Treatment of enterocutaneous fistula in Crohn's Disease with adipose-derived stem cells: a comparison of protocols with and without cell expansion.
BACKGROUND
Expanded adipose-derived stem cells (ASC) have been shown to be effective in treating Crohn's patients with enterocutaneous fistulas. It is possible that unexpanded cells corresponding to the stromal vascular fraction (SVF) may also be effective.


METHODS
A subpopulation of patients from a previous proof-of-concept phase I study with enterocutaneous fistulas received autologous expanded ASCs. The same selection criteria for inclusion were applied to patients who underwent SVF implantation to treat enterocutaneous fistulas. After tract curettage, cell suspensions (either SVF cells from lipoaspirate or expanded ASCs) were injected into the tract walls, and the fistulous tract was sealed with fibrin adhesive (with or without cells).


RESULTS
In the series that received ASCs, four fistulas could be evaluated, and cure was achieved in three out of four cases. In the series that received SVF cells, four fistulas were evaluated, with cure achieved in one out of four cases.


CONCLUSIONS
Although a comparison of case series cannot be considered firm evidence, a therapeutic protocol that uses expansion prior to implantation does seem to be more effective than one that uses SVF cells directly from a lipoaspirate sample.
Garcia-Olmo
Damian
D
Department of Surgery, La Paz University Hospital, Madrid, Spain. damian.garcia@uam.es
Herreros
Dolores
D
Pascual
Maria
M
Pascual
Isabel
I
De-La-Quintana
Paloma
P
Trebol
Jacobo
J
Garcia-Arranz
Mariano
M
D000273:Adipose Tissue / Q000166:cytology*; D000328:Adult; D002469:Cell Separation; D003424:Crohn Disease / Q000150:complications*; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use; D006801:Humans; D007412:Intestinal Fistula / Q000209:etiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D033581:Stem Cell Transplantation; D017154:Stromal Cells / Q000166:cytology; D014014:Tissue Adhesives / Q000627:therapeutic use; D014182:Transplantation, Autologous; D014945:Wound Healing
D015718:Fibrin Tissue Adhesive; D014014:Tissue Adhesives