Veterinary Regenerative Medicine

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Regenerative Medicine and Stem Cell Therapy for Dogs

Veterinary regenerative Medicine and stem cell therapy for dogs is new technology, but already we are seeing impressive results. Because our bodies undergo constant damage and therefore continuous repair, we are equipped with molecules and cells dedicated to initiating that repair.  Researchers are learn more about how to accelerate the healing process, and even ways to heal tissue that we could not heal before. Platelet Rich Plasma (PRP)  and mesenchymal stem cells (MSC) are two of the therapies now available  to regenerate damaged tissue.

Short Answer

What is Regenerative Medicine?

Dax over palasade

 

Veterinary regenerative medicine involves collecting the body’s naturally occurring healing cells and molecules, concentrating them, then returning them to the location where they are needed most to accelerate repair. Currently, the most popular regenerative medicine techniques is the use of platelet rich plasma (PRP) and stem cell therapy (MSC) for dogs.

These therapies can be used to reduce pain and inflammation in arthritic or otherwise injured joints, or to heal damaged muscle, ligaments, and tendons

There are several regenerative therapy options:
  • Stem cells
  • Platelet Rich Plasma
  • Hyaluronic acid injections 

 

To read more on these therapies click next or Long Answer for further explanation

 

Long Answer

Below is a list of potential Regenerative Medicine options:

Stem Cells

Stem Cells

Many tissues in our body host mesenchymal stem cells (MSC) – cells that have the potential to change into a number of different tissues depending on what is needed. They are a key component of tissue repair and it is possible to harvest stem cells from either bone marrow or fat tissue, concentrate them, and then inject them back into arthritic joints, torn tendons, broken bones, or even into the bloodstream itself in order to facilitate healing.

BC/Yukon Regional Agility CompetitionAlthough it is not an inexpensive process, over 80% of owners with pets that have been treated with stem cells report a measurable improvement in quality of life and would recommend it to friends1. A recent independent study showed improvement in 70% of patients. This improvement lasted an average of 11 months2.

Historically, stem cell therapy meant a two stage process.  First we would surgically harvest fat under a full anethesia, then send it to the U.S. for processing, then inject it under sedation a few days later.  Only recently has it been possible to get high yields of viable stem cells from an on-site processor.  Now in most dogs we can collect harvest blood from bone marrow, process it within minutes, then immediately transplant it back into the patient all with just one anesthetic.  For small dogs we may need to collect the stem cells from fat and that processing takes a few hours. It can still be transplanted back into the patient on the same day.

We have also learned that stem cells work more efficiently when combined with platelet rich plasma (PRP), which is collected from a vein, processed and combined with the stem cells as part of the same procedure.

Although we were hoping that stem cells would heal damaged cartilage and reverse arthritic change, they do not appear to be able to do so.  However, once injected into a joint, they can provide long term pain relief (e.g.: 11 months).  Stem cells do appear to be able to regenerate damaged tendons and ligaments in a variety of situations.  There is early work being done demonstrating healing in partially torn cruciate ligaments.

Stem cell therapy should be considered for any patient with chronic arthritis, non-surgical tendon or ligament tears, or for accelerating the repair of broken bones.  Many shoulder injuries greatly benefit from stem cell therapy.

Platelet Rich Plasma (PRP)

Platelet Rich Plasma (PRP)

Duffy after regionalsPlatelet rich plasma (PRP) involves collecting blood and concentrating the platelet fraction, which is high in growth factors and molecules that reduce inflammation. PRP can be used to facilitate healing of tendons, to increase the effectiveness of stem cell therapy, and to provide pain relief for arthritic joints.

PRP therapy is less complicated, less invasive and less expensive than stem cell therapy.  What’s more, it too has been shown to provide long term pain relief in arthritic joints (e.g.: 9 months).  For this reason, PRP might be the superior choice over stem cells for addressing arthritis pain – it may not last quite as long, but it is much easier and less expensive to collect.

PRP can also be used to accelerate tendon repair.  Badly torn, scarred, or calcified tendons fare better with stem cells combined with PRP, but less severe injuries respond to PRP alone.

Intra-articular hyaluronic acid injections +/- anti-inflammatory steroids

Intra-articular hyaluronic acid injections +/- anti-inflammatory steroids

Hyaluronic acid (HA) is a key ingredient of healthy joint fluid, and is considered a major lubricating component. It is also a component of healthy joint cartilage. The injection of a combination of anti-inflammatory steroids with HA is routinely done in horses with good results. Meta-analysis of HA injections involving knee injections in 971 human patients showed a positive benefit.  Injecting HA into arthritic joints appears to stimulate the body to produce more of its own joint fluid.

PWD runningDr. Lane routinely injects arthritic joints with HA, either on its own or more frequently with the addition of steroids, and is pleased by the results.  Unpublished data reports that approximately 70% of dogs with mild to moderate elbow arthritis respond to HA injections on their own, with benefits lasting up to 6 months. Dogs with advanced arthritis need a combination of HA and steroids. Human and horse research has shown that certain steroids have a degenerative effect on joint cartilage, while others have a protective benefit.  However, the steroids that damage cartilage also last longer (e.g.: 7 months vs 5 months).  The decision of which steroid to use depends on the nature of the joint injury – if there is no more healthy joint cartilage left, then the longer acting steroid may be a better choice.

Dr Lane has found the injection of severely arthritic joints to be very helpful, especially for those patients who can’t tolerate anti-inflammatories, or for whom anti-inflammatories are not working well enough.  Hip joint injections are ultrasound guided under heavy sedation, but elbow or wrist injections can be done under light or even no sedation depending on how nervous the dog is.

A research paper presented at the Veterinary Orthopaedic Society symposium in March 2012 found that elbow joints with either PRP or a combination of HA plus steroid did equally well.3

References

1 VetStem, client survey

2 Vogel PL, Proceedings of the Veterinary Orthopaedic Society Annual Conference, Crested Butte CO, 2012

3 Franklin SP, Cook JL, Proceedings of the Veterinary Orthopaedic Society Annual Conference, Crested Butte CO, 2012