Development of novel human in vitro vascularized adipose tissue model with functional macrophages

ORIGINAL ARTICLE Development of novel human in vitro vascularized adipose tissue model with functional macrophages Outi Huttala .Jertta-Riina Sarkanen .Marika Mannerstro ¨m. Tarja Toimela .Tuula Heinonen .Timo Ylikomi Received: 7 March 2020 / Accepted: 4 June 2020 ÓThe Author(s) 2020 Abstract Inflammation has been proven significant factor in development of type 2 diabetes. So far, most of the adipose tissue related research has been performed in animals, mainly rodent models. The relevance of translation of animal results to humans is questionable. However, in vitro model with relevant human cell source, such as human adipose tissue stromal cells (hASC), can be developed and should be utilized for human adipose tissue research. We developed in vitro models of human adipose tissue utilizing hASC, endothelial cells and monocytes/macrophages. By isolating endothelial cells and macrophages from same adipose tissue as hASC, we were able to provide method for constructing personalized models of adipose tissue. With these models, we studied the effect of macrophages on adipogenesis and protein secretion, with and without vasculature. The models were analyzed for immunocytochemical markers, cell number, triglyceride accumulation and protein secretion. We found that lipid accumulation was greater in adipocytes in the presence of macrophages. Interferon gamma increased this difference between adipocyte culture and Adipocyte– Macrophage co-culture. Protein secretion was affected more by macrophages when vasculature was not present compared to the mild effect when vasculature was present. The vascularized adipose model with macrophages is valuable tool for human adipose tissue research, especially for the personalized medicine approaches; for choosing the right treatments and for studying rare medical conditions. Keywords hASC Adipose tissue derived endothelial cells Interferon gamma Adipogenesis  In vitro model development Adipose tissue derived macrophages Abbreviations AMM Adipocyte–Macrophage Model AMMI Adipocyte–Macrophage Model with IFNc ATE Adipose tissue extract G-CSF Granulocyte-colony stimulating factor GMCSF Granulocyte–macrophage colonystimulating factor hASC Human adipose stromal cells HUVEC Human umbilical vein endothelial cells IFNcInterferon gamma IGF Insulin-like growth factor 1 IL-1a Interleukin 1a IL-6 Interleukin 6 IL-8 Interleukin 8 IP-10 Interferon gamma-induced protein 10/CXCL10 O. Huttala M. Mannerstro ¨mT. Toimela T. Heinonen FICAM, Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland O. Huttala (&)J.-R. Sarkanen T. Ylikomi Cell Biology, Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland e-mail: [email protected] 123 Cytotechnology https://doi.org/10.1007/s10616-020-00407-6(0123456789().,-volV)(0123456789().,-volV) LDL Low density lipoprotein PAI Plasminogen activator inhibitor 1 RT Room temperature SFM Serum free medium TGFbTransforming growth factor b TNFaTumor necrosis factor a VATMI Vascularized Adipose Tissue model with Macrophages with IFNc Introduction During the recent decades, the incidence of obesity has increased dramatically throughout the world. As the prevalence of obesity increases the amount of related diseases increases. Obesity is associated with type 2 diabetes as well as cancer, sleep apnea, asthma, degenerative joint disease, hypertension, renal failure, stroke, and cardiovascular disease (Switzer et al. 2013, van Baak 2013). Hence, adipose tissue research, particularly studies of disturbances in normal tissue function, is ever more important. Adipose tissue contains heterogeneous cell population and has multiple functions including energy storage, endocrine functions and maintenance of metabolic homeostasis. Adipose tissue is composed of adipose stem cells, mature adipocytes, immune cells, fibroblasts, endothelial cells. Adipocytes are the main cell type in adipose tissue. Due to their large size, they occupy 90% of the volume of adipose tissue (Kanneganti and Dixit 2012). Inflammation of adipose tissue has been suspected to be key reason behind many of the complications such as type 2 diabetes mellitus (the loss of insulin sensitivity). In adipose tissue, insulin resistance manifests as impaired glucose disposal and enhanced triglyceride lipolysis, resulting in hyperinsulinemia, hyperglycemia, and hyperlipidemia (Shulman 2000). Obesity leads to enlargement of adipocytes and in addition, promotes macrophage accumulation in adipose tissue (Gil et al. 2007; Murano et al. 2008). Obese people have been shown to have a continuous lowgrade inflammation in their adipose tissue (Gil et al. 2007). The first evidence of link between inflammation, obesity and insulin resistance was the finding that increased expression of tumor necrosis factor a (TNFa), an inflammatory cytokine, promoted insulin resistance via serine phosphorylation of IRS1 (Hotamisligil et al. 1993,1996). Interferon gamma (IFNc) produced by macrophages is one of the markers involved in adipose tissue inflammation. Obese IFNc-deficient animals have been shown to have significantly reduced expression of inflammatory genes TNFaand monocyte chemoattractant protein-1, decreased inflammatory cell accumulation, and better glucose tolerance than control animals (Rocha et al. 2008). In addition, obese IFNc-knockouts, have demonstrated improved insulin sensitivity and decreased adipocyte size (O’Rourke et al. 2012). Adipose stem cells have been shown to inhibit the Th1 phenotype and subsequently decrease IFNcand TNFaproduction but also increase the secretion of IFNcproduction from Th17 cells (Eljaafari et al. 2015). Along with inflammation, theories on the reasons leading to insulin resistance include the impaired adipogenesis (Okuno et al. 2018). The process of stem cells maturing into adipocytes is called adipogenesis. Adipogenesis would lead to formation of new adipocytes and hence relieve the stress of over expanding adipocytes. When the adipocytes overexpand the stress signals get activated (Haczeyni et al. 2018). This in turn influences the function of mitochondria and leads to the state of inflammation (Codoner-Franch et al. 2011, Patti and Corvera 2010). It is still not quite clear which event in this cascade finally causes the insulin resistant stage in adipocytes. Information of adipogenesis in the presence of inflammation and studies on the role of these numerous factors known to take part in the formation of insulin resistance would lead to the possibility of new treatment methods for obesity related