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Li B, Ri C, Mao J, Zhao M. A Bibliometric and Visualization Analysis on the Research of Fat Grafting from 1945 to 2021. Aesthetic Plast Surg 2023; 47:397-411. [PMID: 36261744 DOI: 10.1007/s00266-022-03137-6] [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: 06/18/2022] [Accepted: 10/03/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND It is very important to generate a comprehensive assessment of the fat grafting field due to the rapid growth of scientific literature. The current study aimed to use bibliometric analysis to evaluate fat grafting research qualitatively and quantitatively and determine the research hotspots and trends in this field. METHODS Publications on fat grafting research were extracted from the Web of Science core collection database. VOSviewer 1.6.18 was applied to perform the bibliometric analysis of these articles. RESULTS A total of 2558 studies published by 594 different journals authored by 9097 researchers were contained in this study. In the co-authorship analysis, the bulk of the retrieved studies was conducted by the USA, followed by China, Italy and Japan, while the most productive institution, journal and author were Chinese Academy of Medicine Sciences, Plastic and Reconstruction Surgery and Klinger M, respectively. In the co-cited analysis, the most top cited author, journal, organization and country were Coleman Sr, Plastic and Reconstruction Surgery, New York University and the USA, respectively. The map of keywords occurrence revealed the most active research aspects were focused on "surgery," "cell," "breast reconstruction" and "survival" and the time overlay mapping showed that the most active research hotspots were "breast reconstruction" and "retention". CONCLUSIONS The research hotspots include the following four aspects: aesthetic surgeries, cell-assisted lipotransfer, breast reconstruction and grafted fat survival. Breast fat grafting and volume retention may be trends in the future. We are willing to provide more beneficial data to contribute valuable research for the fat grafting through this study. 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)
- Bo Li
- The Second Affiliated Hospital of Dalian Medical University in China, Dalian, China
| | - CholSik Ri
- The Second Affiliated Hospital of Dalian Medical University in China, Dalian, China.,The Pyongyang Medical University in D.P.R of Korea, Pyongyang, Korea
| | - JiaXin Mao
- The Second Affiliated Hospital of Dalian Medical University in China, Dalian, China
| | - MuXin Zhao
- The Second Affiliated Hospital of Dalian Medical University in China, Dalian, China.
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Agaverdiev M, Shamsov B, Mirzoev S, Vardikyan A, Ramirez ME, Nurmukhametov R, Beilerli A, Zhang B, Gareev I, Pavlov V. MiRNA regulated therapeutic potential of the stromal vascular fraction: Current clinical applications - A systematic review. Noncoding RNA Res 2022; 8:146-154. [PMID: 36632616 PMCID: PMC9817091 DOI: 10.1016/j.ncrna.2022.12.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 12/17/2022] [Accepted: 12/18/2022] [Indexed: 12/23/2022] Open
Abstract
Introduction The stromal vascular fraction (SVF) is a heterogeneous population of cells that, interacting with each other, can affect the processes of regeneration, angiogenesis, and immunomodulation. Over the past 20 years, there has been a trend towards an increase in the number of clinical studies on the therapeutic use of SVF. MicroRNAs (miRNAs) are also important regulators of cellular function and they have been shown to be involved in SVF cellular component function. The purpose of this study was to analyze existing clinical studies on the therapeutic use of SVF including the role of miRNAs in the regulation of the function of the cellular component of SVF as an anti-inflammatory, pro-angiogenic and cell differentiation activity. Methods The search strategy was to use material from the clinicaltrials.gov website, which focused on the key term "Stromal vascular fraction", and the inclusion and exclusion criteria were divided into two stages. Results By August 2022, there were 149 registered clinical trials. Most studies belong to either Phase 1-2 (49.37%), Phase 1 (25.32%) or Phase 2 (22.78%). Most of them focused in the fields of traumatology, neurology/neurosurgery, endocrinology, vascular surgery, and immunology. However, only 8 clinical trials had published results. All of clinical trials have similar preparation methods and 8 clinical trials have positive results with no serious adverse effects. Conclusions There appears to be a wide potential for the clinical use of SVF without reports of serious side effects. Many preclinical and clinical studies are currently underway on the use of SVF, and their future results will help to further explore their therapeutic potential. Nevertheless, there are not many studies on the role of miRNAs in the SVF microenvironment; however, this topic is very important for further study of the clinical application of SVF, including safety, in various human diseases.
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Affiliation(s)
- Murad Agaverdiev
- Department of Urology, Bashkir State Medical University, 450008, Ufa, Russian Federation
| | - Bedil Shamsov
- Department of Urology, Bashkir State Medical University, 450008, Ufa, Russian Federation
| | - Sorbon Mirzoev
- Department of Urology, City Clinical Hospital, №21, 450071, Ufa, Russian Federation
| | - Andranik Vardikyan
- Department of Urology, Bashkir State Medical University, 450008, Ufa, Russian Federation
| | - Manuel Encarnacion Ramirez
- Department of Neurosurgery, Рeoples’ Friendship University of Russia (RUDN University), 6 Miklukho-Maklaya Street, Moscow, 117198, Russian Federation
| | - Renat Nurmukhametov
- Division of Spine Surgery, Central Clinical Hospital of the Russian Academy of Sciences, Moscow, Russian Federation
| | - Aferin Beilerli
- Department of Obstetrics and Gynecology, Tyumen State Medical University, 54 Odesskaya Street, 625023, Tyumen, Russia
| | - Bohan Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, No. 23, Youzheng Street, Harbin, 150001, China
| | - Ilgiz Gareev
- Central Research Laboratory, Bashkir State Medical University, 450008, Ufa, Russian Federation,Corresponding author.
| | - Valentin Pavlov
- Department of Urology, Bashkir State Medical University, 450008, Ufa, Russian Federation
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Yoshimura K, Sato K, Aoi N, Kurita M, Hirohi T, Harii K. Cell-Assisted Lipotransfer for Cosmetic Breast Augmentation: Supportive Use of Adipose-Derived Stem/Stromal Cells. Aesthetic Plast Surg 2020; 44:1258-1265. [PMID: 32766920 DOI: 10.1007/s00266-020-01819-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2007] [Accepted: 05/22/2007] [Indexed: 11/27/2022]
Abstract
BACKGROUND Lipoinjection is a promising treatment but has some problems, such as unpredictability and a low rate of graft survival due to partial necrosis. METHODS To overcome the problems with lipoinjection, the authors developed a novel strategy known as cellassisted lipotransfer (CAL). In CAL, autologous adiposederived stem (stromal) cells (ASCs) are used in combination with lipoinjection. A stromal vascular fraction (SVF) containing ASCs is freshly isolated from half of the aspirated fat and recombined with the other half. This process converts relatively ASC-poor aspirated fat to ASC-rich fat. This report presents the findings for 40 patients who underwent CAL for cosmetic breast augmentation. RESULTS Final breast volume showed augmentation by 100 to 200 ml after a mean fat amount of 270 ml was injected. Postoperative atrophy of injected fat was minimal and did not change substantially after 2 months. Cyst formation or microcalcification was detected in four patients. Almost all the patients were satisfied with the soft and natural-appearing augmentation. CONCLUSIONS The preliminary results suggest that CAL is effective and safe for soft tissue augmentation and superior to conventional lipoinjection. Additional study is necessary to evaluate the efficacy of this technique further.
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Affiliation(s)
- Kotaro Yoshimura
- Department of Plastic Surgery, University of Tokyo School of Medicine, 7-3-1 Hongo, Bunkyo-ku, 113-8655, Tokyo, Japan.
| | - Katsujiro Sato
- Cellport Clinic Yokohama, Yokohama Excellent III Building 2F, 3-35, Minami-nakadori, Naka-ku, Yokohama, 231-0006, Kanagawa, Japan
| | - Noriyuki Aoi
- Department of Plastic Surgery, University of Tokyo School of Medicine, 7-3-1 Hongo, Bunkyo-ku, 113-8655, Tokyo, Japan
| | - Masakazu Kurita
- Department of Plastic Surgery, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka-shi, 181-8611, Tokyo, Japan
| | - Toshitsugu Hirohi
- Ritz Cosmetic Surgery Clinic Tokyo, Meguro Toho Building 8F, 3-1-7, Kamiosaki, Shinagawa-ku, 141-0021, Tokyo, Japan
| | - Kiyonori Harii
- Department of Plastic Surgery, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka-shi, 181-8611, Tokyo, Japan
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Munteanu R, Onaciu A, Moldovan C, Zimta AA, Gulei D, Paradiso AV, Lazar V, Berindan-Neagoe I. Adipocyte-Based Cell Therapy in Oncology: The Role of Cancer-Associated Adipocytes and Their Reinterpretation as Delivery Platforms. Pharmaceutics 2020; 12:E402. [PMID: 32354024 PMCID: PMC7284545 DOI: 10.3390/pharmaceutics12050402] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 04/22/2020] [Accepted: 04/23/2020] [Indexed: 12/24/2022] Open
Abstract
Cancer-associated adipocytes have functional roles in tumor development through secreted adipocyte-derived factors and exosomes and also through metabolic symbiosis, where the malignant cells take up the lactate, fatty acids and glutamine produced by the neighboring adipocytes. Recent research has demonstrated the value of adipocytes as cell-based delivery platforms for drugs (or prodrugs), nucleic acids or loaded nanoparticles for cancer therapy. This strategy takes advantage of the biocompatibility of the delivery system, its ability to locate the tumor site and also the predisposition of cancer cells to come in functional contact with the adipocytes from the tumor microenvironment for metabolic sustenance. Also, their exosomal content can be used in the context of cancer stem cell reprogramming or as a delivery vehicle for different cargos, like non-coding nucleic acids. Moreover, the process of adipocytes isolation, processing and charging is quite straightforward, with minimal economical expenses. The present review comprehensively presents the role of adipocytes in cancer (in the context of obese and non-obese individuals), the main methods for isolation and characterization and also the current therapeutic applications of these cells as delivery platforms in the oncology sector.
