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 Table of Contents  
CASE REPORT
Year : 2020  |  Volume : 12  |  Issue : 1  |  Page : 42-46

A case of gingival stem cell administration using adipose tissue-derived stem cells


Omotesando Helene Clinic, Minato City, Tokyo, Japan

Date of Submission02-Oct-2019
Date of Acceptance02-Dec-2019
Date of Web Publication24-Jan-2020

Correspondence Address:
Yukako Suzuki
Omotesando Helene Clinic, Minato City, Tokyo
Japan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jorr.jorr_35_19

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  Abstract 


Adipose tissue-derived stem cells (ASCs) are reported to be capable of differentiating into all of mature cells, including bones and cartilage as same as bone marrow mesenchymal stem cells. In this study, we examined to treat periodontal disease using autologous ASCs to avoid rejection by transplantation. After autologous ASCs were injected into the gingiva, X-ray examination, periodontal pocket examination, and bleeding on probing were good results, and we obtained regeneration of periodontal tissue. Autologous ASCs are also easy to collect. Compared with other periodontal regeneration treatments, the burden on patients with less risk of postoperative infection is also less. In future, we hope to consider combined use with growth factors to aim at the alveolar bone and periodontal tissues regeneration. Moreover, we hope to conduct further investigations with a large number of cases over a long period of time.

Keywords: Adipose tissue-derived stem cells, periodontal disease, periodontal tissue regeneration


How to cite this article:
Suzuki Y. A case of gingival stem cell administration using adipose tissue-derived stem cells. J Oral Res Rev 2020;12:42-6

How to cite this URL:
Suzuki Y. A case of gingival stem cell administration using adipose tissue-derived stem cells. J Oral Res Rev [serial online] 2020 [cited 2020 Jul 3];12:42-6. Available from: http://www.jorr.org/text.asp?2020/12/1/42/276709




  Introduction Top


Mesenchymal stem cells contain a number of cell growth factors and are deeply involved in wound healing. Adipose tissue-derived stem cells (ASCs) and the method of adapting to wounds have been clinically applied to soft tissues such as skin and mucous membranes.[1],[2]

In recent years, stem cells have been shown to be safe and effective in various indications, and mesenchymal stem cells are also known to differentiate into bone and cartilage.[3],[4],[5],[6],[7],[8],[9],[10],[11],[12],[13],[14]

In addition, it is reported that mesenchymal stem cells not only differentiate into vascular endothelial cells but also secrete vascular endothelial growth factor in large quantities.[15],[16]

As ASCs have the same multipotency as bone marrow mesenchymal stem cells, adipose tissue has been reported to be a source of stem cells that replace bone marrow.[17],[18]

As for alveolar bone, a complex of mesenchymal stem cells and extracellular matrix has been reported to be effective for periodontal tissue regeneration in periodontal disease in beagle dogs.[19]

There are many experimental results in periodontal tissue regeneration in animal models, but there are few reports of autologous stem cells.[19] There are many reports using scaffolds, but none have been injected into the human gingiva.

ASCs have also been reported to be able to differentiate into mature cells of all bones and cartilage.[20]

One of the reasons for using mesenchymal stem cells by the patient is that other cells (allogeneic) are rejected by transplantation.[21] Again, autologous mesenchymal stem cells are rejected by transplantation. It has been reported that it is established without using immunosuppressive agents.[22],[23]

Adipose tissue is easy to collect because it can be collected under local anesthesia, is less invasive than bone marrow stem cell collection, has very little pain after collection, and is very deformed or missing on the donor side. There is also an advantage that it can be done less.

In this study, we report the results of adipose-derived mesenchymal stem cell administration in the treatment of periodontal disease.


  Case Report Top


Patient

A 50-year-old male presented with a chief complaint of feeling of teeth floating for some year.

Current medical history

In February 2019, right lower molar tooth was pointed out, and caries treatment was not performed. A few years ago, he had noticed gingival swelling, pain, and a feeling of floating teeth throughout the jaw but left it unattended.

Previous medical history and family history

No special mentioned and no smoking history was noted.

Symptoms

In the oral cavity, the periodontal pocket was 4 mm or more in all jaws, and bleeding on probing (BOP) was observed in many teeth. A deep periodontal pocket was found in the left lower premolar part.

