Paulo Gustavo Kotze*, Antonino Spinelli and Amy Lightner
Background: the management of complex perianal fistulas in Crohn’s disease (CD) represents a challenge for patients, gastroenterologists and colorectal surgeons. There are clear limitations with current medical and surgical options, and healing rates remain far from what is expected. A multidisciplinary approach with optimized medical therapy, usually anti-TNF agents, associated with setons and additional surgical techniques is currently the best strategy to aim fistula healing.Methods: comprehensive review of the literature on the use of mesenchymal stem cells (MSCs). Results: The use of mesenchymal stem cells (MSCs) has recently emerged as a promising new therapeutic strategy for complex fistulas in CD patients. This review summarizes the evidence of the use of MSCs in complex CD fistulas, by exploring in detail the types of cells that can be used and their modes of delivery. Additionally, the results of the most recent phase III randomized trial with local MSCs injection are described, and future challenges of this therapeutic option are discussed. Conclusions: the use of MSCs represent a hope for better outcomes in patients with CD related perianal fistulas. More research in the field will help to position this specific therapy in treatment algorithms.
Colorectal Surgery Unit, IBD outpatient clinics, Catholic University of Paraná, Curitiba, Division of Colon and Rectal Surgery, Humanitas Clinical and Research Center, Rozzano, Division of Colon and Rectal Surgery, Mayo Clinic, Rochester