Autologous Stromal Vascular Fraction Research Articles

Efficacy of a Single Injection of Stromal Vascular Fraction in Dogs with Elbow Osteoarthritis: A Clinical Prospective Study

This study aimed to assess the efficacy of a single intra-articular injection of autologous stromal vascular fraction (SVF) in dogs with chronic lameness due to advanced elbow osteoarthritis (OA) that were unresponsive to conventional drug therapy. In this clinical, prospective, non-blinded, single-center study, twenty-three dogs received autologous SVF derived from falciform adipose tissue. Primary outcome measures over the six-month study period included clinical-orthopedic and radiographic examinations, objective gait analysis and validated owner questionnaires. In 19 of 23 joints, no progression of OA was visible radiographically. Peak vertical force improved significantly at three months and vertical impulse at six months after the injection compared to baseline. Over 33% of dogs demonstrated treatment-related improvements in lameness based on objective gait analysis. Owner questionnaires indicated significant improvement in clinical signs throughout the study period and 26% of dogs showed treatment-related improvements in pain scores according to the Canine Brief Pain Inventory. No side effects were reported. These findings suggest that autologous regenerative cell therapy may provide a promising treatment option for dogs with advanced OA that do not respond to conventional drug therapy. However, the treatment did not improve the clinical symptoms in all dogs, so it cannot be recommended for all patients.

Understanding and controlling the variables for stromal vascular fraction therapy.

In regenerative medicine, the isolation of mesenchymal stromal cells (MSCs) from the adipose tissue's stromal vascular fraction (SVF) is a critical area of study. Our review meticulously examines the isolation process of MSCs, starting with the extraction of adipose tissue. The choice of liposuction technique, anatomical site, and immediate processing are essential to maintain cell functionality. We delve into the intricacies of enzymatic digestion, emphasizing the fine-tuning of enzyme concentrations to maximize cell yield while preventing harm. The review then outlines the filtration and centrifugation techniques necessary for isolating a purified SVF, alongside cell viability assessments like flow cytometry, which are vital for confirming the efficacy of the isolated MSCs. We discuss the advantages and drawbacks of using autologous vs allogeneic SVF sources, touching upon immunocompatibility and logistical considerations, as well as the variability inherent in donor-derived cells. Anesthesia choices, the selection between hypodermic needles vs liposuction cannulas, and the role of adipose tissue lysers in achieving cellular dissociation are evaluated for their impact on SVF isolation. Centrifugation protocols are also analyzed for their part in ensuring the integrity of the SVF. The necessity for standardized MSC isolation protocols is highlighted, promoting reproducibility and successful clinical application. We encourage ongoing research to deepen the understanding of MSC biology and therapeutic action, aiming to further the field of regenerative medicine. The review concludes with a call for rigorous research, interdisciplinary collaboration, and strict adherence to ethical and regulatory standards to safeguard patient safety and optimize treatment outcomes with MSCs.

Autologous Stromal Vascular Fraction and Microfragmented Adipose Tissue for Musculoskeletal Disorders: A Narrative Review

Autologous Stromal Vascular Fraction and Microfragmented Adipose Tissue for Musculoskeletal Disorders: A Narrative Review

Long-Term Effect of Intra-Articular Adipose-Derived Stromal Vascular Fraction and Platelet-Rich Plasma in Dogs with Elbow Joint Disease-A Pilot Study.

(1) Background: The aim of the current pilot study was to describe the long-term effects of a single intra-articular injection of autologous stromal vascular fraction (SVF) with platelet-rich plasma (PRP) in dogs with confirmed elbow OA, using orthopedic lameness scoring and kinetic and kinematic gait analysis. For comparison of normal long-term variation of gait over time, a group of healthy control dogs (CDs) was also evaluated. (2) Methods: A prospective longitudinal clinical pilot study investigating 19 client-owned dogs with elbow OA (OADs) treated with SVF and PRP and eight CDs not receiving treatment. The OAD and CD groups were evaluated before and after 6 and at least 12 months following treatment with SVF and PRP (OAD group) and twice with a six-month interval (CD group), respectively, through orthopedic examinations, goniometry, and kinetic and kinematic analyses (seven variables). (3) Results: The OAD had an increase in fore-hind peak force symmetry ≥12 months after treatment (p < 0.05), but no other objective variables changed over time. Orthopedic consensus scores had improved at ≥six months follow-up evaluation (p < 0.05). None of the investigated gait variables had changed at ≥six months follow-up evaluation in the CD group. (4) Conclusions: The current study could not confirm a significant benefit from SVF and PRP treatment in OADs, but future studies should be conducted in order to fully evaluate the potential of the treatment. The improvement seen in fore-hindlimb symmetry may represent an improvement in gait or an incidental finding.

