Stromal vascular fraction technologies and clinical applications

ABSTRACT

Introduction: The heterogeneous pool of cells found in the stromal vascular fraction of adipose tissue (SVF) and the purified mesenchymal stromal/stem cells (ASCs) isolated from this pool have increasingly been used as therapeutic tools in regenerative medicine.

Areas covered: As SVF and ASCs are different, and should be used in different manners according to various clinical and biological indications, we reviewed the current literature, and focused on the clinical use of SVF to appraise the main medical fields for development. Both enzymatic digestion and mechanical disruption have been used to obtain SVF for non-homologous use. The safety and/or benefits of SVF have been examined in 71 clinical studies in various contexts, mainly musculoskeletal conditions, wound healing, urogenital, and cardiovascular and respiratory diseases. The use of SVF as a therapy remains experimental, with few clinical trials.

Expert opinion: SVF provides a cellular and molecular microenvironment for regulation of ASC’ activities under different clinical conditions. SVF may enhance angiogenesis and neovascularization in wound healing, urogenital and cardiovascular diseases. In joint conditions, therapeutic benefits may rely on paracrine immune-modulatory and anti-inflammatory mechanisms. Novel point of care methods are emerging to refine SVF in ways that meet the regulatory requirements for minimal manipulation.

KEYWORDS:

• Stromal vascular fraction
• mesenchymal stromal/stem cells
• musculoskeletal
• wound healing
• urogenital diseases
• cardiovascular pathologies
• respiratory pathologies

Article highlights

• SVF and culture/expanded ASCs are profoundly different, and emerging data reflect disparities in their efficacy.

• SVF has been used to exploit the curative properties of ASCs; however, SVF encompasses different cell phenotypes, and their activities may be instructed by the peculiarities of the host tissue microenvironment.

• The lack of standardization and the variability between products is not only a strength but also a challenge of SVF treatment; this dichotomy reflects on the complexity of the different cell phenotypes that SVF integrates.

• There is an absence of compelling evidence in any clinical application from controlled trials comparing SVF with standard care

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Additional information

Funding

This paper was not funded.