Stem cell fat grafting

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Stem cell fat grafting is

Regardless of the numerous benefits, there are few side effects and oncology safety issues The rising investment in stem cell cosmetic therapy reflects the high expectation and demands especially in South Korea. Further research on the effectiveness of ADSCs grafting proposed that the aftermath of the therapy can be affected by the quality of stem cells and diet by fostering adequate conditions for stem cell growth and sufficient consumption of nutrients.^[4]

History of stem cell plastic surgery

Dr.James Thomson at the University of Wisconsin first isolated human embryonic stem cells in 1998. However, due to the ethical controversies regarding embryonic stem cells, the induced pluripotent stem cells (iPSCs) were proposed as the substitute. The remaining oncological concern of iPSCs was eased by suggesting adult stem cells as the most primary resource of regenerative medicine.^[5]

History of autologous fat grafting

The first isolation of mesenchymal stem cells from the bone marrow was done by Friednstein et al. in 1986 and considered as a primary clinical stem cell source. However, the painful acquisition and low cell yield limited further research. Then Zuk et al. isolated ADSCs and found it has same potentials as BM-MSCs. Although later other stem cells were identified from different parts of the human body, ADSCs was considered to be the safest as it was the easiest stem cell to isolate and did not require cell expansion. Thus ADSCs are still used as a primary source of fat transfer therapies.^[6]

The concept of autologous fat grafting was first suggested in 1893. The first report described that the adipose tissue without changing its structure was implanted to the adherent scars from

In 1978, a liposuction procedure was invented to remove the excessive fat depositions. Later, Illouz found that this procedure is the ideal supplier of fat tissue and used impurified lipoaspirate as a transplant in 1983 and Fournier proposed a reinjection technique of aspirated fat.^[6]

The third period starts from 1994 when S.R. Coleman introduced the Coleman technique, which uses adipose tissue for lipids cell transfer. The lipoaspirate was centrifuged to separates the

The recent theory is the Host replacement theory that retention rate after fat grafting is determined by the ADSCs replacing adipocytes, as the successful ADSCs activation and replacement of adipocytes is related to the early death of transferred adipocytes in ischemic conditions.[6]

Mechanisms

ADSCs

Fang et al. proposed that ADSCs are the most widely used due to the following three characteristics: their

Around 1.5 million women have breast implant surgeries per year.[15] Yet the side effects of the fat transplant can be severe and cause irreversible damage to the patient's body. The most well-known side effects are foreign body sensation, calcification, fat cell necrosis, capsular construction, rupture, cysts and some fat cells leaving the implanted area.

In most cases, calcification and cysts are the biggest threat of breast augmentation surgery. Fat stem cells failed to pick up a new blood supply will die and be removed from the body by immune cells. However, when this clearing process miss removing dead cells the cluster will lead to calcification and cysts formation. These are visible on the breast as lump sometimes and are more dangerous when these un-picked up dead cells are detected as cancer cells which disturbs accurate diagnosis of breast cancer. The calcified tissue will be diagnosed as a 'benign' cancer and not cause any harm. However, if the tissue is severely damaged the entire breast needs to be removed. Once a patient is diagnosed with calcification of breast implant, regular mammograms should be done to monitor the possible cancer development.^[16]

Facial fat transfer

Gornitsky et al. from McGill University conducted a systematic review of 4577 patients who have received the facial fat transfer. The most prevalent side effects were reported like the following: asymmetry, skin irregularities, hypertrophy, prolonged edema, fat necrosis and such.^[17]

Oncology safety

The homing effect may have advantages in increasing the long-term survival of transferred fat, but concerns remain for patients with post-oncologic history, specifically breast cancer. It is more alarming since breast tumors are closely located with adipose tissue, as they develop a favorable microenvironment for cancer progression through homing and migration.^[18] There are cancer-associated adipocytes (CAAs) crucial for metastasis and the progression of tumors. Under normal conditions, the adipocytes are mature and they do not differentiate. However, when ADSCs migrate and circulate in blood vessels by homing properties can result in the progression of tumor growth. Furthermore, the properties of migratory cells also promote tumor growth by secretion of trophic factors such as

With the rising interest in stem cell cosmetic therapy, this figure demonstrates the content analysis on the 50 clinical websites that appeared on the Google search platform for “stem cell therapy”, “treatment” or “stem cell facelift” in November 2013. The result showed that (A) 90% of the clinics use Autologous adult stem cell. (B) 71% of clinics obtained stem cells were from patient fat. (C) 90% of procedures delivered cells through subcutaneous methods. (D) facial-anti ageing treatment was advertised the most in “stem cell” treatments as well as “stem cell breast augmentation” therapies.^[21]

Case study: South Korea

The International Association of Aesthetic Plastic Surgery (ISAPS), announced the Korean plastic surgery market is estimated to be about the scale of $440 million as of 2017. It is a 1/4 of the world market, and the number of plastic surgeries per year ranked the first (13.5 per 1000 population per year). Korean stem cell markets formed a scale of $1.1 billion in 2016 and they are expected to grow to 26.67% annually by 2025 ($9.5 billion).^[22][23]

In 2017 the government invested in the bio sector for the highest proportion for new drug development (13%), and only 4% on stem cells ($112 million). CartistemTM, Inc. Medipost published successfully developed stem cell-based degenerative knee cartilage therapy and has achieved more than 10 billion sales since 2017.^[22][23]

Legal issues

Behind the large stem cell cosmetic therapy market size of South Korea, non-specialists practice without a licence in some clinics. According to the National Statistical Office data, the number of plastic surgeons is 1,924 in 2018, and the Korean Plastic Surgery Association estimates that non-specialists in cosmetic surgery will be about 10 times that of specialists.

Dr Shin mentioned, "There have been similar surgeries that advocate stem cell breast plastic surgery recently. When receiving stem cell breast surgery, patients need to check whether the doctor has officially proved and whether the hospital has stem cell researchers and high-quality equipment."^[24]

Diet after stem cell therapy

Studies have shown that diet is closely related to stem cell proliferation and performance. Among numerous chemicals that affect the entire stem cell differentiation and settlement process, it is shown that taking extra supplements such as below can help stem cells to function better.

• Vitamins such as A, B3 and C are effective targets in vitamin-dependent pathways in stem cell manipulation. Especially vitamin C stimulates proliferation to produce bone marrow stem cells. Vitamin D assist stem cells during differentiation by stimulating the activities in embryonic stem cells and iPSCs and regulates embryonic hematopoietic stem and progenitor cell production and human umbilical cord stem cell development.^[25][26]
• Glucosamine and Chondroitin improve stem cell function by promoting adequate growth of progenitors of proliferative tissue lineages.^[27][28][4]
• Glycemic index and calorie restriction by cutting carbohydrates and sugar enhance stem cell activity.^[29][30] At mitochondrial level, the MSCs utilise energy more efficiently when the glycemic index was restricted to low by increasing oxygen consumption of MSCs and exhibiting anti-ageing abilities, while their differentiation abilities remain unaffected.^[31]

References