scholarly journals Adipose-Derived Stem Cells in the Treatment of Perianal Fistulas in Crohn’s Disease: Rationale, Clinical Results and Perspectives

2021 ◽  
Vol 22 (18) ◽  
pp. 9967
Author(s):  
Etienne Buscail ◽  
Guillaume Le Cosquer ◽  
Fabian Gross ◽  
Marine Lebrin ◽  
Laetitia Bugarel ◽  
...  

Between 20 to 25% of Crohn’s disease (CD) patients suffer from perianal fistulas, a marker of disease severity. Seton drainage combined with anti-TNFα can result in closure of the fistula in 70 to 75% of patients. For the remaining 25% of patients there is room for in situ injection of autologous or allogenic mesenchymal stem cells such as adipose-derived stem/stromal cells (ADSCs). ADSCs exert their effects on tissues and effector cells through paracrine phenomena, including the secretome and extracellular vesicles. They display anti-inflammatory, anti-apoptotic, pro-angiogenic, proliferative, and immunomodulatory properties, and a homing within the damaged tissue. They also have immuno-evasive properties allowing a clinical allogeneic approach. Numerous clinical trials have been conducted that demonstrate a complete cure rate of anoperineal fistulas in CD ranging from 46 to 90% of cases after in situ injection of autologous or allogenic ADSCs. A pivotal phase III-controlled trial using allogenic ADSCs (Alofisel®) demonstrated that prolonged clinical and radiological remission can be obtained in nearly 60% of cases with a good safety profile. Future studies should be conducted for a better knowledge of the local effect of ADSCs as well as for a standardization in terms of the number of injections and associated procedures.

The Lancet ◽  
2016 ◽  
Vol 388 (10051) ◽  
pp. 1281-1290 ◽  
Author(s):  
Julián Panés ◽  
Damián García-Olmo ◽  
Gert Van Assche ◽  
Jean Frederic Colombel ◽  
Walter Reinisch ◽  
...  

2019 ◽  
Vol 25 (1) ◽  
pp. 41-46 ◽  
Author(s):  
Paulo Gustavo Kotze ◽  
Antonino Spinelli ◽  
Amy Lee Lightner

Background: The management of complex perianal fistulas in Crohn’s disease (CD) represents a challenge for patients, gastroenterologists and colorectal surgeons. There are clear limitations with current medical and surgical options, and healing rates remain far from what is expected. A multidisciplinary approach with optimized medical therapy, usually anti-TNF agents, associated with setons and additional surgical techniques is currently the best strategy to aim fistula healing. Methods: A comprehensive review of the literature was conducted on the use of mesenchymal stem cells (MSCs). Results: The use of mesenchymal stem cells (MSCs) has recently emerged as a promising new therapeutic strategy for complex fistulas in CD patients. This review summarizes the evidence of the use of MSCs in complex CD fistulas, by exploring in detail the types of cells that can be used and their modes of delivery. Additionally, the results of the most recent phase III randomized trial with local MSCs injection are described, and future challenges of this therapeutic option are discussed. Conclusion: The use of MSCs represents hope for better outcomes in patients with CD-related perianal fistulas. More research in the field will help to position this specific therapy in treatment algorithms.


2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Víctor Manuel Maciel Gutiérrez ◽  
Sergio Giovanni Gutiérrez Guillen ◽  
Manuel Willebaldo Centeno Flores ◽  
Jesús Alonso Valenzuela Pérez ◽  
Francisco Manuel Abarca Rendón ◽  
...  

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