Effectiveness of Autodermoplasty in Combination with Injection of Autological Stromal-Vascular Cell Fraction in Treatment of Deep Burns

Introduction. The use of autologous stromal-vascular cell fraction of adipose tissue seems to be one of the promising technologies to increase the effectiveness of skin grafting and other skin restoration options in burnt patients. The main regenerative component of the stromal-vascular fraction are mesenchymal stem cells, which have a high reparative potential and low immunogenicity.The aim of the study was to increase the effectiveness of surgical treatment of patients with skin burns through the injection of autological stromal-vascular cell fraction of the adipose tissue.Materials and methods. The study was conducted as part of a prospective, open, randomized study involving 61 patients with extensive skin burns treated in burn centers Dzhanelidze Saint-Petersburg Research Institute of Emergency Medicine and Vishnevsky National Medical Research Center of Surgery, Ministry of Health of Russia, in 2021-2023. Cells of the stromal-vascular fraction of the adipose tissue were obtained mechanically and enzymatically. The prepared cell suspension was introduced into the granulation tissue during skin grafting with split autodermal grafts having a high perforation coefficient. During the study, planimetric parameters, as well as the results of histological and immunohistochemical tests, were assessed. The obtained findings were processed using generally accepted algorithms of variation and descriptive statistics. The alternative hypothesis was accepted at p0.05.Results. The proposed technique of autologous stromal-vascular cell fraction of the adipose tissue with simultaneous autodermoplasty with a split perforated graft allowed reducing the time of perforating cell epithelization by 28% (p0.05), the time of final engraftment by 11% (p0.05), the frequency of infectious complications in the postoperative period by 20% (p0.05), as well as the frequency of lysis and rejection reactions by 15% (p0.05). As stated, the introduction of an autologous stromal-vascular fraction during skin grafting resulted in early relief of the inflammatory reaction in the area of a deep burn wound, the fact being supported by clinical, cytological, histological and immunohistochemical tests.Conclusion. The use of cells from the stromal-vascular fraction of the adipose tissue can significantly increase the effectiveness of surgical treatment of patients with extensive skin burns. The proposed technique to obtain and apply the stromal-vascular fraction of the adipose tissue at the stage of autodermoplasty can be introduced into clinical practice in both burn centers and surgical/trauma departments, since it does not require special equipment.

Tissue engineering approach to the creation of grafting material for rhinoplasty: clinical сase reports

The use of autologous cartilage and bone grafts remains the gold standard in augmentation rhinoplasty performed to reconstruct of the nasal dorsum. Meanwhile, limited number of available sources, donor site morbidity, and unpredictable graft resorption represent significant disadvantages of autografting. The aim of this study is to test combination of autologous stromal vascular fraction (SVF) and commercially available bone substitutes (BSs) as new tissue-engineered grafting material (GM) for rhinoplasty. A series of consecutive cases includes four adult patients who underwent rhinoplasty to correct saddle nose deformity (SND) using the new graft technique. SVF was isolated from liposuction aspirate using standard methodology of enzymatic digestion. Two types of BSs were combined with SVF: Bio-Oss granules to create a moldable graft (M-graft), and block-shaped BoneMedik-S to create rigid grafts (R-grafts). The moderate SND was treated using an M-graft. In case of major or complex SND, the nasal dorsum was reconstructed with dorso-columellar L-shaped framework made of R-grafts. The results were evaluated over a period of 6 months to 3 years postoperatively using photogrammetry and FACE-Q appearance appraisal scales. Computerised tomography (CT) scanning of the reconstructed nose and histological analysis of grafted material were also carried out. No complications were observed. The photograms show the restoration of the correct contour of the nose. FACE-Q appraisal scale scores increased significantly, including satisfaction with nose appearance, psychological well-being, and social function. In CT evaluation, there was no substantial resorption or warping of the grafts. Histological findings show osteogenic remodeling of the grafted material. Thus, combining autologous SVF with BSs is a promising strategy for developing rhinoplasty GM.

