脂肪组织与各种细胞作用促进伤口愈合

Adipose Tissue Promotes Wound Healing through Interactions with Multiple Cell Types

摘要: 真皮层脂肪及皮下脂肪在伤口中的作用被越来越多地研究。伤口愈合是一个复杂的过程包含不同的阶段，每一个阶段存在不同细胞参与。伤口愈合需再上皮化，同时经历止血、炎症，血管再生和基质的生成和重塑。这篇综述总结了脂肪细胞在伤口愈合的每个阶段与主要的细胞的相互作用。首先脂肪细胞通过分泌胞外囊泡和细胞因子：瘦素与脂联素等促进角质形成细胞的增殖和抗凋亡。其次在伤口第3天真皮层脂肪通过脂解，产生的脂肪酸可以招募炎症细胞促进炎症产生。在第7天时皮下脂肪能发生褐变促进M1型巨噬细胞向M2型巨噬细胞分化使伤口的炎症向下一阶段进发。成熟脂肪细胞还可以去分化，进行细胞重编程形成肌原纤维细胞和成纤维细胞产生细胞外基质实现伤口修复，最后脂肪干细胞分泌的大量细胞因子会稳定诱导血管内皮细胞成血管。最后我们还讨论了未来脂肪与伤口可能的研究方向，以后会有更多的创新性的临床应用出现。

Abstract: The role of dermal and subcutaneous adipose tissue in wound healing is increasingly recognized. Wound healing is a complex biological process that proceeds through distinct, overlapping phases, each involving the coordinated action of various cell types. This process requires re-epithelialization alongside hemostasis, inflammation, angiogenesis, and extracellular matrix synthesis and remodeling. This review summarizes the interactions between adipocytes and key cellular players during each phase of wound healing. First, adipocytes promote keratinocyte proliferation and exert anti-apoptotic effects through the secretion of extracellular vesicles and cytokines, including leptin and adiponectin. Second, on day 3 post-wounding, dermal adipose tissue undergoes lipolysis; the resulting free fatty acids recruit inflammatory cells, thereby promoting the inflammatory response. By day 7, subcutaneous adipose tissue can undergo browning, which facilitates the polarization of M1 macrophages toward the M2 phenotype, thus promoting the transition of the inflammatory phase to the subsequent proliferative phase. Furthermore, mature adipocytes are capable of dedifferentiation and cellular reprogramming into myofibroblasts and fibroblasts, contributing to wound repair through extracellular matrix production. Finally, adipose-derived stem cells secrete a multitude of cytokines that potently induce and stabilize angiogenesis in vascular endothelial cells. We also discuss potential future research directions concerning the role of adipose tissue in wound healing, anticipating the emergence of more innovative clinical applications.