A New Classification for Adipose-derived Stromal-cell Systems

Abstract

Summary Obtaining regenerative cells from adipose tissue and their clinical use has become one of the most popular subjects of plastic surgery. However, there is no accepted classification in terms of methods. In this study, classification is proposed for the first time as a new idea. Accordingly, stromal cells can be obtained from adipose tissue by two approaches: direct methods for the bonds between parenchymal and stromal cells, and indirect methods, which target parenchymal cells rather than strong bonds, and increase the stromal cell ratio relatively. These methods can also be subclassified as fat (+), fat (−), fat (±) in terms of using the remaining fat in the final product as a graft. Direct methods include adinizing and enzymatic techniques; indirect methods include emulsification and micro-fragmentation/micronization techniques. In the enzymatic method, the fat tissue in the final product is considered dirty because it contains enzymes and must be discarded. That is why it is a fat (−) method. The adinizing method using ultra-sharp blades is fat (+) because the adipose tissue after the procedure can be used. Because the fat tissue is exposed to blunt pressure in emulsification techniques, it cannot be used as a graft. Thus, these are fat (−) methods. In micronization techniques using filter systems, there may still be intact adipocytes; therefore, it should be classified as fat (±). Adinizing provides both the highest efficiency and the full use of the end product. This classification will guide clinicians in terms of choosing the right product.

Autologization of Exosomes with Deparenchymized Adipose Tissue: An Innovative Approach for Regenerative Medicine and Surgery

“…This approach not only enabled intensive regeneration obtained from different sources (fat tissue and blood) but also enabled regenerative cells placed in the target tissue to adhere to that area and achieve much more successful results, thanks to fibrin, a biologic glue. Finally, Copcu 25 presented a new perspective on obtaining stromal cells obtained from fat tissue in his study published in 2022. Although previously the generally accepted view was that the classification was divided into two as enzyme and mechanical methods, a clear classification has been made in this publication: parenchymal and stromal cells in adipose tissue are connected to each other very tightly with strong bridges and bonds.…”

“…In these methods, because the blunt pressure is high during the process, cells are damaged, and not only is the number of cells low but also their viability is very low. 25 As a result, it has been proven that the most successful approach to obtaining stromal cells from fat tissue is the use of ultrasharp blade systems. The Adinizer’s successful clinical results in aesthetic and reconstructive surgery and orthopedic applications are also presented in detail in the literature.…”

Effects of Autologous Microfragmented Adipose Tissue on Healing of Tibial Plateau Levelling Osteotomies in Dogs: A Prospective Clinical Trial

“…Microfragmented adipose tissue contains all the cells found in adipose tissue, including adipocytes, and preserves the microenvironment of the perivascular niche. For this reason, it has a greater paracrine and immunomodulatory effect then enzymatic SVF, albeit with fewer stem cells [ 44 , 45 , 46 , 47 ].…”