What you need to know about incorporating regenerative medicine into your general practice.

Regenerative medicine can be easily incorporated into a general veterinary practice whether you recommend stem cell or platelet rich plasma treatment for your patient. The goal of orthobiologics is to take platelet-rich plasma (PRP) or autologous stem cells to an area of otherwise poor healing to stimulate tissue healing and regeneration. Historically, stem cells were acquired through abdominal viscera and submitted to an outside lab for culture expansion, a process which took weeks and multiple anesthetic events. Now we know these Mesenchymal Stem cells may be acquired from bone marrow aspirate concentrate (BMAC), processed in your clinic, and utilized immediately.

The Companion Regenerative Therapies System (CRT) is an in-house system that processes PRP samples in 15 minutes and BMAC in 25 minutes. This machine is top-performing in canine validation studies and is calibrated to produce the highest concentrate of platelet counts, five to nine times above normal. The CRT system also maintains a minimal amount of white blood cells and red blood cells present, which can lead to further inflammation and synoviocyte death.  Now that we have the capability to perform BMAC in-house, obtaining the samples and administering it to your patients is much easier, less expensive and less overwhelming to the practitioner.

Uses for PRP

Platelet-rich plasma is blood plasma concentrated with platelets (PLT) designed for injection for musculoskeletal problems, and can be processed in your office setting for immediate use. Platelets recruit, stimulate, and provide a scaffolding for stem cells. PRP indications include tendon strains, muscle sprains, damaged ligaments, degenerative joint disease and non-healing fractures. For soft tissue injuries the PRP can be directly injected into the affected tissues utilizing musculoskeletal ultrasound.  Platelet-rich plasma may be directly injected into the joint either with a blind intra-articular injection or utilizing fluoroscopy or needle scope/arthroscopy.

Uses for BMAC

Bone Marrow Aspirate Concentrate (BMAC) consists of Hematopoietic stem cells (which form all the types of blood cells in the body and bone marrow stromal stem cells/mesenchymal stem cells which can generate bone, cartilage, fat, connective tissue).  Indications for stem cells include osteoarthritis, tendon injuries, ligament injuries, and spinal injuries. For soft tissue injuries the BMAC or BMAC/PRP combo can be directly injected into the affected tissues utilizing musculoskeletal ultrasound, or may be directly injected into the joint either with a blind intra-articular injection or utilizing fluoroscopy or needle scope/arthroscopy.

Improving revenue, outcomes and client loyalty

The convenience of being able to diagnose and treat your patient in-house and in a single event allows you to provide current and progressive treatment that treats the root cause of the injury or disease. This simple process allows you to further bond the client to your practice while adding an additional revenue stream and experience for your practice.

Regenerative medicine is now a widely accepted and researched area of veterinary medicine backed by research and clinical data.  As the “soft tissue injury” becomes outdated, being able to obtain and administer orthobiologics in an effective and relatively easy manner will help to retain the veterinarian as the main source of knowledge and help for patients. As pharmaceutical companies continue to invade our profession and take what little bit of mark-up we can offer, it is reassuring to know that there is more that we can do in a general practice setting to help both the patient and the practice thrive. In addition, the pet parent will feel more bonded to the practitioner knowing that they are taking care of their pet’s injury in the safest and most effective way possible.

References

1. Stief M, Gottschalk J, Ionita J-C, et al. Concentration of platelets and growth factors in canine autologous conditioned plasma. Vet Comp Orthop Traumatol. 2011;24:122–125.
2. Carr BJ, Canapp SO Jr, Mason DR, Cox C, Hess T. Canine platelet-rich plasma systems: a prospective analysis. Front Vet Sci. 2016;2:73. doi: 10.3389/fvets.2015.0007.
3. Franklin SP, Garner BC, Cook JL. Characteristics of canine platelet-rich plasma prepared with five commercially available systems. Am J Vet Res. 2015;76:822–827.
4. Sample SJ, Racett MA, et al. Use of PRP-collagen scaffold as a bioenhanced repair treatment for management of partial cruciate ligament rupture in dogs. PLoS One. 2018;13(6):e0197204.
5. Upchurch DA, Renberg WC, et al. Effects of administration of adipose-derived SVF and PRP to dogs with OA of the hip joints. Am J Vet Res. 2016;77:940–951.
6. Vilar JM, Cuervo, et al. Effect of IA inoculation of MSC in dogs with hip OA by means of objective force platform gait analysis: concordance with numeric subjective scoring scales. BMC Vet Res. 2016;12:223.
7. Vilar JM, Batista M, et al. Assessment of the effect of IA injection of autologous AD-MSC in OA dogs using a double blinded force platform analysis. BMC Vet Res. 2014;10:143.
8. Vilar JM, Morales, et al. Controlled, blinded force platform analysis of the effect of IA injection of autologous AD-MSC associated to PRGF-Endoret in OA dogs. BMC Vet Res. 2013;9:131.
9. Case JB, Palmer R, et al. Gastrocnemius tendon strain in a dog treated with autologous MSC and a custom orthosis. Vet Surg. 2013;42:355–360.