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CC BY 4.0 · Journal of Coloproctology 2025; 45(02): s00451809678
DOI: 10.1055/s-0045-1809678
Review Article

Mesenchymal Stem Cells for the Treatment of Complex Anovaginal and Rectovaginal Fistulas in Crohn's Disease: A Systematic Review

Kleuber Arias Meireles Martins 
1   Department of Medicine, University Center of Belo Horizonte, Belo Horizonte, MG, Brazil
,
Isabela Coutinho Faria
1   Department of Medicine, University Center of Belo Horizonte, Belo Horizonte, MG, Brazil
,
Leonardo Januário Campos Cardoso
2   Department of Medicine, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
,
Pedro Henrique Gibram Gontijo
2   Department of Medicine, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
,
Ana Júlia da Silva Oliveira Bittarães
3   Department of Medicine, Faculty of Medical Sciences of Minas Gerais, Belo Horizonte, MG, Brazil
,
Mariana Menezes Corcinio
4   Department of Medicine, Tiradentes University, Aracaju, Sergipe, Brazil
,
Bárbara Nogueira Braga
2   Department of Medicine, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
,
Mariana Lisboa de Jesus
2   Department of Medicine, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
› Author Affiliations
Funding The authors declare that no funds or other support was received during the preparation of this manuscript.
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Abstract

Objective

To evaluate the efficacy and safety of mesenchymal stem cells (MSCs) for treating complex anovaginal and rectovaginal fistulas in Crohn's disease (CD) patients through a systematic review.

Methods

This review adhered to PRISMA and Cochrane guidelines. Literature searches were conducted on PubMed, Cochrane Library, Embase, and Web of Science using a PICO framework (P: CD patients with complex fistulas; I: MSC therapy; C: conventional treatments; O: efficacy and safety). Keywords included “stem cell,” “fistula,” and “Crohn's disease.” Articles were screened via the Rayyan® platform for inclusion based on eligibility criteria, with conflicts resolved by consensus.

Results

Of 1,197 records, 7 studies met inclusion criteria. MSC therapy demonstrated variable healing rates ranging from 50% to 75%, with low adverse event profiles. Studies highlighted therapeutic potential in reducing fistula drainage and promoting tissue regeneration. However, significant heterogeneity in patient populations, MSC doses, and study methodologies complicated outcome standardization. A meta-analysis reported fistula healing rates of 58–62% and clinical remission of 62.52%, superior to conventional therapies. Factors such as disease severity, prior treatments, and anatomical differences influenced outcomes.

Conclusions

MSCs offer promising treatment for complex fistulas in CD, demonstrating favorable safety and efficacy. However, variability in study designs, dosing protocols, and patient profiles underscores the need for standardized methodologies and larger clinical trials. Optimizing MSC use, particularly as a first-line therapy, could enhance outcomes and provide a viable alternative to conventional surgical approaches.

Keywords

stem cell - fistula - Crohn's Disease

Author Contributions

Kleuber Arias Meireles Martins, Leonardo Januário Campos Cardoso, Mariana Menezes Corcinio, Isabela Coutinho Faria, and Pedro Henrique Gibram Gontijo were responsible for the conceptualization of the study. The methodology was developed by Kleuber Arias Meireles Martins, Leonardo Januário Campos Cardoso, and Mariana Menezes Corcinio. Software development was carried out by Kleuber Arias Meireles Martins, Leonardo Januário Campos Cardoso, and Isabela Coutinho Faria. Formal analysis was conducted by Ana Júlia da Silva Oliveira Bittarães and Bárbara Nogueira Braga, and Mariana Lisboa de Jesus. Writing, review, nd editing were done Kleuber Arias Meireles Martins and Leonardo Januário Campos. Supervision was provided by Kleuber Arias Meireles Martins and Leonardo Januário Campos. All authors have reviewed and approved the final version of the manuscript.




Publication History

Received: 26 January 2025

Accepted: 21 March 2025

Article published online:
30 June 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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Bibliographical Record
Kleuber Arias Meireles Martins, Isabela Coutinho Faria, Leonardo Januário Campos Cardoso, Pedro Henrique Gibram Gontijo, Ana Júlia da Silva Oliveira Bittarães, Mariana Menezes Corcinio, Bárbara Nogueira Braga, Mariana Lisboa de Jesus. Mesenchymal Stem Cells for the Treatment of Complex Anovaginal and Rectovaginal Fistulas in Crohn's Disease: A Systematic Review. Journal of Coloproctology 2025; 45: s00451809678.
DOI: 10.1055/s-0045-1809678