NCT06930079: ERG

Endoscopic Injection of Autologous, Activated and Emulsified Fat in Chronic Fistulas of the Gastrointestinal Tract and Pelvic Organs

Recruiting now Last updated 18 April 2025

What this trial tests

trial in Fistula Repair in 43 participants. Currently enrolling.

Timeline

20 March 2025

Primary endpoint
31 March 2027

20 December 2027

Quick facts

Lead sponsor	Fondazione Policlinico Universitario Agostino Gemelli IRCCS
Status	Recruiting now
Study type	OBSERVATIONAL
Enrollment	43
Start date	20 March 2025
Primary completion	31 March 2027
Estimated completion	20 December 2027
Sites	1 location across Italy

Conditions studied

• Fistula Repair — all drugs for Fistula Repair →

Sponsor

Fondazione Policlinico Universitario Agostino Gemelli IRCCS

Who can join

18 and older, any sex, with Fistula Repair. Patients with the condition only — healthy volunteers not accepted.

Sponsor's own description

Fistulas are defined as pathologic communications between two epithelialized surfaces and represent a complex nosologic entity that often exposes the patient to life-threatening or disabling sequelae. Their etiology can vary widely (spontaneous, iatrogenic, post-surgical perforation, anastomotic dehiscence, inflammatory process) and their treatment is complex, sometimes unresolved, and often requires a multidisciplinary approach. The chronicity of digestive and pelvic organ fistulas (e.g., vagino-vesical fistulas) is related to tissue repair mechanisms, which are delayed and subverted in favor of fibrotic and inflammatory processes. In these cases, the wound healing cascade stops at the inflammatory phase and does not result in the proliferation phase. The transition depends on changing levels of cytokines and growth factors. In the persistence of the inflammatory phase, polymorphonucleates and macrophages are active, phagocytosing and releasing enzymes that also damage healthy tissue. In this context, the anti-inflammatory, angiogenic, antiapoptotic, and tissue regenerative effects of adipose tissue-derived stromal or stem cells (ADSCs) could play a decisive role. In fact, ADSCs exhibit immunosuppressive properties on the proliferation of T cells, B lymphocytes, dendritic cells, and natural killer cells and modulate inflammation by implanting a regenerative niche with appropriate paracrine communication and subsequent tissue regeneration. "Fat grafting" has a wide range of application: it started with plastic surgery and regenerative medicine, then in orthopedics, maxillofacial surgery, and vascular surgery. Since 2019, a new procedure using processed fat grafting for the treatment of chronic fistulas of the gastrointestinal tract and pelvic organs has been initiated at the Agostino Gemelli IRCCS University Polyclinic Foundation and has become "standard of care," with good results. The procedure is quick, safe, minimally invasive and cost-effective. Subcutaneous fat, immediately after harvesting from the same patient, is mechanically stimulated with oscillatory movements, then injected under endoscopic vision directly onto the orifice of the fistula. When the fat is centrifuged, it stimulates the activation of various mesenchymal stemness-related genes, such as Sox2, Nanog and Oct4. The increase in mRNAs is tens to hundreds of times and is accompanied by a pronounced increase in the expression of the anti-inflammatory protein TSG6 and suppression of TNFalpha, normally expressed by adipose tissue.

The objective of the study is to treat chronic fistula of the gastrointestinal tract and pelvic organs of any type, symptomatic and/or impacting quality of life, in whom all other treatments (medical, endoscopic, or surgical) have failed or are not candidates.

Our primary endpoint is to evaluate the efficacy of the injection of autologous activated adipose tissue injection in these cases. Secondary endpoints evaluate the changes in patients' quality of life and the long-term efficacy of the activated fat injection.

Publications & conference data

No peer-reviewed publications indexed yet for this trial.