Autologe Fetttransplantation in der Brustchirurgie – Klinische und Experimentelle Konzepte: vom Lipofilling bis zum Fettgewebe Tissue Engineering

M. Karagianni; U. Kraneburg; H. Klüter; H.-G. Machens; K. Bieback; J.-T. Schantz; N. Papadopulos

doi:10.1055/s-0033-1334908

Handchirurgie · Mikrochirurgie · Plastische Chirurgie, Inhaltsverzeichnis

Handchir Mikrochir Plast Chir 2013; 45(02): 93-98
DOI: 10.1055/s-0033-1334908

Übersichtsarbeit

Autologe Fetttransplantation in der Brustchirurgie – Klinische und Experimentelle Konzepte: vom Lipofilling bis zum Fettgewebe Tissue Engineering

Autologous Fat Grafts and Supportive Enrichment with Adipose Tissue Stromal Cells

M. Karagianni

¹Institut für Transfusionsmedizin und Immunologie, Medizinische Fakültät Mannheim, Universität Heidelberg; DRK-Blutspendedienst Baden-Württemberg – Hessen

,

U. Kraneburg

¹Institut für Transfusionsmedizin und Immunologie, Medizinische Fakültät Mannheim, Universität Heidelberg; DRK-Blutspendedienst Baden-Württemberg – Hessen

,

H. Klüter

¹Institut für Transfusionsmedizin und Immunologie, Medizinische Fakültät Mannheim, Universität Heidelberg; DRK-Blutspendedienst Baden-Württemberg – Hessen

,

H.-G. Machens

²Klinikum rechts der Isar, Klinik und Poliklinik für Plastische Chirurgie und Handchirurgie, Technische Universität München

,

K. Bieback

¹Institut für Transfusionsmedizin und Immunologie, Medizinische Fakültät Mannheim, Universität Heidelberg; DRK-Blutspendedienst Baden-Württemberg – Hessen

,

J.-T. Schantz

²Klinikum rechts der Isar, Klinik und Poliklinik für Plastische Chirurgie und Handchirurgie, Technische Universität München

,

N. Papadopulos

²Klinikum rechts der Isar, Klinik und Poliklinik für Plastische Chirurgie und Handchirurgie, Technische Universität München

› Institutsangaben

Abstract

Zusammenfassung

Die Fettabsaugung ist ein weit verbreiteter Eingriff in der ästhetischen Chirurgie zur lokalen Fettreduktion. In den letzten Jahrzehnten findet das anfallende Gewebe zunehmend Anwendung als biokompatibler Gewebefüller insbesondere auf dem Gebiet der ästhetischen Gesichtschirurgie und in der Narbenkorrektur. Darüber hinaus kann die autologe Fetttransplantation, auch bekannt als Lipofilling, oder Lipotransfer eine Alternative zur Implantat-Brustrekonstruktion oder -Brustaugmentation bieten. Bisher ist allerdings die postoperative Resorption des Fetttransplantates limitierend, sodass häufig mehrere Eingriffe benötigt werden, um das erwünschte klinische Ergebnis zu erreichen. Der therapeutische Effekt der Eigenfetttransplantation beschränkt sich nicht nur auf den Gewebeaufbau als Füllersubstanz, sondern Eigenfett werden gleichwohl durchblutungsfördernde und wundheilende Eigenschaften zugeschrieben. Letzteres ist nicht den ausdifferenzierten Adipozyten, sondern den undifferenzierten stromalen Zellen (adipose derived stromal cells, ASC) zuzuordnen. Diese Erkenntnis führte zu der Weiterentwicklung der autologen Fetttransplantation durch Anreicherung des Eigenfettes mit autologen ASC, bekannt als zellassistierte Fettgewebetransplantation oder zellassistierter Lipotransfer (Cell assisted Lipotransfer, CAL). Vor einer allgemeinen Etablierung dieses Verfahrens sind jedoch systematische Analysen zur Beantwortung offener Fragen notwendig. Diese betreffen sowohl die operative Technik als auch qualitative Aspekte, die die Herstellung der supportiven Zellfraktion auf Basis der gesetzlichen Rahmenbedingungen für die Zelltherapie in Deutschland umfassen. Nicht zuletzt müssen Fragen der Stammzellbiologie im Rahmen des zellulären Differenzierungspotenziales in vivo geklärt werden.

