Stem Cell Therapy for the Treatment of Crohn's Disease; Current Obstacles and Future Hopes.

Abstract

Crohn's disease (CD) is an autoimmune disease of the gastrointestinal tract, characterized by relapsing and remitting courses. The disease is debilitating in nature with three prominent phenotypic clinical presentations; fistulizing, stenosing, and inflammatory. Stem cells offer new hope for CD patients by modifying the immune response and progression of the healing process. This mini-review discusses the role of stem cells in treating CD, their effectiveness as a new therapy and their current limitations. The author conducted a literature review on recent randomized controlled trials and cohort studies concerned with the topic in question using the following keywords (Crohn's Disease, perianal fistula, Stem cell therapy, mesenchymal stem cells, remission). Clinical trials show that the stem cells are more effective in the CD-associated complex perianal fistula than the CD enteritis. At present, there are no standardized guidelines regarding dose of stem cells used, number of doses administered, route of administration, type of stem cells used. Only one group of researchers proposed a standardized procedure for injecting mesenchymal stem cells in complex perianal fistula, according to their own experience in clinical trials. Moreover, mesenchymal stem cells and their related types (placental, adipose tissue, umbilical tissue, etc.) are the safest and effective in clinical trials. Currently, the commercially available mesenchymal stem cells preparation (Darvadstrocel (Cx601)) is the only one approved by The United States Food and Drug Administration (FDA) for clinical use in refractory CD associated complex perianal fistula. Stem cell therapy (SCT) shows promise in inducing remission in refractory Crohn's colitis, and perianal fistula, but further research is required before SCT could be applied to clinical practice guidelines.