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Adipose tissue is increasingly recognized as an active component of the muscle's regenerative microenvironment. During muscle repair, adipose tissue contributes to local metabolic support and paracrine signalling, but its effects are highly context dependent. Tightly regulated presence of adipose tissue accompanies effective regeneration, whereas excessive or dysregulated ectopic fat accumulation leads to persistent functional impairment. This review synthesizes recent experimental and translational studies investigating the cellular origins, regulatory mechanisms and functional consequences of adipose tissue during skeletal muscle repair. We propose three potential therapeutic directions to improve pathological muscle repair by modulation of the adipose\u2010related intramuscular regenerative microenvironment: (1) targeted modulation of fibro\u2010adipogenic progenitors (FAPs) to curb pathological adipogenesis and fibrosis while leveraging beneficial mediators such as adiponectin and leptin; (2) adipose\u2010derived stem cell transplantation and exosome\u2010based approaches to deliver multipotent cells and remodel the repair microenvironment; and (3) induction of adipose browning to enhance energy availability, immune tone and vascularization while recognizing its context\u2010dependent liabilities. Together, these strategies position adipose tissue as a plastic and environment\u2010sensitive regulator of muscle regeneration and provide a framework for precision interventions to improve structural and functional outcomes.<\/jats:p>","DOI":"10.1002\/jcsm.70269","type":"journal-article","created":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T11:04:11Z","timestamp":1776423851000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Dual Roles of Adipose Tissue in Skeletal Muscle Regeneration: Pro\u2010Regenerative Versus Maladaptive"],"prefix":"10.1002","volume":"17","author":[{"given":"Chongxuan","family":"Lu","sequence":"first","affiliation":[{"name":"Department of Plastic and Cosmetic Surgery Nanfang Hospital, Southern Medical University  Guangzhou Guangdong People's Republic of 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