Comparison of intraoperative procedures for isolation of clinical grade stromal vascular fraction for regenerative purposes: a systematic review

Abstract

Intraoperative application of the stromal vascular fraction (SVF) of adipose tissue requires a fast and efficient isolation procedure of adipose tissue. This review was performed to systematically assess and compare procedures currently used for the intraoperative isolation of cellular SVF (cSVF) and tissue SVF (tSVF) that still contain the extracellular matrix. Pubmed, EMBASE and the Cochrane central register of controlled trials databases were searched for studies that compare procedures for intraoperative isolation of SVF (searched 28 September 2016). Outcomes of interest were cell yield, viability of cells, composition of SVF, duration, cost and procedure characteristics. Procedures were subdivided into procedures resulting in a cSVF or tSVF. Thirteen out of 3038 studies, evaluating 18 intraoperative isolation procedures, were considered eligible. In general, cSVF and tSVF intraoperative isolation procedures had similar cell yield, cell viability and SVF composition compared to a nonintraoperative (i.e. culture laboratory-based collagenase protocol) control group within the same studies. The majority of intraoperative isolation procedures are less time consuming than nonintraoperative control groups, however. Intraoperative isolation procedures are less time-consuming than nonintraoperative control groups with similar cell yield, viability of cells and composition of SVF, and therefore more suitable for use in the clinic. Nevertheless, none of the intraoperative isolation procedures could be designated as the preferred procedure to isolate SVF.

Isolation of adipose tissue derived regenerative cells from human subcutaneous tissue with or without the use of an enzymatic reagent

“…A number of enzymatic and non-enzymatic methods were reported for isolating human ADRCs (Tables 1 and 2; c.f. also Fig 1 and [35][36][37][38]). For enzymatic methods, cell yield between 0.0 [39] and 387×10 5 cells per ml lipoaspirate [63] were reported (Table 1) (mean, 14.6×10 5 ; standard deviation, 61.5×10 5 ; median, 3.1×10 5 ; for 90% of the methods listed in Table 1 cell yield between 0.0 and 12.2×10 5 cells per ml lipoaspirate was reported; Fig 1).…”

Adipose tissue‐derived extracellular matrix hydrogels as a release platform for secreted paracrine factors

“…Concentration of the SVF of adipose tissue, that is, to get rid it of the large amounts of adipocytes and thereby reducing volume, might augment the clinical observed regenerative potential compared with standard autologous fat grafting. To concentrate SVF, the SVF can be isolated enzymatically or mechanically (van Dongen, Tuin, et al, ). Enzymatic isolation destructs the ECM and its interaction with cells and thus yields a suspension of single SVF cells (cellular SVF or cSVF).…”

“…Enzymatic isolation destructs the ECM and its interaction with cells and thus yields a suspension of single SVF cells (cellular SVF or cSVF). Via centrifugation, adipocytes are readily removed with enzymatic isolation (van Dongen, Tuin, et al, 2017). When a nonenzymatic isolation procedure is used, adipocytes are mechanically destructed and the ECM is still intact as are its interactions with bound cells, and it also acts for sustained release of bound factors (tissue-like SVF or tSVF) (van Dongen, Stevens et al, 2017;van Dongen, Tuin, et al, 2017).…”

“…Via centrifugation, adipocytes are readily removed with enzymatic isolation (van Dongen, Tuin, et al, 2017). When a nonenzymatic isolation procedure is used, adipocytes are mechanically destructed and the ECM is still intact as are its interactions with bound cells, and it also acts for sustained release of bound factors (tissue-like SVF or tSVF) (van Dongen, Stevens et al, 2017;van Dongen, Tuin, et al, 2017). Therefore, we anticipate a nonenzymatically obtained SVF to have a higher therapeutic benefit than enzymatic SVF or unprocessed lipografts.…”

Uncultivated stromal vascular fraction is equivalent to adipose‐derived stem and stromal cells on porous polyurethrane scaffolds forming adipose tissue in vivo

“…26 Underlying mechanisms include the natural interplay of endothelial cells, adipocytes, and stem cells and their secreted factors. 28 Therefore, SVF seems to be a promising cell source for translation into clinical practice, as its use is cost-effective, a one-step intraoperative application is possible, 29 devices for automatized procession exist, [30][31][32] and no adverse effects following patient application have been reported to date. 27 To our knowledge, no earlier investigation has compared ASCs and SVF cells with regard to their tissue formation capacities in adipose tissue engineering.…”