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International Journal of Colorectal Disease

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01-05-2012 | Original Article

Long-term follow-up of patients undergoing adipose-derived adult stem cell administration to treat complex perianal fistulas

Authors: Hector Guadalajara, Dolores Herreros, Paloma De-La-Quintana, Jacobo Trebol, Mariano Garcia-Arranz, Damian Garcia-Olmo

Published in: International Journal of Colorectal Disease | Issue 5/2012

Abstract

Purpose

In patients with perianal fistulas, administration of adult stem cells (ASCs) derived from liposuction samples has proved a promising technique in a preceding phase II trial. We aimed to extend follow-up of these patients with this retrospective study.

Method

Patients who had received at least one dose of treatment (ASCs plus fibrin glue or fibrin glue alone) were included. Adverse events notified since the end of the phase II study were recorded. Clinical and magnetic resonance imaging (MRI) criteria were used to determine whether recurrence of the healed fistula had occurred.

Results

Data were available for 21 out of 24 patients treated with ASCs plus fibrin glue and 13 out of 25 patients treated with fibrin glue in the phase II study. Follow-up lasted a mean of 38.0 and 42.6 months, respectively. Two adverse events unrelated to the original treatment were reported, one in each group. There were no reports of anal incontinence associated with the procedure. Of the 12 patients treated with ASCs plus fibrin glue who were included in the retrospective follow-up in the complete closure group, only 7 remained free of recurrence. MRI was done in 31 patients. No relationship was detected between MRI results and the clinical fistula status, independent of the treatment received.

Conclusions

Long-term follow-up reaffirmed the very good safety profile of the treatment. Nevertheless, a low proportion of the stem cell-treated patients with closure after the procedure remained free of recurrence after more than 3 years of follow-up.

García-Olmo D, García-Arranz M, García LG, Cuellar ES, Blanco IF, Prianes LA et al (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(5):451–454PubMedCrossRef

García-Olmo D, García-Arranz M, Herreros D, Pascual I, Peiro C, Rodríguez-Montes JA (2005) A phase I clinical trial of the treatment of Crohn’s fistula by adipose mesenchymal stem cell transplantation. Dis Colon Rectum 48(7):1416–1423PubMedCrossRef

Garcia-Olmo D, Herreros D, Pascual I, Pascual JA, Del-Valle E, Zorrilla J et al (2009) Expanded adipose-derived stem cells for the treatment of complex perianal fistula: a phase II clinical trial. Dis Colon Rectum 52(1):79–86PubMedCrossRef

Silverberg MS, Satsangi J, Ahmad T, Arnott ID, Bernstein CN, Brant SR et al (2005) Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: report of a Working Party of the 2005 Montreal World Congress of Gastroenterology. Can J Gastroenterol 19(Suppl A):5–36PubMed

Gimble J, Guilak F (2003) Adipose-derived adult stem cells: isolation, characterization, and differentiation potential. Cytotherapy 5(5):362–369PubMedCrossRef

van Koperen PJ, Wind J, Bemelman WA, Bakx R, Reitsma JB, Slors JFM (2008) Long-term functional outcome and risk factors for recurrence after surgical treatment for low and high perianal fistulas of cryptoglandular origin. Dis Colon Rectum 51(10):1475–1481PubMedCrossRef

Present DH, Rutgeerts P, Targan S, Hanauer SB, Mayer L, van Hogezand RA et al (1999) Infliximab for the treatment of fistulas in patients with Crohn’s disease. N Engl J Med 340(18):1398–1405PubMedCrossRef

Parsi MA, Lashner BA (2004) Safety of infliximab: primum non nocere. The safety profile of infliximab in patients with Crohn’s disease: the Mayo Clinic experience in 500 patients. Inflamm Bowel Dis 10(4):486–487PubMedCrossRef

Lindsey I, Smilgin-Humphreys MM, Cunningham C, Mortensen NJM, George BD (2002) A randomized, controlled trial of fibrin glue vs. conventional treatment for anal fistula. Dis Colon Rectum 45(12):1608–1615PubMedCrossRef

10.

Sands BE, Blank MA, Patel K, van Deventer SJ (2004) Long-term treatment of rectovaginal fistulas in Crohn’s disease: response to infliximab in the ACCENT II Study. Clin Gastroenterol Hepatol 2(10):912–920PubMedCrossRef

11.

Gurudu SR, Griffel LH, Gialanella RJ, Das KM (1999) Cyclosporine therapy in inflammatory bowel disease: short-term and long-term results. J Clin Gastroenterol 29(2):151–154PubMedCrossRef

12.

Cintron JR, Park JJ, Orsay CP, Pearl RK, Nelson RL, Sone JH et al (2000) Repair of fistulas-in-ano using fibrin adhesive: long-term follow-up. Dis Colon Rectum 43(7):944–949, discussion 949–950PubMedCrossRef

13.

Levy C, Tremaine WJ (2002) Management of internal fistulas in Crohn’s disease. Inflamm Bowel Dis 8(2):106–111PubMedCrossRef

14.

González MA, Gonzalez-Rey E, Rico L, Büscher D, Delgado M (2009) Adipose-derived mesenchymal stem cells alleviate experimental colitis by inhibiting inflammatory and autoimmune responses. Gastroenterol 136(3):978–989CrossRef

15.

Sahni VA, Ahmad R, Burling D (2008) Which method is best for imaging of perianal fistula? Abdom Imaging 33(1):26–30PubMedCrossRef

16.

Tougeron D, Savoye G, Savoye-Collet C, Koning E, Michot F, Lerebours E (2009) Predicting factors of fistula healing and clinical remission after infliximab-based combined therapy for perianal fistulizing Crohn’s disease. Dig Dis Sci 54(8):1746–1752PubMedCrossRef

Title: Long-term follow-up of patients undergoing adipose-derived adult stem cell administration to treat complex perianal fistulas
Authors: Hector Guadalajara
Dolores Herreros
Paloma De-La-Quintana
Jacobo Trebol
Mariano Garcia-Arranz
Damian Garcia-Olmo
Publication date: 01-05-2012
Publisher: Springer-Verlag
Published in: International Journal of Colorectal Disease / Issue 5/2012
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-011-1350-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Long-term follow-up of patients undergoing adipose-derived adult stem cell administration to treat complex perianal fistulas

Abstract

Purpose

Method

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Method

Results

Conclusions

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