Intraoperative Strategies for Minimal Manipulation of Autologous Adipose Tissue for Cell- and Tissue-Based Therapies: Concise Review

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  • Angelo Trivisonno
    a Department of Surgical Science University of Rome “La Sapienza”, Rome, Italy
  • Robert W. Alexander
    b Department of Surgery University of Washington, Seattle, Washington, USA
  • Silvia Baldari
    c Department of Research Advanced Diagnostic and Technological Innovation, IRCCS Regina Elena National Cancer Institute, Rome, Italy
  • Steven R. Cohen
    e FACES+ Plastic Surgery Skin and Laser Center and the University of California, San Diego, California, USA
  • Giuliana Di Rocco
    c Department of Research Advanced Diagnostic and Technological Innovation, IRCCS Regina Elena National Cancer Institute, Rome, Italy
  • Pietro Gentile
    f Department of Plastic and Reconstructive Surgery University of Rome Tor Vergata, Rome, Italy
  • Guy Magalon
    g Plastic Surgery Department Assistance Publique Hôpitaux de Marseille (APHM), Aix Marseille University, Marseille, France
  • Jérémy Magalon
    h Vascular Research Center of Marseille Aix Marseille University, INSERM UMR 1076, Marseille, France
  • Randy B. Miller
    j Private Practice, Miami, Florida, USA
  • Hayley Womack
    e FACES+ Plastic Surgery Skin and Laser Center and the University of California, San Diego, California, USA
  • Gabriele Toietta
    c Department of Research Advanced Diagnostic and Technological Innovation, IRCCS Regina Elena National Cancer Institute, Rome, Italy

Description

<jats:title>Abstract</jats:title><jats:p>The stromal vascular fraction (SVF) is a heterogeneous population of stem/stromal cells isolated from perivascular and extracellular matrix (ECM) of adipose tissue complex (ATC). Administration of SVF holds a strong therapeutic potential for regenerative and wound healing medicine applications aimed at functional restoration of tissues damaged by injuries or chronic diseases. SVF is commonly divided into cellular stromal vascular fraction (cSVF) and tissue stromal vascular fraction (tSVF). Cellular SVF is obtained from ATC by collagenase digestion, incubation/isolation, and pelletized by centrifugation. Enzymatic disaggregation may alter the relevant biological characteristics of adipose tissue, while providing release of complex, multiattachment of cell-to-cell and cell-to-matrix, effectively eliminating the bioactive ECM and periadventitial attachments. In many countries, the isolation of cellular elements is considered as a “more than minimal” manipulation, and is most often limited to controlled clinical trials and subject to regulatory review. Several alternative, nonenzymatic methods of adipose tissue processing have been developed to obtain via minimal mechanical manipulation an autologous tSVF product intended for delivery, reducing the procedure duration, lowering production costs, decreasing regulatory burden, and shortening the translation into the clinical setting. Ideally, these procedures might allow for the integration of harvesting and processing of adipose tissue for ease of injection, in a single procedure utilizing a nonexpanded cellular product at the point of care, while permitting intraoperative autologous cellular and tissue-based therapies. Here, we review and discuss the options, advantages, and limitations of the major strategies alternative to enzymatic processing currently developed for minimal manipulation of adipose tissue. Stem Cells Translational Medicine  2019;8:1265&1271</jats:p><jats:sec><jats:title /></jats:sec>

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