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Schematic representation of the Lipogems device. In this completely closed system, the original lipoaspirate is processed by mild mechanical forces without using collagenase or other enzymes/additives. In the Lipogems device, the lipoaspirate is initially subjected to a first cluster reduction (A), obtained by pushing the aspirated fat from the syringe into the device through the large filter (blue end), and allowing the corresponding quantity of saline to exit towards the wasting bag. Stainless steel marbles contained in the device are essential to obtain a temporary emulsion between oil, blood, and saline, which can be washed away against density following the current of saline moved by gravity (B) (for details, see the Materials and Methods section). After this washing step (the flowing solution appears clear and the lipoaspirate yellow), the saline flux is stopped and the device is reversed (gray cap up), leading to the second adipose cluster reduction (C). Such reduction is obtained by pushing the floating adipose clusters through the second cutting hexagonal filter, pushing fluid from below with a 10-ml syringe. The reduced clusters pass in another 10-ml syringe placed above (C).
Source publication
Adipose tissue contains multipotent elements with phenotypic and gene expression profiles similar to human mesenchymal stem cells (hMSCs) and pericytes. The chance of clinical translation of the multilineage potential of these cells is delayed by the poor/negligible cell survival within cryopreserved lipoaspirates, the difficulty of ex vivo expansi...
Citations
... Processing of the harvested adipose tissue was carried out in a closed system, using the Lipogems ® [11] set, a closed, full-immersion, low-pressure cylindrical system ( Figure 2), to obtain a gradual volume reduction of the adipose tissue clusters and to remove impurities, producing an injectable fluid that contains a large number of pericytes and mesenchimal stem cells, the regenerative component of the subcutaneous tissue. Thanks to this system, fat tissue is micro-fragmented gently and proinflammatory oil and blood residues are washed away without the use of enzymes or other additives [12,13]. The harvesting of an adequate amount of fat tissue (50-100 mL) is performed in a standardized fashion, as previously described, connecting a 20cc Vaclock ® syringe to a 3 mm 13-Gauge blunt cannula [7]. ...
... Processing of the harvested adipose tissue was carried out in a closed system, using the Lipogems ® [11] set, a closed, full-immersion, low-pressure cylindrical system (Figure 2), to obtain a gradual volume reduction of the adipose tissue clusters and to remove impurities, producing an injectable fluid that contains a large number of pericytes and mesenchimal stem cells, the regenerative component of the subcutaneous tissue. Thanks to this system, fat tissue is micro-fragmented gently and proinflammatory oil and blood residues are washed away without the use of enzymes or other additives [12,13]. The purified fat graft was then transferred in smaller Luerlock ® syringes. ...
... Thus, in patients with ARM, pre-operative endoanal ultrasonography showed a thinner IAS compared to normal values for age and sex [12], while it was normal in the tethered cord patient ...
Treatment of organic fecal incontinence in children, typical of anorectal malformations, is most often conservative; however, when necessary, it can be surgical. Autologous fat grafting, or lipofilling, can be used to improve fecal incontinence. We present our experience with the echo-assisted anal-lipofilling and its effects on fecal incontinence in children and on the quality of life of the entire family. Under general anesthesia, fat tissue was harvested according to the traditional technique, and processed in a closed system Lipogems® set. Injection of the processed adipose tissue was guided by trans-anal ultrasound assistance. Ultrasound and manometry were also used for follow-up. From November 2018, we performed 12 anal-lipofilling procedures in six male patients (mean age 10.7 years). Five children had a stable improvement in bowel function with Krickenbeck’s scale scores going from soiling grade 3 pre-treatment in 100% of children to grade 1 post-treatment in 75% of them. No major post-operative complications developed. An increase in thickness of the sphincteric apparatus was shown at ultrasound during follow-up. The quality of life of the entire family, evaluated with a questionnaire, improved after the surgical treatment of the children. Anal-lipofilling is a safe and effective procedure to reduce organic fecal incontinence thereby benefiting both the patients and their families.
... These cells are called a stromal vascular fraction (SVF), which provides paracrine effects on angiogenic, immunomodulatory, and inflammatory modulatory effects [71,72]. The micronized adipose tissue (i.e., microfat), obtained from the mechanical treatment of lipoaspirate, maintains SVF and can enhance angiogenesis and cytocompatibility [73,74]. Schmitt et al. reported a closed-loop fat processing system, called MiniTCTM, that can process the lipoaspirates into microfat clusters involving the viable cells of SVF [51]. ...
