The SVF Procedure

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Stromal Vascular Fraction Cell Procedure

The autologous adipose stromal vascular fraction (SVF) procedure involves obtaining fat (adipose) tissue-derived stem cells, which are used in various autoimmune, urologic, neurologic, pulmonary, ophthalmologic and orthopedic applications for patients. For orthopedic conditions, adipose-derived stromal vascular fraction (collection of stem cells) is being used in patients with ligament/tendon injuries, chondromalacia, osteoarthritis (OA), osteonecrosis of the femoral head, back/neck pain and more.

 

The stromal vascular fraction is a by-product of liposuction of excess fatty tissue.  This fraction contains a large number of stem cells, termed adipose derived stem cells.  These cells are similar to those derived from bone marrow in that they are capable of multilineage differentiation.  The SVF of adipose tissue is a potent source of preadipocytes, mesenchymal stem cells, T cells, B cells, endothelial progenitor cells, and adipose tissue macrophages.

 

The Cell Surgical Network IRB-approved procedure yields 10 million to 40 million stem cells.  After harvesting the cells are either immediately used for banked in a CSN afilliate stem cell bank.  The cells are cryopreserved for future use and expanded to hundreds of millions of autologous stem cells.

 

The stem cell procedure itself requires 4 -5 hours.  First, the doctor will administer a twilight anesthetic, and then make a small incision in an area of the body with fatty tissue, such as buttocks or stomach.  Approximately 100 – 200 mL of adipose tissue will be harvested via liposuction.

 

Next, the stromal vascular fraction with adult stem cells is separated from the fat cells, macrophages, and additional tissue components via centrifugation.  The stem cells from the SVF are then isolated using multi-filtration protocols.

 

After the stem cells have been isolated they are added to the patient’s platelet-rich plasma and the entire solution is activated with a low light laser.

 

Finally, the stem cell solution is administered to the patient.  Alternatively, if stem cells are acquired for banking purposes they are transferred to a stem cell bank.

What are stem cells?

Stem cells are categorized by two major types: embryonic stem cells (ESCs) and adult stem cells (ASCs). Adult stem cells can be further divided into non-cultured expanded forms, such as mesenchymal stem cells (MSCs) and autologous stromal vascular fraction.

How do stem cells and stromal vascular fractions work?

Musculoskeletal damage, degeneration, and injuries are common health problems. Stem cells of a regenerative potential for damaged and injured tissue. Adipose SVF is use for many orthopedic applications in the clinical setting. These types of stem cells differentiate into cartilage and bone tissue, which is proven in many clinical studies. ASCs in the form of SVF possibly work by secreting cytokines, chemokines, and growth factors, which stimulate healing and tissue regeneration.

How are autologous adipose SVF obtained?

To obtain adipose autologous SVF, liposuction is performed. After you are positioned on the procedure table, and the skin is cleaned using an antiseptic. After numbing the area using a local anesthetic, the Chicago stem cell doctor makes a small incision at the abdomen or other body area. A small cannula is inserted, and the adipose cells are gently removed via suction. Once obtained, the solution (called lipoaspirate) is taken to the laboratory for processing, and the incision is closed with Steri-Strips or a Band-Aid.

What happens during processing?

The lipoaspirates (fat tissue components removed by aspiration) are digested with collagenase solution, which breaks down the matrix. The MSCs are released from the tissue. After being processed through centrifugation (spinning) and dilution, the ASCs are washed and isolated. The cells are processed again 3-4 times, and the end product is the SVF.

How many stem cells are in autologous adipose SVF?

In adipose tissue, the number of stem cells derived as SVF can vary. The number of cells range from 500,000 to 2 million cells per gram of adipose tissue, and 1-10% of these cells are adult stem cells (around 4,000-200,000 in quantity). However, a high dose or prolonged exposure to collagenase may damage or kill some stem cells, so the laboratory must be careful with this product.

What conditions are treated using adipose SVF?