Long-Term Structural Changes in the Osteochondral Unit in Patients with Osteoarthritis Undergoing Corrective Osteotomy with Platelet-Rich Plasma or Stromal Vascular Fraction Post-Treatment.

This pilot study examined the long-term structural changes in the osteochondral unit of 20 patients with knee osteoarthritis (KOA) who underwent high tibial osteotomy (HTO) and received post-treatment with either platelet-rich plasma (PRP) or stromal vascular fraction (SVF). Ten patients were injected with autologous PRP (PRP subgroup), while another ten patients received autologous SVF (SVF subgroup) six weeks after surgery and were monitored for 18 months. Histological samples of bone and cartilage (2 mm in diameter and 2 cm long) were taken from tibial and femoral sites during surgery and 18-month post-HTO, and morphometric analyses were conducted using Mega-Morf12 software. Both post-treatment resulted in an increase in articular cartilage height at both sites (p < 0.001 in the tibia and femur), indicating positive outcomes. Significant improvements in subchondral and trabecular bone architecture were also observed, with SVF injection showing higher reparative capacity in terms of bone volume (p < 0.001 for the tibia and p = 0.004 for the femur), subchondral bone height (p < 0.001 for the tibia and p = 0.014 for the femur), trabecular bone volume (p < 0.001 for the femur), and intertrabecular space (p = 0.009 for the tibia and p = 0.007 for the femur). This pilot study, for the first time, demonstrates that HTO surgery combined with PRP and SVF post-treatments can lead to significant enhancements in knee articular cartilage and bone architecture in KOA patients, with SVF showing higher regenerative potential. These findings may contribute to improving treatment strategies for better clinical outcomes in HTO therapy for patients with KOA.

Long Term Rejuvenation of Facial Skin by Transplantation of Autologous Stromal Vascular Fraction and Pre-conditioned Matrix: A Clinical Study

Background: For skin rejuvenation, today no procedure describes a specific treatment of the extracellular matrix (ECM) combined with stromal vascular fraction (SVF) from adipose tissue. A new product AmeaCell® , allows SVF extraction and ECM preconditioning in hypoxic conditions. Hypoxia significantly increased the adhesion of adipose derived stem cells and enhace their proliferation and differentiation. Objective: This clinical study aimed to evaluate safety and efficiency of this new procedure, over one year. Material and methods: The study was performed on 23 patients. After a liposuction and fat proceed, SVF and the matrix were extracted and preconditioned following Ameacell® procedure, then injected into wrinkles. Results were scored for WSRS and GAIS scales at 6, 12 months after surgery. Results: No serious adverse reactions occurred. Regarding efficiency, whatever the baseline, the Ameacell® procedure triggered an improvement of WSRS score in most patients after one year follow-up: 75% of patients when WSRS score at baseline 2; 83% of patients when WSRS score at baseline 3. This is in accordance with the GAIS scored by both investigators and patients. Conclusion: This one-year follow-up clinical study using Ameacell® procedure, exhibited an improvement of facial skin appearance.

