The fascia-adipose Axis: a candidate mechanistic hypothesis for the tissue-level mechanism of acupoint catgut embedding in abdominal obesity

This is the authors' abstract. We don't add key points for this paper.

Abdominal obesity involves a pathological interplay between visceral adipose expansion and fascial structural deterioration. Existing mechanistic accounts of acupoint catgut embedding (ACE) predominantly center on neurohumoral pathways, leaving direct tissue-level effects at the fascia-adipose interface unexplored. We propose the fascia-adipose axis as a candidate mechanistic framework for ACE action in abdominal obesity. We hypothesize that ACE sutures placed at the fascia-adipose interface deliver sustained mechanical stimulation, which activates TRPV4 mechanosensitive channels putatively expressed in fasciacytes—specialized HAS2-expressing fibroblasts of the deep fascia—initiating a Ca 2+ -hyaluronan (CHA) mechanotransduction cascade. This core inference, TRPV4 expression in fasciacytes, remains untested and is explicitly designated as a primary falsifiable prediction. The cascade is proposed to concurrently remodel adipose tissue through AMPK-mTOR-mediated autophagy and AKT-UCP1-mediated browning, while restoring fascial homeostasis through HAS2-dependent hyaluronan synthesis. Four independent lines of indirect evidence support this framework: adipose-specific TRPV4 overexpression studies, the CHA axis in fascia, ACE-induced autophagy in mice, and clinical observations of preferential waist reduction. We critically discuss conflicting findings in existing TRPV4 literature and the current lack of integrated experimental confirmation for this hypothesis. A tiered framework of experimental investigations is outlined, spanning TRPV4 pharmacological perturbation in diet-induced obese mice, HAS2 gene silencing in primary fasciacyte cultures, layer-stratified randomized controlled imaging trials, TGF-β/Smad3 tissue profiling, shear wave elastography biomarker validation, and multi-arm mechanistic trials disentangling acupoint-specific effects from universal fascial mechanical stimulation.Validation of this framework would reposition ACE from an empirically applied acupuncture technique to a mechanism-based precision therapy targeting the fascia-adipose interface.