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The Use of Autologous Adipose Tissue-Derived Cellular Concentration (ADCC-SVF) in the Treatment of Peyronie's Disease and Erectile Dysfunction

   Stem cells can theoretically be obtained from many parts of the body and tissues. Adipose tissue is known to be a tissue rich in mesenchymal stem cells and it is relatively easier to obtain these cells compared to other regions. Mesenchymal stem cells are pluripotent adult stem cell formations that can both self-renew and differentiate into more than one cell form. Today, although still considered experimental in the treatment of organic and severe erectile dysfunctions, adipose tissue-derived stem cells are also utilised. Scientific studies are again promising at this point. Especially in erectile dysfunction due to degenerative and neuropathic causes, adipose stem cells may be more functional than bone marrow stem cells. It is also suggested that adipose stem cells may provide more effective repair in the repair of cavernosal smooth muscle degenerations due to Peyronie's disease and diabetes.

 

  Today, real stem cell therapies require highly developed officially approved stem cell laboratories and long ethical legal processes for authorisation. For this reason, its practical use is not possible except in special cases such as cancer studies. Moreover, medical concerns about the safety of transplantation of incubated and multiplied stem cells to humans are quite high. For these reasons, it is nowadays preferred to prepare and administer stem cell therapies more indirectly and rapidly in the form of cellular concentrations instantaneously. As in the bone marrow aspiration concentration (BMAC) method, the adipose tissue is first aspirated. The fat is first broken down enzymatically or mechanically and then passed through a number of processes and filtrations to finally remove fat cells, proteins and other tissue elements. The result is a cellular concentrate rich in mesenchymal stem cells. This process is called autologous adipose tissue derived cellular concentration (ADCC) or adipose derived tissue stromal vascular fraction (SVF)

 

  The procedure is performed under local anaesthesia and completely under office conditions. Firstly, a large area around the navel is numbed with local anaesthesia (injection). Afterwards, fat tissues are aspirated with the classical liposuction method with the help of a single point of entry and a thin cannula. The aspirated fat tissues are first mechanically broken down for 20 minutes in the G-Cell (autologous tissue separation unit) device, a patented technology, and then subjected to an initial filtration of 50 microns. After this process, the liquid content remaining at the bottom is taken into a glass tube. Then, with the help of a 90-degree centrifuge (MedCGF), the remaining fat and the stem cell-rich cellular suspension are completely separated from each other. At the end of this process, the cellular suspension remaining at the bottom is transferred to another injector and then mechanically passed through a 41 micron filter, that is, through a very fine filtration process for the last time. Thus, the suspension is purified from all fat cells and proteins. Finally, with the help of UV light, photoactivation process is performed in the G-Cell device and the stem cells become bioactive.  Finally, a pure cellular cocktail rich in mesenchymal stem cells but without fat cells is obtained. 5-6 ml of this liquid suspension is injected into the right and left cavernosal tissues of the penis in the same session and the patient's penis is left clamped for 15 minutes. The procedure takes about one hour in total, including all preparation and injection stages, and does not require hospitalisation or rest. Except for small bruises that may occur in the liposuction area, no side effects are expected to occur in the patient.

Who can receive it?

   First of all, it is worth mentioning again that the treatment is still experimental. As with all kinds of regenerative medicine applications, it is not yet included in classical treatment protocols. However, it is very promising that the adipose tissue aspiration and contraction (ADSCc) procedure is minimally invasive and its benefits have begun to be shown in some clinical studies. For this reason, moderate to severe erectile dysfunction (especially neuropathic, degenerative, venous leakage) and Peyronie's disease can be shown as potential areas of use of the technique in urology. Injections are made intracavernosally into the penis in erectile dysfunction and into the plaque in Peyronie's disease. Today, for real stem cell therapies, highly developed officially approved stem cell laboratories and long ethical legal processes are needed for authorisation. For this reason, it is not possible to use it in practice. Moreover, medical concerns about the safety of transplantation of incubated and multiplied stem cells to humans are quite high. For these reasons, clinics nowadays prefer to prepare and administer stem cell therapies more indirectly and rapidly in the form of cellular concentrations instantaneously.

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Advantages of the Method:

*It is performed completely under local anaesthesia under office conditions and does not require procedure anaesthesia.

*The procedure takes about 1 hour in total with all preparation and application stages.

*Stem cell collection is not a real stem cell treatment. In stem cell therapies, stem cells are isolated invitro in the laboratory environment and multiplied by incubation (incubation). Stem cell therapies may have some ethical and medical drawbacks in the future. However, what we aim to obtain is an autologous product rich in mesenchymal stem cells obtained from fat. This is a much more practical and safer way.

* In addition to mesenchymal stem cells, M2 macrophages, pericytes, T lymphocytes, preadipocytes, endothelial progenitor cells are also included in a liquid concentration free of fat cells. These cells are also known to play an extra role in tissue healing (restoration).

*Since stem cells are autologous, that is, they are purified products obtained from the person's own tissue, it is not possible to develop an allergic reaction and cell rejection during or after treatment. Of course, the product obtained can never be applied on another person.

*After the procedure and treatment, the patient can continue his/her daily life.

*The side effect profile of the procedure is minimal.

*The effect of the treatment usually starts to appear after 3-6 weeks, but it may be necessary to wait 2-3 months for maximum effectiveness.

*Depending on the benefit, the same procedure can be repeated after 6-12 months if desired.

  • Nora M Haney -The Use of Stromal Vascular Fraction in the Treatment of Male Sexual Dysfunction: A Review of Preclinical and Clinical Studies Sex Med Rev 2019 Apr;7(2):313-320.

  • Mikkel Fode - Feasibility of minimally invasive, same-day injection of autologous adipose-derived stem cells in the treatment of erectile dysfunction - Scandinavian Journal of Urology Volume 57, 2023 - Issue 1-6

  • Han Zheng - Effect of cells self-aggregation in the treatment of neurogenic erectile dysfunction with traditional single cell suspension of adipose derived stem cells- Urology Vol 158 December 2021

  • Jiancheng Zhai - Adipose Derived Mesenchymal Stem Cells-Derived Mitochondria Transplantation Ameliorated Erectile Dysfunction Induced by Cavernous Nerve Injury - World J Mens Health 2024 Jan;42(1):188-201.

  • Marlene Louise Quaade - Adipose-Derived Stem Cells from Type 2 Diabetic Rats Retain Positive Effects in a Rat Model of Erectile Dysfunction Int J Mol Sci 2022 Feb 1;23(3):1692

stem cell therapy, stem cell therapy for erectile dysfunction, Antalya, Turkey, CaverStem prosedure, adipose derived stem cells

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