Science Presentation
Speaking at the Milano Longevity Summit, Prof. Carlo Tremolada — Scientific Director of IMAGE REGENERATIVE — presents Lipogems® as a regenerative medicine technology already validated, FDA-cleared, and in clinical use today. The presentation covers the science of microfractured adipose tissue, clinical evidence including cartilage regeneration and diabetic foot healing, aesthetic applications with multi-year follow-up, and emerging research into Lipogems® as a drug delivery system for glioblastoma.
Regenerative medicine is often spoken about as a future promise. At the Milano Longevity Summit, Prof. Carlo Tremolada drew a clear distinction: there is tomorrow's regenerative medicine — the frontier research discussed by Nobel laureate Shinya Yamanaka the previous week — and there is today's medicine, already in clinical use with significant scientific validation and, increasingly, reimbursement by national health systems.
Lipogems® belongs firmly in the present tense.
Lipogems® is a patented surgical kit for the optimal transplantation of adipose tissue. The technology is protected by 56 patents worldwide, the original filed in 2010 by Prof. Tremolada. At its core is a completely closed processing device: fat is harvested with thin cannulas in a minimally invasive procedure — often with an aesthetic benefit — then processed within the device to reduce particles from approximately 3 millimetres to 300 microns without destroying them.
This is no small feat. A 3-millimetre piece of adipose tissue has the consistency of a ripe raspberry. Inside the sealed device, two sets of micro-blades cut the tissue while small balls create an emulsion that activates the fat — similar to the effect of extracorporeal shock waves — promoting the release of mesenchymal stem cells. Blood and oil are discarded; what remains are intact micro-fragments of living adipose tissue, each covered by its native capillary network and the pericytes that sit above those capillaries.
This is why every regulatory agency — from the U.S. FDA to Italy's National Transplant Centre — has approved it: the end product is simply a piece of the patient's own adipose tissue, processed but structurally intact.
The microfracturing creates a massive increase in surface area — and therefore in the bioavailability of pericytes and mesenchymal stem cells. Under the electron microscope, pericytes sit directly above capillaries. When introduced into tissue, they detach, enter the surrounding environment, identify the molecular problem, and begin secreting cytokines — signalling substances that guide regeneration.
Crucially, they do not primarily transform into new tissue. As Prof. Tremolada's mentor Arnold Kaplan of Case Western University put it: in the laboratory you can make cells dance into bone, cartilage, or muscle, but in vivo they act as natural personalised pharmacies, secreting the right substances at the right time. This happens in two phases: an initial immunomodulatory, anti-inflammatory phase, followed by an epigenetic phase involving over 600 genes, in which the cells direct regeneration, prevent cell death, and resist infection.
The fundamental advantage over other regenerative approaches — PRP, stromal vascular fraction, or cultured stem cells — is that these intact micro-fragments remain alive in the tissue for months to years, providing sustained regenerative action. A Ministry of Health study comparing three methods in rabbits showed that microfractured fat produced completely normal cartilage at 16 weeks — outperforming both SVF and cultured cells.
Over 250 studies are available on the IMAGE REGENERATIVE website, 90% of them independent. Key areas include:
Orthopaedics. Cartilage and tendon regeneration are the core applications. A landmark study by Prof. Dragan Primorac — former Croatian Minister of Health and professor at Penn University — demonstrated regrowth of normal hyaline cartilage over 12 months, confirmed by glycosaminoglycan analysis. Meniscus tears in adults — which do not heal spontaneously as they do in children — regenerate consistently after Lipogems® injection. In a shoulder comparison case from 2015, a patient who had received a prosthesis on one side and Lipogems® on the other showed excellent functionality on both sides at four years — with much faster recovery from Lipogems®.
Diabetic foot. In the worst cases — ulcers and amputations — a double-blind trial at Boggiovara showed an 80% healing rate with Lipogems® versus 46% with the best available therapies at six months. The re-amputation rate was dramatically lower.
Crohn's disease. At Sant'Orsola with Professor Poggioli, Lipogems® outperformed the leading biologic (Takeda's product) in treating proctological damage from Crohn's disease — at more than ten times lower cost.
Urogenital atrophy. A vaginal treatment with Lipogems® showed resolution of all menopausal symptoms — incontinence, dryness — and resumption of normal sexual activity at three-year follow-up, with long-term vascularisation increases demonstrating true tissue rejuvenation.
Fingertip regeneration. In two cases — a 27-year-old worker and a traumatic amputation — injection of Lipogems® produced complete reconstruction comparable to the fingertip regeneration seen in newborns. Eight months after injection, tissue had regenerated in a manner Prof. Tremolada compared to a lizard regrowing its tail.
Radiation damage. In heavily irradiated tissues — particularly post-mastectomy breast reconstruction — Lipogems® enables the creation of flaps that would normally be impossible, with immediately visible increases in vascularisation.
In aesthetic surgery, Lipogems® produces continuous improvement over months and years — the opposite of the deterioration in skin quality sometimes seen after conventional procedures. A facelift patient showed ongoing skin improvement at multi-year follow-up. A Lipogems®-only patient (with upper blepharoplasty) showed dramatically improved skin quality at eight years.
Prof. Tremolada now considers Lipogems® indispensable for all procedures: complications have been drastically reduced, and recovery times — for example after facelifts — can be cut to a quarter of the standard period.
Several elite athletes use Lipogems® regularly. Alpine skier Sofia Goggia underwent annual Lipogems® treatments — in agreement with FIS physician Dr. Panzeri — to regenerate knee cartilage where PRP was no longer effective. Prof. Tremolada compared elite athletes to Ferraris that need tire changes every twenty laps, while the rest of us are Polo cars cruising smoothly on tires that last much longer.
Among the most striking emerging applications is Lipogems® as a drug delivery system. Veterinary neurosurgeon Offer Zeira treated five dogs with glioblastoma — an invariably fatal condition — by placing Lipogems® loaded with paclitaxel into the surgical cavity. All five dogs died of old age. The approach has been submitted to AIFA (the Italian medicines agency) and to the neurosurgery departments at Besta and Terni. Authorisation for human use — initially in recurrent cases — is expected shortly. The intellectual property is protected by patent, which Prof. Tremolada noted is unfortunately essential: without patent protection, large companies have no interest in pursuing even the most promising therapies.
How many treatments are needed? One. A single procedure. The effects last for years.
Does patient age matter? The therapy is autologous — the patient's own tissue. Between ages 7 and 90, microvascular density decreases by over 95%, but microfracturing increases the bioavailable surface area by 6,000 times. Even in the diabetic foot — a classic case of impaired microcirculation — the double-blind trial results demonstrate effectiveness. The therapy has shown benefit even in patients over 90.
Can it help in acute trauma? The effect in surgery and trauma is impressive — reducing the dangerous swelling phase that can lead to tissue necrosis. Applications alongside knee prostheses, in borderline trauma cases with Professor Zanasi, and in hand surgery all show enhanced tissue resistance and vascularisation. In Prof. Tremolada's view, acute trauma applications are not yet the present — they require further study — but they are definitely the future.