Adipose-derived stromal vascular fraction cells to treat long-term pulmonary sequelae of coronavirus disease 2019: 12-month follow-up

Background aimsLong coronavirus disease (COVID) is estimated to occur in up to 20% of patients with coronavirus disease 2019 (COVID-19) infections, with many having persistent pulmonary symptoms. Mesenchymal stromal cells (MSCs) have been shown to have powerful immunomodulatory and anti-fibrotic properties. Autologous adipose-derived (AD) stromal vascular fraction (SVF) contains MSC and other healing cell components and can be obtained by small-volume lipoaspiration and administered on the same day. This study was designed to study the safety of AD SVF infused intravenously to treat the pulmonary symptoms of long COVID. MethodsFive subjects with persistent cough and dyspnea after hospitalization and subsequent discharge for COVID-19 pneumonia were treated with 40 million intravenous autologous AD SVF cells and followed for 12 months, to include with pulmonary function tests and computed tomography scans of the lung. ResultsSVF infusion was safe, with no significant adverse events related to the infusion out to 12 months. Four subjects had improvements in pulmonary symptoms, pulmonary function tests, and computed tomography scans, with some improvement noted as soon as 1 month after SVF treatment. ConclusionsIt is not possible to distinguish between naturally occurring improvement or improvement caused by SVF treatment in this small, uncontrolled study. However, the results support further study of autologous AD SVF as a treatment for long COVID.

Treatment of knee osteoarthritis with autologous stromal-vascular fraction of adipose tissue

Treatment of knee osteoarthritis with autologous stromal-vascular fraction of adipose tissue

Functional Outcome Analysis of Autologous Stromal Vascular Fraction (SVF) (Sahaj Therapy®) Using Direct Sonication in Osteonecrosis of the Femoral Head (ONFH): A 6-Year Follow-Up Study.

We investigated the safety, efficacy, functional, and clinical outcomes of intra-osseous implantation of mechanically isolated, autologous stromal vascular fraction (SVF), an Australian patented direct ultrasonication technology (Sahaj Therapy®) in osteonecrosis of the femoral head (ONFH). A total of 32 cases of ONFH were enrolled in the study after confirming with an MRI of the affected hip. All cases were treated with an intra-osseous autologous SVF implantation [4-5cc with the cellular dosage of 8.0 × 107 cells with a viability of > 85% SVF cells] on the same surgical sitting. All the cases were followed up clinically, functionally, and radiologically at regular intervals. A comparison of mean HOOS scores at different follow-ups was done using Paired 't'-test. A P value of < 0.05 was considered significant. In our study, male preponderance was seen (53.1%). According to the modified Ficat and Arlet classification, the most common grade of ONFH was grade 2 [right: 25 hips and left: 25 hips]. There was a statistically significant improvement in the mean HOOS score of the right hip (n = 10) and left hip (n = 9) from preoperative time till 72months (P < 0.05). The follow-up MRI of the affected hips shows improved osteogenesis without any further worsening of the contour of the femoral head. No adverse effects were seen in any of the study participants. For individuals with ONFH, treated with intra-osseous autologous SVF implantation in the same surgical procedure is an innovative and promising treatment modality. Even after 6years of follow-up, the study participants with ONFH have shown good clinical and functional outcomes with autologous SVF.

A Modified Study Design for Blinded Randomized Controlled Trial in Orthobiologic Therapy

Background: The utility of cellular based therapeutic agents in management of various ailments and conditions is promising, particularly in the field of orthopedics. However, an evidence-based medicine approach must be implemented to validate these novel cellular based therapies before they can be translated into routine clinical practice. Given pain relief is a primary goal of novel treatments for orthopedic disease, future orthobiologic clinical trials will need to overcome challenges such as the placebo effect or the placebo response and difficult participant recruitment. In this paper, we describe a clinical study that evaluates the safety and efficacy of autologous stromal vascular fraction (SVF) cells that adheres to a patient blinded, randomized and placebo-controlled study design while still offering the patient the opportunity to participate in the therapeutic intervention by using cell preservation techniques. Methods: This pilot clinical trial studies the safety and feasibility of intra-articular transplantation of SVF cells in patients with knee osteoarthritis with secondary outcomes of improving pain relief. The RCT aims to recruit 30 patients. Liposuction is performed on each patient to isolate SVF cells. 15 subjects are randomized to receive SVF injection in the same surgical procedure and 15 subjects receive placebo injection directly into their affected knee joint. The placebo group’s SVF cells are then frozen and preserved. At the 6-month follow-up visit, those who received the placebo are unblinded and have the option to receive the SVF injection as a condition for participation in the trial. Feasibility of liposuction, SVF manufacturing, cell preservation/thaw techniques and adverse outcomes are all primarily tracked. Secondary outcomes include standardized patient reported outcomes score responses to the treatments. Discussion: The design of this pilot study offers study subjects the opportunity to receive a novel therapeutic intervention even within a placebo arm and enables the investigators to blind subjects without performing an unnecessary liposuction or discarding the resulting cellular product which could encourage hesitant individuals to participate in the trial. This may aid in overcoming the challenges associated with recruiting participants for cell therapy trials concerned with being randomized to a control arm. The results of this trial will help to assess both the safety and feasibility of SVF injections to treat knee osteoarthritis as well as help plan larger phase controlled trials. However, precautionary measures are necessary to ensure the safety and well-being of patients receiving cell-based therapy. Proper handling and storage of the cellular product must be considered and are demonstrated here. Trial Registration ClinicalTrials.gov Identifier: NCT03940950

