Introduction to stem cell therapy
Most visitors to this site will want to know whether stem cells may improve the quality of life of their dog (or cat) who is affected by arthritis. The answer is likely yes, if case selection is appropriate, i.e. that the joint isn’t so badly diseased that stem cells simply won’t work. Though the use of stem cells is sometimes referred to as ‘regenerative medicine’, it is important to emphasise that stem cells for the treatment of arthritis are anti-inflammatory; they do not regenerate cartilage. At Fitzpatrick Referrals, we also sometimes use stem cells to grow bone or cartilage and that will be explained below.
For stem cells to have maximal efficacy in the treatment of osteoarthritis (as opposed to inflammatory or infectious arthritis), it is essential to have optimal culturing conditions when cells are harvested from the fat of your canine (or feline) friend. It is also essential to specify the number of cells and within which cocktail they are administered, containing other elements such as blood platelets and a lubricant. We have accumulated a body of evidence having treated hundreds of dogs (cats are less commonly affected by severely debilitating arthritis) and in our experience the therapeutic benefit of cells cultured from a patient’s own tissue (autologous) are superior to results with commercially available preparations. [Note: autologous means from the same patient; allogeneic means from another patient of the same species.]
At Fitzpatrick Referrals, when treating osteoarthritis, we offer all medical management and physiotherapy/hydrotherapy options, stem cell and surgical treatments. For elbow arthritis for example, we offer some surgical management options which are unique to our practice and not available anywhere else in the world. Uniquely also, our on-site laboratory is run by a PhD doctorate of stem cell research, Dr Anita Sanghani-Kerai, and our proprietary process for the elucidation of anti-inflammatory stem cells is available only at Fitzpatrick Referrals.
We strongly feel that it’s very important that a balanced view is provided to the guardian of every animal based on the particular type and magnitude of osteoarthritis affecting their dog (or cat). In our view, no clinical case of arthritis should exclusively be a ‘physio-/hydro- or medical/dietary management case’, a ‘stem cell case’ or a ‘surgical case’ – all options should be fully discussed and treatments offered should be devoid of any vested interest based on whatever modality a clinician may have at their disposal.
What are stem cells and how can they help?
Skeletal stem cells are a population of cells found in various locations within the body including muscle, bone marrow and fat tissue. Most of the time in clinical practice, stem cells are extracted from around the blood vessels (pericytes) in a sample of fat (adipose tissue). These are more correctly referred to as adipose-derived mesenchymal stem cells (AdMSCs). But sometimes at Fitzpatrick Referrals we also extract stem cells from bone marrow. A stem cell is capable of turning into many different types of tissue. Skeletal stem cells have been the subject of intense research over the past decade, especially their application in wound repair and pain relief for debilitating musculoskeletal diseases.
What stem cell treatments are available at Fitzpatrick Referrals?
Most of the time we propagate anti-inflammatory stem cells from fat, but sometimes we propagate stem cells from bone marrow or even cartilage. For example, used in conjunction with a bone-cutting procedure (osteotomy) to unload the diseased part of an elbow joint, bone-marrow derived stem cells may help to heal worn-away cartilage. It should be noted that this isn’t normal joint cartilage (hyaline) but rather a scar covering of fibrous tissue (fibro-cartilage). We can also grow bone or cartilage cells to help heal a defect in bone (a non-union) or a hole in cartilage where the joint isn’t being rubbed away (a condition called osteochondritis dissecans).
When anti-inflammatory stem cells are grown in our laboratory they can be injected to a joint on their own, but we have found a triple cocktail more effective, i.e. where we mix fat-derived stem cells with platelet rich plasma (PRP) and a viscoelastic supplement (e.g. Arthramid™ or Hy-50™, trade names for joint lubricant hydrogels). Hydrogels provide lubrication and also a scaffold for the cells, promoting a slow and steady release of growth factors from the propagated stem cells. The platelets and the cells together release anti-inflammatory molecules which reduce pain and allow patients to mobilise better with improved quality of life. [Note: effectively these anti-inflammatory cytokines counter the pro-inflammatory cytokines released from the lining of the joint, the synovium, in the disease state of osteoarthritis.]
We monitor the effectiveness of the treatment using a gait analysis pressure platform walkway during rechecks at every re-injection appointment.
Which patients benefit from anti-inflammatory stem cell therapy?
- Patients with moderate to severe osteoarthritis where you have elected not to have surgery and often when medical therapy alone is not controlling pain effectively or not tolerated.
Or
- Patients having surgery for joint disease where the surgical team feel that stem cell therapy would be helpful in reducing inflammation and discomfort and also in aiding repair of damaged tissue within the joint. This therapy is more commonly performed in younger patients to try to slow the disease process.
Why choose Fitzpatrick Referrals for stem cell therapy?
Fitzpatrick Referrals was one of the first orthopaedic specialists to begin using stem cell therapy and has been offering this service since 2017. We are one of the leaders in the field of stem cell research and therapy. The stem cells we use have been scientifically characterised and the platelets have been quantified. We have published data to show the efficacy of stem cells and PRP in improving lameness, pain and quality of life in dogs with osteoarthritis.
We only use your own dog’s cells (autologous therapy) for stem cell treatment. This minimises the chances of adverse reactions and maximises effectivity. Quality control is deemed essential.
We take a balanced view and offer you all medical, rehabilitation, joint injection and surgical options and have more unique options than any practice in the world. We recognise that our moral responsibility is to give you all the options in an unbiased fashion, and recognise that osteoarthritis is not reversible or curable, but rather a life-long team commitment to the quality of life of that patient.
