ABSTRACT
Current autologous fat grafting technique suffers from the drawbacks of donor site
morbidity and, more importantly, significant resorption of the grafted fat. Adipose
tissue engineering using adult human stem cells has been found to overcome the shortcomings
of autologous fat grafting in reconstructing facial defects. Mesenchymal stem cells
that can self-renew and differentiate into mature adipocytes have been used to generate
adipose tissue, in both in vitro and in vivo cell transplantation studies. However,
long-term maintenance of the shape and dimension of the produced adipose tissue remains
a challenge, even in tissue engineering with cell transplantation. The choice of appropriate
scaffolds to promote stem cell adhesion, proliferation, and differentiation is essential
for successful adipogenesis. Recent advances in nanotechnology allow the development
of nanostructured scaffolds with a cellular environment that maximally enhances not
only cell expansion but also the neovascularization that is crucial for long-term
maintenance of cell volume. Cell homing is a technique that actively recruits endogenous
host stem cells into a predefined anatomic location for the desired tissue generation.
Bypassing ex vivo cell manipulation, the cell homing technique eliminates donor site
morbidity and rejection, reducing the regulation issue in clinical translation. Mao
et al. introduced the concept of biosurgery, which combined nanostructured scaffolds
and growth factor biocues, with or without cell transplantation, for successful de
novo adipogenesis in restoring facial defects. Important questions, such as the necessity
of cell transplantation in scaling up the size of engineered adipose tissue, need
to be answered with further studies. However, the era of biosurgery replacing conventional
treatments such as biologically inactive filler injections and alloplastic implants
appears to be in the near future.
KEYWORDS
Stem cells - adipose tissue engineering - fat grafting - facial - biosurgery
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Jeffrey M AhnM.D.
Department of Otolaryngology–Head & Neck Surgery, College of Physicians & Surgeons,
Columbia University Medical Center
161 Fort Washington Avenue, Rm. 825, New York, NY 10032
eMail: jma2@columbia.edu