Efficacy and Safety of Mesenchymal Stem Cells in Treatment of Complex Perianal Fistulas: A Meta-Analysis

Complex perianal fistula is a highly debilitating and difficult to treat condition. Local mesenchymal stem cell (MSC) therapy for perianal fistula has shown considerable promise but still remains controversial. Therefore, we performed the meta-analysis to evaluate the efficacy and safety of local MS...

Full description

Saved in:
Bibliographic Details
Main Authors: Fang Cheng, Zhong Huang, Zhi Li
Format: Article
Language:English
Published: Wiley 2020-01-01
Series:Stem Cells International
Online Access:http://dx.doi.org/10.1155/2020/8816737
Tags: Add Tag
No Tags, Be the first to tag this record!
_version_ 1832546982832373760
author Fang Cheng
Zhong Huang
Zhi Li
author_facet Fang Cheng
Zhong Huang
Zhi Li
author_sort Fang Cheng
collection DOAJ
description Complex perianal fistula is a highly debilitating and difficult to treat condition. Local mesenchymal stem cell (MSC) therapy for perianal fistula has shown considerable promise but still remains controversial. Therefore, we performed the meta-analysis to evaluate the efficacy and safety of local MSC therapy for complex perianal fistula. PubMed and Embase databases were searched for published randomized clinical trials (RCTs) that reported local MSC therapy for complex perianal fistulas. The effectiveness and safety data analysis was conducted using RevMan5.3. Subgroup analyses were performed based on the characteristics of the studies. Seven RCTs with 730 participants were included. Local MSC treatment showed significantly higher healing rate (HR) of perianal fistulas compared to control (odds ratio (OR) = 2.03; 95% confidence interval (CI) 1.50, 2.74; P<0.00001). MSCs combined with fibrin glue therapy can improve the HR compared with fibrin glue alone (OR=3.27; 95% CI 1.15, 9.28; P=0.03). Subgroup analyses showed that local therapy can improve the HR in patients with perianal fistulas associated with Crohn’s disease (CD) (OR=2.05; 95% CI 1.41, 3.00; P=0.0002) and cryptoglandular origin (no-Crohn) (OR=2.98; 95% CI 0.86, 10.29; P=0.08). The pooled OR for studies that combined reepithelialization of the external opening with pelvic magnetic resonance imaging (MRI) to evaluate the healing of fistulas was 1.77 (95% CI 1.28, 2.45; P=0.0006). The pooled OR for studies where fistula healing was defined as complete reepithelialization of external openings was 5.92 (95% CI 1.34, 26.15; P=0.02). Both autologous MSCs (OR=3.19; 95% CI 1.05, 9.65; P=0.04) and allogeneic MSCs (OR=1.97; 95% CI 1.34, 2.91; P=0.0006) can obtain higher HR for perianal fistula compared with control. The adipose-derived MSC group can obtain higher HR than the control group (OR=2.29; 95% CI 1.38, 3.79; P=0.001). There were no significant differences in adverse events (AEs) (OR=1.06; 95% CI 0.71, 1.59; P=0.77). None of the adverse events was judged to be related to MSCs. Our study supported that local MSC therapy alone or combined with fibrin glue is safe and efficacious for complex perianal fistula. In the future, more RCTs are needed to confirm this conclusion.
format Article
id doaj-art-ee884a1f8e344fb38539644a9c30913f
institution Kabale University
issn 1687-966X
1687-9678
language English
publishDate 2020-01-01
publisher Wiley
record_format Article
series Stem Cells International
