Abstract
BackgroundIn an earlier pilot study with 10 women, we investigated a new approach for therapy of faecal incontinence (FI) due to obstetric trauma, involving ultrasound-guided injection of autologous skeletal muscle-derived cells (SMDC) into the external anal sphincter (EAS), and observed significant improvement. In the current study, we tested this therapeutic approach in an extended patient group: male and female patients suffering from FI due to EAS damage and/or atrophy. Furthermore, feasibility of lower cell counts and cryo-preserved SMDC was assessed.MethodsIn this single-centre, explorative, baseline-controlled clinical trial, each patient (n = 39; mean age 60.6 ± 13.81 years) received 79.4 ± 22.5 × 106 cryo-preserved autologous SMDC. Changes in FI parameters, Fecal Incontinence Quality of Life (FIQL), anorectal manometry and safety from baseline to 1, 6 and 12 months post implantation were evaluated.ResultsSMDC used in this trial contained a high percentage of myogenic-expressing (CD56+) and muscle stem cell marker-expressing (Pax7+, Myf5+) cells. Intervention was well tolerated without any serious adverse events. After 12 months, the number of weekly incontinence episodes (WIE, primary variable), FIQL and patient condition had improved significantly. In 80.6% of males and 78.4% of females, the WIE frequency decreased by at least 50%; Wexner scores and severity of FI complaints decreased significantly, independent of gender and cause of FI.ConclusionsInjection of SMDCs into the EAS effectively improved sphincter-related FI due to EAS damage and/or atrophy in males and females. When confirmed in a larger, placebo-controlled trial, this minimal invasive procedure has the potential to become first-line therapy for FI.Trial registrationEU Clinical Trials Register, EudraCT 2010-023826-19 (Date of registration: 08.11.2010).
Highlights
In an earlier pilot study with 10 women, we investigated a new approach for therapy of faecal incontinence (FI) due to obstetric trauma, involving ultrasound-guided injection of autologous skeletal musclederived cells (SMDC) into the external anal sphincter (EAS), and observed significant improvement
In the current study, we wanted to test the efficacy of ultrasound-guided SMDC implantation into the EAS in an extended target group: patients suffering from FI associated with EAS damage and/or EAS atrophy
The main aim of the present study was to extend the testing of ultrasound-guided SMDC injection to a population frequently affected by FI: patients suffering from FI due to EAS damage and/or especially atrophy
Summary
In an earlier pilot study with 10 women, we investigated a new approach for therapy of faecal incontinence (FI) due to obstetric trauma, involving ultrasound-guided injection of autologous skeletal musclederived cells (SMDC) into the external anal sphincter (EAS), and observed significant improvement. Therapeutic options for faecal incontinence (FI) are manifold [1, 2] Conservative measures such as biofeedback techniques or dietary changes can be offered to individuals suffering from FI. They might be ineffective so that surgical interventions are needed. A new approach that might meet this need is cell therapy using autologous cells to restore functionality of muscular structures [12]. This approach is based on the isolation of quiescent satellite cells from skeletal muscle
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