Three-dimensional (3D) bioprinted skin equivalents are highlighted as the new gold standard for alternative models to animal testing, as well as full-thickness wound healing. In this review, we focus on the advances and innovations of 3D bioprinting skin for skin regeneration, within the last five years. After a brief introduction to skin anatomy, 3D bioprinting methods and the remarkable features of recent studies are classified as advances in materials, structures, and functions. We will discuss several ways to improve the clinical potential of 3D bioprinted skin, with state-of-the-art printing technology and novel biomaterials. After the breakthrough in the bottleneck of the current studies, highly developed skin can be fabricated, comprising stratified epidermis, dermis, and hypodermis with blood vessels, nerves, muscles, and skin appendages. We hope that this review will be priming water for future research and clinical applications, that will guide us to break new ground for the next generation of skin regeneration.
... Nevertheless, the aforementioned locations are either not abundantly available or are associated with donor site complications and pain. 9 To overcome these hurdles, adipose tissue transpires as a prospective source of MSCs because of its safety, availability, and accessibility. 10 Several RCTs have investigated the role of ADMSCs in knee OA. ...
... 21 It provides multipotent MSCs characterized by their viability, proliferative properties, and high potency for multi-lineage cell differentiation depending on the surrounding milieu. 9,22 ADMSCs tackle the main components of OA by creating an anti-inflammatory and immunomodulatory response through the release of cytokines and growth factors, acting in a paracrine fashion in the damaged joint. [23][24][25][26] In addition, ADMSCs stimulate local tissue repair through cytokines, intact vascular niche, and the differentiation of MSCs leading to pain relief, functional improvement, and cartilage regeneration. ...
Background:
Adipose-derived mesenchymal stem cells (ADMSCs) have recently been studied for the treatment of knee osteoarthritis. The goal is pain reduction and improvement of joint function leading to superior health-related quality of life.
Objectives:
The aim of this study was to provide a comprehensive meta-analysis assessing the evidence on the use of ADMSCs in knee osteoarthritis.
Design:
This is a Meta-analysis of randomised controlled trials.
Data sources and methods:
PubMed/MEDLINE, Embase, and Cochrane Databases were searched for randomized controlled trials using ADMSCs to treat patients with knee osteoarthritis. Only trials comparing ADMSCs to placebo or conservative treatment were included. The outcomes studied were improvement in functional, pain, and quality of life scores along with radiographic findings.
Results:
A total of four trials were included, representing 138 patients with knee osteoarthritis. WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) scores favored ADMSCs with a statistically and clinically significant difference over controls at 6- and 12-month follow-ups (p value < 0.0001). Pain, functional, and quality of life scores also favored ADMSCs at 12-month follow-up (p value < 0.0001).
Conclusion:
ADMSCs are effective in treating knee osteoarthritis symptoms as observed by functional and pain improvements. Furthermore, ADMSCs injection showed improvement of cartilage integrity, which indicates the potential for regenerating the knee cartilage. Future trials with larger number of patients and longer follow-up periods would help to elaborate further the therapeutic potential of ADMSCs.
Plain language summary:
Adipose-derived mesenchymal stem cells use in knee osteoarthritis Knee osteoarthritis is an extremely common disease that causes damage of the lining of the knee joint.This will lead to pain and limited range of motion of the knee hence limited functionality.Multiple treatments are used currently for knee osteoarthritis which all aim at slowing down the progression and limiting the need for knee replacement surgery.Adipose-derived mesenchymal stem cells (ADMSCs) are stem cells harvested from the fat around the belly. These stem cells have the potential to be converted into cells of a certain origin (cartilage, muscle, fat).Many studies are being performed to see whether these cells can transform to cartilage and repair the damaged knee joint.In this study, we tried to find how the results of different studies comparing the usual treatments for knee osteoarthritis with that of ADMSCs compared.We were mostly interested in the pain, functional, stiffness, and quality of life scores.We also reviewed the MRI findings to find out whether the lining of the knee joint improved.Four studies were included with 138 patients having knee osteoarthritis.WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) score which is a self-administered questionnaire evaluating hip and knee osteoarthritis, showed better results in patients receiving ADMSC injections compared with other usual treatments at 12-month follow-up.Pain, functional, stiffness, and quality of life scores also showed better results in ADMSCs at 12-month follow-up.MRI images also showed better cartilage lining in the patients treated with ADMSCs.We concluded that ADMSCs are both effective and safe to be used in treating knee osteoarthritis symptoms. However, studies with longer follow-up periods are needed to better assess the regenerative potential of ADMSCs.
