Combination biological therapy for fistular Crohn's disease: Clinical demonstration


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Abstract

Perianal fistulas are the most common and frequently encountered types of fistulas in Crohn's disease (CD). They are incurable, may worsen quality of life in a patient and increase the risk of total bowel resection. Despite the significant impact of biological (anticytokine) therapy for fistular CD, treatment in this category of patients remains a difficult task with the high risk of recurrent CD. Mesenchymal stromal cells (MSCs) having immunomodulatory properties and a great regenerative potential are currently also used to treat fistulas in CD and perianal fistulas of another etiology. The given clinical case demonstrates that complete fistula healing could be achieved only after a few local administrations of MSCs in combination with infliximab and azathioprine. World and our experiences indicate that there is a need for randomized controlled trials with a sufficient number of patients to prove the efficacy of MSCs in the combination therapy of fistulas in CD.

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Комбинированная биологическая терапия свищевой формы болезни Крона. Клиническая демонстрация. - Аннотация. Перианальные свищи - наиболее распространенные и часто встречающиеся типы свищей при болезни Крона (БК). Они с трудом поддаются лечению, ухудшают качество жизни больного и повышают риск тотальной резекции кишки. Несмотря на значительный эффект от биологической (антицитокиновой) терапии свищевой формы БК, лечение данной категории больных остается трудной задачей, с высоким риском развития рецидива БК. Мезенхимальные стромальные клетки (МСК), обладающие иммуномодулирующими свойствами и большим регенеративным потенциалом, в настоящее время также применяются для лечения свищевой БК и перианальных свищей другой этиологии. Приведенный клинический случай демонстрирует, что полного заживления свища удалось достигнуть лишь после нескольких местных введений МСК, в комбинации с инфликсимабом и азатиоприном. Мировой и наш клинический опыт демонстрирует, что необходимы рандомизированные контролируемые исследования с достаточным количеством пациентов для того, чтобы доказать эффективность МСК в комплексной терапии свищевой формы БК.
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References

  1. Sachar D.B., Andrew H.A., Farmer R.G. et al. Proposed classification of patient subgroups in Crohn's disease. Gastroenterol Intern 1992; 5: 141-154.
  2. Cosnes J., Cattan S., Blain A. et al. Longterm evolution of disease behavior of Crohn's disease. Inflamm Bowel Dis 2002; 8: 244-250.
  3. Solberg I.C., Yarn M.H., Hoie O. et al. Clinical course in Crohn's disease: results of a Norwegian population-based ten-year follow-up study. Clin Gastroenterol Hepatol 2007; 5: 1430-1438.
  4. Munkholm P., Langholz E., Davidsen M., Binder V. Disease activity courses in a regional cohort of Crohn's. Scand J Gastroenterol 1995; 30: 699-706.
  5. Rutgeerts P., Feagan B.C., Lichtenstein G.R. et al. Comparison of scheduled and episodic treatment strategies of infliximab in Crohn's disease. Gastroenterology 2004; 126: 402-413.
  6. Schnitzler E, Fielder H., Ferrante M. et al. Mucosal healing predicts long-term outcome for maintenance therapy with infliximab in Crohn's disease. Inflamm Bowel Dis 2009; 15: 1295-1301.
  7. Solberg I.C., Lygren I., Jahnsen J. et al. Mucosal healing after initial treatment may be a prognostic marker for long-term outcome in inflammatory bowel disease. Gut 2008; 57: Suppl. II: A-15.
  8. Dignass A., Van Assche G., Lindsay J.O. et at. The second European evidencebased consensus on the diagnosis and management of Crohn's disease: current management. J Crohn's Colitis 2010; 4: 28-62.
  9. Beaugerie L., Seksik P., Nion-Larmurier I. et al. Predictors of Crohn's disease. Gastroenterology 2006; 130: 650-656.
  10. Franchimont D., Louis E., Croes F., Belaiche F. Clinical pattern of corticosteroid dependent Crohn's disease. Eur J Gastroenterol Hepatol 1998; 10: 821-825.
  11. Loly C., Belaiche J., Louis E. Predictors of severe Crohn's disease. Scand J Gastroenterol 2008; 43: 948-954.
  12. Lapidus A., Bernell О., Hellers G. et al. Clinical course of colorectal Crohn's disease: a 35-year follow up study of 507 patients. Gastroenterology 1998; 114: 1151-1160.
  13. Lichtenstein G.R., Van S., Bala M. et al. Infliximab maintenance treatment reduces hospitalizations, surgeries, and procedures in fistulizing Crohn's disease. Gastroenterology 2005; 128: 862-869.
  14. Sandborn W.J., Fazio V.W., Feagan B.C. et al. American Gastroenterological Association Clinical Practice Committee. AGA technical review on perianal Crohn's disease. Gastroenterology 2003; 125: 1508-1530.
  15. Sands B.E., Anderson F.H., Bernstein C.N. et al. Infliximab maintenance therapy for fistulizing Crohn's disease. N Engl J Med 2004; 350: 876-885.
  16. Williamson P.R., Hollinger M.D., Larch S.W. et al. Twenty year review of the surgical management of perianal Crohn's disease. Dis Colon Rectum 1995; 38: 389-392.
  17. Zhang Q., Shi S., Liu Y. et al. Mesenchymal stem cells derived from human gingiva are capable of immunomodulatory functions and ameliorate inflammation-related tissue destruction in experimental colitis. J Immunol 2009; 183 (12): 7787-7798.
  18. Ciccocioppo R., Bernardo M.E., Sgarella A. et al. Autologous bone marrow-derived mesenchymal stromal cells in the treatment of fistulising Crohn's disease. Gut 2011; 60 (6): 788-798.
  19. García-Olmo D., García-Arranz M., Herreros D. et al. A phase I clinical trial of the treatment of crohn's fistula by adipose mesenchymal stem cell transplantation. Dis Colon Rectum 2005; 48 (7): 1416-1423.
  20. Garcia-Olmo D., Herreros D., Pascual I. et al. Expanded adipose-derived stem cells for the treatment of complex perianal fistula: a phase ii clinical trial. Dis Colon Rectum 2009; 52 (1): 79-86.
  21. Gonzalez-Rey E., Anderson P., González M.A. et al. Human adult stem cells derived from adipose tissue protect against experimental colitis and sepsis. Gut 2009; 58 (7): 929-939.
  22. Duijvestein M., Wildenberg M.E., Welling M.M. et al. Pretreatment with interferon-γ enhances the therapeutic activity of mesenchymal stromal cells in animal models of colitis. Stem Cells 2011; 29: 1549-1558.
  23. American Gastroenterological Association Medical Position Statement: perianal Crohn's disease. Gastroenterology 2003; 125: 1503-1507.
  24. Present D.H., Rutgeerts P., Targan S. et al. Infliximab for the treatment of fistulas in patients with Crohn's disease. N Engl J Med 1999; 340: 1398-1405.
  25. Щукина О.Б., Маркова Е.А. Перианальная болезнь Крона: диагностика и медикаментозная терапия. Фарматека 2008; 13: 22-29.Поступила 29.09.2013

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