QUESTIONS
FAQs
Here is a list of the common stem cell therapy questions we receive at Fitzpatrick Referrals – if your question is not answered here, please contact us with your query and we will be happy to help!
What conditions do stem cells treat?
When we are treating osteoarthritis in dogs, the most common causes are:
1. Developmental elbow disease (used to be called elbow dysplasia)
2. Hip dysplasia
3. Partial tears of the cranial (anterior) cruciate ligament of the stifle (knee), often in association with surgery
4. Osteochondritis dissecans causing osteoarthritis of the hock, stifle, elbow and shoulder
5. Osteoarthritis of any joint caused by trauma.
What does the stem cell therapy of osteoarthritis involve?
All patients will be fully assessed by one of our senior orthopaedic clinicians which will give you an opportunity to discuss the most optimal plan for your dog (or cat) and yourself. Our team is passionate about treating all of our patients and clients as unique individuals, and recognising that everyone has a right to choose their most optimal path.
At this initial assessment we will perform a gait analysis test to see how your dog is distributing their weight through each of their limbs. This is baseline data so that we can assess progress objectively over time.
If your dog is suitable for stem cell treatment, then we will admit your dog into the hospital to perform a short general anaesthetic – this is to allow us to obtain a small sample of fat tissue from underneath the skin, or from a very small incision near the belly-button to obtain fat from inside the abdomen. Most patients can go home the same day. The fat cells are then cultivated in our on-site laboratory by our dedicated team, which typically takes approximately 14-20 days.
Once your dog’s cells are ready, we will need to see you back at the hospital for the intra-articular injection (stem cell therapy). This is generally performed under sedation. On the day of therapy, a small patch of fur will be shaved at the injection site and patients can go home the same day (usually a two to three-hour turnaround).
Is stem cell therapy painful?
The treatment is performed under sedation or a short general anaesthetic so that the surgeon can prepare the area for the injection and ensure the joint is kept still. This is an injection into the joint, so-called ‘intra-articular.’ Your dog won’t feel anything during the procedure but the joint might be a little swollen, sore or stiff for the next few days.
What is the difference between stem cells and PRP?
PRP is platelet rich plasma. PRP can be used on its own as an intra-articular injection for arthritic joints. The platelets act as biological capsules of anti-inflammatory cytokines which help to reduce joint pain. We take a blood sample from your dog and centrifuge this to concentrate the platelets. We will assess your dog and discuss which treatment may be optimal for you both. Our clinical experience has shown that for most patients the triple combination referred to above is superior in terms of magnitude and longevity of effect than PRP alone.
How much does stem cell therapy cost?
The cost of treatment is variable depending on number of joints affected but a guide price would be approximately £3000 – this includes the initial consultation, the general anaesthesia to perform the fat harvest, growing of the cells and then the follow-up appointment with sedation and one intra-articular injection of stem cells and PRP. The cost of hydrogel is in addition.
Each repeat injection of stem cells and PRP, if needed, would be approximately £700 (includes recheck , sedation, and injection). The cost of hydrogel is in addition.
Can I pay for treatment with pet insurance?
Most insurance companies will cover this therapy but it is always sensible to check your policy prior to treatment. Our finance team will be happy to help you with this in advance of your appointment.
How quickly will stem cell therapy work?
This is variable between patients but we would expect to see an improvement within two weeks of treatment.
How long does stem cell therapy last?
This is also variable since each patient’s disease is different. The physical status of every joint affected by osteoarthritis is different depending on the stage of this progressive disease, the inciting cause and the response of the tissues to the degenerative process. For most patients the effect wanes after 6-12 months; for some this is a shorter time-interval. We will store your dog’s cells in our lab indefinitely (with your consent) for repeat injections. We need about three weeks’ notice for reactivation and regrowth from the frozen state to prepare another dose for injection.
Will stem cell therapy cure arthritis?
Sadly, there is no one cure for this progressive condition. Our team will help advise on the best combination therapy to keep your dog comfortable for as long as possible and work with your primary care vet to this effect.
What are the side effects of stem cell therapy?
It is extremely rare to encounter any problems but as mentioned above, patients may be slightly swollen, sore or stiff for a few days, during which we tend to give paracetamol medication in addition to whatever ongoing medication a patient may be on. There is a very minor risk with all sedations and general anaesthesia procedures and though joint injections are performed in a sterile manner, there is also a very minor risk of infection. We take all precautions to minimise risks.
Can I get this done by my own vet?
Autologous stem cell therapy requires a dedicated laboratory to prepare, store and grow your dog’s stem cells in a sterile environment and this is a complicated process. As mentioned above, we have our own proprietary mechanism for elucidating and mixing the cells subject to very stringent quality controls. Once ready, the cells are only viable for a few hours and are immediately injected. To ensure that the cells your dog receives are of the highest quality for optimum results, we encourage your dog to be injected by our dedicated orthopaedic team.
If you do need to make a long trip to us, we can advise on great local places to stay and your dog is welcome to stay with us overnight where we have a team onsite looking after our patients 24/7 in large spacious kennels.
How can I get my dog booked in for stem cell therapy?
Everyone has access to stem cell therapy for their dog (or cat) at Fitzpatrick Referrals. We are never too busy to book you in. Please contact your own vet and ask them to make you a referral to Fitzpatrick Referrals. This is quick and easy for them to do via our referral form and then we will arrange the appointments at your convenience.
