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Regenerative Medicine For Arthritis: Part One

Matt Brunke, DVM, CCRP, CVPP, CVA Diplomate, American College of Veterinary Sports Medicine and Rehabilitation

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American College of Veterinary Sports Medicine and Rehabilitation

ROSS UNIVERSITY
SCHOOL OF VETERINARY MEDICINE

CHI INSTITUTE
TRADITIONAL CHINESE VETERINARY MEDICINE

IVAPM

IRONMAN
Lake Placid

A little about me... I like to keep busy

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Regenerative?
- Not a starfish growing a new leg
- Reparative?
- Platelet Rich Plasma
- Stem cells? – MSC’s

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Treatment
- My Approach:
- What about chronic OA patents that are at end stage and its affecting quality of life even on conventional treatments?

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IA Injections - Options
- Corticosteroids
- Hyaluronic Acid
- Regenerative Medicine
– Platelet Rich Plasma (PRP)
– Stem Cell Therapy

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Which do we use? Mild OA

Prospective trial of autologous conditioned plasma versus hyaluronan plus corticosteroid for elbow osteoarthritis in dogs.

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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.

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PRP
- Validation?

Concentration of platelets and growth factors in canine autologous conditioned plasma

Copyright 2017

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Which PRP System?

Canine Platelet-Rich Plasma Systems: A Prospective Analysis

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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 chemotaxis

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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 gamma

Post Spin: Don’t Want
- RBC’s
– Damage cartilage and synovium
- WBC’s/Inflammatory Mediators
– Cause synoviocyte death

How do YOU find out?
– CBC machine

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Platelet Rich Plasma
Post spin: Unsure
- Lymphocytes
– Unknown significance
– Helps stimulate collagen production

Post spin: Don’t want
- Neutrophils
– Increase IL-1B, TNF-alpha, IL- 6, IL-8
– Increased MMP-9
- Degrades collagen and other ECM molecules

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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 PRP

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Giant PCV tube

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Weigh it

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Counterbalance 1g H20=1ml

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Spin time

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First Spin

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Look at that buffy coat!

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Pull off the PPP

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Platelet Poor Plasma

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Counterbalance

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2nd spin – 7 minutes total

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Pull off to 4cc remaining

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Re-suspend – aka Agitate

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50cc blood – 4cc PRP

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Questions?
- Matt Brunke, DVM, CCRP, CVPP, CVA
Diplomate, American College of Veterinary Sports Medicine and Rehabilitation
DrMattBrunke@gmail.com
DrBrunke.Wordpress.com