Stem Cell Therapy Enriched Fat Graft Reconstruction of Craniofacial Deficits
Debra A. Bourne, MD1, Francesco M. Egro, MD, MSc, MRCS1, Jacqueline Bliley, MS2, Isaac James, MD1, Gretchen L. Haas, PhD1, E Michael Meyer, PhD3, Vera Donnenberg, PhD4, Albert Donnenberg, PhD4, Barton Branstetter, MD1, Kacey Marra, PhD5, Sydney Coleman, MD6, J Peter Rubin, MD1.
1University of Pittsburgh Medical Center, Pittsburgh, PA, USA, 2Carnegie Mellon University, Pittsburgh, PA, USA, 3University of Pittsburgh Medical McGowan Institute of Regenerative Medicine, Pittsburgh, PA, USA, 4University of Pittsburgh McGowan Institute of Regenerative Medicine, Pittsburgh, PA, USA, 5University of Pittsburgh, Pittsburgh, PA, USA, 6New York Langone Medical Center, New York, NY, USA.
PURPOSE: Craniofacial deformities have serious psychosocial sequelae and can profoundly affect quality of life. Fat grafting is an effective treatment for craniofacial deformities. Stromal vascular fraction (SVF) is a concentrated form of adipose derived stem cells (ASC) that can be isolated from fat through collagenase based procedures. The aim of this clinical trial is to assess the impact of SVF enrichment on craniofacial fat grafting.
METHODS: This IRB-approved prospective cohort study was funded by the Department of Defense. Twelve subjects with at least two regions of craniofacial volume deficit were enrolled and underwent fat grafting with SVF-enriched or standard fat grafting to each area. All patients had bilateral malar regions injected with SVF-enriched graft on one side and control standard fat grafting to the contralateral side. Outcome assessments included: 1) demographic information; 2) volume retention determined by CT scans; 3) SVF cell populations by flow cytometry; 4) SVF cell viability; and, 5) complications. Follow-up was 9 months.
RESULTS: All patients had subjective improvement in appearance (Figure 1). There were no serious adverse events. There was no significant difference in volume retention between the SVF-enriched and control regions overall (50.3% vs 57.3%, p=0.269) or comparing malar regions (51.4% vs 56.7%, p=0.494). Patient age, smoking status, obesity, and diagnosis of diabetes did not impact volume retention. Cell viability was 77.4 ± 7.3%. Cellular subpopulations were 60.1 ± 11.2% ASCs, 12.2 ± 7.0% endothelial cells, and 9.2 ± 4.4% pericytes. There was no significant correlation between cell viability or cellular subpopulations and volume retention.
CONCLUSIONS: Autologous fat transfer for the reconstruction of craniofacial defects is effective and safe. SVF enrichment does not significantly impact volume retention.
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