First clinical case report of local microinjection of autologous fat and adipose-derived stromal vascular fraction for perianal fistula in Crohn’s disease

Abstract

Mesenchymal stem cell therapy is a promising treatment for perianal Crohn’s fistulas refractory to conventional therapy, which are an extremely morbid complication and a true therapeutic challenge. Autologous adipose-derived stromal vascular fraction (ADSVF) is an easily accessible source of cells with angiogenic, anti-inflammatory, immunomodulatory, and regenerative properties. Here, we describe a case involving a patient with severe perianal Crohn’s fistulas refractory to the best medical and surgical practices who received local treatment with ADSVF and microfat. This patient was first examined under anesthesia with drainage via seton placement; 1 week later, on a single day, he underwent adipose tissue extraction, ADSVF and microfat preparation, and the local injection of 14 ml of microfat and approximately 20 million viable ADSVF cells into the soft tissue around the fistulas. No serious adverse events were observed. At the first endpoint at 12 weeks, the fistula had clinically healed with complete re-epithelialization of all external openings; no fistula tract was detected on magnetic resonance imaging, confirming this finding. This good clinical outcome was sustained at 48 weeks and was associated with a reduction in the severity of perianal disease and an improvement in quality of life. The current case highlights the therapeutic potential of a new cellular treatment for Crohn’s patients with refractory perianal fistulas based on the innovative hypothesis that the combined action of ADSVF in association with the trophic characteristics of a microfat graft could be beneficial for this condition.Trial registration: EudraCT number 201325, NCT02520843. Registered on 5 August 2015

Transplantation of Adipose-Derived Mesenchymal Stem Cells in Refractory Crohn’s Disease: Systematic Review

“…The main features found in the 13 included studies are detailed in Figures 2 and 3. Among these, one study is about luminal CD 28 and the other 12 about perianal fistulizing CD 6 , 7 , 11 , 12 , 15 , 16 , 18 , 24 , 25 , 26 , 27 , 30 .…”

“…Ten studies made use of subcutaneous tissue 6,7,11,12,15,18,24,25,27,30 five of which from the abdominal region 6,12,15,18,27 , one from the thigh region 6 and others have not reported 7 , 11 , 16 , 24 , 25 , 26 , 29 , 30 . Ten studies obtained the adipose tissue through liposuction technique 6 , 7 , 11 , 15 , 18 , 27 , 24 , 26 , 29 , 30 , and three also obtained through the extraction technique for obtaining microfragmented adipose tissue 6 , 7 , 12 . Two studies did not report the local nor the way of obtaining the adipose tissue 16,29 and one reported only as obtained tissue 26 .…”

Fat graft for reducing pain in chronic wounds

“…Many researchers investigated ultrafiltered fat graft (or microfat injection) procedure and its useful role in wound healing 29‐32 …”

Stromal Vascular Fraction Cell Therapy for a Stroke Patient—Cure without Side Effects

“…As we previously demonstrated, SVF cells have a huge tissue regeneration potential in patients with osteoarthritis [3,6]. Additionally, SVFs and adipose tissue-derived stem cells (ADSCs) have been clinically used in the treatment of multiple sclerosis [7], chronic myocardial ischemia [8], acute respiratory distress syndrome [9], Crohn’s disease [10], and other diseases. In the case of stroke victims, the standard treatment, including intense physiotherapy and neurorehabilitation, typically leads to improvements during the first few months or years after the stroke but then results in an eventual plateau regardless of the intensity of exercise [11].…”