title: Novel maxillary reconstruction with ectopic bone formation by GMP adipose stem cells.
abstract: Microvascular reconstruction is the state-of-the-art in many fields of defect surgery today. Currently, reconstruction of large bony defects involves harvesting of autologous bone causing donor site morbidity and risk of infection. Specifically, utilizing autologous adipose stem cells (autoASCs), large quantities of cells can be retrieved for cell therapy applications and the risk of tissue rejection is diminished. The authors describe the first case report of a microvascular custom-made ectopic bone flap employing good manufacturing practice (GMP) level ASCs. The patient underwent a hemimaxillectomy due to a large keratocyst. After 36 months of follow-up, the defect was reconstructed with a microvascular flap using autoASCs, beta-tricalcium phosphate and bone morphogenetic protein-2. ASCs were isolated and expanded in clean room facilities according to GMP standards and were characterized in vitro. After 8 months of follow-up, the flap had developed mature bone structures and vasculature and was transplanted into the defect area. Postoperative healing has been uneventful, and further rehabilitation with dental implants has been started. The in vitro characterization demonstrated multipotentiality and mesenchymal stem cell characteristics in ASCs. This is the first clinical case where ectopic bone was produced using autoASCs in microvascular reconstruction surgery and it will pave way for new clinical trials in the field.
authors.affiliation: Department of Oral and Maxillofacial Diseases, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: K
authors.initials: K
authors.lastname: Mesimäki
authors.forename: B
authors.initials: B
authors.lastname: Lindroos
authors.forename: J
authors.initials: J
authors.lastname: Törnwall
authors.forename: J
authors.initials: J
authors.lastname: Mauno
authors.forename: C
authors.initials: C
authors.lastname: Lindqvist
authors.forename: R
authors.initials: R
authors.lastname: Kontio
authors.forename: S
authors.initials: S
authors.lastname: Miettinen
authors.forename: R
authors.initials: R
authors.lastname: Suuronen
mesh_terms: D050153:Abdominal Fat / Q000166:cytology; D000273:Adipose Tissue / Q000166:cytology*; D053687:Adult Stem Cells / Q000166:cytology*; D000368:Aged; D055396:Bone Morphogenetic Protein 2 / Q000502:physiology; D018786:Bone Substitutes / Q000494:pharmacology; D001842:Bone and Bones / Q000166:cytology / Q000502:physiology; D002130:Calcium Phosphates / Q000494:pharmacology; D002454:Cell Differentiation / Q000502:physiology; D006801:Humans; D008297:Male; D008439:Maxillary Diseases / Q000150:complications / Q000601:surgery*; D055806:Microvessels / Q000502:physiology; D039902:Multipotent Stem Cells / Q000166:cytology; D009807:Odontogenic Cysts / Q000150:complications / Q000601:surgery; D019647:Oral Surgical Procedures / Q000379:methods; D009999:Ossification, Heterotopic / Q000139:chemically induced; D010011:Osteocytes / Q000166:cytology; D010012:Osteogenesis / Q000502:physiology; D019736:Prostheses and Implants; D019651:Plastic Surgery Procedures / Q000379:methods*; D013524:Surgical Flaps / Q000502:physiology*; D023822:Tissue Engineering / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D055396:Bone Morphogenetic Protein 2; D018786:Bone Substitutes; D002130:Calcium Phosphates; C018392:tricalcium phosphate