The Use of Stromal Vascular Fraction in Long Bone Defect Healing in Sheep.

The objectives of the present study were to evaluate (a) the feasibility of using stromal vascular fraction (SVF) and nanocrystalline hydroxyapatite (nHA) paste in combination for the treatment of segmental bone defect, (b) the quality of the callus produced, (c) the potential improvement of the autograft technique, and (d) the direct comparison of the biomaterial to the use of autogenous cancellous bone. Unilateral, segmental mid-diaphyseal bone defect was created on the right metatarsus of skeletally mature sheep animals (n = 24) under anesthesia (D0). Residual segments were stabilized by stainless-steel plates and appropriate screws. Defects were managed as follows: group A: use of nHA paste to filling, group B: use of autogenous bone graft mixed with nHA bone paste, placed in defect, group C: use of SVF mixed with nHA bone paste injected into defect, group D: use of bone graft and SVF with nHA paste before apposition in bone defect. SVF had been previously isolated from adipose tissue of the animals intra-operatively after digestion with collagenase solution and neutralization. Animals were evaluated clinically and by X-raying and ultrasonographic examination of the defect, at regular intervals, until D90. Ultrasonographic assessment performed along the length of the defect included calculation of the length of the bone defect and assessment of vascularization. SVF was successfully isolated from group C and D animals, with the average yield being 1.77 × 106 cells. The comparison of clinical scores (based on the 'Kaler scale') on each post-operative day indicated significant differences between the four groups on D1 to D30 (p < 0.01); the median clinical score within group A was 2.5 for D1-D30 and 1 for the entire period; respective scores for other groups were 1.5 (p = 0.07) and 0 (p = 0.033). Differences in radiographic assessment scores were significant for scores obtained on D60 (p = 0.049) and D90 (p = 0.006). There was a significant difference between the four groups in the length of the bone defect, as assessed ultrasonographically, for the entire length of the study; median values were 8, 8.5, 6, and 8 mm for groups A, B, C, and D, respectively (p = 0.008). There was a significance in the differences between median scores obtained during the histopathological examination: 2, 11, 13.5, and 12 for group A, B, C, and D (p = 0.022). There was an inverse correlation between the overall scores of histopathological evaluations and the length of the bone defect (observed on D90) (p < 0.0001) and a correlation between the overall scores and the radiographic assessment scores (obtained on D90) (p < 0.0001). This is the first study in which the efficacy of fresh autologous Stromal Vascular Fraction (SVF) from adipose tissue in enhancing bone healing in a long, weight-bearing, diaphyseal bone was evaluated. It is concluded that the lumbosacral region was an attractive site for harvesting adipose tissue, the use of SVF contributed to faster rehabilitation post-operatively, and SVF significantly enhanced bone formation; in general, the results indicated an osteogenic potential of SVF comparable to the gold standard autologous bone graft.

Clinical Outcome of Minimally Manipulated, Mechanically Isolated Autologous Adipose Tissue-Derived Stromal Vascular Fraction (Sahaj Therapy®) in Knee Osteoarthritis-Randomized Controlled Trial.