Preoperative panoramic X-ray findings and dental X-ray findings

Panoramic X-rays and dental X-ray images showed strong atrophy of the left upper molar alveolar bone [Figure 1], [Figure 2], [Figure 3], [Figure 4].
Figure 1: Periodontal tissue basic examination at the first visit

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Figure 2: Panoramic X-ray at first visit

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Figure 3: IOPA X-ray at first visit

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Figure 4: X-Ray visit at first visit

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Diagnosis and treatment policy

Based on the above examination results, it was diagnosed with chronic periodontitis, and it was judged that stem cell administration was necessary to the upper left first molar part and the lower left second premolar part.

Treatment and progress

  1. Subcutaneous fat was collected after invasive anesthesia and entrusted with mesenchymal stem cell culture to STEMCEL (STEMCELL, Tokyo)
  2. On May 9, 2019, the whole jaw was scaled and periosteal infiltration anesthesia (1/100.000 epinephrine-added lidocaine hydrochloride), then the upper left first molar teeth buccal gingiva and lower left second ASCs were administered from STEMCELL Co., Ltd. diluted in 0.9 cc of physiological saline to the buccal gingiva of the premolar region
  3. At 12 weeks after stem cell administration, panoramic X-rays and dental X-rays were taken, and a basic periodontal examination was performed.



  Results Top


  1. X-ray images 12 weeks after the administration of stem cells showed an increase in bone mass at the alveolar crest [Figure 5], [Figure 6], [Figure 7]
  2. BOP clearly decreased [Figure 8]
  3. A decrease in periodontal pockets was observed [Figure 8].
Figure 5: Panoramic X-ray 3 months after stem cell administration

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Figure 6: IOPA X-ray 3 months after stem cell administration

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Figure 7: X-ray 3 months after stem cell administration

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Figure 8: Periodontal basic examination 3 months after stem cell administration

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  Discussion Top


It is widely known that growth factors such as platelet-derived growth factor and transforming growth factor-β contained in ASCs promote wound healing.[24],[25]

ASCs have been successfully applied to the skin and mucous membranes, have shown good results, and have shown the ability to increase periodontal tissue regeneration.[26] And ASCs have providing safe treatment methods in regenerative medicine approaches.[27]

Therefore, we examined the usefulness of ASCs in the treatment of human periodontal disease, where regenerative medicine related to periodontal disease treatment shows how much periodontal tissue has been regenerated after surgery and the results of periodontal examination. Even if the engraftment of ASCs is recognized, it cannot be said that the periodontal tissue does not improve, and hence, it cannot be said to be successful. In addition, regeneration and improvement in periodontal tissue, especially soft tissue, were observed, which proved useful.

The administration of ASCs uses autologous cells and plasma in the autologous blood and is safe and well-tolerated in the body, so there is less possibility of complications such as infection. When the guided bone regeneration method is applied to a partial periodontal disease progression site like this time, the exposure of the membrane and blood flow to the wound are blocked, healing is delayed, and complications such as infection are likely to occur. The ASCs are superior in bone wound healing and will be used in combination with transplant materials containing growth factors such as bone morphogenetic protein that have strong osteoinductive ability in future. It is thought that effective bone grafting can be performed.


  Conclusion Top


In this study, we used ASCs locally for the treatment of periodontal disease and we reported early periodontal tissue regeneration for periodontal disease.

Infusions of autologous ASCs are safe and feasible in patients with periodontal disease to verify the potential therapeutic effect of this procedure in future, more long-term data, a larger number of samples are necessary.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Salgado AJ, Reis RL, Sousa NJ, Gimble JM. Adipose tissue derived stem cells secretome: Soluble factors and their roles in regenerative medicine. Curr Stem Cell Res Ther 2010;5:103-10.  Back to cited text no. 1
    
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Panés J, García-Olmo D, Van Assche G, Colombel JF, Reinisch W, Baumgart DC, et al. Expanded allogeneic adipose-derived mesenchymal stem cells (CX601) for complex perianal fistulas in Crohn's disease: A phase 3 randomised, double-blind controlled trial. Lancet 2016;388:1281-90.  Back to cited text no. 7
    
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Fisher SA, Doree C, Mathur A, Taggart DP, Martin-Rendon E. Stem cell therapy for chronic ischaemic heart disease and congestive heart failure. Cochrane Database Syst Rev 2016;12:CD007888.  Back to cited text no. 8
    
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Chen X, Wang C, Yin J, Xu J, Wei J, Zhang Y. Efficacy of mesenchymal stem cell therapy for steroid-refractory acute graft-versus-host disease following allogeneic hematopoietic stem cell transplantation: A systematic review and meta-analysis. PLoS One 2015;10:e0136991.  Back to cited text no. 9
    