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Affiliation(s)
- Raluca Munteanu
- Research Center for Advanced Medicine-Medfuture, Iuliu Hatieganu University of Medicine and Pharmacy, 23 Marinescu Street, 400337 Cluj-Napoca, Romania
| | - Anca Onaciu
- Research Center for Advanced Medicine-Medfuture, Iuliu Hatieganu University of Medicine and Pharmacy, 23 Marinescu Street, 400337 Cluj-Napoca, Romania
| | - Cristian Moldovan
- Research Center for Advanced Medicine-Medfuture, Iuliu Hatieganu University of Medicine and Pharmacy, 23 Marinescu Street, 400337 Cluj-Napoca, Romania
| | - Alina-Andreea Zimta
- Research Center for Advanced Medicine-Medfuture, Iuliu Hatieganu University of Medicine and Pharmacy, 23 Marinescu Street, 400337 Cluj-Napoca, Romania
| | - Diana Gulei
- Research Center for Advanced Medicine-Medfuture, Iuliu Hatieganu University of Medicine and Pharmacy, 23 Marinescu Street, 400337 Cluj-Napoca, Romania
| | - Angelo V. Paradiso
- Oncologia Sperimentale, Istituto Tumori G Paolo II, IRCCS, 70125 Bari, Italy
| | - Vladimir Lazar
- Worldwide Innovative Network for Personalized Cancer Therapy, 94800 Villejuif, France
| | - Ioana Berindan-Neagoe
- Research Center for Advanced Medicine-Medfuture, Iuliu Hatieganu University of Medicine and Pharmacy, 23 Marinescu Street, 400337 Cluj-Napoca, Romania
- Research Center for Functional Genomics, Biomedicine and Translational Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 23 Marinescu Street, 400337 Cluj-Napoca, Romania
- Department of Functional Genomics and Experimental Pathology, The Oncology Institute “Prof. Dr. Ion Chiricuta”, 34-36 Republicii Street, 400015 Cluj-Napoca, Romania
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Impact of growth factor content on proliferation of mesenchymal stromal cells derived from adipose tissue. PLoS One 2020; 15:e0230265. [PMID: 32298282 PMCID: PMC7162516 DOI: 10.1371/journal.pone.0230265] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 02/25/2020] [Indexed: 01/15/2023] Open
Abstract
Autologous adipose tissue (AT) transfer has gained widespread acceptance and is used for a broad variety of regenerative clinical indications. It is assumed that the successful outcome of AT transfer essentially depends on the amount of autocrine-generated growth factors (GF). It is supposed that several GF enhance and improve the anatomic and functional integration of the transplanted AT grafts at the site of implantation. In the present study we have investigated for the first time the correlation between the concentration of GF of freshly isolated AT and the proliferation and migration capacity of mesenchymal stroma cells (MSCs) derived from the respective AT sample. We here show that the proliferation and migration capacity of MSCs strongly depends on the GF content of the AT the cells were isolated from but in an inversely proportional manner. The lower the GF content of an AT sample was, the higher was the proliferation and migration capacity of the respective MSC population contained in the AT and vice versa. Furthermore, we found that supplementation with recombinant GFs only in the case of AT samples with low but not with higher growth factor contents led to a significant enhancement of proliferation and migration of the AT-resident MSCs. As we further show, this inefficiency of GFs to enhance MSC proliferation and migration in AT samples with high GF contents indicates a GF-mediated negative feedback mechanism leading to an impaired GF signaling in MSC obtained from those AT samples. Our results might explain why the successful use of AT grafting is frequently limited by low and unpredictable survival rates, and we suggest to use the knowledge of GF content of harvested AT as a predictive clinical parameter for risk assessment of the therapeutic outcome of autologous AT transfer.
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Di Nicola V. Omentum a powerful biological source in regenerative surgery. Regen Ther 2019; 11:182-191. [PMID: 31453273 PMCID: PMC6700267 DOI: 10.1016/j.reth.2019.07.008] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 07/24/2019] [Indexed: 02/06/2023] Open
Abstract
The Omentum is a large flat adipose tissue layer nestling on the surface of the intra-peritoneal organs. Besides fat storage, omentum has key biological functions in immune-regulation and tissue regeneration. Omentum biological properties include neovascularization, haemostasis, tissue healing and regeneration and as an in vivo incubator for cells and tissue cultivation. Some of these properties have long been noted in surgical practice and used empirically in several procedures. In this review article, the author tries to highlight the omentum biological properties and their application in regenerative surgery procedures. Further, he has started a process of standardisation of basic biological principles to pave the way for future surgical practice.
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Lee JS, Eo P, Kim MC, Kim JB, Jin HK, Bae JS, Jeong JH, Park HY, Yang JD. Effects of Stromal Vascular Fraction on Breast Cancer Growth and Fat Engraftment in NOD/SCID Mice. Aesthetic Plast Surg 2019; 43:498-513. [PMID: 30635686 DOI: 10.1007/s00266-018-01304-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Accepted: 12/23/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND To overcome unpredictable fat graft resorption, cell-assisted lipotransfer using stromal vascular fraction (SVF) has been introduced. However, its effect on cancer growth stimulation and its oncological safety are debatable. We investigated the effect of SVF on adjacent breast cancer and transplanted fat in a mouse model. METHODS A breast cancer xenograft model was constructed by injecting 2 × 106 MDA-MB-231-luc breast cancer cells into the right lower back of 40 NOD/SCID mice. Two weeks later, cancer size was sorted according to signal density using an in vivo optical imaging system, and 36 mice were included. Human fat was extracted from the abdomen, and SVFs were isolated using a component isolator. The mice were divided into four groups: A, controls; B, injected with 30 μl SVF; C, injected with 0.5 ml fat and 30 μl saline; group D, injected with 0.5 ml fat and 30 μl SVF. Magnetic resonance imaging and three-dimensional micro-computed tomography volumetric analysis were performed at 4 and 8 weeks. RESULTS Tumor volume was 43.6, 42.3, 48.7, and 42.4 mm3 at the initial time point and 6780, 5940, 6080, and 5570 mm3 at 8 weeks in groups A, B, C, and D, respectively. Fat graft survival volume after 8 weeks was 49.32% and 62.03% in groups C and D, respectively. At 2-month follow-up after fat grafting in the xenograft model, SVF injection showed an increased fat survival rate and did not increase the adjacent tumor growth significantly. CONCLUSION Fat grafting with SVF yields satisfactory outcome in patients who undergo breast reconstruction surgery. 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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Affiliation(s)
- Joon Seok Lee
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, 130 Dongdeokro, Jung-gu, Daegu, 41944, South Korea
| | - PilSeon Eo
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, 130 Dongdeokro, Jung-gu, Daegu, 41944, South Korea
| | | | - Jae Bong Kim
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, 130 Dongdeokro, Jung-gu, Daegu, 41944, South Korea
| | - Hee Kyung Jin
- Department of Laboratory Animal Medicine, College of Veterinary Medicine, Kyungpook National University, Daegu, 41944, South Korea
| | - Jae-Sung Bae
- Department of Physiology, School of Medicine, Kyungpook National University, Daegu, 41944, South Korea
| | - Jae-Hwan Jeong
- Cell and Matrix Research Institute, School of Medicine, Kyungpook National University, Daegu, 41944, South Korea
| | - Ho Yong Park
- Department of Surgery, School of Medicine, Kyungpook National University, Daegu, 41944, South Korea
| | - Jung Dug Yang
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, 130 Dongdeokro, Jung-gu, Daegu, 41944, South Korea.
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Egro F, Marra KG. Soft Tissue Reconstruction. Methods Mol Biol 2018; 1773:203-213. [PMID: 29687392 DOI: 10.1007/978-1-4939-7799-4_17] [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] [Indexed: 06/08/2023]
Abstract
Autologous fat transplantation has revolutionized soft tissue reconstruction, but conventional methods remain unpredictable as graft resorption rates are high due to lack of vascularization. The advent of adipose-derived stem cells (ASCs) has led to improvement of fat grafting outcomes, in part to their ability to undergo facile differentiation into adipose tissue, their angiogenic properties, and their ability to express and secrete multiple growth factors. This chapter discusses the isolation and characterization of human ASCs, its expansion in vitro, and relevant in vivo models for adipose tissue engineering.
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Is Centrifugation Necessary for Processing Lipoaspirate Harvested via Water-Jet Force Assisted Technique before Grafting? Evidence of Lipoaspirate Concentration With Enhanced Fat Graft Survival. Ann Plast Surg 2017; 77:477-84. [PMID: 27070683 DOI: 10.1097/sap.0000000000000718] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Although water-jet force-assisted liposuction technique (WAL) was demonstrated to have favorable effects on fat grafting, controversy continues concerning the application of centrifugation for lipoaspirate harvested via WAL. As a controversial technique, plastic surgeons often get perplexed to the necessity of using centrifugation during fat grafting procedure. In the present study, we adopted the recommended centrifugal intensity (1200g, 3 minutes) to process lipoaspirate and focused on the influence of centrifugation on the fate of lipoaspirate harvested with WAL technique. METHODS Lipoaspirate was obtained from 10 healthy Chinese female patients who underwent cosmetic liposuction. The harvested lipoaspirate was either not centrifuged (group A) or centrifuged at 1200g for 3 minutes (group B). Lipoaspirate from each group was compared in the in vitro and in vivo experiments. The influence of centrifugation on lipoaspirate viability and lipoaspirate survival after grafting were evaluated. RESULTS The viability of the lipoaspirates was similar between equally volumetric uncentrifugal and centrifugal lipoaspirate. However, centrifugation at 1200g for 3 minutes concentrated stromal vascular fraction cells and adipose-derived stem cells in lipoaspirate; greater angiogenesis and weight retention rates were observed in centrifugal lipoaspirate after grafting than those uncentrifugal lipoaspirate. CONCLUSIONS Centrifugation at 1200g for 3 minutes enhanced the survival of lipoaspirate harvested via WAL technique after grafting. Centrifugation at 1200g for 3 minutes was recommended to process lipoaspirate harvested with water-jet force assistance before grafting.
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Claro F, Moreira LR, Morari J, Sarian LOZ, Pinto GA, Velloso LA, Pinto-Neto AOM. Assessment of the Cancer Risk of the Fat-Grafted Breast in a Murine Model. Aesthet Surg J 2017; 37:603-613. [PMID: 27927612 DOI: 10.1093/asj/sjw209] [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: 11/13/2022] Open
Abstract
Background The results of experimental studies indicate that grafting of autologous adipose tissue may induce tumorigenesis at the recipient site, but clinical results do not support a carcinogenic effect of fat grafting to the breast. Objectives The authors assessed cancer risk following transplantation of autologous fat into murine mammary tissue. Methods In this animal study, mammary tissues from 54 breasts of 9 female rats were either grafted with autologous subcutaneous fat, grafted with autologous omental fat, or unmanipulated. Tissues were harvested and processed for histologic and immunohistochemical analyses, and the mRNA expression levels of specific genes were determined. Results No atypia or changes in lobular structures were observed in lipofilled breasts compared with controls. The numbers of ductal cell layers and terminal ductal units were similar for lipofilled and control breasts. Macrophage concentrations also were similar for the 3 groups. The localization and magnitude of plasminogen activator inhibitor 1 were similar for lipofilled and unmanipulated breast tissue. The percentages of cells expressing Ki67 or estrogen receptor (ER) and the ER/Ki67 balance were similar for the 3 groups. Gene expression was not altered in lipofilled breasts, compared with controls. Conclusions No theoretical risk of cancer was detected in the microenvironment of the lipofilled rat breast.