... Under spinal anesthesia while using the orthopedic table, core decompression was done with a DHS drill pit (6.5 mm) to drill one hole in the femoral head, bone wax was used to plug the hole and AD MSCs were injected through the bone wax plug. The AD MSCs were prepared by utilizing a LIPOGEMS kit (Fig. 3), liposuction of abdomen fat was done after infiltration of 400 ml of saline and adrenaline (2 μg/ml) into the lower abdomen and then the lipoaspirate was processed using the kit with sterile saline solution to remove contaminants and rinsing and resizing the fat into smaller clusters and filtering it following manufacturer instructions to get 20 ml of LIPOGEMS final product ready to be injected [12]. ...
Introduction
Core decompression is a well-known modality for treating the early stages of avascular necrosis of the femoral head (AVN), however, several methods have been suggested to augment this procedure and improve the outcomes.
Case report
A 52 male was diagnosed with a stage I AVN of the femoral head and treated with core decompression (CD) and injection of adipose-derived mesenchymal stem cells (AD-MSCs). The MRI showed full healing of the lesion after 3 months with significant clinical and functional improvement.
Discussion
AD-MSCs could have the same capabilities as bone marrow-derived stem cells with many advantages, implantation of AD-MSCs in orthopedics and as an augmentation of core decompression has been tried before, but no clear guidelines nor methods of application are well established in the literature.
Conclusion
Implantation of AD-MSCs with Core decompression could be an effective modality to treat osteonecrosis of the femoral head in pre-collapse stages, however, we need bigger clinical studies to determine the actual effectiveness of this method.
... In alternative, the harvested fat was inland be processed and the final microfragmented tissue was transferred to a syringe and injected intra-articularly [25]. ...
... A lot of scientific studies reporting ADSCs injections for the management of KOA proved notable improvements in terms of knee function and pain in comparison with baseline data, up to 24 months of follow-up [14][15][16][17][18][19][21][22][23][25][26][27][28][29][30][31][32][33][34][35][36][37]. ...
... Koh and Choi studied the effects of a single injection of ADSC lipoaspirate from infrapatellar fat pad after arthroscopic debridement in 25 patients with a control group detecting a 94% of satisfaction rate for the patients but an abnormal cartilage repair tissue rate at second look arthroscopy of 74% [25]. ...
Background: Adipose tissue has achieved a great relevance as possible fount of mesenchymal stem cells for the healing of different articular pathologies including Knee Osteoarthritis (KOA). Stem cells derived from the Adipose Tissue (ADSCs) have a possibility to differentiate into chondrocyte, can reduce the immune response and can stimulate a local tissue repair, improving also the intra-articular Methods and Findings: Intra-articular injections of ADSCs with other conservative or surgical treatments can lead to an improving of all clinical and functional postoperative outcomes evaluated in middle-aged patients with KOA or chondral lesions. Moreover, some scores based on Magnetic Resonance Imaging (MRI) demonstrated an incremented quality of repaired cartilage in comparison with the pre-treatment. We observed no serious advent events. Conclusion: The use of ADSCs appeared to be out of danger, effective and it can be supposed an alternative procedure for the healing of chondral lesions and degenerative OA suitable for middle-aged athlete but no specific studies have been focus on this population and no long term follow-up data are available.
... Before successive (at least 10 min later) adipose tissue aspiration, knee arthroscopy was performed to manage any intraarticular lesions. A standard lipoaspiration technique was then performed (Fig. 2), and the harvested fat (40-60 ml) was introduced into the Lipogems ortho kit (LIPOGEMS International SpA, Milan, Italy) ( Fig. 3), according to the manufacturer's instructions, as previously described [3]. The processed final microfragmented adipose tissue product was transferred to 10 ml syringes (Fig. 4) and injected (10-15 ml) intraarticularly after closing the knee arthroscopy portals with a 3.0 non-resorbable suture (Fig. 5). ...
Purpose
This study aimed to report the clinical and functional results of a series of patients with isolated primary patellofemoral osteoarthritis (PFOA) treated with intraarticular injection of microfragmented autologous adipose tissue plus knee arthroscopy. The results were also analyzed in relation to the age and body mas index (BMI) of patients, and to the stage of PFOA.
