Adipose Derived Stromal Vascular Fraction (SVF)

At our center, we are doing both basic science research combined with clinical treatment on fat-derived mesenchymal cells. Below is a brief description of some of our work:

Cellular treatment is being studied for its potential to shift the balance in arthritic joints away from progressive damage and degeneration. Adipose tissue (fat!) is abundant and easily accessible. There are literally millions of cells trapped within the supportive tissue (stroma) that holds the fat cells. With cellular therapy, we are interested in the cells and the many factors that these cells produce. With cellular therapy, the goal is to isolate the cells and remove the fat.

Using enzyme to process fat

There are 2 primary methods of processing the fat. One method is using an enzyme to dissolve the stroma that releases the cells into solution. Then centrifugation can concentrate the cells for injection. This method however is restricted in many countries including Israel, most of the USA and Europe. In our initial research we studied methods of using enzyme to process fat (link here to the article). We were able to show that fat contains many stem cells that under the right conditions are capable of turning into bone or cartilage. In addition, the number of cells in fat after enzymatic processing was about 2.4 million per milliliter, or 19 million cells in the nearly 8ml that was available for injection. This research showed how many cells can be obtained from a small mini-liposuction.

Using mechanical methods to process fat

Another method that is allowed uses mechanical methods to separate the fat (and then discard) leaving the cells and some supporting stroma for injection. These mechanical methods may include cutting, washing, and centrifugation to name a few. These mechanical methods were previously thought to be inferior but now are considered in some ways to be superior since the cells attached to stroma may be more effective and viable.

Future methods to improve quality and quantity

We currently use mechanical methods, and we are continuing to do research to find even better methods. Racheli Sharon-Gabbay during her PhD work at the Hebrew University of Jerusalem learned statistical methods that we applied to previously published work to find optimum methods for improving the quantity and quality of cells (link here to the article). We have published one article and are currently and actively working on the next generation of methods.

Clinical study

We recently completed the enrollment period of a clinical study. Patients with painful knee arthritis were enrolled in the study. All had moderate to severe pain and many had knee replacement already recommended. We injected one knee with the mSVF (stem cells) and the other with saline. The patients did not know which side was injected with which material. We are seeing them at 3 months, 6 months and 12 months. We are currently analyzing the results and preparing them for publication in a peer-reviewed journal. We will share the results once they have been published. This study was generously funded by the IMRF Fund.

What do you actually do when you treat?

We begin the process with a mini-liposuction. We use a very small cannula (about 2.5mm diameter) to manually aspirate fat. The procedure is done in a mini operating room under local anesthetic. We use sterile technique so that we can re-inject. This takes 30-40 minutes depending on how much fat we need. The more joints that we inject, the more fat we need to harvest. The next step is to process the fat. After removing the fluid and debris from the lipoaspirate, we use special cutting filters from Korea (Adinizers) to cut the fat into smaller and smaller pieces until they are microscopic (down to 100 microns). After centrifugation the material is ready to inject. This processing takes about 45 minutes and the injection takes about 10 minutes which we do after some local anesthetic. Depending on the joint, we can inject directly or use ultrasound to guide the injection. The entire process takes about 2 hours.

How can I get treated, and what does it cost?

If you are interested in treatment, you can contact Chaya at knee@szmc.org.il. If it seems appropriate, we will invite you for an evaluation that includes an examination. Please bring your X-rays so that we can determine the extent of the arthritis. If treatment is reasonable for you, we can then schedule the procedure. The cost depends on how many joints are treated in the same session, and we will explain it in full at your consultation, before you decide.

What arthritic joints are you injecting?

We are currently focused on the knees. However, we have injected thumbs, toes, hips, elbows and shoulders. We are open to consider joints that are arthritic and painful

What are the risks and is it painful?

The risks are low, but no procedure is completely without risk. The donor site (usually from the flank) may be mildly painful for a few days. The risk of bleeding or infection is very low. Although we inject your own cells, you can have an inflammatory reaction sometimes the same night or sometimes it can last 2-3 days that can cause significant knee pain. We ask people to minimize their activities for 3 days after the injection and no sports for one week.

How long does it take to see improvement?

Any improvement is gradual and can take weeks to months to appear. Not every patient improves.

How successful is the treatment?

Results vary from patient to patient, and we cannot promise that treatment will help. The results of our clinical trial will be shared once they have been published in a peer-reviewed journal. At your consultation we will go over the published evidence with you and discuss whether treatment is reasonable for your joint. Improving results is what drives the research part of our program.

How do I schedule an appointment?

Email Chaya at: knee@szmc.org.il