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Affiliation(s)
- Francisco Claro
- Department of Gynecology and Obstetrics, Laboratory of Specialized Pathology and Laboratory of Cell Signaling, Obesity and Comorbidities, School of Medical Sciences, State University of Campinas, Campinas-SP, Brazil
| | - Luciana R Moreira
- Department of Gynecology and Obstetrics, Laboratory of Specialized Pathology and Laboratory of Cell Signaling, Obesity and Comorbidities, School of Medical Sciences, State University of Campinas, Campinas-SP, Brazil
| | - Joseane Morari
- Department of Gynecology and Obstetrics, Laboratory of Specialized Pathology and Laboratory of Cell Signaling, Obesity and Comorbidities, School of Medical Sciences, State University of Campinas, Campinas-SP, Brazil
| | - Luis O Z Sarian
- Department of Gynecology and Obstetrics, Laboratory of Specialized Pathology and Laboratory of Cell Signaling, Obesity and Comorbidities, School of Medical Sciences, State University of Campinas, Campinas-SP, Brazil
| | - Glauce A Pinto
- Department of Gynecology and Obstetrics, Laboratory of Specialized Pathology and Laboratory of Cell Signaling, Obesity and Comorbidities, School of Medical Sciences, State University of Campinas, Campinas-SP, Brazil
| | - Licio A Velloso
- Department of Gynecology and Obstetrics, Laboratory of Specialized Pathology and Laboratory of Cell Signaling, Obesity and Comorbidities, School of Medical Sciences, State University of Campinas, Campinas-SP, Brazil
| | - Aara O M Pinto-Neto
- Department of Gynecology and Obstetrics, Laboratory of Specialized Pathology and Laboratory of Cell Signaling, Obesity and Comorbidities, School of Medical Sciences, State University of Campinas, Campinas-SP, Brazil
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Cervellione RM, Hajnal D, Varga G, Rakoczy G, Kaszaki J, Keene D, Goyal A, Dickson A, Cserni T. Mucosectomy impairs ileal microcirculation and results in flap contraction after experimental ileocystoplasty. J Pediatr Urol 2017; 13:81.e1-81.e5. [PMID: 28040322 DOI: 10.1016/j.jpurol.2016.11.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 11/03/2016] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Bladder augmentation with demucosalized ileal flap is a promising alternative approach for mucus free bladder augmentation; however, the contraction of the flap is still a major concern. It has been hypothesized that mucosectomy causes ischemic damage, but no direct histological evidence has been found and attention is now focused on the urothelium cover to prevent the exposure of the denuded surface to urine or the use of balloons to keep the flaps distended. OBJECTIVE Our aim was to study the effect of mucosectomy on the microcirculation of ileal flaps during reverse clam ileocystoplasty using direct intraoperative imaging of the ileum. Since the omentum is successfully used to revascularize ischemic tissue, we also examined whether omentopexy can prevent contraction. STUDY DESIGN Clam ileocystoplasty was performed in anesthetized minipigs with seromuscular (n = 3), seromusculo-submucosal (n = 3) reverse demucosalized ileal flaps. The velocity of the circulating red blood cells (RBCV) and the perfusion rate (PR) was measured with intravital videomicroscopy (Cytoscan A/R, Cytometrics, Philadelphia, PA, USA) before and after mucosectomy and the denuded surface of the ileum was covered with omentum after the reverse augmentation was complete (Figure). Animals were sacrificed after 8 weeks and the ileal flap dimensions were measured. RESULTS Significant reduction in RBCV and PR was detected after mucosectomy in both groups; however, no sign of acute flap necrosis or bladder perforation was seen. The omentum was found firmly attached to the ileal flaps, but contraction of the flaps was significant in both groups. CONCLUSION The disturbance in the microcirculation observed after mucosectomy may be responsible for flap contraction in ileocystoplasty with demucosalized ileum. Omentopexy did not help to prevent contraction. DISCUSSION Contraction of demucosalized intestinal flaps used for bladder augmentation has been frequently reported. This study provides direct evidence the first time for severely compromised microcirculation of the ileal flaps after mucosectomy. Limitation of the study is the relative low number of animals sacrificed.
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Affiliation(s)
- Raimondo M Cervellione
- Department of Paediatric Urology, Royal Manchester Children's Hospital, UK; Institute of Surgical Research, School of Medicine, University of Szeged, Hungary
| | - Daniel Hajnal
- Institute of Surgical Research, School of Medicine, University of Szeged, Hungary
| | - Gabreilla Varga
- Institute of Surgical Research, School of Medicine, University of Szeged, Hungary
| | - George Rakoczy
- Department of Paediatric Surgery, Royal Manchester Children's Hospital, UK
| | - Jozsef Kaszaki
- Institute of Surgical Research, School of Medicine, University of Szeged, Hungary
| | - David Keene
- Department of Paediatric Urology, Royal Manchester Children's Hospital, UK
| | - Anju Goyal
- Department of Paediatric Urology, Royal Manchester Children's Hospital, UK
| | - Alan Dickson
- Department of Paediatric Urology, Royal Manchester Children's Hospital, UK
| | - Tamas Cserni
- Department of Paediatric Urology, Royal Manchester Children's Hospital, UK; Institute of Surgical Research, School of Medicine, University of Szeged, Hungary.
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Stem cell regenerative potential for plastic and reconstructive surgery. Cell Tissue Bank 2016; 17:735-744. [PMID: 27604466 DOI: 10.1007/s10561-016-9583-4] [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: 06/15/2016] [Accepted: 09/01/2016] [Indexed: 12/20/2022]
Abstract
Stem cells represent heterogeneous population of undifferentiated cells with unique characteristics of long term self renewal and plasticity. Moreover, they are capable of active migration to diseased tissues, secretion of different bioactive molecules, and they have immunosuppressive potential as well. They occur in all tissues through life and are involved in process of embryogenesis and regeneration. During last decades stem cells attracted significant attention in each field of medicine, including plastic and reconstructive surgery. The main goal of the present review article is to present and discuss the potential of stem cells and to provide information about their safe utilization in chronic wounds and fistulae healing, scar management, breast reconstruction, as well as in bone, tendon and peripheral nerve regeneration.
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Abstract
BACKGROUND Despite the widespread use of autologous fat grafting in both reconstructive and cosmetic surgery, volume retention remains a significant problem. We aimed to critically appraise the current body of literature in fat grafting to provide a framework to guide application and comparison. METHOD Search of scientific databases and gray literature was conducted. Articles examining nonadipogenic applications of adipose tissue and those specific to breast reconstruction were excluded. RESULTS One hundred three articles were included. These fell under the headings of donor site, effect of infiltration solution, harvest method, effect of centrifugation, reinjection method, supplementation, the role of adipose-derived stem cells, and scaffolding. CONCLUSIONS Despite the significant research effort in this field, there remains no consensus as to the optimum technique. This stems from the vast array of research methods and short follow-up durations. Further, extrapolation of in vitro results to clinical settings has led to many conflicting practices.
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Jung HK, Kim CH, Song SY. Prospective 1-Year Follow-Up Study of Breast Augmentation by Cell-Assisted Lipotransfer. Aesthet Surg J 2016; 36:179-90. [PMID: 26342099 DOI: 10.1093/asj/sjv164] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Breast augmentation by cell-assisted lipotransfer (CAL) may achieve a more natural breast contour than silicone implants. Moreover, certain complications associated with these prosthetic devices can be avoided with CAL. Few prospective studies of CAL have been performed to examine long-term volume changes, effects on breast parenchymal tissue, and the effect of stromal vascular fraction (SVF) on graft survival. OBJECTIVES In a 1-year prospective study of patients who underwent CAL, the authors examined changes in breast volume, effects on parenchymal tissue, and the impact of SVF on graft survival. METHODS Following preoperative radiologic examination, patients underwent primary augmentation mammaplasty by CAL to both breasts. The SVF was characterized, and changes in breast volume were determined from magnetic resonance imaging studies performed postoperatively at 3 months and 1 year. A breast-imaging specialist reviewed all scans to detect changes in breasts. RESULTS Five patients (10 breasts) were enrolled. Averagely 23% of grafted fat in volume was additionally harvested from each patient to isolate SVF cells. One year after CAL, breast volume had decreased to 47% of the initial postoperative volume. There was no parenchymal changes except small oil cysts. The ratio of SVF cell count to grafted fat volume showed no correlation with graft survival. Patterns of breast-volume decrease differed between older women with a history of breastfeeding and younger women without a history of breastfeeding. CONCLUSIONS The addition of SVF cells did not appear to improve the retention of grafted fat in these patients. Skin tension may be an important factor influencing the absorption pattern of grafted fat. LEVEL OF EVIDENCE 4: Therapeutic.
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Affiliation(s)
- Hae Kyoung Jung
- Dr Jung is an Associate Professor, Department of Radiology, and Dr Kim is a Professor, Department of Plastic and Reconstructive Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Gyeonggi-do, Republic of Korea. Dr Song is an Assistant Professor, Department of Plastic and Reconstructive Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Chung Hun Kim
- Dr Jung is an Associate Professor, Department of Radiology, and Dr Kim is a Professor, Department of Plastic and Reconstructive Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Gyeonggi-do, Republic of Korea. Dr Song is an Assistant Professor, Department of Plastic and Reconstructive Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seung Yong Song
- Dr Jung is an Associate Professor, Department of Radiology, and Dr Kim is a Professor, Department of Plastic and Reconstructive Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Gyeonggi-do, Republic of Korea. Dr Song is an Assistant Professor, Department of Plastic and Reconstructive Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
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15
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Byrne M, O'Donnell M, Fitzgerald L, Shelley OP. Early experience with fat grafting as an adjunct for secondary burn reconstruction in the hand: Technique, hand function assessment and aesthetic outcomes. Burns 2015; 42:356-65. [PMID: 26739087 DOI: 10.1016/j.burns.2015.06.017] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 04/27/2015] [Accepted: 06/26/2015] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Fat transfer is increasingly used as part of our reconstructive armamentarium to address the challenges encountered in secondary burn reconstruction. The aim of this study was to review our experience with autologous fat transfer in relation to hand function, scarring and cosmesis, in patients undergoing secondary reconstruction after burns. METHOD Retrospective analysis of burn patients (2010-2013) who underwent autologous fat transfer to improve scarring, contour deformity and/or scar contracture was performed. Hand function was assessed using grip strength measurement, Total Active Movement (TAM), the Disabilities of the Arm, Shoulder and Hand (DASH) Questionnaire and Michigan Hand Outcome Questionnaire (MHQ). Patients' satisfaction was assessed using the Patient Observer Scar Assessment Scale (POSAS). RESULTS Thirteen patients were included in this analysis. The average time from burns and from fat transfer were 2.3 years (10 months-3.9 years) and 9.1 months (3 months-1.3 years), respectively. There was a statistically significant improvement in TAM measurement. The total score, activity of daily living score and satisfaction score of the MHQ also statistically increased following fat transfer. The changes in function score, work score and pain score of the MHQ were not significant. Grip strength measurement and DASH score did not show improvement. For scar assessment, total score and overall score of POSAS improved significantly. Similarly, scores for scar colour, scar thickness, scar stiffness and scar regularity increased significantly. DISCUSSION Autologous fat transfer directly replaces volume loss in the subcutaneous layer, physically releases tethered skin from underlying tissues and exerts downstream regenerative effects. Skin quality improvements combined with replacement of the subcutaneous adipose volume in the hand reduces overall scar tightness and tissue tethering and has the potential to enhance hand therapy. In our series, modest improvement in range of movement, scar quality and hand outcome scores were demonstrated following a single session of fat transfer.
