Fat Prospects for Healing Cutaneous Wounds: New Activities Under the Sheets.

Abstract

In this issue of Diabetes , Kato et al. (1) describe new results for dermal wound healing in full-thickness skin defects in Zucker diabetic fatty (ZDF) rats. The team fabricated and applied transplanted living cell sheets comprising allogeneic adipose-derived stem cells (ASCs) harvested from the inguinal fat pads of normal rats. They attempt to address the current challenges with abnormal wound healing in increasing numbers of patients with diabetes who present with difficult cutaneous wound healing problems (2,3). This deficiency is often clinically characterized by persistent inflammation, hypergranulation, excessive tissue bed exudates, and chronic inability to resolve, resulting in enhanced bacterial burdens, infections, ulcerations, and more serious complications. Delayed cutaneous healing in these patients is attributed to combinations of predisposing factors associated with chronic diabetes pathology, including oxidative imbalance, vascular abnormalities, neuropathy, infection, and local metabolic deficiencies intrinsic to diabetes. Pathological disruption of normal regenerative and degenerative extracellular matrix processing alters the dermal matrix composition, resulting in reduced amounts and quality of tissue matrix (2,3). Natural balances between proinflammatory cytokines (e.g., interleukin [IL]-1α and -1β and tumor necrosis factor-α) stimulating endogenous protease activities and prohealing cytokines (e.g., IL-4, IL-8, IL-10, IL-11, IL-13, granulocyte macrophage colony-stimulating factor, MCP-1, and macrophage inflammatory protein 2) apparently do not exist in diabetic tissues. Additionally, reduced levels of potent growth factors platelet-derived growth factor, basic fibroblast growth factor, epidermal growth factor, and transforming growth …