Cai Yunpeng, Wu Xiaoyan, Chen Xiaodong. Correlation study of Staphylococcus aureus superantigens and formation of human ear keloid[J]. Chin j Burns, 2021, 37(3): 257-262. DOI: 10.3760/cma.j.cn501120-20200225-00091
Citation: Wei ZR,Dong Y,Qiao GH,et al.Changes in biological characteristics of adipose-derived stem cells in obese patients post successful weight loss[J].Chin J Burns Wounds,2024,40(11):1066-1074.DOI: 10.3760/cma.j.cn501225-20231205-00225.

Changes in biological characteristics of adipose-derived stem cells in obese patients post successful weight loss

doi: 10.3760/cma.j.cn501225-20231205-00225
Funds:

Science and Technology Development Plan Program of Henan Province of China in 2022 222102310188

More Information
  •   Objective  To explore the changes in biological characteristics of adipose-derived stem cells (ASCs) in obese patients post successful weight loss, so as to provide a reference for the clinical application of these ASCs in refractory wound repair.  Methods  This study was an experimental study. Twelve obese patients (8 females and 4 males, aged (50±9) years) who underwent abdominal skin tightening surgery after successful weight loss and were admitted to the First Affiliated Hospital of Zhengzhou University from April 2021 to April 2023 were included in weight loss group, and 12 healthy volunteers (10 females and 2 males, aged (50±9) years) who underwent abdominal liposuction and facial fat grafting surgery during the same period in the same institution were included in healthy group. Adipose tissue was collected from patients in weight loss group and volunteers in healthy group, and ASCs were extracted. Experiments were conducted using ASCs at passages 4 and 5. Cell proliferation levels were assessed using the methyl thiazolyl tetrazolium assay at 0 (immediately), 24, 48, and 72 hours of culture. The cell scratch test was performed and the cell migration rates at 12 and 24 hours after scratching were calculated. The cell Transwell assay was performed and the number of migration cells at 24 hours after culture was counted. Adipogenic and osteogenic induction assays were carried out, and the adipogenic and osteogenic differentiation levels of cells were detected after 18 and 21 days of induction, respectively. Real-time fluorescence quantitative reverse transcription polymerase chain reaction was employed to measure the mRNA expressions of lipoprotein lipase (LPL), peroxisome proliferator-activated receptor gamma (PPARγ), Runt-related transcription factor 2 (Runx2), osteopontin, alkaline phosphatase (ALP), matrix metalloproteinase 9 (MMP-9), and transforming growth factor beta (TGF-β). The sample number of each experiment was 12.  Results  At 0 hour of culture, the cell proliferation levels of patients in weight loss group and volunteers in healthy group were 1.022±0.056 and 1.000±0.144, respectively, with no statistically significant difference between the groups (P>0.05). At 24, 48, and 72 hours of culture, the cell proliferation levels of patients in weight loss group were 1.366±0.030, 1.353±0.012, and 1.390±0.016, respectively, which were significantly lower than 1.755±0.077, 1.737±0.014, and 1.700±0.023 of volunteers in healthy group (with t values of 16.27, 71.35, and 38.56, respectively, P values all <0.05). In the cell scratch test, at 12 and 24 hours after scratching, the cell migration rates of patients in weight loss group were lower than those of volunteers in healthy group, but the differences were not statistically significant (P>0.05). In the cell Transwell assay, after 24 hours of culture, there was no statistically significant difference in the number of migrated cells between patients in weight loss group and volunteers in healthy group (P>0.05). After 18 days of adipogenic induction, the cell adipogenic differentiation level of patients in weight loss group was significantly lower than that of volunteers in healthy group (t=27.81, P<0.05). After 21 days of osteogenic induction, the cell osteogenic differentiation level of patients in weight loss group was significantly lower than that of volunteers in healthy group (t=14.85, P<0.05). Compared with those of volunteers in healthy group, the mRNA expressions of LPL, PPARγ, TGF-β, and Runx2 of patients in weight loss group were significantly reduced (with t values of 59.48, 146.10, 46.10, and 3.13, respectively, P<0.05), while there were no statistically significant changes in the mRNA expressions of osteopontin, ALP, or MMP-9 (P>0.05).  Conclusions  Compared with healthy volunteers, the proliferative capacity of ASCs in obese patients after successful weight loss is significantly diminished, the differentiation potential is relatively weak, and the expression levels of some genes corresponding to adipogenic and osteogenic differentiation are decreased, which may affect the therapeutic efficacy of these ASCs in treating refractory wounds caused by burns, diabetes, or radiation injuries. Therefore, the donor differences of ASCs need to be considered in clinical application.

