Stromal Vascular Fraction for Knee Osteoarthritis – An Update

Abstract

Orthobiologics never cease to cause popularity within the medical science field, distinctly in regenerative medicine. Recently, adipose tissue has been an object of interest for many researchers and medical experts due to the fact that it represents a novel and potential cell source for tissue engineering and regenerative medicine purposes. Stromal vascular fraction (SVF), for instance, which is an adipose tissue-derivative, has generated optimistic results in many scenarios. Its biological potential can be harnessed and administered into injured tissues, particularly areas in which standard healing is disrupted. This is a typical feature of osteoarthritis (OA), a common degenerative joint disease which is outlined by persistent inflammation and destruction of surrounding tissues. SVF is known to carry a large amount of stem and progenitor cells, which are able to perform self-renewal, differentiation, and proliferation. Furthermore, they also secrete several cytokines and several growth factors, effectively sustaining immune modulatory effects and halting the escalated pro-inflammatory status of OA. Although SVF has shown interesting results throughout the medical community, additional research is still highly desirable in order to further elucidate its potential regarding musculoskeletal disorders, especially OA.Usually, health care providers may prescribe a course of multiple combined drugs for different OA stages, with the objective of controlling inflammatory nociceptive pain. Non-steroidal antiinflammatory drugs (NSAIDs), other analgesics and corticosteroids, for example, may be commonly prescribed to aid in pain management. However, chronic NSAID use is of great concern as reported. Although NSAIDs effectively mitigate pain, they are also responsible for the increased risk of several adverse events, such as peptic ulcer disease, acute renal failure, and myocardial infarction [9] . Non-pharmacological strategies are usually limited to physical therapy, low impact exercise, weight loss, physical aids, and nerve ablation. In severe cases, however, such as grade IV OA, surgical intervention with joint replacement procedures may be unavoidable and therefore extremely detrimental to the patient [6,7] .These obstacles have led researchers to explore non-surgical alternatives, such as prescribing orthobiologics in particular. Orthobiologics are biologic products derived from substances that are naturally found in the human body which can mitigate the healing process of orthopedic injuries. Popular examples include platelet-rich plasma (PRP), hyaluronic acid (HA) and bone marrow aspirate/concentrate (BMA/BMAC), as well as adipose tissuederived stem cells (ADSCs) [10,11] . According to the literature, these biological materials contain cytokines, mesenchymal, and

The role of orthobiologics in chronic wound healing

“… 58 Histologic analysis in human studies revealed that fat grafting may increase vascularity, new collagen deposition and reorganization. 63 Piccolo et al showed improved wound healing and fibrosis in acute and subacute wounds. 64 ADSCs promote angiogenesis, regulate the inflammatory process, can differentiate into multiple cell types and secrete growth factors such as keratinocyte growth factor, vascular endothelial growth factor (VEGF), hepatocyte growth factor, fibroblast growth factor‐2, EGF and platelet‐derived growth factor.…”

“…According to the literature, these biological materials contain cytokines, mesenchymal and stem/progenitor cells. 18 …”

The Synergistic Effects of Hyaluronic Acid and Platelet-Rich Plasma for Patellar Chondropathy

“…By definition, orthobiologics are organic or synthetic materials that promote enhanced healing of musculoskeletal disorders [9]. Many orthobiologic products have been discussed in the literature, including acellular solutions like hyaluronic acid (HA) and cellular alternatives such as platelet-rich plasma (PRP), injectable platelet-rich fibrin (i-PRF), bone marrow aspirate/bone marrow aspirate concentrate (BMA/BMAC) and adipose tissue derivatives [10][11][12][13][14]. These products can have autologous or allogeneic origins and are known to contain a rich secretome and a wide variety of cells with potent stimulatory effects [15].…”

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

“…Stromal vascular fraction contains paracrine factors that stimulate and enhance endogenic regenerative pathways [ 60 , 62 ]. Its biological and biomolecular action mechanisms include stimulation of angiogenesis, immune modulation, cell proliferation, and differentiation and extracellular matrix functionalization [ 63 ]. Isolation of AD-tSVF from the abdominal fat tissue is almost always possible in all patients.…”