Use of Mesenchymal Stem Cells in Crohn's Disease and Perianal Fistulas: A Narrative Review

: Crohn's disease (CD) which usually leads to anal fistulas among patients is the most important inflammatory bowel disease that causes morbidity in many people around the world. This review article proposes using MSCs as a hopeful therapeutic strategy for CD and anal fistula treatment in both preclinical and clinical conditions. Finally, Darvadstrocel - a cell based medication to treat complex anal fistulas in adults- as the only European Medicines Agency (EMA)-approved product for the treatment of anal fistulas in CD is addressed. Although several common therapies such as surgery and anti-tumor necrosis factor-alpha (TNF-α) drugs as well as a combination of these methods is used to improve this disease, however, due to the low effectiveness of these treatments, the use of new strategies with higher efficiency is still recommended. Cell therapy is among the new emerging therapeutic strategies that have attracted great attention from clinicians due to its unique capabilities. One of the most widely used cell sources administrated in cell therapy is mesenchymal stem cell (MSC). This review article will discuss preclinical and clinical studies about MSCs as a potent and promising therapeutic option in the treatment of CD and anal fistula.

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Healing of rectal advancement flaps for anal fistulas in patients with and without Crohn’s disease: a retrospective cohort analysis

BMC Surgery ◽

10.1186/s12893-021-01282-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Claudia Seifarth ◽

Kai S. Lehmann ◽

Christoph Holmer ◽

Ioannis Pozios

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Anal Fistula ◽

Healing Rate ◽

Cohort Analysis ◽

Patient Specific ◽

Anal Fistulas ◽

Surgical Closure ◽

Fistula Healing ◽

Advancement Flaps

Abstract Background Surgical closure of anal fistulas with rectal advancement flaps is an established standard method, but it has a high degree of healing failure in some cases. The aim of this study was to identify risk factors for anal fistula healing failure after advancement flap placement between patients with cryptoglandular fistulas and patients with Crohn’s disease (CD). Methods From January 2010 to October 2020, 155 rectal advancement flaps (CD patients = 55, non-CD patients = 100) were performed. Patients were entered into a prospective database, and healing rates were retrospectively analysed. Results The median follow-up period was 189 days (95% CI: 109–269). The overall complication rate was 5.8%. The total healing rate for all rectal advancement flaps was 56%. CD patients were younger (33 vs. 43 years, p < 0.001), more often female (76% vs. 30%, p < 0.001), were administered more immunosuppressant medication (65% vs. 5%, p < 0.001), and had more rectovaginal fistulas (29% vs. 8%, p = 0.001) and more protective stomas (49% vs. 2%, p < 0.001) than patients without CD. However, no difference in healing rate was noted between patients with or without CD (47% vs. 60%, p = 0.088). Conclusions Patients with anal fistulas with and without Crohn’s disease exhibit the same healing rate. Although patients with CD display different patient-specific characteristics, no independent factors for the occurrence of anal fistula healing failure could be determined. Trial registration Not applicable due to the retrospective study design.

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Healing of rectal advancement flap for anal fistula in patients with and without Crohn’s disease: a retrospective cohort analysis

10.21203/rs.3.rs-244257/v1 ◽

2021 ◽

Author(s):

Claudia Seifarth ◽

Kai S. Lehmann ◽

Cristoph Holmer ◽

Ioannis Pozios

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Anal Fistula ◽

Healing Rate ◽

Advancement Flap ◽

Patient Specific ◽

Anal Fistulas ◽

Surgical Closure ◽

Rectal Advancement Flap ◽

Fistula Healing

Abstract Background Surgical closure of anal fistulas with rectal advancement flap is an established standard method, but in some cases, it has a high degree of healing failure. There are few studies in literature with a small number of cases examining differences between patients with and without Crohn's disease (CD). The aim of this study was to identify risk factors for anal fistula healing failure after advancement flap between patients with cryptoglandular fistulas and patients with CD. Methods From January 2010 to October 2020, 155 rectal advancement flaps (CD patients = 55, non-CD patients = 100) were performed. Patients were entered into a prospective database and retrospectively analyzed for healing rates. Results Median follow up was 189 days (95 % CI: 109–269). Overall complication rate was 5.8 %. Total healing rate for all rectal advanced flaps was 56 %. CD patients were younger (33 vs. 43 years, p < 0.001), more often female (76 vs. 30 %, p < 0.001), had more immunosuppressant medication (65 vs. 5 %, p < 0.001), more vaginal fistulas (29 vs. 8 %, p = 0.001) and more protective stomas (49 vs. 2 %, p < 0.001) than patients without CD. However, there was no difference in the healing rate of patients with or without CD (47 % vs. 60 %, p = 0.088). Conclusions Patients with anal fistulas without and with Crohn’s disease have the same healing rate. Although patients with CD differ in their patient-specific characteristics, no independent factors for the occurrence of anal fistula healing failure could be determined. Trial registration: Not applicable due to the retrospective study design.

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Faculty Opinions recommendation of Long-term Efficacy and Safety of Stem Cell Therapy (Cx601) for Complex Perianal Fistulas in Patients With Crohn's Disease.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.732366531.793553283 ◽

2018 ◽

Author(s):

Eduard Stange

Keyword(s):

Stem Cell ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Cell Therapy ◽

Stem Cell Therapy ◽

Efficacy And Safety ◽

Perianal Fistulas ◽

Term Efficacy

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Infliximab: A Review of its use in the Treatment of Pediatric Crohn's Disease

Clinical Medicine Insights Therapeutics ◽

10.4137/cmt.s2840 ◽

2010 ◽

Vol 2 ◽

pp. CMT.S2840

Author(s):

Arkady Broder ◽

Joel R. Rosh

Keyword(s):

Monoclonal Antibodies ◽

Crohn’S Disease ◽

Chronic Disease ◽

Crohn's Disease ◽

Tumor Necrosis ◽

Immune Dysregulation ◽

Necrosis Factor Alpha ◽

The Past ◽

Factor Alpha ◽

Necrosis Factor

The past decade has brought great change to the treatment of pediatric Crohn's disease. The majority of affected patients now receive therapy directed at the underlying immune dysregulation that is associated with this chronic disease. The monoclonal antibodies directed against tumor necrosis factor alpha play an increasing role in such therapy. Infliximab is the prototype of this class of biologic based therapy. This review covers the basic pharmacokinetics of infliximab while reviewing the data on its efficacy in pediatric Crohn's disease patients. Current issues related to infliximab dosing and safety are also reviewed.

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