Published online Jul 26, 2020. doi: 10.4252/wjsc.v12.i7.676
Peer-review started: February 18, 2020
First decision: April 25, 2020
Revised: May 8, 2020
Accepted: May 28, 2020
Article in press: May 28, 2020
Published online: July 26, 2020
Lymphedema is a chronic, debilitating and incurable disease that affects 0.13%-2% of the global population. Emerging evidence indicates that adipose-derived stem cells (ADSCs) might serve as suitable seed cells for lymphatic tissue engineering and lymphedema therapy. Here, we appraise the in vivo evidence for the application of ADSCs for lymphedema treatments.
Emerging research findings have suggested that ADSCs might serve as suitable seed cells for tissue engineering of lymphatic vessels in vitro and potentially in the treatment of secondary lymphedema in vivo. It is critical that we systematically summarize the application of ADSCs for lymphedema treatments in animal studies and in clinical trials and discuss the future perspectives.
The main objectives of this review are to systematically summarize the application of ADSCs for lymphedema treatments as shown in animal studies and clinical trials. In addition, the future perspectives of ADSCs in lymphedema therapy are discussed.
A systematic search was performed on four databases – PubMed, Clinicaltrials.gov, the evidence-based Cochrane library, and OVID – using the following search string: (“lymphedema” or “lymphoedema” or “lymphangiogenesis”) and (“adipose-derived stem cells” or “adipose-derived stromal cells” or “adipose-derived regenerative cells”). A manual search was performed by skimming the references of relevant studies. Animal studies and clinical trials using adipose-derived cells for the treatment of any kind of lymphedema were included.
A total of eight research articles published before November 2019 were included for this analysis. Five articles focused on animal studies and another three focused on clinical trials. ADSC transplantation therapy was demonstrated to be effective against lymphedema in all studies. The animal studies found that coadministration of ADSCs and controlled-release vascular endothelial growth factor-C or platelet-rich plasma could improve the effectiveness of ADSC therapy. Three sequential clinical trials were conducted on breast cancer-related lymphedema patients, and all showed favorable results.
The results of in vitro studies, animal models, and clinical trials characterize ADSC-based treatment as a promising option and one that can be used within biologically rational and controllable environments for the treatment of lymphedema.
Further preclinical studies in larger animal models and large-scale, multicenter randomized controlled clinical trials with more reliable and rigorous safety assessments are needed to develop more effective and durable therapeutic strategies. Advances in lymphatic imaging methods will provide opportunities for lymphedema translational medicine as well.