Inflammation in anal fistula

Onkelen, Robbert S. van; Gosselink, M.; Laman, Jon D.; Schouten, W. R.

doi:10.1111/codi.12991

Cited by 4 publications

(3 citation statements)

References 2 publications

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“…Using sophisticated molecular techniques less prone to the risks of poor sensitivity and contamination, recent studies have demonstrated the absence of viable bacteria in the fistula track . Granulation tissue is constantly present, and there has been a recent emphasis on the potential role of chronic inflammation .…”

Section: Discussionmentioning

confidence: 99%

Immunopathological characterization of cryptoglandular anal fistula: a pilot study investigating its pathogenesis

et al. 2016

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Section: Discussionmentioning

confidence: 99%

Immunopathological characterization of cryptoglandular anal fistula: a pilot study investigating its pathogenesis

et al. 2016

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“…Recently, other work has reported that no live bacteria were present in the fistula tract [ 22 ], thus dismantling this hypothesis. What is clear is that there is formation of granulation tissue that is constantly present, suggesting a possible role of chronic inflammation [ 6 , 22 , 23 ].…”

Section: Discussionmentioning

confidence: 99%

The pathogenesis of cryptoglandular anal fistula: New insight into the immunological profile

et al. 2022

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Aim The aetiology of cryptoglandular anal fistula (AF) is poorly understood. Evidence suggests that persistence and/or recurrence of the disease is more related to inflammatory than infectious factors. The aim of this study was to investigate the immune profile of cryptoglandular AF and to perform a histopathological characterization. Method Fistulectomy was performed in all patients; healthy ischioanal fat from the same patients was used as a control. Samples were evaluated by the Luminex xMAP system for the detection of 27 analytes. AF tissues were analysed using immunofluorescence. Staining was performed using primary antibodies to identify M1 inflammatory and M2 anti‐inflammatory macrophages. Selective staining of total T lymphocytes and different T lymphocyte subsets was performed. Results Twenty patients with AF underwent a fistulectomy. Specific cytokine pathways differentiated AF from healthy tissue: pro‐inflammatory cytokines interleukin (IL)‐1β, IL‐4, IL‐8 and IL‐17 and the anti‐inflammatory cytokine IL‐10 were overexpressed in AF compared with controls. Chemokines involved in macrophage recruitment (CCL2, CCL3, CCL4) were higher in AF than in healthy fatty tissue. Moreover, we showed that Tc17 cells characterize AF patients, thus confirming the enzyme‐linked immunosorbent assay data. Furthermore, elevated infiltration of CD68+ myeloid cells and a reduction of the M1/M2 ratio characterize AF patients. Conclusion A combination of inflammatory cytokines, chemokines and growth factors reside in the wound microenvironment of AF patients. For the first time an important prevalence of Tc17 cells and a reduction in the M1/M2 ratio was observed, thus suggesting new insights into the immunological characterization of AF patients.

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“…Recent emphasis has been placed on the potential role of chronic inflammation in the development of AF ( 25 ), with epithelial to mesenchymal transition (EMT) representing one possible pathophysiological mechanism both in Crohn's ( 26 ) and cryptoglandular AF ( 27 ). Future studies are needed to determine whether the immunomodulatory properties of the HAM may interfere with the pathway(s) involved in the proinflammatory process.…”

Section: Discussionmentioning

confidence: 99%

Anal Fistula Human Amniotic Membrane Endosealing (F-HAME): A Proof of Concept Study

et al. 2022

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The treatment of cryptoglandular anal fistula (AF) is often a challenge for surgeons. Several sphincter-saving procedures have been described as an alternative to fistulotomy, with the common goal of promoting healing and preserve anal continence. The aim of this proof of concept study was to assess the outcomes of human amniotic membrane (HAM) implantation in cryptoglandular transphincteric AF. Two consecutive female were recruited. The primary outcome was clinical healing at 6 months. Secondary outcomes were ultrasonographic healing, complications and reinterventions, AF symptoms, fecal incontinence, psychological impact of treatment, recurrence, development of additional AF, patient satisfaction, and quality of life, as measured using validated questionnaires. Both patients (40 and 54-year-old) previously underwent incision and drainage of anal abscess with concomitant seton placement. HAM implantation was performed as a day case under local anesthesia. No intra- or post-procedural complications occurred. Clinical and radiological healing were not achieved at 6 months. However, the external outlet discharge diminished through time, with sustained improvements in quality of life. Clinical healing occurred at 7 months in both patients. Psychological impact of treatment and patient satisfaction were overall good, with improvements in the PHQ-9, GAD-7, and Short Assessment of Patients Satisfaction. HAM implantation is safe and improves patients' quality of life, progressively leading to clinical healing. Future studies are needed to assess its safety in other etiology of AF.

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Inflammation in anal fistula

Cited by 4 publications

References 2 publications

Immunopathological characterization of cryptoglandular anal fistula: a pilot study investigating its pathogenesis

Immunopathological characterization of cryptoglandular anal fistula: a pilot study investigating its pathogenesis

The pathogenesis of cryptoglandular anal fistula: New insight into the immunological profile

Anal Fistula Human Amniotic Membrane Endosealing (F-HAME): A Proof of Concept Study

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