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Affiliation(s)
- Miriam Byrne
- National Burns Centre & Department of Plastic, Reconstructive and Hand Surgery, Ireland.
| | - Michelle O'Donnell
- Department of Occupational Therapy, St. James's Hospital, Dublin 8, Ireland
| | - Lisa Fitzgerald
- Department of Occupational Therapy, St. James's Hospital, Dublin 8, Ireland
| | - Odhran P Shelley
- Senior Clinical Lecturer, School of Medicine, Trinity College Dublin, College Green, Dublin 2, Ireland; St. Andrew's Centre for Plastic Surgery and Burns, Chelmsford, Essex, United Kingdom
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Vaicik MK, Morse M, Blagajcevic A, Rios J, Larson J, Yang F, Cohen RN, Papavasiliou G, Brey EM. Hydrogel-Based Engineering of Beige Adipose Tissue. J Mater Chem B 2015; 3:7903-7911. [PMID: 26693015 PMCID: PMC4675174 DOI: 10.1039/c5tb00952a] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Brown and beige adipose tissues have a significant capacity for energy expenditure that may be exploited as a treatment for obesity and metabolic disease. However, the limited volumes of these tissues in adults hinders realization of this potential. Engineering beige adipose tissue may provide an alternative source of this tissue. In this paper we describe the preparation of poly(ethylene glycol) (PEGDA) hydrogels with mechanical properties similar to native adipose tissue. Adipose derived stem cells (ASC) were cultured in hydrogels without adhesive sequences or degradable monomers. Cells were able to differentiate, independent of scaffold properties and were maintained as a viable and functioning adipose tissue mass. The cells expressed their own basement membrane proteins consistent with the composition of adipose tissue. The ASCs could be induced to express uncoupling protein-1 (UCP-1) and cIDEA, makers of beige adipocytes with expression level varying with hydrogel stiffness. This hydrogel-based culture system serves as a first step in engineering beige adipose tissue.
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Affiliation(s)
- M K Vaicik
- Department of Biomedical Engineering, Illinois Institute of Technology, Chicago, IL ; Research Service, Veteran Affairs Hospital, Hines, IL
| | - M Morse
- Section of Endocrinology, Department of Medicine, University of Chicago, Chicago, IL
| | - A Blagajcevic
- Section of Endocrinology, Department of Medicine, University of Chicago, Chicago, IL
| | - J Rios
- Department of Biomedical Engineering, Illinois Institute of Technology, Chicago, IL
| | - J Larson
- Department of Biomedical Engineering, Illinois Institute of Technology, Chicago, IL
| | - F Yang
- Department of Biomedical Engineering, Illinois Institute of Technology, Chicago, IL
| | - R N Cohen
- Section of Endocrinology, Department of Medicine, University of Chicago, Chicago, IL
| | - G Papavasiliou
- Department of Biomedical Engineering, Illinois Institute of Technology, Chicago, IL
| | - E M Brey
- Department of Biomedical Engineering, Illinois Institute of Technology, Chicago, IL ; Research Service, Veteran Affairs Hospital, Hines, IL
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Lequeux C, Rodriguez J, Boucher F, Rouyer O, Damour O, Mojallal A, Auxenfans C. In vitro and in vivo biocompatibility, bioavailability and tolerance of an injectable vehicle for adipose-derived stem/stromal cells for plastic surgery indications. J Plast Reconstr Aesthet Surg 2015; 68:1491-7. [PMID: 26282247 DOI: 10.1016/j.bjps.2015.07.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 06/18/2015] [Accepted: 07/28/2015] [Indexed: 12/23/2022]
Abstract
Soft tissue reconstruction is a challenge in plastic surgery, when replacing lost materials and correcting contour defects. Many permanent and temporary fillers have been used to restore the volume of these lesions, but often with poor results and even complications. Adipose-derived stem/stromal cells (ASCs) and adipose tissue engineering have been suggested as valuable alternatives. In order to inject these cultured cells, it was essential to find a suitable vehicle. The purpose of this study was to evaluate Cytocare(®), an injectable medical device, composed of hyaluronic acid plus amino acids, vitamins and mineral salts. First, ASC viability and bioavailability in the 3 different available Cytocare(®) formulations using the MTT test were assessed; then an animal experiment, testing the tolerance after intradermal injections of both Cytocare(®) alone and with ASCs was carried out. Our in vitro results demonstrate a high biocompatibility of Cytocare(®) resulting in a better viability of ASCs when cultured in Cytocare(®) compared to culture medium (p < 0.05, Mann and Whitney). Cytocare(®) also permits their bioavailability and proliferation, making it a potential transfer vehicle that can retain the cells before their integration around the recipient site. Finally, our animal experiment shows that the ASC + Cytocare(®) combination is well tolerated. In conclusion, Cytocare(®) can be used as a biocompatible scaffold for cultured ASCs in therapeutic treatments, ensuring ASC bioavailability, as well as evidence of excellent tolerance in nude mice.
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Affiliation(s)
- Charlotte Lequeux
- Cell and Tissue Bank, Edouard Herriot Hospital, 5 Place d'Arsonval, 69437 Lyon, Cedex 03, France; Institut de Biologie et Chimie des Protéines, LBTI, UMR 5305, CNRS/Université de Lyon, Lyon, France
| | - Jonathan Rodriguez
- Cell and Tissue Bank, Edouard Herriot Hospital, 5 Place d'Arsonval, 69437 Lyon, Cedex 03, France; Institut de Biologie et Chimie des Protéines, LBTI, UMR 5305, CNRS/Université de Lyon, Lyon, France.
| | - Fabien Boucher
- Department of Plastic Surgery, Croix Rousse Hospital, 103 Grande rue de la Croix Rousse, 69317 Lyon, Cedex 04, France
| | - Ondine Rouyer
- Cell and Tissue Bank, Edouard Herriot Hospital, 5 Place d'Arsonval, 69437 Lyon, Cedex 03, France; Institut de Biologie et Chimie des Protéines, LBTI, UMR 5305, CNRS/Université de Lyon, Lyon, France
| | - Odile Damour
- Cell and Tissue Bank, Edouard Herriot Hospital, 5 Place d'Arsonval, 69437 Lyon, Cedex 03, France; Institut de Biologie et Chimie des Protéines, LBTI, UMR 5305, CNRS/Université de Lyon, Lyon, France
| | - Ali Mojallal
- Department of Plastic Surgery, Croix Rousse Hospital, 103 Grande rue de la Croix Rousse, 69317 Lyon, Cedex 04, France
| | - Céline Auxenfans
- Cell and Tissue Bank, Edouard Herriot Hospital, 5 Place d'Arsonval, 69437 Lyon, Cedex 03, France; Institut de Biologie et Chimie des Protéines, LBTI, UMR 5305, CNRS/Université de Lyon, Lyon, France
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Satish L, Krill-Burger JM, Gallo PH, Etages SD, Liu F, Philips BJ, Ravuri S, Marra KG, LaFramboise WA, Kathju S, Rubin JP. Expression analysis of human adipose-derived stem cells during in vitro differentiation to an adipocyte lineage. BMC Med Genomics 2015. [PMID: 26205789 PMCID: PMC4513754 DOI: 10.1186/s12920-015-0119-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background Adipose tissue-derived stromal stem cells (ASCs) represent a promising regenerative resource for soft tissue reconstruction. Although autologous grafting of whole fat has long been practiced, a major clinical limitation of this technique is inconsistent long-term graft retention. To understand the changes in cell function during the transition of ASCs into fully mature fat cells, we compared the transcriptome profiles of cultured undifferentiated human primary ASCs under conditions leading to acquisition of a mature adipocyte phenotype. Methods Microarray analysis was performed on total RNA extracted from separate ACS isolates of six human adult females before and after 7 days (7 days: early stage) and 21 days (21 days: late stage) of adipocyte differentiation in vitro. Differential gene expression profiles were determined using Partek Genomics Suite Version 6.4 for analysis of variance (ANOVA) based on time in culture. We also performed unsupervised hierarchical clustering to test for gene expression patterns among the three cell populations. Ingenuity Pathway Analysis was used to determine biologically significant networks and canonical pathways relevant to adipogenesis. Results Cells at each stage showed remarkable intra-group consistency of expression profiles while abundant differences were detected across stages and groups. More than 14,000 transcripts were significantly altered during differentiation while ~6000 transcripts were affected between 7 days and 21 days cultures. Setting a cutoff of +/-two-fold change, 1350 transcripts were elevated while 2929 genes were significantly decreased by 7 days. Comparison of early and late stage cultures revealed increased expression of 1107 transcripts while 606 genes showed significantly reduced expression. In addition to confirming differential expression of known markers of adipogenesis (e.g., FABP4, ADIPOQ, PLIN4), multiple genes and signaling pathways not previously known to be involved in regulating adipogenesis were identified (e.g. POSTN, PPP1R1A, FGF11) as potential novel mediators of adipogenesis. Quantitative RT-PCR validated the microarray results. Conclusions ASC maturation into an adipocyte phenotype proceeds from a gene expression program that involves thousands of genes. This is the first study to compare mRNA expression profiles during early and late stage adipogenesis using cultured human primary ASCs from multiple patients. Electronic supplementary material The online version of this article (doi:10.1186/s12920-015-0119-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Latha Satish
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 3550 Terrace Street, 6B Scaife Hall, 15261, Pittsburgh, PA, USA.,McGowan Institute for Regenerative Medicine, Pittsburgh, PA, USA
| | | | - Phillip H Gallo
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 3550 Terrace Street, 6B Scaife Hall, 15261, Pittsburgh, PA, USA
| | | | - Fang Liu
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 3550 Terrace Street, 6B Scaife Hall, 15261, Pittsburgh, PA, USA
| | - Brian J Philips
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 3550 Terrace Street, 6B Scaife Hall, 15261, Pittsburgh, PA, USA
| | - Sudheer Ravuri
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 3550 Terrace Street, 6B Scaife Hall, 15261, Pittsburgh, PA, USA
| | - Kacey G Marra
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 3550 Terrace Street, 6B Scaife Hall, 15261, Pittsburgh, PA, USA.,McGowan Institute for Regenerative Medicine, Pittsburgh, PA, USA
| | | | - Sandeep Kathju
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 3550 Terrace Street, 6B Scaife Hall, 15261, Pittsburgh, PA, USA.,McGowan Institute for Regenerative Medicine, Pittsburgh, PA, USA
| | - J Peter Rubin
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 3550 Terrace Street, 6B Scaife Hall, 15261, Pittsburgh, PA, USA. .,McGowan Institute for Regenerative Medicine, Pittsburgh, PA, USA.
