Vasculogenic potential of adipose tissue derived stem cells from patients with chronic spinal cord injury and pressure injuries

Limited vascularization and ischemia are major contributors to the chronicity of wounds, such as ulcers and traumatic injuries, which impose significant medical, social, and economic burdens. These challenges are particularly pronounced in patients with spinal cord injury (SCI), a disabling condition associated with vascular dysfunction, infections, and impaired peripheral circulation, complicating the treatment of pressure injuries (PIs) and the success of reconstructive procedures like grafts and flaps. Regenerative medicine aims to address these issues by identifying effective cellular therapies to restore vascular beds. Among these, cells from the stromal vascular fraction (SVF) of adipose tissue (AT) are promising due to their abundance of angiogenic and vasculogenic cells, including mesenchymal stem cells (MSCs) and endothelial colony-forming cells (ECFCs). This study evaluated the vasculogenic potential of AT-derived cellular fractions isolated via enzymatic digestion of white adipose tissue (WAT). We compared adipose-derived stem cells (ASCs) cultured from SVF with a combination of ECFCs and MSCs, expanded separately and transplanted in a 40:60 ratio. Results showed that while ASCs promote angiogenesis and vasculogenesis, the ECFC/MSC combination is superior, consistently forming perfused vascular beds in subcutaneous implants in nude mice. Furthermore, ECFCs and MSCs extracted from small amounts of WAT in SCI patients with PIs demonstrated similar functionality and vasculogenic potential to cells from healthy controls. These findings highlight the potential of AT-derived ECFCs and MSCs in autologous cell therapies, offering a promising avenue for advancing vascular regeneration in patients with SCI.