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Application of a three-dimensional graft of autologous osteodifferentiated adipose stem cells in patients undergoing minimally invasive transforaminal lumbar interbody fusion: clinical proof of concept

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Abstract

Background

The authors applied a scaffold-free osteogenic three-dimensional (3D) graft made of adipose-derived mesenchymal stem cells (AMSCs) in patients undergoing minimally invasive transforaminal lumbar interbody fusion (MI-TLIF).

Methods

Three patients (two patients and one patient with 1 and 2 levels, respectively) with degenerative spondylolisthesis underwent MI-TLIF with 3D graft made of AMSCs. To obtain the AMSCs, fatty tissue was collected from the abdomen by lipoaspiration and differentiated afterwards in our Cell/Tissue bank. Clinical outcomes, including the Oswestry Disability Index (ODI) and visual analog scale (VAS) as well as fusion status were assessed preoperatively and up to 12 months postoperatively.

Results

At 12 months, all four operated AMSC levels could be assessed (n = 4). Grade 3 fusion could be confirmed at two levels out of four. Mean VAS score improved from 8.3 to 2 and ODI also improved from 47 to 31%. No donor site complication was observed. The final AMSC osteogenic product was stable, did not rupture with forceps manipulation, and was easily implanted directly into the cage with no marked modification of operating time.

Conclusions

A scaffold-free 3D graft made of AMSCs can be manufactured and used as a promising alternative for spinal fusion procedures. Nevertheless, further studies of a larger series of patients are needed to confirm its effectiveness.

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Authors and Affiliations

  1. Department of Neurosurgery, University Hospital Saint Luc, Université Catholique de Louvain (UCL), Avenue Hippocrate, 10, 1200, Brussels, Belgium

    E. Fomekong & C. Raftopoulos

  2. Department of Radiology, University Hospital Saint Luc, Université Catholique de Louvain (UCL), Avenue Hippocrate, 10, 1200, Brussels, Belgium

    B. Vande Berg

  3. Endocrine Cell Therapy Unit, Center of Tissue and Cell Therapy, university hospital Saint-Luc, Université Catholique de Louvain (UCL), Avenue Hippocrate, 10, 1200, Brussels, Belgium

    D. Dufrane, W. André, N. Aouassar & S. Veriter

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  1. E. Fomekong
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  2. D. Dufrane
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  3. B. Vande Berg
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  4. W. André
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Correspondence to C. Raftopoulos.

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No funding was received for this research.

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The authors declare that they have no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Comments

This is an interesting and important study. It demonstrates that we can already obtain autologous scaffold-free osteogenic grafts from stem cells of fat tissue. The study also demonstrates that we can do it while avoiding any harvesting site complications and without limitation. Nevertheless, I believe this study, at this present stage, remains a proof-of-concept. There are still issues that need to be clarified before we can consider this technique as a definitive alternative for spinal fusion. Even though the authors, in a previous study (1), reported that no complications occurred in a series of 17 patients during short-term or long-term periods after the implantation of the product, questions concerning the genetic safety of cell therapy need further studies to be definitively answered. Furthermore, a multicentric study, involving many patients will be necessary to assess the clinical value of such stem cells-derived autografts as compared with conventional allograft techniques.

1. Veriter S, Andre W, Aouassar N, Poirel HA, Lafosse A, Docquier PL, Dufrane D (2015) Human Adipose-Derived Mesenchymal Stem Cells in Cell Therapy: Safety and Feasibility in Different “Hospital Exemption” Clinical Applications. PloS one 10:e0139566

Alfredo Conti

Messina, Italy

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Fomekong, E., Dufrane, D., Berg, B.V. et al. Application of a three-dimensional graft of autologous osteodifferentiated adipose stem cells in patients undergoing minimally invasive transforaminal lumbar interbody fusion: clinical proof of concept. Acta Neurochir 159, 527–536 (2017). https://doi.org/10.1007/s00701-016-3051-6

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