Stem Cell Therapy Shows Promise for Crohn's Fistulas

This comprehensive review examines how mesenchymal stromal cells (MSCs)—including those from fat tissue—may help heal stubborn perianal fistulas in Crohn's disease patients.

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Crohn's Fistulas Affect One-Third of Patients

Perianal fistulas are abnormal tunnel-like connections near the rectum. They develop in about 20 percent of Crohn's disease patients. These fistulas cause significant pain and dramatically reduce quality of life. They tend to follow a pattern of improvement and relapse, making long-term healing extremely difficult.

Traditional treatments often fall short. Current options include medications and various surgical procedures. However, even the best treatment plans frequently fail to provide lasting results. Many also cause troublesome side effects. This reality has pushed researchers to explore stem cell therapy as a promising alternative.

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Fat Tissue Provides Abundant Healing Cells

Mesenchymal stromal cells can be harvested from several body sources. Bone marrow and fat tissue are the most common donors. Notably, fat tissue contains a much greater number of these regenerative cells than bone marrow.

Lipogems® technology offers a unique approach to processing fat tissue. The procedure takes less than 20 minutes from harvest to clinical use. It uses gentle mechanical processing rather than chemical digestion. This preserves the natural supportive structure around the cells. One consideration: patients with low body weight may have less fat tissue available for harvesting.

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Healing Cells Calm Inflammation and Repair Tissue

MSCs work through immunomodulation—they help regulate the body's immune response. In Crohn's disease, the immune system is overactive and attacks healthy tissue. MSCs can increase regulatory T cells, which act like "peacekeepers" in the immune system.

These healing cells migrate to areas of inflammation. Once there, they promote tissue repair and reduce harmful immune activity. This dual action—calming inflammation while encouraging healing—makes them particularly suited for treating Crohn's fistulas.

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Multiple Clinical Trials Show Encouraging Results

The review examined numerous studies testing MSC therapy for Crohn's fistulas. Both bone marrow and fat-derived cells have been studied. Researchers have tested different doses and delivery methods. The cells are typically injected directly around the fistula tract.

Results across studies have been promising. Many patients achieved complete fistula healing. Others showed significant improvement. The therapy appears safe, with few serious side effects reported. These findings have led to regulatory approval in some regions.

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Treatment Offers Alternative to Repeat Surgeries

Standard surgical treatments for Crohn's fistulas present challenges. Procedures that cut through muscle can cause bowel control problems in 5 to 10 percent of patients. Tissue flap repairs work less well in Crohn's patients than in those with simpler fistulas. Newer techniques like laser closure show promise but still have limited success rates in uncontrolled disease.

For patients with difficult fistulas, stem cell therapy provides a sphincter-sparing option. It avoids cutting through important muscles. It works with the body's natural healing processes. For some patients, it may reduce the need for more invasive procedures.

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Research Continues to Refine Best Approaches

Scientists are still working to optimize MSC therapy. Key questions remain about the ideal cell source, dose, and delivery method. Both single and multiple injections have been studied. Researchers continue comparing bone marrow cells with fat-derived cells.

The evidence strongly supports continued investigation. For Crohn's patients with perianal fistulas who have not responded to standard treatments, MSC therapy represents a meaningful option worth discussing with their medical team.

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Source: Gallo et al., Medicina, 2020.