Gelatin Sponge-Embedded Adipose-Derived Stromal Cells Enable Allogeneic Application for Revascularization of Ischemic Wounds

Chronic wounds are ulcers unable to heal due to vascular insufficiency, diabetes, or obesity. Adipose-derived stromal cells (ASCs) are promising candidates for regenerative therapies owing to their pro-healing and angiogenic properties. Compared with autologous approaches, allogeneic ASC therapies offer the opportunity for off-the-shelf use, enabling immediate availability, standardized qualification, and consistent potency. Gelatin sponges have been shown to reprogram ASCs toward a highly angiogenic phenotype. However, because this activation also modulates some immune-related genes, including MHC, its impact on immunogenicity is unknown and could be critical for allogeneic applications. This study evaluated whether ASCs embedded in a gelatin sponge could be used in an allogeneic setting for ischemic wound repair. To mimic clinical allogeneic conditions, a controlled MHC mismatch was introduced in a rat ischemic wound model: donor ASCs carrying RT1^n or RT1^l haplotypes were implanted into outbred RT1^a recipients. Embedding ASCs within the gelatin sponge upregulated MHC class I but not class II expression, without inducing systemic or local alloreactivity. Serum acute-phase proteins remained unchanged, and no CD3+ T-cell infiltration was detected. Histology confirmed efficacy on ischemic wounds, with increased granulation tissue thickness, red blood cell infiltration, and enhanced vessel density versus controls. Allogeneic ASCs activated by a gelatin scaffold promote wound revascularization without eliciting immune rejection, supporting their development as standardized, off-the-shelf therapies for chronic ischemic wounds.