Methods
Twenty-three patients with early-to-moderate (stage 1–3 according to the Iwano classification system) PFOA who received this treatment were retrospectively analyzed, with a mean follow-up of 22.1 ± 4.2 months. Patients were assessed using the International Knee Society (IKS) knee and function and visual analog scale (VAS) scores, and relative to their capacity for climbing stairs. Differences in improvements of IKS and VAS scores in relation to age (< 60 versus ≥ 60 years), BMI (< 30 versus ≥ 30 kg/m ² ), and stage of PFOA (stages 1–2 versus stage 3) were finally analyzed.
Results
The mean IKS knee score significantly improved from 35.6 ± 14.9 points preoperatively to 61.9 ± 17.8 points at the latest follow-up, while the mean IKS function score significantly improved from 52.0 ± 14.7 points preoperatively to 82.3 ± 19.1 points at the latest follow-up. The mean VAS score significantly decreased from 8.7 ± 2.2 preoperatively to 5.2 ± 2.5 at the latest follow-up. A significant improvement in the capacity to climb stairs was found. No significant differences in improvements of IKS knee and function and VAS scores were found in relation to age, BMI, or stage of PFOA.
Conclusion
Intraarticular injection of microfragmented autologous adipose tissue following arthroscopic debridement significantly improved overall clinical and functional scores in patients with early or moderate isolated primary PFOA at a mean follow-up of almost 2 years. Improvements were not significantly affected by age, BMI, or stage of PFOA.
Level of evidence
Level IV, retrospective case series.
... Written consent was obtained from each patient undergone liposuction from abdominal subcutaneous adipose tissue during cosmetic procedures. About 30 ml of lipoaspirate was collected and processed with Lipogems device (Cat# LG PK 240, Lipogems International, Milan, Italy) and obtained 10 ml of final Lipogems product as per the manufacturer's protocol (Bianchi et al. 2013). ...
Background
Mesenchymal stem cells (MSCs) are multipotent stromal cells and could exert hepatoprotective effects against acute liver injury, steatohepatitis, and fibrogenesis. Here, we evaluated the effects of human adipose derived stem cells (hADSCs) to attenuate experimentally induced hepatic fibrosis and early cirrhosis in rats.
Methods
Hepatic fibrosis was induced by intraperitoneal injections of CCl 4 (0.1 ml/100 g body weight) twice a week for 8 weeks. hADSCs were isolated and cultured on polyethylene discs coated with hydroxyapatite and 2 cm diameter disc was surgically implanted on the right lateral lobe of the liver. Discs implanted without hADSCs served as control. The animals were injected again with CCl 4 once a week for another 8 weeks. All the animals were sacrificed at the end of 16th week.
Results
Serial administrations of CCl 4 resulted in well developed fibrosis and early cirrhosis at 8th week which maintained until the 16th week. Animals treated with hADSC discs depicted over 50% decrease of collagen with significant increase in serum albumin and total protein levels. Immunohistochemical staining for TGF-β1, α-smooth muscle actin, and collagen type I and type III demonstrated marked decrease compared to the animals without hADSC treatment.
Conclusions
Treatment with hADSCs improved liver functions, markedly reduced hepatic fibrosis and early cirrhosis. Various pleiotropic and paracrine factors secreted from the hADSCs seem to serve as reparative functions in the attenuation of liver cirrhosis. The data demonstrated that treatment with hADSCs can be successfully used as a potent therapeutic method to prevent progression of hepatic fibrosis and related adverse events.
... Written consent was obtained from each patient undergone liposuction from abdominal subcutaneous adipose tissue during cosmetic procedures. About 30 ml of lipoaspirate was collected and processed with Lipogems device (Cat# LG PK 240, Lipogems International, Milan, Italy) and obtained 10 ml of final Lipogems product as per the manufacturer's protocol (Bianchi et al. 2013). ...
... Regulatory issues within the European Community greatly limit the use of enzymatic procedures which could deliver a product with higher cell viability and differentiative potential compared to non-enzymatic methods [12]. However, various authors [13,14] advocate the important role played by extracellular matrix, which is preserved via mechanical processing. Recently introduced systems offer easy harvesting (according to Coleman technique [15]), processing and transfer of refined autologous micro-fragmented adipose tissue (aMFAT), without expansion and/or enzymatic treatment [16]. ...
