To evaluate the role of allogeneic mesenchymal stem cells for treatment of perianal fistulizing Crohn disease. Twenty (20) Crohn's disease patients with complex or multiple perianal or rectovaginal fistulas will be included and will be scheduled to undergo peri-fistula injections after meeting all inclusion/exclusion criteria's at baseline. Following the Pilot Phase of four (4) subjects, sixteen (16) subjects are scheduled to undergo perianal injections and after meeting all inclusion/exclusion criteria's, will be evaluated at baseline.
Twenty (20) subjects will be treated with 20 million (2 x 10\^7) allogeneic MSC's total divided into 10 injections of 2 million cells/cm of tract in 0.5 ml volume (for total volume of 5 ml per visit) at 4 week intervals for a maximum of 4 treatment sessions based on the discretion of the endoscopist at the time of injection.. For patients with more than 6 fistula tracts, the largest of the tracts will be injected. The first four (4) subjects that receive their initial injections will not be treated less than 5 days apart. As stated in the above response, these first four (4) patients will have an initial safety follow up period of one month prior to proceeding with the treatment of further patients. Follow up: Clinical (CDAI, PDAI, and perianal examination +/- under anesthesia), and endoscopic ultrasound will be performed at the time of each treatment. MRI evaluation will be performed at screening, 4 weeks after the fourth treatment (week 16) and at 16 months, if fistula closure has not been achieved. Clinical evaluation will be performed at months 1, 3, 6, 12. Endoscopic ultrasound and MRI will also be performed as needed for symptomatic patients if an abscess is suspected. Duration of Study participation: 17 Months (Follow-up visits will be at 4, 7, 10 and 16 Months post treatment. The Allo-hMSCs will be supplied from an allogeneic human mesenchymal stem cell source manufactured by the University of Miami.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Peri-fistula injections
Evaluation of treatment emergent adverse events from the bone marrow-derived allogeneic mesenchymal stem cells implant
Evaluation of treatment emergent adverse events based on viability, safety and tolerance of the bone marrow-derived allogeneic mesenchymal stem cells implant (MSCs) in fistulizing Crohn's Disease patients, defined as: * Treatment emergent adverse event (AE) rates, infections, hospitalizations or surgical interventions. * Physical examination * Vital signs * Laboratory tests (biochemistry, hematology, urinalysis)
Time frame: At each intervention and 7, 10, and 16 months after last intervention
Clinically: to assess changes in the Crohn's Disease Activity Index (CDAI), the Perianal Disease Activity Index (PDAI).
To monitor the number of draining fistulas, fistula healing efficiency, relapse rate among patients who achieved treatment success and amount local inflammation: Complete closure will be defined as absence of discharge and absence of collections of ≥2 cm directly related to the treated fistulas tracts as assessed by perianal examination. Partial closure will be defined as a reduction in \>50% draining fistulas or no discharge on finger compression.
Time frame: At each intervention and 7, 10, and 16 months after last intervention
Endoscopic assessment of rectum using a limited simplified endoscopic activity score for Crohn's disease (SES-CD) to evaluate extent and severity of ulcers.
Endoscopic ultrasound and Examination under anesthesia to evaluate baseline fistula state and during each intervention to assess tract closure and abscesses. Remission will be defined as healing of rectal ulcers and/or closure of fistula tracts by endoscopic ultrasonography.
Time frame: At each intervention and 7, 10, and 16 months after last intervention
Radiologic assessment using MRI
to examine number of tracts, inflammation in tracts, and extent of fibrosis or regenerative tissue via MRI assessment. Radiologic remission will be defined as substitution of tracts with fibrosis or regenerative tissue.
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Time frame: Baseline, Month 4, and 16 months only if fistula closure has not been achieved at month 4
Evaluate symptomatic patients.
Endoscopic ultrasound and MRI will be used to evaluate symptomatic patients.
Time frame: Month 4 and Month 16
Evaluate the effect of local treatment with allogeneic bmMSCs using the short Inflammatory Bowel Disease Questionnaire (sIBDQ)
To evaluate the effect of local treatment with allogeneic bmMSCs on the quality of life of patients with fistulizing CD using the short Inflammatory Bowel Disease Questionnaire (sIBDQ)
Time frame: At each intervention and 7, 10, and 16 months after last intervention
Evaluate the effect of local treatment with allogeneic bmMSCs using the Short Form (SF)-36 score
To evaluate the effect of local treatment with allogeneic bmMSCs on the quality of life of patients with fistulizing CD using the Short Form (SF)-36 score
Time frame: At each intervention and 7, 10, and 16 months after last intervention
C-reactive protein (CRP)
To summarize the changes from baseline compared to 12 weeks in serum C-reactive protein
Time frame: At each intervention and 7, 10, and 16 months after last intervention
Major Adverse Events
• Incidence of the Major Adverse Events endpoint, defined as the composite incidence of (1) death (2) hospitalization for worsening fistulizing disease (3) or infection caused by the intervention.
Time frame: At each intervention and 7, 10, and 16 months after last intervention