Celution System Seminar ASPI 25 October 2008 Fat Transfer with Adipose-derived Stem and Regenerative Cells for Breast Reco...
Fat Transfer <ul><li>Used in reconstruction (to fill defect) and augmentation </li></ul><ul><li>Benefit: </li></ul><ul><ul...
Adipose-derived Stem & Regenerative Cells <ul><li>Adult stem cells that have unique properties: </li></ul><ul><ul><li>Resi...
ADRCs
ADRC vs BM-MSC <ul><li>Advantages of ADRC over BM-MSC: </li></ul><ul><ul><li>Minimal morbidity upon harvest </li></ul></ul...
Celution Sytem – Overview <ul><li>Developed as the 1 st  bedside device to enable real-time, adult stem cell processing  <...
Celution System <ul><li>Celution 800/CRS Device  </li></ul><ul><li>Celution 500/CRS Instrument Set </li></ul><ul><li>Celut...
How it works
Breast Reconstruction <ul><li>Breast reconstruction is a physically and emotionally rewarding procedure for a woman who ha...
Reconstructive Surgery after Mastectomy American Society of Plastic Surgeon Bleeding, infection,  poor healing of incision...
TRAM flap Latissimus dorsi flap Tissue expansion in breast implantation procedure American Society of Plastic Surgeon
Reconstructive Surgery after BCT <ul><li>No standard therapy. When the defect is small surgeon will perform tissue arrange...
<ul><li>Status: enrollment complete </li></ul><ul><li>Reconstruction post-partial mastectomy </li></ul><ul><li>Endpoints: ...
RESTORE I Trial Pre-Op 12 Months Post-Op Dr. Sugimachi, Dr. Kitamura Kyushu Central Hospital Fukuoka, Japan
RESTORE I Trial Pre-Op 12 Months Post-Op Dr. Sugimachi, Dr. Kitamura Kyushu Central Hospital Fukuoka, Japan
6.1 16.0 14.4 0 2 4 6 8 10 12 14 16 Pre One month One year P < 0.05 P = NS P < 0.05 mm Restore I:  Breast Tissue Thickness...
Not satisfied 4 (21.1 %) Satisfied  7 (36.9 %) Very satisfied 8 (42.1 %) N = 19 Restore I: Patient Satisfaction Survey Dr....
Conclusion <ul><li>Adipose tissue is the richest source of adult stem cell    real-time ADRC-processing with Celution sys...
Every woman is created by God beautifully, “big&quot; or &quot;small&quot; depends on how a woman herself sees in her. If ...
Correlation between the ADRC Cell Yield to Processing Volume <ul><li>Typical yields are approximately 300,000 cells/g of t...
How long does it take Celution System to process the ADRCs?
How much graft tissue is needed with the ADRCs? <ul><li>Cytori’s research has shown that the typical fat graft is made up ...
Comparison of 3 sources of MSC Kern, Stem Cells 2006;24:1294 – 1301  p<0.001 7.10%   64.20% towards 2 lineages p<0.001 89....
Expression of Surface Proteins of MSCs derived from BM, UCB & AT
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Fat Transfer with Adipose-derived Stem and Regenerative Cells for Breast Reconstruction

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  • Fat Transfer with Adipose-derived Stem and Regenerative Cells for Breast Reconstruction

    1. 1. Celution System Seminar ASPI 25 October 2008 Fat Transfer with Adipose-derived Stem and Regenerative Cells for Breast Reconstruction
    2. 2. Fat Transfer <ul><li>Used in reconstruction (to fill defect) and augmentation </li></ul><ul><li>Benefit: </li></ul><ul><ul><li>Autologous  no rejection, feel more natural </li></ul></ul><ul><ul><li>Patient’s preference  to reduce the unwanted fat in certain body part as well as to improve defects in certain body part </li></ul></ul><ul><ul><li>No incision scar </li></ul></ul><ul><ul><li>Safe in comparison with implant </li></ul></ul><ul><li>Risk: </li></ul><ul><ul><li>Fat reabsorption due to necrosis </li></ul></ul><ul><ul><ul><li> No more than 3 month tissue survival </li></ul></ul></ul><ul><ul><ul><li> Produce microcalsification  misinterpretation with malignancy in radiology </li></ul></ul></ul><ul><ul><ul><li> Overcorrection </li></ul></ul></ul><ul><ul><li>Need liposuction </li></ul></ul><ul><li>The technique to avoid fat reabsorption: </li></ul><ul><ul><li>Wash the adipose tissue with normal saline </li></ul></ul><ul><ul><li>Centrifugation </li></ul></ul><ul><ul><li>The addition of nutrients or growth factors </li></ul></ul><ul><ul><li>Microinjection of the fat to vascular-rich tissue </li></ul></ul><ul><ul><li>Use ADRC </li></ul></ul>
