Aesthetic Surgery Applications for Adipose-Derived Stem Cells

on

 


Dr. Joel Aronowitz, Daniel Oheb, Nathan Cai, Asli Pekcan, Bridget Winterhalter, and Joseph Clayton

Joel A. Aronowitz, MD

Division of Plastic Surgery

Los Angeles, CA, USA


Abstract

Adipose derived stem cells (ADSCs) possess regenerative properties based on their observed cellular and paracrine behavior in a large body of preclinical lab and animal studies. These intriguing properties suggest ADSC’s offer a unique and powerful modality for many age-related changes and elective cosmetic treatments. ADSC’s are reported as a primary modality or adjunct aesthetic treatment for many conditions, including senescent skin changes, restoration of the subcutaneous adipose layer, photoaging, improvement of hypertrophic scars, optimizing fat graft engraftment especially in small volume applications and, most recently, hair regeneration for early androgenic alopecia. Here, we explore the scientific rationale and range of aesthetic applications reported for autologous ADSC’s, reported benefits, and current limitations. Further clinical research is needed to document efficacy, establish a dose/effect relationship and optimal method of administration. But unquestionably ADSCs represent a significant autologous modality on the horizon for cellular based aesthetic therapies in the face and body.

Keywords

Adipose-derived stem cells, aging, fat grafting, wound care, photoaging, vitiligo, scarring, breast, autologous

Overview

Adipose derived stem cells (ADSCs) are small stellate shaped pluripotential cells which reside in large numbers on the walls of small vasculature. It is estimated that each gram of adipose tissue contains approximately 3 million of these mesenchymal cells. Although the HLA surface protein expression of these cells is heterogenous, including CD 34, the sine qua non of definitive identification is their tendency to adhere and form colonies in vitro (Yu 2010, Gronthos 2001). This tendency is reported in a standard laboratory test known as Colony Forming Units (CFU). Adipose cells expressing this ability are further categorized by a range of tests including mRNA arrays, flow cytometry, and transcriptomic analyses (Yu 2010, Gronthos 2001). Interest in these cells has resulted in publications from a wide range of researchers from cell biologists to practicing clinicians. This profusion of scientific papers often produces a confusing terminology as authors frequently suggest updated nomenclature to reflect an evolving understanding of the behavior of these complex cells. In the final analysis, ADSCs may be properly classified as mesenchymal, connective tissue pluripotential messenger cells found most abundantly in peripheral adipose tissue. They possess the potential to repeatedly divide 25-28 times to produce daughter stem cells. The somatic daughter cells may differentiate to virtually any connective tissue cell type, recruit circulating cells such as the macrophage and direct the differentiation of these and locally resident cells. The term messenger is appended to ADSCs because they are well known to direct the behavior of other cells through a protean range of paracrine effects.

A large body of preclinical research elucidates the cellular characteristics and behavior of these pluripotential cells which are found concentrated in the stroma of adipose tissue and supports the concept of utilizing these cells for cosmetic purposes to replace senescent volume loss and reverse other aesthetic changes in the skin and subcutaneous tissue observed with age such as attenuation of dermal thickness, loss of subcutaneous adipose tissue, loss of dermal elasticity and pigment changes.

Based on the preclinical literature, clinicians applied autologous adipose derived stem cells in the treatment of a wide variety of aesthetic purposes. The ease of accessibility of autologous cells from adipose tissue, their regenerative properties and a proven clinical safety profile suggest that ADSCs offer the possibility of a unique treatment modality for many age related and elective cosmetic treatments [1]. These applications include restoration of volume loss and redistribution due to aging, improvement of thin and fragile skin and reversal of unsightly pigmentary changes associated with age and sun exposure. Most of these reports pertain to treatment of facial senescent changes but there are many applications relating to other areas of the body as well.

A brief summary of age associated and environmental exposure induced changes in the skin and subcutaneous layer is necessary to understand stem cell applications in treatment.

