The Skinny on Fat Stem Cells

10 takeaways from: the iFats International Stem Cell Conference December 2018 Las Vegas

iFats “The International Federation for Adipose (Fat Cell) Therapeutics and Science” is an organization of physicians and scientists from around the world with a special interest in stem cell applications from fat. I am proud to be one of the few Orthopaedic Surgeon members of this organization. Their annual meeting just concluded in Las Vegas and featured papers and symposia from the most accomplished experts regarding adipose stem cell advances from around the world. Here are 10 important takeaways from this important conference:

1. Fat Represents The Immediate Future Of Stem Cell Treatment
   While stem cells may also be harvested from bone marrow and blood, fat contains hundreds of times more stem cells per ml than both bone marrow and blood. For this reason, fat has the greatest potential to heal and its use is advancing rapidly internationally.
2. Fat Benefits Arthritis
   There was further evidence presented that fat grafts and fat derived mesenchymal stem cells have a beneficial effect on arthritis. This is an area of active work at our clinic.
3. Fat Is Beneficial For Autoimmune Disease
   There was also further evidence of the beneficial effects of fat derived stem cells for the treatment of autoimmune diseases such as MS and type 1 diabetes.
4. Autologous (Your Own Stem Cells) Are Generally Better Than Allogeneic (Someone Else’s)
   The best results in all aspects of medical care – cancer, arthritis, autoimmune disease, even cosmetic – have occurred using your own, autologous stem cells. This was also reflected in the results presented at the meeting. In addition to producing better results, your own cells are also always less expensive because there is no pharmaceutical or other company “middleman” to pay. Your cells are also always the safest as there is no chance of rejection.
5. Fat Derived Stem Cells Produce Amazing Benefits Primarily By Promoting Healing And Fighting Inflammation Rather Than Growing New Tissue
   There is continuously increasing evidence of how stem cells benefit the immune system. These mesenchymal stem cells act on other cells, specifically the blood-born “T” cells that cause unwanted inflammation and change them so that they are less harmful – a process called “immunomodulation.” Since unwanted inflammation is the sole cause of all autoimmune diseases (MS, type 1 diabetes, ALS, lupus, rheumatoid arthritis etc.) and the primary cause of arthritis pain, these findings are tremendously important. While many focus on the ability of stem cells in some applications to grow new tissue, this “immunomodulatory” effect is possibly even more important.
6. The FDA Is Primarily Concerned With Efficacy Rather Than Safety Regarding Fat Stem Cells
   The FDA is concerned with safety and efficacy. However, safety is not an issue with fat as techniques are extremely safe. The question is efficacy, with the FDA still involved with reviewing data regarding clinical benefits of stem cells.
7. It Is Not Clear If Any One Method Of Fat Utilization Is Superior By Itself
   The most important parameter in choosing a method is highest clinical efficacy. There are conflicting data in this regard. But SVF, and culture-expanded stem cells seem to have the most evidence of efficacy, although one theoretical paper advocated whole fat grafts.
8. Regulatory Concerns From The US FDA Are Extremely Important In Deciding How To Process Fat
   In the US, only whole fat graft is permitted by FDA guidelines. Elsewhere in the world both SVF and culture-expanded stem cells are readily available. There is a current lawsuit against the FDA by a stem cell clinic challenging the FDA’s right to regulate how a patient’s own tissue is used in their own body.
9. The Hottest Topic In Current Fat Stem Cell Research Concerns The Best Way To Process And Use Fat
   The most interest at the conference concerned the best way to prepare fat for injection to obtain maximum benefit. The main debate revolves around whether to use:
   1. Whole fat grafts
   2. SVF (Stromal Vascular Fraction) - Fat with non-fat cells retained but other components of the tissue removed or
   3. Culture-expanded Stem Cells - Cultured, numerically expanded adipose mesenchymal stem cells without other related non-stem cellular types present.
10. The Best Way To Process And Utilize Fat Is Becoming Clearer
    While there is still debate, an approach using a combination of SVF in addition to culture-expanded cells appears to offer the highest potential efficacy and is probably the best approach. At our clinics in the US (Glenview, Illinois and Naples, Florida) we strictly follow FDA guidelines. However, we are making plans to use advanced fat stem cell techniques outside the US where they are permitted. We hope to be up and running by summer 2019.

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