Regenerative Medicine For Arthritis: Part 1
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              p.1 p.1 Regenerative Medicine For Arthritis: Part One Matt Brunke, DVM, CCRP, CVPP, CVA Diplomate, American College of Veterinary Sports Medicine and Rehabilitation p.1
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              p.2 p.2 American College of Veterinary Sports Medicine and Rehabilitation ROSS UNIVERSITY 
 SCHOOL OF VETERINARY MEDICINECHI INSTITUTE 
 TRADITIONAL CHINESE VETERINARY MEDICINEIVAPM IRONMAN 
 Lake PlacidA little about me... I like to keep busy p.2
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              p.3 p.3 Regenerative? 
 - Not a starfish growing a new leg
 - Reparative?
 - Platelet Rich Plasma
 - Stem cells? – MSC’sp.3
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              p.4 p.4 Treatment 
 - My Approach:
 - What about chronic OA patents that are at end stage and its affecting quality of life even on conventional treatments?p.4
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              p.5 p.5 IA Injections - Options 
 - Corticosteroids
 - Hyaluronic Acid
 - Regenerative Medicine
 – Platelet Rich Plasma (PRP)
 – Stem Cell Therapyp.5
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              p.6 p.6 Which do we use? Mild OA Prospective trial of autologous conditioned plasma versus hyaluronan plus corticosteroid for elbow osteoarthritis in dogs. p.6
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              p.7 p.7 A dog study – but not a vet med one Multiple injections of leukoreduced platelet rich plasma reduce pain and functional impairment in a canine model of ACL and meniscal deficiency. p.7
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              p.8 p.8 PRP 
 - Validation?Concentration of platelets and growth factors in canine autologous conditioned plasma Copyright 2017 p.8
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              p.9 p.9 Which PRP System? Canine Platelet-Rich Plasma Systems: A Prospective Analysis p.9
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              p.10 p.10 Regenerative Medicine - PRP 
 - Platelet Rich Plasma
 - 50cc of blood – 4 cc of platelets
 - Positive effects on angiogenesis and extracellular matrix remodeling
 - Fibrin for matrix
 - Growth factors –VEGF, TGFB, IL8
 - Cell proliferation and differentiation
 - Stem cell recruitment and chemotaxisp.10
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              p.11 p.11 Platelet Rich Plasma 
 Post Spin: Want
 - Increased # of platelets
 - Increased # of granules with growth factors
 - Monocytes
 – Increase in cellular metabolism and collagen production
 - Decrease release of ant- angiogenic cytoines
 – IL-12 and Interferon gammaPost Spin: Don’t Want 
 - RBC’s
 – Damage cartilage and synovium
 - WBC’s/Inflammatory Mediators
 – Cause synoviocyte deathHow do YOU find out? 
 – CBC machinep.11
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              p.12 p.12 Platelet Rich Plasma 
 Post spin: Unsure
 - Lymphocytes
 – Unknown significance
 – Helps stimulate collagen productionPost spin: Don’t want 
 - Neutrophils
 – Increase IL-1B, TNF-alpha, IL- 6, IL-8
 – Increased MMP-9
 - Degrades collagen and other ECM moleculesp.12
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              p.13 p.13 Let’s Make PRP 
 - Shave – sterile prep
 - 10cc ACD – 50 cc whole blood
 – 4cc PRP
 - <30 pound dog?
 – 5cc ACD, 25cc whole blood
 - 2cc PRP
 – 2.5cc ACD, 12.5cc whole blood
 - 1cc PRPp.13
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              p.14 p.14 Giant PCV tube p.14
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              p.15 p.15 Weigh it p.15
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              p.16 p.16 Counterbalance 1g H20=1ml p.16
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              p.17 p.17 Spin time p.17
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              p.18 p.18 First Spin p.18
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              p.19 p.19 Look at that buffy coat! p.19
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              p.20 p.20 Pull off the PPP p.20
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              p.21 p.21 Platelet Poor Plasma p.21
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              p.22 p.22 Counterbalance p.22
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              p.23 p.23 2nd spin – 7 minutes total p.23
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              p.24 p.24 Pull off to 4cc remaining p.24
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              p.25 p.25 Re-suspend – aka Agitate p.25
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              p.26 p.26 50cc blood – 4cc PRP p.26
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              p.27 p.27 Questions? 
 - Matt Brunke, DVM, CCRP, CVPP, CVA
 Diplomate, American College of Veterinary Sports Medicine and Rehabilitation
 DrMattBrunke@gmail.com
 DrBrunke.Wordpress.comp.27
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     00:08:31 00:08:31Regenerative Medicine For Arthritis: Part 2Matt Brunke, DVM, CCRP, CVPP, CVA, Diplomate, ACVSMRVetScope
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     00:16:57 00:16:57Regenerative Medicine For Arthritis: Part 3Matt Brunke, DVM, CCRP, CVPP, CVA, Diplomate, ACVSMRVetScope
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     00:17:02 00:17:02Care of the Down Dog Pt. 2Matt Brunke, DVM, CCRP, CVPP, CVA, Diplomate, ACVSMRVetScope
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     01:26:51 01:26:51Physical Rehabilitation as Part of Multimodal Pain ManagementMary Ellen Goldberg, BS, LVT, CVT, SRA, CCRVN, CVPPVetScope