Overcoming functional challenges in autologous and engineered fat grafting trends

• Published in: Trends in biotechnology (Regular ed.) Vol. 40; no. 1; pp. 77 - 92
• Main Authors: Major, Gretel S., Simcock, Jeremy W., Woodfield, Tim B.F., Lim, Khoon S.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.01.2022; Elsevier Limited
• Subjects: Adipocytes; Adipose Tissue; Angiogenesis; Apoptosis; Autografts; autologous fat grafting; Bioengineering; Biomedical materials; Body fat; breast reconstruction; contour deformities; Grafting; Grafts; Ischemia; lipoaspirate; Reconstructive surgery; Retention; soft tissue regeneration; Soft tissues; Structural integrity; Transplantation, Autologous; Transplants & implants; Vascularization; lipoaspirate; adipose tissue; contour deformities; autologous fat grafting; soft tissue regeneration; breast reconstruction
• ISSN: 0167-7799; 1879-3096
• DOI: 10.1016/j.tibtech.2021.04.006

Autologous fat grafting offers significant promise for the repair of soft tissue deformities; however, high resorption rates indicate that engineered solutions are required to improve adipose tissue (AT) survival. Advances in material development and biofabrication have laid the foundation for the generation of functional AT constructs; however, a balance needs to be struck between clinically feasible delivery and improved structural integrity of the grafts. A new approach combining the objectives from both the clinical and research communities will assist in developing morphologically and genetically mature AT constructs, with controlled spatial arrangement and increased potential for neovascularization. In a rapidly progressing field, this review addresses research in both the preclinical and bioengineering domains and assesses their ability to resolve functional challenges. The current and emerging adipose tissue regeneration strategies are somewhat misaligned, without a clear focus on the appropriate structural and functional demands required in vivo.The development of biomimetic materials has been rigorous, but these materials now need to be unified with established biofabrication strategies to meet the clinical design challenges.Efforts to prevascularize adipose tissue constructs have been significant; however, scalability and surgical feasibility remain an issue.Generating mature adipose tissue constructs is a major challenge in the field; however, refined culture strategies and adjuvant factors have made headway, laying the foundation for future clinical relevance.There is a clear trade-off between minimally invasive delivery and architectural control in vivo. Striking a balance between these will be key to fast-tracking engineered adipose tissue grafting.