    3. 3. Adipose-derived Stem & Regenerative Cells <ul><li>Adult stem cells that have unique properties: </li></ul><ul><ul><li>Resides abundantly in adipose tissue  the richest source of stem cells </li></ul></ul><ul><ul><li>Differentiate into multiple cell lineages </li></ul></ul><ul><ul><li>Extensive self renewal capacity </li></ul></ul><ul><li>Represent tremendous opportunities for treating cardiovascular disease, spine and orthopedic disorders, vascular conditions, reconstructive surgery as well as a variety of other areas of medicine  “Regenerative cells” </li></ul>
    4. 4. ADRCs
    5. 5. ADRC vs BM-MSC <ul><li>Advantages of ADRC over BM-MSC: </li></ul><ul><ul><li>Minimal morbidity upon harvest </li></ul></ul><ul><ul><li>Clinically relevant stem cell numbers extractable from tissue isolates  no need in vitro propagation </li></ul></ul><ul><ul><li>Stem cell frequency is significantly higher in adipose tissue compared with in BM (2% vs 0.002%)  1000 times higher </li></ul></ul><ul><ul><li>Higher proliferation rate than BM-MSC </li></ul></ul>Strem, Hedrick, Trends in Biotechnology 2005;23(2):64 – 66 Fraser, Strem, Nature Clinical Practice Cardiovascular Medicine 2006;3(suppl1):33 – 37
    6. 6. Celution Sytem – Overview <ul><li>Developed as the 1 st bedside device to enable real-time, adult stem cell processing </li></ul><ul><li>This innovative technology automates & standardized the separation & concentration of a patient’s own (autologous) adult stem & regenerative cells from body fat (adipose) for real-time redelivery to the same patient </li></ul><ul><li>The Celution System makes cells available in about one hour </li></ul>
    7. 7. Celution System <ul><li>Celution 800/CRS Device </li></ul><ul><li>Celution 500/CRS Instrument Set </li></ul><ul><li>Celution 805/CRS Kit: </li></ul><ul><ul><li>Celution 805/CRS Consumable set </li></ul></ul><ul><ul><li>CELASE 835/CRS Reagent </li></ul></ul><ul><ul><li>Celution 200/CRS Therapeutic Packs </li></ul></ul>
    8. 8. How it works
    9. 9. Breast Reconstruction <ul><li>Breast reconstruction is a physically and emotionally rewarding procedure for a woman who has lost a breast due to cancer or other condition. </li></ul><ul><li>Breast reconstruction is a good option for you if: </li></ul><ul><ul><li>You are able to cope well with your diagnosis and treatment </li></ul></ul><ul><ul><li>You do not have additional medical conditions or other illnesses that may impair healing </li></ul></ul><ul><ul><li>You have a positive outlook and realistic goals for restoring your breast and body image </li></ul></ul><ul><li>Breast reconstruction typically involves several procedures performed in multiple stages. It can: </li></ul><ul><ul><li>Begin at the same time as mastectomy, or </li></ul></ul><ul><ul><li>Be delayed until you heal from mastectomy and recover from any additional cancer treatments </li></ul></ul>American Society of Plastic Surgeon
    10. 10. Reconstructive Surgery after Mastectomy American Society of Plastic Surgeon Bleeding, infection, poor healing of incisions, and anesthesia risks General risk -Gradual procedure over 4-6 months, tissue expansion -Capsular contracture  firm -Implant Rupture No scar in other place Implant -Partial or complete loss of the flap and a loss of sensation at both the donor and reconstruction site -Produce scar in other place Standard therapy Latissimus dorsi flap -Partial or complete loss of the flap and a loss of sensation at both the donor and reconstruction site -Produce scar in other place Standard therapy TRAM flap Disadvantages Advantages Procedure
    11. 11. TRAM flap Latissimus dorsi flap Tissue expansion in breast implantation procedure American Society of Plastic Surgeon
    12. 12. Reconstructive Surgery after BCT <ul><li>No standard therapy. When the defect is small surgeon will perform tissue arrangement. But when the defect is large enough, no standard therapy was established. Implant can only be done in some special case if the implant size and shape suits the defect which is very rare. </li></ul><ul><li>Good opportunity for breast reconstruction with Celution: </li></ul><ul><ul><li>No scar  only a point of needle inserted </li></ul></ul><ul><ul><li>No capsular contracture </li></ul></ul><ul><ul><li>No rupture </li></ul></ul><ul><ul><li>No thinning  compared with absorbed conventional fat graft </li></ul></ul><ul><ul><li>Less risks of bleeding, infection and anesthetic risks since it can be done with local anesthesia </li></ul></ul><ul><ul><li>Flatter tummy at a time </li></ul></ul>
