title: Novel bronchoscopic treatment for bronchopleural fistula using adipose-derived stromal cells.
abstract: OBJECTIVE
  In this report, we describe the successful bronchoscopic management of bronchopleural fistula in two patients, using autologous adipose-derived stromal cells. Cell therapy was considered for 2 cases of bronchopleural fistula refractory to conventional surgical treatment after control of the primary disease was confirmed and active pleural infection was ruled out. Briefly, adipose-derived stem cells were first isolated from lipoaspirate and used without cell expansion. In 24 months, we have not received more patients with bronchopleural fistula in our hospital and we have not been able to include more patients.
  
  
  METHODS
  Briefly, adipose-derived stem cells were first isolated from lipo-aspirate and used without cell expansion. A bronchopleural fistula was identified through bronchoscopy, and the mucosa surrounding the fistula was ablated with an argon plasma coagulator. Isolated stem cells were then endoscopically injected into the de-epithelialized area and fistulous tract. If an open thoracostomy was present at the time of the intervention, the same procedure was performed on the pleural side. Bronchoscopic follow-up was scheduled weekly during the first month, monthly during the first year, and then yearly. The underlying etiologies were left pneumonectomy and right lower video-assisted lobectomy for non-small-cell lung cancer. The sizes of the fistulas were 6 mm and 3 mm in diameter, respectively.
  
  
  RESULTS
  Both patients were discharged on the first postoperative day. The 3-year follow-up revealed a successful and maintained fistula closure, no treatment-related adverse reactions, nonlocal malignant recurrence and improved quality of life.
  
  
  CONCLUSIONS
  This preliminary study showed that bronchoscopic application of autologous adipose-derived stem cells is a feasible, safe and effective procedure for treating bronchopleural fistula.
authors.affiliation: Department of Thoracic Surgery, University Hospital La Paz, Madrid, Spain.
authors.forename: Prudencio J
authors.initials: PJ
authors.lastname: Díaz-Agero Álvarez
authors.affiliation: Health Research Institute-Fundación Jiménez Díaz, (IIS-FJD), Madrid, Spain.
authors.forename: Yury A
authors.initials: YA
authors.lastname: Bellido-Reyes
authors.affiliation: Department of Thoracic Surgery, University Hospital La Paz, Madrid, Spain.
authors.forename: Joaquín G
authors.initials: JG
authors.lastname: Sánchez-Girón
authors.affiliation: Health Research Institute-Fundación Jiménez Díaz, (IIS-FJD), Madrid, Spain; Department of Surgery, Universidad Autónoma de Madrid, Madrid, Spain.
authors.forename: Damián
authors.initials: D
authors.lastname: García-Olmo
authors.affiliation: Health Research Institute-Fundación Jiménez Díaz, (IIS-FJD), Madrid, Spain; Department of Surgery, Universidad Autónoma de Madrid, Madrid, Spain. Electronic address: mariano.garcia@idcsalud.es.
authors.forename: Mariano
authors.initials: M
authors.lastname: García-Arranz
mesh_terms: D017667:Adipocytes / Q000166:cytology; D000273:Adipose Tissue / Q000166:cytology*; D000328:Adult; D000368:Aged; D001983:Bronchial Fistula / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D001999:Bronchoscopy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010995:Pleural Diseases / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D011013:Pneumonectomy; D011859:Radiography; D012008:Recurrence; D017154:Stromal Cells / Q000166:cytology
keywords: Bronchoscopy fistula; Cell transplantation; Stem cells; Wound closure