spelling doaj-art-ee884a1f8e344fb38539644a9c30913f2025-02-03T06:46:30ZengWileyStem Cells International1687-966X1687-96782020-01-01202010.1155/2020/88167378816737Efficacy and Safety of Mesenchymal Stem Cells in Treatment of Complex Perianal Fistulas: A Meta-AnalysisFang Cheng0Zhong Huang1Zhi Li2Division of Gastroenterology, Zigong First People’s Hospital, Sichuan, ChinaDivision of Gastroenterology, Zigong First People’s Hospital, Sichuan, ChinaDivision of Gastroenterology, Zigong First People’s Hospital, Sichuan, ChinaComplex perianal fistula is a highly debilitating and difficult to treat condition. Local mesenchymal stem cell (MSC) therapy for perianal fistula has shown considerable promise but still remains controversial. Therefore, we performed the meta-analysis to evaluate the efficacy and safety of local MSC therapy for complex perianal fistula. PubMed and Embase databases were searched for published randomized clinical trials (RCTs) that reported local MSC therapy for complex perianal fistulas. The effectiveness and safety data analysis was conducted using RevMan5.3. Subgroup analyses were performed based on the characteristics of the studies. Seven RCTs with 730 participants were included. Local MSC treatment showed significantly higher healing rate (HR) of perianal fistulas compared to control (odds ratio (OR) = 2.03; 95% confidence interval (CI) 1.50, 2.74; P<0.00001). MSCs combined with fibrin glue therapy can improve the HR compared with fibrin glue alone (OR=3.27; 95% CI 1.15, 9.28; P=0.03). Subgroup analyses showed that local therapy can improve the HR in patients with perianal fistulas associated with Crohn’s disease (CD) (OR=2.05; 95% CI 1.41, 3.00; P=0.0002) and cryptoglandular origin (no-Crohn) (OR=2.98; 95% CI 0.86, 10.29; P=0.08). The pooled OR for studies that combined reepithelialization of the external opening with pelvic magnetic resonance imaging (MRI) to evaluate the healing of fistulas was 1.77 (95% CI 1.28, 2.45; P=0.0006). The pooled OR for studies where fistula healing was defined as complete reepithelialization of external openings was 5.92 (95% CI 1.34, 26.15; P=0.02). Both autologous MSCs (OR=3.19; 95% CI 1.05, 9.65; P=0.04) and allogeneic MSCs (OR=1.97; 95% CI 1.34, 2.91; P=0.0006) can obtain higher HR for perianal fistula compared with control. The adipose-derived MSC group can obtain higher HR than the control group (OR=2.29; 95% CI 1.38, 3.79; P=0.001). There were no significant differences in adverse events (AEs) (OR=1.06; 95% CI 0.71, 1.59; P=0.77). None of the adverse events was judged to be related to MSCs. Our study supported that local MSC therapy alone or combined with fibrin glue is safe and efficacious for complex perianal fistula. In the future, more RCTs are needed to confirm this conclusion.http://dx.doi.org/10.1155/2020/8816737
spellingShingle Fang Cheng
Zhong Huang
Zhi Li
Efficacy and Safety of Mesenchymal Stem Cells in Treatment of Complex Perianal Fistulas: A Meta-Analysis
Stem Cells International
title Efficacy and Safety of Mesenchymal Stem Cells in Treatment of Complex Perianal Fistulas: A Meta-Analysis
title_full Efficacy and Safety of Mesenchymal Stem Cells in Treatment of Complex Perianal Fistulas: A Meta-Analysis
title_fullStr Efficacy and Safety of Mesenchymal Stem Cells in Treatment of Complex Perianal Fistulas: A Meta-Analysis
title_full_unstemmed Efficacy and Safety of Mesenchymal Stem Cells in Treatment of Complex Perianal Fistulas: A Meta-Analysis
title_short Efficacy and Safety of Mesenchymal Stem Cells in Treatment of Complex Perianal Fistulas: A Meta-Analysis
title_sort efficacy and safety of mesenchymal stem cells in treatment of complex perianal fistulas a meta analysis
url http://dx.doi.org/10.1155/2020/8816737
work_keys_str_mv AT fangcheng efficacyandsafetyofmesenchymalstemcellsintreatmentofcomplexperianalfistulasametaanalysis
AT zhonghuang efficacyandsafetyofmesenchymalstemcellsintreatmentofcomplexperianalfistulasametaanalysis
AT zhili efficacyandsafetyofmesenchymalstemcellsintreatmentofcomplexperianalfistulasametaanalysis