Current clinical procedures using autologous adipose SVF include:

  • Orthopedic – arthritis, tendonitis, ligament injury, soft tissue injury.
  • Neurologic – MS, Post Concussion Syndrome, Parkinson’s, CRPS, RSD, Cerebral Palsy, ALS, Muscular Dystrophy, CIDP.
  • Autoimmune – Multiple Sclerosis, Lupus, Diabetes, Crohn’s, Sclerosis.
  • Ophthalmologic – Macular Degeneration, Dry Eye, Glaucoma, Optinc Neuritis.
  • Pulmonary – COPD, CHF, Asthma.
  • Urologic – Peyronie’s Disease, Interstitial Cystitis, Erectile Dysfunction.
  • Cartilage regeneration for osteoarthritis (OA) – OA is a debilitating health condition that is common among aging people. SVF is an alternative to conservative measures, and is often used when these treatments fail. SVF may help treat the underlying problem of cartilage degeneration. In a 2011 study, several patients with knee OA were treated with SVF and regenerating cartilage tissue. When SVF was mixed with hyaluronic acid (HA) and platelet-rich plasma (PRP) was injected into the knee joints, patients found it helped. In the study, range of motion, visual analog scores for pain, and functional rating index scores all improved. In addition, several months after treatment, MRI studies showed evidence of cartilage regeneration in these patients. In a 2013 study, the efficacy rate of this treatment was 65% for people with OA of the hips and knees, as well as those with femoral head osteonecrosis.
  • Chondromalacia patellae (CMP) – This condition involves cartilaginous softening of the patellar cartilage and knee pain. In a recent research study, patients with knee CMP were treated with autologous adipose SVF. At the 3-month follow-up, the patients reported improvement in pain scores, functionality, and range of motion. In addition, post-treatment MRIs showed regeneration of the hyaline cartilage at the patellofemoral joints in all study subjects.
  • Meniscal tear – The knee meniscus is a fibro-cartilaginous disc that absorbs shock in the knee. This structure if often torn with knee injuries. In a 2014 clinical study, researchers found that SVF injected with HA and PRP helped pain and mobility for participants. In addition, meniscus cartilage regeneration was documented in all patients in post-therapy MRIs.
  • Osteonecrosis – This is a debilitating disorder, common in young males. The bone material dies, and this leads to collapse of the hip joint. Patients treated with autologous adipose SVF are regenerating bone in the femur (thigh bone) head that is diseased from osteonecrosis lesions. In a recent study, patients had MRI evidence of new bone and cartilage growth of the hip joint, as well as increased range of motion and decreased pain. In another study, which involved use of SVF, PRP, and HA, the femoral head necrosis completely resolved in one study subject.
  • Achilles tendinopathy – Tendon degeneration is often a cause of pain. The Achilles tendon runs along the heel region, and often develops pain and decrease function with injury or damage. In a 2016 randomized clinical trial with 56 patients, researchers randomly assigned the participants to a single SVF injection or a single PRP injection. The treatments were repeated at the 4 and 6-month follow-ups. SVF injection patients had faster and more pronounced improvements, and researchers concluded it was effective and safe for treating Achilles tendinopathy.
  • Rheumatoid arthritis (RA) – According to a recent clinical trial, intravenous (IV) administration of SVF had an 80% efficacy rate for improving symptoms of RA. In this study, the patients had adipose-derived SVF obtained in the usual manner, and then the concentrated solution was administered systemically into the body through a vein. Through normal circulation, the SVF made its way to all body systems and organs. In the study, patients had no adverse reactions.
  • Multiple sclerosis (MS) – In two case report studies, patients suffering from MS all received IV administration of autologous adipose SVF. In the first study, all 3 patients reported significant improvement neurologically, and no participants suffered adverse reactions. In addition, one patient had complete remission following treatment. Another study involved 13 patients, all who had improvement of MS symptoms following autologous SVF therapy.
How long can SVF stay in the joint after injection?

Current researchers have found that most of the injected SVF fluid is reabsorbed within 2-4 days following the injection. ASCs attach to the lesion, however, and survive a prolonged amount of time. Adipose-derived SVFs offer many other cells in addition to MSCs. They have red blood cells, adipocytes, and white blood cells, which work together to heal the treated structure.

Resources

Ichim TE, et al. (2010). Autologous stromal vascular fraction cells: a tool for facilitating tolerance in rheumatic disease. Cell Immunol, 264(1):7–17.

Pak J, Lee JH, Park KS, et al. (2017). Current use of autologous adipose tissue-derived stromal vascular fraction cells for orthopedic applications. Journal of Biomedical Science, 24, 9.

Riordan NH, et al. (2009). Non-expanded adipose stromal vascular fraction cell therapy for multiple sclerosis. J Translational Med, 7:29.