早期脂肪移植物血管化的调节及机制

Early vascularization of fat transplantation:regulation and mechanism

背景:组织移植是整形外科最常用的治疗手段,移植后组织存活的最基本条件是在组织耐缺血时限内建立血液循环,移植物的存活率和质量与血运重建的时间相关。目的:从细胞因子、脂肪干细胞、外泌体、组织工程、信号通路以及不同部位来源脂肪等方向对促进早期脂肪移植物血管化的调节及机制进行综述。方法:以“fat graft,fat grafting,vascularization,vascularize,cytokines,exosomes,VEGF,ADSCs,EPC,SVF,mechanisms,signal pathway”等为英文检索词;以“脂肪移植;血管化;外泌体;血管内皮生长因子;脂肪干细胞;内皮祖细胞;基质血管成分;信号通路”为中文检索词,检索PubMed、Google Scholar、EMBASE、中国知网、万方、重庆维普等数据库1995年至2020年的相关文献,排除与文章内容无关、低质量或重复性高的文章,最后选取73篇文献进行综述。结果与结论:①发现添加各种细胞因子或细胞、干细胞、不同部位脂肪细胞的选择、相关信号通路、预处理脂肪、组织工程、外泌体和其他相关处理等,都有助于脂肪移植物早期血管化,从而提高脂肪移植物的存活率;②脂肪干细胞可以通过VEGF-PLCγ-ERK1/ERK2途径调节血管生成,并抑制炎症反应,通过内皮祖细胞的募集和分化来促进早期血管形成;③不同部位脂肪干细胞在血管化和存活率方面存在差异,使用基质血管组分是提高脂肪移植物存活的高效技术;④脂肪干细胞促进脂肪移植物存活和血管再生的可能机制在于脂肪干细胞的旁分泌产物,其可以促进新血管形成并减轻炎症反应,从而提高脂肪移植物体积保留率。

BACKGROUND: Tissue transplantation is the most commonly used treatment in plastic surgery. After transplantation, it is essential for tissue survival to establish blood circulation within the time limit of tissue ischemia resistance. The survival rate and quality of the graft are related to the time of revascularization. OBJECTIVE: To review the regulation and mechanism of promoting early vascularization of fat grafts from different sites with regard to cytokines, adipocytes, exosomes, tissue engineering, and signaling pathway.METHODS: PubMed, Google Scholar, EMbase, CNKI, WanFang, and VIP were searched for relevant literatures published from 1995 to 2020 using the keywords of "fat graft, fat grafting, vascularization, vascularize, cytokines, exosomes, VEGF, ADSCs, EPC, SVF, mechanisms, signal pathway" in English and Chinese, respectively. The articles irrelevant to the content, with low quality or high repeatability were excluded. Finally, 73 articles were selected for review.RESULTS AND CONCLUSION: Various treatments can contribute to early vascularization of fat grafts, including addition of various cytokines or cells, stem cells, selection of fat cells in different parts, relevant signaling pathways, fat pretreatment, tissue engineering, exosomes, etc. Adipose stem cells can regulate angiogenesis and inhibit inflammation through the VEGF-PLCγ-ERK1/ERK2 pathway, and promote early vascularization through the recruitment and differentiation of endothelial progenitor cells. Adipose stem cells from different sites have some differences in vascularization and survival rate. The use of stromal vascular components is an efficient technology to improve the survival of fat grafts. The possible mechanism by which adipose stem cells promote fat graft survival and angiogenesis is that the paracrine products of adipose stem cells can promote vascularization, reduce inflammation, and thereby enhance the volume retention rate of fat grafts.