Discipline of Surgery, Lambe Institute for Translational Research, National University of Ireland Galway, Galway, Ireland.
University Hospital Galway, Galway, Ireland.
Stem Cell Rev Rep. 2021 Apr;17(2):523-538. doi: 10.1007/s12015-020-10038-1. Epub 2020 Sep 14.
Tissue engineering using Adipose Derived Stromal Cells (ADSCs) has emerged as a novel regenerative medicine approach to replace and reconstruct soft tissue damaged or lost as a result of disease process or therapeutic surgical resection. ADSCs are an attractive cell source for soft tissue regeneration due to the fact that they are easily accessible, multipotent, non-immunogenic and pro-angiogenic. ADSC based regenerative strategies have been successfully translated to the clinical setting for the treatment of Crohn's fistulae, musculoskeletal pathologies, wound healing, and cosmetic breast augmentation (fat grafting). ADSCs are particularly attractive as a source for adipose tissue engineering as they exhibit preferential differentiation to adipocytes and support maintenance of mature adipose graft volume. The potential for reconstruction with an autologous tissue sources and a natural appearance and texture is particularly appealing in the setting of breast cancer; up to 40% of patients require mastectomy for locoregional control and current approaches to post-mastectomy breast reconstruction (PMBR) are limited by the potential for complications at the donor and reconstruction sites. Despite their potential, the use of ADSCs in breast cancer patients is controversial due to concerns regarding oncological safety. These concerns relate to the regeneration of tissue at a site where a malignancy has been treated and the impact this may have on stimulating local disease recurrence or dissemination. Pre-clinical data suggest that ADSCs exhibit pro-oncogenic characteristics and are involved in stimulating progression, and growth of tumour cells. However, there have been conflicting reports on the oncologic outcome, in terms of locoregional recurrence, for breast cancer patients in whom ADSC enhanced fat grafting was utilised as an alternative to reconstruction for small volume defects. A further consideration which may impact the successful translation of ADSC based regenerative strategies for post cancer reconstruction is the potential effects of cancer therapy. This review aims to address the effect of malignant cells, adjuvant therapies and patient-specific factors that may influence the success of regenerative strategies using ADSCs for post cancer tissue regeneration.
利用脂肪来源的基质细胞（ADSCs）进行组织工程已成为一种替代和重建因疾病过程或治疗性外科切除而受损或丢失的软组织的新型再生医学方法。ADSCs 是软组织再生的一种有吸引力的细胞来源，因为它们易于获得、多能性、非免疫原性和促血管生成。ADSC 为基础的再生策略已成功转化为临床应用，用于治疗克罗恩病瘘管、肌肉骨骼病变、伤口愈合和美容乳房增大（脂肪移植）。ADSCs 作为脂肪组织工程的来源特别有吸引力，因为它们表现出向脂肪细胞的优先分化，并支持成熟脂肪移植物体积的维持。在乳腺癌中，使用自体组织来源和自然外观和质地进行重建的潜力特别吸引人；多达 40%的患者需要乳房切除术进行局部区域控制，目前的乳房切除术后重建（PMBR）方法受到供体和重建部位并发症的限制。尽管有其潜力，但 ADSCs 在乳腺癌患者中的使用存在争议，因为担心其对肿瘤学安全性的影响。这些担忧涉及到在已经治疗过恶性肿瘤的部位再生组织，以及这可能对刺激局部疾病复发或传播的影响。临床前数据表明，ADSCs 表现出促癌特性，并参与刺激肿瘤细胞的进展和生长。然而，对于接受 ADSC 增强脂肪移植作为小体积缺陷重建替代的乳腺癌患者，在肿瘤学结果方面存在相互矛盾的报告，即局部区域复发。另一个可能影响基于 ADSC 的再生策略在癌症后重建中成功转化的考虑因素是癌症治疗的潜在影响。本综述旨在探讨恶性细胞、辅助治疗和患者特定因素对使用 ADSC 进行癌症后组织再生的再生策略成功的影响。
