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Clinical Application of Adipose Derived Stem Cells for the Treatment of Aseptic Non-Unions: Current Stage and Future Perspectives—Systematic Review
Open accessAbstract
Fracture non-union is a challenging orthopaedic issue and a socio-economic global burden. Several biological therapies have been introduced to improve traditional surgical approaches. Among these, the latest research has been focusing on adipose tissue as a powerful source of mesenchymal stromal cells, namely, adipose-derived stem cells (ADSCs). ADSC are commonly isolated from the stromal vascular fraction (SVF) of liposuctioned hypodermal adipose tissue, and their applications have been widely investigated in many fields, including non-union fractures among musculoskeletal disorders. This review aims at providing a comprehensive update of the literature on clinical application of ADSCs for the treatment of non-unions in humans. The study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Only three articles met our inclusion criteria, with a total of 12 cases analyzed for demographics and harvesting, potential manufacturing and implantation of ADSCs. The review of the literature suggests that adipose derived cell therapy can represent a promising alternative in bone regenerative medicine for the enhancement of non-unions and bone defects. The low number of manuscripts reporting ADSC-based therapies for long bone fracture healing suggests some critical issues that are discussed in this review. Nevertheless, further investigations on human ADSC therapies are needed to improve the knowledge on their translational potential and to possibly achieve a consensus on their use for such applications.
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There was no incidence of ASCs promoting a pro-tumor tumor microenvironment in the clinical studies of ASCs for non-unions post OS resection.
“Importantly, there was no incidence of ASCs promoting a pro-tumor TME.”
From Mesenchymal Stem/Stromal Cells: Immunomodulatory and Bone Regeneration Potential after Tumor Excision in Osteosarcoma Patients (2023) · cites this paper as [89]
The Discussion (§4.2; page unavailable) reports that the reviewed adipose-derived stem-cell graft studies found no oncological side effects, and the Results (§3; page unavailable) report no further complications beyond those described. That supports an absence of reported clinical oncological events, but the review does not report assessing whether the cells promoted a pro-tumor microenvironment. (LLM, conf=0.84)
Experimental — accuracy not yet measuredIn two clinical studies of ASCs for aseptic non-unions post oncological resection of OS, all patients experienced favorable general clinical outcomes characterized by successful fracture healing and effective filling of bone defects.
“In both studies, it was observed over time that all patients experienced favorable general clinical outcomes characterized by successful fracture healing and effective filling of bone defects [89,107,108].”
From Mesenchymal Stem/Stromal Cells: Immunomodulatory and Bone Regeneration Potential after Tumor Excision in Osteosarcoma Patients (2023) · cites this paper as [89]
The Results (page not provided) report fracture healing and bone-defect filling in patients followed across the included studies. However, three patients did not achieve consolidation and required further surgery, so the claim that all patients healed overstates the review's findings. (LLM, conf=0.90)
Experimental — accuracy not yet measuredScaffold-free ASCs have the ability to promote osteogenesis without oncological side effects short-term (within 3 months) and long-term (up to 4 years) post-transplantation.
“The results showed that scaffold-free ASCs have the ability to promote osteogenesis without oncological side effects short-term (within 3 months) and long-term (up to 4 years) post-transplantation.”
From Mesenchymal Stem/Stromal Cells: Immunomodulatory and Bone Regeneration Potential after Tumor Excision in Osteosarcoma Patients (2023) · cites this paper as [89]
The Discussion (§4.2; page unavailable) reports that scaffold-free adipose-derived grafts helped restore bone anatomy and function in nonunions, with no oncological side effects reported. The Results (§3; page unavailable) give a mean follow-up of about 27 months, but our copy does not establish the claimed short-term (within 3 months) and long-term (up to 4 years) time points. (LLM, conf=0.85)
Experimental — accuracy not yet measuredIn Vériter et al., three osteosarcoma patients who received scaffold-free ASCs post wide bone resection showed adequate bone regrowth filling in the bone defect at 54, 27, and 48 months follow-up, respectively, with no evidence of prolonged inflammation or neoplastic growth.
“In Vériter et al. study, three osteosarcoma patients received scaffold-free ASCs post wide bone resection. In all three patients at the 54, 27, and 48 months follow-up, respectively, there was an adequate bone regrowth filling in the bone defect, with no evidence of prolonged inflammation or neoplastic growth [89,107].”
From Mesenchymal Stem/Stromal Cells: Immunomodulatory and Bone Regeneration Potential after Tumor Excision in Osteosarcoma Patients (2023) · cites this paper as [89]
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Experimental — accuracy not yet measuredResults from some studies have shown that the use of non-scaffolded MSCs can induce bone regrowth in patients with bone lesions or defects.
“While there has been less research on non-scaffolded ASCs in bone regrowth, results from some studies have shown that the use of non-scaffolded MSCs can induce bone regrowth in patients with bone lesions or defects [89].”
From Mesenchymal Stem/Stromal Cells: Immunomodulatory and Bone Regeneration Potential after Tumor Excision in Osteosarcoma Patients (2023) · cites this paper as [89]
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Metadata
- Authors
- Smakaj, A., De Mauro, D., Rovere, G., Pietramala, S., Maccauro, G., Parolini, O., Lattanzi, W., & Liuzza, F.
- Affiliations
- Università Cattolica del Sacro Cuore (IT)
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Agostino Gemelli University Polyclinic (IT)
- Corresponding author
- Lattanzi, Wanda
- Liuzza, Francesco
- ORCID
- Venue
- International Journal of Molecular Sciences
- Publisher
- MDPI AG
- Published
- 2022-03-11
- Volume
- 23
- Issue
- 6
- Pages
- 3057
- ISSN
- 1422-0067 (ISSN-L)
- PMC
- PMC8950719
- OpenAlex
- W4220746626
- Cited by
- 31
- References
- 50
- Citations by year
- 2026: 4 · 2025: 7 · 2024: 8 · 2023: 7 · 2022: 5
- FWCI
- 1.12
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- International Journal of Molecular Sciences (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Cineca Institutional Research Information System (Tor Vergata University) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- PubliCatt (Università Cattolica del Sacro Cuore) (submittedVersion, cc-by)
- Funders
- Università Cattolica del Sacro Cuore
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Cell Biology › Mesenchymal stem cell research
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone fractures and treatments
- Physical Sciences › Engineering › Biomedical Engineering › Bone Tissue Engineering Materials
- Keywords
- adipose-derived stem cells, aseptic nonunion, nonunion, mesenchymal stem cells, stromal vascular fraction, cell therapy, bone regeneration, bone defects, clinical application
- MeSH terms
- Adipose Tissue, Humans, Adipocytes, Regenerative Medicine, Mesenchymal Stem Cells, Cell- and Tissue-Based Therapy
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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