Adipose-derived MSCs After Enzymatic Digestion vs. Mechanically Fragmented Fat Transfer in Knee Osteoarthritis Treatment

Study Overview
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Brief Summary
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The aim of the study is to compare the clinical effects of treatment of knee osteoarthritis using adipose tissue mesenchymal stromal cells obtained by an enzymatic method with the outcomes of the therapy with the mechanically fragmented adipose tissue. Identification and functional analysis of the regenerative capacity of MSCs derived from the adipose tissue depending on three variables (body weight, sex and age) will help to develop a targeted therapy for different groups of patients and will determine the effectiveness of both methods of treatment. An attempt was made to identify the groups of patients with the greatest regeneration potential of the adipose tissue, and thus indicate those with the most probable improvement of the joint condition.

Detailed Description
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Based on the calculation of the sample size using power analysis of the test, investigators plan to include 100 adults with primary knee osteoarthritis in this study. The patients will undergo lipoaspiration under sterile conditions of the operating theatre, the collected lipoaspirates will be further processed - enzymatically with the use of collagenase or mechanically using the Lipogems system. After collection, lipoaspirates will be immediately transferred to the laboratory of the Department of Regenerative Medicine with a tissue and cells bank in Warsaw, and the preparations will be administered to the patients' knee joints in the operating room under ultrasound control. The Lipogems system is defined as a minimal tissue manipulation system. In contrast, the administration of preparations produced using an enzymatic method requires advanced actions. Lipoaspiration will be performed using blind cannulas and vacuum syringes introduced through the abdominal wall with a three-millimetre incision on the skin after previous injection to the adipose tissue with modified Klein's solution (500 ml of saline solution, 1 ml of adrenaline, 40 ml of 2% lignocaine), which makes the collection easier. 10 ml of the collected adipose tissue will be used to examine the samples after previous gradient drainage from Klein's solution. Immediately after collection, the samples will be sent to the laboratory for analysis (cell count testing, culture, phenotype identification, analysis by flow cytometry). The patients will be monitored in the hospital outpatient clinic for one year after the procedure; the control visits will take place: after 2 and 6 weeks, then after 3 and 6 months and after a year. A physical examination and the assessment using the KOOS questionnaire will be performed. Before the procedure and after one year, an X-ray and MRI with T-2 Mapping will be carried out in order to evaluate the condition of the cartilage.

Official Title
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Comparison of the Treatment Results of Knee Osteoarthritis Using Adipose Tissue Mesenchymal Stromal Cells Derived Through Enzymatic Digestion and Mechanically Fragmented Adipose Tissue

Conditions
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Knee Osteoarthritis, Chondropathy

Intervention / Treatment
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* Procedure: Autologous adipose derived Mesenchymal Stromal Cells (MSC) injection into the knee joint


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Adults with symptomatic gonarthrosis diagnosed based on the X-ray, MRI and clinical examination, previously unsuccessfully treated (rehabilitation, NSAIDs, hyaluronic acid, platelet-rich plasma) Primary knee osteoarthritis Willingness and consent to participate in the study Readiness to attend control visits Exclusion Criteria: Failure to meet the inclusion criteria Active chronic infection Metal implant made of a ferromagnetic material that will exclude the patient from magnetic resonance imaging Use of anticoagulants General and intra-articular use of steroids during the last year Pregnancy, breastfeeding Any autoimmune and rheumatic disease, or conditions that influence the accuracy of test results Taking drugs or cytostatic medications in the last 30 days Mental disorders, alcohol and drug addiction

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Enzymatic digestion group<br>A group treated with a stromal vascular fraction (SVF) with mesenchymal stromal cells (MSC) injection in the knee joint after an enzymatic digestion of autologous adipose tissue | Procedure: Autologous adipose derived Mesenchymal Stromal Cells (MSC) injection into the knee joint<br>* Injections of the two adipose tissue derived products containing MSCs into the knee joints with osteoarthritis<br>* Other names: Autologous mechanically fragmented adipose tissue injection into the knee joint using Lipogems device;|
| Active Comparator: Mechanical fragmentation group<br>A group treated with a mechanically fragmented (using Lipogems device) autologous adipose tissue injection in the knee joint | Procedure: Autologous adipose derived Mesenchymal Stromal Cells (MSC) injection into the knee joint<br>* Injections of the two adipose tissue derived products containing MSCs into the knee joints with osteoarthritis<br>* Other names: Autologous mechanically fragmented adipose tissue injection into the knee joint using Lipogems device;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Changes in patients reported outcome measures - Knee Injury and Osteoarthritis Outcome Score (KOOS) | The KOOS is self-administered and assesses five outcomes: pain, symptoms, activities of daily living, sport and recreation function, and knee-related quality of life.The KOOS's five patient-relevant dimensions are scored separately: Pain (nine items); Symptoms (seven items); ADL Function (17 items); Sport and Recreation Function (five items); Quality of Life (four items). A Likert scale is used and all items have five possible answer options scored from 0 (No problems) to 4 (Extreme problems) and each of the five scores is calculated as the sum of the items included. Scores are transformed to a 0-100 scale, with zero representing extreme knee problems and 100 representing no knee problems as common in orthopaedic scales and generic measures. Scores between 0 and 100 represent the percentage of total possible score achieved. | 1,3,6 and 12 months after procedure | 
| Changes in flexibility of the knee joint | Range of motion assessment by goniometer measurements | 1,3,6, and 12 months after procedure | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Changes in X-ray imaging of the knee joint in a standing position (AP view) | Articular cartilage volume evaluation by joint gap measurements | 6 months and 1 year after procedure | 
| Changes in MRI with T-2 Mapping of the knee cartilage | Articular cartilage quality evaluation in T-2 Mapping | 6 months and 1 year after procedure | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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MSC, SVF, adipose tissue, knee osteoarthritis