University of Groningen
Enhancement of Progenitor Cells by Two-Step Centrifugation of Emulsified Lipoaspirates Dongen, Joris A van; Tuin, A Jorien; Harmsen, Martin C; Stevens, Hieronymus P; van der Lei, Berend
Published in:
Plastic and Reconstructive Surgery
DOI:
10.1097/PRS.0000000000005464
IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite from it. Please check the document version below.
Document Version
Final author's version (accepted by publisher, after peer review)
Publication date: 2019
Link to publication in University of Groningen/UMCG research database
Citation for published version (APA):
Dongen, J. A. V., Tuin, A. J., Harmsen, M. C., Stevens, H. P., & van der Lei, B. (2019). Enhancement of Progenitor Cells by Two-Step Centrifugation of Emulsified Lipoaspirates. Plastic and Reconstructive Surgery, 143(4), 893E-894E. https://doi.org/10.1097/PRS.0000000000005464
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Plastic and Reconstructive Surgery Advance Online Article DOI:10.1097/PRS.0000000000005464
Reply to: ‘Enhancement of Progenitor Cells by Two-Step Centrifugation of Emulsified Lipoaspirates.’
Joris A. van Dongen, B.Sc1, 2, 3, A. Jorien Tuin, MD4, Martin C. Harmsen, PhD2, Hieronymus P. Stevens, MD, PhD1, Berend van der Lei, MD, PhD3, 5,*
1
Bey Bergman Clinics, location The Hague, the Netherlands
2
Department of Pathology & Medical Biology, University of Groningen and University Medical Center Groningen, Groningen, the Netherlands
3
Department of Plastic Surgery, University of Groningen and University Medical Center Groningen, Groningen, the Netherlands
4
Department of Oral & Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
5
Bey Bergman Clinics, location Heerenveen, Zwolle and Groningen, the Netherlands
None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript.
*CORRESPONDING AUTHOR:Prof. dr. Berend van der Lei, MD, PhD, University Medical Center of Groningen, Hanzeplein 1, 9713 GZ Groningen, Phone: +31648089039, Email:
info@berendvanderlei.nl
Dear editor,
With great interest we have read the article of Pallua et al. entitled: ‘Enhancement of progenitor cells by two step centrifugation of emulsified lipoaspirates.’(1) The article adds valuable
information to the already existing literature concerning the Nanofat procedure and the modified Nanofat procedure (2); their procedure results in increased amounts of adipose derived stromal cell (ASC) in the obtained fractions.
The article of Pallua et al. is, however, not the only article presenting a modification of the Nanofat procedure in the recent time span: both Mashiko et al. (3) and we (4) have described such a procedure with additional two steps of centrifugation. Both the micronization of lipoaspirate
procedure of Mashiko et al. (2) as well as our Fractionation of Adipose Tissue (FAT) procedure were very successful in the isolation of tissue-like stromal vascular fraction (tSVF).(3, 4) All aforementioned mechanical isolation procedures to obtain tSVF are based on the principle of concentrating potential regenerative cell types (e.g. ASC) by disruption of adipocytes. Despite similarities, there are also some small technical differences in the aforementioned techniques that have influence on the composition of the isolated tSVF. These differences in composition could interfere with the clinical outcome and should therefore be addressed.
Nanofat procedure emulsifies the lipoaspirate by shifting the adipose tissue through a luer-to-luer transfer (containing one hole of 2.4mm) prior to filtering through the Nanotransfer. This results in an injectable fraction with higher numbers of ASC as compared to unprocessed
lipoaspirate.(1, 2) Pallua et al. added two steps of centrifugation prior and after the original Nanofat procedure, resulting in even higher concentrations of ASC.(1) Our FAT procedure also adds two
ACCEPTED
In the Nanofat procedure with or without centrifugation, it is most likely that large particles of ECM are removed due to the Nanotransfer filter step, which will enhance the injectability of tSVF. However, less ECM may result in less regenerative potential since ECM is important for cell survival and proliferation as well as cell differentiation.(5) ASC and other cell types in tSVF are able to bind to integrin specific binding sites in ECM resulting in a better retention after injection and, therefore, a better clinical effect. Moreover, ECM can bind and release growth factors in order to stimulate important regenerative processes such as angiogenesis. Hence, we surmise that the final Nanotransfer filtering step might decrease the regenerative potential of the isolated tSVF.
Thus far, the different mechanical isolation procedures of tSVF i.e. the Nanofat procedure and adaptive procedures, have been extensively studied in vitro. Only a few clinical case reports or case series have indicated that tSVF might be effective for skin rejuvenation, scar remodeling or alopecia androgenic.(2, 6, 7) Therefore well-designed randomized placebo-controlled trials are now warranted to prove that tSVF indeed is an effective treatment modality for regenerative purposes.
References
1. Pallua N, Grasys J, Kim BS. Enhancement of Progenitor Cells by Two-Step Centrifugation of Emulsified Lipoaspirates. Plastic and reconstructive surgery. 2018;142(1):99-109.
2. Tonnard P, Verpaele A, Peeters G, Hamdi M, Cornelissen M, Declercq H. Nanofat grafting: basic research and clinical applications. Plastic and reconstructive surgery. 2013;132(4):1017-26. 3. Mashiko T, Wu SH, Feng J, Kanayama K, Kinoshita K, Sunaga A, et al. Mechanical micronization of lipoaspirates: squeeze and emulsification techniques. Plastic and reconstructive surgery. 2016.
4. van Dongen JA, Stevens HP, Parvizi M, van der Lei B, Harmsen MC. The fractionation of adipose tissue procedure to obtain stromal vascular fractions for regenerative purposes. Wound repair and regeneration : official publication of the Wound Healing Society [and] the European Tissue Repair Society. 2016;24(6):994-1003.
5. Mescher LA. Junquira's Basic Histology. Text and Atlas 12th ed: The McGraw-Hill Companies 2010. 480 p.
6. Gu Z, Li Y, Li H. Use of Condensed Nanofat Combined With Fat Grafts to Treat Atrophic Scars. JAMA facial plastic surgery. 2018;20(2):128-35.
7. Stevens HP, Donners S, de Bruijn J. Introducing Platelet-Rich Stroma: Platelet-Rich Plasma (PRP) and Stromal Vascular Fraction (SVF) Combined for the Treatment of Androgenetic
Alopecia. Aesthetic surgery journal / the American Society for Aesthetic Plastic surgery. 2018;38(8):811-22.
