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The Role of Stem Cells in the Treatment of Anal Fistulas

  • George E. Theodoropoulos
  • Efterpi Mihailidou
  • Georgios N. Kolovos
Chapter
Part of the Stem Cell Biology and Regenerative Medicine book series (STEMCELL)

Abstract

The (peri)anal fistula or fistula-in-ano is defined as an abnormal channel between the anal canal and the surrounding structures, usually the perianal skin. In many occasions anal fistula treatment may become challenging. Available surgical methods are still plagued by recurrences and may be related to varying degrees of fecal incontinence. Except for the complex cases of idiopathic anal fistulas, the results provided by current medical and surgical approaches for the difficult to treat Crohn’s disease-related fistulas remain rather disappointing. In addition to their several applications, mesenchymal stromal cells (MSCs) injection in the fistula tract has arisen as a novel method with potential to manage this difficult entity. Their anti-inflammatory and immune-regulatory properties play major role at their use as a proposed treatment modality for anal fistulas. This chapter focuses on the methods of isolation and application of both autologous and allogeneic MSCs, described by the groups experienced in their use at anal fistulas, as well as on the analysis of published series, with emphasis on MSC efficacy and likely side effects. Existing studies suggest that both adipose tissue and bone marrow have been used as sources for MSCs in clinical trials for treatment of anal fistulas. Except for two phase III clinical trials, all the rest in this field were conducted as phase I and II, aiming at safety and efficacy of MSCs. MSCs have been proven safe for clinical practice, and they can be currently used alone or as an adjunct to conventional surgical treatments for complex anal fistulas.

Keywords

Anal fistula Fistula-in-ano Mesenchymal stem cells Autologous stem cells Allogeneic stem cells Crohn’s disease Adipose-derived stem cells 

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • George E. Theodoropoulos
    • 1
  • Efterpi Mihailidou
    • 1
  • Georgios N. Kolovos
    • 1
    • 2
  1. 1.Medical School, National and Kapodistrian University of AthensAthensGreece
  2. 2.Colorectal Unit, First Department of Propaedeutic Surgery, Medical SchoolNational and Kapodistrian University of AthensAthensGreece

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