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Efficacy of Mesenchymal Stromal Cells for Fistula Treatment of Crohn’s Disease: A Systematic Review and Meta-Analysis

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Abstract

Background and Aim

The introduction of mesenchymal stromal cells (MSCs) has changed the management of Crohn’s fistula, while it remains controversial. The aim of this study was to provide an overview of efficacy and optimum state of MSCs treatment on Crohn’s fistula.

Methods

Studies reporting MSCs treatment on Crohn’s fistula were searched and included. A fixed-effects model was used to assess the efficacy of MSCs, and outcomes of healing and recurrence were used to evaluate the best states of MSCs intervention.

Results

Fourteen articles were enrolled (n = 477). Pooled analysis showed MSCs had a significant efficacy compared to other treatments [risk difference: 0.21 (0.09, 0.32), P = 0.000]. Notably, after MSCs treatment, the group of Crohn’s disease activity index (CDAI) baseline >150 group had a higher healing rate (HR) and a clinical response (a change in CDAI of >50 points) (79.17 ± 8.78 vs. 47.54 ± 15.90, P = 0.011) compared to CDAI baseline of <150. The duration time of CD and fistulas had a negative correlation with HR accompanied by MSC therapy (r = −0.900, −0.925). Then, a moderate dose MSCs (2–4 × 107 cells/ml) had a higher HR (80.07%) and lower recurrence rate (RR 13.98%) compared to other dosages. Moreover, adipose-derived MSCs therapy had an advantage over bone marrow-derived MSCs in terms of low RR (7.4 ± 4.28 vs. 13.39 ± 0.89).

Conclusions

The evidence supported the effect of MSCs at a more appropriate time of Crohn’s fistula. And CDAI baseline (the points >150) has been a candidate for evaluating effectiveness of MSCs application on Crohn’s fistula.

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Acknowledgments

This study was supported in part by the National Natural Science Foundation of China (Nos. 81272656, 81572428, 81330014).

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Authors and Affiliations

  1. Division of Gastroenterology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, Hubei Province, China

    Yantian Cao, Zhen Ding, Chaoqun Han, Huiying Shi, Lianlian Cui & Rong Lin

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  1. Yantian Cao
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Cao, Y., Ding, Z., Han, C. et al. Efficacy of Mesenchymal Stromal Cells for Fistula Treatment of Crohn’s Disease: A Systematic Review and Meta-Analysis. Dig Dis Sci 62, 851–860 (2017). https://doi.org/10.1007/s10620-017-4453-x

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