Investigating the Influence of Tranexamic Acid on Adipocyte Differentiation in an In Vitro Model.

[BACKGROUND] Tranexamic acid (TXA) is widely used in plastic surgery to reduce perioperative blood loss, hematoma formation, and postoperative ecchymosis. Its incorporation into tumescent solution for liposuction and fat grafting has increased; however, the effects of TXA on adipose tissue biology and progenitor cell function remain incompletely understood.

[METHODS] Human subcutaneous adipose tissue explants were cultured in a 3-dimensional system with vehicle control (0), 5, 10, 100, and 1000μg/mL TXA. Capillary sprouting was assessed from days 4 to 11. After 14 days, human adipose capillary-associated progenitor cells (HACAPs) were isolated from explants and expanded in 2-dimensional culture under identical TXA conditions. An independent HACAP line derived from panniculectomy tissue was evaluated in parallel. Cell proliferation was assessed over 2 to 3 expansion cycles. Adipogenic differentiation was induced using standard differentiation media and evaluated by lipid accumulation and RT-qPCR for adipogenic markers (AdipoQ, PLIN1, FABP4). Thermogenic responsiveness was assessed after forskolin stimulation by measuring expression of UCP1, LINC473, and DIO2.

[RESULTS] Increasing TXA concentrations were associated with a transient attenuation of early capillary sprouting at early time points (≤4d); this effect resolved by day 5, with no sustained differences in sprouting thereafter. HACAP yield, proliferation rates, and cellular morphology were comparable across all treatment groups. Adipogenic differentiation, as assessed by lipid droplet formation and expression of adipogenic genes, did not differ between TXA-treated and control cells. After thermogenic stimulation, expression of thermogenic markers was similarly unchanged across all conditions.

[CONCLUSIONS] Clinically relevant concentrations of TXA do not impair adipose progenitor cell viability, proliferation, adipogenic differentiation, or thermogenic responsiveness in vitro. These findings support the cellular safety of TXA use in liposuction and fat grafting and provide reassurance as adoption of TXA continues to expand in plastic and reconstructive surgery.