Autologous fibroblasts transplant after infliximab administration: a new approach in Crohn’s perianal fistulas?

Ascanelli, Simona; Tullio, Damiano De; Gregorio, Carmela Di; Azzena, Gianfranco; Occhionorelli, Savino

doi:10.1007/s00384-006-0141-6

Cited by 9 publications

(5 citation statements)

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“…Preclinical work at St Mark’s has demonstrated that the addition of autologous fibroblasts to a collagen glue improved the histological appearance of the healed track compared with glue alone and clinical studies are in progress 106 . A single case report of autologous fibroblasts on a biological scaffold (HYAFF) has been described in a Crohn’s patient with a trans‐sphincteric fistula 107 . The patient had a seton inserted and three doses of intravenous infliximab administered before fistulectomy and then insertion of the scaffold with autologous fibroblasts into the track until it was completely filled.…”

Section: Modified Infill Materialsmentioning

confidence: 99%

Review article: medical, surgical and radiological management of perianal Crohn’s fistulas

Tozer

Burling

Gupta

et al. 2010

Aliment Pharmacol Ther

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SUMMARY BackgroundCrohn's anal fistulas are common and cause considerable morbidity. Their management is often difficult; medical and surgical treatments rarely lead to true healing with frequent recurrence and complications. AimTo examine medical treatments previously and currently used, surgical techniques and the important role of optimal imaging. MethodsWe conducted a literature search in the Pub Med database using Crohn's, Anal Fistula, Surgery, Imaging and Medical Treatment as search terms. ResultsAntibiotics and immunosuppressants have a role, but slow initial response, side effects and relatively low remission rates of up to around a third with frequent recurrence limit their value. Long-term infliximab produces clinical remission in 36-58% of patients with combined medical and surgical management achieving optimal outcomes. Traditional and newer surgical procedures often have a high rate of recurrence with a significant risk of temporary or, in up to 10% of cases, permanent stomas, incontinence and unhealed or slowly healing wounds in 30%. ConclusionsManagement of Crohn's anal fistulas remains challenging. Established principles are to drain infection, use setons as required, aggressively manage active proctitis, give antibiotics, immunosuppressants and employ antiTNFa therapy, and they demand significant co-operation between gastroenterologists and surgeons.

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Section: Modified Infill Materialsmentioning

confidence: 99%

Review article: medical, surgical and radiological management of perianal Crohn’s fistulas

Tozer

Burling

Gupta

et al. 2010

Aliment Pharmacol Ther

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“…Complete healing was noted in 3 weeks and the patient remained healed throughout a 20-month follow-up period. 59 About one-third of Crohn's fistulae are (at least partially) epithelialized. 51 In addition to being a physical barrier, the epithelium protects the host by secreting substances with antimicrobial activity, including defensins.…”

Section: Immunological Factorsmentioning

confidence: 99%

Etiology of perianal Crohnʼs disease: Role of genetic, microbiological, and immunological factors

Tozer

Whelan

Phillips

et al. 2009

Inflammatory Bowel Diseases

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Perianal fistulation is a common complication of Crohn's disease (CD). Fistulating perianal CD appears to represent a distinct phenotype of CD, separate from luminal fistulating disease, with differing disease behavior and which often requires different therapeutic strategies. The etiology of Crohn's perianal fistulae appears to have genetic, microbiological, and immunological components. Relationships with IBD5, which codes for the organic/cation transporter and IRGM, important in the autophagy pathway, have been identified but further genetic associations remain elusive. The partially efficacious use of antibiotics and fecal diversion imply a microbiological component and, similarly, the partial efficacy of immunosuppressants and anti-tumor necrosis factor alpha (TNFalpha) treatments suggest not only that an immunological process is taking place, but also that microbiota alone cannot account for the pathogenesis. Recent work implicates failures in the tissue injury/repair process with myofibroblasts, matrix metalloproteinases, and an epithelial-to-mesenchymal transition being possible culprits. We examine these areas in a review of the current understanding of the etiology of Crohn's perianal fistulae.

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“… 143 Furthermore, transplantation of autologous skin fibroblasts and adipose tissue, 144 , 145 including stromal cells, has also been suggested for the treatment of CD perianal fistulas. 146 …”

Section: Therapeutic Modalities To Modify the Stromal Compartment mentioning

confidence: 99%

Stromal Cells in the Pathogenesis of Inflammatory Bowel Disease

Barnhoorn

Hakuno

Bruckner

et al. 2020

Journal of Crohn's and Colitis

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Up till now, research on inflammatory bowel disease [IBD] has mainly been focused on the immune cells present in the gastrointestinal tract. However, recent insights indicate that stromal cells also play an important and significant role in IBD pathogenesis. Stromal cells in the intestines regulate both intestinal epithelial and immune cell homeostasis. Different subsets of stromal cells have been found to play a role in other inflammatory diseases [e.g. rheumatoid arthritis], and these various stromal subsets now appear to carry out also specific functions in the inflamed gut in IBD. Novel potential therapies for IBD utilize, as well as target, these pathogenic stromal cells. Injection of mesenchymal stromal cells [MSCs] into fistula tracts of Crohn’s disease patients is already approved and used in clinical settings. In this review we discuss the current knowledge of the role of stromal cells in IBD pathogenesis. We further outline recent attempts to modify the stromal compartment in IBD with agents that target or replace the pathogenic stroma.

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Autologous fibroblasts transplant after infliximab administration: a new approach in Crohn’s perianal fistulas?

Cited by 9 publications

References 0 publications

Review article: medical, surgical and radiological management of perianal Crohn’s fistulas

Review article: medical, surgical and radiological management of perianal Crohn’s fistulas

Etiology of perianal Crohnʼs disease: Role of genetic, microbiological, and immunological factors

Stromal Cells in the Pathogenesis of Inflammatory Bowel Disease

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