE with a second surgery. (A). The bleeding, ulcerative tumor was in the left dorsum of the hand, and the diameter was approximately 30 mm before treatment. (B). A rotational interpolation flap was subsequently designed to incorporate a template along the proximal radial forearm. (C). Completion of the second stage. The interpolation flap survived well, and after the second surgery, the flap was used to reconstruct the defect. (D-F) Preoperative and postoperative appearance of case 2. (D). A template of the defect was made and marked along ulnar proximal skin (purple-marked line). (E). A combined rotation and interpolation flap for the treatment of neoplasms in the ulnar forearm. (F). Division of the pedicle was performed. After the secondary stage of surgery, a light skin ulcer was found in the flap. (G-J) Appearance of the two stages of case 3 in approximately one and a half months. (G). The neoplasm was in the left lower leg, and the diameter was approximately 20 mm. (H). A local rotational flap was inserted from the proximal lower leg into the defect. (I). After the second surgery, the interpolation flap survived well. (J). Ten days after the second surgery, the flap was used to reconstruct the defect. cSCC, cutaneous squamous cell carcinoma; WLE, wide local excision

Background: Keloids represent the dysregulation of cutaneous wound healing caused by aberrant fibroblast activities. Adipose-derived stem cells have been recognized as a promising treatment for keloids. However, their molecular mechanisms have not been fully elucidated. Methods: Skin biopsies were obtained from 10 keloid patients and 9 healthy volunteers. Fibroblasts isolated from all samples were divided into 2 groups, one co-cultured with adipose-derived stem cells, the other growing independently. Between each group, we compared the wound healing rate, fibroblasts’ survival rate, apoptosis rates, mRNA expressions and protein level of Col-1, Col-3, CTGF, P-4-HB. Results: In our research, no significant differences between normal fibroblasts and keloid fibroblasts in terms of wound-healing rate, survival rate, or apoptosis rate were found at the baseline. Adipose-derived stem cells strongly suppressed keloid fibroblasts’ proliferative and invasive behavior, but negatively regulated keloid fibroblast apoptosis. The further measurement of key components in keloid formation showed that adipose-derived stem cells upregulated Col-3 and CTGF levels in normal fibroblasts but downregulated protein expression of CTGF and P-4-HB in keloid fibroblasts. Conclusions: Adipose-derived stem cells had the potential to serve as a promising alternative for keloid treatment.