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Review
. 2024 Jan-Dec:33:9636897241264976.
doi: 10.1177/09636897241264976.

The Evolving Function of Vasculature and Pro-angiogenic Therapy in Fat Grafting

Zhang Xining  1 , Luo Sai  1
Affiliations
Review

The Evolving Function of Vasculature and Pro-angiogenic Therapy in Fat Grafting

Zhang Xining et al. Cell Transplant. 2024 Jan-Dec.

Abstract

Autologous fat grating is a widely-accepted method to correct soft tissue deficiency. Although fat transplantation shows excellent biocompatibility and simple applicability, the relatively low retention rate caused by fat necrosis is still a challenge. The vasculature is integral after fat grafting, serving multiple crucial functions. Rapid and effective angiogenesis within grafts is essential for supplying oxygen necessary for adipocytes' survival. It facilitates the influx of inflammatory cells to remove necrotic adipocytes and aids in the delivery of regenerative cells for adipose tissue regeneration in fat grafts. The vasculature also provides a niche for interaction between adipose progenitor cells and vascular progenitor cells, enhancing angiogenesis and adipogenesis in grafts. Various methods, such as enriching grafts with diverse pro-angiogenic cells or utilizing cell-free approaches, have been employed to enhance angiogenesis. Beige and dedifferentiated adipocytes in grafts could increase vessel density. This review aims to outline the function of vasculature in fat grafting and discuss different cell or cell-free approaches that can enhance angiogenesis following fat grafting.

Keywords: angiogenesis; cell-enrichment therapy; fat grafting; vasculature function.

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Conflict of interest statement

Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Graphical Abstract
Graphical Abstract
Figure 1.
Figure 1.
Vasculature function in fat grafting. Vasculature provides a timely and enough supply of oxygen and nutrients to reduce the apoptosis of adipocytes in the early hypoxia and ischemic environment and transport unessential triglycerides to the blood to avoid lipo-toxin-induced inflammation. Vasculature delivers early-stage inflammatory cells that could clear the damaged cells and extracellular matrix to give regenerative cells a better regenerative microenvironment. Vasculature provides a perivascular niche for the mesenchymal stem cells (especially ASCs) to proliferate and differentiate into regenerated adipocytes and promote neovasculogenesis through paracrine pro-angiogenic factors or transdifferentiate into ECs. ASCs, adipose-derived stem cells; ECs, endothelial cells.
Figure 2.
Figure 2.
Macrophage function in microenvironment after fat grafting. IL, interleukin; iNOS, inducible nitric oxide synthase; VEGF, vascular endothelial growth factor; VEGFR2, vascular endothelial growth factor receptor 2; ECM, extracellular matrix; TGF-β, transforming growth factor-β; CCL, C-C motif chemokine ligand; CXCL, C-X-C motif chemokine; PPARγ, peroxisome proliferatoractivated receptor γ; PDGF-BB, platelet-derived growth factor subunit B.
Figure 3.
Figure 3.
The function of VEGF in the angiogenesis. Under hypoxia conditions, macrophages and ASCs-derived VEGF specify the expression of endothelial cells into tip cells and stalk cells. Tip cells function as a guider to build connections with the adjacent vessels and stalk cells function as a supporter to give structural support.
Figure 4.
Figure 4.
The difference between beige adipocyte and white adipocyte. White adipocytes are unilocular cells specializing in lipid storage with one big lipid droplet and low mitochondria density. The beige adipocytes are multiple lipid droplets with the expression of UCP1 and a high level of mitochondria density. Under hypoxia conditions, beige adipocytes show better endurance and less apoptosis compared with white adipocytes. higher surface-to-volume ratio makes it more easily to get enough blood supply and therefore more easily to survive after fat grafting. Beige adipocytes could also induce more M2 macrophage polarization. UCP1, uncoupling protein 1.
Figure 5.
Figure 5.
The pro-angiogenic function of dedifferentiated adipocyte. DAs in was founded in the SVFs in the grafts after 1 week of fat transplantation. In vitro ceiling culture also induces adipocyte dedifferentiation. With enough vascular supply, DAs could redifferentiate into mature adipocytes. DAs acquire the ability to differentiate into ECs or pericytes and also enhance the proliferation, cell migration, and tube formation of ECs through secretory proteins such as VEGF and HGF. HGF, hepatocyte growth factor; VEGF, vascular endothelial growth factor.
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