Adipose tissue stromal vascular fraction and adipose tissue stromal vascular fraction plus platelet‐rich plasma grafting: New regenerative perspectives in genital lichen sclerosus

Abstract

Lichen sclerosus (LS) is a chronic relapsing, inflammatory skin disorder usually involving the anogenital region of both sexes lacking a resolutive therapy. This study compared adipose tissue derived-stromal vascular fraction (AD-SVF) and AD-SVF-enriched plateletrich plasma (PRP) therapy in the management of genital LS patients. Additionally, in vitro evaluation of cells and growth factors contained in the injected SVF has been evaluated as possible predictive factors for treatment outcome. The study population was 40 patients diagnosed with LS who were symptomatic despite medical treatment. Patients (age 43-78 years) randomized into two groups using a 1:1 allocation ratio, were evaluated clinically and assessing dermatology life quality index (DLQI) before and 6 months after treatment. Both procedures demonstrated a strong safety profile with no complications linked to the therapy. After 6 months, both treatments allowed for a significant improvement respect to baseline. Combinatory therapy demonstrated decreased efficacy in late stage patients. No correlations have been found between clinical and biological findings. AD-SVF and AD-SVF plus PRP are safe and effective regenerative approaches for genital LS patients. Clinical results support the preferential use of combinatory therapy for early stage patients confirming a synergic effect of AD-SVF and PRP. In contrast, AD-SVF plus PRP is discouraged for late stage patients. K E Y W O R D S adipose-derived stromal vascular factors (AD-SVF), genital lichen sclerosus, growth factors, immunomodulatory factors, mesenchymal stem cell (MSC), platelet-rich plasma (PRP) 1 | INTRODUCTION Lichen sclerosus (LS) is a chronic relapsing, inflammatory mucocutaneous disorder which affects both gender with a common localization at the anogenital region. LS etiology is unclear. However, autoimmunity seems to play a significant pathogenetic role as evidenced by the association with many autoimmune disorders. 1-3 The diagnosis of LS may be challenging, particularly during the onset and early stages. Thus the incidence rate, reported between 0.1% to 3% and 1.7%, is considered an underestimate. 4,5 Women are more commonly affected than men. 6 The diagnosis is usually based on clinical signs and symptoms, but histological confirmation is recommended. Commonly, Marinella Tedesco and Barbara Bellei contributed equally to this manuscript.

Autologous lipoaspirate as a new treatment of vulvar lichen sclerosus: A review on literature

“…Significant improvement of QoL was observed in both groups after one month using the validated DLQI questionnaire. After 6 months, the tSVF‐group (mixed female and male patients) still showed a significant improvement of QoL, but the tSVF and PRP group showed only limited improvement compared with the pre‐operative QoL, 40 suggesting that PRP may mitigate the beneficial effects of tSVF. Willemsen et al demonstrated a concentration‐related effect of PRP to the regenerative capacity of ASCs.…”

Vulvar Lichen Sclerosus from Pathophysiology to Therapeutic Approaches: Evidence and Prospects

“…A recent study compared the effectiveness of local injection of purified adiposederived stromal vascular fraction (AD-SVF) compared with purified SVF plus PRP in two randomized groups of LS patients [230]. Each patient received two surgical procedures, in general anaesthesia, distanced by a 4-month period.…”

Lichen sclerosus

“…The results of both treatments were encouragingimprovement of signs and symptoms of the disease was noteworthy, although some limitations were recognized (lack of a control group, insufficient number of participants, requirement for long-term follow-up and standardization of therapeutic procedure, absence of well-established standardized outcome measurement methods). Tedesco et al compared adipose tissue derived-stromal vascular fraction (AD-SVF) and AD-SVF-enriched PRP therapy as the alternative therapeutic approach for refractory male and female genital LS [69]. Forty patients were randomized into 2 groups in which one of the surgical procedures was administered 2 times in a 4-month interval.…”

“…Tedesco i wsp. porównali leczenie komórkami AD-SVF (pochodzącymi z tkanki tłuszczowej komórkami frakcji stromalnej) z leczeniem AD-SVF wzbogaconym PRP jako alternatywnym podejściem terapeutycznym u pacjentów i pacjentek z opornym na leczenie LS umiejscowionym w obszarze genitalnym [69]. Czterdziestu uczestników badania randomizowano do jednej z dwóch grup, w których jeden z zabiegów przeprowadzano dwukrotnie w odstępie 4 miesięcy.…”