Treatment of perianal fistulas is challenging, but now doctors and researchers have developed a promising stem cell treatment.
Perianal fistulas, which affect people with Crohn’s disease, are small tunnels that develop between the end of the bowel and the skin near the anus.
These fistulas impair people’s quality of life and people with the condition have difficulty controlling their stools, with faeces continually leaking and a high risk of infection and other negative effects.
Unfortunately, there has been no optimal way of treating people with perianal fistulas – until now.
A new study shows that using fat grafts enriched with adipose-derived stem cells can close up the fistula, thereby eliminating the discomfort.
The procedure has greatly improved the quality of life for people receiving it.
“We have good experience with using fat tissue and stem cells to treat people with other conditions, and this study shows that this treatment also looks very promising for treating perianal fistulas. The results of the pilot study have been so positive that we are now starting a larger trial to determine how to treat patients optimally,” explains a researcher behind the discovery, Jens Ahm Sørensen, Professor and Head of Research, Department of Plastic Surgery, University of Southern Denmark, Odense.
The research published in Inflammatory Bowel Diseasesis a collaboration between Jens Ahm Sørensen and Karam Matlub Sørensen, a surgeon and Niels Qvist, a surgeon and clinical professor, both from the Research Unit for Surgery, Odense University Hospital; and Ditte Caroline Andersen, Professor at Odense University Hospital and head of the OUH CELL BENCH facility.
Positive outcomes for 75% of those treated
Twelve people with Crohn’s disease and perianal fistulas participated in the study.
Jens Ahm Sørensen explains that all 12 had tried various other treatments, including surgery, but nothing had worked. Surgical treatment of perianal fistulas has also never been optimal.
Instead, the researchers and doctors cleaned the fistula and then inserted the fat graft along the entire length of the fistula tunnel. They then closed the fistula with sutures at the end of the bowel.
The fat graft serves as the foundation for reconstructing tissues, and is further boosted with a cocktail of stem cells, thereby trying to ensure that as many cells as possible survive.
The results of the trial were as the researchers and doctors had hoped.
The procedure meant that the fistulas were clamped together by the fat tissue, closing the tunnel from the end of the bowel to the skin near the anus.
“We achieved a 75% success rate and are very pleased. One patient outside the protocol had a relapse, but we closed the fistula with another treatment. We have now monitored the patients for over 1 year; no one has experienced a relapse, and everyone’s quality of life has improved,” says Jens Ahm Sørensen.
The positive results mean that the researchers will now carry out a larger trial to investigate how to optimally treat perianal fistulas with fat grafts enriched with adipose-derived stem cells.
Jens Ahm Sørensen says that, based on the pilot study, they are not certain why the treatment has been so successful, but the following are some possible reasons.
- The surgeons were skilled.
- They inserted a fat graft around the fistula.
- Treating the fat tissue with adipose-enriched stem cells led to the result.
This will be elucidated in a new trial in which the researchers will divide a larger group of patients into three groups, each of which will receive different treatments.
- One group will only be treated with a fat graft and saline solution.
- The second group will be treated with a fat graft enriched with freshly harvested stem cells.
- The third group will be treated with a fat graft enriched with cultured stem cells.
Completely new approach
The difference between the two stem cell treatments is whether freshly harvested stem cells are simply extracted centrifugally or whether, following centrifugation, the stem cells are then cultured and refined in a tissue laboratory.
“It will be interesting to see what works best, and we will then carry out the procedure on people with Crohn’s disease and on people with perianal fistulas caused by other diseases. We need enough patients to be able to show any difference between the various treatments,” explains Jens Ahm Sørensen.
Jens Ahm Sørensen thinks that if the researchers and doctors can replicate the good results from the pilot study, it could mean a completely new approach to treating perianal fistulas.
“Then this will be seen not as a supplement or an alternative to another type of treatment but as the treatment that is used for people with perianal fistulas. The question is just whether to use freshly harvested stem cells, stem cells cultured in a laboratory or none at all. This is what we need to determine,” concludes Jens Ahm Sørensen.