{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T20:20:04Z","timestamp":1788553204600,"version":"build-2803163510"},"reference-count":68,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T00:00:00Z","timestamp":1783641600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJMS"],"abstract":"<jats:p>Micro-fragmented adipose tissue (mFAT) is a promising autologous biologic in regenerative medicine because it provides a mechanically processed adipose-derived product that preserves native extracellular matrix architecture and a cellular milieu rich in mesenchymal stem cells, pericytes, growth factors, cytokines, and extracellular vesicles. Mechanistically, mFAT is hypothesized to act largely through paracrine signaling that dampens inflammation, supports vascular stabilization, and promotes cartilage and soft-tissue repair; in vitro data suggest modulation of osteoarthritic synovial macrophage signaling, including reductions in chemokines such as CCL2 and CCL3. Preparation involves liposuction harvest followed by closed, sterile mechanical processing without enzymatic digestion or cell expansion, aligning with \u201cminimal manipulation\u201d concepts relevant to regulatory frameworks. Preclinical animal studies generally demonstrate favorable effects on synovial inflammation and cartilage matrix markers (e.g., glycosaminoglycan content) with limited adverse events. Clinically, the strongest body of evidence is in knee osteoarthritis, where multiple prospective and retrospective studies report improvements in pain and function from months to several years after single injections, though response rates vary and study designs are heterogeneous. Evolving data support potential benefit in hip osteoarthritis and select tendon conditions, but cohorts remain small. Overall, mFAT appears safe and potentially effective, yet larger, standardized, long-term randomized controlled trials and comparative studies versus platelet-rich plasma and bone marrow aspirate concentrates are needed to clarify indications, dosing, durability, and mechanisms in vivo.<\/jats:p>","DOI":"10.3390\/ijms27146185","type":"journal-article","created":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T14:14:25Z","timestamp":1783692865000},"page":"6185","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Micro-Fragmented Adipose Tissue (MFAT) in Orthopedic Regenerative Medicine: A Narrative Review of the Biological Basis and Clinical Evidence"],"prefix":"10.3390","volume":"27","author":[{"given":"Claire","family":"Yuan","sequence":"first","affiliation":[{"name":"Department of History and Philosophy of Science, Christ\u2019s College, University of Cambridge, Cambridge CB2 3RH, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashu K.","family":"Goyle","sequence":"additional","affiliation":[{"name":"Integrated Spine, Pain and Wellness, Scottsdale, AZ 85260, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maged","family":"Guirguis","sequence":"additional","affiliation":[{"name":"Department of Interventional Pain, Oschner Health System, New Orleans, LA 70121, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2464-0187","authenticated-orcid":false,"given":"Alan D.","family":"Kaye","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA 71103, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vahid","family":"Grami","sequence":"additional","affiliation":[{"name":"Division of Pain Medicine, Department of Anesthesiology and Critical Care, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karan","family":"Dave","sequence":"additional","affiliation":[{"name":"Aurora Life, Grand Cayman KY1-1209, Cayman Islands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronald J.","family":"Kulich","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA 02114, USA"},{"name":"Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy","family":"Deer","sequence":"additional","affiliation":[{"name":"Spine and Nerve Center of the Virginias, West Virginia University\u2014Health Sciences Campus, Morgantown, WV 25301, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Rosenblum","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Maimonides Medical Center, Brooklyn, NY 11219, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vwaire","family":"Orhurhu","sequence":"additional","affiliation":[{"name":"MVM Health: Pain Vein, and Wellness, East Stroudsburg, PA 18301, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8227-1864","authenticated-orcid":false,"given":"Jamal J.","family":"Hasoon","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, Critical Care, and Pain Medicine, UTHealth, McGovern Medical School, Houston, TX 77030, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6276-9056","authenticated-orcid":false,"given":"Christopher L.","family":"Robinson","sequence":"additional","affiliation":[{"name":"Division of Pain Medicine, Department of Anesthesiology and Critical Care, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e41724","DOI":"10.1097\/MD.0000000000041724","article-title":"Micro-Fragmented Adipose Tissue\u2014An Innovative Therapeutic Approach: A Narrative Review","volume":"104","author":"Fu","year":"2025","journal-title":"Medicine"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"16107","DOI":"10.1038\/s41598-022-20581-1","article-title":"Micro-Fragmented Adipose Tissue Cellular Composition Varies by Processing Device and Analytical Method","volume":"12","author":"Greenwood","year":"2022","journal-title":"Sci. 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