From the Department of Plastic and Cosmetic Surgery, Nanfang Hospital, Southern Medical University.
Plast Reconstr Surg. 2022 Sep 1;150(3):578-587. doi: 10.1097/PRS.0000000000009435. Epub 2022 Jun 28.
Scleroderma is a chronic autoimmune disease with an incidence of 2.7 per 100,000 people. Traditional lipotransfer has been used to treat atrophic sclerotic skin. Enzymatically processed cell-assisted lipotransfer and mechanically processed stromal vascular fraction gel are fat products with abundant adipose-derived stem cells. This study assessed whether adipose-derived stem cell-enriched lipotransfer elicits superior therapeutic effects on scleroderma.
Scleroderma was induced in nude mice by injections of bleomycin for 4 weeks. Human-derived Coleman fat, cell-assisted lipotransfer, or stromal vascular fraction gel (0.1 ml) was injected into sclerotic lesions. Histologic examinations, terminal deoxynucleotidyl transferase dUTP nick end labeling, and expression analyses of inflammatory factors in skin lesions and transferred fat were performed at 4 weeks after implantation.
Dermal thickness was lower in the groups injected with Coleman fat (339.0 ± 19.66 µm), cell-assisted lipotransfer (271.0 ± 16.15 µm), and stromal vascular fraction gel (197.8 ± 12.99 µm) than in the group injected with phosphate-buffered saline (493.3 ± 28.13 µm) ( p < 0.05). The numbers of terminal deoxynucleotidyl transferase dUTP nick end labeling + and Mac2 + cells in fat tissue were significantly higher in the group injected with Coleman fat than in those injected with stromal vascular fraction gel and cell-assisted lipotransfer. Expression of monocyte chemotactic protein-1 and interleukin-6 was significantly lower in the adipose-derived stem cell-enriched groups than in the Coleman fat group. Histologic analysis showed there were far fewer macrophages and myofibroblasts in skin lesions in the adipose-derived stem cell-enriched groups than in the Coleman fat group.
Transplantation of stromal vascular fraction gel and cell-assisted lipotransfer, which contain abundant adipose-derived stem cells, reduces the levels of apoptotic cells and inflammation, significantly reverses skin sclerosis, and elicits superior anti-inflammatory and antifibrotic effects on scleroderma.
This study provided an alternative adipose-based therapy, adipose-derived stem cell-enriched fat, for sclerotic lesions and showed its validity for interfering with the inflammation and fibrosis.
硬皮病是一种慢性自身免疫性疾病，发病率为每 10 万人中有 2.7 人。传统的脂肪转移已被用于治疗萎缩性硬化皮肤。酶处理的细胞辅助脂肪转移和机械处理的基质血管部分凝胶是富含脂肪来源干细胞的脂肪产品。本研究评估了富含脂肪来源干细胞的脂肪转移是否对硬皮病有更好的治疗效果。
通过注射博来霉素诱导裸鼠硬皮病 4 周。将人源 Coleman 脂肪、细胞辅助脂肪转移或基质血管部分凝胶（0.1ml）注射到硬化病变处。在植入后 4 周时，对皮肤病变和转移脂肪中的组织学检查、末端脱氧核苷酸转移酶 dUTP 缺口末端标记和炎症因子的表达进行分析。
与注射磷酸盐缓冲盐水的组（493.3 ± 28.13µm）相比，注射 Coleman 脂肪（339.0 ± 19.66µm）、细胞辅助脂肪转移（271.0 ± 16.15µm）和基质血管部分凝胶（197.8 ± 12.99µm）的真皮厚度较低（p < 0.05）。脂肪组织中端粒酶 dUTP 缺口末端标记+和 Mac2+细胞的数量在注射 Coleman 脂肪的组中明显高于注射基质血管部分凝胶和细胞辅助脂肪转移的组。富含脂肪来源干细胞的组中单核细胞趋化蛋白-1 和白细胞介素-6 的表达明显低于 Coleman 脂肪组。组织学分析显示，富含脂肪来源干细胞的组中皮肤病变中的巨噬细胞和肌成纤维细胞明显较少。
富含基质血管部分凝胶和细胞辅助脂肪转移的移植，含有丰富的脂肪来源干细胞，可降低细胞凋亡和炎症水平，显著逆转皮肤硬化，并对硬皮病产生更好的抗炎和抗纤维化作用。
本研究为硬化病变提供了一种替代的脂肪治疗方法，即富含脂肪来源干细胞的脂肪，并证明了其干扰炎症和纤维化的有效性。
