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World J Stem Cells. Aug 26, 2021; 13(8): 1084-1093
Published online Aug 26, 2021. doi: 10.4252/wjsc.v13.i8.1084
Effects of radiation and chemotherapy on adipose stem cells: Implications for use in fat grafting in cancer patients
Rebecca Platoff, Miguel A Villalobos, Ashleigh Rapp Hagaman, Yuan Liu, Martha Matthews, Michael E DiSanto, Jeffrey P Carpenter, Ping Zhang
Rebecca Platoff, Miguel A Villalobos, Ashleigh Rapp Hagaman, Yuan Liu, Martha Matthews, Jeffrey P Carpenter, Ping Zhang, Department of Surgery, Cooper University Health Care, Camden, NJ 08103, United States
Yuan Liu, Martha Matthews, Jeffrey P Carpenter, Ping Zhang, Department of Surgery, Cooper Medical School of Rowan University, Camden, NJ 08103, United States
Michael E DiSanto, Department of Biomedical Sciences, Cooper Medical School of Rowan University, Camden, NJ 08103, United States
Author contributions: Platoff R reviewed the literature and drafted the manuscript; Villalobos MA and Hagaman AR performed the majority of experiments and drafted the manuscript; Liu Y and Matthews M conception and design; DiSanto ME and Carpenter JP critical revision and editing of the manuscript; Zhang P conceived the manuscript, reviewed the literature, performed conception and design, wrote the article and approved the final version as the corresponding author.
Conflict-of-interest statement: The authors declare that there is no conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ping Zhang, DDS, PhD, Assistant Professor, Department of Surgery, Cooper University Health Care, 401 Haddon Avenue, Camden, NJ 08103, United States. zhang-ping@cooperhealth.edu
Received: February 25, 2021
Peer-review started: February 25, 2021
First decision: April 20, 2021
Revised: April 30, 2021
Accepted: July 29, 2021
Article in press: July 29, 2021
Published online: August 26, 2021
Abstract

Autologous fat transplantation is a versatile tool in reconstructive surgery. Adipose-derived stem cells (ASCs) increase survival of fat grafts and thus are increasingly used for breast reconstruction in breast cancer patients. However, radiation and/or chemotherapy have been proposed to inhibit soft tissue regeneration in wound healing thus suggesting alteration in stem cell pathways. Therefore, elucidating effects of radiation and chemotherapy on ASCs is critical if one desires to enhance the survival of fat grafts in patients. This review outlines our work evaluating the function and recoverability of ASCs from radiation or chemotherapy patients, focusing specifically on their availability as a source of autologous stem cells for fat grafting and breast reconstruction in cancer patients. Even though evidence suggests radiation and chemotherapy negatively influence ASCs at the cellular level, the efficiency of the isolation and differentiation capacity did not appear influenced in patients after receiving chemotherapy treatment, although fat from radiated patients exhibited significantly altered ASC differentiation into endothelial-like cells. Further, the in vitro growth rates of patient’s ASCs do not differ significantly before or after treatment. Taken together, these studies suggest ASCs as an important new tool for grafting and reconstruction even when radiation and chemotherapy treatment are involved.

Keywords: Fat grafting, Breast reconstruction, Stem cells, Breast cancer, Radiation, Chemotherapy

Core Tip: Breast reconstruction with fat grafting after surgery is a major therapy that is enhanced by the use of autologous adipose-derived stem cells (ASCs) following surgery for breast cancer. Emerging studies suggest that cancer treatment therapies have a cytotoxic effect that may limit stem cell cellular functions. In this review, we summarize our work on evaluating the functional recovery potential of autologous ASCs in patients post-radiation or chemotherapy. In addition, we provide evidence that ASCs may represent a novel and effective cellular mechanism for enhancing fat grafting and reconstruction outcomes especially in those patients with cancer.