Regenerative therapy has shown promising results in the treatment of osteoarthritis (OA) knee with Kellgren-Lawrence (KL) Grades I-III. We compared the safety, efficacy, functional, and clinical outcomes of intra-articular implantation of autologous adipose tissue-derived stromal vascular fraction (SVF) isolated using direct ultrasonic cavitation (Sahaj therapy-Cell Innovation Patented Technology) and saline injection in knee osteoarthritis. The present prospective observational study was conducted over 3years. We enrolled 120 patients in our study, where four patients got excluded as they did not meet the inclusion criteria. The remaining 116 patients were randomized into two groups, one with autologous adipose tissue-derived SVF and the other group with saline injection. A comparison of mean KOOS and VAS scores at different follow-ups was done using Paired 't' test. A p value of < 0.05 was considered significant. The results show that the SVF group had significantly higher KOOS scores (78.49 ± 6.54 in the SVF group vs 59.19 ± 5.14 in the saline group), respectively (p < 0.001). Similarly, the SVF group had significantly lesser VAS scores (3.17 ± 0.94 in the SVF group vs 3.89 ± 1.04 in the saline group), respectively (p < 0.001). Autologous adipose tissue-derived SVF is a better choice for treating knee osteoarthritis. For individuals with degenerative osteoarthritis, autologous SVF grafting in the same surgical procedure is an innovative and promising treatment modality. Even after 3years of follow-up, the study participants with OA knee have shown a good clinical and functional outcome.

Geometric Mismatch Promotes Anatomic Repair in Periorbital Bony Defects in Skeletally Mature Yucatan Minipigs.

Porous tissue-engineered 3D-printed scaffolds are a compelling alternative to autografts for the treatment of large periorbital bone defects. Matching the defect-specific geometry has long been considered an optimal strategy to restore pre-injury anatomy. However, studies in large animal models have revealed that biomaterial-induced bone formation largely occurs around the scaffold periphery. Such ectopic bone formation in the periorbital region can affect vision and cause disfigurement. To enhance anatomic reconstruction, geometric mismatches are introduced in the scaffolds used to treat full thickness zygomatic defects created bilaterally in adult Yucatan minipigs. 3D-printed, anatomically-mirrored scaffolds are used in combination with autologous stromal vascular fraction of cells (SVF) for treatment. An advanced image-registration workflow is developed to quantify the post-surgical geometric mismatch and correlate it with the spatial pattern of the regenerating bone. Osteoconductive bone growth on the dorsal and ventral aspect of the defect enhances scaffold integration with the native bone while medio-lateral bone growth leads to failure of the scaffolds to integrate. A strong positive correlation is found between geometric mismatch and orthotopic bone deposition at the defect site. The data suggest that strategic mismatch >20% could improve bone scaffold design to promote enhanced regeneration, osseointegration, and long-term scaffold survivability.

Long-Term Safety of Bone Regeneration Using Autologous Stromal Vascular Fraction and Calcium Phosphate Ceramics: A 10-Year Prospective Cohort Study.

This prospective cohort study aimed to assess long-term safety, dental implant survival, and clinical and radiological outcomes after maxillary sinus floor elevation (MSFE; lateral window technique) using freshly isolated autologous stromal vascular fraction (SVF) combined with calcium phosphate ceramics. All 10 patients previously participating in a phase I trial were included in a 10-year follow-up. They received either β-tricalcium phosphate (β-TCP; n = 5) or biphasic calcium phosphate (BCP; n = 5) with SVF-supplementation on one side (study). Bilaterally treated patients (6 of 10; 3 β-TCP, 3 BCP) received only calcium phosphate on the opposite side (control). Clinical and radiological assessments were performed on 44 dental implants at 1-month pre-MSFE, and 0.5- to 10-year post-MSFE. Implants were placed 6 months post-MSFE. No adverse events or pathology was reported during a 10-year follow-up. Forty-three dental implants (98%) remained functional. Control and study sides showed similar peri-implant soft-tissue quality, sulcus bleeding index, probing depth, plaque index, keratinized mucosa width, as well as marginal bone loss (0-6 mm), graft height loss (0-6 mm), and graft volume reduction. Peri-implantitis was observed around 6 implants (control: 4; study: 2) in 3 patients. This study is the first to demonstrate the 10-year safety of SVF-supplementation in MSFE for jawbone reconstruction. SVF-supplementation showed enhanced bone regeneration in the short term (previous study) and led to no abnormalities clinically and radiologically in the long term.

