Journal of Clinical Medicine

Review Adipose : A Source of Stem Cells with Potential for Regenerative Therapies for Wound Healing

Lucy V Trevor 1,2 , Kirsten Riches-Suman 3 , Ajay L Mahajan 1,2 and M Julie Thornton 1,3,*

1 Plastic Surgery and Burns Research Unit, University of Bradford, Bradford BD71DP, UK; [email protected] (L.V.T.); [email protected] (A.L.M.) 2 Department of Plastic and Reconstructive Surgery, Bradford Teaching Hospitals NHS Foundation Trust, Bradford BD71DP, UK 3 Centre for Skin Sciences, Faculty of Life Sciences, University of Bradford, Bradford BD71DP, UK; [email protected] * Correspondence: [email protected]

 Received: 3 June 2020; Accepted: 6 July 2020; Published: 8 July 2020 

Abstract: Interest in is fast becoming a focus of research after many years of being considered as a simple . It is becoming increasingly apparent that adipose tissue contains a number of diverse types, including adipose-derived stem cells (ASCs) with the potential to differentiate into a number of cell lineages, and thus has significant potential for developing therapies for regenerative medicine. Currently, there is no gold standard treatment for and impaired wound healing continues to be a challenge faced by clinicians worldwide. This review describes the current understanding of the origin, different types, anatomical location, and of adipose tissue before discussing the properties of ASCs and their promising applications for tissue engineering, scarring, and wound healing.

Keywords: adipose tissue; grafting; stromal vascular fraction; adipose-derived stem cells; regenerative medicine; wound healing

1. Introduction The epidemic has transformed the way we think about adipose tissue. Adipose tissue, once considered as a simple inert tissue functioning as insulation and energy storage, is now seen as one of the largest endocrine organs in the body, containing a variety of cell types, with multiple potential applications for regenerative medicine. Just one-third of adipose tissue volume is comprised of mature ; the remainder consists of a heterogenous group of preadipocytes, fibroblasts, mesenchymal stem cells (MSCs), endothelial progenitor cells (EPCs), , , T-cells, and erythrocytes in a stromal vascular cell network (Figure1)[ 1]. Enzymatic digestion of adipose tissue produces a heterogeneous population of precursor cells within a cell pellet which is referred to as the stromal vascular fraction (SVF). Components of the SVF were quantified by the International Federation for Adipose Therapeutics and Science (IFATS) and International Society for Cellular Therapy (ISCT) who reported cells were present in the following proportions: 15–30% stromal cells, 10–20% endothelial cells, 10–15% lymphocytes, 10–15% granulocytes, 5–15% monocytes, 3–5% pericytes, and <0.1% stem and progenitor cells [2]. This diverse SVF cell population, derived from adipose tissue, has been investigated for its potential therapeutic use in regenerative medicine. More specifically, MSCs present in the SVF, termed adipose-derived stem cells (ASCs), have been explored as the key cell type responsible for the beneficial effects of SVF. ASCs have been shown in vitro to promote human dermal fibroblast proliferation and migration and production of by both direct cell-to-cell contact and paracrine activation [3]. It remains to be seen whether these