     

  • [1]
    邢楠,霍然,王海涛,等.脂肪干细胞基质胶促进创面愈合的研究进展[J].中华烧伤与创面修复杂志,2023,39(1):81-84.DOI: 10.3760/cma.j.cn501120-20211204-00404.
    [2]
    WangJM,GuY,PanCJ,et al.Isolation, culture and identification of human adipose-derived stem cells[J].Exp Ther Med,2017,13(3):1039-1043.DOI: 10.3892/etm.2017.4069.
    [3]
    Lopez-YusM,García-SobrevielaMP,Del Moral-BergosR,et al.Gene therapy based on mesenchymal stem cells derived from adipose tissue for the treatment of obesity and its metabolic complications[J].Int J Mol Sci,2023,24(8):7468.DOI: 10.3390/ijms24087468.
    [4]
    李畅,冷清阳,冷华卿,等.基于生物信息学筛选通过调控脂肪细胞功能改善肥胖的中药单体[J].解放军医学杂志,2022,47(8):771-780.DOI: 10.11855/j.issn.0577-7402.2022.08.0771.
    [5]
    ZhuXY,MaS,EirinA,et al.Functional plasticity of adipose-derived stromal cells during development of obesity[J].Stem Cells Transl Med,2016,5(7):893-900.DOI: 10.5966/sctm.2015-0240.
    [6]
    BrazelCB,SimonJC,TuckermannJP,et al.Inhibition of 11β-HSD1 expression by insulin in skin: impact for diabetic wound healing[J].J Clin Med,2020,9(12):3878.DOI: 10.3390/jcm9123878.
    [7]
    YangHJ,KimKJ,KimMK,et al.The stem cell potential and multipotency of human adipose tissue-derived stem cells vary by cell donor and are different from those of other types of stem cells[J].Cells Tissues Organs,2014,199(5/6):373-383.DOI: 10.1159/000369969.
    [8]
    ChenS,HeZ,XuJ.Application of adipose-derived stem cells in photoaging: basic science and literature review[J].Stem Cell Res Ther,2020,11(1):491.DOI: 10.1186/s13287-020-01994-z.
    [9]
    MirzaeiA,DeyhimfarR,Azodian GhajarH,et al.Quercetin can be a more reliable treatment for metastatic prostate cancer than the localized disease: an in vitro study[J].J Cell Mol Med,2023,27(12):1725-1734.DOI: 10.1111/jcmm.17783.
    [10]
    ZhangC,JiangT,JiangG,et al.White adipose tissue-derived small extracellular vesicles: a new potential therapeutic reagent for accelerating diabetic wound healing[J].FASEB J,2023,37(12):e23314.DOI: 10.1096/fj.202301549R.
    [11]
    周晓洁,于湄,田卫东.前成脂细胞及其临床应用潜能研究进展[J].解放军医学杂志,2022,47(2):178-185.DOI: 10.11855/j.issn.0577-7402.2022.02.0178.
    [12]
    包郁露,孔维诗,沈纵,等.脂肪间充质干细胞的抗衰老作用[J].中华整形外科杂志,2023,39(10):1147-1152.DOI: 10.3760/cma.j.cn114453-20220218-00043.
    [13]
    杨洪秋,邓映,杜晓霜,等.脂肪干细胞在面部抗衰老中的研究进展[J].中国医疗美容,2023,13(4):57-61.DOI: 10.19593/j.issn.2095-0721.2023.04.015.
    [14]
    韩李念,王君.放射性皮肤损伤治疗的研究进展[J/CD].中华损伤与修复杂志(电子版),2023,18(6):533-537.DOI: 10.3877/cma.j.issn.1673-9450.2023.06.015.
    [15]
    孙皓,蒲胤瑄,刘佳林,等.过表达miR-378a修饰骨髓间充质干细胞复合胶原蛋白海绵支架对大鼠股骨缺损的修复作用[J].解放军医学杂志,2023,48(2):175-182.DOI: 10.11855/j.issn.0577-7402.2023.02.0175.
    [16]
    PestelJ,BlangeroF,EljaafariA.Pathogenic role of adipose tissue-derived mesenchymal stem cells in obesity and obesity-related inflammatory diseases[J].Cells,2023,12(3):348.DOI: 10.3390/cells12030348.
    [17]
    刘裴裴,丁世杰,宋文娟,等.NAC通过调控活性氧影响脂肪间充质干细胞增殖和分化[J].中国农业科学,2023,56(21):4330-4343.DOI: 10.3864/j.issn.0578-1752.2023.21.015.
    [18]
    WangT,LiY,ZhuY,et al.Anti-aging mechanism of different age donor-matched adipose-derived stem cells[J].Stem Cell Res Ther,2023,14(1):192.DOI: 10.1186/s13287-023-03415-3.
    [19]
    EirinA,MengY,ZhuXY,et al. The micro-RNA cargo of extracellular vesicles released by human adipose tissue-derived mesenchymal stem cells is modified by obesity[J].Front Cell Dev Biol,2021,9:660851.DOI: 10.3389/fcell.2021.660851.
