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Handchir Mikrochir Plast Chir 2013; 45(02): 99-107
DOI: 10.1055/s-0032-1329944
Übersichtsarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Angiogenese und Vaskularisation beim Tissue Engineering von Fettgewebe

Angiogenesis and Vascularisation in Adipose Tissue Engineering
J. H. Dolderer   *
1   Hochschulzentrum für Plastische, Hand- und Wiederherstellungschirurgie, ­Universitätsklinikum Regensburg, Regensburg
,
F. Medved   *
2   Klinik für Hand, Plastische, Rekonstruktive und Verbrennungschirurgie, ­BG-Unfallklinik, Eberhard Karls Universität Tübingen, Tübingen
,
R. M. Haas
2   Klinik für Hand, Plastische, Rekonstruktive und Verbrennungschirurgie, ­BG-Unfallklinik, Eberhard Karls Universität Tübingen, Tübingen
,
D. I. Siegel-Axel
3   Klinik für Innere Medizin, Endokrinologie, Diabetologie, Angiologie, Nephrologie und Klinische Chemie, Eberhard Karls Universität Tübingen, Tübingen
,
S. M. Schiller
4   Freiburg Institute for Advanced Studies (FRIAS), Albert-Ludwigs Universität Freiburg, Freiburg
,
H.-E Schaller
2   Klinik für Hand, Plastische, Rekonstruktive und Verbrennungschirurgie, ­BG-Unfallklinik, Eberhard Karls Universität Tübingen, Tübingen
› Author Affiliations
Further Information

Publication History

eingereicht 25 March 2012

akzeptiert 08 October 2012

Publication Date:
22 January 2013 (online)

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Zusammenfassung

Der heutige Standard für die Deckung und Rekonstruktion größerer Haut-/Weichteildefekte mit freiliegenden Knochen, Nerven oder Gefäßen, wie sie z. B. nach ausgedehnten Tumorresek­tionen oder komplexen Unfallverletzungen vorkommen, ist der lokale oder freie mikrochirurgische Gewebetransfer. Trotz Einführung und Weiterentwicklung neuer chirurgischer Techniken sowie zahlreicher synthetischer Materialien, ist nach wie vor eine große Anzahl von Limitationen und Komplikationen an der Hebe-/und Empfängerstelle vorhanden. Es besteht daher ein großer Bedarf an Entwicklung neuer Methoden und Materialien, welche einen dauerhaften körpereigenen Weichteilersatz ermöglichen. Ein vielversprechender Therapieansatz ist der Weichteilersatz mit körpereigenem Fettgewebe. Klinische und experimentelle Untersuchungen zur Wiederherstellung von Weichteilen mithilfe körpereigenen Fettgewebes zeigten allerdings bei den freien Fettgewebstransplantationen ohne einen direkten Gefäßanschluss, v. a. im Hinblick auf das Langzeitüberleben des Transplantates, bis dato eher enttäuschende Ergebnisse. Häufig wurde ein Volumenverlust bzw. eine komplette Resorption des Transplantates aufgrund einer insuffizienten Gewebequalität durch ausbleibende Zelldifferenzierung beobachtet. Diese Tatsache verweist auf die besondere Rolle der Unterhaltung und Entwicklung der transplantateigenen Blutversorgung (Vaskularisation und Angiogenese), entscheidend für den Erhalt einer Volumenkonstanz des Gewebes und damit für die Deckung größerer Weichteildefekte. Das schnell wachsende, interdisziplinäre Gebiet des Tissue- Engineerings bietet alternative Lösungsansätze zu den bisherigen Therapiemöglichkeiten. Die Zielsetzung ist hierbei Fettgewebe im Labor sowie zukünftig autolog im Patienten herzustellen, welches als permanenter Gewebeersatz an ­entsprechende Körperstellen volumenstabil transplantiert werden kann. Zahlreiche Untersuchungen haben die Vaskularisation als bedeutendsten und gleichzeitig kritischsten Faktor für Qualität, Volumen und Langzeitüberleben der transplantierten und komplett neu generierten Fettgewebekonstrukte aufgezeigt. Und obwohl unser Verständnis der regulatorischen Mechanismen der Adipogenese noch sehr eingeschränkt ist, bestehen klare Hinweise darauf, dass die komplexen Abläufe der Zellinteraktionen bei der Proliferation und Differenzierung von Adipozyten in direkter Weise mit der Angiogenese korrelieren.

Abstract

The current standard for the reconstruction of large soft tissue defects with exposed bone, nerves or blood vessels, for example after extensive tumor resections, complex injuries, severe burns or infections, is the local or free microsurgical tissue transfer. Despite the development of new surgical techniques and many synthetic materials, there are still a large number of limitations and complications at the donor and recipient site. Thus, in a subset of patients either complete treatment is not possible or poses problems. Therefore, there is a great need for the development of new methods and materials allowing for a permanent replacement with body own soft tissue. A promising therapeutic approach is the soft tissue replacement with autologous adipose tissue. Innovative research on the reconstruction of soft tissue by adipose tissue, and clinical and experimental studies on the long-term survival and transplantation of autologous adipose tissue showed that the free fat tissue graft without direct vascular connection come along with disappointing results. Often a loss of volume or a complete resorption of the graft because of insufficient tissue quality by lack of cell differentiation was observed. This fact points to the special role of the maintenance and development of the graft’s blood supply (angiogenesis and vascularization) crucial for maintaining a constant volume of the tissue. The rapidly growing interdisciplinary field of tissue engineering offers alternative solutions to the existing treatment options with the aim to produce autologous adipose tissue, stable in volume in vitro as well as in vivo, which can be transplanted as a permanent tissue replacement to corresponding parts of the body. Numerous studies have demonstrated the important and most critical factor of vascularisation for quality, volume and long-term survival of transplanted newly generated adipose tissue constructs. Although our understanding of the regulatory mechanisms of adipogenesis is still limited, there are clear indications that the complex sequences of cell interactions in the differentiation and proliferation of adipocytes is directly related to angiogenesis.

Schlüsselwörter

Angiogenese - Vaskularisation - Adipogenese - Gewebezüchtung - Weichteildefekt

Key words

angiogenesis - vascularisation - adipogenesis - tissue engineering - soft-tissue defect
*

* Die Autoren sind zu gleichen Teilen an der Publikation beteiligt.


 

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