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Published: Journal of Evidence Based Medicine & Healthcare – 2015
“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.” (Tantuway et al., 2015)
“Knee osteoarthritis is a common chronic orthopedic disease that significantly reduces the patient’s quality of life. In re- cent years, stem cell application to osteoarthritis has rapidly developed, with promising results in pre-clinical and clinical trials. This clinical study showed that SVF injection brought about some good outcomes for patients with osteoarthritis. We have seen significant improvement in pain & symptom score as early as in first week that shows strong anti-inflammatory and analgesic effect of stromal vascular fraction derived from autologous adipose tissue obtained by liposuction. The anti-inflammatory and pain reduction effects are also contributed by soluble factors secreted from the SVF or ADSCs. ADSCs secrete many important soluble factors, such as HGF, VEGF, NGF, EGF, FGF, and TGF. Unlike PRP, growth factors from ADSCs are continuously produced after injection of these cells into the joint (22, 23, 24). Clinical case reports provides clear MRI evidence of apparent bone regeneration in osteonecrosis of femoral heads and meniscus cartilage regeneration in osteoarthritis of human knees. Along with MRI evidence, the measured physical therapy outcomes, subjective pain, and functional status all improved.(25) In a level IV study, all 21 patients showed improved joint function after 8.5 months. The pain score decreased from 7.6±0.5 before injection to 3.5±0.7 at 3 months and 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. Since this study was designed as autologous cell therapy, there is strong previously documented clinical evidence of safety of autologous non-manipulated or minimally manipulated cell therapies.(26) On the other hand, this study is well designed and strong evidence for minimal risks based on previous studies exists, can lead to a cost-effective, safe, ethical and objective evaluation of a novel treatment.” (Tantuway et al., 2015)
“To summarize, 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.” (Tantuway et al., 2015)
REF: Vinay Tantuway, S. A. Mustafa Johar, Murtza Rassiwala, Chhavi Jain (MPT), Neethu Shaji, Farida Bandookwala. Use of Autologous Adipose Tissue Derived Stromal Vascular Fraction in Treatment of Knee Osteoarthritis and Chondral Lesions. Journal of Evidence based Medicine and Healthcare; Volume 2, Issue 41, October 12, 2015; Page: 7085-7098, DOI: 10.18410/jebmh/2015/964
Tags: Macquarie Stem Cells, Dr. Bright, Osteoarthritis Treatment, Dr. Ralph Bright, Biological Therapy, Macquarie Stem Cells Publication
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