diseases. Also, the role of different cells in the development of insulin resistance is still largely unknown. Personalized in vitro models with cells from only one patient could also result in even better insights of the development of these diseases. Relevant and reliable adipose tissue research requires suitable tools to achieve high quality results. Although the natural heterogeneity of adipose tissue is achieved when using animal models, the species-tospecies variation in translating these results is too great flaw to dismiss (Seok et al. 2013). Murine models have been extensively used to identify and test drug candidates prior to clinical trials (European Commission 2010; US Department of Health and Human 123 Cytotechnology Services Food and Drug Administration, Center for Drug Evaluation and Research Guidance for Industry 2006; Woodcock and Woosley 2008). However, only few of these candidates have been successful in the human trials (Hackam and Redelmeier 2006; van der Worp et al. 2010). The success rates for those trials and animal experiments, where the studied disease involves inflammation, seem to be especially low (Mitka 2011; Seok et al. 2013). As an alternative, in vitro models have been developed. However, most in vitro models developed so far contain animal cells including 3T3-L1 adipocytes but lack all other components of adipose tissue (Ruiz-Ojeda et al. 2016). These may shed light on some aspects of adipose tissue function but are not optimal for studying human adipose tissue biology. Hence, the need for better models is evident for the research of human adipose tissue and its complications, especially inflamed adipose tissue. Human adipose tissue is a vast and easy source of cells, which are relevant due to their human origin. Human adipose tissue stromal cells (hASC), obtained from adipose tissue, are widely used, due to their wellestablished isolation and culturing methods, plasticity, easiness to obtain and lack of ethical concerns. One great advantage for them is the ability to produce them in reproducible manner and in ways that allow clinical use (Patrikoski et al. 2013). Consequently, hASC have been utilized in many different in vitro tissue models including vasculature/angiogenesis models (Huttala et al. 2015; Merfeld-Clauss et al. 2010), adipose tissue models (Huttala et al. 2016,2018; Volz et al. 2018) and in cartilage and bone tissue engineering (Ojansivu et al. 2015; Vuornos et al. 2016). Here we present adipose tissue models, which combine in vitro human adipocytes (differentiated from hASC), vascularization (composed of human umbilical vein endothelial cells (HUVEC) and hASC) and human primary monocytes differentiated to macrophages. Others have developed similar human hASC-immune cell co-culture models (Eljaafari et al. 2015; Kongsuphol et al. 2019; Liu et al. 2019) but have not contained endothelial cells. Also, no other endothelial cell containing adipose tissue model including immune cells were found in literature which would utilize natural adipogenesis induction (Sarkanen et al. 2012a,b). The use of natural adipogenesis induction (Adipose Tissue Extract, ATE) is also beneficial for the vascular development compared to the commonly used chemical adipogenesis cocktail (Kang et al. 2009; Sheu et al. 2006). Our goal was to develop versatile models which allow studying the effects of inflammation markers like IFNcon adipocytes, immune cells and vasculature. Also, the aim was that these models allow the studies of the interaction between adipocytes, vasculature (endothelial cells) and immune cells. In these developed models we specifically study the effect of macrophages by comparing each culture set-up to a same set-up lacking the macrophages. Finally, for the personalized medicine purposes, the developed method would allow the use of single donor adipose tissue sample (isolation the endothelial cells and macrophages from adipose tissue along with hASC). This type of protocol provides a relevant model for the needs of personalized medicine. Materials and methods Ethical considerations This in vitro study conforms to the ethical principles outlined in the Declaration of Helsinki. The human adipose tissue samples and human umbilical cords were received with written informed consent from Tampere University Hospital, Tampere, Finland. The use of adipose tissue derived cells and human umbilical cord endothelial cells (HUVEC) were approved by The Regional Ethics Committee of Tampere University Hospital’s Responsibility Area, Tampere, Finland with permit numbers of R15161 and R15033, respectively. The blood samples from which monocytes were isolated, were ordered from Finnish Red Cross Blood service, and used with their permit number 35/2014. Isolation and treatment of hASC, HUVEC and monocytes Isolation and culture hASC and HUVEC Isolation of hASC and HUVEC is depicted in Sarkanen et al. (2012a,b). Before cryopreservation, the cells were screened for mycoplasma utilizing MycoAlert Ò Detection Kit (Lonza Group LTD, Basel Switzerland) and were mycoplasma free. The used batches of hASC were proven to express CD73, CD90 and CD105 (BD) 123 Cytotechnology as described previously (Huttala et al. 2015). Same cell batch of hASC (adipose tissue obtained from one patient) was utilized throughout this study. The adipose tissue sample was subcutaneous fat from abdomen of obese female who was not known to suffer from any metabolic disorder. Also, same batch of HUVEC (umbilical cord from another patient) was used throughout this study when HUVEC were utilized. hASC were propagated in hASC medium (Table 1). HUVEC were propagated in EGM-2 Endothelial Cell Growth Medium-2 (Lonza). In the models, hASC were used at passage 2 and HUVEC at passage 4. Isolation of monocytes from human blood Monocytes were isolated from blood utilizing Ficoll Paque Plus (GE Health care). Blood sample diluted with PBS was added on top of Ficol and these tubes were centrifuged for 40 min at 400 G without brakes. Buffy coat was collected, and PBS washes were performed three times, first centrifugation at 350 gfor 10 min, second at 200 gfor 10 min and third at 350 gfor 10 min. This pellet, containing mononuclear cells from blood, was resuspended to PBS and suspension was filtered through 30 lm filter (BD), centrifuged at 300 g for 10 min and supernatant was removed. To separate T cells from this cell suspension, human Pan T cell isolation kit (Miltenyi Biotec, Table 1 Media utilized in the study, their content and manufacturer Medium name Components Manufacturer hASC medium 10% Human Serum 2mML-Glutamine in Dulbecco’s