Treatments for Crohn’s Disease–Associated Bowel Damage: A Systematic Review
2019
Background & Aims Despite significant advances in the treatment of Crohn's disease (CD), most patients still develop stricturing or penetrating complications that require surgical resections. We performed a systematic review of mechanisms and potential treatments for tissue damage lesions in CD patients. Methods We searched the PubMed,
MBASE, and Cochrane databases from January 1960 to July 2017 for full-length articles on CD, fibrosis, damage lesions,
mesenchymal stem cells, and/or treatment. We also searched published conference abstracts and performed manual searches of all reference lists of relevant articles. Results Mechanisms of intestinal damage in patients with CD include fibroblast proliferation and migration, activation of stellate cells, recruitment of intestinal or extra-intestinal fibroblast, and cell trans-differentiation. An altered balance of metalloproteinases and
tissue inhibitorsof
metalloproteinasesmight contribute to fistula formation. Treatment approaches that reduce excessive
transforming growth factor beta(TGFB) activation might be effective in treating established intestinal damage.
Stem cell therapieshave been effective in tissue damage lesions in CD. Particularly, randomized controlled trials have shown local injections of
mesenchymal stem cellsto heal perianal fistulas. Conclusion In a systematic review of mechanisms and treatments of bowel wall damage in patients with CD, we found a need to test drugs that reduce TGFB and increase healing of transmural damage lesions and to pursue research on local injection of
mesenchymal stem cells.
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