Abstract

Liposuction is a most common surgical procedure in aesthetic surgery that aims at the local fat reduction. The obtained adipose tissue is currently used as a biocompatible filler. Autologous fat transplantation, also known as lipofilling, has become an attractive treatment method in the field of aesthetic facial surgery and scar tissue reconstruction. Lipofilling may also offer an alternative method to prosthetic breast surgery. Nevertheless, postoperative fat tissue resorption is still a limitiation to lipofilling in breast reconstruction leading to multiple revisions in order to reach the requested clinical outcome. The therapeutic effect of autologous fat grafts does not solely lie in its role as a filler material, but also in its wound healing and angiogenetic properties. The latter is not attributed to the mature adipocytes, but rather to the undifferentiated adipose derived stromal cells (ASC). Thus enrichment of the fat graft with autologous ASC, known as cell-assisted lipotransfer (CAL) may lead to further optimisation of lipofilling concerning fat graft survival. Still aiming to establish the application of autologous fat grafts and ASC in breast reconstruction, there is a necessity for systematic analyses in order to resolve questions regarding the operational technique and qualitative aspects of the ASC manufacturing in accordance with pharmaceutical guidelines and regulations in Germany. Besides, some open questions need to be addressed regarding the ASC differentiation potential in vivo.

Schlüsselwörter

autologe Fetttransplantation - Lipofilling - stromale Fettvorläuferzellen (ASC) - mesenchymale stromale Zellen (MSC) - zellassistierte autologe Fetttransplantation (CAL) - Gewebegesetz, ATMP

Key words

autologous fat grafting - lipofilling - adipose tissue stromal cells (ASC) - mesencymal stromal cells (MSC) - cell-assisted lipotransfer (CAL) - Tissue and Cell Directive, ATMP