Modified Eagle’s Medium Nutrient Mixture F-12 (DMEM/F12) Lonza Gibco (Carlsbad, CA, USA) Gibco HUVEC medium EGM-2 Endothelial Cell Growth Medium-2 Lonza Serum free medium (SFM) ITS (1.15 lM insulin, 6.65 lg/ml Transferrin, 6.65 ng/ml seleniuous acid) 2.56 mM L-glutamine 1% Bovine serum albumin 2.8 mM Sodium Pyruvate 50 U/ml Penicillin/50 lg/ml Streptomycin 0.1 nM 3,30,5-Triiodo-L-thyronine sodium salt 10 ng/ml Vascular endothelial growth factor A 1 ng/ml fibroblast growth factor 2 100 lg/ml Ascorbic acid 50 ng/ml heparin 0.2 lg/ml hydrocortisone in DMEM/F12 BD Biosciences (NJ, USA) Gibco Biosera (Boussens, France) Gibco Gibco Sigma Aldrich (MO, USA) R&D Systems (Abingdon, UK) R&D Systems Sigma-Aldrich Sigma Aldrich Sigma Aldrich Gibco Monocyte medium 50 U/ml Penicillin/Streptomycin in RPMI-1640 Gibco ATCC ATE medium 1700 lg/ml of ATE 10% HS 2mML-Glutamine 50 U/ml Penicillin/Streptomycin in DMEM/F12 Own production, see Chapter 4.4 Lonza Gibco Gibco Gibco Monocyte-to-macrophage medium 10% inactivated Human serum in RPMI-1640 Lonza ATCC 123 Cytotechnology Bergisch Gladbach, Germany) and MACS magnetic separator midiMACS (Miltenyi Biotec) were utilized according to the manufacturer instructions. Cells were suspended to buffer and Pan T cell biotin-antibody cocktail was added and incubated at 4 °C for 10 min. Pan T cell Microbead cocktail was then added and incubated at 4 °C for 15 min. After wash and centrifugation at 300 gfor 10 min, the supernatant was removed, and cells were suspended to the buffer and added into the MACS LS column (Miltenyi Biotec). The unlabeled flow-through is the T cell population, which was not utilized in the study, and cells attached to the column include monocytes. Monocytes were cultured in monocyte medium (Table 1). Cells were cryopreserved in RPMI-1640 (ATCC) supplemented with 10% DMSO (Sigma), 10% human serum (Lonza type AB filtered) and 50 U/ml Penicillin and streptomycin (Gibco). Differentiation of monocytes to macrophages Monocytes, isolated from blood as well as commercial monocytes i.e. CD14 ?Monocytes from Peripheral blood, single donor (PromoCell, C-12909), were utilized. After thawing, the cells were cultured in a 25 cm 2 culture bottle in monocyte-to-macrophage medium (Table 1) to differentiate the monocytes towards macrophages. Human serum in the medium differentiates monocytes into macrophages (Andreesen et al. 1983; Musson 1983). For the first 24 h after thawing, the cells were allowed to recover. Then fresh medium was changed. After 3 days, some of monocytes had attached to the bottom and differentiated to macrophages, whereas some of monocytes were growing in suspension. Every 4–5 days, half of the medium was changed, and the morphology of the cells was monitored by microscope. After 10 days, cells growing were subcultured with ratio of 1:2 into 25 cm 2 culture bottles. After culturing the cells for 24 days, the macrophages were differentiated and ready to be used in the construction of the in vitro models. Maturity was tested with methods presented in paragraph ‘‘Analysis of isolated and differentiated macrophages’’. Detachment of macrophages was done by Macrophage detachment solution DXF (PromoCell, C-41330) and scraping with a cell scraper. Isolation of cells from adipose tissue for the personalized model CD11b positive cells and endothelial cells (CD31 positive) were isolated from the same adipose tissue sample as hASC. Isolation of CD11b positive cells from adipose tissue CD11b selection was used to obtain immune cells (mainly monocytes/macrophages) from adipose tissue. The adipose tissue was cut into small pieces and incubated in 0.15% collagenase I (Gibco) for 12 h. This was then centrifuged at 600 gfor 10 min followed by the removal of the supernatant. To remove red blood cells by bursting them, the pellet was incubated in sterile water for 2 min. DMEM/F12 (Gibco) supplemented with 1% L-glutamine (Gibco), 10% Human serum (Lonza) and 50 U/ml Penicillin and streptomycin (Gibco) was added to dilute the water and this was centrifuged at 600 gfor 10 min which resulted in cell pellet (the tissue was processed similarly up to this step also for endothelial cell isolation). The cell pellet was resuspended and filtered through 100 lm mesh. The CD11b positive cells were isolated utilizing mouse/human CD11b Microbeads kit (Miltenyi Biotec) and MACS magnetic separator miniMACS (Miltenyi Biotec) according to manufacturer’s instructions. Cells in the adipose tissue derived cell suspension were counted and divided 1 x 10 7 cells per tube followed by incubation with CD11b antibody for 10 min at ?4°C and wash with MACS running buffer. Cell suspension was then centrifuged at 300 gfor 5 min, supernatant was removed, and fresh running buffer added. This suspension was then run through a MACS column with pre separation filter (Miltenyi Biotec). Column was washed three times before collecting the cells captured into the column. Cells were cultured in Monocyte medium (Table 1) prior to analysis of their functionality. Isolation of endothelial cells from adipose tissue Pluribead anti-human CD31 S-bead kit (PluriSelect, Leipzig, Germany) was utilized for positive selection of endothelial cells from adipose tissue. The adipose tissue was treated as described in paragraph ‘‘Isolation of CD11b positive cells from adipose tissue’’ until cell pellet was reached. The pellet was resuspended in the 123 Cytotechnology buffer of the Pluribead kit and the cell number was adjusted to be max 5 x 10 6 target cells/ml and this suspension was filtered through provided filter. CD31 S-Pluribeads were then mixed with the cell suspension and incubated at room temperature (RT) for 30 min on rotation on MACSmix TM Tube Rotator (Miltenyi Biotec). This suspension was then filtered through equilibrated strainers. The strainer was then transferred on top of sterile 50 ml tube, washed and detachment buffer was added and incubated for 10 min at RT. Cells were released from the strainer and strainer was washed with HUVEC medium. This suspension was then centrifuged 10 min at 300 x g without brake. The pellet was suspended into EGM-2 Endothelial Cell Growth Medium-2 medium (Lonza) and transferred into 25 cm 2 culture bottle. Preparation of adipose tissue extract In order to obtain adipose tissue extract (ATE) (Lopez et al. 2016,2018; Sarkanen et al. 2012a,b), human adipose tissue specimens were mechanically cut into small pieces and incubated in DMEM/F12 (Gibco) in ?37 °C for 1–24 h. After the incubation, the liquid was collected, centrifuged and sterile filtered and stored in -70 °C until use. Protein