Age-related changes to the skin include a loss of skin elasticity, wrinkling, decreased amount of hair follicles, and a reduction in sweat and sebaceous glands. Overall, the epidermis regenerates at a slower rate with age, influenced in part by slowed collagen synthesis [2]. Skin thickness is decreased due to loss of vascularization and cell proliferation, particularly of keratinocytes and collagen [3,4]. Changes in the structure and adhesion levels of subcutaneous white adipose tissue reduces skin elasticity [5]. As the number of adipose-derived stem cells decreases, the number of adipocytes in a given area of the face decreases, reducing skin stiffness and increasing wrinkles [5].

Environmental factors such as tobacco smoking, infrared radiation, and ultraviolet exposure can accelerate the skin ageing process and further contribute to wrinkles and loss of epidermal thickness [2,6]. Environmental damage to the skin, including photoaging, tends to occur more often in males than in females [7]. Ultraviolet exposure in particular alters skin pigmentation and texture as well [6].

Beyond aging, the skin can undergo aesthetic changes such as vitiligo, a skin condition in which loss of melanocytes leads to skin discoloration [8]. Though it only affects about 1% of the population, it serves as a good example of a disorder that drives patients to seek cosmetic treatments to preserve their appearance [9]. Traditionally, vitiligo is treated with melanocyte transplantation [8].

With respect to the subcutaneous fat layer, the aging face exhibits a change in the distribution of adipose tissue with age. Three-dimensional modeling of young and old facial shapes shows an increase in the mobility of facial tissues with age, specifically towards the lower anterior portion of the face [10]. Overall migration of facial fat to the inferior portion of the face contributes to a more masculine, square face and more prominent fat pads below the eyelid [11-12]. The nasolabial fold also becomes more defined, and loss of subcutaneous fat in the orbital area leads to a deeper orbital rim that makes the eyes appear sunken [12]. There has been an increase in efforts to identify more ways to address the facial volume loss a patient might experience as they age [13].

Historically, tissue volume concerns have been addressed with fat grafting. This technique is not only used for facial procedures but can also be useful for breast reconstruction purposes in breast cancer patients following mastectomy [14]. However, traditional autologous fat grafting is limited by unpredictable rates of reabsorption, causing patients to undergo multiple fat grafting procedures in order to maintain the desired result [15-17]. Furthermore, there is an apparent lack of consensus regarding good clinical practices related to autologous fat transfer procedures that further contributes to the large variation in results [15].

Traditional treatments for aging and environment-induced changes to the skin include topical treatments, such as retinoid creams. These creams are meant to increase collagen synthesis and counteract the degradation of skin cells that causes a loss of skin thickness and an increase in skin discoloration [18-19]. Chemical peeling is another common treatment for dermatological concerns such as photoaging to stimulate keratinocyte regeneration [20]. However, chemical peels run the risk of a wide range of complications, including but not limited to hyperpigmentation, skin irritation, and scarring [21]. Preclinical and clinical research in recent years suggests that the efficacy of these treatments rest, at least in part, from initiation of natural tissue regeneration mechanisms through the controlled application of a chemical, mechanical or thermal trauma. ADSCs are rapidly attracted to the zone of injury and adipose derived stem cell’s normal regenerative activities are likely key to the desired effects of traditional cosmetic treatments such as dermabrasion, laser therapy, intense pulsed light, and chemical peels with caustics or acids. The idea of activating the regenerative and anti-aging effects of pluripotential cells without the negative effects of an inciting trauma is fundamental to the use of cosmetic cellular therapies.

