Regenerative Medicine

Biologic and Regenerative Medicine for Pets:What does it mean?

Read about the new and exciting, cutting-edge medical therapies currently and soon to be offered at TotalBond Veterinary Hospitals and Carolinas Animal Pain Management.

Pet owners are hearing and seeing more and more information about Regenerative Medicine for pets (dogs, cats and horses). This area can be confusing for pet owners AND their Veterinarians! Biologic and Regenerative medicine are terms that describe a form of therapy to help the body heal itself, in a safe and non-toxic manner. Either cells of the patient or other cellular technology are infused/injected. These therapies elicit a number of biologic responses, including the stimulation of growth factors, anti-inflammatory mediators, and in some cases the actual regeneration of tissue.

What science does tell us is that our bodies have an abundance of existing "repair" cells (stem cells) already present at any time. The problem is: as we have aged (into our first 6 months of life), these cells start to lose their ability to grow new tissues and certainly repair damaged tissues, not because the cells will not function, but because the "instruction manual" on healing has closed (think closed book vs. open book). In simpler terms, our bodies have abundant stem cells, but in adulthood they have become dormant. When tissue damage occurs, what we get is not new healthy tissue, but scar tissue instead.

There are 5 major categories of Biologic/Regenerative medicine at the present time:

1. Stem Cells

2. Platelet Rich Plasma

3. Autologous Conditioned Serum

4. BioScaffolding (also called Extracellular matrix

5. Gene Therapy

Stem Cell Therapy

Arguably the most studied and certainly the best known Biologic/Regenerative modality involves the use of stem cells, specifically: "Adipose-derived Autologous Mesenchymal Stem Cell" transplantation. It is important to note here that we are not talking about embryonic stem cells, which is an entire different area of study and currently does not have any approved medical utility. "Autologous" means that the stem cells are the dormant ones isolated from the patient (from fat, "adipose" tissue) that are then subsequently placed ("transplanted") back into the same patient. The principle is to concentrate stem cells and growth factors, activate them, and get them to damaged tissue to elicit a cascade of healing processes. The advantages of this technology is that there is published literature supporting its use in osteoarthritis (dogs) and ligament injuries (horses), and can be administered intravenously (and even intra-arterially) in addition to local infiltration. Further, the stem cells can be frozen and even cultured so that theoretically, there remains available a supply of viable cells for repeating the transplantation far into the future. A disadvantage is that it requires general anesthesia and a surgical procedure to harvest the fat, which then has to be processed, followed by a second episode of sedation in order to proceed with the transplantation. The total cost of these various steps is in the $2000 range.

Our hospital has used VetStem (www.vet-stem.com) with success since 2009 and now also utilize in-house Medi-Vet technology (www.medivet-america.com) to provide same-day processing and transplantation.

Platelet Rich Plasma or "PRP"

PRP is another form of therapy that takes a blood sample, puts it through a process to concentrate its platelets in a fraction of the plasma, which is then re-injected into the affected joint , tendon or area being treated. Platelets are normally known for their function of clotting blood, but recent research has revealed they also have hundreds of unique proteins and growth factors that have been shown to help manage inflammation and tissue degeneration. There "MIGHT" be some stem cells in the concentrate, but there is no way to quantify this fact. Because of its relative simplicity, the ability of PRP to affect tissue healing and pain relief is an area of intense study.

Autologous Conditioned Serum

ACS involves the drawing a patient's blood sample, incubating it with special test tubes designed to active certain growth factors and anti-inflammatory mediators, then centrifuged to collect the now "conditioned" serum for injection into a joint or other tissue. A special high speed centrifuge and a medical grade freezer are needed on site to manage these products. There is one FDA-approved ACS product for horses, called "IRAP" or Interleukin-1 Receptor Antagonist Protein, which is then into arthritic joints once weekly for 3 weeks. This is focused on inhibiting a particular inflammatory mediator, Interleukin-1 and has proven helpful but usually NOT a stand-alone procedure to manage osteoarthritis disease. There is currently no equivalent product on the market for dogs.