concentrations of ATE was determined utilizing Pierce BCA Protein Assay Kit (Thermo Scientific, Waltham, MA) according to manufacturer’s instructions using bovine serum albumin as a standard. Results were measured after 30 min incubation at 37 °C at 562 nm with Varioskan Flash Multimode Reader (Thermo Scientific). Analysis of isolated and differentiated macrophages and endothelial cells LDL uptake by CD11b positive cells and endothelial cells Low density lipoprotein 488 (LDL-488, Molecular probes, Eugene, Oregon, USA) at 10 lg/ml concentration was added on cells and incubated for 4 h at 37 °C. After incubation, cells were washed and analyzed by microscope and imaged with automated imaging system Cell-IQ (Chipman Technologies, Tampere, Finland). Test of engulfment function of macrophages To ensure the successful differentiation of macrophages, fluorescein stained cell debris was fed to the macrophages. This debris was produced by staining hASC with cell membrane label mini-67 PKH67 Green fluorescent cell linker kit (Sigma) according to manufacturer’s instructions. Cells were washed with PBS (Gibco), detached from the culture bottle, centrifuged 400 x g for 5 min followed by removal of supernatant. The pellet was suspended into residual supernatant. Diluent was added on cells followed by addition of PKH67 at concentration of 4 lM. This was incubated for 5 min in RT and mixed once during this time. Equal amount of hASC medium was added to the tube and centrifuged 400 gfor 10 min. Washing was performed two times in a fresh tube using hASC medium. This stained cell suspension was then frozen and thawed for four times. The breakdown of cells was confirmed by microscopy. Cell debris was stored at -20 °C until used. Stained cell debris was added on macrophages and the engulfment of these particles was visualized and recorded for 5 h using automated imaging system, Cell-IQ (Chipman technologies). Hematoxylin–eosin staining of macrophages Hematoxylin–eosin staining was performed by pipetting cell suspension containing macrophages on a microscopy glass and embedding them with TissueTek Ò O.C.T. Compound (Miles inc. Elkhart, IN, USA). Absolut alcohol, 94% ethanol, 70% ethanol and distilled water were added on the glass in sequence each for 1 min. Mayer hematoxylin was added for 10 min and this was rinsed with water and then with distilled water. 1% Eosin was added for 2 min followed by 96% ethanol, absolute ethanol and xylene. Cells were imaged with Nikon Eclipse TS100 inverted fluorescence microscope (Nikon, Tokyo, Japan) and Nikon digital sight DS-U2 –camera (Nikon). In vitro cell models developed in the study Adipocyte–macrophage Model The development of adipose tissue depicting cell models was started by combining the macrophages and hASC i.e. creating Adipocyte–Macrophage model (AMM). In this model adipogenesis was induced with 123 Cytotechnology ATE and the angiogenesis induction medium (serum free medium, SFM, Table 1) was utilized to obtain more mature adipocytes as published earlier (Huttala et al. 2018). SFM was also used to confirm that it is suitable medium for sustaining macrophages. No cytokines were added except those found in ATE. hASC were plated on 48 well plate at density of 20,000 cells/cm 2 in hASC medium (Table 1). Detachment of hASC was done by Tryple Express (Gibco). Monocytes isolated from blood were seeded on top of hASC at density of 7500 cells/cm 2 in the Monocyte medium (Table 1). One day after the plating, the medium was changed to ATE medium (Table 1). On day 4, medium was changed to SFM (Table 1) which was replenished every third day. Analysis were performed on day 13. To analyze the triglyceride accumulation Adipored (Lonza) reagent was utilized and for viability measurements, WST-1 (Roche, Basel, Switzerland) reagent was utilized. Control (AMM without macrophages) was cultured in exactly same manner as AMM but lacked the macrophages. The medium compositions and protocol summary can be seen in Table 1and 2, respectively. Adipocyte–macrophage model with IFNc and vascularized adipose tissue model with macrophages with IFNc We further optimized the AMM to allow studies of effects of cytokines. The optimization was done keeping in mind the addition of endothelial cells in the later stage. Hence the protocol was developed so that this protocol would also allow the addition of endothelial cells without changes to the protocol. IFNc was utilized as example cytokine. The following protocol was developed to construct Adipocyte–Macrophage model with IFNc(AMMI). On day 0, hASC plated on 48 well plate at density of 20,000 cells/cm 2 in hASC medium (Table 1). On day 1, the medium was changed to ATE medium. ATE has been previously shown to induce natural adipogenesis (Sarkanen et al. 2012a). On day 8, the medium was changed to serum free medium (Table 1). On day 11, the medium was replenished, and macrophages were added at a density of 34,000 cells/cm 2 in serum free medium. ATE was added in the wells in final protein concentration of 387.1 lg/ml. On day 12, 20 ng/ml of IFNc(R&D Systems) was added in wells and on day 13, IFNcwas added to concentration of 60 ng/ml. On day 21, the whole medium from the wells was collected, frozen and stored in -80 °C until analysis by ELISA. To analyze the triglyceride accumulation Adipored (Lonza) reagent was utilized. Control was cultured in exactly same manner as the AMMI except lacked macrophages. The media used and protocol outlines can be seen in Tables 1and 3, respectively. To analyze the cytokine content of the medium samples collected from AMMI, Human obesity ELISA Strips (Signosis, Silicon valley, CA, USA) containing TNFa, insulin-like growth factor 1 (IGF), resistin, interleukin 6 (IL-6), plasminogen activator inhibitor 1 (PAI), transforming growth factor b (TGFb), adiponectin and leptin were used according to manufacturer’s instructions. Standards, controls and samples were incubated on the plate for 1 h at RT with shaking. After washes, the biotin-labelled antibody mixture was incubated for 1 h at RT with shaking followed by washing steps. Streptavidin-HRP conjugate was added and incubated for 45 min at RT with shaking. After washes, substrate was added and incubated for 20 min at which point the stop solution was added. The optical density was measured at 450 nm with plate reader Varioskan Flash (Thermo Scientific). To construct the Vascularized Adipose Tissue model with Macrophages with IFNc(VATMI) similar protocol to AMMI was developed, except for the additions. On day 7, HUVEC were plated in EGM-2 medium (Lonza) at density of 4000 cells/cm 2 . The