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Regenerative Medicine For Arthritis: Part Two

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

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Stem Cells – Marrow or Fat?
- Bone Marrow Derived MSC
- Contains hematopoietic stem cells
- Contains marrow stromal cells (MSC)
– Generates bone, cartilage, fat, connective tissue
- Types:
– Culture Expanded
– Bone Marrow Aspirate Concentrate (BMAC)
- Adipose derived MSC
- Adipose derived stem/stromal cells (ASCs)
– International Fat Applied Technology Society
- Contain (MSC) adipose stromal cells
– Generates bone, cartilage, fat, connective tissue
- Types:
– Culture Expanded
– Stromal Vascular fraction (SVF)
- Two anesthesia episodes
- FDA – “drug”

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Regen Med – Stem Cells
- Bone Marrow
- Contribute to generating new tissue
- Chemotactic for progenitor cells
- Supply growth factors
- Make extracellular matrix
- Angiogenesis
- Anti-apoptosis
- Anti-inflammatory
- Anti-fibrotic

Mature stem cells
Haematopoietic stem cell
Stromal stem cell

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IA Injections – Collecting Bone Marrow
- In-clinic – same day harvest and treatment, single anesthesia

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Bone Marrow Stem Cells
- Sedation/Anesthesia
- Proximal Humerus or Proximal Femur
- 25cc of marrow – 3cc of stem cells

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Filtering the Bone Marrow

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Research

Partial Cranial Cruciate Ligament Tears Treated with Stem Cell and Platelet-Rich Plasma Combination Therapy in 36 Dogs: A Retrospective Study

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<50% tear of cranio-medial band only intact caudolateral

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But it’s NOT Magic Pixie Dust!!!
- Best Response for Regenerative Medicine
– Must have a definitive diagnosis
– Must be able to treat the underlying condition
- Not replacing tissue
- Multimodal approach
– Medical
– Surgical
– MSC/PRP
– Rehab

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After Joint Injections
- Injected HA? Keep on NSAID (PRN), hold on LASER for 2 weeks. Ice is fine.
- Steroid? – No NSAID for 1-2 weeks, LASER, Ice are fine.
- Start REHAB – 7-14 days later

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After Joint Injections - Regen
PRP
- No Class 4 for 2 weeks (3b ok)
- No NSAID for 2 weeks?
- Galliprant ok
- No ice for 2 weeks
- No MSM for 2 weeks?
- YES REHAB

Stem Cells/PRP
- No Class 4 for 8 weeks (3b ok)
- No NSAID for 8 weeks
- Galliprant not ok?
- No ice for 8 weeks
- No MSM for 8 weeks
- REHAB

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Multimodal approach
arthritis. Today, veterinarians have a range of treatment options, called a multimodal approach, that can be used together to improve the quality of life for their patients.

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