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Veterinary Forum September 2008 (Vol 25, No 9)

FORUM FIVE — Stemming the pain

    Adipose-derived stem cell therapy (Ad-SCT) is a relatively new process that may be an alternative to surgery for a variety of conditions. Here Jerrold A. Bausman, DVM, staff surgeon at Animal Specialty Group in Los Angeles, gives a rundown of how this treatment could be used in the average practice.

    Jerrold A. Bausman, DVM

    1. What practical applications does stem cell therapy offer for general practitioners?

    Arthritis is something all small animal practitioners see on a daily basis. One of the mainstays of therapy for arthritis in veterinary patients is NSAIDs, but there can be side effects associated with these drugs. Therefore, Ad-SCT is a part of my multimodal approach to the treatment of osteoarthritis. It can easily be incorporated into any practitioner's typical treatment protocol of weight and exercise control, NSAID therapy and joint supplementation. I have found that most of my Ad-SCT patients can either be removed from NSAIDs entirely or their dosage changed to an as-needed basis. Patients with chronic poor-healing fractures also may benefit from Ad-SCT when it is used with proper fracture stabilization.

    2. What is one of your success stories?

    One of my early patients was Hunter, an older golden retriever with a bad left hip — you may have seen us on Nightline (ABC News). He originally presented for a left total hip replacement, but during the initial consult, his owners expressed some hesitation about total hip replacement. I introduced Ad-SCT as a possible option to try before doing the total hip procedure. After much thought, however, the owners decided to move forward with the total hip replacement.

    The evening before surgery, one of the owners mentioned how nervous she was about the surgery — so much so she was breaking out in hives. We reviewed the Ad-SCT procedure again, and the owners then changed their decision. Hunter didn't bat an eye during the short surgical procedure to harvest his adipose tissue, and within 2 weeks of Ad-SCT injection into his left hip, he was showing improvement. Three weeks later, Hunter even jumped onto the bed — something he had not done in a several years.

    3. What is the credentialing process like?

    I was trained in a live course that has been refined and modified to a 3- to 4-hour complimentary online course. The first module in the course is an introduction to regenerative medicine. Module 2 is on clinical trials conducted by Vet-Stem, the company that processes the fat samples. This helps veterinarians understand potential outcomes so they can set reasonable expectations for clients. In Module 3, Jamie Gaynor, DVM, DACVA, discusses how he uses regenerative medicine in his hospital. Joint injections and protocols are covered as well in this module. Module 4 explains how to submit cells for processing. Veterinarians can register for the course at www.vet-stem.com.

    4. What tips do you have for general practitioners who want to start using this technology?

    The credentialing program must be completed before a case can be scheduled. Harvesting the adipose tissue requires a strict aseptic surgical procedure, but most primary care veterinarians are set up for this. I transfer the adipose tissue directly from the surgical wound to the shipping vial to ensure that contaminants are not picked up from the drapes or gauze. Scheduling and shipping are critical, so these need to be established before your first case. Case selection likewise is important. For example, I have had primary care veterinarians refer patients for hip dysplasia when they actually had lumbosacral disease. Injecting the hips of these patients will not improve ambulation.

    5. What future applications does Ad-SCT offer?

    Researchers are investigating hepatic and renal disease, gingival stomatitis in cats, canine atopy and recurrent obstructive airway disease in horses. Areas of interest for future exploration may include degenerative myelopathy, diabetes and perianal fistulas. I think we are only scratching the surface of possibilities.

    NEXT: Hill's donates SNPs to Morris Animal Foundation