Epanomeritakis IE, Khan WS. Adipose-derived regenerative therapies for the treatment of knee osteoarthritis. World J Stem Cells 2024; 16(4): 324-333 [PMID: 38690511 DOI: 10.4252/wjsc.v16.i4.324]
Corresponding Author of This Article
Wasim S Khan, FRCS, MBChB, MSc, PhD, Associate Professor, Surgeon, Division of Trauma and Orthopaedic Surgery, Department of Surgery, University of Cambridge, Hills Road, Cambridge CB2 0QQ, United Kingdom. wk280@cam.ac.uk
Research Domain of This Article
Cell & Tissue Engineering
Article-Type of This Article
Editorial
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Stem Cells. Apr 26, 2024; 16(4): 324-333 Published online Apr 26, 2024. doi: 10.4252/wjsc.v16.i4.324
Adipose-derived regenerative therapies for the treatment of knee osteoarthritis
Ilias E Epanomeritakis, Wasim S Khan
Ilias E Epanomeritakis, Division of Trauma and Orthopaedic Surgery, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, United Kingdom
Wasim S Khan, Division of Trauma and Orthopaedic Surgery, Department of Surgery, University of Cambridge, Cambridge CB2 0QQ, United Kingdom
Author contributions: Epanomeritakis IE and Khan WS designed the overall concept and outline of the manuscript, contributed to the review of literature, and contributed to the writing and editing of the manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wasim S Khan, FRCS, MBChB, MSc, PhD, Associate Professor, Surgeon, Division of Trauma and Orthopaedic Surgery, Department of Surgery, University of Cambridge, Hills Road, Cambridge CB2 0QQ, United Kingdom. wk280@cam.ac.uk
Received: January 17, 2024 Peer-review started: January 17, 2024 First decision: February 3, 2024 Revised: February 15, 2024 Accepted: March 1, 2024 Article in press: March 1, 2024 Published online: April 26, 2024
Abstract
Knee osteoarthritis is a degenerative condition with a significant disease burden and no disease-modifying therapy. Definitive treatment ultimately requires joint replacement. Therapies capable of regenerating cartilage could significantly reduce financial and clinical costs. The regenerative potential of mesenchymal stromal cells (MSCs) has been extensively studied in the context of knee osteoarthritis. This has yielded promising results in human studies, and is likely a product of immunomodulatory and chondroprotective biomolecules produced by MSCs in response to inflammation. Adipose-derived MSCs (ASCs) are becoming increasingly popular owing to their relative ease of isolation and high proliferative capacity. Stromal vascular fraction (SVF) and micro-fragmented adipose tissue (MFAT) are produced by the enzymatic and mechanical disruption of adipose tissue, respectively. This avoids expansion of isolated ASCs ex vivo and their composition of heterogeneous cell populations, including immune cells, may potentiate the reparative function of ASCs. In this editorial, we comment on a multicenter randomized trial regarding the efficacy of MFAT in treating knee osteoarthritis. We discuss the study’s findings in the context of emerging evidence regarding adipose-derived regenerative therapies. An underlying mechanism of action of ASCs is proposed while drawing important distinctions between the properties of isolated ASCs, SVF, and MFAT.
Core Tip: Adipose tissue products are becoming increasingly popular regenerative therapies for treating knee osteoarthritis. Encouraging results have been demonstrated in numerous observational studies and randomized trials. However, it is important to distinguish among isolated adipose-derived mesenchymal stromal cells (ASCs), stromal vascular fraction (SVF), and micro-fragmented adipose tissue (MFAT) to avoid study heterogeneity and improve the quality of evidence regarding these therapies. Different modes of preparation, cell composition, and physical properties are likely to influence the regenerative function of ASCs. To elucidate which adipose-derived therapy is superior for cartilage regeneration, randomized trials are needed to compare ASCs, SVF, and MFAT as distinct therapies.