Volltext

Referenzen

Literatur
1 Hoehnke C, Eder M, Papadopulos NA et al. Minimal invasive reconstruction of posttraumatic hemi facial atrophy by 3-D computer-assisted lipofilling. J Plast Reconstr Aesthet Surg 2007; 60: 1138-1144
2 Petit JY, Lohsiriwat V, Clough KB et al. The oncologic outcome and immediate surgical complications of lipofilling in breast cancer patients: a multicenter study – Milan-Paris-Lyon experience of 646 lipofilling procedures. Plast Reconstr Surg 2011; 128: 341-346
3 Khouri RK, Eisenmann-Klein M, Cardoso E et al. Brava and Autologous Fat Transfer Is a Safe and Effective Breast Augmentation Alternative: Results of a Six-Year, Eighty-One Patients Prospective Multicenter Study. Plast Reconstr Surg 2012; 129: 1173-1187
4 Uzzan C, Boccara D, Lachere A et al. Treatment of facial lipoatrophy by lipofilling in HIV infected patients: Retrospective study on 317 patients on 9 years. Ann Chir Plast Esthet 2012; 57: 210-216
5 Yeh CC, Williams 3rd EF. Long-term results of autologous periorbital lipotransfer. Arch Facial Plast Surg 2011; 13: 252-258
6 Lee PE, Kung RC, Drutz HP. Periurethral autologous fat injection as treatment for female stress urinary incontinence: a randomized double-blind controlled trial. J Urol 2001; 165: 153-158
7 Patel N. Fat injection in severe burn outcomes: a new perspective of scar remodeling and reduction. Aesthetic Plast Surg 2008; 32: 470-472
8 Giunta RE, Eder M, Machens HG et al. Structural fat grafting for rejuvenation of the dorsum of the hand. Handchir Mikrochir Plast Chir 2010; 42: 143-147
9 DelBene M, Melotto A, Borgonovo A et al. Rizoartrosi: Esperienza di trattament con lipofilling negli stadi iniziali e paragone con infiltrazione locale di acido jaluronico. 4th international symposium Fat Injection and Tissue Regeneration 2011;
10 Prantl L, Heine N. Options for regenerative therapy in the field of breast surgery. Handchir Mikrochir Plast Chir 2012; 44: 103-111
11 Illouz YG, Sterodimas A. Autologous fat transplantation to the breast: a personal technique with 25 years of experience. Aesthetic Plast Surg 2009; 33: 706-715
12 Gutowski KA. Current applications and safety of autologous fat grafts: a report of the ASPS fat graft task force. Plast Reconstr Surg 2009; 124: 272-280
13 Kern S, Eichler H, Stoeve J et al. Comparative analysis of mesenchymal stem cells from bone marrow, umbilical cord blood, or adipose tissue. Stem Cells 2006; 24: 1294-1301
14 Yoshimura K, Sato K, Aoi N et al. Cell-assisted lipotransfer for cosmetic breast augmentation: supportive use of adipose-derived stem/stromal cells. Aesthetic Plast Surg 2008; 32: 48-55 discussion 56–47
15 Lin CS, Xin ZC, Deng CH et al. Defining adipose tissue-derived stem cells in tissue and in culture. Histol Histopathol 2010; 25: 807-815
16 Bieback K, Kinzebach S, Karagianni M. Translating research into clinical scale manufacturing of mesenchymal stromal cells. Stem Cells Int 2011; 2010: 193519
17 Gimble JM, Bunnell BA, Chiu ES et al. Concise review: Adipose-derived stromal vascular fraction cells and stem cells: let’s not get lost in translation. Stem Cells 2011; 29: 749-754
18 Dominici M, Le Blanc K, Mueller I et al. Minimal criteria for defining multipotent mesenchymal stromal cells. The International Society for Cellular Therapy position statement. Cytotherapy 2006; 8: 315-317
19 Yoshimura K, Suga H, Eto H. Adipose-derived stem/progenitor cells: roles in adipose tissue remodeling and potential use for soft tissue augmentation. Regen Med 2009; 4: 265-273
20 Sterodimas A, de Faria J, Nicaretta B et al. Autologous fat transplantation versus adipose-derived stem cell-enriched lipografts: a study. Aesthet Surg J 2011; 31: 682-693
21 Chhaya MA, Melchels FPW, Wiggenhauser PS et al. Breast Reconstruction using biofabrication-based tissue engineering strategies. Biofabrication. Elsevier Publishing; 2012. in press
22 Wiggenhauser PS, Muller DF, Melchels FP et al. Engineering of vascularized adipose constructs. Cell Tissue Res 2012; 347: 747-757
23 Melchels FPW, Domingos MAN, Klein TJ et al. Additive manufacturing of tissues and organs. Progress in Polymer Science 2012; 37: 1079-1104
24 Conde-Green A, Baptista LS, de Amorin NF et al. Effects of centrifugation on cell composition and viability of aspirated adipose tissue processed for transplantation. Aesthet Surg J 2010; 30: 249-255
