Stem Cell Transplants for Peri-anal Fistulas

I'd like to nominate this article for one of the top ten most interesting stem cell applications to date.


The background

Crohn's disease is an inflammatory bowel disease which can cause swelling anywhere along the digestive tract but mostly affects the small intestine. The most common symptom leading to its diagnosis is diarrhea. The most common complication leading to its diagnosis is the blockage of the intestines. Due to the thickening of the intestinal wall, the passage narrows and may also cause sores or ulcers involving surrounding tissues and organs such as the bladder, vagina, and the anus and rectum.


Anal Fistulas

The anal glands which drain into the anal canal can become blocked and infected, resulting in an abscess formed in an abnormal tunnel called a fistula. The fistula can cross the anal sphincter, and if infected, may present the patient with a painful and problematic condition.

Crohn's disease is typically diagnosed in people (males and females) between the ages of 15-35, but can strike at any point in their life.


Phase II Clinical Trials

The article described a clinical study conducted in Madrid, where patients with Crohn's disease (or a similar glandular condition) and symptomatic anal fistulas were treated with and without stem cells complementing the existing therapeutic strategy.

Previously, patients with perianal fistulas were provided with the option of surgery. However, while this cures the fistula, it leaves behind a scar which can cause incontinence problems. What they were performing in Madrid, were fibrin glue injections which involves the injection of a biodegradable glue into the fistula to close the tunnel and prevent any bacteria from entering to form an abscess. This procedure provides minimal risk of incontinence (no surgery to damage muscle tissue) and also much less stress for the patient.

Disappointingly, fibrin glue treatment only cures 16% of conditions and this prompted the doctors to explore a more definitive method of curing the fistula internally and externally (closing the fistula completely).


Plus Stem Cells

In this phase II clinical trial led by Prof. Damian Garcia-Olmo of La Paz Hospital, patients were treated with fibrin glue and stem cells derived by liposuction from their own fatty tissue. The cells were grown in the lab to an order of 20 million and re-injected into the internal opening of the fistula 3 months later. Control patients only got the fibrin glue.

The patients were monitored for 8 weeks and if the fistula still was not healed, the patients got a second dose of 40 million stem cells + fibrin glue or fibrin glue alone depending on which group they were in (note that the second dose of stem cells was also a double dose).

The stem cell treatment was apparently effective and recorded a significant difference and the patients are now leading a better quality of life with no further fistulas.


I wonder if Prof. Garcia-Olmo will try this procedure with stem cells from other sources which may be able to avoid surgical intervention for extraction of stem cells altogether. I'm not sure what the incidence of Crohn's disease is in Malaysia, but as it seems to be a condition which might be related to urban lifestyle (and possibly poor diet) there might be an undiagnosed population out there who are too embarrassed to seek help unless its very severe. Well, at least now there is way to improve the chances of removing an uncomfortable part of the problem altogether with stem cells.

There is no cure for Crohn's disease at this time and treatment involved medication and/or surgery.