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Stem Cell Therapy Offers New Hope for Treating Fistulas

Fistulas are a common and painful complication of Crohn’s disease. Find out how stem cells can help.

By Ajai Raj

Medically Reviewed by Kareem Sassi, MD

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Stem cells can develop into many different cell types, and can be used to treat diseases.
Stem cells can develop into many different cell types, and can be used to treat diseases.
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Crohn’s disease can result in sores that bore through the intestines and into the surrounding tissue, most often around the rectal area, including the anus. These ulcers, called fistulas, will afflict about 40 percent of people with Crohn’s disease in their lifetimes, causing pain and inflammation.

Fistulas not only have a major negative impact on quality of life, but they’re also predictive of poor long-term outcomes, according to a study published in August 2019 in the journalNature Reviews Gastroenterology and Hepatology.

They’re also notoriously difficult to treat. According to an article published in October 2019 in the journalGastroenterology and Hepatology, antibiotics may be effective in the short-term, but symptoms recur in over 90 percent of patients who are treated. Immunosuppressants are another treatment option, but the limited data available suggests that they only help about a quarter of patients who are treated with them.

In one study, the anti-tumor necrosis factor (anti-TNF) drug Remicade (infliximab) benefited about half the patients who achieved remission in 14 weeks and sustained a positive response for a year, but more research is needed.

Surgery is another option for treating fistulas, but it’s generally avoided unless there are other complications, such as hemorrhaging or sepsis. And fistulas often recur even after surgical treatment. More effective and safer options are needed to better treat fistulas in people with Crohn’s disease.

Stem Cells — a Potentially Better Approach

Therapy with stem cells may offer a safer and more effective means of treating fistulas than existing methods. Stem cells are unique cells that have the ability to differentiate into other types of cells, as well as to self-replicate and adhere to plastic. As a result, they provide a highly promising strategy for treating a variety of diseases, such as injuries to the heart, lungs, kidneys, and liver.

Where Crohn’s is concerned, cells known as adipose mesenchymal stem cells, derived from a person’s own fat tissue, have been found to be an effective treatment for fistulas in a number of trials.

A review published in November 2019 in theCanadian Journal of Gastroenterology and Hepatologyexamined findings from seven studies of stem cell therapy for Crohn’s fistulas, and found effectiveness ranged from 50 to 85 percent.

Moreover, stem cell therapy has not been found to be associated with any negative side effects, apart from those that also occur with treatment using a placebo: pain at the site of injection, or abscesses that occur due to bacteria that are already present in the fistulas themselves.

“There are probably a couple of different mechanisms that make stem cell therapy effective for treating fistulas in Crohn’s disease,” says William Faubion, MD, a consultant in the division of gastroenterology and hepatology at the Mayo Clinic in Rochester, Minnesota. “One is that because of their anti-inflammatory effect, stem cells decrease the amount of inflammation that’s present in the Crohn’s fistula, allowing the body to heal.

“Stem cells will also make proteins that encourage the normal healing responses of the body, and provide a matrix for healthy tissue to grow and close up those fistulas that are related to Crohn’s disease,” Dr. Faubion adds.

Increasing Stem Cell Effectiveness

Faubion is at work on a method to increase the effectiveness of stem cell therapy for treating Crohn’s fistulas. At present, he says, stem cell therapy is somewhat imprecise, and getting the stem cells to adhere to fistulas for long enough to promote healing is a challenge. He and his colleagues presented the results of preliminary trials of a potentially more effective approach in a paper published in July 2019 in the journalGastroenterology.

“We grew the cells initially on a matrix,” or a plastic scaffold for holding cells, “and then we pulled the matrix through the fistula, and we think that there’s a few advantages,” Faubion says. One advantage is that, because the stem cells stick to the plastic, they have time to turn into healthy tissue to close the fistula.

“Another advantage is feasibility — we think this is a simpler way to deliver the stem cells into fistulas,” he says.

The initial study found this method to be safe, and to promote healing in 10 out of 12 patients studied. Faubion says that he and his team are in the process of planning another trial to further study the effectiveness of this approach.






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Date: 05.12.2018, 17:20 / Views: 81364