... The harvesting procedure was performed by a plastic surgeon or by a trainee orthopedic surgeon. After harvesting, the adipose tissue was processed according to the manufacturer's procedure as previously reported [14,22]. In the meantime, arthroscopy was performed. ...
Background
Adipose tissue has recently gained growing interest in the treatment of osteoarthritis (OA). The aim of the present study was to evaluate the efficacy of a single injection of autologous micro-fragmented adipose tissue (aMFAT) associated with arthroscopy (cartilage debridement/meniscal regularization or selective meniscectomy/micro-drilling) for symptomatic knee OA.
Methods
This retrospective, single-center study included 49 patients (50 knees) affected by knee OA (radiographic Kellgren-Lawrence III-IV) treated with a single injection of autologous micro-fragmented adipose tissue and knee arthroscopy. Knee Injury and Osteoarthritis Outcome Score (KOOS) and subjective International Knee Documentation Committee (IKDC) score were the primary outcome measures and were collected at one and 2 years post-operatively. Patients were divided into clusters based on age, complexity of arthroscopic procedures and chondral lesion grade.
Results
Four patients underwent knee replacement (8%). No major adverse events were reported. Minimal Clinically Important Difference (MCID) for KOOS and IKDC was reached by 84 and 74% of all cases at 1 year and by 80 and 76% at 2 years, respectively. High grade chondral lesions negatively affected the outcome at 2 years follow-up (p < 0.05 for IKDC, KOOS overall and 3 out of 5 subscales).
Conclusion
The injection of micro-fragmented adipose tissue associated with arthroscopy demonstrated to be a safe and effective procedure for the treatment of knee OA, with a substantial improvement in IKDC and KOOS scores and without major complications.
... Stromal vascular fraction was also combined with hyaluronan-based scaffolds with good results in animal experiments [118]. The enzymatic [119] and non-enzymatic mechanical separation methodology of SVF is well defined [120,121]. Preserving the cell-matrix integrity by using mild mechanical forces is another advantage of AD-tSVF. Tissue integrity protects cellular destruction and implements a biophysical support. ...
Adipose tissue contains adult mesenchymal stem cells that may modulate the metabolism when applied to other tissues. Stromal vascular fraction (SVF) can be isolated from adipose tissue mechanically and/or enzymatically. SVF was recently used to decrease the pain and improve the function of knee osteoarthritis (OA) patients. Primary and/or secondary OA causes inflammation and degeneration in joints, and regenerative approaches that may modify the natural course of the disease are limited. SVF may modulate inflammation and initiate regeneration in joint tissues by initiating a paracrine effect. Chemokines released from SVF may slow down degeneration and stimulate regeneration in joints. In this review, we overviewed articular joint cartilage structures and functions, OA, and macro-, micro-, and nano-fat isolation techniques. Mechanic and enzymatic SVF processing techniques were summarized. Clinical outcomes of adipose tissue derived tissue SVF (AD-tSVF) were evaluated. Medical devices that can mechanically isolate AD-tSVF were listed, and publications referring to such devices were summarized. Recent review manuscripts were also systematically evaluated and included. Transferring adipose tissues and cells has its roots in plastic, reconstructive, and aesthetic surgery. Micro- and nano-fat is also transferred to other organs and tissues to stimulate regeneration as it contains regenerative cells. Minimal manipulation of the adipose tissue is recently preferred to isolate the regenerative cells without disrupting them from their natural environment. The number of patients in the follow-up studies are recently increasing. The duration of follow up is also increasing with favorable outcomes from the short- to mid-term. There are however variations for mean age and the severity of knee OA patients between studies. Positive outcomes are related to the higher number of cells in the AD-tSVF. Repetition of injections and concomitant treatments such as combining the AD-tSVF with platelet rich plasma or hyaluronan are not solidified. Good results were obtained when combined with arthroscopic debridement and micro- or nano-fracture techniques for small-sized cartilage defects. The optimum pressure applied to the tissues and cells during filtration and purification of the AD-tSVF is not specified yet. Quantitative monitoring of articular joint cartilage regeneration by ultrasound, MR, and synovial fluid analysis as well as with second-look arthroscopy could improve our current knowledge on AD-tSVF treatment in knee OA. AD-tSVF isolation techniques and technologies have the potential to improve knee OA treatment. The duration of centrifugation, filtration, washing, and purification should however be standardized. Using gravity-only for isolation and filtration could be a reasonable approach to avoid possible complications of other methodologies.
