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Key Points
- Because fat comes from a person's body, there are no immune factors and no immunogenicity.
SAN DIEGO — Adipocyte-derived stem cells added to fat provide all the benefits of fat grafting with longer-lasting, more predictable results.
"Fat grafting has huge promise as a technique, but, because we don't know how much of the fat lasts, it seems as though other kinds of techniques that might enhance that graft take would be very beneficial," says Steven R. Cohen, M.D., in practice in San Diego.
He notes that fat is the ideal filler material. Because it comes from the person's body, there are no immune factors and no immunogenicity. "Stem cell therapy or regenerative therapies come about because we have discovered that within fat, not only are there adult stem cells, which are multipotential cells that have the possibility of turning into other kinds of tissue like bone or skin, but there are also a number of regenerative cells that come from the vascular endothelium.
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Figure 1: Patient pre-injection. (ALL PHOTOS CREDIT: STEVEN R. COHEN, M.D.)
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"If you can extract these from fat and recombine them with fat grafting, these regenerative cells stick on the outside of the fat cells and they seem to promote angiogenesis or an improved blood supply, so they seem to enhance graft take," he explains.
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Figure 2: One month after injection of fat, fat regenerative cells and fat-derived stem cells in bilateral nasolabial folds and upper lip. (ALL PHOTOS CREDIT: STEVEN R. COHEN, M.D.)
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ADVANTAGES OF ADDING STEM CELLS A study conducted in Japan by Matsumoto et al found that cell-assisted lipotransfer fat survived longer and had more prominent microvasculature than other fat. This study included three patients who underwent a tummy-tuck procedure and had aspirated fat and excised fat harvested. Histologic examination found that aspirated fat contained fewer vascular structures than excised fat. Identical amounts of aspirated fat and excised fat were processed for isolation of vascular stromal fractions.
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Figure 3: Six months after injection of fat, fat regenerative cells and fat-derived stem cells. (ALL PHOTOS CREDIT: STEVEN R. COHEN, M.D.)
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The investigators found that the number of adherent adipose-derived stromal (stem) cells at one week was greater in the excised fat than in the aspirated fat. Human aspirated fat was transplanted with or without freshly isolated vascular stromal fractions containing adipose-derived stromal (stem) cells taken from the same patient. Microscopically detected microvasculature was prominent in cell-assisted lipotransfer fat, but not in non-cell-assisted lipotransfer fat.
Cytori Therapeutics manufactures a system called the Celution, which processes adipose tissue to obtain a diverse and mixed population of cells. Surgeons use syringes to remove the fat. Half of the fat is put into the Celution machine, which removes stem cells. "Then, you can take the regular fat, put these cells into it, and agitate it," Dr. Cohen explains. Studies have shown survival rates of 75 percent to 100 percent a year after surgery, which indicates that the results may be permanent, he adds.
These cells can also be used for difficult wounds, such as diabetic foot ulcers, and they can be used for breast reconstruction. "There are a whole host of applications. Because of that, there is a whole new world of cell banking. It is a very exciting field. Unfortunately, in the United States, we are a little bit behind, because these devices have yet to become FDA- approved," Dr. Cohen says. The Cytori Celution is currently being reviewed by the FDA.
