Clinical treatment of radiotherapy tissue damage by lipoaspirate transplant:: A healing process mediated by adipose-derived adult stem cells
Clinical treatment of radiotherapy tissue damage by lipoaspirate transplant:: A healing process mediated by adipose-derived adult stem cells
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DOI：
10.1097/01.prs.0000256047.47909.71
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发表时间：
2007-04-15
影响因子：
3.6
通讯作者：
Sbarbati, Andrea
中科院分区：
文献类型：
--
作者：
Rigotti, Gino;Marchi, Alessandra;Sbarbati, Andrea
背景：有证据表明干细胞有助于组织血管形成和器官功能的恢复。这项研究的目的是评估脂肪来源的成人干细胞在纯化的脂肪吸入物中是否存在于其天然支架中，并评估脂肪吸入物移植在治疗放射副作用方面的临床有效性。方法：这项研究始于2002年的外科手术，预计患者将获得持续31个月的随访。连续20例因放射治疗的副作用而接受治疗的患者均有严重症状或不可逆的功能损害(Lent-SOMA分级为3级和4级)。取自健康供体部位的纯化自体脂肪抽吸物(60至120毫升)，通过重复低侵入性计算机辅助注射进行注射。结果：在2cc的人脂肪抽吸物中，具有间充质干细胞物理特性和免疫表型的细胞平均为1.07%+/-0.5%(n=4)，其中克隆形成比例为0.139%。每个脂肪抽吸物中至少有1.02×10(3)个集落形成单位--成纤维细胞。靶组织的超微结构系统地表现为渐进性再生，包括新生血管的形成和改善的水化。临床结果导致所有接受评估的患者的症状得到系统性改善或缓解，包括表现出最初不可逆转的功能损害的其他无法治疗的患者。结论：该手术是一种解决放射治疗晚期副作用的微创治疗方法。根据放射性渗漏的缺血性假说，抽脂移植的治疗有可能扩展到其他形式的微血管病变。
Background: There is evidence that stem cells contribute to the restoration of tissue vascularization and organ function. The objective of this study was to assess the presence of adipose-derived adult stem cells left in their natural scaffold in the purified lipoaspirate and to assess the clinical effectiveness of lipoaspirate transplantation in the treatment of radiation side effects.Methods: This study was designed beginning with surgical procedures in 2002 and envisaging a continuous patient follow-up to 31 months. Twenty consecutive patients undergoing therapy for side effects of radiation treatment with severe symptoms or irreversible function damage (LENT-SOMAscale grade 3 and 4) were enrolled. Purified autologous lipoaspirates (60 to 120 cc) taken from a healthy donor site were administered by repeated low-invasive computer-assisted injection. Therapy outcomes were assessed by symptoms classification according to the LENT-SOMA scale, cytofluorimetric characterization, and ultrustructural evaluation of targeted tissue.Results: In the isolated stromal vascular fraction of 2 cc of human lipoaspirate, cells with mesenchymal stem cell physical properties and immunophenotype were in average 1.07 +/- 0.5 percent (n = 4), with a clonogenic fraction of 0.139 percent. At least 1.02 X 10(3) colony-forming units-fibroblast were present in each lipoaspirate. Ultrastructure of target tissue systematically exhibited progressive regeneration, including neovessel formation and improved hydration. Clinical outcomes led to a systematic improvement or remission of symptoms in all evaluated patients, including otherwise untreatable patients exhibiting initial irreversible functional damage.Conclusions: This surgical procedure is a low-invasive therapeutic approach for resolving the late side effects of radiotherapy. According to the proposed hypothesis of the ischemic nature of radiolesions, treatment with lipoaspirate transplantation is potentially extended to other forms of microangiopathies.