cells were added into the medium in which hASC had grown for the week. Control samples were cultured in Table 2 Construction of the Adipocyte–Macrophage model (AMM) and its control Model/control Day 0 Days 1 Day4 Day 7 Day 9 Day 13 AMM without macrophages Plating of hASC ATE medium SFM SFM SFM Analysis AMM Plating of hASC and monocytes ATE medium SFM SFM SFM 123 Cytotechnology the same manner as VATMI, except the macrophages were not added into the control wells. The media used and protocol outlines can be seen in Tables 1and 3, respectively. To analyze the cytokine content of the medium samples collected from VATMI, Human inflammation ELISA strips (Signosis) containing TNFa, granulocyte-colony stimulating factor (GCSF), granulocyte-macrophage colony-stimulating factor (GM-CSF), interleukin 1a (IL-1a) and 8 (IL8), interferon gamma-induced protein 10 (IP-10 also known as CXCL10) and rantes were used according to manufacturer’s instructions and as described above. Analysis of models Viability and triglyceride accumulation The relative number of living cells was analyzed by WST-1 (Roche) with 1-h incubation. Absorbance was measured at 450 nm with Varioskan flash multimode reader (Thermo Fischer Scientific). Triglyceride accumulation to the cell cultures was measured with Adipored assay reagent (Lonza) with 10 min incubation at RT after the WST-1 analysis. Fluorescence was measured with Varioskan flash multimode reader (Thermo Fischer Scientific), with excitation at 485 nm and emission at 572 nm. The Adipored values were normalized with WST-1 values to obtain relative amount of triglycerides per cell. Immunocytochemical staining To visualize the vascular-like network formation and macrophages in the co-culture immunocytochemical stainings were performed. The immunocytochemical staining was performed as described earlier (Huttala et al. 2015) except for the fixative used here was 4% paraformalaldehyde at RT for 20 min. After fixation, the cells were permeabilized with 0.5% Triton-X100 (MP Biochemicals, Ohio, USA) and non-specific binding sites were blocked with 10% BSA (Roche). Primary antibody dilution in 1% BSA in PBS was applied on the cells. Primary antibodies were aAntivon Willebrant factor IgG (produced in rabbit, Sigma), CD11b and CD68 (both from BD). Secondary antibodies were also applied in 1% BSA in PBS solution. Secondary antibodies used were TRITC-labeled goat polyclonal antibody anti-rabbit IgG (Sigma), FITClabeled goat polyclonal antibody anti-mouse IgG (Sigma), DAB Peroxidase (HRP) Substrate Kit, (Vector labs) and V450 (BD). After immunocytochemical staining the vascular-like network was photographed with Nikon Eclipse TS100 inverted fluorescence microscope (Nikon) and Nikon digital sight DS-U2 –camera (Nikon). Images were further processed with NIS Elements (Nikon) and Adobe Photoshop CS3-software (Adobe Systems Incorporated, San Jose, CA, United States). Table 3 Construction of the Adipocyte–Macrophage model with IFNc(AMMI) and vascularized adipose tissue model with IFNc (VATMI). SFM = serum free medium Model Day 0 Days 1–7 Day 7 Days 8–10 Day 11 Day 12 Day 13 Day 21 AMMI Plating of hASC ATE medium SFM Plating of macrophages, SFM supplemented with ATE 20 ng/ml of IFNc Addition of 60 ng/ml IFNc Analysis AMMI without macrophages Plating of hASC ATE medium SFM SFM with ATE 20 ng/ml of IFNc Addition of 60 ng/ml IFNc VATMI Plating of hASC ATE medium Plating of HUVEC SFM Plating of macrophages, SFM supplemented with ATE 20 ng/ml of IFNc Addition of 60 ng/ml IFNc VATMI without macrophages Plating of hASC Plating of HUVEC SFM SFM supplemented with ATE 20 ng/ml of IFNc Addition of 60 ng/ml IFNc 123 Cytotechnology Statistical analysis All results were plotted and statistical analyzes were performed with GraphPadPrism (GraphPad Software Inc., California, USA). Results are depicted as mean ±standard deviation. Triglyceride accumulation comparisons (n = 6 in all) analyzed with Mann– Whitney test. For ELISA (n = 2) comparisons were performed with Two-way ANOVA with Sidak’s multiple comparisons test. Differences were considered significant when *p \0.05, **p \0.01 and ***p \0.001. Results Isolated cells are functional As one of the goals was to be able to construct the model from one lipid sample, we tested the isolation methods for isolation of macrophages and endothelial from adipose tissue. When one patient model is not needed, the monocytes are isolated from blood and differentiated to macrophages. Also, endothelial cells are routinely obtained from umbilical cord (HUVEC). Macrophages and endothelial cells from all sources were tested for their correct phenotype and functional features. The isolated monocytes, which were differentiated towards macrophages, engulfed the cell debris they were given (Fig. 1). The uptake of LDL was also seen in both macrophages and endothelial cells which shows they are functioning normally. In addition, the staining of the macrophages proved them positive for CD11b and CD68 (Fig. 1). Presence of macrophages affects the lipid accumulation in adipocytes The development of adipose tissue depicting cell models was started by combining the macrophages and hASC i.e. creating Adipocyte–Macrophage model (AMM). In this model adipogenesis was induced with ATE, a natural adipogenesis inducer. The impact of macrophages on lipid accumulation was studied in AMM by comparing it with AMM without macrophages. Figure 2a shows the morphology of the cell models. The interaction of adipocytes and macrophages leads to larger lipid vesicles in adipocytes (Fig. 2a). This difference was also seen in the analysis of amount of triglycerides per cell (cell number was relative total cell number of the model determined by WST-1) however, the difference was not significant (Fig. 2b). The larger lipid vesicles in adipocytes could indicate more mature state i.e. further and better differentiation, of the adipocytes in presence of macrophages. Adipocyte–Macrophage model with IFNc The Adipocyte–Macrophage model was further optimized to allow studies of cell–cell interactions together with studies of the effect of IFNc(now called AMMI). This modification also allows other cytokines to be studied in the future. In this co-culture setting, the differentiation of hASC to adipocytes was studied by analyzing the lipid accumulation with or without the presence of macrophages. Macrophages attached on top of the hASC, which were differentiated into adipocytes (Fig. 3a). The immunostaining image (Fig. 3b) shows macrophage stained with CD11b in red and triglycerides inside the adipocytes in green (stained with