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OPINION | ANTI-AGEING MEDICINE | procedure known as cell-assisted


lipotransfer has been used. It has been known for some time that human adipose tissue is a source of multipotent stem cells that have the capacity to differentiate into various types of cell. These stem cells, also known as adipose-derived stem/ stromal cells (ASCs), have been suggested as being suitable for a use in a range of cell-based therapies. In carrying out cell-assisted lipotransfer,


the liposuction aspirates are washed and the stromal cells separated by standing or centrifugation. The stromal cells are then either mixed with the adipose cells prior to injection, or injected immediately after conventional lipoinjection. The injections are made into the fatty layers around the mammary glands. The whole procedure takes approximately 1 hour. Used in this way, stem cells are thought


to have two benefits. They permit a greater proportion of the transplanted fat to survive, and they encourage the growth of additional fat cells in the transplant area. The technique has been claimed to produce an increase in breast circumference of up to the equivalent of three brassiere cup sizes, and to produce results that are more natural looking than with other techniques. A further point to note is that there are no ethical concerns about the source of the stem cells. However, even cell-assisted lipotransfer


is not free from controversy. Earlier this year, the British Association of Aesthetic Plastic Surgeons (BAAPS) warned that the long-term safety of the procedure is not yet established, and the organisation’s president, Fazal Fatah, called for its use for cosmetic purposes to be banned. In 2003 it was discovered that breast tumours contained so-called cancer stem cells, and that these cells, which are resistant to anticancer medications, are responsible for the growth and spread of breast cancer. There is concern, therefore, that introducing adipose-derived stem cells may promote cancer, although this still has to be proven either way.


Fat transfer and contouring Stem cell-enhanced fat transplant is also being applied to facial procedures, although experience to date is more limited. Many clinics claim to offer ‘stem cell facelifts’, but most of these simply involve lipotransfer, with no attempt to enrich the injected material with stem cells. As with breast augmentation


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procedures, the benefits claimed for the use of stem cells include greater survival of the transplanted material in its new location, and a more natural appearance of the rejuvenated area compared with more established fillers like collagen. But just as with breast procedures, there is also concern about the possible long-term effects of using stem cells. One of the leading suppliers of products


for the separation of stem cells from aspirated fat is San Diego, California-based Cytori Therapeutics. Its lead product in the US is the PureGraft system, which was introduced in 2010. It selectively washes the lipoaspirate and drains the tumescent fluid (a cocktail of saline, a local anaesthetic and a vasoconstrictor which is injected into fat before liposuction to facilitate its removal), free lipid and debris in less than 15 minutes, streamlining the graft preparation process. Compared with conventional


graft preparation


techniques, the system has been designed to prepare grafts more rapidly and to process larger volumes (up to 250 ml). The PureGraft system is complemented


by the 9100/STEM system, which provides everything needed to process adipose tissue and to store the adipose-derived stem and regenerative cells in the same facility, and the 9300/STEM system for facilities that already have a functioning cryopreservation facility. In Europe and Asia-Pacific, Cytori also


offers the Celution 800/CRS, which automates and standardises the extraction, washing, and concentration of


January/February 2012 | prime-journal.com


a patient’s adipose-derived stem cells. The system mixes adipose tissue with the processed stem cells to create a cell-enriched graft for immediate re-implantation into the same patient. An updated version of this system, the Celution One System, which offers greater cell yield, greater range of processing volumes and faster processing times, has just received CE Mark approval. In addition, Cytori is in the process of seeking FDA approval for the use of the Celution system for soft tissue filling/aesthetic body contouring applications in the US. Another company that is developing


products for extracting adipose-derived stem cells is Honolulu, Hawaii-based Tissue Genesis.


Conclusions Even in the field of medicine, there are many hurdles to be overcome before the use of stem cells enters the mainstream. Only last month, the biopharmaceutical company Geron announced that it was putting its stem cell assets up for sale after dwindling funds forced it to drop its clinical programme for a stem cell therapy for acute spinal cord injury. Perhaps investors have got cold feet about stem cell treatments. Whatever the reason, the hard truth is that the use of stem cells in areas such as ameliorating the effects of ageing still has a long way to go before it is an everyday practice.


Even in the field of medicine, there are many


hurdles to be overcome before the use of stem cells enters the mainstream.


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