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Al Qurashi AA, Shah Mardan QNM, Alzahrani IA, AlAlwan AQ, Bafail A, Alaa Adeen AM, Albahrani A, Aledwani BN, Halawani IR, AlBattal NZ, Mrad MA. Efficacy of Exclusive Fat Grafting for Breast Reconstruction: An Updated Systematic Review and Meta-analysis. Aesthetic Plast Surg 2024:10.1007/s00266-024-03978-3. [PMID: 38772941 DOI: 10.1007/s00266-024-03978-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 02/29/2024] [Indexed: 05/23/2024]
Abstract
BACKGROUND Exclusive fat grafting is an alternative method to implant- or flap- based reconstruction techniques following mastectomies or breast conservation therapies. Its efficacy has been explored before but new data has come to light, resulting in previous results becoming outdated. Concerns have also been raised about the oncological safety of this procedure which must be evaluated alongside the efficacy to gain a comprehensive understanding of the merits of this alternative technique. METHODS We queried the PubMed electronic database from its inception until August 2023 for studies evaluating the efficacy and oncological safety of exclusive fat grafting breast reconstruction following cancer-related mastectomy or breast conservation therapy. Results of the analysis were pooled and presented as means or valid proportions. Results of the analysis were pooled using a random-effects model and presented with 95% confidence intervals (95% CIs) where appropriate. RESULTS 41 studies were included in our analysis. Pooled results show that on average, 1.7 sessions of exclusive fat grafting were required to complete reconstruction in Breast Conservation Therapy (BCT) patients, with an average volume of 114.2 ml being injected. For mastectomy patients with irradiated breasts, 4.7 sessions were needed on average with 556.8 ml being required to complete reconstruction, compared to their non-irradiated Counterparts requiring only 2.6 sessions and 207.2 ml to complete reconstruction. Oncological recurrence events were found in 29/583 non-irradiated mastectomy patients (p = 0.014) and in 41/517 BCT patients (p = 0.301) CONCLUSION: Exclusive fat grafting is an oncologically safe and reasonably efficacious alternative to more common methods of breast reconstruction. More data is needed to fully characterize the oncological safety of this procedure in irradiated and non-irradiated mastectomy patients. LEVEL OF EVIDENCE III 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 .
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Affiliation(s)
- Abdullah A Al Qurashi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Qutaiba N M Shah Mardan
- Plastic and Reconstructive Surgery Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | | | - Abdullah Q AlAlwan
- Department of Plastic and Reconstructive Surgery, Security Forces Hospital, Riyadh, Saudi Arabia
| | - Anas Bafail
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Abdulqader Murad Alaa Adeen
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Abdulaziz Albahrani
- Department of Plastic and Reconstructive Surgery, King Fahad Hospital, Al Hofuf, Saudi Arabia
| | - Batoul Najeeb Aledwani
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | | | - Nouf Z AlBattal
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Mohamed Amir Mrad
- Plastic and Reconstructive Surgery Section, Department of Surgery, King Faisal Specialist Hospital & Research Centre, P.O. Box 3354, 11211, Riyadh, Saudi Arabia.
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Shen S, Huo H, Ren H, Shao Y. Comparative Efficacy and Safety of Cell-Assisted and Conventional Lipotransfer in Facial Filling: A Systematic Review and Meta-Analysis. Aesthetic Plast Surg 2024; 48:1444-1456. [PMID: 37794201 DOI: 10.1007/s00266-023-03650-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 08/20/2023] [Indexed: 10/06/2023]
Abstract
PURPOSE We aim to compare the efficacy and safety of cell-assisted lipotransfer (CAL) and conventional lipotransfer (CLT) in facial filling. METHODS The PubMed and Embase databases were searched for relevant publications until February 2023. All studies evaluating the efficacy and safety of cell-assisted and conventional lipotransfer in facial filling were included. We calculated pooled standardized mean difference (SMD) and 95% CIs for continuous outcomes and pooled risk ratio (RR) with 95% CIs for binary outcomes. The Cochrane's Risk of Bias Tool and the Newcastle-Ottawa Scale (NOS) were used to evaluate the quality of studies. RESULTS A total of 15 studies with 737 patients were included in this analysis. The fat survival rate and patient satisfaction rate were significantly higher in the CAL group compared to the CLT group (SMD: 3.04, 95% CI 2.09-3.99; RR: 1.34, 95% CI 1.08-1.67). However, no significant difference in complication rates (RR: 0.95, 95% CI 0.50-1.81) and a lower secondary operation rate in the CAL group (RR: 0.52, 95% CI 0.03-0.82) were observed. No obvious publication bias was observed in the funnel plot (Egger's P values = 0.084 and 0.403). CONCLUSIONS Based on the pooled results, we tentatively conclude that CAL may have superior fat survival rate and satisfaction rate compared to CLT in facial filling, without compromising patient safety. However, the majority of the included studies were observational studies with small sample sizes. Future research should focus on investigating the long-term efficacy and safety of these techniques. NO LEVEL ASSIGNED This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. 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 .
