Joris van Dongen

44 Chapter 2 Table 6B. Effect sizes of studies evaluating viable nucleated cells. Study Procedure Non-intraoperative isolation protocol Effect size N % viable cells SD N % viable cells SD Enzymatic AIS, SundarRaj, 2015 11 97.5 2.8 11 97.3 1.5 0.13 CYT, Lin, 2008 3 89.2 1.1 3 90.8 1.3 -1.23 TGCIS, Doi, 2012 6 80.7 7.1 6 82.4 7.7 -0.22 Non-enzymatic FEF, Mashiko, 2016 10 39.3 9.1 10 93.8 1.2 -45.4 REF, Mashiko, 2016 10 90.6 2.8 10 93.8 1.2 -2.67 SF, Mashiko, 2016 10 89.9 4.6 10 93.8 1.2 -3.25 STCELL, Millan, 2014 a 3 87.7 8.9 3 74.5 20.1 0.66 a No exact data described in text, data extracted from figures by authors JAD and AJT. AIS Automated Isolation System; CYT Celution System Enzymatic (Cytori); FEF Filtrated fluid of emulsified fat; REF Residual tissue of emulsified fat; SF Squeezed fat; STCELL StromaCell; TGCIS Tissue Genesis Cell Isolation System (Tissue Genesis) VIABILITY OF NUCLEATED CELLS Eight studies described viabilities from39% to 98% of nucleated cells in the SVF. No big differences in viabilitywere seen between enzymatic and non-enzymatic intraoperative isolation procedures. The Filtrated fluid of emulsified fat procedure showed the lowest viability 66 , while the Automated isolation system showed the highest viability of nucleated cells of 98% after isolation (Table 5A and table 5B) 69 . Three enzymatic and three non-enzymatic intraoperative isolation procedures were compared to a non- intraoperative isolation protocol regarding the viability of nucleated cells (Table 6B) 69,73,76 . The viability of five intraoperative isolation procedures was comparable to their non-intraoperative isolation protocol controls; the effect sizes were close to zero in many studies (Table 6B). Only the Filtrated fluid of emulsified fat procedure showed an effect size of -45.4 66 . In general, viability did not differ between non-intraoperative isolation protocols and the individual intraoperative isolation procedures tested. Composition of stromal vascular fractions The SVF compositions is reported in nine studies evaluating six enzymatic procedures and three non-enzymatic procedures. The stromal cell population is larger in the SVF isolated by the enzymatic Celution system, Sepax and Tissue genesis cell isolation