The stem cell therapy debate: Experimental therapies, veterinary science and needy pets
Here's a reprised topic for you: the increasingly popular procedure called "stem cell therapy." Why a reprise? Because this novel approach to treating orthopedic ails in horses and dogs is all the rage in vet med … now more than ever.
The idea is this: You take a bunch of cells from the body that have the potential to turn into any kind of cell (we've demonstrated this in the lab), and then inject them into a place where they're needed (like a sick joint or injured tendon), and voilá — they turn into the kind of cells the body most needs to effect a repair (we hope).
And guess what? It's more than aches and pains of the joints that is being treated with stem cells. Indeed, it's chronic renal failure (CRF) and inflammatory bowel disease (IBD) in cats, too! But here's the rub: Does this therapy deliver results?
Here's the short answer: Based on current peer reviewed literature, injecting stem cells into afflicted tissues is NOT justified. The stats are just not there to prove its efficacy. Which means it's experimental.
Translation: Between the cost and invasiveness of this approach, the very real question remains — why subject your pet (horse, dog, or cat) to a procedure that requires a surgical retrieval of deep belly fat, a precarious injection, and lots and lots of cash?
Here's why you might: Judging from the media reports, it would seem that most pet owners are happy enough with the results (measured subjectively as some improved comfort) to have their pets endure a surgical procedure to collect stem cells from the falciform fat (deep in the umbilicus) and have it injected into a sensitive spot (usually into or around a tendon or joint). A payout of perhaps $2-3,000 in expenses per go-round is considered the acceptable loss for this procedure (prices will vary by locale).
Yes, despite its high cost and fiddly-ness, this is one procedure that horse and dog owners are clamoring for in droves. They hear how successful it is and how some animals are effectively reborn after receiving injections. When your beloved pet is ailing, you'd try anything, wouldn't you? (I might, too.)
As a result of all these reports leaking into the pet-o-sphere, a niche industry has been created around the procedure. It's gotten so that veterinarians who may not even feel comfortable with the safety and efficacy of the procedure are feeling driven to offer it.
(Because of the relatively high degree of skill required to perform the necessary injections, board-certified surgeons are the providers most typically employed to undertake them.)
All of this is probably why the Journal of the American Veterinary Medical Association (JAVMA) featured a debate over this novel approach in the lead article of its most recent issue. They offered up both sides:
1. Promising new therapy. Sure the research is technically still considered equivocal, but do we have the right to keep such an exciting approach from the pet owners who are so desperate for any treatment that might help their crippled or terminal pets? And with all the success stories out there it's getting even harder to keep the pet owners who are demanding this procedure at bay. An exact quote from the article reads, "It’s an exciting time to be in veterinary medicine."
2. Then there's this less sanguine take: We have no idea whether the cells we're putting into these animals do anything at all. And because every surgeon and his/her mother is offering stem cell injections for orthopedic issues without first participating in clinical trials (as any experimental therapy would seem to warrant), we may never know. (For the record, the work being done in cats with respect to IBD and CRF is being undertaken in an educational setting and, as such, is being treated as a purely experimental therapy.)
After all, they say, this is not a "do no harm" approach. Indeed, to offer this procedure without an understanding of the true risks and rewards would seem to contradict the demands of our Hippocratic Oath.
Among the naysayers is long time Fully Vetted reader, SkeptVet, who gets to have his say and then some. Perhaps we can drag him over here to address the same question I'll put to all of you:
Given the reality that the pets most affected by this are those with conditions that are untreatable by any conventional means, and that time-consuming clinical trials would require onerous delays in treatment, is it wrong to keep this therapy out of owners' hands? Or is it worse to fail to live up to the oath that exhorts us to act as scientists first?
Dr. Patty Khuly