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Affiliation(s)
- Shurui Shen
- Department of Plastic and Cosmetic Surgery, The First Hospital of Jilin University, Changchun, China
| | - Huasong Huo
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
| | - Hang Ren
- Department of Gynecologic Oncology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Ying Shao
- Department of Plastic and Cosmetic Surgery, The First Hospital of Jilin University, Changchun, China.
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Jian C, Wu T, Wang L, Gao C, Fu Z, Zhang Q, Shi C. Biomimetic Nanoplatform for Dual-Targeted Clearance of Activated and Senescent Cancer-Associated Fibroblasts to Improve Radiation Resistance in Breast Cancer. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2024:e2309279. [PMID: 38214439 DOI: 10.1002/smll.202309279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/19/2023] [Indexed: 01/13/2024]
Abstract
Radiation resistance in breast cancer resulting in residual lesions or recurrence is a significant cause to radiotherapy failure. Cancer-associated fibroblasts (CAFs) and radiotherapy-induced senescent CAFs can further lead to radiation resistance and tumor immunosuppressive microenvironment. Here, an engineering cancer-cell-biomimetic nanoplatform is constructed for dual-targeted clearance of CAFs as well as senescent CAFs. The nanoplatform is prepared by 4T1 cell membrane vesicles chimerized with FAP single-chain fragment variable as the biomimetic shell for targeting of CAFs and senescent CAFs, and PLGA nanoparticles (NPs) co-encapsulated with nintedanib and ABT-263 as the core for clearance of CAFs and senescent CAFs, which are noted as FAP-CAR-CM@PLGA-AB NPs. It is evidenced that FAP-CAR-CM@PLGA-AB NPs directly suppressed the tumor-promoting effect of senescent CAFs. It also exhibits prolonged blood circulation and enhanced tumor accumulation, dual-cleared CAFs and senescent CAFs, improved radiation resistance in both acquired and patient-derived radioresistant tumor cells, and effective antitumor effect with the tumor suppression rate of 86.7%. In addition, FAP-CAR-CM@PLGA-AB NPs reverse the tumor immunosuppressive microenvironment and enhance systemic antitumor immunity. The biomimetic system for dual-targeted clearance of CAFs and senescent CAFs provides a potential strategy for enhancing the radio-sensitization of breast cancer.
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Affiliation(s)
- Chen Jian
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Hubei Province Clinical Research Center for Precision Medicine for Critical Illness, Wuhan, 430022, China
| | - Tingting Wu
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Hubei Province Clinical Research Center for Precision Medicine for Critical Illness, Wuhan, 430022, China
| | - Lulu Wang
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Hubei Province Clinical Research Center for Precision Medicine for Critical Illness, Wuhan, 430022, China
| | - Chen Gao
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Hubei Province Clinical Research Center for Precision Medicine for Critical Illness, Wuhan, 430022, China
| | - Zhiwen Fu
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Hubei Province Clinical Research Center for Precision Medicine for Critical Illness, Wuhan, 430022, China
| | - Qian Zhang
- Key Laboratory for Thin Film and Microfabrication Technology of the Ministry of Education, Department of Instrument Science and Engineering, School of Electronic Information and Electrical Engineering, Institute of Nano Biomedicine and Engineering, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Chen Shi
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Hubei Province Clinical Research Center for Precision Medicine for Critical Illness, Wuhan, 430022, China
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Wu Q, Chen S, Peng W, Chen D. Current perspectives on cell-assisted lipotransfer for breast cancer patients after radiotherapy. World J Surg Oncol 2023; 21:133. [PMID: 37069583 PMCID: PMC10108507 DOI: 10.1186/s12957-023-03010-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 03/30/2023] [Indexed: 04/19/2023] Open
Abstract
BACKGROUND Cell-assisted lipotransfer (CAL), a technique of autologous adipose transplantation enriched with adipose-derived stem cells (ADSCs), has the potential to improve cosmetic outcomes at irradiated sites. However, many concerns have been raised about the possibility of ADSCs increasing oncological risk in cancer patients. With the increasing demand for CAL reconstruction, there is an urgent need to determine whether CAL treatment could compromise oncological safety after radiotherapy, as well as to evaluate its efficacy in guiding clinical decisions. METHODS A PRISMA-compliant systematic review of the safety and efficacy of CAL in breast cancer patients after radiotherapy was conducted. The PubMed, Ovid, Cochrane Library, and ClinicalTrials.gov databases were comprehensively searched from inception to 31 December 2021. RESULTS The search initially yielded 1185 unique studies. Ultimately, seven studies were eligible. Based on the limited outcome evidence, CAL did not increase recurrence risk in breast cancer patients but presented aesthetic improvement and higher volumetric persistence in a long-term follow-up. Although breast reconstruction with CAL also had oncological safety after radiotherapy, these patients needed more adipose tissue and had relatively lower fat graft retention than the non-irradiated patients (P < 0.05). CONCLUSIONS CAL has oncological safety and does not increase recurrence risk in irradiated patients. Since CAL doubles the amount of adipose required without significantly improving volumetric persistence, clinical decisions for irradiated patients should be made more cautiously to account for the potential costs and aesthetic outcomes. There is limited evidence at present; thus, higher-quality, evidence-based studies are required to establish a consensus on breast reconstruction with CAL after radiotherapy.
