Published: September 29th, 2018
Here, we present a protocol to produce an adipose tissue-derived stromal vascular fraction and its application to improve knee functions by regenerating cartilage-like tissue in human patients with osteoarthritis.
Osteoarthritis (OA) is one of the most common debilitating disorders. Recently, numerous attempts have been made to improve the functions of the knees by using different forms of mesenchymal stem cells (MSCs). In Korea, bone marrow concentrates and cord blood-derived stem cells have been approved by the Korean Food and Drug Administration (KFDA) for cartilage regeneration. In addition, an adipose tissue-derived stromal vascular fraction (SVF) has been allowed by the KFDA for joint injections in human patients. Autologous adipose tissue-derived SVF contains extracellular matrix (ECM) in addition to mesenchymal stem cells. ECM excretes various cytokines that, along with hyaluronic acid (HA) and platelet-rich plasma (PRP) activated by calcium chloride, may help MSCs to regenerate cartilage and improve knee functions. In this article, we presented a protocol to improve knee functions by regenerating cartilage-like tissue in human patients with OA. The result of the protocol was first reported in 2011 followed by a few additional publications. The protocol involves liposuction to obtain autologous lipoaspirates that are mixed with collagenase. This lipoaspirates-collagenase mixture is then cut and homogenized to remove large fibrous tissue that may clog up the needle during the injection. Afterwards, the mixture is incubated to obtain adipose tissue-derived SVF. The resulting adipose tissue-derived SVF, containing both adipose tissue-derived MSCs and remnants of ECM, is injected into knees of patients, combined with HA and calcium chloride activated PRP. Included are three cases of patients who were treated with our protocol resulting in improvement of knee pain, swelling, and range of motion along with MRI evidence of hyaline cartilage-like tissue.
Mesenchymal stem cells (MSCs) are known to have the capability to regenerate cartilage1,2,3,4,5,6. They can be easily obtained from various sources: bone marrow, cord blood, and adipose tissue among many others. Among these sources, adipose tissue is the only source where a sufficient number of MSCs can be obtained without any culture expansion to regenerate cartilage in clinical settings7,8. Autologous bone marrow....
The approval and consent to report following case reports were waived by Myongji University Institutional Review Board committee (MJUIRB). Further, this clinical protocol was in compliance with the Declaration of Helsinki and regulation guidelines of the KFDA. For the procedures, informed consents were obtained from the patients.
NOTE: Perform with sterile technique.
Three patients (one 87-year-old female with stage 3 OA, one 68-year-old male with stage 3 OA, and one 60-year-old female with stage 3 OA) without any significant past medical history presented to the clinic with persistent knee pain and desired for potential autologous adipose tissue-derived SVF treatment. All three patients had their knee examined by an orthopedic surgeon and were offered to have total knee replacement (TKR) and were reluctant to have the surgery. Prior to the procedure,.......
In 2001, Zuk et al. isolated stem cells from adipose tissue by breaking down the collagen matrix with collagenase6. Afterwards, the group showed that these stem cells isolated from the adipose tissue could transform into cartilage and other tissues of mesoderm in origin, proving that these stem cells were mesenchymal in origin.
Likewise, the procedure presented in this article is a modified protocol to apply the similar method to human patients. The main .......
The author acknowledges the support from the staff of Mipro Medical Clinic and the figure design by Jaepil/David Lee. This work was supported by research grants from the Bio & Medical Technology Development Program of the NRF funded by the MSIT (number NRF-2017M3A9E4078014); and the National Research Foundation of Korea (NRF) funded by the Ministry of Science and ICT (numbers NRF-2017R1A2B4002315 and NRF-2016R1C1B2010308).....
|5% Betadine (povidone-iodine)
|Firson Co., Ltd.
|Daehan Pharmaceutical Co.
|Myungmoon Pharm. Co. Ltd.
|The solution was composed of 500 mL normal saline, 40 mL 2% lidocaine, 20 mL 0.5% marcaine, and 0.5 mL epinephrine 1:1000.
|Liberase TL and TM research grade
|Roche Applied Science
|Dahan Pharm. Co., Ltd.
|Dextrose 5% in lactated Ringer's solution
|Anticoagulant citrate dextrose solution
|The solution was composed of 0.8% citric acid,
0.22% sodium citrate, and 0.223% dextrose.
|3% (w/v) Calcium chloride
|Choongwae Pharmaceutical Co.
|0.5% (w/v) HA (Hyaluronic acid )
|Dongkwang pharm. Co., Ltd.
|Huons Co., Ltd.
|3.0 mm Cannula
|WOOJU Medical Instruments Co.
|60-mL Luer-Lock syringe
|BD (Becton Dickinson)
|Centrifuge Barrel Kit
|CPL Co., Ltd.
|Tissue homogenizer that contains blades
|CPL Co., Ltd.
|Rotating incubator mixer
|Medikan Co., Ltd
|Hanil Scientific Inc.
|Magnetic Resonance Imaging
|Philips Medical Systems Inc.
|Ultrasound Imaging System
|Samsung Medison co., Ltd
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