Treatment of enterocutaneous fistula in Crohn’s Disease with adipose-derived stem cells: a comparison of protocols with and without cell expansion
- 794 Downloads
Expanded adipose-derived stem cells (ASC) have been shown to be effective in treating Crohn’s patients with enterocutaneous fistulas. It is possible that unexpanded cells corresponding to the stromal vascular fraction (SVF) may also be effective.
Materials and methods
A subpopulation of patients from a previous proof-of-concept phase I study with enterocutaneous fistulas received autologous expanded ASCs. The same selection criteria for inclusion were applied to patients who underwent SVF implantation to treat enterocutaneous fistulas. After tract curettage, cell suspensions (either SVF cells from lipoaspirate or expanded ASCs) were injected into the tract walls, and the fistulous tract was sealed with fibrin adhesive (with or without cells).
In the series that received ASCs, four fistulas could be evaluated, and cure was achieved in three out of four cases. In the series that received SVF cells, four fistulas were evaluated, with cure achieved in one out of four cases.
Although a comparison of case series cannot be considered firm evidence, a therapeutic protocol that uses expansion prior to implantation does seem to be more effective than one that uses SVF cells directly from a lipoaspirate sample.
KeywordsCell therapy Adipose stem cells Enterocutaneous fistula
The authors acknowledge the technical support from the Plastic Surgery Department (Drs. Casado, Leyva, Recatero, and Salvatierra) of La Paz University Hospital. We also thank the assistance and support from our hospital and the funding from Cellerix S.A.
- 1.Caprilli R, Gassull MA, Escher JC, Moser G, Munkholm P, Forbes A, Hommes DW, Lochs H, Angelucci E, Cocco A, Vucelic B, Hildebrand H, Kolacek S, Riis L, Lukas M, de Franchis R, Hamilton M, Jantschek G, Michetti P, O’Morain C, Anwar MM, Freitas JL, Mouzas IA, Baert F, Mitchell R, Hawkey CJ (2006) European Crohn’s and Colitis Organisation: European evidence based consensus on the diagnosis and management of Crohn’s disease: special situations. Gut 55(Suppl 1):i36–i58PubMedCrossRefGoogle Scholar
- 3.Sands BE, Anderson FH, Bernstein CN, Chey WY, Feagan BG, Fedorak RN, Kamm MA, Korzenik JR, Lashner BA, Onken JE, Rachmilewitz D, Rutgeerts P, Wild G, Wolf DC, Marsters PA, Travers SB, Blank MA, van Deventer SJ (2004) Infliximab maintenance therapy for fistulizing Crohn’s disease. N Engl J Med 350:876–885PubMedCrossRefGoogle Scholar
- 6.Garcia-Olmo D, Garcia-Arranz M, Garcia LG, Serna E, Fernandez-Blanco I, Asensio L, Rodríguez-Montes JA, Lima Pinto F, Herreros D, García-Sancho L (2003) Autologous stem cell transplantation for treatment of rectovaginal fistula in perianal Crohn’s disease: a new cell-based therapy. Int J Colorectal Dis 18:451–454PubMedCrossRefGoogle Scholar
- 8.Gasche C, Scholmerich T, Brynskov J, D’Haens G, Hanauer SB, Irvine EJ, Jewell DP, Rachmilewitz D, Sachar DB, Sandborn WJ, Sutherland LLR (2000) A simple classification of Crohn’s I disease: report of the Working Party for the World Congresses of Gastroenterology—Vienna 1998. Inflamm Bowel Dis 6:8–15PubMedGoogle Scholar
- 9.Daniels E (2004) Adipose derived cell therapy—the future data series in regenerative cell therapy. MicroPore Biosurgery, San DiegoGoogle Scholar