Tissue Engineering and Regenerative Medicine

Stromal vascular fraction (SVF) was first isolated from adipose tissue around 1970. SVF has proved very effective to manage many hitherto difficulties or untreatable conditions, including severe degenerative joint disease (DJD), medically. Nonetheless, it has not been effective in every case, especially in the more severe cases of DJD, possibly reflecting the diversity of the pathology within each category. Extracorporeal Pulse Activation Technology (EPAT), alias dictus shock or Pressure Wave Therapy (ESWT), is a non-invasive technology platform of Storz Medical that employs acoustic pressure waves to affect a mechanic-transduction response at the cellular level, which leads to cell activation, improved metabolism, angiogenesis, neovascularization and improved healing. This has been used as a stand-alone modality for treating various musculoskeletal conditions in Germany over the past two decades. In a small series of patients with severe DJD who have either refused surgery or had undergone multiple unsuccessful surgeries, we found the addition of EPAT to the deployment of SVF intravenously as well as locally, were perceived to be highly effective in decreasing pain, reducing stiffness and increasing functionality. It was also perceived that giving 2-43 treatments of EPAT to the region in question, days apart and one treatment immediately before the SVF deployment, enhanced the benefit. This possibly recruited more local repair processes, attracting more regenerative cells, and releasing growth factors and cytokines for repair.