Efficacy of Injection of Freshly Collected Autologous Adipose Tissue Into Complex Cryptoglandular Anal Fistulas

Dalby, Helene Rask; Dige, Anders; Pedersen, Birthe D.; Krogh, Klaus; Agnholt, Jørgen; Hougaard, Helene Tarri; Lundby, Lilli

doi:10.1097/dcr.0000000000002379

Cited by 6 publications

(14 citation statements)

References 15 publications

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“…The afore-listed results demonstrated clearly that MSCs transplantation was an effective treatment method. Furthermore, apart from stem cells, adipose tissues have also been adopted for fistulas treatment in clinical trials [ 55 , 56 ] because progenitor cells were contained. However, considering that the different treatment materials, MSCs and adipose tissues, might have different features, we did not include the trials in which tissues were used in the experimental group in our study.…”

Section: Discussionmentioning

confidence: 99%

Mesenchymal stem cells transplantation for perianal fistulas: a systematic review and meta-analysis of clinical trials

Wang

Jiang²,

Zhang

et al. 2023

Stem Cell Res Ther

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Background Perianal fistulas, characterised as granulomatous inflammation of fistulas around the anal canal, are associated with significant morbidity resulting in a negative impact on quality of life and a tremendous burden to the healthcare system. Treatment of anal fistulas usually consists of anal surgery; however, results of closure rates are not satisfactory especially with complex perianal fistulas, after which many patients may suffer from anal incontinence. Recently, the administration of mesenchymal stem cells (MSCs) has shown promising efficacy. Herein, we aim to explore whether MSCs are effective for complex perianal fistulas and if they have either short-term, medium-term, long-term or over-long-term efficacy. Additionally, we want to elucidate whether factors such as drug dosage, MSC source, cell type, and disease aetiology influence treatment efficacy. Main body of the abstract We searched four online databases and analysed data based on information within the clinical trials registry. The outcomes of eligible trials were analysed with Review Manager 5.4.1. Relative risk and related 95% confidence interval were calculated to compare the effect between the MSCs and control groups. In addition, the Cochrane risk of bias tool was applied to evaluate the bias risk of eligible studies. Meta-analyses showed that therapy with MSCs was superior to conventional treatment for complex perianal fistulas in short-, long- and over-long-term follow-up phases. However, there was no statistical difference in treatment efficacy in the medium term between the two methods. Subgroup meta-analyses showed factors including cell type, cell source and cell dosage were superior compared to the control, but there was no significant difference between different experimental groups of those factors. Besides, local MSCs therapy has shown more promising results for fistulas as a result of Crohn’s Disease (CD). Although we tend to maintain that MSCs therapy is effective for cryptoglandular fistulas equally, more studies are needed to confirm this conclusion in the future. Short conclusion MSCs Transplantation could be a new therapeutic method for complex perianal fistulas of both cryptoglandular and CD origin showing high efficacy in the short-term to over-long-term phases, as well as high efficacy in sustained healing. The difference in cell types, cell sources and cell dosages did not influence MSCs’ efficacy.

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Section: Discussionmentioning

confidence: 99%

Mesenchymal stem cells transplantation for perianal fistulas: a systematic review and meta-analysis of clinical trials

Wang

Jiang²,

Zhang

et al. 2023

Stem Cell Res Ther

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“…14 In february of 2023 the same group published a study evaluating the treatment efficacy of freshly collected ASCs injection in CPAF. 11 Overall, 51% of the 77 included patients achieved the primary outcome of fistula healing, whereas another 12% reported reduced secretion and decreased anal discomfort. Thus, 63% of all treated patients had a positive treatment outcome.…”

Section: Discussionmentioning

confidence: 91%

“…The treatment is inexpensive and requires a single surgical procedure and there is no need for a laboratory and cell culture as with the use of cultured ASCs. 11 In this case report, we show our first experience in the treatment of CPAF with the application of collected adipose tissue in a tertiary referral hospital from Belo Horizonte, Brazil. The patient had a good postoperative recovery with a complete fistula healing after 8 months without adverse effects.…”

Section: Introductionmentioning

confidence: 96%

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Injection of Freshly Collected Adipose Tissue for the Treatment Complex Cryptoglandular Anal Fistula: Case Report

