The biological and clinical basis for the use of adipose-derived stem cells in the field of wound healing

Abstract

Worldwide, hard-to-heal lower limb wounds are estimated to affect 1.5–3% of the adult population with a treatment-related annual cost of $10 billion. Thus, chronic skin ulcers of the lower limb are a matter of economic and public concern. Over the years, multiple medical and surgical approaches have been proposed but they are still inadequate, and no effective therapy yet exists. Regenerative medicine and stem cell-based therapies hold great promise for wound healing. Recently, many plastic surgeons have studied the potential clinical application of adipose-derived stem cells (ASCs), which are a readily available adult stem cell population that can undergo multilineage differentiation and secrete growth factors that can enhance wound-healing processes by promoting angiogenesis, and hence increase local blood supply. ASCs have been widely studied in vitro and in vivo in animal models. However, there are few randomized clinical trials on humans, and these are still ongoing or recruiting patients. Moreover, there is no consensus on a common isolation protocol that is clinically feasible and which would ensure reproducible results. The authors aim to provide readers with an overview of the biological properties of ASCs as well as their clinical application, to help better understanding of present and future strategies for the treatment of hard-to-heal wounds by means of stem cell-based therapies.

Ex Vivo Human Adipose Tissue Derived Mesenchymal Stromal Cells (ASC) Are a Heterogeneous Population That Demonstrate Rapid Culture-Induced Changes

“…Human adipose tissue derived stromal cells (ASC) are currently being tested as cell-based therapies against a wide range of diseases and conditions in numerous clinical trials (Bateman et al, 2018) including wound healing, (Bertozzi et al, 2017) cardiovascular disease (Ma et al, 2017) and cartilage regeneration (Pak et al, 2018). ASC are isolated from adipose tissue and are therefore an abundant source of stromal cells that can be accessed with relative ease using the minimally invasive procedure of liposuction.…”

Comparison of Proangiogenic Effects of Adipose-Derived Stem Cells and Foreskin Fibroblast Exosomes on Artificial Dermis Prefabricated Flaps

“…Most researchers currently believe that ADSCs differentiate mainly into vascular endothelial cells and smooth muscle cells to form a new vascular network [5], or secrete paracrine factors, such as basic fibroblast growth factor, vascular endothelial growth factor, hepatocyte growth factor, platelet-derived growth factor, and other angiogenesisrelated cytokines and growth factors to promote local microvascularization [6,7]. ADSC transplantation has achieved better therapeutic effects than current conventional treatment methods in patients with refractory wounds [8]. However, despite the many advantages of ADSCs, technical problems and the risk of tumor formation currently limit their clinical application [9].…”

Efficiency of stem cell based therapy in the treatment of diabetic foot ulcer: a meta-analysis

“…But only when the kind of stem is massive, easy to obtained, induced in a controllable manner, safety and effectively, that they be applied in clinical care. The application of embryonic stem cells was restrained due to ethical consideration, while induced pluripotent stem cells (iPSCs) are limited due for safety and effectively uncertainties [12]. At present, the most common used stem cells are bone marrow derived stem cells and adipose derived stem cells.…”