Regenerative Therapy with Autologous Stromal Vascular Fraction Derived Mesenchymal Stem Cells and Platelet-Rich Plasma to Treat Complex Perianal Diseases

Abstract Background The high recurrence rate of surgically treated anal fistula remains a concern in proctology. Aims This study investigated the healing rate of complex anal fistula procedures supplemented by regenerative therapy with autologous stromal vascular fraction derived mesenchymal stem cells and platelet-rich plasma (SVF-PRP). Methods Consecutive patients with complex anal fistula were prospectively assessed by a validated incontinence questionnaire and MRI 4 and 12 months after surgery. Fistula were drained with setons prior to definitive surgery. SVF was harvested from subcutaneous abdominal fat and PRP from peripheral blood. Distal fistulectomy to the sphincter was performed and the wound left open, while the internal orifice was closed. SVF-PRP was injected around the fistula. Patients showered their excision wound until dry. Outcomes were reported as median &amp; interquartile range (IQR). Results 40 patients (23 males : 17 females) were included from December 2019 to December 2022. Age was 40 years (IQR 30-53). Five patients (12.5%) suffered from perineal Crohn's disease and 3 had a rectovaginal fistula (7.5%). Patients had 2 prior fistula surgeries (IQR 1-3) and SVF-PRP fistula repair was performed 8 months (IQR 5-22.5) after initial diagnosis. Operation time was 82 minutes (IQR 73-95). Five patients were discharged on the day of surgery, 32 on postoperative day 1, and 3 on postoperative day 2. Follow up was 12 months (IQR 6-16). There was no deterioration in fecal continence. Two out of 40 patients (5%) experienced an early failure within 2 months of SVF PRP. All other patients were back to work and leisure. At 4 months of follow-up, 34/40 (85%) patients were clinically well with no active fistula. Of 30 patients who reached 12 months follow-up, 5 had an active fistula in MRI (16%) or on clinical ground. Conclusions SVF-PRP is a safe and promising addition to the broad armentarium of treatments for complex perianal fistula.

Efficacy and Safety of Transplantation of Autologous Fat, Platelet-Rich Plasma (PRP) andStromal Vascular Fraction (SVF) in the Treatment of Acne Scar: Systematic Review and Meta-analysis.

The efficacy and safety evaluation of the transplantation of autologous fat, platelet-rich plasma (PRP) and stromal vascular fraction (SVF) in acne scars has not been completely unified. This article will analyze and process the data of the included studies through evidence-based medicine to evaluate the efficacy and safety of autologous fat grafting, PRP and SVF for acne scar treatment, so as to provide treatment basis and strategy for the clinical treatment of acne scars. We searched the PubMed, Embase, Cochrane Library databases, CNKI, Wanfang and CQVIP databases for studies published during the time between the establishment of the databases through October 2022. We included studies that report autologous fat grafting, SVF and PRP for patients with acne scars. We excluded repeated publication, researches without full text, incomplete information or inability to conduct data extraction and animal experiments, case report, reviews and systematic reviews. STATA 15.1 software was used to analyze the data. The findings showed that fat grafting had excellent improvement, marked improvement, moderate improvement and mild improvement rates of 36%, 27%, 18% and 18%, respectively, PRP had excellent improvement, marked improvement, moderate improvement and mild improvement rates of 0%, 26%, 47% and 25%, respectively, and the SVF had excellent improvement, marked improvement, moderate improvement and mild improvement rates of 73%, 25%, 3% and 0%, respectively. Additionally, the pooled results showed that there was no significant difference between PRP treatment and pre-treatment in Goodman and Baron scale score. However, Shetty et al. reported that Goodman and Baron scale score after fat grafting was significantly lower than pre-treatment. The results also showed that after fat grafting treatment, incidence of pain after fat grafting was 70%. After PRP treatment, in addition to pain (17%), there is a higher probability of postinflammatory hyperpigmentation (17%) and hematoma (6%). After SVF treatment, the incidence of postinflammatory hyperpigmentation and hematoma was all 0%. Autologous fat grafting, PRP and SVF are effective for the treatment of acne scars, and the safety of autologous fat grafting, PRP and SVF is acceptable. Autologous fat grafting and SVF may be a better treatment for acne scars than PRP. However, this hypothesis still needs to be tested in the future large randomized controlled trials. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Cell-assisted lipotransfer in treating uncontrollable sepsis associated perianal fistula: a pilot study.