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19
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Sustained regeneration of high-volume adipose tissue for breast reconstruction using computer aided design and biomanufacturing. Biomaterials 2015; 52:551-60. [DOI: 10.1016/j.biomaterials.2015.01.025] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Revised: 01/14/2015] [Accepted: 01/20/2015] [Indexed: 01/08/2023]
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20
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Targeted protection of donor graft vasculature using a phosphodiesterase inhibitor increases survival and predictability of autologous fat grafts. Plast Reconstr Surg 2015; 135:488-499. [PMID: 25626795 DOI: 10.1097/prs.0000000000000909] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Fat grafting is limited by unpredictable long-term graft retention. The authors postulate that injury to the donor-derived microvasculature during harvest and subsequent ischemia may account for this clinical variability. They examined the use of the U.S. Food and Drug Administration-approved phosphodiesterase-5 inhibitor sildenafil citrate to protect graft microvasculature and its role in revascularization and survival. METHODS Inguinal fat of donor Tie2/LacZ mice was infiltrated with sildenafil or saline, harvested, and transplanted onto the dorsa of recipient FVB mice. Additional donor mice were perfused with intraarterial trypsin to inactivate the fat graft microvasculature before harvest and transplantation. Differences in graft revascularization, perfusion, volume of retention, and biochemical changes were assessed. RESULTS Surviving fat grafts were characterized by exclusively donor-derived vasculature inosculating with the recipient circulation at the graft periphery. Inactivation of donor-derived microvasculature decreased early graft perfusion and led to nearly total graft loss by 8 weeks. Sildenafil attenuated vascular ischemic injury, consistent with reductions in VCAM-1 and SDF1α expression at 48 hours and 4-fold increases in microvasculature survival by 2 weeks over controls. Compared with controls, targeted sildenafil treatment improved early graft perfusion, doubled graft retention at 12 weeks (83 percent versus 39 percent; p < 0.05), ultimately retaining 64 percent of the original graft volume by 24 weeks (compared to 4 percent; p < 0.05) with superior histologic features. CONCLUSIONS Fat graft vascularization is critically dependent on maintenance of the donor microvasculature. Sildenafil protects the donor microvasculature during transfer and revascularization, increasing long-term volume retention. These data demonstrate a rapidly translatable method of increasing predictability and durability of fat grafting in clinical practice.
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21
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Philips BJ, Marra KG, Rubin JP. Healing of grafted adipose tissue: current clinical applications of adipose-derived stem cells for breast and face reconstruction. Wound Repair Regen 2015; 22 Suppl 1:11-3. [PMID: 24813358 DOI: 10.1111/wrr.12164] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Accepted: 01/24/2014] [Indexed: 12/25/2022]
Abstract
Since their isolation and characterization nearly a decade ago, adipose-derived stem cells (ASCs) have become one of the most popular adult stem cell populations for soft tissue engineering and regenerative medicine applications. Compared with other stem cell sources, ASCs offer several advantages including abundant autologous source, minor invasive harvesting (liposuction), significant proliferative capacity in culture, and multilineage potential. In this mini review, we focus on some of the more salient published clinical and preclinical data to date regarding ASC treatment for breast and facial soft tissue reconstruction.
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Affiliation(s)
- Brian J Philips
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
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22
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Pallua N, Serin M, Wolter TP. Characterisation of angiogenetic growth factor production in adipose tissue-derived mesenchymal cells. J Plast Surg Hand Surg 2014; 48:412-6. [DOI: 10.3109/2000656x.2014.903196] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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23
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Tanzi MC, Farè S. Adipose tissue engineering: state of the art, recent advances and innovative approaches. Expert Rev Med Devices 2014; 6:533-51. [DOI: 10.1586/erd.09.37] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Abstract
There is high clinical need for an adequate reconstruction of soft tissue defects as found after tumor resections, deep burns or severe trauma. A promising solution for these defects is adipose tissue engineering, with adult stem cells of the adipose tissue, implanted on 3D biomaterials. These adipogenic precursor cells survive ischemia better than mature adipocytes and have the potency to proliferate and differentiate into fat cells after transplantation. They can be yielded from excised adipose tissue or liposuction material. When preadipocytes are seeded on carriers for the generation of adipose tissue, chemical composition, mechanical stability and 3D architecture of the construct are crucial factors. They ensure cellular penetration into the construct, sufficient proliferation on the material and full differentiation inside the construct after transplantation. In hydrogels, it is especially the use and combination of growth factors that determine the overall outcome of the applied biopolymer. Over recent years, in vivo trials in particular have allowed significant insights into the potential, the perspectives, but also the current difficulties and draw-backs in adipose tissue engineering. This review focuses on the main strategies in adipose tissue regeneration, compares the various materials that have been used as carrier matrices so far and considers them in light of the challenges they have yet to meet.
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Affiliation(s)
- Karsten Hemmrich
- University Hospital of the Aachen, University of Technology RWTH, Department of Plastic Surgery and Hand Surgery - Burn Centre, Pauwelsstr. 30, D-52057 Aachen, Germany.
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Prevalence of endogenous CD34+ adipose stem cells predicts human fat graft retention in a xenograft model. Plast Reconstr Surg 2013; 132:845-858. [PMID: 23783061 DOI: 10.1097/prs.0b013e31829fe5b1] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Fat grafting is a promising technique for soft-tissue augmentation, although graft retention is highly unpredictable and factors that affect graft survival have not been well defined. Because of their capacity for differentiation and growth factor release, adipose-derived stem cells may have a key role in graft healing. The authors' objective was to determine whether biological properties of adipose-derived stem cells present within human fat would correlate with in vivo outcomes of graft volume retention. METHODS Lipoaspirate from eight human subjects was processed using a standardized centrifugation technique and then injected subcutaneously into the flanks of 6-week-old athymic nude mice. Graft masses and volumes were measured, and histologic evaluation, including CD31+ staining for vessels, was performed 8 weeks after transplantation. Stromal vascular fraction isolated at the time of harvest from each subject was analyzed for surface markers by multiparameter flow cytometry, and also assessed for proliferation, differentiation capacity, and normoxic/hypoxic vascular endothelial growth factor secretion. RESULTS Wide variation in percentage of CD34+ progenitors within the stromal vascular fraction was noted among subjects and averaged 21.3 ± 15 percent (mean ± SD). Proliferation rates and adipogenic potential among stromal vascular fraction cells demonstrated moderate interpatient variability. In mouse xenograft studies, retention volumes ranged from approximately 36 to 68 percent after 8 weeks, with an overall average of 52 ± 11 percent. A strong correlation (r = 0.78, slope = 0.76, p < 0.05) existed between stromal vascular fraction percentage of CD34+ progenitors and high graft retention. CONCLUSION Inherent biological differences in adipose tissue exist between patients. In particular, concentration of CD34+ progenitor cells within the stromal vascular fraction may be one of the factors used to predict human fat graft retention.
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Pallua N, Wolter T. The lipo-facelift: merging the face-lift and liposculpture: eight years experience and a preliminary observational study. Aesthetic Plast Surg 2013; 37:1107-13. [PMID: 24142113 DOI: 10.1007/s00266-013-0218-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 04/30/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Since the introduction of the classic submucosal aponeurotic system (SMAS) face-lift, the surgical approach to improve the changes of an aging face has evolved, and significant technical improvements have been made. However, several problems still have not been solved satisfactorily. These problems include facial lipodystrophy and changes in skin and skin texture. METHODS The Lipo-Facelift procedure consists of facial liposculpturing performed simultaneously with a biplanar, bivectorial SMAS face-lift procedure. The authors analyzed pre- and postsurgical photographs of 12 patients with a Lipo-Facelift after 3 and 12 months and analyzed their charts for complications. Furthermore, O2C measurement was performed to assess improved microcirculation. The longest follow-up period was 8 years. RESULTS The Lipo-Facelift demonstrated very satisfying results. Initial swelling and bruising were seen as well as two cases of wound-healing disorders, but no surgical intervention or revision was needed. The findings show lasting improvement of skin quality and a youthful appearance. CONCLUSION The Lipo-Facelift corrects age-related skin and SMAS changes as well as age-related lipodystrophy, improves skin circulation and skin revitalization, and provides a lasting and natural result. The skin quality resulting from simultaneous lipofilling can be explained by improved angiogenesis due to transferred growth factors in the lipoaspirate. Also, differentiation of progenitor cells to fibroblasts and increased production of collagen contribute to firmer skin. LEVEL OF EVIDENCE IV 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)
- N Pallua
- Department of Plastic and Reconstructive Surgery, Hand Surgery - Burn Centre, University Hospital of the RWTH, Pauwelsstrasse 30, 52074, Aachen, Germany,
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Fat grafts supplemented with adipose-derived stromal cells in the rehabilitation of patients with craniofacial microsomia. Plast Reconstr Surg 2013; 132:141-152. [PMID: 23806916 DOI: 10.1097/prs.0b013e3182910a82] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Although first reports of the clinical use of adipose-derived stromal cells suggest that this approach may be feasible and effective for soft-tissue augmentation, there is a lack of randomized, controlled clinical trials in the literature. Thus, this study aimed to investigate whether a faster protocol for isolation of adipose-derived stromal cells and their use in combination with fat tissue improve the long-term retention of the grafts in patients with craniofacial microsomia. METHODS Patients with craniofacial microsomia (n = 14) were grafted either with supplementation of adipose-derived stromal cells (experimental group) or without supplementation of adipose-derived stromal cells (control group). The number of viable cells isolated before and after the supplementation of the grafts was calculated, and these cells were examined for mesenchymal cell surface markers using flow cytometry. Computed tomography was performed to assess both hemifaces preoperatively and at 6 months postoperatively. RESULTS The average number of viable cells isolated before and after the supplementation of the grafts was 5.6 × 10 and 9.9 × 10 cells/ml of fat tissue (p = 0.015). Flow cytometric analysis revealed that the adipose-derived stromal cells were positive for mesenchymal cell markers (>95 percent for CD73 and CD105). Surviving fat volume at 6 months was 88 percent for the experimental group and 54 percent for the control group (p = 0.003). CONCLUSION These results suggest that this strategy for isolation and supplementation of adipose-derived stromal cells is effective, safe, and superior to conventional lipoinjection for facial recontouring in patients with craniofacial microsomia. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, II.