The use of mesenchymal stem cells (MSCs) as a supplement and/or substitute for existing aesthetic treatments is promising. MSCs possess the benefit of high availability from autologous sources, ease of isolation, and ease of in vitro expansion. Adipose tissue and bone marrow are two major sources of MSCs, both of which have similar properties to each other [22]. However, adipose tissue has proven to be a more favorable source of mesenchymal stem cells, as there are a higher percentage of MSCs present in adipose tissue in comparison with bone marrow. MSCs make up approximately 1% of adipose tissue, while they make up only about .001% of bone marrow [23]. Adipose derived stem cells (ADSCs) are isolated from Stromal Vascular Fraction (SVF), a heterogeneous population of cells isolated from adipose tissue using a simple and safe protocol [24,1]. The umbilical cord is also a viable source of MSCs [25]. These cells, though not autologously sourced like adipose stem cells, do appear to enjoy the same immunologic tolerance of all mesenchymal stem cells and clinical experience shows they can be administered with a high safety profile. The clinical safety of these cells depends on the integrity of the tissue bank that sources and prepares the cells, thus FDA tissue bank accreditation is essential.

Applications of Adipose Stem Cells for Aesthetic Therapies

Tissue Volume

Traditional fat grafting techniques aiming to restore volume to the face struggle with the limitation of a lack of volume retention following the procedure [15-17]. This limitation may be attributed to the hypoxic conditions the adipose graft experiences following transplantation. The process of revascularization of an adipose tissue graft can be inefficient, causing the graft to suffer hypoxic conditions beyond its upper limit, which is around 24 hours. The signaling pathway that connects hypoxia to apoptosis of adipose cells is also not clearly defined [26]. The use of mesenchymal stem cells (MSCs) in conjunction with autologous fat grafting might address this issue [27]. Studies have identified that fat grafts enriched with adipose derived stem cells might mitigate that drawback of fat grafting. In one such study comparing traditional fat grafts to those supplemented with ADSCs, no patients that received stem cell therapy had to return for another grafting procedure to preserve volume [17].

ADSCs can be used in conjunction with lipoaspirated fat in a method referred to as cell-assisted lipotransfer (CAL) [28]. This can be a safe and effective option for patients interested in an increase in facial volume (Figure 29.1), as well as patients interested in breast reconstruction or buttock augmentation (Figure 29.2-Figure 29.4) [28-30].

Dermatological Applications (*Pigmentation, thickness, elasticity, vitiligo)

The uses of ADSCs extends beyond preservation of tissue volume to aesthetic therapies related to the skin. ADSCs have been suggested to kickstart the re-epithelialization process, stimulating keratinocyte production and organizing these newly formed cells. ADSCs can also promote collagen synthesis to further counteract the loss of dermal thickness that occurs due to aging [4].

ADSCs reduce cell death related to UVB ray exposure, indicating they could play a role in reducing wrinkles caused by photoaging [31]. The antioxidative effects of ADSCs could combat the oxidative stress that might lead to skin discoloration. Proteomic analysis of cultured ADSCs show a wide range of antioxidant proteins in the culture, such as SOD2, PEDF, and HGF [6]. Since antioxidants can influence melanin production, ADSCs can be a useful skin whitening agent to counteract skin discoloration [6].

With respect to vitiligo, one study of nude mice found that a skin graft containing both melanocytes and ADSCs was significantly more effective than a graft of melanocytes alone, as shown by a higher increase in overall melanocytes [8]. These findings can be reconciled with the aforementioned skin-whitening potential of ADSCs. While ADSCs reduce the number of Trp-1-positive mature melanocytes, they can increase the number of Trp-2 positive precursor cells that are later differentiated into melanocytes. Preparing melanocyte grafts supplemented with ADSCs requires a particular balance of ADSCs and melanocytes in order to combat the effects of vitiligo [32].

Hair (Kerastem STYLE Trial)

Hair loss and the decrease in subcutaneous scalp tissue occur simultaneously, highlighting the relationship of hair loss to adipose tissue [33]. Conveniently, ADSCs show promise for the treatment of early androgenetic alopecia. Results from an FDA approved Phase II clinical trial determined that injection of fat supplemented with a low dose of ADSCs into the scalp led to an increase in the amount of hair in subjects exhibiting the early stages of hair loss (Figure 29.5). [34]

Improvement of Wound Healing and Scarring

ADSCs show promise for a wide array of applications in the field of wound care. Wound care entails regular treatment of acute and chronic wounds, often involving skin grafts. MSCs are particularly useful for this purpose due to their immunoprivileged status as well as their ability to signal cell proliferation [35].

