Effect of N-Acetylcysteine on Autologous Fat Graft Survival

A single-centre triple-blind study looking at the addition of NAC to tumescent solution for liposuction and fat grafting in healthy patient volunteers already undergoing bilateral breast reduction. Three-dimensional reconstructions and volumetric analysis will be performed based on CT scans at 0, 1 and 3 months and then histological analysis will be performed after fat graft explantation at 3 months to determine fat graft vascularity and quality.

Study Overview

• Status: Unknown
• Conditions: Adipose Tissue Atrophy; Graft Loss; Deformity of Reconstructed Breast
• Intervention / Treatment: Drug: Acetylcysteine

Detailed Description

Autologous fat grafting is an increasingly popular technique for soft tissue reconstruction; however, the surgical technique is limited by inconsistent graft take, undercorrection, and requirement for repeat procedures. The authors previously examined whether a widely available, clinically safe anti-oxidant, N-acetylcysteine (NAC), could improve adipose-derived stem cell survival and subsequent graft take when added to tumescent solution at the time of fat harvest in mice. The addition of NAC to tumescent fluid during fat harvest in mice protects ADSCs against oxidative stress, increases their survival and proliferation, and inhibits their early differentiation into mature adipocytes in vitro. In an in vivo model, NAC treatment at the time of harvest improved survival and quality of autologous fat grafts. These observations provide proof-of-principle for the use of NAC in the clinical setting to optimize fat graft yields.

Hypothesis: The addition of NAC to the tumescent solution used in fat grafting will improve fat graft survival in humans to potentially decrease the amount of re-operations and undercorrection that occurs.

Plan: The study will be conducted as a single-centre, randomized, triple-blind placebo-controlled trial to be performed at the QEII Health Sciences Centre, Halifax, Nova Scotia. Subjects will be chosen as healthy female patients already presenting to the operating room for elective breast reduction surgery. These patients will be enrolled and booked for surgery as they present to clinic and will not be expedited in receiving their elective surgery if enrolled in the study. Each subject will serve as her own control. The hypothesis will be tested by performing lipoaspiration of the thigh/hip region of healthy patients after the addition of tumescent solution with or without NAC. Approximately 10 millilitres of the fat graft will be injected into each pre-tibial area depending on the randomization allocation, as described by Kolle et al. (1) The volume of fat graft will be measured at 0, 1 and 3 months using computed tomographic (CT) scans according to institutional standards. The CT images will be exported into Materialise Interactive Medical Image Control System (MIMICS) and volumetric three-dimensional reconstructions will be made to measure the size and volume of the grafts at each of the time points. The grafts will then be explanted at 3 months and weighed. The histologic appearance, graded on the amount of inflammation, cysts/vacuoles, integrity and vascularity with CD31 staining will be assessed. The results will be compared using two-tailed t-tests. Statistical significance will be set at p<0.05.

• Study Type: Interventional
• Enrollment (Anticipated): 14
• Phase: Phase 4

Contacts and Locations

• Study Contact: Name: Michael Bezuhly, MD; Phone Number: (902) 470-8168; Email: mbezuhly@dal.ca
• Study Contact Backup: Name: Joshua A Gillis, MD; Phone Number: (902) 452-4880; Email: jgillis@dal.ca

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 45 years (Adult)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: Female

Description

Inclusion Criteria:

1. Women
2. Desire and surgical indication for liposuction of the thigh/hip region for women already undergoing elective breast reduction surgery
3. Age 18-45 years
4. BMI of 20-30
5. ASA Class I

Exclusion Criteria:

1. Known chronic illnesses: Diabetes, HIV, renal/liver failure, metabolic disease, history of cancer or family pre-disposition of cancer, peripheral vascular disease, illness that would preclude a general anaesthetic
2. Pregnancy or planned pregnancy within 1 year
3. Contraindications to CT
4. Previous hip/thigh surgery or injury
5. Previous lower leg surgery/injury
6. Smoker
7. Breastfeeding
8. Other disease according to investigator's judgment

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Quadruple

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Acetylcysteine (NAC); NAC added to tumescent solution for liposuction and eventual fat grafting.	Drug: Acetylcysteine; See arm description; Other Names: N-acetylcysteine
No Intervention: Control; Just tumescent solution for liposuction and fat grafting.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in fat graft volume over time	Based on CT scans of fat grafts and three-dimensional reconstructions/volumetric analysis	0, 1 and 3 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Weight of fat graft	Fat grafts will be explanted and weighed at 3 months.	3 months
Fat graft vascularity	Vascularity of fat graft with CD31 staining.	3 months
Fat graft quality	Quality of fat graft through histological analysis of cysts/vacuoles/intact fat cells/fibrosis and also through adipocyte slide coverage analysis.	3 months
Adverse effects or complications	Collecting data regarding any adverse complications of the fat grafting procedure and subsequent recovery.	1 year

Collaborators and Investigators

• Sponsor: Michael Bezuhly

Study record dates

Study Major Dates

• Study Start: July 1, 2016
• Primary Completion (Anticipated): December 1, 2017
• Study Completion (Anticipated): June 1, 2018

Study Registration Dates

• First Submitted: April 18, 2016
• First Submitted That Met QC Criteria: May 27, 2016
• First Posted (Estimate): June 2, 2016

Study Record Updates

• Last Update Posted (Estimate): June 2, 2016
• Last Update Submitted That Met QC Criteria: May 27, 2016
• Last Verified: May 1, 2016

More Information

Terms related to this study

• Keywords: three-dimensional reconstruction; autologous fat grafting; acetylcysteine
• Additional Relevant MeSH Terms: Pathological Conditions, Anatomical; Atrophy; Physiological Effects of Drugs; Molecular Mechanisms of Pharmacological Action; Anti-Infective Agents; Antiviral Agents; Protective Agents; Respiratory System Agents; Antioxidants; Antidotes; Free Radical Scavengers; Expectorants; Acetylcysteine; N-monoacetylcystine
• Other Study ID Numbers: NSHA-RS/2016-2961

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: IPD will not be available, but will be published as an average of outcomes.