Stem Cell Mythbusters: Ads for Adipose Stem Cells in Joint Repair

By Chris Centeno, MD /

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fat stem cell arthritis

Fat stem cell arthritis cure?  Stem Cell Mythbusters visits some recent web-based marketing material foucused on adipose stem cells for joint repair (knee, hip, ankle, shoulder arthritis) and found by one of my partners. Since we’ve treated more human joints with stem cells than any other clinic (of which we’re aware) we think we’re in a position to comment. The marketing material makes the following claims and each will be vetted:

-The use of fat-derived stem cells in joint repair has been documented through several medical journals. Capable of extensive self-renewal, they are proven to help restore joints, and are fast replacing joint replacement surgery as an alternative treatment option.

First, some background. The clinic is offering the use of what’s called an adipose “stromal vascular fraction” (SVF). This is a portion of the fatty tissue that contains some stem cells, mostly mesenchymal stem cells (MSCs). This is a same day procedure where fat is taken via liposuction, digested with an enzyme or mechanically, and then centrifuged to concentrate a cellular fraction. No culture of the cells is contemplated. As of today’s date, while there are 14,000 publications on MSCs, there are only 243 on SVF under all topics. So right out of the gate, we know there’s not a lot published on this type of stem cell treatment. This paucity of published data is a good example of the disconnect between what’s in the research versus what’s being performed clinically. Researchers have shown that isolated and cultured MSCs from bone marrow are capable of healing cartilage in animal joints and early human studies are encouraging (including our own studies on stem cells in knee and hip arthritis). However, cultured bone marrow MSCs (which are the vast majority of these papers) aren’t the same as the adipose SVF fraction that’s being offered. Next let’s look at what’s published in the category of joint repair for the SVF the clinic is using (again, not the well studied, cultured bone marrow MSCs). When I restrict the search to adipose SVF joint, only 5 papers are listed in the US National Library of Medicine. One is a discussion of how fat cells in arthritis patients can cause inflammation, one an opinion piece, two involve culturing the SVF for weeks (not what’s being offered). The fifth paper brings up yet another problem. When compared to bone marrow MSCs, adipose SVF didn’t work better than a placebo, while bone marrow MSCs helped horses with arthritis function better. So maybe this is just one paper showing that bone marrow MSCs work better in joints than adipose stem cells? Nope, there are many other papers as well. So if there’s very limited published data that adipose SVF does anything in human patients, how can the clinic make this claim? Good question.

How about this claim?

-If any of the following apply, you may be a good candidate for stem cell treatment:

  • Inability to perform normal activities
  • Have had one or more surgical procedures with little or no improvement
  • Require chronic pain medicine
  • Suffering from significant disability

Wow! If you go through the list, this is just about every patient we see with a knee, hip, shoulder, or ankle joint problem who seeks medical care. So there seems to be no attempt to put patients into a good, fair, or poor candidate category. If you have a joint problem, you qualify. We’ve blogged in the past that reputable clinics discuss candidacy with their patients as stem cells aren’t magic pixie dust, but just another medical procedure with a success and failure rate.

In another part of the document:

  • Stem cells restore function, repair damage, and slow down the aging process.
  • These cells are unique because they are ‘pluripotent,’ it has the ability to morph into over 220 types of cells.
  • They begin working at an accelerated rate to repair damage regardless of the nature of the disease, condition, or injury.

We do not claim to offer a cure for any condition or disease and cannot predict the outcome of Adipose Stem Cell Treatment. Response to any medical treatment does vary from patient to patient. However, we do know it will not harm you and will potentially improve the quality of life for both you and your family.

Let’s take it from the top. The claim that “Stem cells restore function, repair damage, and slow down the aging process.” Huh? The first part of this blog addresses that SVF hasn’t been shown to do much in animal or human joints. Are there stem cells that can restore function and repair damage, yes, just not these stem cells. “Stem cells…slow down the aging process”! I know of no research that supports that your own stem cells slow down the aging process. The study, if it were to be done would take decades. This is a completely unsupported statement.

These cells…morph into over 220 types of cells“. I performed a literature review, but didn’t count up how many cell types have been documented through adipose SVF differentiation. However, this is another wildly inflated claim, as there are only 243 published papers on SVF and most have nothing to do with the cells differentiating. The claim is even wildly inflated if one considers the much more sophisticated offering of culturing adipose MSCs, which the clinic doesn’t offer.

“They begin working at an accelerated rate to repair damage regardless of the nature of the disease, condition, or injury.” This is a very concerning statement. It states that regardless of how bad the damage in your joint that the cells will begin working “at an accelerated rate to repair damage”. First, let’s hope nothing is accelerated as far as rate of repair, as that’s how tumors form. Second, the concept that your joint will be magically repaired despite having severe arthritis is ridiculous based on our clinical experience. Rather than taking up room here, see our discussion on why stem cells aren’t magic.

Last, after a reasonable disclaimer that seems to go against everything else in the document, we find, “However, we do know it will not harm you and will potentially improve the quality of life for both you and your family.” Wow, this stuff is so good that not only you, but your entire family will be positively impacted by the magic pixie dust. Next let’s tackle the safety issue. Unlike a bone marrow nucleated cell fraction that has been used clinically for decades, adipose SVF is a “new animal”, which has only seen some human clinical use in the last few years. While I personally don’t believe adipose SVF poses a safety issue, a more accurate statement would be that while it makes sense that it’s safe, the data has yet to be published. Or perhaps that because this is investigational care, the patients are required to enter into a tracking registry. What data is published to support the claim that adipose SVF won’t harm you? Under the search terms “adipose stromal vascular fraction complications” I can only find 8 papers, none of which address human safety. The latest paper that came up under a different search states that not much is known about safety, but more clinical data should be published soon.

Finally, other materials state that the clinic injects the cells IV (meaning intravenous or through a vein) and not in the joint with arthritis. This would be a great delivery method if you were treating a pulmonary problem as almost all of these cells will be trapped in the lungs, but not a great way to treat arthritis. In addition, many of these statements above seem to have been lifted from promotional materials from one of the companies selling “shaker kits” to process fat tissue. I’ve blogged on serious safety concerns that have arisen with this method of cell processing.

The upshot? The claims made don’t hold water.

Chris Centeno, MD

Regenexx Founder

Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications.
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