Published online Jan 26, 2021. doi: 10.4252/wjsc.v13.i1.30
Peer-review started: July 8, 2020
First decision: December 1, 2020
Revised: December 4, 2020
Accepted: December 11, 2020
Article in press: December 11, 2020
Published online: January 26, 2021
Adipose-derived stem cells (ADSCs) residing in the stromal vascular fraction (SVF) of white adipose tissue are recently emerging as an alternative tool for stem cell-based therapy in systemic sclerosis (SSc), a complex connective tissue disorder affecting the skin and internal organs with fibrotic and vascular lesions. Several preclinical and clinical studies have reported promising therapeutic effects of fat grafting and autologous SVF/ADSC-based local treatment for facial and hand cutaneous manifestations of SSc patients. However, currently available data indicate that ADSCs may represent a double-edged sword in SSc, as they may exhibit a pro-fibrotic and anti-adipogenic phenotype, possibly behaving as an additional pathogenic source of pro-fibrotic myofibroblasts through the adipocyte-to-myofibroblast transition process. Thus, in the perspective of a larger employ of SSc-ADSCs for further therapeutic applications, it is important to definitely unravel whether these cells present a comparable phenotype and similar immunosuppressive, anti-inflammatory, anti-fibrotic and pro-angiogenic properties in respect to healthy ADSCs. In light of the dual role that ADSCs seem to play in SSc, this review will provide a summary of the most recent insights into the preclinical and clinical studies employing SVF and ADSCs for the treatment of the disease and, at the same time, will focus on the main findings highlighting the possible involvement of these stem cells in SSc-related fibrosis pathogenesis.
Core Tip: Adipose-derived stem cells (ADSCs) represent a promising cell source for cell-based therapy in the treatment of systemic sclerosis (SSc), but at the same time, they may be involved in the disease pathogenesis. In this review, the current status of fat grafting and autologous stromal vascular fraction/ADSC-based therapeutic applications as well as SSc-ADSC functional characterization and possible implication in disease-related fibrosis are discussed.