AdipoRed). The triglyceride accumulation in adipocytes was significantly increased in the presence of macrophages and IFNc(Fig. 3b). IFNc has not changed the total body weight in animal studies to (Rocha et al. 2008) which could indicate the role of macrophages in increasing the lipid accumulation in presence of IFNc. Secretion of proteins in AMMI was analyzed from the medium samples collected on day 21 of the culture (Fig. 4). Studied proteins were TNFa, IGF, resistin, IL-6, PAI, TGFb, adiponectin and leptin as these are proteins found in adipose tissue and they are secreted mainly from adipocytes and immune cells (Makki et al. 2013). Addition of macrophages increased the secretion of adiponectin significantly. This was surprising as adiponectin favors insulin-sensitivity and IFNcknockout rather than presence of IFNchas been linked to modest improvements in insulin sensitivity and decreased adipocyte size (O’Rourke et al. 2012). Secretion of adipocyte and obesity related proteins IGF, PAI, and Leptin were increased in AMMI compared to AMMI without macrophages. Resistin secretion seemed to increase but due to the high variation of control treatment, this cannot be confirmed. Production of pro-inflammatory cytokines TNFaand IL-6 was also increased in AMMI. TGFb 123 Cytotechnology macrophages seems to be affecting the lipid accumulation characteristics of adipocytes, it should be studied further. The presence of vascularization seemed to attenuate the changes in protein secretions. This could lead to more relevant intervention methods for the obesity related diseases related to inflammation and vascular changes. The in vitro model presented here is especially relevant for the personalized medicine approaches. Personalized in vitro models enable studies of individual disease variants. Hence, the in vitro models utilizing one patient material would be especially important for disease studies in the rare disease types. Further efforts are still needed to fully utilize these new research tools in research as well as in drug development and diagnostic applications. Acknowledgements We thank the patients and treating staff of Tampere university hospital for donating the tissue samples. We also like to acknowledge SPR for providing the blood samples and for the help with the cell isolation methods related to those samples. We like to acknowledge Ms. Sari Leinonen, Ms. Tuula Ja ¨rvinen, Ms. Mirja Hyppo ¨nen, Ms. Hilkka Ma ¨kinen, Ms. Paula Helpio ¨la ¨and Ms. Maaret Vaani for the excellent and pedant technical assistance they provided. We would like to express our gratitude to The Diabetes Research Foundation for providing funding for this research. Compliance with ethical standards Conflicts of Interest TY and JR.S. have ATE patent issued in USA (US9056084B2) and Brazil (BRPI0918851A2), pending elsewhere (WO2010026299A1). Other authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. References Andreesen R, Picht J, Lohr GW (1983) Primary cultures of human blood-born macrophages grown on hydrophobic teflon membranes. J Immunol Methods 56:295–304 Bodnar RJ, Yates CC, Wells A (2006) IP-10 blocks vascular endothelial growth factor-induced endothelial cell motility and tube formation via inhibition of calpain. Circ Res 98:617–625 Chawla A, Nguyen KD, Goh YP (2011) Macrophage-mediated inflammation in metabolic disease. Nat Rev Immunol 11:738–749 Codoner-Franch P, Valls-Belles V, Arilla-Codoner A, AlonsoIglesias E (2011) Oxidant mechanisms in childhood obesity: the link between inflammation and oxidative stress. Transl Res 158:369–384 Coelho M, Oliveira T, Fernandes R (2013) Biochemistry of adipose tissue: an endocrine organ. Arch Med Sci 9:191–200 Dandona P, Weinstock R, Thusu K, Abdel-Rahman E, Aljada A, Wadden T (1998) Tumor necrosis factor-alpha in sera of obese patients: fall with weight loss. J Clin Endocrinol Metab 83:2907–2910 DeFronzo RA (2004) Dysfunctional fat cells, lipotoxicity and type 2 diabetes. Int J Clin Pract Suppl 143:9–21 Dominici M, Le Blanc K, Mueller I, Slaper-Cortenbach I, Marini F, Krause D, Deans R, Keating A, Prockop D, Horwitz E (2006) Minimal criteria for defining multipotent mesenchymal stromal cells. The International Society for Cellular Therapy position statement. Cytotherapy 8:315–317 Eljaafari A, Robert M, Chehimi M, Chanon S, Durand C, Vial G, Bendridi N, Madec AM, Disse E, Laville M, Rieusset J, Lefai E, Vidal H, Pirola L (2015) Adipose tissue-derived stem cells from obese subjects contribute to inflammation and reduced insulin response in adipocytes through differential regulation of the Th1/Th17 balance and monocyte activation. Diabetes 64:2477–2488 European Commission (2010) Sixth Report from the Commission to the Council and the European Parliament on the Statistics on the Number of Animals Used for Experimental and Other Scientific Purposes in the Member States of the European Union COM2010 Gil A, Maria Aguilera C, Gil-Campos M, Canete R (2007) Altered signalling and gene expression associated with the immune system and the inflammatory response in obesity. Br J Nutr 98(Suppl 1):S121–S126 Gordon S, Taylor PR (2005) Monocyte and macrophage heterogeneity. Nat Rev Immunol 5:953–964 Hackam DG, Redelmeier DA (2006) Translation of research evidence from animals to humans. JAMA 296:1731–1732 Haczeyni F, Bell-Anderson KS, Farrell GC (2018) Causes and mechanisms of adipocyte enlargement and adipose expansion. Obes Rev 19:406–420 Halaas JL, Gajiwala KS, Maffei M, Cohen SL, Chait BT, Rabinowitz D, Lallone RL, Burley SK, Friedman JM (1995) Weight-reducing effects of the plasma protein encoded by the obese gene. Science 269:543–546 Harms MJ, Li Q, Lee S, Zhang C, Kull B, Hallen S, Thorell A, Alexandersson I, Hagberg CE, Peng XR, Mardinoglu A, 123 Cytotechnology Spalding KL, Boucher J (2019) Mature human white adipocytes cultured under membranes maintain identity, function, and can transdifferentiate into brown-like Adipocytes. Cell Rep 27:213–225 Hotamisligil GS, Shargill NS, Spiegelman BM (1993) Adipose expression of tumor necrosis factor-alpha: direct role in obesity-linked insulin resistance. Science 259:87–91 Hotamisligil GS, Johnson RS, Distel RJ, Ellis R, Papaioannou VE, Spiegelman BM (1996) Uncoupling of obesity from insulin resistance through a targeted mutation in aP2, the adipocyte fatty acid binding protein. Science 274:1377–1379 Huttala O, Vuorenpaa H, Toimela T, Uotila J, Kuokkanen H, Ylikomi T, Sarkanen JR, Heinonen T (2015) Human vascular model with defined stimulation medium—a characterization study. Altex 32:125–136 Huttala O, Mysore R, Sarkanen JR, Heinonen T, Olkkonen