Activating resident progenitor cells with Lipogems could be a practical and cost-effective new therapeutic approach for increasing rotator cuff tendon healing. Research Paper by Pietro Randelli and Alessandra Menon.
Rotator cuff tears represent the vast majority of shoulder injuries in adult patients and are a common contributing factor to shoulder pain and occupational disability, whose prevalence is rising due to the increase of the world population age. Although surgical procedures for rotator cuff repair have evolved and improved over the past decades, a high rate of retear is still observed. This is mainly caused by a failure of tendon healing, especially in the case of the supraspinatus tendon. Therefore, increasing the success rate of rotator cuff healing remains a tremendous challenge for orthopedic surgeons, which encourages the development of new alternative therapies. In fact, once injured, tendons do not completely regain the normal structural and biomechanical properties, resulting in the formation of scar tissue, adhesions, fatty infiltration, and matrix disorganization, which increase the risk of retear. Among several factors, tendon poor vascularization reduces the availability of oxygen, growth-factors, and other nutrients necessary for tissue regeneration and significantly affects the quality and speed of the tendon healing response. Therefore, in considering new strategies for tendon engineering, the goal of promoting neoangiogenesis is vital to accelerate Hindawi Publishing Corporation Stem Cells International Article ID 4373410 2 Stem Cells International the healing process. Moreover, several studies have shown that different types of stimuli could activate the normal growth-factor-mediated healing cascades . Along this line, it has been recently demonstrated that lipoaspirates contain and produce growth-factors, such as plateletderived growth-factor (PDGF), fibroblast growth-factor (FGF), transforming growth-factor beta (TGF-𝛽), and vascular endothelial growth-factor (VEGF), which are known to play important regulatory roles in cellular functions, including adhesion, chemotaxis, proliferation, migration, matrix synthesis, differentiation, and angiogenesis. The cell fraction responsible for growth-factor production and regulation is mainly the stromal vascular fraction, which could have acceleratory effect on the healing process of injured tendons. Given the tissue availability, as well as the easy and minimally invasive access to tissue sources, adipose tissue may in fact represent a potential choice for tendon repair and regeneration. Among many approaches, an innovative technology, Lipogems, provides a nonexpanded, ready-to-use, and microfragmented adipose tissue that is expected to have the peculiar advantage of maintaining an intact stromal vascular niche harboring cellular elements with mesenchymal stem cell and pericyte characteristics. This system works through a mild mechanical tissue clustersize reduction in a completely closed system, avoiding the use of any enzyme, additives, and other additional manipulations (i.e., centrifugation and subfractional harvesting).