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Affiliation(s)
- Qiuwan Wu
- The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, 55 Zhenhai Road, Siming District, Xiamen, Fujian, 361003, P. R. China
- The Third Clinical Medical College, Fujian Medical University, Xiamen, Fujian, P. R. China
| | - Shuai Chen
- The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, 55 Zhenhai Road, Siming District, Xiamen, Fujian, 361003, P. R. China
| | - Wuyun Peng
- The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, 55 Zhenhai Road, Siming District, Xiamen, Fujian, 361003, P. R. China
| | - Donghan Chen
- The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, 55 Zhenhai Road, Siming District, Xiamen, Fujian, 361003, P. R. China.
- The Third Clinical Medical College, Fujian Medical University, Xiamen, Fujian, P. R. China.
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Kuruvilla AS, Yan Y, Rathi S, Wang F, Weichman KE, Ricci JA. Oncologic Safety in Autologous Fat Grafting After Breast Conservation Therapy: A Systematic Review and Meta-analysis of the Literature. Ann Plast Surg 2023; 90:106-110. [PMID: 36534109 DOI: 10.1097/sap.0000000000003385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Autologous fat grafting (AFG) is often used to reconstruct defects after breast conservation therapy (BCT). However, concerns exist about the possibility of AFG-related recurrence or metastasis. This study aims to evaluate the literature to evaluate oncologic outcomes in patients undergoing AFG at the time of BCT. METHODS A systematic review of articles related to AFG based reconstruction at the time of BCT from 1970 to 2021 was performed via PubMed. Patients were grouped based on the presence or lack of AFG usage at the time of BCT, and oncologic outcomes and complications were compared. RESULTS Of the 146 articles identified, 15 were included. Nine hundred patients underwent BCT alone and 1063 patients underwent BCT with AFG patients. Similar average follow-up time was observed between the groups, 58.7 months (BCT only) and 55.2 months (BCT with AFG). On pooled analysis, no difference was identified in local recurrence 4.8% (43 patients) of the BCT group and 3% (32 patients) in the AFG group (P = 0.8), metastasis 4.8% (43 patients) of the BCT group and 6.9% (73 patients) in the AFG group (P = 0.3), or fat necrosis (P = 0.44). Meta-analysis additionally did not identify any statistically significant odds ratios between the BCT only group and BCT with AFG group when evaluated for total recurrence, local recurrence, metastasis or fat necrosis. CONCLUSIONS The results show no significant difference in cancer recurrence or metastasis in the BCT only group versus BCT and AFG, showing that fat grafting has safe outcomes.
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Affiliation(s)
- Annet S Kuruvilla
- From the Renaissance School of Medicine at Stony Brook University, Stony Brook, NY
| | - Yufan Yan
- Division of Plastic and Reconstructive Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx
| | - Sourish Rathi
- New York Institute of Technology College of Osteopathic Medicine (NYITCOM), Old Westbury, NY
| | - Fei Wang
- Division of Plastic and Reconstructive Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx
| | - Katie E Weichman
- Division of Plastic and Reconstructive Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx
| | - Joseph A Ricci
- Division of Plastic and Reconstructive Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx
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Aronowitz JA, Oheb D, Cai N, Pekcan A, Winterhalter B, Clayton J. Esthetic Surgery Applications for Adipose-Derived Stem Cells. Regen Med 2023. [DOI: 10.1007/978-3-030-75517-1_26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Ouyang H, Xie X, Xie Y, Wu D, Luo X, Wu J, Wang Y, Zhao L. Compliant, Tough, Anti-Fatigue, Self-Recovery, and Biocompatible PHEMA-Based Hydrogels for Breast Tissue Replacement Enabled by Hydrogen Bonding Enhancement and Suppressed Phase Separation. Gels 2022; 8:gels8090532. [PMID: 36135244 PMCID: PMC9498755 DOI: 10.3390/gels8090532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/19/2022] [Accepted: 08/23/2022] [Indexed: 11/30/2022] Open
Abstract
Although hydrogel is a promising prosthesis implantation material for breast reconstruction, there is no suitable hydrogel with proper mechanical properties and good biocompatibility. Here, we report a series of compliant and tough poly (hydroxyethyl methacrylate) (PHEMA)-based hydrogels based on hydrogen bond-reinforcing interactions and phase separation inhibition by introducing maleic acid (MA) units. As a result, the tensile strength, fracture strain, tensile modulus, and toughness are up to 420 kPa, 293.4%, 770 kPa, and 0.86 MJ/m3, respectively. Moreover, the hydrogels possess good compliance, where the compression modulus is comparable to that of the silicone breast prosthesis (~23 kPa). Meanwhile, the hydrogels have an excellent self-recovery ability and fatigue resistance: the dissipative energy and elastic modulus recover almost completely after waiting for 2 min under cyclic compression, and the maximum strength remains essentially unchanged after 1000 cyclic compressions. More importantly, in vitro cellular experiments and in vivo animal experiments demonstrate that the hydrogels have good biocompatibility and stability. The biocompatible hydrogels with breast tissue-like mechanical properties hold great potential as an alternative implant material for reconstructing breasts.
