Background

Autologous adipose-derived stem cells (ADSCs) are pluripotent medical stimulatory cells. In damaged tissues, they activate regeneration by secretion of various growth factors, anti-inflammatory cytokines and migration factors. Autologous ADSCs are harvested from subcutaneous fat tissue.

Methods

The aim of our study was to create a protocol of combined surgical and biologic treatment of perianal fistulas followed with transfer of autologous ADSCs into fistulas. It was a prospective study. We selected patients diagnosed with Crohn’s disease with perianal fistulas, confirmed in MRI or transanal US, with no symptoms of abscess formation. In this protocol, we started from fistulas setoning. Afterwards, two courses of biologic agents were conducted. In the next step, autologous ADSCs were harvested from subcutaneous fat tissue and transferred to inactive fistulas. We used Arthrex®system to acquire ADSCs. Further courses with biologic agents followed the ADSCs transfer. To evaluate the outcomes we used Pikarky’s Perianal Crohn’s Disease Activity Index. A good resolution was defined as fistula closure, incomplete healing as partial resolution without complete closure and fistula reactivation as no resolution.

Results

In a preliminary study we collected data of 10 patients. The mean volume of lipoaspirate was 30 ml. The mean amount of ADSCs transferred was 4 ml. The mean operative time was 90 min. The early observation time varied from 1 to 3 months. In all cases, these were bifurcated complex and trans-sphincteric fistulas. There were no cases of no resolution. Early results were promising with almost all cases of good resolution. However, longer observation is required.

Conclusion

Autologous adipose-derived stem cells in combination with surgical setoning and biological agents are a good alternative for patients with perianal manifestation of Crohn’s disease.

中文翻译：

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P667肛周瘘与自体脂肪干细胞联合治疗

背景

自体脂肪干细胞（ADSC）是多能医学刺激细胞。在受损的组织中，它们通过分泌各种生长因子，抗炎细胞因子和迁移因子来激活再生。从皮下脂肪组织中收获自体ADSC。

方法

我们研究的目的是创建一种结合外科手术和生物疗法治疗肛周瘘管，然后将自体ADSC转移至瘘管的方案。这是一项前瞻性研究。我们选择了经肛周瘘管确诊为克罗恩病的患者，经MRI或经肛门US证实，无脓肿形成症状。在该协议中，我们从瘘管结扎开始。之后，进行了两个疗程的生物制剂。下一步，从皮下脂肪组织中收集自体ADSC，并将其转移至无活动性瘘管。我们使用Arthrex®系统获取ADSC。ADSC转移后，还进行了有关生物制剂的进一步培训。为了评估结果，我们使用了Pikarky氏肛周克罗恩氏病活动指数。良好的分辨率被定义为瘘管闭合，

结果

在初步研究中，我们收集了10位患者的数据。脂肪抽吸物的平均体积为30 ml。ADSC的平均转移量为4 ml。平均手术时间为90分钟。早期观察时间从1到3个月不等。在所有情况下，这些都是分叉的复杂性和括约肌瘘。没有没有解决的情况。几乎所有情况下，早期结果都令人鼓舞。但是，需要更长的观察时间。

结论

自体脂肪干细胞与外科set割和生物制剂相结合是克罗恩病肛周表现患者的良好选择。