Adipose-derived stem cell therapy shows promising results for secondary lymphedema

Abstract

Lymphedema is mainly identified by progressive soft tissue swelling in impaired lymphatic system. Secondary lymphedema attributed to cancer therapy, parasite infection, and trauma remains a serious global disease. Patients with lymphedema suffer swelling, pain, and fatigue, with the dysfunction of the deformed extremities reducing the quality of life and increasing the risk of infection and lymphangiosarcoma. Adipose-derived stem cells (ADSCs) possess prominent regenerative potential to differentiate into multilineage cells, and produce various lymphangiogenic factors, making ADSC therapy a promising approach for lymphedema. The development of lymphedema consists of local inflammation, the fibrosis of lymphatic vessels, and the deposition of adipose fat. Existing animal models do not mimic the chronic inflammation environment, therefore suitable models are required in further studies. Some signal pathways and molecular mechanisms in physiological and pathological lymphagiogenesis remain unclear. In previous animal and human trials, ADSC therapy reduced edema in varying degrees. A larger number of trials with larger samples and longer follow-up periods are required to verify the efficiency and feasibility of ADSC therapy. ADSCs are of easy availability and immune exemption, making them a candidate for lymphedema treatment. Whether ADSCs enhance malignant characteristics or trigger the malignant change deserves further exploration and study before ADSC therapy can be made widely available.

Lymphatic regeneration after implantation of aligned nanofibrillar collagen scaffolds: Preliminary preclinical and clinical results

“…Additionally, adipose-derived stem cells (ADSCs) have been demonstrated to possess stimulatory activity on lymphangiogenesis. [34][35][36] Our previous experience 33,37 indicated that BB implantation alone or cell injection alone may not be sufficient for treatment whereas a combination of BB scaffolds and seeded cells may substantially enhance the treatment outcome.…”

“…Thread‐like BB scaffold has a multilumen structure and therefore, after implantation, it induces unidirectional interstitial capillary flow, which is driven by hydrostatic and oncotic pressure. Additionally, adipose‐derived stem cells (ADSCs) have been demonstrated to possess stimulatory activity on lymphangiogenesis 34–36 . Our previous experience 33,37 indicated that BB implantation alone or cell injection alone may not be sufficient for treatment whereas a combination of BB scaffolds and seeded cells may substantially enhance the treatment outcome.…”

Hormone Therapy: A Potential Risk Factor Affecting Survival and Functional Restoration of Transplanted Lymph Nodes

“…According to previous studies ( Takeda et al, 2015 ; Li et al, 2020 ), adipose-derived stem cells (ADSCs) could promote proliferation, migration, and tube formation of LECs in vitro by secreting various lymphangiogenic factors. In addition, it has been demonstrated that ADSCs can increase the number of lymphatic vessels and promote the restoration of lymphatic drainage in vivo ( Hayashida et al, 2017 ; Hu and Pan, 2020 ). Clinical research indicates that breast cancer survivors undergoing hormone therapy may be at an increased risk of poor fat graft survival during surgical reconstruction ( Zhu et al, 2010 ).…”

Biology of Lymphedema

“…However, no changes in arm volume were found in a follow up study (up to one year) as well as no significant improvement, being assessed via lymphoscintigraphy post-treatment with adipose-derived stem cells [ 109 ]. Hu et al (2020) report a new promising approach in secondary lymphedema treatment by using adipose-derived stem cells; however, this still needs to be evaluated in larger clinical studies [ 110 ].…”