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Affiliation(s)
- Hongyan Ouyang
- College of Chemistry and Materials Science, Sichuan Normal University, Chengdu 610068, China
| | - Xiangyan Xie
- College of Chemistry and Materials Science, Sichuan Normal University, Chengdu 610068, China
| | - Yuanjie Xie
- College of Chemistry and Materials Science, Sichuan Normal University, Chengdu 610068, China
| | - Di Wu
- College of Chemistry and Materials Science, Sichuan Normal University, Chengdu 610068, China
| | - Xingqi Luo
- College of Chemistry and Materials Science, Sichuan Normal University, Chengdu 610068, China
| | - Jinrong Wu
- State Key Laboratory of Polymer Materials Engineering, College of Polymer Science and Engineering, Sichuan University, Chengdu 610065, China
| | - Yi Wang
- College of Chemistry and Materials Science, Sichuan Normal University, Chengdu 610068, China
- Correspondence: (Y.W.); (L.Z.)
| | - Lijuan Zhao
- College of Chemistry and Materials Science, Sichuan Normal University, Chengdu 610068, China
- Correspondence: (Y.W.); (L.Z.)
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Attenuation of Knee Osteoarthritis Progression in Mice through Polarization of M2 Macrophages by Intra-Articular Transplantation of Non-Cultured Human Adipose-Derived Regenerative Cells. J Clin Med 2021; 10:jcm10194309. [PMID: 34640324 PMCID: PMC8509129 DOI: 10.3390/jcm10194309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 09/16/2021] [Accepted: 09/17/2021] [Indexed: 12/12/2022] Open
Abstract
Adipose-derived regenerative cells (ADRCs) are non-cultured heterogeneous or mixed populations of cells obtained from adipose tissue by collagenase digestion. The injection of ADRCs have been tried clinically for the treatment of osteoarthritis (OA). The purpose of this study was to evaluate the effect of intra-articular transplantation of human ADRCs on OA progression in mice and the effect of ADRCs on macrophage polarization. In in vivo experiments, BALB/c-nu mice with knee OA received intra-articular transplantation of either phosphate buffered-saline or human ADRCs. OA progression was evaluated histologically and significantly attenuated in the ADRC group at both four and eight weeks postoperatively. The expression of OA-related proteins in the cartilage and macrophage-associated markers in the synovium were examined by immunohistochemistry. The numbers of MMP-13-, ADAMTS-5-, IL-1β-, IL-6- and iNOS-positive cells significantly decreased, and type II collagen- and CD206-positive cells were more frequently detected in the ADRC group compared with that in the control group. In vitro co-culture experiments showed that ADRCs induced macrophage polarization toward M2. The results of this study suggest that the intra-articular transplantation of human ADRCs could attenuate OA progression possibly by reducing catabolic factors in chondrocytes and modulating macrophage polarization.
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Update on the Basic Science Concepts and Applications of Adipose-Derived Stem Cells in Hand and Craniofacial Surgery. Plast Reconstr Surg 2021; 148:475e-486e. [PMID: 34432707 DOI: 10.1097/prs.0000000000008279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
SUMMARY Adipose-derived stem cell therapy offers plastic surgeons a novel treatment alternative for conditions with few therapeutic options. Adipose-derived stem cells are a promising treatment because of their broad differentiation potential, capacity for self-renewal, and ease of isolation. Over the past decade, plastic surgeons have attempted to harness adipose-derived stem cells' unique cellular characteristics to improve the survival of traditional fat grafting procedures, a process known as cell-assisted lipotransfer. However, the full implications of cell-assisted lipotransfer in clinical practice remain incompletely understood, stressing the urgent need to assess the scientific evidence supporting adipose-derived stem cell-based interventions. Furthermore, with the strict regulatory climate surrounding tissue explantation therapies, reviewing the safety and efficacy of these treatments will clarify their regulatory viability moving forward. In this report, the authors provide a comprehensive, up-to-date appraisal of best evidence-based practices supporting adipose-derived stem cell-derived therapies, highlighting the known mechanisms behind current clinical applications in tissue engineering and regenerative medicine specific to plastic and reconstructive surgery. The authors outline best practices for the harvest and isolation of adipose-derived stem cells and discuss why procedure standardization will elucidate the scientific bases for their broad use. Finally, the authors discuss challenges posed by U.S. Food and Drug Administration oversight of these cell-based therapies and examine the role of adipose-derived stem cell-based applications in the future of plastic surgery.
