On June 8th, 2017 there was a Stem Cell study for canine arthritis. It claimed that a 1-month course of non-steroidal anti-inflammatory drugs has the same effect as a single postoperative intra-articular injection of allogeneic neonatal mesenchymal Stem Cells. The study outcome confirms this hypothesis.
General information
In recent years, various clinical studies have reported mesenchymal Stem Cells (MSCs) as a promising therapeutic approach. In order to manage inflammation and pain in patients with joint disorders. Also patients with spinal cord injury, and patients suffering from rheumatoid arthritis.
The objective of this study was to evaluate an alternative postoperative management protocol to the standard non-steroidal anti-inflammatory drugs. The studies hypothesis was that dogs receiving one intraoperative intra-articular (IA) injection of umbilical-derived MSCs after surgery to treat cranial cruciate ligament rupture, without postoperative drug treatment, exhibited no difference on the postoperative outcome (up to 6 months) compared to dogs receiving IA MSC-vehicle injection and non-steroidal anti-inflammatory drug treatment for 1 month.
Cranial cruciate ligament rupture and its treatments
Cranial cruciate ligament rupture (CrCLR) in dogs is one of the most common orthopedic diseases in veterinary medicine. It leads to stifle joint instability and inflammation and inevitably resulting in the development of stifle osteoarthritis (OA). Treatment involves surgical joint stabilization and the medical management of pain and inflammation.
To restore joint stability, tibial plateau leveling osteotomy (TPLO) is one of the most common surgical procedures performed worldwide. TPLO delivers quick and good clinical outcomes for a majority of the treated dogs.
Immediate postoperative management includes non-steroidal anti-inflammatory drugs to alleviate pain. Also to reduce inflammation resulting from both preoperative CrCLR-related arthritis and the surgical procedure. However, some patients cannot be treated with drugs either. Because they developed intolerance with gastrointestinal symptoms. Also because of concurrent gastrointestinal bleeding, impaired renal, hepatic, cardiac function, or hemorrhagic disorders.
Are There Any Other Parts Of The Joint Affected When CrCLR Ruptures?
Let’s be straightforward with this – YES. There is a big chance that something else will be affected because of CrCLR rupture.
The medial meniscus (MM) is a fibrous pad attached to the top of the tibia that acts as a cushion inside the joint. In fact, there is also a lateral meniscus, but it is less often injured. The MM can be injured at the time of CrCLR but is more often damaged after prolonged instability of the stifle joint.
So that means, without CrCLR, the femur puts a crazy high pressure on the MM and that can lead to tearing and shredding of the meniscus.
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How Can I Know That My Dog Has Problems With CrCLR?
It’s just like everything else, even in humans. When we have problems with our legs or have some injuries, we tend to limp. The same is with animals. That is obvious, isn’t it?
In the same way, the dog also whines when he is in pain. He will also be lazy and not want to do anything. If you ignore his lameness then it will improve in the next weeks. Furthermore, that can also make problems with MM because it will get damaged – it will be torn.
If your dog has a partial CrCLR rupture, then he will be lame only when he does some active exercise and will improve with resting. However, mentioned does not mean that you don’t need to get treatment for him.
If you do not find any treatment then the ligament will continue to weaken and the joint will become increasingly unstable.
Eventually, the ligament will likely rupture completely and no amount of rest will improve the lameness.
Study criteria and treatment protocol
Included animals were client-owned dogs presented for a natural occurring unilateral CrCLR and weighing between 20 and 60 kg. CrCLR was diagnosed at the clinical examination.
Eligible animals were randomly assigned to two groups through a clinical pilot study conducted independently from clinicians. The dogs in the “MSCs group” received in a blinded fashion 10 × 10^6 MSCs in the operated stifle joint by a single injection in the arthroscopic portal site before the closure of the joint. Dogs receiving MSCs prescribed them from the day after surgery and for 1 month thereafter. They were received with an “A” treatment corresponding to an AINS placebo with no claim for any anti-inflammatory or an OA management in the product datasheet.
The dogs in the “NSAIDs group” received the MSC vehicle (phosphate-buffered saline; PAN Biotech, Germany) at the same time of surgery as dogs in the “MSCs group”. They also were prescribed with a “B” treatment corresponding to non-steroidal anti-inflammatory drugs (firocoxib, 5 mg/kg, orally, once daily) for 1 month, starting the day after surgery.
Results
Twenty dogs met the inclusion criteria and were enrolled in the present study. Fourteen dogs completed the present study (nine in the MSCs group and five in the NSAIDs group).
Overall, this clinical trial did not reveal any difference in clinical scores, gait evaluation, and lameness improvement between dogs. Either they received one single IA articular injection of canine allogeneic neonatal MSCs at the time of the surgery or a 1-month course of oral NSAIDs after a TPLO procedure. Clinical evaluation using a scoring system revealed adequate pain management for dogs treated using both approaches.
No significant difference was observed for any parameters at the Month 1, Month 3, and Month 6 follow- up time points. An objective, semiquantitative assessment of lameness was performed in the present study using a pressure walkway system (GaitRite®). The results from the walkway system showed no difference in either the forelimb or hindlimb total pressure ratio. As well as in the symmetry index between MSCs and NSAIDs groups at any time of the trial. This finding enables the objective comparison of both approaches without suffering from the bias introduced by the evaluator when using standard gait evaluation, suggesting that MSCs do not induce gait worsening.
Conclusion Of Stem Cell Studies For Canine Arthritis
Single postoperative intra-articular injection of canine allogeneic neonatal MSCs leads to a level of postoperative lameness and pain outcome after tibial plateau leveling osteotomy, not significantly different to ones obtained with NSAIDs systemic administration in dogs, and, in some cases such as bone healing, even better results.
These promising results are a first step to considering MSCs as an efficient alternative to long-term drugs in the management of postoperative pain after surgery. They also may justify the use of these cells in veterinary medicine. In order to widen the therapeutic arsenal of the clinician in the management of postoperative pain, ease treatment observance and avoid drug side effects.
MCSs have also shown very good results in treating dog arthritis and osteoarthritis, as the only solution that can help. With Stem Cell studies for canine arthritis, there is no doubt that these treatments can and should be used as a great drug alternative. As well as a treatment of many diseases in animal regenerative medicine.
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