The Adipovascular Unit in Lipedema: A Framework for Regional Adipose Tissue Dysregulation.
4 affiliations
- 1Clinic for Dermatology, Venerology, and Allergology, University Medical Center Mannheim, Ruprecht-Karls-University Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
- 2Laser and Skin Surgery Center of Indiana, Indianapolis, IN 46260, USA.
- 3Lipedema Center Linz, Starhembergstrasse 12/3, 4020 Linz, Austria.
- 4Lipedema Center Vienna, Schönbrunnerstrasse 153/6/21, 1120 Vienna, Austria.
Abstract
Lipedema is a chronic, predominantly female disorder characterized by disproportionate regional expansion of subcutaneous adipose tissue, pain, tenderness, and easy bruising. Reported abnormalities involve adipocytes, stromal/progenitor cells, microvascular and immune compartments, extracellular matrix (ECM), and, variably, lymphatic function, but their causal and temporal relationships remain unresolved. Here, we propose the adipovascular unit (AVU) as a systems-level framework that links these compartments within a spatially organized regenerative niche. The conceptual advance is not the identification of a new anatomical structure, but the prediction that regional disease expression depends on reciprocal interactions among adipose stem and progenitor cells (ASPCs), endothelial and mural cells, immune populations, ECM, and mature adipocytes, rather than on a universal defect in any single cell type. We hypothesize that physiological female reproductive signals may expose a regionally susceptible AVU in which regenerative responses are inadequately constrained in space, magnitude, or duration. This framework also distinguishes lipedema from obesity-associated adipose dysfunction: lipedema is regionally patterned and may coexist with relatively preserved systemic metabolic function, whereas obesity-related adipose dysfunction is more closely linked to whole-body energy excess, ectopic fat, insulin resistance and cardiometabolic risk. Evidence demonstrated directly in lipedema is separated throughout from general adipose-tissue biology used to establish plausibility and from mechanisms that remain hypothetical. We derive falsifiable predictions involving depot-specific molecular states, endocrine context, multicellular cross-talk, extracellular-vesicle cargo and transfer, spatial biological boundaries, and persistence after stimulus withdrawal. Testing these predictions in paired-depot, spatially resolved and multicellular systems will determine whether AVU dysregulation is a causal organizing principle of lipedema or a descriptive consequence of established disease.
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BibTeX
@article{faulhaber2026adipovascular,
title = {{The Adipovascular Unit in Lipedema: A Framework for Regional Adipose Tissue Dysregulation.}},
author = {Jörg Faulhaber and C William Hanke and Martin Barsch and Matthias Sandhofer},
journal = {Cells},
year = {2026},
month = oct,
doi = {10.3390/cells15191820},
url = {https://europepmc.org/article/MED/42882518},
note = {CC BY},
}
RIS
TY - JOUR
TI - The Adipovascular Unit in Lipedema: A Framework for Regional Adipose Tissue Dysregulation.
AU - Jörg Faulhaber
AU - C William Hanke
AU - Martin Barsch
AU - Matthias Sandhofer
PY - 2026
DA - 2026/10/07
JO - Cells
DO - 10.3390/cells15191820
UR - https://europepmc.org/article/MED/42882518
AB - Lipedema is a chronic, predominantly female disorder characterized by disproportionate regional expansion of subcutaneous adipose tissue, pain, tenderness, and easy bruising. Reported abnormalities involve adipocytes, stromal/progenitor cells, microvascular and immune compartments, extracellular matrix (ECM), and, variably, lymphatic function, but their causal and temporal relationships remain unresolved. Here, we propose the adipovascular unit (AVU) as a systems-level framework that links these compartments within a spatially organized regenerative niche. The conceptual advance is not the identification of a new anatomical structure, but the prediction that regional disease expression depends on reciprocal interactions among adipose stem and progenitor cells (ASPCs), endothelial and mural cells, immune populations, ECM, and mature adipocytes, rather than on a universal defect in any single cell type. We hypothesize that physiological female reproductive signals may expose a regionally susceptible AVU in which regenerative responses are inadequately constrained in space, magnitude, or duration. This framework also distinguishes lipedema from obesity-associated adipose dysfunction: lipedema is regionally patterned and may coexist with relatively preserved systemic metabolic function, whereas obesity-related adipose dysfunction is more closely linked to whole-body energy excess, ectopic fat, insulin resistance and cardiometabolic risk. Evidence demonstrated directly in lipedema is separated throughout from general adipose-tissue biology used to establish plausibility and from mechanisms that remain hypothetical. We derive falsifiable predictions involving depot-specific molecular states, endocrine context, multicellular cross-talk, extracellular-vesicle cargo and transfer, spatial biological boundaries, and persistence after stimulus withdrawal. Testing these predictions in paired-depot, spatially resolved and multicellular systems will determine whether AVU dysregulation is a causal organizing principle of lipedema or a descriptive consequence of established disease.
SN - 2073-4409
ER -