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Sakai Y, Fukunishi S, Takamura M, Kawaguchi K, Inoue O, Usui S, Takashima S, Seki A, Asai A, Tsuchimoto Y, Nasti A, Bich Ho TT, Imai Y, Yoshimura K, Murayama T, Yamashita T, Arai K, Yamashita T, Mizukoshi E, Honda M, Wada T, Harada K, Higuchi K, Kaneko S. Clinical trial of autologous adipose tissue-derived regenerative (stem) cells therapy for exploration of its safety and efficacy. Regen Ther 2021; 18:97-101. [PMID: 34095367 PMCID: PMC8165289 DOI: 10.1016/j.reth.2021.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 04/03/2021] [Accepted: 04/27/2021] [Indexed: 12/14/2022] Open
Abstract
Introduction Liver cirrhosis is the ultimate condition of chronic liver diseases. Non-alcoholic steatohepatitis and fatty liver diseases are emerging in association with metabolic syndrome largely due to excess nutrition. Stromal cells of adipose tissue are enriched mesenchymal stem cells which are pluripotent and immunomodulatory, which are expected to be applied for repairing/regenerative therapy of the impaired organs. Methods We conducted the multi-institutional clinical trial (Japanese UMIN Clinical Trial Registry: UMIN000022601) of cell therapy using freshly isolated autologous adipose tissue-derived regenerative (stem) cells (ADRCs), which are obtained by the investigational trial device, adipose tissue dissociation device, for liver cirrhosis patients due to non-alcoholic steatohepatitis or fatty liver disease, to exploratory assess efficacy as well as safety of this trial. We completed treatment and 24 weeks follow-up for 7 patients. Results We observed that 6 out of 7 patients' serum albumin concentration was improved. As for prothrombin activity, 5 out of 7 patients showed improvement. No trial-related adverse events, which were serious or non-serious, was observed. Besides, no malfunction of the investigational trial device was encountered. Conclusion Thus, treatment with autologous ADRCs obtained with the investigational trial device in steatohepatitis-related cirrhosis was confirmed to be safely conductible and potentially promising for the retaining or improving the impaired hepatic reserve.
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Affiliation(s)
- Yoshio Sakai
- Department of Gastroenterology, Kanazawa University Hospital, Kanazawa, Japan
- Corresponding author. 13-1 Takara-machi, Kanazawa, Ishikawa 920-8641, Japan. Fax: +81 76 234 4250.
| | - Shinya Fukunishi
- Department of Gastroenterology, Osaka Medical College, Takatsuki, Japan
| | - Masayuki Takamura
- Department of Cardiovascular Medicine, Kanazawa University Hospital, Kanazawa, Japan
| | - Kazunori Kawaguchi
- Department of Gastroenterology, Kanazawa University Hospital, Kanazawa, Japan
| | - Oto Inoue
- Department of Cardiovascular Medicine, Kanazawa University Hospital, Kanazawa, Japan
| | - Soichiro Usui
- Department of Cardiovascular Medicine, Kanazawa University Hospital, Kanazawa, Japan
| | - Shinichiro Takashima
- Department of Cardiovascular Medicine, Kanazawa University Hospital, Kanazawa, Japan
| | - Akihiro Seki
- Department of Gastroenterology, Kanazawa University Hospital, Kanazawa, Japan
| | - Akira Asai
- Department of Gastroenterology, Osaka Medical College, Takatsuki, Japan
| | - Yusuke Tsuchimoto
- Department of Gastroenterology, Osaka Medical College, Takatsuki, Japan
| | - Alessandro Nasti
- System Biology, Graduate School of Advanced Preventive Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Tuyen Thuy Bich Ho
- System Biology, Graduate School of Advanced Preventive Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Yasuhito Imai
- Innovative Clinical Research Center, Kanazawa University, Kanazawa, Japan
| | - Kenichi Yoshimura
- Innovative Clinical Research Center, Kanazawa University, Kanazawa, Japan
| | - Toshinori Murayama
- Innovative Clinical Research Center, Kanazawa University, Kanazawa, Japan
| | - Taro Yamashita
- Department of General Medicine, Kanazawa University Hospital, Kanazawa, Japan
| | - Kuniaki Arai
- Department of Gastroenterology, Kanazawa University Hospital, Kanazawa, Japan
| | - Tatsuya Yamashita
- Department of Gastroenterology, Kanazawa University Hospital, Kanazawa, Japan
| | - Eishiro Mizukoshi
- Department of Gastroenterology, Kanazawa University Hospital, Kanazawa, Japan
| | - Masao Honda
- Department of Gastroenterology, Kanazawa University Hospital, Kanazawa, Japan
| | - Takashi Wada
- Department of Nephrology, Kanazawa University Hospital, Kanazawa, Japan
| | - Kenichi Harada
- Department of Human Pathology, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | - Kazuhide Higuchi