25 Gehmert S, Hidayat M, Sultan M et al. Angiogenesis: the role of PDGF-BB on adipose-tissue derived stem cells (ASCs). Clin Hemorheol Microcirc 2011; 48: 5-13
26 Coleman SR. Long-term survival of fat transplants: controlled demonstrations. Aesthetic Plast Surg 1995; 19: 421-425
27 Fraser JK, Wulur I, Alfonso Z et al. Differences in stem and progenitor cell yield in different subcutaneous adipose tissue depots. Cytotherapy 2007; 9: 459-467
28 Schreml S, Babilas P, Fruth S et al. Harvesting human adipose tissue-derived adult stem cells: resection versus liposuction. Cytotherapy 2009; 11: 947-957
29 Torio-Padron N, Huotari AM, Eisenhardt SU et al. Comparison of Pre-Adipocyte Yield, Growth and Differentiation Characteristics from Excised versus Aspirated Adipose Tissue. Cells Tissues Organs 2010; 191: 365-371
30 Mojallal A, Auxenfans C, Lequeux C et al. Influence of negative pressure when harvesting adipose tissue on cell yield of the stromal-vascular fraction. Biomed Mater Eng 2008; 18: 193-197
31 Sommer B, Sattler G. Current concepts of fat graft survival: histology of aspirated adipose tissue and review of the literature. Dermatol Surg 2000; 26: 1159-1166
32 Pulsfort AK, Wolter TP, Pallua N. The effect of centrifugal forces on viability of adipocytes in centrifuged lipoaspirates. Ann Plast Surg 2011; 66: 292-295
33 Ueberreiter K, von Finckenstein JG, Cromme F et al. BEAULI – a new and easy method for large-volume fat grafts. Handchir Mikrochir Plast Chir 2010; 42: 379-385
34 Keck M, Zeyda M, Gollinger K et al. Local anesthetics have a major impact on viability of preadipocytes and their differentiation into adipocytes. Plast Reconstr Surg 2010; 126: 1500-1505
35 Padoin AV, Braga-Silva J, Martins P et al. Sources of processed lipoaspirate cells: influence of donor site on cell concentration. Plast Reconstr Surg 2008; 122: 614-618
36 Jurgens WJ, Oedayrajsingh-Varma MJ, Helder MN et al. Effect of tissue-harvesting site on yield of stem cells derived from adipose tissue: implications for cell-based therapies. Cell Tissue Res 2008; 332: 415-426
37 Tchkonia T, Giorgadze N, Pirtskhalava T et al. Fat depot origin affects adipogenesis in primary cultured and cloned human preadipocytes. Am J Physiol Regul Integr Comp Physiol 2002; 282: R1286-R1296
38 Niesler CU, Siddle K, Prins JB.. Human preadipocytes display a depot-specific susceptibility to apoptosis. Diabetes 1998; 47: 1365-1368
39 Duckers HJ, Pinkernell K, Milstein AM et al. The Bedside Celution system for isolation of adipose derived regenerative cells. EuroIntervention 2006; 2: 395-398
40 Bieback K, Hecker A, Schlechter T et al. Replicative aging and differentiation potential of human adipose tissue-derived mesenchymal stromal cells expanded in pooled human or fetal bovine serum. Cytotherapy 2012; 14: 570-583
41 Bieback K, Schallmoser K, Kluter H et al. Clinical Protocols for the isolation and expansion of mesenchymal stromal cells. Transfusion Medicine and Hemotherapy 2008; 35: 286-294
42 Buchholz CJ, Sanzenbacher R, Schule S. The European hospital exemption clause-new option for gene therapy?. Hum Gene Ther 2012; 23: 7-12
43 Rennekampff HO, Reimers K, Gabka CJ et al. Current perspective and limitations of autologous fat transplantation – “consensus meeting” of the German Society of Plastic, Reconstructive and Aesthetic Surgeons at Hannover; September 2009. Handchir Mikrochir Plast Chir 2010; 42: 137-142
44 Schantz JT, Woodruff MA, Lam CX et al. Differentiation potential of mesenchymal progenitor cells following transplantation into calvarial defects. J Mech Behav Biomed Mater 2012; 11: 132-142
45 Wong RS. Mesenchymal stem cells: angels or demons?. J Biomed Biotechnol 2011; 2011: 459510
46 Zimmerlin L, Donnenberg AD, Rubin JP et al. Regenerative therapy and cancer: in vitro and in vivo studies of the interaction between adipose-derived stem cells and breast cancer cells from clinical isolates. Tissue Eng Part A. 2011; 17: 93-106
47 ASPRS, committee . Report on autologous fat transplantation. ASPRS Ad-Hoc Committee on New Procedures, September 30, 1987. Plast Surg Nurs 1987; 7: 140-141
48 Delay E, Garson S, Tousson G et al. Fat injection to the breast: technique, results, and indications based on 880 procedures over 10 years. Aesthet Surg J 2009; 29: 360-376
49 Petit JY, Botteri E, Lohsiriwat V et al. Locoregional recurrence risk after lipofilling in breast cancer patients. 2012; 23: 582-588