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28
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Fate of Adipose-Derived Stromal Vascular Fraction Cells after Co-implantation with Fat Grafts. Plast Reconstr Surg 2013; 132:363-373. [DOI: 10.1097/prs.0b013e31829588b3] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Porzionato A, Sfriso MM, Macchi V, Rambaldo A, Lago G, Lancerotto L, Vindigni V, De Caro R. Decellularized omentum as novel biologic scaffold for reconstructive surgery and regenerative medicine. Eur J Histochem 2013; 57:e4. [PMID: 23549463 PMCID: PMC3683611 DOI: 10.4081/ejh.2013.e4] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Revised: 09/17/2012] [Accepted: 09/19/2012] [Indexed: 12/17/2022] Open
Abstract
Homologous tissues, such as adipose tissue, may be an interesting source of acellular scaffolds, maintaining a complex physiological three-dimensional (3D) structure, to be recellularized with autologous cells. The aim of the present work is to evaluate the possibility of obtaining homologous acellular scaffolds from decellularization of the omentum, which is known to have a complex vascular network. Adult rat and human omenta were treated with an adapted decellularization protocol involving mechanical rupture (freeze-thaw cycles), enzymatic digestion (trypsin, lipase, deoxyribonuclease, ribonuclease) and lipid extraction (2-propanol). Histological staining confirmed the effectiveness of decellularization, resulting in cell-free scaffolds with no residual cells in the matrix. The complex 3D networks of collagen (azan-Mallory), elastic fibers (Van Gieson), reticular fibers and glycosaminoglycans (PAS) were maintained, whereas Oil Red and Sudan stains showed the loss of lipids in the decellularized tissue. The vascular structures in the tissue were still visible, with preservation of collagen and elastic wall components and loss of endothelial (anti-CD31 and -CD34 immunohistochemistry) and smooth muscle (anti-alpha smooth muscle actin) cells. Fat-rich and well vascularized omental tissue may be decellularized to obtain complex 3D scaffolds preserving tissue architecture potentially suitable for recellularization. Further analyses are necessary to verify the possibility of recolonization of the scaffold by adipose-derived stem cells in vitro and then in vivo after re implantation, as already known for homologus implants in regenerative processes.
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Affiliation(s)
- A Porzionato
- Section of Human Anatomy, Department of Molecular Medicine, University of Padua, Padova,
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Sarkanen JR, Ruusuvuori P, Kuokkanen H, Paavonen T, Ylikomi T. Bioactive Acellular Implant Induces Angiogenesis and Adipogenesis and Sustained Soft Tissue Restoration In Vivo. Tissue Eng Part A 2012; 18:2568-80. [DOI: 10.1089/ten.tea.2011.0724] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
- Jertta-Riina Sarkanen
- Department of Cell Biology, School of Medicine, University of Tampere, Tampere, Finland
- FICAM, Finnish Center for Alternative Methods, School of Medicine, University of Tampere, Tampere, Finland
- Science Center, Tampere University Hospital, Tampere, Finland
| | - Pekka Ruusuvuori
- Department of Signal Processing, Tampere University of Technology, Tampere, Finland
| | - Hannu Kuokkanen
- Department of Plastic Surgery, Tampere University Hospital, Tampere, Finland
| | - Timo Paavonen
- Department of Pathology, University of Tampere and Tampere University Hospital, Tampere, Finland
| | - Timo Ylikomi
- Department of Cell Biology, School of Medicine, University of Tampere, Tampere, Finland
- FICAM, Finnish Center for Alternative Methods, School of Medicine, University of Tampere, Tampere, Finland
- Department of Clinical Chemistry, Tampere University Hospital, Tampere, Finland
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Valorani MG, Montelatici E, Germani A, Biddle A, D'Alessandro D, Strollo R, Patrizi MP, Lazzari L, Nye E, Otto WR, Pozzilli P, Alison MR. Pre-culturing human adipose tissue mesenchymal stem cells under hypoxia increases their adipogenic and osteogenic differentiation potentials. Cell Prolif 2012; 45:225-38. [PMID: 22507457 DOI: 10.1111/j.1365-2184.2012.00817.x] [Citation(s) in RCA: 111] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES Hypoxia is an important factor in many aspects of stem-cell biology including their viability, proliferation, differentiation and migration. We evaluated whether low oxygen level (2%) affected human adipose tissue mesenchymal stem-cell (hAT-MSC) phenotype, population growth, viability, apoptosis, necrosis and their adipogenic and osteogenic differentiation potential. MATERIALS AND METHODS hAT-MSCs from four human donors were cultured in growth medium under either normoxic or hypoxic conditions for 7 days and were then transferred to normoxic conditions to study their differentiation potential. RESULTS Hypoxia enhanced hAT-MSC expansion and viability, whereas expression of mesenchymal markers such as CD90, CD73 and endothelial progenitor cell marker CD34, remained unchanged. We also found that pre-culturing hAT-MSCs under hypoxia resulted in their enhanced ability to differentiate into adipocytes and osteocytes. CONCLUSIONS This protocol could be useful for maximizing hAT-MSC potential to differentiate in vitro into the adipogenic and osteogenic lineages, for use in plastic and reconstructive surgery, and in tissue engineering strategies.
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Affiliation(s)
- M G Valorani
- Centre for Diabetes, Blizard Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK.
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Abstract
INTRODUCTION Since their isolation and characterization nearly a decade ago, adipose-derived stem cells (ASCs) have become one of the most popular adult stem cell populations for research in soft tissue engineering and regenerative medicine applications. Compared with other stem cell sources, ASCs offer several advantages including an abundant autologous source, minor invasive harvesting (liposuction), significant proliferative capacity in culture and multi-lineage potential. Numerous preclinical studies have been pursued, with early clinical data appearing in the literature. AREAS COVERED Autologous fat grafting has gained tremendous momentum in clinical practice over the past several years due to its potential applications in trauma and reconstructive surgery. This review focuses on the published clinical and pre-clinical (i.e., animal) data to date using ASCs for soft tissue reconstruction, with particular attention to experimental models and methodologies. Future directions for rendering soft tissue reconstructive therapies more effective are discussed. EXPERT OPINION Although standardization of ASC harvesting and processing techniques, as well as long-term results of existing clinical studies, remains to be addressed, the known biological properties of ASCs suggest a potential role in enhancing fat graft retention and facilitating minimally invasive reconstructive treatments. While clinical applications are being reported, well controlled clinical studies are needed to demonstrate safety and efficacy.
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Affiliation(s)
- Brian J Philips
- University of Pittsburgh, Division of Plastic Surgery, Department of Surgery, Pittsburgh, PA 15261, USA
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Stem cells, mature adipocytes, and extracellular scaffold: what does each contribute to fat graft survival? Aesthetic Plast Surg 2011; 35:1061-72. [PMID: 21590499 DOI: 10.1007/s00266-011-9734-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2011] [Accepted: 04/06/2011] [Indexed: 12/19/2022]
Abstract
BACKGROUND Soft tissue engineering offers new perspectives for improving fat graft survival, for which the appropriate association of cells and scaffold seems essential. This study aimed to analyze the survival of free-cell grafts compared with adipose-derived stem cells (ASCs) seeded on collagen scaffolds. METHODS Adipose tissue from a single volunteer was used for the following preparations: purified adipose tissue, isolated mature adipocytes (free-cell graft), cultured ASCs without scaffold (free-cell graft), collagen scaffold only, cultured ASCs in collagen scaffold without and with bioactive factors, and freshly-isolated ASCs in collagen scaffold. These were grafted on 18 nude mice for 2 months, after which specimens were evaluated grossly and histologically using hematoxylin-phloxine-safran (HPS), Oil-Red-O, and antivimentin labeling. Specimens and animals were weighed before implantation and after explantation, and weight values were statistically analyzed. RESULTS Free-cell grafts (mature adipocytes and free ASCs) showed complete resorption in 50 and 60% of the animals (remaining weight fraction was 22.5 and 5.3%, respectively). The survival of purified adipose tissue was 81.8% (statistically greater compared with free-cell grafts; p < 0.05). In the ASCs-scaffold association, the remaining weight fractions (87.3-70.4%) were statistically greater than in free-cell grafts (5.3-22.5%; p < 0.05), but the difference between ASC-scaffolds and fat grafts was not statistically significant. These results were confirmed by clinical and histologic observations. CONCLUSION Three-dimensional collagen scaffolds seem to improve survival of ASCs compared with free-cell grafts (adipocytes and free ASCs).
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Jeong SH, Han SK, Kim WK. Soft tissue augmentation using in vitro differentiated adipocytes: a clinical pilot study. Dermatol Surg 2011; 37:760-7. [PMID: 21605235 DOI: 10.1111/j.1524-4725.2011.01950..x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Although various commercially available filler materials are now commonly used, their variable degrees of resorption require repeated percutaneous injections. To overcome these drawbacks, a new injectable in vitro differentiated adipocyte filler has been developed, and animal studies have demonstrated that implantation of the filler successfully enhances in vivo adipose tissue formation. This study was undertaken to evaluate the clinical efficacy of this method, particularly in soft tissue augmentation. MATERIALS AND METHODS Autologous adipose-derived stromal cells were isolated, cultured, and differentiated to adipocytes in vitro. The differentiated adipocytes were suspended in Dulbecco's modified Eagle medium and injected into the lesion requiring soft tissue augmentation. Eight patients were treated with this tissue-engineered filler. Long-term follow-up for longer than 1 year was possible in all patients. RESULTS Two or 3 weeks after the injection, volume increment of subcutaneous tissue was observed around the injection area in the ensuing 1 to 5 weeks. Thereafter, additional volume augmentation was not found and the augmentation effect was well-maintained. All patients agreed on the clinical effectiveness of the procedure, and no complications occurred. CONCLUSIONS The results obtained indicate that this method is well tolerated and may be an effective means of achieving soft tissue augmentation. The authors have indicated no significant interest with commercial supporters.
