Human mesenchymal stem cell therapy in the management of luminal and perianal fistulizing Crohn's disease - review of pathomechanism and existing clinical data.

INTRODUCTION: Crohn's disease (CD) is a chronic, recurring, idiopathic disease which is associated with imbalanced mucosal immune response, manifesting as a chronic inflammation of any location throughout the gastrointestinal tract. The purpose of currently available therapy is to suppress the heightened immune response. However, these treatments have no direct influence on the healing process of damaged tissues. The mesenchymal stem cell (MSC) therapy may represent a new alternative solution in both luminal and fistulizing CD, as it is able to inhibit the inflammation and promote the regeneration process at the same time. Areas covered: Aim of this review is to summarize the existing clinical data about the clinical impact of MSC therapy in luminal and perianal fistulizing CD. Expert opinion: Clinical trials demonstrated that MSC transplantation has an outstanding, durable efficacy with low fistula recurrence in biological therapy-refractory fistulizing CD; however, further clinical trials are required to confirm its effectiveness in luminal CD. Unlike to biological therapy, MSCs are able to promote the regeneration process of damaged tissues as well. This additional benefit besides their sustained immunosuppressive effect with no decrease of efficiency over time makes MSCs a new, highly potential therapeutic approach in the management of inflammatory bowel disease.