- Department of Gastroenterology, Osaka Medical College, Takatsuki, Japan
| | - Shuichi Kaneko
- Department of Gastroenterology, Kanazawa University Hospital, Kanazawa, Japan
- System Biology, Graduate School of Advanced Preventive Medical Sciences, Kanazawa University, Kanazawa, Japan
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Safety and Effectiveness of Autologous Fat Grafting after Breast Radiotherapy: A Systematic Review and Meta-Analysis. Plast Reconstr Surg 2021; 147:1-10. [PMID: 33370043 DOI: 10.1097/prs.0000000000007416] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate the safety and effectiveness of autologous fat grafting after radiotherapy. METHODS All studies published before December of 2019 were collected by searching on PubMed, Embase, Cochrane, Web of Science, China National Knowledge Infrastructure, and Wanfang Data. After independently screening the studies and extracting the data, Stata was applied to perform meta-analysis. RESULTS Seventeen qualified articles were eventually included, involving a total of 1658 patients, of which 1555 underwent autologous fat grafting. Overall, empirically from the data, the use of autologous fat grafting after radiotherapy does not increase the incidence of complications or the risk of tumor recurrence. Through statistical analysis, the authors found that 152 patients suffered complications after undergoing autologous fat grafting [152 of 1555 (9.8 percent)]; 72 patients suffered complications after undergoing postradiotherapy autologous fat grafting [72 of 1040 (6.9 percent)], including seven cases of tumor recurrence [seven of 1040 (0.7 percent)]; and 80 patients suffered complications after undergoing autologous fat grafting without radiotherapy [80 of 515 (15.5 percent)], including seven cases of tumor recurrence [seven of 515 (1.4 percent)]. The authors also found that 970 of 1040 patients (93.3 percent) were satisfied with the results of postradiotherapy autologous fat grafting for breast reconstruction. CONCLUSIONS This study has provided an evidence-based conclusion supporting the use of autologous fat grafting for breast reconstruction after radiotherapy. Autologous fat grafting can effectively correct breast deformity and contracture caused by breast-conserving therapy and radiotherapy and increase patient satisfaction without increasing the rate of tumor recurrence.
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Fat Grafting in Radiation-Induced Soft-Tissue Injury: A Narrative Review of the Clinical Evidence and Implications for Future Studies. Plast Reconstr Surg 2021; 147:819-838. [PMID: 33776031 DOI: 10.1097/prs.0000000000007705] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
SUMMARY Radiation-induced changes in skin and soft tissue result in significant cosmetic and functional impairment with subsequent decrease in quality of life. Fat grafting has emerged as a therapy for radiation-induced soft-tissue injury, and this narrative review aims to evaluate the current clinical evidence regarding its efficacy. A review was conducted to examine the current clinical evidence of fat grafting as a therapy for radiation-induced injury to the skin and soft tissue and to outline the clinical outcomes that can be used to more consistently quantify chronic radiation-induced injury in future clinical studies. The current clinical evidence regarding the efficacy of fat grafting to treat radiation-induced injury of the skin and soft tissue suggests that fat grafting increases skin softness and pliability, induces volume restoration, improves hair growth in areas of alopecia, reduces pain, and improves cosmetic and functional outcomes. However, literature in this field is far from robust and mired by the retrospective nature of the studies, lack of adequate controls, and inherent limitations of small case series and cohorts. A series of actions have been identified to strengthen future clinical data, including the need for physical examination using a validated scale, appropriate imaging, skin biomechanics and microcirculation testing, and histologic analysis. In conclusion, radiation-induced soft-tissue injury is a significant health burden that can lead to severe functional and aesthetic sequelae. Although still in a preliminary research phase, there is promising clinical evidence demonstrating the benefits of fat grafting to treat chronic changes after radiation therapy. Future clinical studies will require larger cohorts, adequate controls, and consistent use of objective measurements.