Bioscaffolding or Extracellular Matrix

Bioscaffolding or Extracellular Matrix involves taking tissue from another animal (usually small intestine or bladder from a pig) and removing all of the "live" cellular material from it. What is left is strands of collagen and associated molecules. Studies have shown that when this material is injected into and around damaged tissue, it forms a scaffold for cell proliferation, differentiation and integration. What appears to happen is that the collagen fibers activate the area's existing stem cells…as opposed to having to transplant stem cells from another part of the body. (This means: we are opening up the book on HOW the EXISTING stem cells can be turned on and activated to help regenerate tissues). You are probably familiar with this technology if you have heard about people that have been able to "grow back" an amputated digit, wounded combat veterans that have had large areas of muscle "regrown", and growing "artificial tissue" (ears, bladders) in the laboratory. It's ability to treat the pain of osteoarthritis is just beginning to be explored, but anecdotal experience, and one pilot study, is encouraging.

Our hospital uses OsteoBioScaff™, a structurally unique medical device that is composed of a proprietary, non-immunogenic copolymer. An advantage of this technology is that the material comes as a gel that can be stored until ready to use - no anesthesia or surgery to harvest tissue, no special equipment to process tissue or blood from the patient. When ready to implant, it is simply warmed to body temperature, pulled into a standard syringe, and then injected into the site and around areas of soft/hard tissue damage…including joints. Only one episode of sedation and local block is required, and the lack of a procedure to harvest and process tissue makes this a less expensive proposition than Stem Cell transplantation and may be an option for many patients. Our hospital has been utilizing OsteoBioScaff™ since 2011 and consider it a viable option for many patients. An additional advantage is that the ease of use and apparent safety of OsteoBioScaff™ means that patients can be treated repeatedly over time if necessary. OsteoBioScaff™ is supplied by BioPharma Products, LLC and exclusively distributed by VetSource into the veterinary industry. Learn more at www.osteobioscaff.com

Gene Therapy: The future of medicine

The "Holy Grail" of Biologic medicine is to learn how to instruct the body to click off certain DNA segments (genes) and click on others to teach the body to repair itself. While an area of intense research, it currently remains a hope of future therapy rather than anything we can apply clinically at this time.

Conclusion:

Reviewing, currently Biologic & Regenerative medicine can be focused in one of TWO areas:

Transplant Stem Cells and growth factors, expecting they will "know what to do" in the body and affect changes to damaged tissues and organs.
Activate the body's local and existing but otherwise dormant Stem cells (pluripotent mesenchymal cells to affect healing changes in damaged tissue.

As with all medical procedures, proper patient selection and evaluation prior to Regenerative Medicine procedures is extremely important. The doctor needs to set appropriate patient and pet parent expectations from any therapy option. This usually includes radiographs of affected sites, blood tests and urine tests for internal health - especially in older patients we are treating, that often will have other pre-existing conditions.

One KEY FACT about Regenerative Medicine: NONE of these therapies will "fix" the actual UNDERLYING cause of genetic or traumatic damage that occurred in a joint (i.e., genetic hip dysplasia). We are looking to Regenerative Medicine to help manage the worn out areas around and on the surfaces of these joints that cause PAIN and DISCOMFORT and decreased MOBILITY. The actual "biomechanics" of an abnormal joint will still be there. This is why we will see patients needing a repeat therapy in months or years, depending upon the type of Regenerative Medicine procedure used for the pets' condition.

We hope this PRIMER course on Regenerative Medicine has helped you sift through the decision process. The choices available are ever increasing in this area of medicine. This frontier is exciting and confusing at the same time, for pet owners AND veterinarians. It is always best to consult with your veterinarian or find a veterinarian whom has studied and utilized Regenerative medicine options in their practice. OsteoBioScaff™ is one of the newly available options to veterinarians and their pet patients, but NOT a NEW (untested) therapy in the Regenerative Medical world!