The etiology of PD remains uncertain, but is well accepted that there is a chronic
inflammation of tunica albuginea and this reflect perturbations in normal wound healing and
aberrant deposition of extracellular matrix components in the soft tissue of the penis.
There appears to be significant pathophysiologic and genetic overlap of PD with other
superficial fibrosing disorders such as Dupuytren disease (palmar fibromatosis) and
Ledderhose disease (plantar fibromatosis) but not with more diffuse conditions such as
systemic sclerosis. Since PD was discovered, a lot of treatment were proposed. In the acute
stage of PD treatments aim to alleviate penile pain and minimise disease progression and
treatement attempts to mitigate inflammation: oral, intralesional injection, topical
treatement were used but with few non significant results.
In the chronic phase, surgical treatments aims to correct the curvature but with not a few
negative implications include penile shortening, erectile dysfunction, glans hypoaesthesia,
residual or recurrent curvature and palpable or uncomfortable suture knots below the skin.
Recent findings on scar biology explain some factors that influence pro-fibrotic pathways.
Preventions and treatment strategies mainly focus on reducing inflammation and hypoxia.
Emerging therapies shows that Mesenchymal stem cells (MSCs) have immunomodulatory and
antifibrotic effects by secreting paracrine growth factors.
Zuk et al. in 2001 and 2002 showed that lipoaspirate contains multipotent adipose stem cells
(ADSCs) population comparable to that isolated from the bone marrow. Because of its
availability and accessibility, white adipose tissue is considered a "stem cell depot."
Nanofat grafting technique firstly reported by Tonnard is an ultra-purified adipose
tissue-derived product that is devoid of mature adipocytes but contains rich in ADSCs,
microvascular fragments, growth factors [vascular endothelial growth factor (VEGF),
platelet-derived growth factor (PDGF), hepatocyte growth factor (HGF), transforming growth
factor-beta (TGF-β), basic fibroblast growth factor (bFGF), insulin-like growth factor 1
(IGF-1), and granulocyte-macrophage colony-stimulating factor (GM-CSF)], biological peptides
[lipoxins, resolvins, protectins, neurotrophic factors, angiogenin, matrix metalloproteinase,
leukemia inhibitory factor, and macrophage migration inhibitory factor], and cytokines . It
is a liquefied, autologous injectable product with the property of biological integration
with adjacent cells and tissues due to its homogenous consistency. At the site of injury,
these stromal cells initiate a site-specific reparative response comprised of remodeling of
extracellular matrix, enhanced and sustained angiogenesis, immune system modulation, and
cellular turnover. These properties of stromal cells provide a platform for the usage of
cellular therapy in various diseases. Peyronie's "plaque" is a scarred tissue, results from
abnormal extracellular matrix production through upregulation of myofibroblast activity and
tissue inhibitors of matrix metalloproteinases, among other mechanisms. The aim of the study
is to investigate the possible therapeutic role of nanofat grafting in the treatement of PD.