Adipose-Based Therapies for Knee Pain—Fat or Fiction

Abstract

Regenerative cell therapies are emerging as promising treatments for numerous musculoskeletal conditions, including knee osteoarthritis (OA). Adipose-derived stem cells and possibly other adipose-based therapies have a greater chondrogenic potential than stem cells derived from bone marrow, and thus a lot of attention is being placed on them as potential regenerative agents in the treatment of knee OA. Several types of adipose-based therapies have good basic science and preclinical data supporting their translation to human therapeutic intervention. Cultured, adipose-derived stem cells appear to be good source of bioactive cells with convenient accessibility, relative abundance, and well-documented regenerative capacity. Non-culture expanded adipose-based therapy, in the forms of stromal vascular fraction and most recently micronized adipose tissue (MAT), have been utilized in patients to treat OA and other cartilage abnormalities with encouraging preliminary data. These adipose-based therapies have shown a lot of therapeutic potential; however, because of the regulatory restrictions on enzymatic isolation and cell expansion, only MAT is currently available in clinical practice in the United States. While no serious adverse reactions have been reported, adipose-derived therapies also have the potential for adverse reactions including inflammation and infection. The current review provides an update on the latest research and presents this evidence on the therapeutic potential of adipose-based therapies in the treatment of knee OA.

Clinical Efficacy of Bone Marrow Aspirate Concentrate Versus Stromal Vascular Fraction Injection in Patients With Knee Osteoarthritis: Letter to the Editor

“…This is then centrifuged to create a pellet of SVF that has a concentration of nucleated cells, including mesenchymal stem cells (MSCs), much higher than MFAT. 10 In the work of Garza et al, 4 total nucleated cell (TNC) counts in SVF were 5-10 million/mL. Microfragmented adipose tissue is created by rinsing and resizing lipoaspirate without enzymatic digestion or cell concentration.…”

Arthroscopic Debridement and Autologous Micronized Adipose Tissue Injection in the Treatment of Advanced-Stage Posttraumatic Osteoarthritis of the Ankle

“…ADSCs have demonstrated early promise in managing the pain associated with OA. 5 However, because both culture-expanded ADSCs and enzymatic derived stromal vascular fraction have faced difficult-to-navigate regulatory policies in the United States, MAT therapy was developed as an alternative method for utilizing autologous adipose stem cells to treat an osteoarthritic joint. Although several studies have evaluated MAT injection for the management of knee OA, 5 limited data exist describing the effect of MAT on ankle PTOA.…”

“…Among these, adipose-derived stem cells (ADSCs) have attracted attention as a promising treatment due to the propensity for these cells to differentiate into chondrocytes and therefore potentially provide chondrogenic capability as well as a chondroprotective role to arthritic joints. 5 Regulatory constraints, however, hinder the use of ADSCs in the United States. Micronized adipose tissue (MAT) injection was introduced as an innovative isolation method for autologous ADSCs, reducing costs and avoiding the regulatory issues with expanding ADSCs in a laboratory setting.…”

Stromal Vascular Fraction for Osteoarthritis of the Knee Regenerative Engineering

“…B Cells, frequency of occurrence, and associated markers of SVF and MAT-SVF led to the development of MAT-SVF [12,14,30]. MAT-SVFs are obtained from micromincing, fragmentation, and homogenization of lipoaspirate adipose contents, without enzymatic digestion and cell expansion [16,25]. The isolation procedure involves mechanical agitation, which breaks down the component tissue matrix and releases the stem cells.…”

“…Recently, native cells in adipose tissues have attracted great attention due to their abundance in the body, ease of accessibility, and regenerative capabilities [ 16 , 24 ]. Adipose-derived stem cells (ADSCs), stromal vascular fractions (SVFs), and micronized/microfragmented adipose tissue-stromal vascular fractions (MAT-SVFs) are among the most frequently reported cell interventions [ 25 ]. These cellular products are believed to evoke their regenerative effect through the secretion of bioactive molecules that act in a paracrine fashion to prime and sustain angiogenic, anti-fibrotic, anti-apoptotic, and immuno-modulatory responses in the target tissues [ 3 , 10 , 21 , 26 ].…”