Clinical Evidence

Professor Mark Slevin: The work describes a pilot clinical trial investigating the utility of autologous liposucted, Lipogems-derived MFAT for treatment of knee pain caused by mild to moderate osteoarthritis from original mostly complex meniscal tears in 20 patients (mean age 59 years) who had failed in initial alternative conservative management. The individuals were treated with ultrasound-guided intra-meniscal articular MFAT injections. Follow up was provided by measurement of the NPS (pain) and KOOS (outcome scale) after 3, 6 and 12 months. Results showed a significant reduction in pain (NPS mean 5.4 to 2.2) and increase in KOOS (mean 58 to 78) by 3 months and this remained constant up to the 12-month test period. The authors suggest MFAT treatment could be an effective and safe treatment for degenerative osteoarthritis and meniscal tears and that a large randomized controlled clinical trial is warranted.

Professor Mark Slevin: This review provides a thorough investigation of the literature surrounding the potential utilization of mesenchymal stem cells (MSCs) for therapeutic application for cell and tissue repair, replacement and regeneration. In particular, it describes and compares the sources of these MSCS i.e. derivation from adipose tissue (ADSCs), bone marrow (BM-MSCs) and umbilical cord (UC-MSCs). The authors summarized that all sources of MSCs possessed similar anti-inflammatory properties through secretion of proteins such as IL-1R-alpha antagonist, although ADSCs had the greatest level of secretion of these factors and secreted more proteins with higher gene activity than MSCs from other sources.

The harvesting of these cells ranges from the most simple-UC-MSCs at birth through liposucted ADSCs to the most invasive and painful procedure for the removal of BM-MSCs. BM-MSCs constitute only around 0.002% of the total cell population, their isolation is variable and the maximum number of divisions (for expansion and storage or use) is limited to around 12 passages. All sources of MSCs are multi-potent, that is that they can differentiate into adipogenic, chondrogenic or osteogenic precursors, however, the potential of BM-MSCs to differentiate decreases with age as does their number and life span. UC-MSCs generally maintain there multipotency for longer, have higher potency of osteogenic differentiation and also express embryonic stem cell markers-that have translated into their experimental use for treatment of neurological disease following differentiation into spinal cord tissue etc. ADSCs present at around 2% of the stromal cell fraction (making it much easier to culture up required numbers for treatment or strorage) maintaining their differentiation capacity in aged subjects and with almost zero expression of HLADR, are suitable for allogeneic transplantation. In addition, they also possess multi-potency giving them the potential to be used beyond mesodermal regenerative and reparative applications.

In a summary of current use, the authors indicate the advantages in safety and efficacy of ADSCs when compared to other sources of MSCs, in regard to clinical studies involving wound healing, stroke, brain and spinal cord injury, autoimmune disorders such as Lupus, osteoarthritis     

concerning bone and cartilage repair and regeneration, and cardiovascular disease such as myocardial tissue repair.

Mr Nima Heidari: Here at The Regenerative Clinic, we have been treating patients with knee arthritis with micro-fragmented fat for two and a half years.  We have collected data diligently on all of our patients in order to keep a very close eye on the improvements that they have following our treatment.  We have now collated and analysed this data for a group of our patients with knee arthritis.  We have looked at the group with moderate-to-severe arthritis where their pain is graded above 50 on the visual analogue scale.  The visual analogue scale is such that 0 is no pain at all and 100 represents pain where the patient needs to access emergency care due to this pain.  We have found consistently across various patient reported outcome measures that there is an improvement in the majority of patients who are treated this way.  4/5 patients treated see an improvement in their symptoms at one year.  Interestingly, we have also noted that there are very few complications and adverse events associated with this treatment.  The most common being discomfort at the site where the fat is usually harvested around the abdomen.

Although not all of our patients have had improvements in the symptoms with 1/5 not deriving a great deal of benefit, 4/5 are glad that they have undertaken the treatment and have seen improvements in their pain and function.