VM, Ylikomi T (2016) Differentiation of human adipose stromal cells in vitro into insulin-sensitive adipocytes. Cell Tissue Res 366:63–74 Huttala O, Palmroth M, Hemminki P, Toimela T, Heinonen T, Ylikomi T, Sarkanen JR (2018) Development of Versatile Human In Vitro Vascularized Adipose Tissue Model with Serum-Free Angiogenesis and Natural Adipogenesis Induction. Basic Clin Pharmacol Toxicol 123:62–71 Imai T, Takakuwa R, Marchand S, Dentz E, Bornert JM, Messaddeq N, Wendling O, Mark M, Desvergne B, Wahli W, Chambon P, Metzger D (2004) Peroxisome proliferatoractivated receptor gamma is required in mature white and brown adipocytes for their survival in the mouse. Proc Natl Acad Sci USA 101:4543–4547 Kang JH, Gimble JM, Kaplan DL (2009) In vitro 3D model for human vascularized adipose tissue. Tissue Eng Part A 15:2227–2236 Kanneganti TD, Dixit VD (2012) Immunological complications of obesity. Nat Immunol 13:707–712 Kawai T, Seki M, Hiromatsu K, Eastcott JW, Watts GF, Sugai M, Smith DJ, Porcelli SA, Taubman MA (1999) Selective diapedesis of Th1 cells induced by endothelial cell RANTES. J Immunol 163:3269–3278 Kongsuphol P, Gupta S, Liu Y, Bhuvanendran Nair Gourikutty S, Biswas SK, Ramadan Q (2019) In vitro micro-physiological model of the inflamed human adipose tissue for immune-metabolic analysis in type II diabetes. Sci Rep 9:4887019 Li A, Dubey S, Varney ML, Dave BJ, Singh RK (2003) IL-8 directly enhanced endothelial cell survival, proliferation, and matrix metalloproteinases production and regulated angiogenesis. J Immunol 170:3369–3376 Liu P, Kong F, Wang J, Lu Q, Xu H, Qi T, Meng J (2015) Involvement of IGF-1 and MEOX2 in PI3K/Akt1/2 and ERK1/2 pathways mediated proliferation and differentiation of perivascular adipocytes. Exp Cell Res 331:82–96 Liu Y, Kongsuphol P, Chiam SY, Zhang QX, Gourikutty SBN, Saha S, Biswas SK, Ramadan Q (2019) Adipose-on-a-chip: a dynamic microphysiological in vitro model of the human adipose for immune-metabolic analysis in type II diabetes. Lab Chip 19:241–253 Lopez J, Huttala O, Sarkanen JR, Kaartinen I, Kuokkanen H, Ylikomi T (2016) Cytokine-rich adipose tissue extract production from water-assisted lipoaspirate: methodology for clinical use. Bioresour Open Access 5:269–278 Lopez JF, Sarkanen JR, Huttala O, Kaartinen IS, Kuokkanen HO, Ylikomi T (2018) Adipose tissue extract shows potential for wound healing: in vitro proliferation and migration of cell types contributing to wound healing in the presence of adipose tissue preparation and platelet rich plasma. Cytotechnology 70:1193–1204 Louis F, Kitano S, Mano JF, Matsusaki M (2019) 3D collagen microfibers stimulate the functionality of preadipocytes and maintain the phenotype of mature adipocytes for long term cultures. Acta Biomater 84:194–207 Lumeng CN, Deyoung SM, Saltiel AR (2007) Macrophages block insulin action in adipocytes by altering expression of signaling and glucose transport proteins. Am J Physiol Endocrinol Metab 292:E166–E174 Maeda N, Shimomura I, Kishida K, Nishizawa H, Matsuda M, Nagaretani H, Furuyama N, Kondo H, Takahashi M, Arita Y, Komuro R, Ouchi N, Kihara S, Tochino Y, Okutomi K, Horie M, Takeda S, Aoyama T, Funahashi T, Matsuzawa Y (2002) Diet-induced insulin resistance in mice lacking adiponectin/ACRP30. Nat Med 8:731–737 Makki K, Froguel P, Wolowczuk I (2013) Adipose tissue in obesity-related inflammation and insulin resistance: cells, cytokines, and chemokines. ISRN Inflamm 2013:139239 Marcu R, Choi YJ, Xue J, Fortin CL, Wang Y, Nagao RJ, Xu J, MacDonald JW, Bammler TK, Murry CE, Muczynski K, Stevens KR, Himmelfarb J, Schwartz SM, Zheng Y (2018) Human organ-specific endothelial cell heterogeneity. iScience 4:20–35 Mariotti M, Castiglioni S, Bernardini D, Maier JA (2006) Interleukin 1 alpha is a marker of endothelial cellular senescent. Immun Ageing 3:4 Matulewicz N, Stefanowicz M, Nikolajuk A, KarczewskaKupczewska M (2017) Markers of adipogenesis, but not inflammation, in adipose tissue are independently related to insulin sensitivity. J Clin Endocrinol Metab 102:3040–3049 Maury E, Noel L, Detry R, Brichard SM (2009) In vitro hyperresponsiveness to tumor necrosis factor-alpha contributes to adipokine dysregulation in omental adipocytes of obese subjects. J Clin Endocrinol Metab 94:1393–1400 Merfeld-Clauss S, Gollahalli N, March KL, Traktuev DO (2010) Adipose tissue progenitor cells directly interact with endothelial cells to induce vascular network formation. Tissue Eng Part A 16:2953–2966 Mitka M (2011) Drug for severe sepsis is withdrawn from market, fails to reduce mortality. JAMA 306:2439–2440 Murano I, Barbatelli G, Parisani V, Latini C, Muzzonigro G, Castellucci M, Cinti S (2008) Dead adipocytes, detected as crown-like structures, are prevalent in visceral fat depots of genetically obese mice. J Lipid Res 49:1562–1568 Murray PJ, Wynn TA (2011) Protective and pathogenic functions of macrophage subsets. Nat Rev Immunol 11:723–737 Musson RA (1983) Human serum induces maturation of human monocytes in vitro. Changes in cytolytic activity, intracellular lysosomal enzymes, and nonspecific esterase activity. Am J Pathol 111:331–340 Nakao-Hayashi J, Ito H, Kanayasu T, Morita I, Murota S (1992) Stimulatory effects of insulin and insulin-like growth 123 Cytotechnology factor I on migration and tube formation by vascular endothelial cells. Atherosclerosis 92:141–149 Nosalski R, Guzik TJ (2017) Perivascular adipose tissue inflammation in vascular disease. Br J Pharmacol 174:3496–3513 Ojansivu M, Vanhatupa S, Bjorkvik L, Hakkanen H, Kellomaki M, Autio R, Ihalainen JA, Hupa L, Miettinen S (2015) Bioactive glass ions as strong enhancers of osteogenic differentiation in human adipose stem cells. Acta Biomater 21:190–203 Okuno Y, Fukuhara A, Hashimoto E, Kobayashi H, Kobayashi S, Otsuki M, Shimomura I (2018) Oxidative stress inhibits healthy adipose expansion through suppression of SREBF1-mediated lipogenic pathway. Diabetes 67:1113–1127 O’Rourke RW, White AE, Metcalf MD, Winters BR, Diggs BS, Zhu X, Marks DL (2012) Systemic inflammation and insulin sensitivity in obese IFN-gamma knockout mice. Metabolism 61:1152–1161 Ota T (2013) CCR5: a novel player in the adipose tissue inflammation and insulin resistance? Adipocyte 2:99–103 Patrikoski M, Juntunen M, Boucher S, Campbell A, Vemuri MC, Mannerstrom B, Miettinen S (2013) Development of fully defined xeno-free culture system for the preparation and propagation of cell therapy-compliant human adipose stem cells. Stem Cell Res Ther 4:27 Patti ME, Corvera S (2010) The role of mitochondria in the pathogenesis of type 2 diabetes. Endocr Rev 31:364–395 Pradhan