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Affiliation(s)
- Seong-Ho Jeong
- Department of Plastic Surgery, Korea University Guro Hospital, Seoul, Korea
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35
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Tissue Engineering Generation of adipose tissue: an overview of current standards and possibilities. Eur Surg 2010. [DOI: 10.1007/s10353-010-0548-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Condé-Green A, Baptista LS, de Amorin NFG, de Oliveira ED, da Silva KR, Pedrosa CDSG, Borojevic R, Pitanguy I. Effects of centrifugation on cell composition and viability of aspirated adipose tissue processed for transplantation. Aesthet Surg J 2010; 30:249-55. [PMID: 20442104 DOI: 10.1177/1090820x10369512] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Centrifugation is one of the preferred methods of fat processing. Although it has been promoted for nearly three decades to separate adipose tissue components before grafting, there remain many controversies regarding the results obtained with centrifuged adipose tissue. OBJECTIVES The authors demonstrate the effects of centrifugation on the cellular components of aspirated fat. METHODS Fat harvested from the lower abdomen of 10 female patients undergoing liposuction was divided in two equal parts, then processed by decantation or centrifugation and sent to the laboratory. Each processed lipoaspirate was analyzed histologically after hematoxylin and periodic acid-Schiff staining for the presence of intact adipocytes. It was then cultured and analyzed by multicolor flow cytometry for identification of adipose-derived mesenchymal stem cells. RESULTS The middle layer of the centrifuged lipoaspirate, which is used by many surgeons, showed a great majority of altered adipocytes and very few mesenchymal stem cells in comparison with the decanted sample, which maintained the integrity of the adipocytes and showed a greater number of mesenchymal stem cells. The pellet observed as a fourth layer at the bottom of the centrifuged lipoaspirate showed the greatest concentration of endothelial cells and mesenchymal stem cells, which play a crucial role in the angiogenic and adipogenic effect of the grafted tissue. CONCLUSIONS If centrifuged lipoaspirate is used, the pellet (rich in adipose-derived mesenchymal stem cells) and the middle layer should be employed to increase fat graft survival.
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Affiliation(s)
- Alexandra Condé-Green
- Department of Plastic Surgery, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, Brazil.
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Etienne O, Schneider A, Kluge JA, Bellemin-Laponnaz C, Polidori C, Leisk GG, Kaplan DL, Garlick JA, Egles C. Soft tissue augmentation using silk gels: an in vitro and in vivo study. J Periodontol 2009; 80:1852-8. [PMID: 19905955 DOI: 10.1902/jop.2009.090231] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Restoration of a three-dimensional shape with soft tissue augmentation is a challenge for surgical reconstruction and esthetic improvement of intraoral mucosa and perioral skin tissues. A connective tissue graft or free gingival graft, classically used for such indications, requires a donor site, which may lead to various clinical complications. METHODS In this article, a new three-dimensional scaffold made of silk fibroin that could be of great interest for these indications was studied. Mechanical tests were conducted to characterize the physical properties of the materials. The biocompatibility of such scaffolds was positively assessed in vitro using a combination of immunostaining, 5-bromo-2'-deoxyuridine proliferation assays, and histologic staining. Finally, the shaped material was grafted subcutaneously in nude mice for a long-time implantation study. RESULTS Human fibroblasts embedded in this material had a survival rate up to 68.4% and were able to proliferate and synthesize proteins. One month after subcutaneous implantation, the three-dimensional soft tissue augmentation was stable, and histologic analysis revealed revascularization of the area through the biomaterial. A mild inflammatory reaction disappeared after 12 weeks. CONCLUSION The results indicate that silk-gel material was able to create a lasting three-dimensional soft tissue augmentation and is a promising biomaterial for periodontal and maxillofacial therapies, either as a scaffold for cells or alone as a biomaterial.
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Affiliation(s)
- Olivier Etienne
- Division of Cancer Biology and Tissue Engineering, Department of Oral and Maxillofacial Pathology, School of Dental Medicine, Tufts University, Boston, MA 02111, USA
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Verseijden F, Jahr H, Posthumus-van Sluijs SJ, Ten Hagen TL, Hovius SER, Seynhaeve ALB, van Neck JW, van Osch GJVM, Hofer SOP. Angiogenic capacity of human adipose-derived stromal cells during adipogenic differentiation: an in vitro study. Tissue Eng Part A 2009; 15:445-52. [PMID: 18652540 DOI: 10.1089/ten.tea.2007.0429] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Improving vascularization of engineered adipose tissue constructs is a major challenge in the field of plastic surgery. Although human adipose-derived stromal cells (hASCs) are known to release factors that stimulate new blood vessel formation, detailed information about the effects of adipogenic differentiation on the angiogenic potential of hASCs remains largely unknown. In the present study, we studied the expression and secretion of a large panel of angiogenic factors during hASC differentiation and evaluated the effects of hASC-conditioned medium (hASC-CM) on endothelial cells. METHODS hASCs were cultured on adipogenic medium or basal medium. Conditioned medium was collected, and cells were harvested following 0, 3, 7, 14, and 22 days of culture. The stage of adipogenic differentiation of hASC was assessed using Oil Red O staining, fatty acid binding protein-4 gene expression, and glycerol-3-phosphate dehydrogenase activity. RESULTS Gene expression of vascular endothelial growth factor (VEGF), placental growth factor, angiopoietin-1 (ANGPT1), angiopoietin-2 (ANGPT2), and protein secretion of VEGF significantly increased during short-term adipogenic differentiation of hASCs. Moreover, conditioned medium from differentiated hASCs strongly enhanced endothelial cell numbers compared to conditioned medium from undifferentiated hASCs. CONCLUSION In vitro adipogenic differentiation of hASCs improves their ability to support endothelial viable cell numbers and suggests that hASCs differentiated for a short period potentially improve angiogenic responses for in vivo implantation.
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Affiliation(s)
- Femke Verseijden
- Department of Plastic and Reconstructive Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
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Yoshimura K, Asano Y, Aoi N, Kurita M, Oshima Y, Sato K, Inoue K, Suga H, Eto H, Kato H, Harii K. Progenitor-enriched adipose tissue transplantation as rescue for breast implant complications. Breast J 2009; 16:169-75. [PMID: 19912236 DOI: 10.1111/j.1524-4741.2009.00873.x] [Citation(s) in RCA: 180] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Breast enhancement with artificial implants is one of the most frequently performed cosmetic surgeries but is associated with various complications, such as capsular contracture, that lead to implant removal or replacement at a relatively high rate. For replacement, we used transplantation of progenitor-supplemented adipose tissue (cell-assisted lipotransfer; CAL) in 15 patients. The stromal vascular fraction containing adipose tissue progenitor cells obtained from liposuction aspirates was used to enrich for progenitor cells in the graft. Overall, clinical results were very satisfactory, and no major abnormalities were seen on magnetic resonance imaging or mammogram after 12 months. Postoperative atrophy of injected fat was minimal and did not change substantially after 2 months. Surviving fat volume at 12 months was 155 +/- 50 mL (Right; mean +/- SD) and 143 +/- 80 mL (Left) following lipoinjection from an initial mean of 264 mL. These preliminary results suggest that CAL is a suitable methodology for the replacement of breast implants.
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Affiliation(s)
- Kotaro Yoshimura
- Department of Plastic Surgery, University of Tokyo School of Medicine, Bunkyo-ku, Tokyo, Japan.
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Yoshimura K, Suga H, Eto H. Adipose-derived stem/progenitor cells: roles in adipose tissue remodeling and potential use for soft tissue augmentation. Regen Med 2009; 4:265-73. [PMID: 19317645 DOI: 10.2217/17460751.4.2.265] [Citation(s) in RCA: 171] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Many features of adipose tissue-specific stem/progenitor cells, such as physiological function and localization, have recently been examined. Adipose-tissue turnover is very slow and its perivascular progenitor cells differentiate into adipocytes in the next generation. The progenitor cells play important roles in physiological turnover, hyperplasia and atrophy of adipose tissue, as well as in incidental remodeling, such as postinjury repair. Adipose tissue has been used as an autologous filler for soft tissue defects, despite unpredictable clinical results and a low rate of graft survival, which may be due to the relative deficiency of progenitor cells in graft materials. A novel transplantation strategy, termed cell-assisted lipotransfer, involves the enrichment of adipose progenitor cells in grafts; preliminary results suggest this approach to be safe and effective.
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Affiliation(s)
- Kotaro Yoshimura
- Department of Plastic Surgery, University of Tokyo School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
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Tissue engineering in plastic surgery: an up-to-date review of the current literature. Ann Plast Surg 2009; 62:97-103. [PMID: 19131730 DOI: 10.1097/sap.0b013e3181788ec9] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Tissue engineering is an interdisciplinary field that applies the principles of engineering and life sciences toward the development of biological substitutes that restore, maintain, or improve tissue function. This field has enjoyed tremendous growth in the past 10 years fuelled by its potential role in regenerating new tissues and naturally healing injured or diseased organs. Stem cells due to their pluripotentiality and unlimited capacity for self-renewal, may allow significant advances for distinct reconstructive and cosmetic procedures. This review aims at outlining the principles of tissue engineering, focusing on the use of adult-derived stem cells as applied to the research and practice of plastic surgery. Review categories have been divided into tissue engineering of the skin and connective tissue, bone marrow, cartilage, adipose tissue, and breast tissue. An analytical review of the current literature on stem cell technology on the above mentioned areas is presented. There have been reports of side effects and unsuccessful treatments. The key to the progress of tissue engineering is an understanding between basic scientists, biochemical engineers, clinicians, and industry. Although there has been an ongoing research pointing to the enormous potential of using stem cells in cosmetic and reconstructive surgery, at this stage, stem cell therapy is still a hope that has not been fully studied and approved. More long-term studies are needed and many questions remain to be answered.
