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Stem Cell Injection for Complex Refractory Perianal Fistulas in Crohn's Disease: A Single Center Initial Experience

From 30 to 70% of patients with Crohn's disease (CD) may develop perianal fistulas during their lifetime. The medical and surgical management of this complication is challenging, and its treatment still gives unsatisfactory results. However, recent studies on adipose-derived mesenchymal stem ce...

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Autores principales: Colombo, Francesco, Cammarata, Francesco, Baldi, Caterina, Rizzetto, Francesco, Bondurri, Andrea, Carmagnola, Stefania, Gridavilla, Daniele, Maconi, Giovanni, Ardizzone, Sandro, Danelli, Piergiorgio
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8858969/
https://www.ncbi.nlm.nih.gov/pubmed/35198598
http://dx.doi.org/10.3389/fsurg.2022.834870
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author Colombo, Francesco
Cammarata, Francesco
Baldi, Caterina
Rizzetto, Francesco
Bondurri, Andrea
Carmagnola, Stefania
Gridavilla, Daniele
Maconi, Giovanni
Ardizzone, Sandro
Danelli, Piergiorgio
author_facet Colombo, Francesco
Cammarata, Francesco
Baldi, Caterina
Rizzetto, Francesco
Bondurri, Andrea
Carmagnola, Stefania
Gridavilla, Daniele
Maconi, Giovanni
Ardizzone, Sandro
Danelli, Piergiorgio
author_sort Colombo, Francesco
collection PubMed
description From 30 to 70% of patients with Crohn's disease (CD) may develop perianal fistulas during their lifetime. The medical and surgical management of this complication is challenging, and its treatment still gives unsatisfactory results. However, recent studies on adipose-derived mesenchymal stem cells have proven their anti-inflammatory and immuno-modulatory potential, representing a new promising tool in the treatment of such stubborn disease. We report our initial experience with three patients who had recurrent perianal CD treated with local infiltration of stem cell darvadstrocel (Alofisel). All the patients had a long history of perianal disease refractory to multiple medical and surgical treatments. The preoperative workup included transperineal ultrasound (TP-US), pelvic MRI, and colonoscopy that ruled out active proctitis in all the patients. The post-treatment follow-up included clinical assessment at 1, 3, and 6 months with repeated MRI and TP-US at 6 months. At 6 months, 2 patients had a clinical response despite radiological persistence of fistula tracts, while one patient presented perianal fistula recurrence complicated by perianal abscess. Although our experience is limited to 3 patients and a short follow-up, our results confirm that darvadstrocel injection is a safe procedure, with a good clinical response in most of the patients, but that it apparently had no effect on the anatomical modification of the fistula tracts. Long-term results, with a rigorous assessment of anatomical lesions, are still needed to support the promising data of the literature.
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spelling pubmed-88589692022-02-22 Stem Cell Injection for Complex Refractory Perianal Fistulas in Crohn's Disease: A Single Center Initial Experience Colombo, Francesco Cammarata, Francesco Baldi, Caterina Rizzetto, Francesco Bondurri, Andrea Carmagnola, Stefania Gridavilla, Daniele Maconi, Giovanni Ardizzone, Sandro Danelli, Piergiorgio Front Surg Surgery From 30 to 70% of patients with Crohn's disease (CD) may develop perianal fistulas during their lifetime. The medical and surgical management of this complication is challenging, and its treatment still gives unsatisfactory results. However, recent studies on adipose-derived mesenchymal stem cells have proven their anti-inflammatory and immuno-modulatory potential, representing a new promising tool in the treatment of such stubborn disease. We report our initial experience with three patients who had recurrent perianal CD treated with local infiltration of stem cell darvadstrocel (Alofisel). All the patients had a long history of perianal disease refractory to multiple medical and surgical treatments. The preoperative workup included transperineal ultrasound (TP-US), pelvic MRI, and colonoscopy that ruled out active proctitis in all the patients. The post-treatment follow-up included clinical assessment at 1, 3, and 6 months with repeated MRI and TP-US at 6 months. At 6 months, 2 patients had a clinical response despite radiological persistence of fistula tracts, while one patient presented perianal fistula recurrence complicated by perianal abscess. Although our experience is limited to 3 patients and a short follow-up, our results confirm that darvadstrocel injection is a safe procedure, with a good clinical response in most of the patients, but that it apparently had no effect on the anatomical modification of the fistula tracts. Long-term results, with a rigorous assessment of anatomical lesions, are still needed to support the promising data of the literature. Frontiers Media S.A. 2022-02-07 /pmc/articles/PMC8858969/ /pubmed/35198598 http://dx.doi.org/10.3389/fsurg.2022.834870 Text en Copyright © 2022 Colombo, Cammarata, Baldi, Rizzetto, Bondurri, Carmagnola, Gridavilla, Maconi, Ardizzone and Danelli. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Surgery
Colombo, Francesco
Cammarata, Francesco
Baldi, Caterina
Rizzetto, Francesco
Bondurri, Andrea
Carmagnola, Stefania
Gridavilla, Daniele
Maconi, Giovanni
Ardizzone, Sandro
Danelli, Piergiorgio
Stem Cell Injection for Complex Refractory Perianal Fistulas in Crohn's Disease: A Single Center Initial Experience
title Stem Cell Injection for Complex Refractory Perianal Fistulas in Crohn's Disease: A Single Center Initial Experience
title_full Stem Cell Injection for Complex Refractory Perianal Fistulas in Crohn's Disease: A Single Center Initial Experience
title_fullStr Stem Cell Injection for Complex Refractory Perianal Fistulas in Crohn's Disease: A Single Center Initial Experience
title_full_unstemmed Stem Cell Injection for Complex Refractory Perianal Fistulas in Crohn's Disease: A Single Center Initial Experience
title_short Stem Cell Injection for Complex Refractory Perianal Fistulas in Crohn's Disease: A Single Center Initial Experience
title_sort stem cell injection for complex refractory perianal fistulas in crohn's disease: a single center initial experience
topic Surgery
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8858969/
https://www.ncbi.nlm.nih.gov/pubmed/35198598
http://dx.doi.org/10.3389/fsurg.2022.834870
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