AD, Manson JE, Rifai N, Buring JE, Ridker PM (2001) C-reactive protein, interleukin 6, and risk of developing type 2 diabetes mellitus. JAMA 286:327–334 Ralph P, Harris PE, Punjabi CJ, Welte K, Litcofsky PB, Ho MK, Rubin BY, Moore MA, Springer TA (1983) Lymphokine inducing ‘‘terminal differentiation’’ of the human monoblast leukemia line U937: a role for gamma interferon. Blood 62:1169–1175 Ridker PM, Rifai N, Stampfer MJ, Hennekens CH (2000) Plasma concentration of interleukin-6 and the risk of future myocardial infarction among apparently healthy men. Circulation 101:1767–1772 Robciuc MR, Kivela R, Williams IM, de Boer JF, van Dijk TH, Elamaa H, Tigistu-Sahle F, Molotkov D, Leppanen VM, Kakela R, Eklund L, Wasserman DH, Groen AK, Alitalo K (2016) VEGFB/VEGFR1-induced expansion of adipose vasculature counteracts obesity and related metabolic complications. Cell Metab 23:712–724 Rocha VZ, Folco EJ, Sukhova G, Shimizu K, Gotsman I, Vernon AH, Libby P (2008) Interferon-gamma, a Th1 cytokine, regulates fat inflammation: a role for adaptive immunity in obesity. Circ Res 103:467–476 Rotter V, Nagaev I, Smith U (2003) Interleukin-6 (IL-6) induces insulin resistance in 3T3-L1 adipocytes and is, like IL-8 and tumor necrosis factor-alpha, overexpressed in human fat cells from insulin-resistant subjects. J Biol Chem 278:45777–45784 Ruiz-Ojeda FJ, Ruperez AI, Gomez-Llorente C, Gil A, Aguilera CM (2016) Cell models and their application for studying adipogenic differentiation in relation to obesity: a review. Int J Mol Sci 17:1040 Sarkanen JR, Vuorenpaa H, Huttala O, Mannerstrom B, Kuokkanen H, Miettinen S, Heinonen T, Ylikomi T (2012a) Adipose stromal cell tubule network model provides a versatile tool for vascular research and tissue engineering. Cells Tissues Organs 196:385–397 Sarkanen JR, Kaila V, Mannerstrom B, Raty S, Kuokkanen H, Miettinen S, Ylikomi T (2012b) Human adipose tissue extract induces angiogenesis and adipogenesis in vitro. Tissue Eng Part A 18:17–25 Seok J, Warren HS, Cuenca AG, Mindrinos MN, Baker HV, Xu W, Richards DR, McDonald-Smith GP, Gao H, Hennessy L, Finnerty CC, Lopez CM, Honari S, Moore EE, Minei JP, Cuschieri J, Bankey PE, Johnson JL, Sperry J, Nathens AB, Billiar TR, West MA, Jeschke MG, Klein MB, Gamelli RL, Gibran NS, Brownstein BH, Miller-Graziano C, Calvano SE, Mason PH, Cobb JP, Rahme LG, Lowry SF, Maier RV, Moldawer LL, Herndon DN, Davis RW, Xiao W, Tompkins RG, Inflammation and Host Response to Injury, Large Scale Collaborative Research Program (2013) Genomic responses in mouse models poorly mimic human inflammatory diseases. Proc Natl Acad Sci USA 110:3507–3512 Sheu WH, Ou HC, Chou FP, Lin TM, Yang CH (2006) Rosiglitazone inhibits endothelial proliferation and angiogenesis. Life Sci 78:1520–1528 Shigematsu S, Yamauchi K, Nakajima K, Iijima S, Aizawa T, Hashizume K (1999) IGF-1 regulates migration and angiogenesis of human endothelial cells. Endocr J 46(Suppl):S59–S62 Shulman GI (2000) Cellular mechanisms of insulin resistance. J Clin Invest 106:171–176 Singh NK, Gupta A, Behera DR, Dash D (2013) Elevated plasminogen activator inhibitor type-1 (PAI-1) as contributing factor in pathogenesis of hypercoagulable state in antiphospholipid syndrome. Rheumatol Int 33:2331–2336 Steppan CM, Bailey ST, Bhat S, Brown EJ, Banerjee RR, Wright CM, Patel HR, Ahima RS, Lazar MA (2001) The hormone resistin links obesity to diabetes. Nature 409:307–312 Switzer NJ, Mangat HS, Karmali S (2013) Current trends in obesity: body composition assessment, weight regulation, and emerging techniques in managing severe obesity. J Interv Gastroenterol 3:34–36 Thomas D, Apovian C (2017) Macrophage functions in lean and obese adipose tissue. Metabolism 72:120-143 Torres-Leal FL, Fonseca-Alaniz MH, de Oliveira AC, AlonsoVale MIC (2012) Adipose Tissue Inflammation and Insulin Resistance. InTech Open:137-156 US Department of Health and Human Services Food and Drug Administration, Center for Drug Evaluation and Research Guidance for Industry (2006) Nonclinical Safety Evaluation of Drug or Biologic Combinations Uysal KT, Wiesbrock SM, Marino MW, Hotamisligil GS (1997) Protection from obesity-induced insulin resistance in mice lacking TNF-alpha function. Nature 389:610–614 van Baak MA (2013) Nutrition as a link between obesity and cardiovascular disease: how can we stop the obesity epidemic? Thromb Haemost 110:689–696 van der Worp HB, Howells DW, Sena ES, Porritt MJ, Rewell S, O’Collins V, Macleod MR (2010) Can animal models of disease reliably inform human studies? PLoS Med 7:e1000245 123 Cytotechnology Volz AC, Hack L, Atzinger FB, Kluger PJ (2018) Completely defined co-culture of adipogenic differentiated ASCs and microvascular endothelial cells. Altex 35:464–476 Volz AC, Omengo B, Gehrke S, Kluger PJ (2019) Comparing the use of differentiated adipose-derived stem cells and mature adipocytes to model adipose tissue in vitro. Differentiation 110:19–28 Vuornos K, Bjorninen M, Talvitie E, Paakinaho K, Kellomaki M, Huhtala H, Miettinen S, Seppanen-Kaijansinkko R, Haimi S (2016) Human Adipose Stem Cells Differentiated on Braided Polylactide Scaffolds Is a Potential Approach for Tendon Tissue Engineering. Tissue Eng Part A 22:513–523 Wagoner B, Hausman DB, Harris RB (2006) Direct and indirect effects of leptin on preadipocyte proliferation and differentiation. Am J Physiol Regul Integr Comp Physiol 290:R1557–R1564 Weisberg SP, McCann D, Desai M, Rosenbaum M, Leibel RL, Ferrante AW Jr (2003) Obesity is associated with macrophage accumulation in adipose tissue. J Clin Invest 112:1796–1808 Woodcock J, Woosley R (2008) The FDA critical path initiative and its influence on new drug development. Annu Rev Med 59:1–12 Yamauchi T, Kamon J, Waki H, Terauchi Y, Kubota N, Hara K, Mori Y, Ide T, Murakami K, Tsuboyama-Kasaoka N, Ezaki O, Akanuma Y, Gavrilova O, Vinson C, Reitman ML, Kagechika H, Shudo K, Yoda M, Nakano Y, Tobe K, Nagai R, Kimura S, Tomita M, Froguel P, Kadowaki T (2001) The fat-derived hormone adiponectin reverses insulin resistance associated with both lipoatrophy and obesity. Nat Med 7:941–946 Ye J (2008) Regulation of PPARgamma function by TNF-alpha. Biochem Biophys Res Commun 374:405–408 Ye J, Gimble JM (2011) Regulation of stem cell differentiation in adipose tissue by chronic inflammation. Clin Exp Pharmacol Physiol 38:872–878 Zhang B, Berger J, Zhou G, Elbrecht A, Biswas S, White-Carrington S, Szalkowski D, Moller DE (1996) Insulinand mitogen-activated protein kinase-mediated phosphorylation and activation of peroxisome proliferator-activated receptor gamma. 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