Using platelet-rich plasma, stem cell therapy and veterinary rehabilitation therapy to treat osteoarthritis and soft-tissue injuries.
Zelenskaya/ Shutterstock.comRegenerative therapies can help treat osteoarthritis and soft-tissue injuries in canine athletes, says Brittany Jean Carr, DVM, CCRT, who presented at the 2016 Purina Canine Sports Medicine Symposium held recently in Gray Summit, Missouri.
Platelet-rich plasma potential
In her proceedings paper, Carr says platelet-rich plasma (PRP), a fluid concentrate of mostly platelets and growth factors, “has been shown to support healing by supplying growth factors, cytokines, chemokines and other bioactive compounds” and can be effective in managing osteoarthritis and soft tissue injuries (as observed in several human and canine studies).
In her lecture, Carr discussed a 2015 study she co-authored in which researchers evaluated key parameters of the PRP product from five commercial canine PRP systems in healthy adult dogs. According to the study, “no claims regarding the efficacy of PRP therapy in canines or the efficacy of the PRP formulations evaluated [could] be deduced.” Further study is needed to determine clinical applications.
A study of stem cell therapy
Most veterinary research has involved mesenchymal stem cells (MSCs) derived from both bone marrow and adipose tissue. There is no evidence in canine literature to suggest that one is superior over the other, Carr says-she notes that positive clinical outcomes have been reported for both. Determining the optimal type and amount of stem cells for soft-tissue and and osteoarthritis therapy will require further research.
When PRP and stem cell therapy join forces
A combination of PRP and MSCs is common, Carr says in the proceedings. Although MSCs “have potent anti-inflammatory, antifibrosis, proangiogenic properties,” they need growth factor supplementation in order to be grown in vitro-something PRP can contribute. Furthermore, PRP can provide a “fibrin scaffold” for MSCs, which “prefer to connect into a three-dimensional fibrous environment.”
When PRP and MSCs are combined, “certain growth factors and cytokines released from platelets bind to receptors on the surface of stem cells and initiate a cascade involving signal transduction, gene expression, and stem cell proliferation, migration and differentiation,” explains Carr. And “PRP provides a delivery vehicle and three-dimensional scaffold to support cell survival and proper differentiation.”
According to Carr, regenerative therapy is most effective when paired with rehabilitation therapy, which can help “speed healing by decreasing inflammation and swelling, building muscle mass, increasing range of motion, and improving overall comfort.” In addition to manual therapies and standard isometric exercise, Carr recommends Class 3B low-level laser therapy as “recent studies have shown it can stimulate stem-cell differentiation, proliferation and viability.”
On the other hand, Carr recommends avoiding Class 4 laser therapy, underwater treadmills, therapeutic ultrasound, shockwave therapy, neuromuscular electrical stimulation/transcutaneous electrical neurostimulation, and NSAIDs for the first eight weeks after regenerative therapy because their effects on stem cells and PRP haven't been fully investigated.
The average regenerative therapy patient is able to heal and build the amount of muscle mass needed to return to competition or normal activity within four to six months of treatment, Carr says.