The most common type of fistula associated with Crohn’s are anal fistulas which create “narrow tears that extend from the muscles that control the anus (anal sphincters) up into the anal canal.”
Fistulas are just one of many Crohn’s-related issues which are grouped into the category of extra-intestinal conditions. Such conditions demonstrate that Crohn’s is “much more than a bathroom issue.” (IBD News Today/ IBD News)
Or, as IBD News contributing author Mary Horsley says, “It’s not all about the poop!”
If you have suffered with fistulas, you are aware they have a high probability of becoming infected. Treatment may include a short round of antibiotics and medicated creams. A stool softener is often used to reduce the discomfort of bowel movements. Also, pain relievers and anti- inflammatory medications are somewhat helpful. (Jackson/Sigelbaum Gastroenterology)
The last resort for treating fistulas is surgery, which is seldom done unless there are complications, such as an abscess. The surgical approach is often unsuccessful, as relapse, with the appearance of new fistulas, often occurs. (Web MD)
Good news on the research front
But, there’s good news on the research front.
Mesenchymal stem cells, (MSCs) have recently been shown to be involved with the repair of tissue. This property makes MSCs a viable treatment option for treatment of many diseases, to include fistulas associated with Crohn’s.
Per Euro Stem Cell, MSCs, referred to as “the 'other' bone marrow stem cells” are an example of tissue or 'adult' stem cells.
Euro Stem Cell also informs us that blood marrow contains many types of stem cells, to include blood stem cells, also called hematopoietic stem cells (HSCs).
Many scientific studies are researching the possible use of both MSCs and HSCs in treating human diseases, to include Crohn’s disease.
One such study, “Mesenchymal Stem Cells to Treat Crohn's Disease with Fistula”, has been published in the Human Gene Therapy journal. The study’s abstract states that “several studies suggest that mesenchymal stem cells (MSCs) could improve Crohn's disease and Crohn's fistula.” In fact, that research reports that many in the study group have achieved remission. Additionally, the study “showed that MSCs can be safely administered to Crohn's disease patients,” (PubMed)
Before we go any further, let’s backtrack a bit and clarify exactly what stem cells are.
What are stem cells?
Stem cells are ‘neutral’, in a sense. They are composed of genetic material but aren’t any certain type of body cell. They are therefore referred to as ‘undifferentiated’ cells. However, stem cells have the amazing ability to become and then reproduce whatever type of tissue or cell that’s required by the body.
As the National Institute of Health (NIH) informs us, stem cells can act in organs as an ‘internal repair system’ to repair or replace damaged cells as required.
Where do the stem cells for medical use come from?
Because of this healing ability, stem cells are seen by scientists as an untapped opportunity for the treatment of numerous human conditions, to include Crohn's.
For human use, Mesenchymal Stem Cells (MSCs) are available from bone marrow, and also from adipose (fatty) tissue. In contrast, hematopoietic stem cells (HSCs) are “usually derived from bone marrow, peripheral blood, or umbilical cord blood.” (Medline Plus)
Per Wikipedia, we learn that transplants with hematopoietic stem cells (HSCs) had a prior history of extreme complications, but now that the post-procedure survival rate has improved, its use has expanded beyond cancer to autoimmune diseases. As Crohn’s is an autoimmune disease, this increases the hope that treatment with stem cell infusion will lead to a hopeful positive outcome for those with Crohn’s.
Stem cell infusion is considered by scientists in the field as a possible treatment and hopeful cure for Crohn’s-associated fistulas.
Stem cell infusion
From Boston Children’s’ Hospital, we learn that this genetic material (stem cells) is harvested for IV administration to the recipient of the cells.
When the stem cells are administered by IV infusion, (referred to as a stem cell transplant) the stem cells find their own way to the area of trouble and begin forming the needed new tissues and cells.
Can you catch the excitement about this possible treatment for Crohn’s? Isn’t it mind-blowing to know other researchers are also studying stem cell treatment for?
Other research studies on stem cell treatment for Crohn’s
- Per Medscape, in the largest series reported, patients with Crohn's disease achieved remission, but usually required continued use of immunosuppressive drugs after Hematopoietic Stem Cell (HSCs) transplantation. (Autologous Stem Cell transplantation International Crohn's Disease (ASTIC) Trial group)
- Per IBD News, hematopoietic stem cell transplant therapy is ‘potentially effective’ in Crohn’s Disease while a random-effects meta-analysis of all perianal Crohn’s disease studies also demonstrated that 57% (251 patients) had healed fistulas after stem cell therapy. The study was published in the journal Stem Cell Research & Therapy. However, the study results noted that “toxicity remains the most significant barrier to systemic stem cell therapy in patients with Crohn’s.”
- An NCBI report on Stem Cell Therapy for Perianal Fistulas in Crohn’s Disease: “mesenchymal stem cells lessen the inflammatory response, intestinal inflammation and consequences associated with perianal fistulas.”
- Mesenchymal Stem Cells to Treat Crohn's Disease with Fistula. Zhang XM1,2, Zhang YJ1, Wang W et al). Several studies suggest that mesenchymal stem cells (MSCs) could improve Crohn's disease and Crohn's fistula and that MSCs can be safely administered to Crohn's disease patients, with some achieving positive clinical responses.” Also, these cells have a “regenerative capability,” allowing them to morph “into fibroblasts to help form a scar in the tract of a fistula.” (PubMed)
More about stem cells and Crohn’s
Per Stem Cells and Research: “Scientists are also exploring ways to stimulate self-repairing, coaxing stem cells in the human body to generate healthy cells to heal damaged tissue from within or to prevent further damage.”
Additionally, from the same source, stem cell research “holds tremendous promise for medical treatments, but scientists still have much to learn about how stem cells, and the specialized cells they generate, work in the body and their capacity for healing.”
Studies regarding Crohn’s Disease and fistulas have been carried out with both mesenchymal stem cells (MSCs) and hematopoietic stem cells (HSCs).
Per IBD News, the HSC transplants are suspect as “toxicity remains the most significant barrier to systemic stem cell therapy (with HSCs) in patients with Crohn’s.”
On the other hand, MSCs are found to “lessen the inflammatory response, intestinal inflammation and consequences associated with perianal fistulas.” (IBD News)
However, all seem to agree that further research is needed on the use of stem cells to help heal fistulas to those with Crohn’s.
Nevertheless, “though MSC therapy appears promising, there are still key questions to be answered, such as the ideal type of MSC, the dosage of cells required, the number of injections (or IV therapy), and its long-term efficacy.” (NIH)