Tissue Engineering von Fettgewebe mittels bioabbaubaren Biomaterialien zur Weichteildefektdeckung

Zusammenfassung

Bestehende Weichteildefekte nach Unfallverletzungen, onkologischen Tumorresektionen, kongenitalen Anomalien oder chronischen Wunden stellen eine zentrale Herausforderung in der rekonstruktiven Chirurgie dar. Der derzeitige Goldstandard in der Therapie von Gewebedefekten besteht in der Gewebetrans plantation in Form von freien oder lokalen Lappenplastiken. Limitierend ist jedoch die unumgängliche Morbidität an der Spenderstelle nach dem Gewebetransfer. Vor diesem Hintergrund wurden in den letzten Jahren aufgrund der günstigen Gewebetextur und hohen Plastizität große Anstrengungen im Bereich des Tissue Engineerings von vaskularisierten, langzeitstabilen autologen Fettgewebskonstrukten unternommen. Dabei stellt der enge Zusammenhang von Adipogenese und Angiogenese eine entscheidende Hürde in der de novo Erzeugung von Fettgewebe dar. Eine besondere Rolle kommt hierbei bioabbaubaren Biomaterialien (Scaffolds) als Trägereinheiten für Zellen und der damit verbundenen Zell-Matrix-Interaktion zu. Ein ideales Biomaterial sollte die Zellproliferation, -adhäsion und -differenzierung unterstützen, und gleichzeitig unbedenklich in seiner Biokompatibilität sein. Die vorliegende Übersichtsarbeit gewährt einen Überblick über derzeitige Ansätze des Tissue Engineerings von Fettgewebe vor dem Hintergrund der aktuell verfügbaren Evidenz.

Die Problematiken bisheriger Modelle sind einerseits hohe Resorptionsraten der gezüchteten Gewebekonstrukte und andererseits der fehlende Nachweis von klinisch relevanten Gewebevolumina. Das Tissue Engineering von Fettgewebe in einem Wachtumskammermodell in Kombination mit Scaffolds bietet eine weitere Möglichkeit zur in vivo Gewebezüchtung. Hier zeigen aktuelle Ergebnisse, dass eine de novo Fettgewebezüchtung mit klinisch relevanten und langzeitstabilen Volumina in vivo möglich ist. Dieses Modell besitzt, unserer Auffassung nach, das Potential die Therapie großer Weichteildefekte signifikant zu verbessern.

Abstract

Soft tissue defects resulting from injuries, tumor resection, congenital anomalies or chronic wounds pose a great challenge to reconstructive surgery. The current gold standard in therapy of such defects is the tissue transplantation in terms of free or local flaps. Unfortunately, donor site morbidity remains a considerable risk of flap surgery. Therefore, tissue engineering of autologous vascularized long term stable adipose tissue constructs could enrich the therapeutic possibilities of soft tissue defects. De novo adipose tissue growing requires fundamental knowledge about this kind of tissue and its synthesis, closely linked to angiogenesis. Bioresorbable biomaterials (scaffolds) are of crucial importance for adipose tissue engineering. Simulation or replacement of extracellular matrix for tissue growth by scaffold application requires a profound understanding of cell-matrix interactions. A proper biomaterial should be capable of supporting cell adherence, proliferation and differentiation. Important features are biocompatibility and resorption without toxic metabolites. In this review, various scaffold materials are discussed and novel achievements are presented. Persisting problems of de novo adipose tissue formation are high resorption rates and small tissue volumes of adipose constructs. Adipose tissue formation in a tissue engineering chamber is an additional possibility for in vivo tissue engineering. Recent studies proof that long term stable de novo adipose tissue formation of clinically relevant tissue volumes is possible. This method, in our opinion, has the potential to improve therapeutic strategies of soft tissue defects significantly.

Schlüsselwörter

Tissue engineering - Biomaterialien - Fettgewebe - Weichteildefekt - Rekonstruktive Chirurgie

Key words

tissue engineering - biomaterials - adipose tissue - soft tissue defect - reconstructive surgery

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