One application of ADSCs in wound care is the treatment of wound patients suffering from Diabetes Mellitus (DM). Wound healing in these patients is challenging due to a lack of re-epithelialization of tissue as a result of deficient cellular proliferation, similar to the lack of proliferation that causes wrinkles in aging patients. Wounds treated with ADSCs have shown an increased level of some of the growth factors necessary for cellular proliferation, such as transforming growth factor-Beta1 (TGF-β1) and transforming growth factor-Beta3 (TGF-β3) [36]. TGF-β1 is implicated in cellular migration to a wound site, while TGF-β3 enhances collagen organization, indicating that ADSCs might accelerate wound healing through these mechanisms [36,6]. Moreover, ADSCs that are introduced systemically seem to migrate to an injury site to promote growth in that area [23]. Studies have also suggested the effectiveness of ADSCs in treatment for fibrotic scars that might arise after a wound has healed [37].

Benefits of using Adipose Stem Cells for Aesthetic Purposes

The benefits of using adipose-derived stem cells for aesthetic therapies are vast. An autologous and abundant sample can be extracted from a patient’s abdominal area [36]. ADSCs possess the most promise for isolation in a safe and minimally invasive fashion [38,1]. SVF extraction yields a higher amount of mesenchymal stem cells compared to bone marrow and can also be expanded in vitro in order to increase the amount of cells available for transplantation into patients [24,36]. Adipose derived stem cells are also immunoprivileged, lacking the class II major histocompatibility complex (MHC-II) [23]. This makes ADSCs ideal candidates for fat grafting procedures, minimizing the adverse immune response of the patient [23].

Current Limitations and Future Directions for Adipose Stem Cell Treatments

Though ADSCs show a great deal of promise for aesthetic therapies, limitations exist that merit consideration. While SVF can be isolated easily from a patient, the resulting sample is heterogeneous, containing fibroblasts, pericytes, smooth muscle cells, preadipocytes, endothelial cells, and immune cells [38]. Isolation of ADSCs requires further effort and runs the risk of an ADSC culture that is not exclusively made up of ADSCs.

Another limitation of these therapies lies in the possible tumorigenic effects of ADSCs. One study suggests that certain signaling molecules such as CXCL1 that can be derived from ADSCs might increase the risk of breast cancer recurrence [39]. Obesity also seems to play a role, altering the properties of ADSCs [40]. One study identified that leptin secreted from obesity-altered ADSCs might stimulate breast cancer growth through estrogen dependent pathways [40-41]. Potential cross contamination of stem cell samples must also be taken into account and underscores the importance of clearly defined and closely followed protocols for cell extraction and maintenance [42]. Further consideration should be given to these risks before implementing ADSC related aesthetic treatments.

At the time of this publication, clinical trials are currently recruiting to explore some of the benefits of ADSCs for aesthetic purposes. One such study sponsored by the Medical University of Warsaw [43] aims to explore the use of ADSC injections to treat scars. Another study, also sponsored by the Medical University of Warsaw [44], aims to explore the effectiveness of using ADSCs to treat chronic wounds related to diabetic foot syndrome.

Conclusions

Adipose-derived stem cells possess a great deal of promise for applications in aesthetic therapies ranging from anti-aging treatments to tissue reconstruction and wound care. They have the potential to address issues of fat graft volume retention, skin elasticity, skin pigmentation, and skin thickness. Moreover, ADSCs can supplement wound care procedures to provide more effective treatment. Though further research is necessary to solidify the safety and efficacy of these treatments, current findings suggest that ADSCs may play a pivotal role in aesthetic therapies in the near future.


