Why Fat & Why MFAT? Adipose-Derived Mesenchymal Stem Cells

Samuel G Oltman, ND, RMSK

Your own fat tissue is the most abundant and safest source of stem cells in the body. Fat has more stem cells than bone marrow, and is much easier to obtain. It’s safe because it’s yours– there’s no risk of rejection or reaction to the material because it’s you (this is termed “autologous”). Micro-Fragmented Adipose Tissue (MFAT) is a product created from your own fat that contains a cocktail of mesenchymal stem cells, growth factors, and a collagen matrix to support and cushion damaged tissue. MFAT is on the cutting edge of orthopedic treatments for joint arthritis and damage with very promising research and clinical results.

Stem Cells In Fat

Fat, or “adipose tissue”, has up to 500x the concentration of mesenchymal stem cells compared to bone marrow (1). Mesenchymal stem cells are defined as cells that have the capability to turn into bone, cartilage, and connective tissue (2). This can be confirmed with cellular analysis of the genes they express and by growing them in a petri dish to analyze their characteristics (3). When injected into a joint, these cells can promote a powerful healing response (4). The MFAT procedure is all done within the same 1-2 hours so the cells extracted from your body remain viable and living. The viability of cells is also independent of age and BMI, meaning the idea that “you’re too old” to benefit from MFAT is false (5). Overall health is the most impactful factor on success and is a part of every patient plan.

Umbilical cord injection products (amniotic fluid, Wharton’s jelly, etc) may sound promising but there are 2 big problems:

1. There likely aren’t any living cells in those products after all the processing (6)

2. The FDA has made it abundantly clear that they are illegal

The process that fetal tissue products go through before injection.

Whether or not you agree with this stance by the FDA, it is currently the state of the field. MFAT (and bone marrow) fit into the human cell, tissue, or cellular tissue-based product (HCT/P) category: MFAT is minimally manipulated and used for homologous tissue, making it an acceptable procedure for cushioning and supporting joints (7).

MFAT Is Safe & Effective

The safety for MFAT is already well-established. The rate of complication is extremely low and is similar to any other injection procedure. Because the medicine is your own cells and tissue, there is no chance of an immune response or rejection. Compared to bone marrow, the other common source of autologous stem cells, the harvesting of adipose tissue is very simple and pain-free. Bone marrow requires a painful procedure to drill into your bone. Adipose tissue only requires a simple minor surgery usually lasting 20-30 minutes.

Bridging The Gap Between Physical Therapy and Surgery

The effectiveness of MFAT looks more promising with each study that’s published (8, 9, 10, 11, 12, 13). In my clinical experience, MFAT is the most effective and longest lasting non-surgical option for most people with arthritis. This is what we mean by addressing the gap between physical therapy and surgery. The scientific literature backs this up with many long term studies showing decreases in pain and increase in function over 3+ years periods. MFAT can result in MRI confirmed structural improvements to cartilage surfaces and torn tendons/ligaments by creating structural support for the damaged area (14). While the full benefits of an MFAT procedure can take several months to show because we’re still working at the speed of your body (15), the results also last for a long time.

Non-Surgical Arthritis Treatment

MFAT is safe, rich in stem cells, and effective. At Cascade Regenerative Medicine, we are continually looking for ways to improve our care to provide our patients with the most effective cutting-edge treatments available. If you have arthritis and have been told there’s no option but to get cortisone injections and wait for surgery, you have been told wrong. See what the future of orthopedic medicine looks like, and schedule with us today.

References:

1. Cherian DS, Bhuvan T, Meagher L, Heng TSP. Biological considerations in scaling up therapeutic cell manufacturing. Front Pharmacol. 2020;11:654.

2. Brown C, McKee C, Bakshi S, et al. Mesenchymal stem cells: Cell therapy and regeneration potential. J Tissue Eng Regen Med. 2019;13(9):1738-1755.

3. Debnath T, Chelluri LK. Standardization and quality assessment for clinical grade mesenchymal stem cells from human adipose tissue. Hematol Transfus Cell Ther. 2019;41(1):7-16.

4. Fraser JK, Wulur I, Alfonso Z, Hedrick MH. Fat tissue: an underappreciated source of stem cells for biotechnology. Trends Biotechnol. 2006;24(4):150-154.

5. Schmitz C, Alt C, Azares AR, et al. The composition of adipose-derived regenerative cells isolated from lipoaspirate using a point of care system does not depend on the subject’s individual age, sex, body mass index and ethnicity. Cells. 2022;12(1):30.

6. Centeno CJ, Pastoriza SM. Past, current and future interventional orthobiologics techniques and how they relate to regenerative rehabilitation: a clinical commentary. Int J Sports Phys Ther. 2020;15(2):301-325.

7. Non-homologous use of adipose-derived cell and tissue therapies: Osteoarthritis as a case study. Bone Reports. 2022;17:101601.

8. Kenneth Mautner, Robert Bowers, Kirk Easley, Zachary Fausel, Ryan Robinson, Functional Outcomes Following Microfragmented Adipose Tissue Versus Bone Marrow Aspirate Concentrate Injections for Symptomatic Knee Osteoarthritis, Stem Cells Translational Medicine, Volume 8, Issue 11, November 2019, Pages 1149–1156, https://doi.org/10.1002/sctm.18-0285

9. Gobbi A, Dallo I, Rogers C, et al. Two-year clinical outcomes of autologous microfragmented adipose tissue in elderly patients with knee osteoarthritis: a multi-centric, international study. Int Orthop. 2021;45(5):1179-1188.

10. Kim KI, Lee WS, Kim JH, Bae JK, Jin W. Safety and efficacy of the intra-articular injection of mesenchymal stem cells for the treatment of osteoarthritic knee: a 5-year follow-up study. Stem Cells Transl Med. 2022;11(6):586-596.

11. Malanga GA, Bemanian S. Microfragmented adipose injections in the treatment of knee osteoarthritis. J Clin Orthop Trauma. 2019;10(1):46-48.

12. Heidari N, Slevin M, Zeinolabediny Y, et al. Comparison of the effect of mfat and mfat + prp on treatment of hip osteoarthritis: an observational, intention-to-treat study at one year. Journal of Clinical Medicine. 2022;11(4):1056.

13. Vinet-Jones H, F Darr K. Clinical use of autologous micro-fragmented fat progressively restores pain and function in shoulder osteoarthritis. Regenerative Medicine. 2020;15(10):2153-2161.

14. Primorac D, Molnar V, Rod E, et al. Knee osteoarthritis: a review of pathogenesis and state-of-the-art non-operative therapeutic considerations. Genes (Basel). 2020;11(8):854.

15. Harrison JL, Shetty A, Richter D, Schenck R. Sp26. Efficacy of microfragmented adipose tissue for treatment of symptomatic knee osteoarthritis: a randomized, placebo-controlled study. Plast Reconstr Surg Glob Open. 2023;11(5 Suppl):136-137.