Londoño Estrada,

Fernandes,

Oliveira

et al. 2023

Journal of Coloproctology

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Introduction Perianal fistula is a common colorectal disease which is caused mainly by cryptoglandular disease. Although most cases are treated successfully by surgery, management of complex perianal fistulas (CPAF) remains a challenge with limited results in recurrence and sometimes associated with fecal incontinence. The CPAF treatment with autologous adipose-derived mesenchymal stem cells (ASCs) had become a research hotspot. The technique started to be used in the treatment of Crohn's disease (CD) fistulas, where the studies showed safe and goods result from the procedure. Cultured ASCs have been used but this approach requires the preceding collection of adipose tissue, time for isolation of ASCs and subsequent in vitro expansion, need for laboratory facilities, and expertise in cell culturing. These factors have been getting over by using the commercially available alternative, allogenic ASCs. Treatment with allogeneic ASCs has shown good results in patients with CD fistulas, however with the disadvantage of being expensive. Objective To show that the injection with freshly collected adipose tissue is an alternative to treatment with autologous or allogenic ASCs with several advantages. Methods: In this case report, we show our first experience in the treatment of CPAF with the application of collected adipose tissue in a tertiary referral hospital from Belo Horizonte, Brazil. Results The patient had a good postoperative recuperation with a complete fistula healing after 8 months without adverse effects. Conclusion Injection with freshly collected adipose tissue is a promising and apparently safe sphincter-sparing technique in the treatment of CPAF.

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“…Autologous or allogeneic transplantation of non-commercial cultured stem cells is a complex procedure, subjected to strict safety regulations, and unavailable outside the scope of research projects. Using commercially available cultured allogeneic stem cells (Darvadstrocel-Alo sel®) is a highly expensive technique, costing between $65,000 and $87,000 per therapy [13,14]. The Spanish public health system covers the cost of Alo sel® for CD stulas but not for cryptoglandular stulas.…”

Section: Introductionmentioning

confidence: 99%

Non-Crohn's complex and multirelapsed perianal fistulas treated with sphincter sparing surgical procedures and adjuvant adipose tissue injection

Guillaumes,

Hidalgo,

Bachero

et al. 2024

Preprint

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Purpose The purpose of this study was to evaluate the results obtained by the treatment of non-Crohn’s-related complex and multirelapsed perianal fistulas using a surgical sphincter-sparing technique with adjuvant adipose tissue injection, a rich source of progenitor and immunomodulatory cells. Methods A prospective, non-randomized, interventional, single-center, open-label clinical trial was conducted from January 2020 to December 2022. Nine patients were enrolled and assessed after a minimum of twelve months of follow-up. All patients underwent removal of the setons, excision, or curettage of the fistula tract and mucosal flap or internal opening suture. The collection and processing of adipose tissue to be injected was performed using a commercially available system. Results Selected cases included six men and three women with a mean age of 42. All patients had an extended disease course period, ranging from 3 to 13 years (mean 6.6 years), and a history of multiple previous surgeries, including two to eight interventions (an average of 4.4 per case). All fistulas were high transsphincteric, in four cases in horseshoe and two cases with secondary suprasphincteric or peri-elevator tract fistulas. At a mean follow-up of 18 months (range 12–36), a complete healing rate was documented in six cases (66%) and a remarkable improvement in three cases (33,3%). Conclusions In the group of patients described with complex fistulas with multiple recurrences, many from palliative treatments with setons, the adjuvant injection of adipose tissue associated with a sphincter-sparing surgical procedure might help to achieve closure or improvement in a significant percentage of cases. The study protocol was prospectively registered on Clinicaltrials.gov (NCT 04750499).

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Efficacy of Injection of Freshly Collected Autologous Adipose Tissue Into Complex Cryptoglandular Anal Fistulas

Cited by 6 publications

References 15 publications

Mesenchymal stem cells transplantation for perianal fistulas: a systematic review and meta-analysis of clinical trials

Mesenchymal stem cells transplantation for perianal fistulas: a systematic review and meta-analysis of clinical trials

Injection of Freshly Collected Adipose Tissue for the Treatment Complex Cryptoglandular Anal Fistula: Case Report

Non-Crohn's complex and multirelapsed perianal fistulas treated with sphincter sparing surgical procedures and adjuvant adipose tissue injection

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