 

References

  1. Aronowitz JA, Lockhart RA, Hakakian CS, Hicok KC. Clinical safety of stromal vascular fraction separation at the point of care. Ann Plast Surg 2015; 75(6):666-71.
  2. Kohl E, Steinbauer J, Landthaler M, Szeimies RM. Skin ageing. J Eur Acad Dermatol Venereol 2011; 25(8):873-84.
  3. Zouboulis CC, Makrantonaki E. Clinical aspects and molecular diagnostics of skin aging. Clin Dermatol 2011; 29(1):3-14.
  4. Gaur M, Dobke M, Lunyak VV. Mesenchymal stem cells from adipose tissue in clinical applications for dermatological indications and skin aging. Int J Mol Sci 2017; 18(1):208.
  5. Wollina U, Wetzker R, Abdel-Naser MB, Kruglikov IL. Role of adipose tissue in facial aging. Clin Interv Aging 2017; 12:2069.
  6. Kim WS, Park BS, Sung JH. Protective role of adipose-derived stem cells and their soluble factors in photoaging. Arch Dermatol Res 2009; 301(5):329-36.
  7. Durai PC, Thappa DM, Kumari R, Malathi M. Aging in elderly: chronological versus photoaging. Indian J Dermatol 2012; 57(5):343.
  8. Lim WS, Kim CH, Kim JY, Do BR, Kim EJ, Lee AY. Adipose-derived stem cells improve efficacy of melanocyte transplantation in animal skin. Biomol Ther 2014; 22(4):328.
  9. Ezzedine K, Eleftheriadou V, Whitton M, van Geel N. Vitiligo. Lancet. 2015; 386:74-84.
  10. Iblher N, Gladilin E, Stark BG. Soft-tissue mobility of the lower face depending on positional changes and age: a three-dimensional morphometric surface analysis. Plast Reconstr Surg. 2013; 131(2):372-81.
  11. Cotofana S, Fratila AA, Schenck TL, Redka-Swoboda W, Zilinsky I, Pavicic T. The anatomy of the aging face: A review. Facial Plast Surg. 2016; 32(03):253-60.
  12. Ko AC, Korn BS, Kikkawa DO. The aging face. Surv Ophthalmol. 2017; 62(2):190-202.
  13. Lambros V. Models of facial aging and implications for treatment. Clin Plast Surg 2008; 35(3):319-27.
  14. Kolasinski J. Total Breast Reconstruction with Fat Grafting Combined with Internal Tissue Expansion. Plast Reconstr Surg Glob Open 2019; 7(4):e2009.
  15. Gir P, Brown SA, Oni G, Kashefi N, Mojallal A, Rohrich RJ. Fat grafting: evidence-based review on autologous fat harvesting, processing, reinjection, and storage. Plast Reconstr Surg 2012; 130(1):249-58.
  16. Mazzola RF, Mazzola IC. History of fat grafting: from ram fat to stem cells. Clin Plast Surg. 2015; 42(2):147-53.
  17. Sterodimas A, de Faria J, Nicaretta B, Boriani F. Autologous fat transplantation versus adipose-derived stem cell–enriched lipografts: a study. Aesthet Surg J. 2011; 31(6):682-93.
  18. Poon F, Kang S, Chien AL. Mechanisms and treatments of photoaging. Photodermatol Photoimmunol Photomed 2015; 31(2):65-74.
  19. Hubbard BA, Unger JG, Rohrich RJ. Reversal of skin aging with topical retinoids. Plast Reconstr Surg 2014; 133(4):481e-90e.
  20. Truchuelo M, Cerdá P, Fernández LF. Chemical peeling: a useful tool in the office. Actas Dermosifiliogr 2017; 108(4):315-22.
  21. Nikalji N, Godse K, Sakhiya J, Patil S, Nadkarni N. Complications of medium depth and deep chemical peels. J Cutan Aesthet Surg 2012 Oct; 5(4):254.
