Closure of Bronchopleural Fistula with Mesenchymal Stem Cells: Case Report and Brief Literature Review

Abstract

Closure of bronchopleural fistula remains a difficult challenge for clinicians. Although several therapeutic approaches have been proposed, the clinical results are commonly unsatisfactory. Previous reports have indicated that autologous mesenchymal stem cells (MSCs) are useful for aiding treatment of bronchopleural fistula. We report here the use of umbilical cord MSCs to effect the successful closure of a bronchopleural fistula (5 mm) in a 33-year-old woman 6 months after a lobectomy. A review of the relevant literature is included. The use of MSCs may be a promising therapeutic method for the closure of bronchopleural fistula. Randomized controlled trials with larger samples are required.

Regenerative medicine approaches for the management of respiratory tract fistulas

“…Oroantral fistula Autologous buccal fat pad 1+ 25 [32][33][34] Pharyngocutaneous fistula Autologous fat 1 + 1 [35,36] Tracheoesophageal fistula Autologous fat 1 [37] Tracheomediastinal fistula Autologous adipose tissue SVF in fibrin glue 1 [38] Bronchopleural fistula Autologous adipose tissue-derived MSC-seeded matrix graft 1 [39] Autologous bone marrow-derived MSC 1 + 2 [40,41] Umbilical cord MSC 1 [42] Autologous fat 8 [43] SVF stromal vascular cells (uncultured), MSC mesenchymal stromal cells pressure ventilation [53] (Fig. 1).…”

“…As conservative alternative to more traumatic surgical procedures, administration of mesenchymal cells has been performed in order to promote healing of the tissue surrounding the fistula [42,59]. In particular, Petrella et al described an approach of autologous bronchoscopic perilesional transplantation of ten million bone marrow-derived mesenchymal cells for the treatment of a small-caliber (3 mm) BPF developed in a 42year-old man after right extra pleural pneumonectomy for malignant mesothelioma [40].…”

“…Patients were observed for a 3-year follow-up, and no treatment-related adverse effects were reported [41]. Recently, Zeng et al described a case report of successful closure of a BPF (5 × 2 mm) resulting from lobectomy, treated by administration through a flexible bronchoscope of 2.0 × 10 7 umbilical cord MSC around the fistula [42]. A computed tomography scan performed 6 months after the treatment revealed fistula healing and the BPF did not relapsed during the 2-year follow-up.…”

Utilizing Adipose Tissue-Derived Stem Cell Strategies for Obtaining Regeneration of Respiratory Tract Fistulas-A Systematic Review

“…Hence, surgery or bronchoscopy is required for facilitating the closure of BPF. In view of conservative other methods for greater damaging extensive surgeries, delivery of mesenchymal cells has been carried out for facilitating healing of the tissues that surround the fistula [53,54] [58,59]. Recently endoscopic delivery of autologous fat was conducted for the therapy of BPF in 8 cases as well as resolution was seen in all patients [60].…”

“…They kept following up the patients for a 3 years follow up as well as no treatment -associated side effects were seen. More recently Zeng et al, documented a case report of a patient where successfully BPF measuring 5 mm × 2 mm was closed that occurred secondary to a lobectomy, that received delivery via a flexible bronchoscope of 2 × 107 umbilical-cord MSC's around the fistula[53]. A Computerized Tomography (CT) Scan done 6 months following the treatment displayed fistula repair as well as the BPF did not relapse during the 2 years follow up.…”