Implantation of autologous muscle-derived stem cells in treatment of fecal incontinence: results of an experimental pilot study.
BACKGROUND
The aim of this study is to present results of the implantation of autologous myoblasts into the external anal sphincter (EAS) in ten patients with fecal incontinence.


METHODS
After anatomical and functional assessment of the patients' EAS, a vastus lateralis muscle open biopsy was performed. Stem cells were extracted from the biopsy specimens and cultured in vitro. Cell suspensions were then administered to the EAS. Patients were scheduled for follow-up visits in 6-week intervals. Total follow-up was 12 months.


RESULTS
All biopsy and cell implantation procedures were performed without complications. Nine of the patients completed a full 12-month follow-up. There was subjective improvement in six patients (66.7 %). In manometric examinations 18 weeks after implantation, squeeze anal pressures and high-pressure zone length increased in all patients, with particularly significant sphincter function recovery in five patients (55.6 %). Electromyographic (EMG) examination showed an increase in signal amplitude in all patients, detecting elevated numbers of propagating action potentials. Twelve months after implantation two patients experienced deterioration of continence, which was also reflected in the deterioration of manometric and EMG parameters. The remaining four patients (44.4 %) still described their continence as better than before implantation and retained satisfactory functional examination parameters.


CONCLUSIONS
Implantation of autologous myoblasts gives good short-term results not only in a subjective assessment, but also in objective functional tests. It seems that this promising technology can improve the quality of life of patients with fecal incontinence, but further study is required to achieve better and more persistent results.
3rd Department of General Surgery, Jagiellonian University Medical College, ul. Pradnicka 35-37, 31-202, Kraków, Poland. m.romaniszyn@mp.pl.
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Romaniszyn
Department of Reproductive Biology and Stem Cells, Institute of Human Genetics, Polish Academy of Science, Strzeszynska 32, 60-479, Poznan, Poland.
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Rozwadowska
Department of Reproductive Biology and Stem Cells, Institute of Human Genetics, Polish Academy of Science, Strzeszynska 32, 60-479, Poznan, Poland.
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Malcher
Department of Reproductive Biology and Stem Cells, Institute of Human Genetics, Polish Academy of Science, Strzeszynska 32, 60-479, Poznan, Poland.
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Kolanowski
3rd Department of General Surgery, Jagiellonian University Medical College, ul. Pradnicka 35-37, 31-202, Kraków, Poland.
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Walega
Department of Reproductive Biology and Stem Cells, Institute of Human Genetics, Polish Academy of Science, Strzeszynska 32, 60-479, Poznan, Poland. kurpimac@man.poznan.pl.
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Kurpisz
D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000503:physiopathology / Q000601:surgery; D004576:Electromyography; D005242:Fecal Incontinence / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D032446:Myoblasts / Q000637:transplantation*; D010865:Pilot Projects; D011312:Pressure; D011446:Prospective Studies; D052097:Quadriceps Muscle / Q000166:cytology / Q000601:surgery; D020127:Recovery of Function; D014182:Transplantation, Autologous / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult
Anal manometry; Electromyography; Fecal incontinence; Muscle regeneration; Myoblasts; Stem cells