  22. Izadpanah R, Trygg C, Patel B, Kriedt C, Dufour J, Gimble JM, Bunnell BA. Biologic properties of mesenchymal stem cells derived from bone marrow and adipose tissue. J Cell Biochem. 2006; 99(5):1285-97.
  23. Ong WK, Sugii S. Adipose-derived stem cells: fatty potentials for therapy. Int J Biochem Cell Biol 2013; 45(6):1083-6.
  24. Aronowitz JA,Lockhart RA, Dos-Anjos Vilaboa S. Use of freshly isolated human adipose stromal cells for clinical applications. Aesthet Surg J. 2017; 37(suppl_3):S4-8.
  25. Kamolz LP, Kolbus A, Wick N, Mazal PR, Eisenbock B, Burjak S, Meissl G. Cultured human epithelium: human umbilical cord blood stem cells differentiate into keratinocytes under in vitro conditions. Burns. 2006; 32(1):16-9.
  26. Landau MJ, Birnbaum ZE, Kurtz LG, Aronowitz JA. Proposed Methods to Improve the Survival of Adipose Tissue in Autologous Fat Grafting. Plast Reconstr Surg Glob Open 2018; 6(8).
  27. Salibian AA, Widgerow AD, Abrouk M, Evans GR. Stem cells in plastic surgery: a review of current clinical and translational applications. Arch Plast Surg 2013; 40(6):666.
  28. Yoshimura K, Sato K, Aoi N, Kurita M, Hirohi T, Harii K. Cell-assisted lipotransfer for cosmetic breast augmentation: supportive use of adipose-derived stem/stromal cells. Aesthetic Plast Surg. 2008; 32(1):48-55.
  29. Aronowitz JA. Lockhart (2016) Cell-assisted Lipotransfer for the Correction of Facial Contour Deformities. Stem Cell Res Th.
  30. Ito S, Kai Y, Masuda T, Tanaka F, Matsumoto T, Kamohara Y, Hayakawa H, Ueo H, Iwaguro H, Hedrick MH, Mimori K. Long-term outcome of adipose-derived regenerative cell-enriched autologous fat transplantation for reconstruction after breast-conserving surgery for Japanese women with breast cancer. Surg Today. 2017; 47(12):1500-11.
  31. Kim WS, Park BS, Park SH, Kim HK, Sung JH. Antiwrinkle effect of adipose-derived stem cell: activation of dermal fibroblast by secretory factors. J Dermatol Sci 2009; 53(2):96-102.
  32. Kim JY, Park CD, Lee JH, Lee CH, Do BR, Lee AY. Co-culture of melanocytes with adipose-derived stem cells as a potential substitute for co-culture with keratinocytes. Acta Derm Venereol 2012; 92(1):16-23.
  33. Festa E, Fretz J, Berry R, Schmidt B, Rodeheffer M, Horowitz M, Horsley V. Adipocyte lineage cells contribute to the skin stem cell niche to drive hair cycling. Cell. 2011; 146(5):761-71.
  34. ClinicalTrials.gov [Internet]. Bethesda (MD): National Library of Medicine (US). 2000 Feb 29. Identifier NCT02503852, STYLE -- A Trial of Cell Enriched Adipose For Androgenetic Alopecia (STYLE); 2015 July 21 [cited 2019 November 13]. Available from: https://clinicaltrials.gov/ct2/show/NCT02503852
  35. Huang L, Burd A. An update review of stem cell applications in burns and wound care. Indian J Plast Surg. 2012; 45(2):229.
  36. Gadelkarim M, Abushouk AI, Ghanem E, Hamaad AM, Saad AM, Abdel-Daim MM. Adipose-derived stem cells: Effectiveness and advances in delivery in diabetic wound healing. Biomed Pharmacother. 2018; 107:625-33.
  37. Spiekman M, van Dongen JA, Willemsen JC, Hoppe DL, van der Lei B, Harmsen MC. The power of fat and its adipose‐derived stromal cells: emerging concepts for fibrotic scar treatment. J Tissue Eng Regen Med 2017; 11(11):3220-35.