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Tayeh S, Muktar S, Wazir U, Carmichael AR, Al-Fardan Z, Kasem A, Hamdi M, Mokbel K. Is Autologous Fat Grafting an Oncologically Safe Procedure following Breast Conserving Surgery for Breast Cancer? A Comprehensive Review. J INVEST SURG 2020; 35:390-399. [PMID: 33302753 DOI: 10.1080/08941939.2020.1852343] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Autologous fat grafting (AFG) is a recognized surgical procedure to correct deformities following breast conservation surgery (BCS) for breast cancer. However, there are concerns about the oncological safety of this technique. In this study we have reviewed the current literature to assess whether AFG adversely influences the oncological outcome after BCS for breast cancer. METHODS We have searched the medical literature using the Embase and PubMed search engines from conception until May 2019 to identify all relevant studies of patients who underwent AFG after BCS. Meta-analysis and meta-regression methodologies were used to calculate the overall relative risk (RR) of loco-regional recurrence (LRR) rates for case-control and case series studies (with historical controls) respectively. RESULTS We have identified 26 eligible studies with a total of 1640 patients who had undergone fat transfer after lumpectomy for breast cancer. The meta-analysis of 11 studies revealed an overall RR for LRR of 0.82 [95% confidence interval (CI):0.14-1.66]. The meta-regression of case series revealed an overall incidence of LRR of 1.85% compared with 2.53% for historical controls. CONCLUSIONS Our study lends further support to the notion that fat transfer after lumpectomy for breast cancer does not seem to increase the risk of LRR. However further prospective research is required in order to confirm this.
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Affiliation(s)
- Salim Tayeh
- The London Breast Institute, Princess Grace Hospital, London, UK.,Department of General Surgery, Homerton University Hospital, London, UK
| | - Samantha Muktar
- The London Breast Institute, Princess Grace Hospital, London, UK
| | - Umar Wazir
- The London Breast Institute, Princess Grace Hospital, London, UK.,Department of General Surgery, Khyber Teaching Hospital, Peshawar, Pakistan
| | - Amtul R Carmichael
- University Hospital of Derby and Burton NHS Foundation Trust, Queens Hospital, Burton upon Trent, UK
| | | | - Abdul Kasem
- Department of General Surgery, King's College Hospitals NHS Trust, Brixton, UK
| | - Moustapha Hamdi
- Brussels University Hospital, Vrij Universiteit Brussels (VUB), Brussels, Belgium
| | - Kefah Mokbel
- The London Breast Institute, Princess Grace Hospital, London, UK
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Wang L, Li Y, Zhang M, Huang K, Peng S, Xiao J. Application of Nanomaterials in Regulating the Fate of Adipose-derived Stem Cells. Curr Stem Cell Res Ther 2020; 16:3-13. [PMID: 32357820 DOI: 10.2174/1574888x15666200502000343] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 02/18/2020] [Accepted: 03/06/2020] [Indexed: 01/22/2023]
Abstract
Adipose-derived stem cells are adult stem cells which are easy to obtain and multi-potent. Stem-cell therapy has become a promising new treatment for many diseases, and plays an increasingly important role in the field of tissue repair, regeneration and reconstruction. The physicochemical properties of the extracellular microenvironment contribute to the regulation of the fate of stem cells. Nanomaterials have stable particle size, large specific surface area and good biocompatibility, which has led them being recognized as having broad application prospects in the field of biomedicine. In this paper, we review recent developments of nanomaterials in adipose-derived stem cell research. Taken together, the current literature indicates that nanomaterials can regulate the proliferation and differentiation of adipose-derived stem cells. However, the properties and regulatory effects of nanomaterials can vary widely depending on their composition. This review aims to provide a comprehensive guide for future stem-cell research on the use of nanomaterials.
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Affiliation(s)
- Lang Wang
- Department of Oral and Maxillofacial Surgery, The Affiliated Stomatology Hospital of Southwest Medical University, Luzhou 646000, China
| | - Yong Li
- Department of Oral and Maxillofacial Surgery, The Affiliated Stomatology Hospital of Southwest Medical University, Luzhou 646000, China
| | - Maorui Zhang
- Department of Oral Implantology, The Affiliated Stomatology Hospital of Southwest Medical University, Luzhou 646000, China
| | - Kui Huang
- Department of Oral and Maxillofacial Surgery, The Affiliated Stomatology Hospital of Southwest Medical University, Luzhou 646000, China
| | - Shuanglin Peng
- Department of Oral Implantology, The Affiliated Stomatology Hospital of Southwest Medical University, Luzhou 646000, China
| | - Jingang Xiao
- Department of Oral and Maxillofacial Surgery, The Affiliated Stomatology Hospital of Southwest Medical University, Luzhou 646000, China
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Chen Y, He Y, Wang X, Lu F, Gao J. Adipose‑derived mesenchymal stem cells exhibit tumor tropism and promote tumorsphere formation of breast cancer cells. Oncol Rep 2019; 41:2126-2136. [PMID: 30816504 PMCID: PMC6412463 DOI: 10.3892/or.2019.7018] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 01/25/2019] [Indexed: 12/12/2022] Open
Abstract
Mesenchymal stem cells reportedly have a marked effect on tumor growth or suppression. However, it remains uncertain whether adipose-derived mesenchymal stem cells (ADSCs) from grafted fat can contribute to breast cancer growth and recurrence. In the present study, interactions between ADSCs and MCF-7 breast cancer cells were evaluated in a Matrigel co-culture system and in an in vivo nude mouse model. Results suggested that MCF-7 cells exerted tumor tropism effects on ADSCs and this may be regulated by chemokines, such as the macrophage inflammatory protein (MIP)-1δ and MIP-3α. Additionally, ADSCs significantly induced tumorsphere formation in vitro and promoted tumorigenicity in vivo. RT-qPCR analysis indicated that tumorsphere formation by MCF-7 cells was associated with the induction of stem-like properties, which was mediated by epithelial-mesenchymal transition. Together, the present findings indicated that ADSCs exhibit tropism and induce tumorsphere formation of MCF-7 cells.
