Background— The delivery of autologous cells to increase angiogenesis is emerging as a treatment option for patients with cardiovascular disease but may be limited by the accessibility of sufficient cell numbers. The beneficial effects of delivered cells appear to be related to their pluripotency and ability to secrete growth factors. We examined nonadipocyte stromal cells from human subcutaneous fat as a novel source of therapeutic cells. Methods and Results— Adipose stromal cells (ASCs) were isolated from human subcutaneous adipose tissue and characterized by flow cytometry. ASCs secreted 1203±254 pg of vascular endothelial growth factor (VEGF) per 10 6 cells, 12 280±2944 pg of hepatocyte growth factor per 10 6 cells, and 1247±346 pg of transforming growth factor-β per 10 6 cells. When ASCs were cultured in hypoxic conditions, VEGF secretion increased 5-fold to 5980±1066 pg/10 6 cells ( P =0.0016). The secretion of VEGF could also be augmented 200-fold by transfection of ASCs with a plasmid encoding VEGF ( P <0.05). Conditioned media obtained from hypoxic ASCs significantly increased endothelial cell growth ( P <0.001) and reduced endothelial cell apoptosis ( P <0.05). Nude mice with ischemic hindlimbs demonstrated marked perfusion improvement when treated with human ASCs ( P <0.05). Conclusions— Our experiments delineate the angiogenic and antiapoptotic potential of easily accessible subcutaneous adipose stromal cells by demonstrating the secretion of multiple potentially synergistic proangiogenic growth factors. These findings suggest that autologous delivery of either native or transduced subcutaneous ASCs, which are regulated by hypoxia, may be a novel therapeutic option to enhance angiogenesis or achieve cardiovascular protection.

Abstract-It has been shown that stromal-vascular fraction isolated from adipose tissues contains an abundance of CD34 ϩ cells. Histological analysis of adipose tissue revealed that CD34 ϩ cells are widely distributed among adipocytes and are predominantly associated with vascular structures. The majority of CD34 ϩ cells from freshly isolated stromal-vascular fraction were CD31 Ϫ /CD144 Ϫ and could be separated from a distinct population of CD34 ϩ /CD31 ϩ /CD144 ϩ (endothelial) cells by differential attachment on uncoated plastic. The localization of CD34 ϩ cells within adipose tissue suggested that the nonendothelial population of these cells occupied a pericytic position. Analysis of surface and intracellular markers of the freshly isolated CD34 ϩ /CD31 Ϫ /CD144 Ϫ adipose-derived stromal cells (ASCs) showed that Ͼ90% coexpress mesenchymal (CD10, CD13, and CD90), pericytic (chondroitin sulfate proteoglycan, CD140a, and CD140b), and smooth muscle (␣-actin, caldesmon, and calponin) markers. ASCs demonstrated polygonal self-assembly on Matrigel, as did human microvascular endothelial cells. Coculture of ASCs with human microvascular endothelial cells on Matrigel led to cooperative network assembly, with enhanced stability of endothelial networks and preferential localization of ASCs on the abluminal side of cords. Bidirectional paracrine interaction between these cells was supported by identification of angiogenic factors (vascular endothelial growth factor, hepatocyte growth factor, basic fibroblast growth factor), inflammatory factors (interleukin-6 and -8 and monocyte chemoattractant protein-1 and -2), and mobilization factors (macrophage colony-stimulating factor and granulocyte/macrophage colony-stimulating factor) in media conditioned by CD34 ϩ ASCs, as well a robust mitogenic response of ASCs to basic fibroblast growth factor, epidermal growth factor, and platelet-derived growth factor-BB, factors produced by endothelial cells. These results demonstrate for the first time that the majority of adipose-derived adherent CD34

Abstract-Rapid induction and maintenance of blood flow through new vascular networks is essential for successfully treating ischemic tissues and maintaining function of engineered neo-organs. We have previously shown that human endothelial progenitor cells (EPCs) form functioning vessels in mice, but these are limited in number and persistence; and also that human adipose stromal cells (ASCs) are multipotent cells with pericytic properties which can stabilize vascular assembly in vitro.In this study, we tested whether ASCs would cooperate with EPCs to coassemble vessels in in vivo implants. Collagen implants containing EPCs, ASCs, or a 4:1 mixture of both were placed subcutaneously into NOD/SCID mice. After a range of time periods, constructs were explanted and evaluated with regard to vascular network assembly and cell fate; and heterotypic cell interactions were explored by targeted molecular perturbations. The density and complexity of vascular networks formed by the synergistic dual-cell system was many-fold higher than found in implants containing either ASCs or EPCs alone. Coimplantation of ASCs and EPCs with either pancreatic islets or adipocytes produced neoorgans populated by these parenchymal cells, as well as by chimeric human vessels conducting flow. This study is the first to demonstrate prompt and consistent assembly of a vascular network by human ASCs and endothelial cells and vascularization by these cells of parenchymal cells in implants. Mixture of these 2 readily available, nontransformed human cell types provides a practical approach to tissue engineering, therapeutic revascularization, and in vivo studies of human vasculogenesis. A ssembly of new vascular networks for therapeutic purposes has been critical but elusive for tissue engineering and angiogenesis. A general requirement for preserving viability within a regenerating region is that a vascular bed is assembled or expanded sufficiently to ensure adequate tissue perfusion. Also important to success of such applications is the ability of any network to anastomose or inosculate promptly with the vessels of immediately adjacent tissues. Cell-based revascularization therapies were tested in patients with various ischemic diseases. These studies used progenitor cells from bone marrow 1,2 and skeletal muscle 3,4 to treat patients with myocardial infarction, 1,2 heart failure, 3-6 and peripheral vascular disease. 7,8 Despite accumulating data and recent metaanalyses 9,10 that support the hypothesis that progenitor cells have high potential for promoting tissue revascularization and functional recovery, invasive methods of cells harvest and their low abundance may limit adoption some of progenitor cells for therapies. Recent approaches were focused on evaluating cells derived from more available tissues including adipose tissue 11,12 and umbilical cord blood. 13,14 Endothelial progenitor cells (EPCs) isolated from adult peripheral blood, 15 bone marrow, umbilical cord blood, 13 and vessel wall 16 were intensively studied over the past decade. ...