Stromal Vascular Fraction for Osteoarthritis of the Knee Regenerative Engineering

Abstract

Purpose The knee joint is prone to osteoarthritis (OA) due to its anatomical position, and several reports have implicated the imbalance between catabolic and anabolic processes within the joint as the main culprit, thus leading to investigations towards attenuation of these inflammatory signals for OA treatment. In this review, we have explored clinical evidence supporting the use of stromal vascular fraction (SVF), known for its anti-inflammatory characteristics for the treatment of OA. Methods Searches were made on PubMed, PMC, and Google Scholar with the keywords “adipose fraction knee regeneration, and stromal vascular fraction knee regeneration, and limiting searches within 2017–2020. Results Frequently found interventions include cultured adipose-derived stem cells (ADSCs), SVF, and the micronized/microfragmented adipose tissue-stromal vascular fraction (MAT-SVF). Clinical data reported that joints treated with SVF provided a better quality of life to patients. Currently, MAT-SVF obtained and administered at the point of care is approved by the Food and Drug Administration (FDA), but more studies including manufacturing validation, safety, and proof of pharmacological activity are needed for SVF. The mechanism of action of MAT-SVF is also not fully understood. However, the current hypothesis indicates a direct adherence and integration with the degenerative host tissue, and/or trophic effects resulting from the secretome of constituent cells. Conclusion Our review of the literature on stromal vascular fraction and related therapy use has found evidence of efficacy in results. More research and clinical patient follow-up are needed to determine the proper place of these therapies in the treatment of osteoarthritis of the knee. Lay Summary Reports have implicated the increased inflammatory proteins within the joints as the main cause of osteoarthritis (OA). This has attracted interest towards addressing these inflammatory proteins as a way of treatment for OA. The concentrated cell-packed portion of the adipose product stromal vascular fraction (SVF) from liposuction or other methods possesses anti-inflammatory effects and has been acclaimed to heal OA. Thus, we searched for clinical evidence supporting their use, for OA treatment through examining the literature. Data from various hospitals support that joints treated with SVF provided a better quality of life to patients. Currently, there is at least one version of these products that are obtained and given back to patients during a single clinic visit, approved by the FDA.

Autologous Adipose-Derived Tissue Stromal Vascular Fraction (AD-tSVF) for Knee Osteoarthritis

“…Kunze et al [ 85 ] listed enzymatic and mechanical ADMSCs’ products. They were also reviewed by Ude et al [ 264 ]. Mechanical separation systems used centrifugation, syringe emulsification, electromagnetic vibration, and filtration.…”

Intraoperative Administration of Adipose Stromal Vascular Fraction Does Not Improve Functional Outcomes in Young Patients with Anterior Cruciate Ligament Reconstruction

“…Recently, SVF has been proposed as a biological product superior to single-type cell therapies because it contains versatile cell types, including stem cells with therapeutic potential involving paracrine activity modulation, and preparing it for intraoperative application is easy [ 13 , 14 , 15 , 16 , 17 , 18 ]. In orthopedic medicine, SVF has been used in treating patients with various conditions, including knee osteoarthritis [ 20 , 21 , 22 , 23 ], chondromalacia [ 24 ], degenerative meniscal injuries [ 25 ], pseudoarthrosis [ 26 ], and Achilles tendinopathy [ 27 , 28 ], all of which show optimistic results. However, regarding the condition of the ACLR, there has been only one animal study.…”

“…Previous studies have shown that patients aged ≤ 30 years with ACLR have better functional outcomes during the follow-up than patients aged >30 years because of their higher healing potential [ 38 , 39 ]. In previous studies, orthopedic patients who benefited from SVF therapy were either old people with degenerative diseases or had a mean age of over 48 years [ 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 ]. The mean age of the patient cohort in this study was 28 years.…”

“…SVF has several advantages over ADSCs such as easy preparation, no need for time-consuming ex vivo expansion, and containing other cell types with regenerative and healing potentials that involves paracrine activity modulation [ 15 , 16 , 17 , 18 ]. In orthopedic medicine [ 19 ], SVF has been used in treating patients with certain conditions, mainly degenerative cartilage diseases [ 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 ]. However, to date, there has been only one animal study reporting that SVF stimulated graft healing after ACLR [ 29 ].…”

Stromal Vascular Fraction for Knee Osteoarthritis – An Update

“…In addition to creating new cells and replenishing damaged tissue, MSCs also elicit paracrine and autocrine effects, which allow them to regulate inflammation and attenuate tissue destruction, as it is observed in OA [46] . These cells may be more advantageous not only due to the fact that they are easily obtained in abundance, but also because research has demonstrated the significant efficacy these cells provide as an alternative treatment [47][48][49][50][51] .…”