    13. 13. <ul><li>Status: enrollment complete </li></ul><ul><li>Reconstruction post-partial mastectomy </li></ul><ul><li>Endpoints: safety and efficacy </li></ul><ul><li>Design: </li></ul><ul><ul><li>T2 or smaller, 2 yrs post radiation therapy </li></ul></ul><ul><ul><li>21 patients </li></ul></ul><ul><ul><li>6, 12 month follow up </li></ul></ul>Reconstructive Surgery: RESTORE I Dr. Sugimachi, Dr. Kitamura Kyushu Central Hospital Fukuoka, Japan
    14. 14. RESTORE I Trial Pre-Op 12 Months Post-Op Dr. Sugimachi, Dr. Kitamura Kyushu Central Hospital Fukuoka, Japan
    15. 15. RESTORE I Trial Pre-Op 12 Months Post-Op Dr. Sugimachi, Dr. Kitamura Kyushu Central Hospital Fukuoka, Japan
    16. 16. 6.1 16.0 14.4 0 2 4 6 8 10 12 14 16 Pre One month One year P < 0.05 P = NS P < 0.05 mm Restore I: Breast Tissue Thickness Dr. Sugimachi, Dr. Kitamura Kyushu Central Hospital Fukuoka, Japan * ultrasound
    17. 17. Not satisfied 4 (21.1 %) Satisfied 7 (36.9 %) Very satisfied 8 (42.1 %) N = 19 Restore I: Patient Satisfaction Survey Dr. Sugimachi, Dr. Kitamura Kyushu Central Hospital Fukuoka, Japan 12 Months
    18. 18. Conclusion <ul><li>Adipose tissue is the richest source of adult stem cell  real-time ADRC-processing with Celution system </li></ul><ul><li>ADRC benefits over MSC in: </li></ul><ul><ul><li>More accessible </li></ul></ul><ul><ul><li>1000-times higher frequency  no cell processing needed </li></ul></ul><ul><ul><li>Higher proliferation rate </li></ul></ul><ul><li>The limitation of conventional fat transfer can be managed by ADRC-enriched fat transfer: no reabsorption  good results, no calcification (safe), do not need overcorrection </li></ul><ul><li>The benefits of ADRC-enriched fat transfer over implant: </li></ul><ul><ul><li>More natural </li></ul></ul><ul><ul><li>No scar  only a point of needle inserted </li></ul></ul><ul><ul><li>Safer: </li></ul></ul><ul><ul><ul><li>No capsular contracture </li></ul></ul></ul><ul><ul><ul><li>No rupture </li></ul></ul></ul><ul><ul><li>Flatter tummy at a time </li></ul></ul><ul><li>Indication of ADRC-enriched fat transfer with Celution system: </li></ul><ul><ul><li>Breast reconstruction post BCT & benign tumour (giant FAM, Phylloides) </li></ul></ul><ul><ul><li>Breast augmentation </li></ul></ul>
    19. 19. Every woman is created by God beautifully, “big&quot; or &quot;small&quot; depends on how a woman herself sees in her. If there is any dissatisfaction in her body, why not try to change it? Especially she, who had no choice but had to lose hers because of disease. Thank God, He has created every single cell in the human body to be useful, including restoring her beauty and regaining her confidence Thank you
    20. 20. Correlation between the ADRC Cell Yield to Processing Volume <ul><li>Typical yields are approximately 300,000 cells/g of tissue </li></ul>75,000,000 250 60,000,000 200 45,000,000 150 30,000,000 100 ADRC output Adipose tissue volume (g)
    21. 21. How long does it take Celution System to process the ADRCs?
    22. 22. How much graft tissue is needed with the ADRCs? <ul><li>Cytori’s research has shown that the typical fat graft is made up of 25 – 30% water. </li></ul>
    23. 23. Comparison of 3 sources of MSC Kern, Stem Cells 2006;24:1294 – 1301 p<0.001 7.10%   64.20% towards 2 lineages p<0.001 89.30%   28.60% towards all 3 lineages Multilineage differentiation capacity of BM-CFU-F & AT-CFU-F   71.40% 0 71.40% Differentiation capacities into all three lineages All samples show cartilage-type phenotype with chondrocyte-like lacunae Chondrogenic differentiation capacity p<0.01 94% 0 100% Adopogenic differentiation capacity Non significant 71.40% 100% 78.8% Osteogenic differentiation capacity Multilineage differentiation potential   P8 P10 P7 Maximal passage   in the middle highest lowest Population doubling numbers p=0.02 between AT & UCB 5.60% 43.60% 23.60% Senescence ratio up to passage 2 Expansion characteristic p<0.001 557±673 0.002±0.004 83±61 Number of CFU-F Isolation p AT UCB BM  
    24. 24. Expression of Surface Proteins of MSCs derived from BM, UCB & AT

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