    [20]
    WuX,MuY,YaoJ,et al.Adipose-derived stem cells from patients with ulcerative colitis exhibit impaired immunosuppressive function[J].Front Cell Dev Biol,2022,10:822772.DOI: 10.3389/fcell.2022.822772.
    [21]
    SohrabiK,AhmadiH,AminiA,et al.Promising improvement in infected wound healing in type two diabetic rats by combined effects of conditioned medium of human adipose-derived stem cells plus photobiomodulation[J].Lab Anim Res,2023,39(1):29.DOI: 10.1186/s42826-023-00178-z.
    [22]
    岳强,刘立强.人体不同部位和个体差异对脂肪组织及其间充质干细胞的影响[J].中华整形外科杂志,2024,40(8):917-923.DOI: 10.3760/cma.j.cn114453-20221105-00349.
    [23]
    高俊丽,徐静,余春丽,等.黄芪甲苷对高糖环境下脂肪干细胞衰老的延缓作用[J].中国临床医学,2023,30(3):460-467.DOI: 10.12025/j.issn.1008-6358.2023.20230192.
    [24]
    陶宁,王华.间充质干细胞衰老的研究进展[J].中国医药生物技术,2023,18(1):56-59.DOI: 10.3969/j.issn.1673-713X.2023.01.011.
    [25]
    Lopes AlvesDV,Claudio-da-SilvaC,SouzaMCA,et al.Adipose tissue-derived mesenchymal stromal cells from ex-morbidly obese individuals instruct macrophages towards a M2-like profile in vitro[J].Int J Stem Cells,2023,16(4):425-437.DOI: 10.15283/ijsc22172.
    [26]
    车丽娜,李凤娇,赵崇杰,等.长白猪骨髓和脂肪间充质干细胞复制性衰老过程中生物学特性和抗氧化损伤能力的比较[J].天津科技大学学报,2023,38(2):1-10.DOI: 10.13364/j.issn.1672-6510.20220177.
    [27]
    杨超富,谭国庆,徐展望.骨质疏松中衰老相关分泌表型调控机制的研究进展[J].中国全科医学,2024,27(29):3685-3695.DOI: 10.12114/j.issn.1007-9572.2023.0721.
    [28]
    MikłoszA,ŁukaszukB,SupruniukE,et al.RabGAP AS160/TBC1D4 deficiency increases long-chain fatty acid transport but has little additional effect on obesity and metabolic syndrome in ADMSCs-derived adipocytes of morbidly obese women[J].Front Mol Biosci,2023,10:1232159.DOI: 10.3389/fmolb.2023.1232159.
    [29]
    CortezM,CarmoLS,RogeroMM,et al.A high-fat diet increases IL-1, IL-6, and TNF-α production by increasing NF-κB and attenuating PPAR-γ expression in bone marrow mesenchymal stem cells[J].Inflammation,2013,36(2):379-386.DOI: 10.1007/s10753-012-9557-z.
    [30]
    GriescheN,LuttmannW,LuttmannA,et al.A simple modification of the separation method reduces heterogeneity of adipose-derived stem cells[J].Cells Tissues Organs,2010,192(2):106-115.DOI: 10.1159/000289586.
    [31]
    FrazierTP,GimbleJM,DevayJW,et al.Body mass index affects proliferation and osteogenic differentiation of human subcutaneous adipose tissue-derived stem cells[J].BMC Cell Biol,2013,14:34.DOI: 10.1186/1471-2121-14-34.
    [32]
    Oregel-CortezMI,Frayde-GómezH,Quintana-GonzálezG,et al.Resistin induces migration and invasion in PC3 prostate cancer cells: role of extracellular vesicles[J].Life (Basel),2023,13(12):2321.DOI: 10.3390/life13122321.
    [33]
    黎鑫,艾克拜尔·艾力,阿力木江·麦斯依提,等.外周血WBC和NLR对肥胖症合并胃食管反流病的临床诊断价值[J].解放军医学杂志,2023,48(10):1180-1185.DOI: 10.11855/j.issn.0577-7402.2153.2023.0410.
    [34]
    王跃东,叶再元,莫大超,等.腹腔镜胃肠部分切除术治疗重度肥胖症[J].中华普通外科杂志,2009,24(4):307-309.DOI: 10.3760/cma.j.issn.1007-631X.2009.04.014.
    [35]
    AdemiH,Michalak-MickaK,MoehrlenU,et al.Effects of an adipose mesenchymal stem cell-derived conditioned medium and TGF-β1 on human keratinocytes in vitro[J].Int J Mol Sci,2023,24(19):14726.DOI: 10.3390/ijms241914726.
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