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Affiliation(s)
- Yanqing Chen
- Department of Plastic and Cosmetic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Yunfan He
- Department of Plastic and Cosmetic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Xuecen Wang
- Department of Plastic and Cosmetic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Feng Lu
- Department of Plastic and Cosmetic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Jianhua Gao
- Department of Plastic and Cosmetic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
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Nanofat Increases Dermis Thickness and Neovascularization in Photoaged Nude Mouse Skin. Aesthetic Plast Surg 2018; 42:343-351. [PMID: 29380024 DOI: 10.1007/s00266-018-1091-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Accepted: 01/21/2018] [Indexed: 12/15/2022]
Abstract
OBJECT To investigate the effects of nanofat injection into photoaged nude mouse skin on dermis thickness, neovascularization, and cell proliferation. METHODS Adipose-derived stem cells (ADSCs) and nanofat were prepared from human liposuction aspirates. The photoaged skin model was created using ultraviolet B (UVB) radiation onto BALB/c nude mice. A total of 24 mice were used in this study; 6 mice without treatment (natural aging) served as controls, while 18 mice were irradiated under the UVB lamp and treated with PBS (200 μl per injection area), ADSCs (1 × 106/200 μl ADSCs per injection area), or nanofat (200 μl per injection area) on the dorsal skin. Four weeks after injection, skin specimens were collected. The skin texture of each group was evaluated by general observation. Histological analyses were performed to analyze skin structure, dermis thickness, collagen fiber arrangement, capillary density, and cell proliferation. RESULTS Four weeks after injection, no obvious differences were observed between the PBS group, ADSCs group, and nanofat group by skin gross observation. From the histological analyses, the ADSCs group and the nanofat group showed obviously thicker dermis than the PBS group (P < 0.05). More capillaries were observed in skin using anti-CD31 staining in the ADSCs and Nanofat groups than was observed in the PBS group (P < 0.05). No significant differences in the average dermis proliferation index were observed between groups by anti-Ki-67 staining. However, an increased epidermal proliferation index was observed in the ADSCs and Nanofat groups, compared to that in the PBS group (P < 0.05). CONCLUSIONS Nanofat increased dermis thickness and neovascularization in photoaged skin. NO LEVEL ASSIGNED 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 .
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Griessl M, Buchberger AM, Regn S, Kreutzer K, Storck K. Uncultivated stromal vascular fraction is equivalent to adipose-derived stem and stromal cells on porous polyurethrane scaffolds forming adipose tissue in vivo. Laryngoscope 2018; 128:E206-E213. [PMID: 29446455 DOI: 10.1002/lary.27124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 01/09/2018] [Accepted: 01/16/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVES/HYPOTHESIS To find an alternative approach to contemporary techniques in tissue augmentation and reconstruction, tissue engineering strategies aim to involve adipose-derived stem and stromal cells (ASCs) harboring a strong differentiation potential into various tissue types such as bone, cartilage, and fat. STUDY DESIGN Animal research. METHODS The stromal vascular fraction (SVF) was used directly as a cell source to provide a potential alternative to contemporary ASC-based adipose tissue engineering. Seeded in TissuCol fibrin, we applied ASCs or SVF cells to porous, degradable polyurethane (PU) scaffolds. RESULTS We successfully demonstrated the in vivo generation of volume-stable, well-vascularized PU-based constructs containing host-derived mature fat pads. Seeded human stem cells served as modulators of host-cell migration rather than differentiating themselves. We further demonstrated that preliminary culture of SVF cells was not necessary. CONCLUSIONS Our results bring adipose tissue engineering, together with automated processing devices, closer to clinical applicability. The time-consuming and cost-intensive culture and induction of the ASCs is not necessary. LEVEL OF EVIDENCE NA. Laryngoscope, 128:E206-E213, 2018.
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Affiliation(s)
- Michael Griessl
- Department of ENT, Head and Neck Surgery, Technical University of Munich, Munich, Germany
| | - Anna-Maria Buchberger
- Department of ENT, Head and Neck Surgery, Technical University of Munich, Munich, Germany
| | - Sybille Regn
- Department of ENT, Head and Neck Surgery, Technical University of Munich, Munich, Germany
| | - Kilian Kreutzer
- Department of Maxillofacial Surgery, University Clinic of the Charité Berlin, Berlin, Germany
| | - Katharina Storck
- Department of ENT, Head and Neck Surgery, Technical University of Munich, Munich, Germany
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