Stem cell therapy in refractory perineal Crohn's disease

long-term follow-up

C. Wainstein, R. Quera, D. Fluxá, U. Kronberg, Jorge A. Conejero, F. López-Köstner, C. Jofre, A. J. Zarate

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Aim: To describe the long-term outcomes of adipose-mesenchymal stem cells, platelet-rich plasma and endorectal advancement flaps in patients with perineal Crohn's disease. Method: This was a single-centre, prospective, observational pilot study performed between March 2013 and December 2016. The study included adult patients diagnosed with perianal Crohn's disease (with complex perianal fistulas) refractory to previous surgical and/or biological treatment. Patients underwent surgical treatment in two stages. Stage 1 consisted of fistula mapping, drainage, seton placement and lipoaspiration to obtain adipose-mesenchymal stem cells. In stage 2 the setons were removed and the fistula tract was debrided. A small endorectal advancement flap was created, with closure of the previous internal fistula opening. Then, 100–120 million adipose-mesenchymal stem cells mixed with platelet-rich plasma were injected into the internal fistula opening and fistula tract. Results: The study included nine patients (seven women), with a median age of 36 years (range 23–57 years). Eleven fistula tracks were treated, of which two were pouch–vaginal fistulas. The median follow-up period was 31 months (range 21–37 months). At the end of the follow-up period, 10/11 (91%) fistulas were completely healed and 1/11 (9%) was partially healed. At the end of this period, there was no evidence of fistula relapse or adverse reactions in any patients. The Perianal Disease Activity Index and Inflammatory Bowel Disease Questionnaire scores significantly improved after the procedure. Conclusion: Combined therapy with adipose-mesenchymal stem cells, platelet-rich plasma and endorectal advancement flaps yielded good results in patients with refractory perineal Crohn's disease.

Original languageEnglish (US)
Pages (from-to)O68-O75
JournalColorectal Disease
Volume20
Issue number3
DOIs
StatePublished - Mar 1 2018
Externally publishedYes

Fingerprint

Cell- and Tissue-Based Therapy
Crohn Disease
Fistula
Stem Cells
Mesenchymal Stromal Cells
Platelet-Rich Plasma
Inflammatory Bowel Diseases
Observational Studies
Drainage
Therapeutics
Recurrence

Keywords

  • Crohn's disease
  • fistula
  • inflammatory bowel disease
  • platelet-rich plasma
  • stem cells

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Wainstein, C., Quera, R., Fluxá, D., Kronberg, U., Conejero, J. A., López-Köstner, F., ... Zarate, A. J. (2018). Stem cell therapy in refractory perineal Crohn's disease: long-term follow-up. Colorectal Disease, 20(3), O68-O75. https://doi.org/10.1111/codi.14002

Stem cell therapy in refractory perineal Crohn's disease : long-term follow-up. / Wainstein, C.; Quera, R.; Fluxá, D.; Kronberg, U.; Conejero, Jorge A.; López-Köstner, F.; Jofre, C.; Zarate, A. J.

In: Colorectal Disease, Vol. 20, No. 3, 01.03.2018, p. O68-O75.

Research output: Contribution to journalArticle

Wainstein, C, Quera, R, Fluxá, D, Kronberg, U, Conejero, JA, López-Köstner, F, Jofre, C & Zarate, AJ 2018, 'Stem cell therapy in refractory perineal Crohn's disease: long-term follow-up', Colorectal Disease, vol. 20, no. 3, pp. O68-O75. https://doi.org/10.1111/codi.14002
Wainstein C, Quera R, Fluxá D, Kronberg U, Conejero JA, López-Köstner F et al. Stem cell therapy in refractory perineal Crohn's disease: long-term follow-up. Colorectal Disease. 2018 Mar 1;20(3):O68-O75. https://doi.org/10.1111/codi.14002
Wainstein, C. ; Quera, R. ; Fluxá, D. ; Kronberg, U. ; Conejero, Jorge A. ; López-Köstner, F. ; Jofre, C. ; Zarate, A. J. / Stem cell therapy in refractory perineal Crohn's disease : long-term follow-up. In: Colorectal Disease. 2018 ; Vol. 20, No. 3. pp. O68-O75.
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abstract = "Aim: To describe the long-term outcomes of adipose-mesenchymal stem cells, platelet-rich plasma and endorectal advancement flaps in patients with perineal Crohn's disease. Method: This was a single-centre, prospective, observational pilot study performed between March 2013 and December 2016. The study included adult patients diagnosed with perianal Crohn's disease (with complex perianal fistulas) refractory to previous surgical and/or biological treatment. Patients underwent surgical treatment in two stages. Stage 1 consisted of fistula mapping, drainage, seton placement and lipoaspiration to obtain adipose-mesenchymal stem cells. In stage 2 the setons were removed and the fistula tract was debrided. A small endorectal advancement flap was created, with closure of the previous internal fistula opening. Then, 100–120 million adipose-mesenchymal stem cells mixed with platelet-rich plasma were injected into the internal fistula opening and fistula tract. Results: The study included nine patients (seven women), with a median age of 36 years (range 23–57 years). Eleven fistula tracks were treated, of which two were pouch–vaginal fistulas. The median follow-up period was 31 months (range 21–37 months). At the end of the follow-up period, 10/11 (91{\%}) fistulas were completely healed and 1/11 (9{\%}) was partially healed. At the end of this period, there was no evidence of fistula relapse or adverse reactions in any patients. The Perianal Disease Activity Index and Inflammatory Bowel Disease Questionnaire scores significantly improved after the procedure. Conclusion: Combined therapy with adipose-mesenchymal stem cells, platelet-rich plasma and endorectal advancement flaps yielded good results in patients with refractory perineal Crohn's disease.",
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