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Jiang X, Zhang H, Teng M. Effectiveness of autologous stem cell therapy for the treatment of lower extremity ulcers: A systematic review and meta-analysis. Medicine (Baltimore) 2016;95:e2716.  Back to cited text no. 10
    
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Xu S, Liu H, Xie Y, Sang L, Liu J, Chen B. Effect of mesenchymal stromal cells for articular cartilage degeneration treatment: A meta-analysis. Cytotherapy 2015;17:1342-52.  Back to cited text no. 11
    
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El-Badawy A, El-Badri N. Clinical efficacy of stem cell therapy for diabetes mellitus: A Meta-Analysis. PLoS One 2016;11:e0151938.  Back to cited text no. 12
    
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Caplan AI. Mesenchymal stem cells. J Orthop Res 1991;9:641-50.  Back to cited text no. 13
    
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15.
Nagaya N, Fujii T, Iwase T, Ohgushi H, Itoh T, Uematsu M, et al. Intravenous administration of mesenchymal stem cells improves cardiac function in rats with acute myocardial infarction through angiogenesis and myogenesis. Am J Physiol Heart Circ Physiol 2004;287:H2670-6.  Back to cited text no. 15
    
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Kagiwada H, Yashiki T, Ohshima A, Tadokoro M, Nagaya N, Ohgushi H. Human mesenchymal stem cells as a stable source of VEGF-producing cells. J Tissue Eng Regen Med 2008;2:184-9.  Back to cited text no. 16
    
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Zuk PA, Zhu M, Mizuno H, Huang J, Futrell JW, Katz AJ, et al. Multilineage cells from human adipose tissue: Implications for cell-based therapies. Tissue Eng 2001;7:211-28.  Back to cited text no. 17
    
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De Ugarte DA, Morizono K, Elbarbary A, Alfonso Z, Zuk PA, Zhu M, et al. Comparison of multi-lineage cells from human adipose tissue and bone marrow. Cells Tissues Organs 2003;174:101-9.  Back to cited text no. 18
    
19.
Takewaki M, Kajiya M, Takeda K, Sasaki S, Motoike S, Komatsu N, et al. MSC/ECM cellular complexes induce periodontal tissue regeneration. J Dent Res 2017;96:984-91.  Back to cited text no. 19
    
20.
Kakudo N, Suzuki K, Kushida S, Kusumoto K. Isolation and differentiation of human adipose-derived stem cells into adipose, bone, and cartilage cells. J Kansai Med Univ2008;59:169-176.  Back to cited text no. 20
    
21.
Akahane M, Ohgushi H, Yoshikawa T, Sempuku T, Tamai S, Tabata S, et al. Osteogenic phenotype expression of allogeneic rat marrow cells in porous hydroxyapatite ceramics. J Bone Miner Res 1999;14:561-8.  Back to cited text no. 21
    
22.
Arinzeh TL, Peter SJ, Archambault MP, van den Bos C, Gordon S, Kraus K, et al. Allogeneic mesenchymal stem cells regenerate bone in a critical-sized canine segmental defect. J Bone Joint Surg Am 2003;85:1927-35.  Back to cited text no. 22
    
23.
Aggarwal S, Pittenger MF. Human mesenchymal stem cells modulate allogeneic immune cell responses. Blood 2005;105:1815-22.  Back to cited text no. 23
    
24.
Sporn MB, Roberts AB, Shull JH, Smith JM, Ward JM, Sodek J. Polypeptide transforming growth factors isolated from bovine sources and used for wound healing in vivo. Science 1983;219:1329-31.  Back to cited text no. 24
    
25.
Pierce GF, Mustoe TA, Lingelbach J, Masakowski VR, Griffin GL, Senior RM, et al. Platelet-derived growth factor and transforming growth factor-beta enhance tissue repair activities by unique mechanisms. J Cell Biol 1989;109:429-40.  Back to cited text no. 25
    
26.
Fawzy El-Sayed KM, Paris S, Becker ST, Neuschl M, De Buhr W, Sälzer S, et al. Periodontal regeneration employing gingival margin-derived stem/progenitor cells: An animal study. J Clin Periodontol 2012;39:861-70.  Back to cited text no. 26
    
27.
Tabatabaei Qomi R, Sheykhhasan M. Adipose-derived stromal cell in regenerative medicine: A review. World J Stem Cells 2017;9:107-17.  Back to cited text no. 27
    


    Figures

  [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 1]



 

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