title: Bone Regeneration Using the Freshly Isolated Autologous Stromal Vascular Fraction of Adipose Tissue in Combination With Calcium Phosphate Ceramics.
abstract: : In patients undergoing maxillary sinus floor elevation (MSFE) for dental implant placement, bone substitutes are currently evaluated as alternatives for autologous bone. However, bone substitutes have only osteoconductive properties and lack osteoinductive potential. Therefore, this phase I study evaluated the potential additive effect on bone regeneration by the addition of freshly isolated, autologous but heterologous stromal vascular fraction (SVF), which is highly enriched with adipose stromal/stem cells when compared with native adipose tissue. From 10 patients, SVF was procured using automatic processing, seeded on either β-tricalcium phosphate (n = 5) or biphasic calcium phosphate carriers (n = 5), and used for MSFE in a one-step surgical procedure. Primary objectives were feasibility and safety. The secondary objective was efficacy, evaluated by using biopsies of the augmented area taken 6 months postoperatively, concomitant with dental implant placement. Biopsies were assessed for bone, graft, and osteoid volumes. No adverse effects were reported during the procedure or follow-up (≥3 years). Bone and osteoid percentages were higher in study biopsies (SVF supplemented) than in control biopsies (ceramic only on contralateral side), in particular in β-tricalcium phosphate-treated patients. Paired analysis on the six bilaterally treated patients revealed markedly higher bone and osteoid volumes using microcomputed tomography or histomorphometric evaluations, demonstrating an additive effect of SVF supplementation, independent of the bone substitute. This study demonstrated for the first time the feasibility, safety, and potential efficacy of SVF seeded on bone substitutes for MSFE, providing the first step toward a novel treatment concept that might offer broad potential for SVF-based regenerative medicine applications.
  
  
  
  This is the first-in-human study using freshly isolated, autologous adipose stem cell preparations (the stromal vascular fraction [SVF] of adipose tissue) applied in a one-step surgical procedure with calcium phosphate ceramics (CaP) to increase maxillary bone height for dental implantations. All 10 patients received CaP plus SVF on one side, whereas bilaterally treated patients (6 of 10) received CaP only on the opposite side. This allowed intrapatient evaluation of the potential added value of SVF supplementation, assessed in biopsies obtained after 6 months. Feasibility, safety, and potential efficacy of SVF for bone regeneration were demonstrated, showing high potential for this novel concept.
authors.affiliation: Department of Oral Cell Biology, Academic Centre for Dentistry Amsterdam (ACTA), MOVE Research Institute Amsterdam, VU University Amsterdam, Amsterdam, The Netherlands Department of Oral and Maxillofacial Surgery, MOVE Research Institute Amsterdam, VU University Medical Center/ACTA, Amsterdam, The Netherlands.
authors.forename: Henk-Jan
authors.initials: HJ
authors.lastname: Prins
authors.affiliation: Department of Oral and Maxillofacial Surgery, MOVE Research Institute Amsterdam, VU University Medical Center/ACTA, Amsterdam, The Netherlands.
authors.forename: Engelbert A J M
authors.initials: EA
authors.lastname: Schulten
authors.affiliation: Department of Oral and Maxillofacial Surgery, MOVE Research Institute Amsterdam, VU University Medical Center/ACTA, Amsterdam, The Netherlands.
authors.forename: Christiaan M
authors.initials: CM
authors.lastname: Ten Bruggenkate
authors.affiliation: Department of Oral Cell Biology, Academic Centre for Dentistry Amsterdam (ACTA), MOVE Research Institute Amsterdam, VU University Amsterdam, Amsterdam, The Netherlands.
authors.forename: Jenneke
authors.initials: J
authors.lastname: Klein-Nulend
authors.affiliation: Department of Orthopedic Surgery, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands m.helder@vumc.nl.
authors.forename: Marco N
authors.initials: MN
authors.lastname: Helder
mesh_terms: D000273:Adipose Tissue / Q000166:cytology; D000368:Aged; D001861:Bone Regeneration; D002130:Calcium Phosphates / Q000627:therapeutic use*; D015921:Dental Implants; D005260:Female; D005434:Flow Cytometry; D006801:Humans; D008297:Male; D008437:Maxilla; D045164:Mesenchymal Stem Cell Transplantation; D059630:Mesenchymal Stem Cells / Q000166:cytology; D008855:Microscopy, Electron, Scanning; D008875:Middle Aged; D044968:Regenerative Medicine / Q000379:methods; D059546:Sinus Floor Augmentation / Q000379:methods*; D055114:X-Ray Microtomography
chemical_list: D002130:Calcium Phosphates; D015921:Dental Implants; C485817:beta-tricalcium phosphate
keywords: Adipose stem cells; Bone regeneration; Calcium phosphates; Clinical study; Maxillary sinus floor elevation; Regenerative medicine