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Skeletal Muscle-Derived Cell Implantation for the Treatment of Fecal Incontinence: A Randomized, Placebo-Controlled Study

A. Frudinger, A. Gauruder-Burmester, W. Graf, JP. Lehmann, U. Gunnarsson, M. Mihov, P. Ihnát, P. Kosorok, J. Orhalmi, P. Slauf, A. Emmanuel, V. Hristov, A. Jungwirthova, PA. Lehur, A. Müller, M. Amort, R. Marksteiner, M. Thurner

. 2023 ; 21 (2) : 476-486.e8. [pub] 20220810

Language English Country United States

Document type Randomized Controlled Trial, Multicenter Study, Journal Article, Research Support, Non-U.S. Gov't

Persistent link   https://www.medvik.cz/link/bmc23004455

BACKGROUND AND AIMS: Fecal incontinence (FI) improvement following injection of autologous skeletal muscle-derived cells has been previously suggested. This study aimed to test the efficacy and safety of said cells through a multicenter, placebo-controlled study, to determine an appropriate cell dose, and to delineate the target patient population that can most benefit from cell therapy. METHODS: Patients experiencing FI for at least 6 months were randomized to receive a cell-free medium or low or high dose of cells. All patients received pelvic floor electrical stimulation before and after treatment. Incontinence episode frequency (IEF), FI quality of life, FI burden assessed on a visual analog scale, Wexner score, and parameters reflecting anorectal physiological function were all assessed for up to 12 months. RESULTS: Cell therapy improved IEF, FI quality of life, and FI burden, reaching a preset level of statistical significance in IEF change compared with the control treatment. Post hoc exploratory analyses indicated that patients with limited FI duration and high IEF at baseline are most responsive to cells. Effects prevailed or increased in the high cell count group from 6 to 12 months but plateaued or diminished in the low cell count and control groups. Most physiological parameters remained unaltered. No unexpected adverse events were observed. CONCLUSIONS: Injection of a high dose of autologous skeletal muscle-derived cells followed by electrical stimulation significantly improved FI, particularly in patients with limited FI duration and high IEF at baseline, and could become a valuable tool for treatment of FI, subject to confirmatory phase 3 trial(s). (ClinicalTrialRegister.eu; EudraCT Number: 2010-021463-32).

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$a Frudinger, Andrea $u Department of Obstetrics and Gynaecology, Medical University of Graz, Graz, Austria. Electronic address: andrea.frudinger@medunigraz.at
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$a Skeletal Muscle-Derived Cell Implantation for the Treatment of Fecal Incontinence: A Randomized, Placebo-Controlled Study / $c A. Frudinger, A. Gauruder-Burmester, W. Graf, JP. Lehmann, U. Gunnarsson, M. Mihov, P. Ihnát, P. Kosorok, J. Orhalmi, P. Slauf, A. Emmanuel, V. Hristov, A. Jungwirthova, PA. Lehur, A. Müller, M. Amort, R. Marksteiner, M. Thurner
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$a BACKGROUND AND AIMS: Fecal incontinence (FI) improvement following injection of autologous skeletal muscle-derived cells has been previously suggested. This study aimed to test the efficacy and safety of said cells through a multicenter, placebo-controlled study, to determine an appropriate cell dose, and to delineate the target patient population that can most benefit from cell therapy. METHODS: Patients experiencing FI for at least 6 months were randomized to receive a cell-free medium or low or high dose of cells. All patients received pelvic floor electrical stimulation before and after treatment. Incontinence episode frequency (IEF), FI quality of life, FI burden assessed on a visual analog scale, Wexner score, and parameters reflecting anorectal physiological function were all assessed for up to 12 months. RESULTS: Cell therapy improved IEF, FI quality of life, and FI burden, reaching a preset level of statistical significance in IEF change compared with the control treatment. Post hoc exploratory analyses indicated that patients with limited FI duration and high IEF at baseline are most responsive to cells. Effects prevailed or increased in the high cell count group from 6 to 12 months but plateaued or diminished in the low cell count and control groups. Most physiological parameters remained unaltered. No unexpected adverse events were observed. CONCLUSIONS: Injection of a high dose of autologous skeletal muscle-derived cells followed by electrical stimulation significantly improved FI, particularly in patients with limited FI duration and high IEF at baseline, and could become a valuable tool for treatment of FI, subject to confirmatory phase 3 trial(s). (ClinicalTrialRegister.eu; EudraCT Number: 2010-021463-32).
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$a Gauruder-Burmester, Annett $u Interdisciplinary Pelvic Floor Center, Berlin, Germany
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$a Graf, Wilhelm $u Department of Surgery, Akademiska Sjukhuset, Uppsala, Sweden
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$a Lehmann, Jan-Peter $u Department of Surgery, Östersunds Hospital, Östersund, Sweden
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$a Gunnarsson, Ulf $u Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
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$a Mihov, Minko $u Medical Center Unimed EOOD, Sevlievo, Bulgaria
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$a Ihnát, Peter $u Department of Surgical Studies, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
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$a Kosorok, Pavle $u Department of Proctology, Iatros Medical Centre, Ljubljana, Slovenia
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$a Orhalmi, Julius $u Department of Surgery, University Hospital Hradec Kralove, Faculty of Medicine in Hradec Kralove, Charles University, Prague, Czech Republic
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$a Slauf, Petr $u Surgical Clinic 1, Faculty of Medicine, University Hospital Bulovka, Charles University, Prague, Czech Republic
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$a Emmanuel, Anton $u Gastrointestinal Physiology Unit, University College Hospital, London, United Kingdom
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$a Hristov, Vladislav $u Pirogov Hospital, Sofia, Bulgaria
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$a Jungwirthova, Anna $u Department of Gastroenterology, St. Anna Clinic, Prague, Czech Republic
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$a Lehur, Paul-Antoine $u Clinique de Chirurgie Digestive et Endocrinienne, Institut des Maladies de l'Appareil Digestif, University Hospital of Nantes, Nantes, France
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$a Müller, Andreas $u GastroZentrum Hirslanden, Klinik Hirslanden, Zürich, Switzerland
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$a Amort, Melanie $u Innovacell AG, Innsbruck, Austria
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$a Marksteiner, Rainer $u Innovacell AG, Innsbruck, Austria
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