… rates have been reported even in the anti-TNF era. Autologous stems cells (ASC) are able to differentiate into multiple different cell lines, and moreover present anti-inflammatory and angiogenic effects. Platelet-rich plasma (PRP) improves wound healing and acts as scaffold for ASC. The purpose…
Background
The treatment of patients with IBD-related complex anal fistulae (IBD-CAF) remains challenging, and high recurrence rates have been reported even in the anti-TNF era. Autologous stems cells (ASC) are able to differentiate into multiple different cell lines, and moreover present anti-inflammatory and angiogenic effects. Platelet-rich plasma (PRP) improves wound healing and acts as scaffold for ASC. The purpose of this study is to analyze the treatment results with a combination of ASC and RPR in patients with recurrent IBD-CAF.
Methods
Adult patients with IBD-CAF were prospectively enrolled between January 2013 and August 2014. This protocol was approved by the local IRB, and all patients signed informed consent. All patients had been treated unsuccessfully with anti-TNF and/or surgery before entering the study. The treatment protocol included 2 stages: (1) exam under anesthesia with fistula mapping and seton placement, combined with a lipoaspiration of 200 cc followed by ASC culture and expansion in the Laboratory of Tissue Engineering. (2) Between weeks 4 and 6, the closure of the internal fistula opening was performed using a flap advancement technique, combined with implantation of 100.000—200.000 ASC with PRP in the fistula tract and surrounding tissues. Standard follow-up was performed at 4 months, assessing the patients by a physical exam and MRI imaging. Results were classified into complete healing (CH), partial healing (PH) or no healing (NH). Patients were further followed, and current follow-up data were included in this report.
Results
A total of 5 patients were enrolled (4 female), 4 of them with Crohn’s disease and 1 with indeterminate colitis. Three patients had high transsphincteric fistulae, and 2 had pouch-vaginal fistulae. The mean time span from fistula diagnose to enrollment was 22 months (r: 9—60). No ASC-related peri- or postoperative complications were observed. At 4 months follow-up, 4 patients showed CH, and 1 patient with a pouch-vaginal fistula referred symptoms consistent with PH, without any radiologic evidence of a persisting fistula neither on MRI nor on Gastrografin enema of the pouch. At 9, 2 months follow-up, all the patients were completely healed.
Conclusions
The present treatment protocol with ASC and PRP for recurrent IBD-CAF shows encouraging results at a mid-term follow-up, achieving complete healing in all patients. A larger number of patients and a longer follow-up are required to confirm these preliminary results.
Kronberg Udo, Wainstein Claudio, Quera Rodrigo, Lopez Francisco, Jofre Claudio …
in Inflammatory Bowel Diseases
Inflammatory Bowel Diseases, Volume 20, Issue suppl_1, 1 December 2014, Pages S74–S75, https://doi.org/10.1097/01.MIB.0000456844.47907.0a
Published: 01 December 2014
