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P406 Adipose derived regenerative cells injection as a novel method of enterovesical fistula treatment in Crohn's Disease: A case report

A. Moniuszko*1, A. Sarnowska2, W. Rogowski3, M. Durlik4, 5, G. Rydzewska1, 5

1Central Clinical Hospital of the Ministry of Internal Affairs, Department of Gastroenterology, Warsaw, Poland, 2Polish Academy of Sciences - Mossakowski Medical Research Center, Translative Platform for Regenerative Medicine, Warsaw, Poland, 3Central Clinical Hospital of the Ministry of Internal Affairs, Clinic of Urology and Oncological Urology, Warsaw, Poland, 4Central Clinical Hospital of the Ministry of Internal Affairs, Department of Gastroenterology and Transplant Surgery, Warsaw, Poland, 5Polish Academy of Sciences - Mossakowski Medical Research Center, Department of Surgical Research and Transplantology, Warsaw, Poland

Background

Up to date, the mesenchymal stromal cells (MSC) have been adapted in the treatment of fistulising Crohn`s disease with promising results. However, in most of the trials the MSC were obtained from healthy donors or needed long cultivation in laboratory environment.

Methods

A 52-year-old female, suffering from Crohn`s Disease for 12 years, did not achieve remission since the time of diagnosis, despite numerous treatments such as anti-TNFs and other non-standard therapies (i.e. tacrolimus or mycofenolate mofetil). The fistulising and penetrating subtype of the disease led to numerous laparotomies and several repositions of the ileostomy due to the formation of enterocutaneous fistula and lack of healing.

Patient was hospitalized with suspicion of urosepsis and symptoms suggestive of faecaluria. At the time two fistulas were present - enterocutaneous and perianal. The urine culture revealed severe polibacterial infection susceptible only to imipenem, however the targeted therapy did not lead to alleviation of the symptoms. The cystoscopy performed after oral application of methylene-blue colorant showed the presence of enterovesical fistula, approximately 3x1cm, with active suppuration of the intestinal content. As the patient was in critical state with signs of cachexia and had undergone numerous laparotomies, the standard surgical intervention was not considered.

After the acceptance of the Ethic Commitee, the injection of adipose derived regenerative cells (ADRC) into the enterovesical fistula was performed. Under general anaesthesia, a manual liposuction was carried out. 260 ml of lipoaspirate was immediately transferred into the CellCelution 800 system. After 2 hours, 5ml of ADRC suspended in Ringer solution was obtained.

During cystoscopy 4,5 ml solution containing 2,43*10^7 ADRC was injected through the needle routinely used for the botulin injections, in 0,5 mL portions around the fistula into the detrusor muscle. All procedure took 20 minutes. Obtained ADRC expressed in 99,5 ± 0.4% CD73, CD90 , CD105 and 9.0 ± 0,5% cells CD34, CD19, CD11b and HLA-DR surface markers.

Results

During the first 24 hours after the treatment patient suffered from temporal mild hypertension. No other AE were observed. Control cystoscopies after 2 and 3 weeks revealed complete healing of the fistula. During 5-month follow-up, the symptoms suggestive of enterovesical fistula did not recur.

Conclusion

In our study for the very first time we managed to close the enterovesical fistula in critically-ill CD patient resistant to standard treatment, as traditional surgical approach was no longer appropriate. Further studies are needed to assess the safety and efficacy of the estabilished method.