Surgeons can treat debilitating conditions of uncontrollable complex anorectal fistulas with sepsis, even after repeated fistula surgeries, for curative intention. Adipose-derived stem cells have shown good outcomes for refractory Crohn fistula. Unfortunately, cell therapy has some limitations, including high costs. We have therefore attempted immediate cell-assisted lipotransfer (CAL) in treating refractory complex anal fistulas and observed its outcomes. In a retrospective study, CAL, using a mixture of freshly extracted autologous stromal vascular fraction (SVF) and fat tissues, was used to treat 22 patients of refractory complex anal fistula from March 2018 to May 2021. Preoperative and postoperative assessments were performed with direct visual inspection, digital palpation, and endoanal ultrasonography. A fistula was considered completely healed if (1) the patient had no symptoms of discharge or inflammation; (2) there were no visible secondary openings of fistula tract inside and outside of the anorectal unit and even in the perineum; and (3) there was no primary opening in the anus. The endpoint of complete remission was wound healing without signs of inflammation 3 months after CAL treatment. In a total of 22 patients who received CAL treatment, 19 patients showed complete remission, 1 patient showed partial improvement, and 2 patients showed no improvement. One of the 2 patients without improvement at primary endpoint showed complete remission 9 months after CAL. There were no significant adverse effects of the procedure. We found that the immediately-collected CAL procedure for refractory complex anal fistula showed good outcomes without adverse side effects. It can be strongly recommended as an alternative surgical option for the treatment of complex anal fistula that is uncontrollable even after repeated surgical procedures. However, considering the unpredictable characteristics of SVF, long-term follow-up is necessary.

Platelet-Rich stroma from Crohn’s disease patients for treatment of perianal fistula shows a higher myeloid cell profile compared to non-IBD controls

BackgroundNew cell-based therapies are under investigation to improve perianal fistulizing Crohn’s disease (pCD) healing. Autologous stromal vascular fraction combined with platelet-rich plasma (referred to as platelet-rich stroma [PRS]) is a new adipose-derived stromal therapy. The effect of Crohn’s disease (CD) on adipose tissue, and adipose-derived therapies, is largely unknown. We characterized the cellular composition of subcutaneous lipoaspirate and PRS of pCD patients and non-Inflammatory Bowel Disease (IBD) controls. MethodsConsecutive pCD patients (≥18 years) and non-IBD controls, who underwent liposuction for the purpose of autologous PRS therapy, were included (October 2020 and March 2021). Mechanically fractionated lipoaspirate and the combined PRS product were analyzed for cell surface marker expression using fluorescence-activated cell sorting analysis. ResultsTwenty-three patients (37.8 [IQR 30.7–45.0] years; 9 [39.1 %] male; 11CD patients) were included. Similar total number of cells were found in CD and non-IBD lipoaspirate (CD 8.23 ± 1.62*105 cells/mL versus non-IBD 12.20 ± 3.39*105). Presence of stromal cells, endothelial like cells, immune cells, T-cells, myeloid cells and M2/M1 macrophage ratio were similar in CD and non-IBD lipoaspirate. In PRS samples, more cells/mL were seen in CD patients (P = 0.030). Myeloid cells were more abundant in CD PRS samples (P = 0.007), and appeared to have a higher regulatory M2/M1 ratio. Interdonor variation was observed between lipoaspirate and PRS samples. ConclusionsThe composition of CD and non-IBD lipoaspirate were found to be similar and interdonor variation was observed. However, PRS from CD patients showed more myeloid cells with a regulatory phenotype. Crohn’s disease does not appear to alter the immunological composition of adipose-derived products.