  38. Nowacki M, Kloskowski T, Pietkun K, Zegarski M, Pokrywczyńska M, Habib SL, Drewa T, Zegarska B. The use of stem cells in aesthetic dermatology and plastic surgery procedures. A compact review of experimental and clinical applications. Postepy Dermatol Alergol 2017; 34(6):526.
  39. Wang Y, Liu J, Jiang Q, Deng J, Xu F, Chen X, Cheng F, Zhang Y, Yao Y, Xia Z, Xu X. Human adipose‐derived mesenchymal stem cell‐secreted CXCL1 and CXCL8 facilitate breast tumor growth by promoting angiogenesis. Stem Cells. 2017; 35(9):2060-70.
  40. Sabol, R. A., Giacomelli, P. , Beighley, A. and Bunnell, B. A. (2019), Adipose Stem Cells and Cancer: Concise Review. Stem Cells. 37: 1261-1266. doi:10.1002/stem.3050
  41. Strong AL, Strong TA, Rhodes LV, Semon JA, Zhang X, Shi Z, Zhang S, Gimble JM, Burow ME, Bunnell BA. Obesity associated alterations in the biology of adipose stem cells mediate enhanced tumorigenesis by estrogen dependent pathways. Breast Cancer Res. 2013; 15(5):R102.
  42. Torsvik A, Røsland GV, Svendsen A, Molven A, Immervoll H, McCormack E, Lønning PE, Primon M, Sobala E, Tonn JC, Goldbrunner R. Spontaneous malignant transformation of human mesenchymal stem cells reflects cross-contamination: putting the research field on track–letter. Cancer Res. 2010; 70(15):6393-6.
  43. ClinicalTrials.gov [Internet]. Bethesda (MD): National Library of Medicine (US). 2000 Feb 29. Identifier NCT03887208, Therapy of Scars and Cutis Laxa With Autologous Adipose Derived Mesenchymal Stem Cells (2ABC); 2019 March 22 [cited 2019 November 13]. Available from: https://clinicaltrials.gov/ct2/show/NCT03887208
  44. ClinicalTrials.gov [Internet]. Bethesda (MD): National Library of Medicine (US). 2000 Feb 29. Identifier NCT03865394, Treatment of Chronic Wounds in Diabetic Foot Syndrome With Autologous Adipose Derived Mesenchymal Stem Cells (1ABC); 2019 March 6 [cited 2019 November 13]. Available from: https://clinicaltrials.gov/ct2/show/NCT03865394

 

 

Added sources (will change numbers in final draft):

Yu G, Wu X, Dietrich MA, Polk P, Scott LK, Ptitsyn AA, Gimble JM. Yield and characterization of subcutaneous human adipose-derived stem cells by flow cytometric and adipogenic mRNA analyzes. Cytotherapy. 2010; 12(4):538-46.

Gronthos S, Franklin DM, Leddy HA, Robey PG, Storms RW, Gimble JM. Surface protein characterization of human adipose tissue‐derived stromal cells. Journal of cellular physiology. 2001; 189(1):54-63.

 

Figure Legends

Figure 29.1: 64 year old man before and 1 year post op CAL bilateral cheeks with 30 cc enhanced fat graft per side

Figure 29.2: 48 year old woman, 4 months post op CAL fat graft to buttock

Figure 29.3: 30 year woman, 6 months post op, CAL fat graft to buttock for steroid injection defect

Figure 29.4: 36 Year old woman receiving CAL Fat Transfer to breast, 1 year post op

Figure 29.5: STYLE Trial, adipose stem cells injected into scalp for early stage androgenic alopecia, preop, 6 months and 12 months post op

Location: Beverly Hills, CA, USA

Comments

Post a Comment