SVF Stromal vascular fraction – Uses in osteoarthritis and sports injuries

The seed of a plant develops into root and shoot. This shoot then becomes the stem. The stem gives rise to branches, leaves, fruits & flowers. In this same way, stem cells of our body have the potential to develop into more stem cells, as well as specialised cells such as muscle cell, blood cell or a brain cell. These specialised cells can then form or repair tissues of our body.

Stem cells are of 2 types: embryonic and non-embryonic, also called adult stem cells.

Embryonic stem cells are derived from eggs fertilized in a laboratory (In vitro fertilization) and never from eggs fertilized in a female’s body.

Adult stem cells are found in tissue or an organ. They are also called as somatic stem cells, meaning they are not derived from germ cells, namely eggs and sperm.

If a stem cell forms different types of blood cells, then it is called hematopoietic stem cells. And when the stem cells form cells of connective tissue namely bone, cartilage, fat, then it is known as stromal stem cell.

Adult stem cells are found in brain, bone marrow, peripheral blood, blood vessels, skeletal muscle, skin, teeth, heart, gut, liver, ovarian epithelium, and testis.

Stromal vascular fraction (SVF) is an alternative source of stem cells.

Contents of SVF:

SVF contains premature fat cells, mesenchymal stem cells (MSC), endothelial progenitor cell, T cells, B cells, mast cells & adipose tissue macrophages and large amounts of growth hormone.

Data suggests that 2-10% Adipose-derived stromal (stem) cells are found in SVF.

How is SVF made?

SVF is derived from fat found under the skin. The extra subcutaneous fat that is removed surgically as waste product during the process of liposuction or has been isolated is used to make SVF.

This extra adipose tissue is processed by enzymatic digestion to free itself of other body products.

The 3 properties of stem cells, regardless of their source are:

1) Self renewal: they are capable of multiplying and replicating themselves for long periods.

2) Undifferentiated: they are unspecialized.

3) Differentiation: and they can form specialized cell types.

Synonyms:

Stem cells derived from adipose tissue have been known by many names like:

SVF; adipose-derived adult stem (ADAS) cells; adipose-derived adult stromal cells; adipose-derived stromal cells (ADSC); adipose stromal cells (ASC); adipose mesenchymal stem cells (AdMSC); processed lipoaspirate (PLA) cells; adipose-derived stromal/stem cells (ASCs).

Indications of SVF in OA:

If you are responding well to the medicines, then SVF is not ideal for you.

For those who have not responded to medicines.

For those in whom medicines have helped earlier, but are not helping now.

For those who are intolerant to medicines or have drug allergies.

For those who wish to avoid surgery.

For those who have tried all time tested remedies, surgeries & physiotherapy exercises, but yet are suffering.

Role of SVF in Sports Injuries:

SVF can be used with considerable benefit in the following 5 types of sport injuries:

1) Bone injuries – fracture.

2) Soft tissue injuries – including muscle, ligaments, tendons, cartilage and skin abrasions and ecchymosis.

3) Joint injuries – dislocations, post-injury arthritis

4) Head injuries – blunt trauma, & concussions.

5) Overuse injuries – due to excessive wear & tear of joints & structures supporting the joint.

Stem cells aid in faster recovery & healing, even in conditions or tissues which are slow to heal.

Action of SVF:

SVF promotes formation of new blood vessels at the site of its implantation.

The growth factors found in SVF have anti-inflammatory properties.

The stem calls in SVF secrete large amounts of cytokines within the joint, which has a positive effect on cartilage cells. The cartilage cells multiply and produce collagen, which is the main component of cartilage. Even the life span of chondrocytes increases.

The production & secretion of the enzyme that destroys cartilage within the joint is inhibited by SVF. This enzyme called metalloproteinase digests the matrix of the cartilage.

Cons of Platelet rich plasma (PRP):

Platelet rich plasma used may be of poor quality due to inadequate centrifuging methods.

The drawback of PRP collecting method is that only a certain percentage of a given platelet count is collected. Add to this the individual variation of platelet count in the population. The different platelet concentrating methods may change the mechanism in which platelets act and this may have adverse clinical results with PRP.

Secondly, local injectable form of PRP may increase circulating levels of cytokines and thus may affect doping tests (in athletes and players). Doubt still remains if PRP causes systemic anabolic effects or boosts performance. Thus PRP may not follow the norms laid down by anti doping agencies.

Cons of Ozone therapy:

There is insufficient evidence that ozone therapy may be used in treatment of any disease, according to American Cancer Society.

U.S. FDA suggests that ozone may be a toxic gas, having no health benefits discovered yet.

In the history of medical usage of ozone, it has caused destruction of membranes of lung by inhalation.

When ozone mixes with human blood, it reacts to produce abundant free radicals. These free radicals cause cellular damage and are thought to be involved in progression of degenerative diseases.

Cons of Steroid injections

Acute reactions: Increase in joint pains within the first 24 hours after using injectable steroids.

Chronic effects: Steroids may interfere with the hormones controlling menstruation.

Steroids may cause mood swings, especially if there is a part history of such complaints.

In diabetic patients, steroids may increase blood sugar levels. Injectable steroids may rarely cause infection inside a joint while injecting. Steroids cannot be used in a secretly affected and damaged joint.

If a person is taking anticoagulants, then steroid injections will increase the risk of internal bleeding. The risk of weakening surrounding tissues is always there with injectable steroids.

Overall,

SVF is the safest therapy for osteoarthritis and is a leading therapy in sports medicine. Its safety lies in the fact that the stem cells needed are harvested from the patient himself! That too from the fat tissue found in excess in the patient’s body. It is autologous in nature! Also it is not known to have any adverse clinical effects. The long term benefits of SVF continue to outweigh other therapies.