Efficacy of stem cells therapy for Crohn’s fistula: a meta-analysis and systematic review

Abstract

Background Fistulas have puzzled us all the time and stem cell therapy for it is still in its infancy. We conducted a meta-analysis and systematic review to evaluate the efficacy of stem cells and its potential mechanisms in the management of Crohn’s fistula. Methods Electronic databases were searched comprehensively for studies reporting the efficacy and safety of stem cells in patients with any form of Crohn’s fistula. A random-effects model was used, and all outcomes were calculated by SPSS 24.0. Results Twenty-nine articles with 1252 patients were included. It showed that stem cell group had a higher rate of fistula healing compared to placebo group in patients of Crohn’s fistula (61.75% vs 40.46%, OR 2.21, 95% CI 1.19 to 4.11, P < 0.05). 3 × 107 cells/mL stem cell (SC) group had an advantage in fistula healing rate with 71.0% compared to other doses group of stem cells (RR 1.3, 95% CI 0.76 to 2.22). And the healing rates of patients with perianal and transsphincteric fistulas (77.95%, 76.41%) were higher than those with rectovaginal fistulas. It was an amazing phenomenon that CDAI and PDAI scores occurred an obviously transient rise with the use of stem cells after 1 month (both of P < 0.05), while they returned to the baseline level by giving stem cells 3 months later. Furthermore, the incidence rate of treatment-related adverse events in the stem cell group was significantly lower than in the placebo group (RR 0.58, 95% CI 0.30 to 1.14). Conclusions Our study has highlighted that stem cells was a promising method in the treatment of Crohn’s fistula based on its higher efficacy and lower incidence of adverse events, especially ADSCs and Cx601. While it also needs more clinical and pre-clinical studies to strengthen evidences in the future.

Treatment of Inflammatory Bowel Disease: A Comprehensive Review

“…A metaanalysis and systematic review reported that patients receiving MSCs transplantation had a higher rate of fistula healing than patients receiving placebo (61.75 vs. 40.46%, P < 0.05). MSCs transplantation, especially ADSCs, was well-tolerated with a lower incidence of adverse events than placebo (195).…”

Current Overview on the Use of Mesenchymal Stem Cells for Perianal Fistula Treatment in Patients with Crohn’s Disease

“…According to a meta-analysis based on four clinical trials involving different doses of stem cell therapy ranging from 1 × 10 7 to 9 × 10 7 MSCs per mL, the dose of 2 × 10 7 and 3 × 10 7 cells/mL were characterized by a highest rate of fistula healing in Crohn's patients [17]. However, the mentioned study is strongly limited by a low number of included patients (n = 31).…”

A systematic review of the patient burden of Crohn’s disease-related rectovaginal and anovaginal fistulas

“…Additionally, beyond the surgeries discussed in this review, it is important to note that other treatment methods, such as stem cell transplantation, have shown some degree of efficacy. A recent meta-analysis of Crohn’s fistula patients treated with stem cell transplantation utilized data from 7 studies of RVF and found a healing rate of 27.2% [ 32 ].…”