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Content of the Growth Factors bFGF, IGF-1, VEGF, and PDGF-BB in Freshly Harvested Lipoaspirate after Centrifugation and Incubation. Plast Reconstr Surg 2009; 123:826-833. [PMID: 19319045 DOI: 10.1097/prs.0b013e318199ef31] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
Electrospun 3-dimensional nanofibrous scaffolds share morphologic similarities to collagen fibrils, and promote favorable biologic responses of seeded cells. In this study, we have fabricated a 3-dimensional nanofibrous scaffold made of poly L-lactic acid, and examined its ability to support and maintain the adipogenic differentiation of human bone marrow-derived mesenchymal stem cells in vitro. After a 21-day incubation, oil red O staining of constructs treated with adipogenic supplements revealed positive adipose-like staining, compared with lack of staining in untreated cultures. Semi-quantitative RT-PCR analysis of human bone marrow-derived mesenchymal stem cells cultured in adipogenic medium revealed highly elevated levels of adipogenesis-associated genes (1797-fold for lipoprotein lipase, and 5.6-fold for peroxisome proliferator-activated receptor gamma). Immunofluorescence staining of cellular constructs in adipogenic culture media showed the presence of lipoprotein lipase vesicles, a characteristic feature of adipose tissue. These results suggest that the poly L-lactic acid-based nanofibrous scaffold is a promising candidate for adult stem cell-based engineering of adipose tissue.
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Hefty TR, Kuhr CS, Chong KT, Guinee DG, Wang W, Reems JA, Greenbaum CJ. Omental roll-up: a technique for islet engraftment in a large animal model. J Surg Res 2008; 161:134-8. [PMID: 19394649 DOI: 10.1016/j.jss.2008.11.842] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2008] [Revised: 11/07/2008] [Accepted: 11/20/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Attrition of transplanted islets is significant after hepatic embolization. This study was designed to investigate a novel surgical technique for islet transplantation into the omentum. This site allows placement of the islets in a three-dimensional (3D) matrix, with growth factors, to temporarily culture the islets in vivo while revascularization progresses. MATERIALS AND METHODS Five female dogs (three partial and two total pancreatectomies) received an autologous islet transplant in the omentum. Islets were suspended in 1 mL of PBS containing 10 ug of vascular endothelial growth factor (VEGF). Fresh autologous plasma (10 mL) was mixed with the islet/VEGF suspension. The coagulum containing the islets and VEGF was then placed on the greater omentum. The leading edge of omentum was rolled up to secure the islet/VEGF/coagulum in position and to present the thin islet layer with two omental surfaces for implantation. Omentum was recovered at 2, 13, 21, 42, and 180 d. RESULTS Immunohistochemical staining for synaptophysin, glucagon, and insulin confirmed the presence of transplanted islets in all omenta. Insulin and C peptide production from the omental islets was confirmed in portal venous samples, and normalization of morning glucose levels beginning on day 7 was seen in the total pancreatectomy experiment. CONCLUSIONS Autologous islets implant in rolled-up omentum when placed as a VEGF/autologous plasma coagulum. This technique has potential benefits, including the opportunity to accelerate revascularization and to investigate local strategies for modulating the immune response.
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Affiliation(s)
- Thomas R Hefty
- Division of Renal and Pancreas Transplantation, Virginia Mason Medical Center, Seattle, Washington 98101, USA.
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YOSHIMURA KOTARO, SATO KATSUJIRO, AOI NORIYUKI, KURITA MASAKAZU, INOUE KEITA, SUGA HIROTAKA, ETO HITOMI, KATO HARUNOSUKE, HIROHI TOSHITSUGU, HARII KIYONORI. Cell-Assisted Lipotransfer for Facial Lipoatrophy. Dermatol Surg 2008. [DOI: 10.1097/00042728-200809000-00003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Influences of centrifugation on cells and tissues in liposuction aspirates: optimized centrifugation for lipotransfer and cell isolation. Plast Reconstr Surg 2008; 121:1033-1041. [PMID: 18317153 DOI: 10.1097/01.prs.0000299384.53131.87] [Citation(s) in RCA: 143] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Although injective autologous fat transplantation is one of the most attractive options for soft-tissue augmentation, problems such as unpredictability and fibrosis resulting from fat necrosis limit its universal acceptance. Centrifugation is one of most common methods for overcoming these difficulties. This study was performed to investigate quantitatively the effects of centrifugation on liposuction aspirates to optimize centrifugal conditions for fat transplantation and isolation of adipose-derived stem cells. METHODS Liposuction aspirates, obtained from eight healthy female donors, were either not centrifuged or centrifuged at 400, 700, 1200, 3000, or 4200 g for 3 minutes. The volumes of the oil, adipose, and fluid portions and numbers of blood cells and adipose-derived cells in each portion were examined. The processed adipose tissues (1 ml) were injected into athymic mice, and grafts were harvested and weighed at 4 weeks. Morphologic alterations were observed using light and scanning electron microscopy. RESULTS Centrifugation concentrated adipose tissues and adipose-derived stem cells in the adipose portion and partly removed red blood cells from the adipose portion. Centrifugation at more than 3000 g significantly damaged adipose-derived stem cells. Centrifugation enhanced graft take per 1 ml centrifuged adipose but reduced calculated graft take per 1 ml adipose before centrifugation. CONCLUSIONS Excessive centrifugation can destroy adipocytes and adipose-derived stem cells, but appropriate centrifugation concentrates them, resulting in enhanced graft take. The authors tentatively recommend 1200 g as an optimized centrifugal force for obtaining good short- and long-term results in adipose transplantation.
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Weiser B, Prantl L, Schubert TE, Zellner J, Fischbach-Teschl C, Spruss T, Seitz AK, Tessmar J, Goepferich A, Blunk T. In VivoDevelopment and Long-Term Survival of Engineered Adipose Tissue Depend onIn VitroPrecultivation Strategy. Tissue Eng Part A 2008; 14:275-84. [DOI: 10.1089/tea.2007.0130] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Barbara Weiser
- Department of Pharmaceutical Technology, Institute of Pharmacy, University of Regensburg, Regensburg, Germany
| | - Lukas Prantl
- Department of Trauma and Reconstructive Surgery, University of Regensburg, Regensburg, Germany
| | | | - Johannes Zellner
- Department of Trauma and Reconstructive Surgery, University of Regensburg, Regensburg, Germany
| | | | - Thilo Spruss
- Department of Pharmaceutical Technology, Institute of Pharmacy, University of Regensburg, Regensburg, Germany
| | - Anna K. Seitz
- Department of Pharmaceutical Technology, Institute of Pharmacy, University of Regensburg, Regensburg, Germany
| | - Joerg Tessmar
- Department of Pharmaceutical Technology, Institute of Pharmacy, University of Regensburg, Regensburg, Germany
| | - Achim Goepferich
- Department of Pharmaceutical Technology, Institute of Pharmacy, University of Regensburg, Regensburg, Germany
| | - Torsten Blunk
- Department of Pharmaceutical Technology, Institute of Pharmacy, University of Regensburg, Regensburg, Germany
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Yoshimura K, Sato K, Aoi N, Kurita M, Hirohi T, Harii K. Cell-assisted lipotransfer for cosmetic breast augmentation: supportive use of adipose-derived stem/stromal cells. Aesthetic Plast Surg 2008; 32:48-55; discussion 56-7. [PMID: 17763894 PMCID: PMC2175019 DOI: 10.1007/s00266-007-9019-4] [Citation(s) in RCA: 587] [Impact Index Per Article: 36.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2007] [Accepted: 05/22/2007] [Indexed: 01/08/2023]
Abstract
BACKGROUND Lipoinjection is a promising treatment but has some problems, such as unpredictability and a low rate of graft survival due to partial necrosis. METHODS To overcome the problems with lipoinjection, the authors developed a novel strategy known as cell-assisted lipotransfer (CAL). In CAL, autologous adipose-derived stem (stromal) cells (ASCs) are used in combination with lipoinjection. A stromal vascular fraction (SVF) containing ASCs is freshly isolated from half of the aspirated fat and recombined with the other half. This process converts relatively ASC-poor aspirated fat to ASC-rich fat. This report presents the findings for 40 patients who underwent CAL for cosmetic breast augmentation. RESULTS Final breast volume showed augmentation by 100 to 200 ml after a mean fat amount of 270 ml was injected. Postoperative atrophy of injected fat was minimal and did not change substantially after 2 months. Cyst formation or microcalcification was detected in four patients. Almost all the patients were satisfied with the soft and natural-appearing augmentation. CONCLUSIONS The preliminary results suggest that CAL is effective and safe for soft tissue augmentation and superior to conventional lipoinjection. Additional study is necessary to evaluate the efficacy of this technique further.
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Affiliation(s)
- Kotaro Yoshimura
- Department of Plastic Surgery, University of Tokyo School of Medicine, 7-3-1 Hongo, Bunkyo-ku, 113-8655, Tokyo, Japan.
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Cho SW, Song KW, Rhie JW, Park MH, Choi CY, Kim BS. Engineered adipose tissue formation enhanced by basic fibroblast growth factor and a mechanically stable environment. Cell Transplant 2007; 16:421-34. [PMID: 17658132 DOI: 10.3727/000000007783464795] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Engineered adipose tissue can be used in plastic and reconstructive surgery to augment soft tissue lost due to mastectomy or lumpectomy. The three-dimensional space provided by a scaffold capable of withstanding in vivo compressive forces and neovascularization may promote engineered adipose tissue formation. The objective of this study was to determine whether voluminous adipose tissue can be engineered by combining a mechanically stable environment with basic fibroblast growth factor (bFGF). Mechanical support structures, fabricated from biodegradable synthetic polymers, were placed into subcutaneous pockets of athymic mice. Human preadipocytes, containing fibrin matrix, with (group 1) or without (group 2) bFGF were injected into the space created by the support structures. Additionally, human preadipocytes containing fibrin matrix, with (group 3) or without (group 4) bFGF, were injected into subcutaneous spaces without support structures. Six weeks after implantation, the original implant volume was approximately maintained in groups 1 and 2, whereas groups 3 and 4 showed significant implant shrinkage. Adipogenesis and angiogenesis were more extensive in the group 1 than any other group. The fraction of human nuclear antigen-positive adipocytes in the implant was highest in group 1. Mouse adipocyte-specific genes were also expressed in the implants, again at the highest levels in group 1. Implanted preadipocyte apoptosis was significantly reduced in the groups treated with bFGF (groups 1 and 3) as opposed to those without (groups 2 and 4). This study demonstrates that combining a mechanically stable environment with bFGF can promote voluminous adipose tissue regeneration. This adipogenesis was likely promoted by the mechanically stable three-dimensional space, enhanced neovascularization, implanted cell survival, and host adipogenic cell migration. The method described in this study could be useful to augment adipose tissue used in plastic and reconstructive surgery.
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Affiliation(s)
- Seung-Woo Cho
- Department of Bioengineering, Hanyang University, Seoul 133-791, Korea
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