USE OF AUTOLOGOUS ADIPOSE TISSUE DERIVED STROMAL VASCULAR FRACTION IN TREATMENT OF KNEE OSTEOARTHRITIS AND CHONDRAL LESIONS

: Osteoarthritis is a joint inflammation that results from cartilage degeneration. It can be caused by aging, heredity and injury from trauma or disease. Stromal vascular fraction (SVF), containing large amount of stem cells and other regenerative cells, can be easily obtained from loose connective tissue that is associated with adipose tissue. Here we evaluated safety and clinical efficacy of freshly isolated autologous SVF cells in patients with grade 2-4 degenerative osteoarthritis (OA). A total of 31 patients underwent standard liposuction under local anesthesia and SVF cells were isolated and prepared for application into joints. A total of 61 joints, mainly knee and hip joints, were treated with a single dose of SVF cells. 19 patients were followed for minimum 6 weeks for safety and efficacy. Modified KOOS Clinical Score was used to evaluate clinical effect and was based on pain, non-steroid analgesic usage, limping, extent of joint movement, and stiffness evaluation before and at pre-operative, 1 week post-op, 1 month and 6 weeks after the treatment. No serious side effects, systemic infection or cancer was associated with SVF cell therapy. All patients improved after the treatment. Average KOOS score improved from pre-operative 37.5 to post-operative 6 week average 66.6. All sub scale parameter for pain, symptoms, activity of living & quality of life are also improved. Higher grade of OA were associated with slower healing. In conclusion, here we report a novel and promising treatment approach for patients with degenerative OA that is safe, cost-effective, and relying only on autologous cells, and can be used as one of the minimal invasive treatment modality for osteoarthritis. OA of weight-bearing joints is associated with chronic devastating pain, stiffness, decreasing range of motion and joint deformity, being one of the leading causes of decreased quality of life and work limitations in elderly. Despite ongoing research, treatments to manage the disease remain symptomatic. Treatment generally involves a combination of lifestyle modification, analgesics, non-steroidal anti-inflammatories, and joint injections with steroids or hyaluronic acid (lubricant). If pain becomes debilitating, joint replacement surgery may be used to improve the quality of life, e.g. partial joint resurfacing (hip and shoulder), and total joint replacement (hip and knee). Total joint arthroplasty (TJA) is the mainstay of treatment for end-stage OA of the hip or knee. Unfortunately, TJA is relatively frequently associated with serious and life-threatening complications including increased risk of infection, thromboembolism, myocardial infarction, stroke, increased risk of death at 30 and 90 days after surgery, and the life-span of the prosthesis is limited. (5,6,7,8) Recently, it was shown that mesenchymal stromal/stem cells (MSCs) hold a great promise for their healing potential in regenerative medicine. (9) Preclinical animal studies that utilize MSCs demonstrated safety and efficacy in treatment of OA, cartilage defects or other orthopedic conditions. (10,11,12,13) The use of autologous SVF derived from adipose tissue as a treatment option has been rapidly gaining momentum. trials listed on IRCM IRB 1.5±0.5 at 6 months after injection. The Lysholm score increased from 61±11 before injection to 82±8.1 after injection. Significant improvements were noted in MRI findings, with increased thickness of the cartilage layer. Moreover, there were no side effects or complications related to microorganism infection, graft rejection, or tumorigenesis. These results provide a new opportunity for osteoarthritis treatment. (17) The patients will be further monitored and longer follow-up data will help to answer question about durability and long-term safety of SVF cell therapy. Although in a clinical study, with single injection of SVF almost all patients showed significant improvement in all clinical outcomes at the final follow-up examination. All clinical results significantly improved at 2-year follow-up compared to 12-month follow-up (P< 0.05). Among elderly patients aged [65 years, only five patients demonstrated worsening of Kellgren– Lawrence grade. On second-look arthroscopy, 87.5 % of elderly patients (14/ 16) improved or maintained cartilage status at least 2 years postoperatively. Moreover, none of the patients underwent total knee arthroplasty during this 2-year period. (19) Another limitation of our study is no randomization and no placebo control. There were two reasons for designing that case control study: 1) ethical aspect and 2) economical aspect. We believe it would be rather unethical to ask placebo group of patients to undergo liposuction and placebo administration to the joint with OA. study cell minimally autologous SVF injection is a safe and efficient method for treating osteoarthritis. The efficiency of transplantation clearly improved after 6 months. Overall, 100% of patients were pleased with this method. Pain was strongly reduced after therapy, and the quality of life was significantly improved. Although further studies with control subjects and more patients need to be performed to confirm the above results, this study suggests that our treatment is a promising minimally invasive therapy for osteoarthritis patients.