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Concentrated adipose tissue infusion for the treatment of knee osteoarthritis: clinical and histological observations

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Abstract

Purpose

Osteoarthritis (OA) is characterized by articular cartilage degeneration and subchondral bone sclerosis. OA can benefit of non-surgical treatments with collagenase-isolated stromal vascular fraction (SVF) or cultured-expanded mesenchymal stem cells (ASCs). To avoid high manipulation of the lipoaspirate needed to obtain ASCs and SVF, we investigated whether articular infusions of autologous concentrated adipose tissue are an effective treatment for knee OA patients.

Methods

The knee of 20 OA patients was intra-articularly injected with autologous concentrated adipose tissue, obtained after centrifugation of lipoaspirate. Patients’ articular functionality and pain were evaluated by VAS and WOMAC scores at three, six and 18 months from infusion. The osteogenic and chondrogenic ability of ASCs contained in the injected adipose tissue was studied in in vitro primary osteoblast and chondrocyte cell cultures, also plated on 3D-bone scaffold. Knee articular biopsies of patients previously treated with adipose tissue were analyzed. Immunohistochemistry (IHC) and scanning electron microscopy (SEM) were performed to detect cell differentiation and tissue regeneration.

Results

The treatment resulted safe, and all patients reported an improvement in terms of pain reduction and increase of function. According to the osteogenic or chondrogenic stimulation, ASCs expressed alkaline phosphatase or aggrecan, respectively. The presence of a layer of newly formed tissue was visualized by IHC staining and SEM. The biopsy of previously treated knee joints showed new tissue formation, starting from the bone side of the osteochondral lesion.

Conclusions

Overall our data indicate that adipose tissue infusion stimulates tissue regeneration and might be considered a safe treatment for knee OA.

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Acknowledgments

This work was supported by Compagnia di San Paolo and CRT Foundations, Banca d’Italia, and Fondazione Ricerca Molinette ONLUS. The authors thank Dr. Dario Picenoni, at SAMM (Politecnico di Milano), for his technical contribution to SEM analyses, Dr. Francesca Veneziano for immunohistochemistry.

Author information

Authors and Affiliations

  1. Center for Research and Medical Studies, A.O.U. Città della Salute e della Scienza, Turin, Italy

    Ilaria Roato, Dimas Carolina Belisario & Mara Compagno

  2. Department of Traumatology and Rehabilitation, C.T.O. Hospital-A.O.U. Città della Salute e della Scienza, Turin, Italy

    Aurora Lena & Alessandro Bistolfi

  3. Department of Surgical Sciences (DISC), Orthopaedic Clinic-IRCCS A.O.U, San Martino, Genoa, Italy

    Luca Maccari, Matteo Formica, Lamberto Felli & Riccardo Ferracini

  4. Department of Surgical Sciences, University of Turin, Turin, Italy

    Federico Mussano

  5. Department of Life Sciences & Systems Biology, University of Turin, Turin, Italy

    Tullio Genova

  6. Pathology Unit, A.O.U. Città della Salute e della Scienza of Turin, Turin, Italy

    Laura Godio

  7. Industrie Biomediche Insubri SA, Mezzovico-Vira, Switzerland

    Giuseppe Perale

  8. University of Applied Sciences and Arts of Southern Switzerland – SUPSI, Manno, Switzerland

    Giuseppe Perale

  9. Skin Bank, Department of General and Specialized Surgery, A.O.U. Città della Salute e della Scienza, Turin, Italy

    Irene Cambieri & Carlotta Castagnoli

  10. Department of Imaging and Radio-diagnostic, C.T.O. Hospital-A.O.U. Città della Salute e della Scienza, Turin, Italy

    Tiziana Robba

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  1. Ilaria Roato
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Corresponding author

Correspondence to Ilaria Roato.

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Conflict of interest

Giuseppe Perale is affiliated to the Company manufacturing the bone substitute used in this study

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Roato, I., Belisario, D.C., Compagno, M. et al. Concentrated adipose tissue infusion for the treatment of knee osteoarthritis: clinical and histological observations. International Orthopaedics (SICOT) 43, 15–23 (2019). https://doi.org/10.1007/s00264-018-4192-4

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  • DOI: https://doi.org/10.1007/s00264-018-4192-4

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