A pilot study on ex vivo expanded autologous adipose-derived stem cells of improving fat retention in localized scleroderma patients

Abstract

In patients with localized scleroderma (LoS), facial deformity induced by subcutaneous atrophy greatly reduces life quality. Autologous fat grafting (AFG) is used for volume restoration but with low-fat retention due to various reasons. Adipose-derived stem cells (ADSCs) have shown potential effects in improving fat retention. We aimed to compare the feasibility and efficacy of improving fat retention in LoS patients among the ADSCs-assisted, the stromal vascular fraction (SVF)-assisted and conventional AFG methods. A pilot study with a 6-month follow-up among 18 LoS patients was conducted. Participants were randomly assigned into three AFG groups: conventional group, SVF-assisted group, and ADSCs-assisted group. The SVF-assisted group received SVF-assisted AFG at the SVF:fat ratio of 1:1. The ADSCs-assisted group received the mixture of ADSCs-enriched fat graft supplemented with 5 × 105 ADSCs/mL fat. Volume retention was measured by magnetic resonance imaging, and clinical photographs were taken for outcome evaluation. At sixth-month follow-up, the fat retention of ADSCs-assisted group was 49.83 ± 3.61%, significantly higher than 31.75 ± 1.73% of SVF-assisted group (P = .0004), and 21.86 ± 1.68% of the conventional group (P < .0001). A significant difference of the fat retention was also observed between the SVF-assisted and conventional group (P = .0346). No severe adverse events occurred during the procedure and follow-up. This pilot study suggests that ADSCs-assisted AFG is a safe, feasible, and attractive alternative to conventional and SVF-assisted AFG in the correction of facial atrophy of LoS patients. Future studies with large patient samples are needed for confirmation. (Chinese Clinical Trial Registry, ChiCTR1900025717).

Keywords: adipose-derived stem cells; fat grafting; localized scleroderma; stromal vascular fraction.

Conflict of interest statement

The authors declared no potential conflicts of interest.

© 2021 The Authors. STEM CELLS TRANSLATIONAL MEDICINE published by Wiley Periodicals LLC on behalf of AlphaMed Press.

Figures

FIGURE 1

An overview description of the intervention in this pilot study. ADSCs, adipose‐derived stem cells. AFG, autologous fat grafting; MRI, magnetic resonance imaging; SVF, stromal vascular fraction

FIGURE 2

Magnetic resonance images and delineation of the subcutaneous adipose tissue. A region of interest (ROI) was precisely drawn on each axial slide by comprising pre‐ and post‐operational scans. After ensuring that the entire targeted subcutaneous adipose tissue was included in the ROIs, the volumes were calculated automatically

FIGURE 3

Statistical outcomes. A, The injection volumes of the fat graft of three groups. B, The fat retention at the 3‐month follow‐up. C, The fat retention at 6‐month follow‐up. D, The trend of fat retention changes during the 6 months period

FIGURE 4

The expert satisfaction on clinical outcome of the three groups

FIGURE 5

A, A 24‐year‐old female LoS patient underwent ADSCs‐assisted AFG in the forehead (A1, pre‐operation; A2, after 6 months). B, A 25‐year‐old female LoS patient underwent ADSCs‐assisted AFG in the forehead (B1, pre‐operation; B2, after 6 months). C, A 22‐year‐old female LoS patient underwent ADSCs‐assisted AFG in the cheek (C1, pre‐operation; C2, after 6 months)