Métodos não invasivos e minimamente invasivos indutores de apoptose adipocitária lipodistrofia localizada: uma revisão de escopo

Abstract

Localized lipodystrophy is characterized by the regional accumulation of subcutaneous adipose tissue and represents one of the main concerns related to body contouring. Several non-invasive and minimally invasive technologies have been used for its reduction and are frequently associated with the induction of adipocyte apoptosis. However, the evidence supporting this mechanism remains heterogeneous. Objective: To map and describe the scientific evidence on non-invasive and minimally invasive interventions investigated for their potential to induce adipocyte apoptosis in the reduction of localized lipodystrophy in adults. Methods: A scoping review was conducted according to the Joanna Briggs Institute (JBI) methodology and reported following the PRISMA-ScR guidelines. Searches were performed in MEDLINE/PubMed, Embase, Scopus, Web of Science Core Collection, Virtual Health Library, and Google Scholar. Studies published from 2015 onward that evaluated non-invasive or minimally invasive methods for reducing localized fat in adults were included. Results: Sixteen studies involving 528 participants were included. Identified interventions comprised cryolipolysis, radiofrequency, ultrasound, high-intensity electromagnetic technologies, combined protocols, and the injectable agent CBL-514. The main clinical outcomes were reductions in fat thickness and abdominal circumference, improved body contour, and high patient satisfaction. Evidence consistent with adipocyte apoptosis was observed in a subset of studies through histological, immunohistochemical, and molecular analyses, including caspases, Bax/Bcl-2 ratio, perilipin, CD68, and TNF-α. However, direct confirmation of apoptosis was inconsistent across the different therapeutic modalities. Conclusion: The evaluated interventions demonstrated favorable clinical outcomes for localized fat reduction and body contour improvement. Nevertheless, the biological evidence supporting adipocyte apoptosis as the primary mechanism of action remains limited and heterogeneous. Future studies using standardized protocols and specific biological markers are needed to better elucidate the underlying mechanisms.