Vet-Stem says, 'Arthritis begone!' (One California company's quest to curb joint pain)

Patty Khuly, DVM
March 27, 2008
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Vet-Stem is a San Diego-based biotech company that prides itself on thinking outside the box. In this case it’s looking “outside the joint” for solutions to the crippling arthritic pain our pets often face. Unsavory as it sounds, they’re doing this by getting a sample of your pet’s fat—surgically.

Vet-Stem Regenerative Cell (VSRC) therapy is the company’s term for a proprietary process in which “stem cells” are isolated from fat then injected into your pet’s joint or tendon.

It’s gotten great press across the country recently (including on PetConnection’s blog just this week) for how such new therapies speak to our willingness to pay for expensive procedures to relieve our pets of their pain. But it’s also stirred up its share of controversy in vet circles.

“High-tech Voodoo,” some scientists and vet specialists call it.

“Don’t knock it if it works,” is the increasingly common rejoinder.

The idea involves the sourcing of a cell type that has the power to promote healing once it’s injected into the exact right spot they’re needed. As to the exact mechanism, here’s a direct quote from an email interview the company graciously granted:

“The current working theory on how these cells work is that they act as trophic mediators, cells that signal to other cells to come in to repair response to the environment.  These cells secrete a variety of cytokines, cells that help regenerate and repair the tissue, and growth factors. A diverse population of cells with different roles help the natural healing process regenerate the tissue."

It’s possible that many surgically inaccessible areas might be well served by stem cells. Unfortunately, these cells also have the power to send the pro-life minions into political overdrive.

Luckily, Vet-Stem’s cells are sourced from pets themselves. If this technology were ever employed in humans, so too would they come from the same individual receiving the therapy—not from the ethically controversial sources that spawned a national debate on the subject.

In fact, some clinical pathologists deny this practice uses the stem cells we’re all familiar with when it comes to Alzheimer’s research, for instance. In other words, they say, these are not the embryonic  stem cells capable of becoming any cell in the body. Rather, they’re more likely a less potent cousin to these.

But that’s scientific quibbling, isn’t it? Perhaps. Vet-Stem cites research backing up their claim to the term “stem cell.” Despite this, my clin path colleague says, “This is what I do for a living. Trust me. They’re not stem cells.”

Her contention is that if marketing nomenclature doesn’t hold up to scientific scrutiny, it always has a way of degrading trust in a company’s offerings. On those grounds alone she questions the therapy’s mode of action, which she says is highly doubtful as it’s described.

Even if she’s got a point, even if she’s 100% correct on the biology, that doesn’t mean VSRC it doesn’t work. Just because we have no idea how glucosamine can serve to decrease joint pain doesn’t mean we should throw it out the window.  The true mechanism of our cancer isn’t understood by us mere mortals, either, and that certainly doesn’t keep animals from dying of it in droves. Right?

But come now, you ask, doesn’t a therapy have to prove how it works—exactly—before it’s accepted by the FDA for approval? Actually, a drug or procedure’s FDA approval is based on its safety and efficacy. We’re not sure exactly how many of our drugs work. In fact, most of our drugs have many modes of action whose interrelationship evades us. But if the benefits (we know of) significantly outweigh the risks (we know of) it’s off to market.

And that brings up a nice point. This therapy doesn’t need FDA approval—because it’s not a drug. It’s reportedly more like a “supplement” in its action, therefore requiring no FDA oversight. And we’re talking animals here, not people. Lots of new stuff unable to meet US human medical standards for safety and efficacy (sometimes just because of the expense the process entails) ends up being used in animals, instead.

As with the collagen injections whose effects line starlets’ lips, it’s also been reported that this therapy’s benefits, if any, aren’t destined to last very long. Follow-up injections may be required. For a dog with degenerative elbow disease inaccessible by conventional surgical techniques, however, four months can be a very long time—if it works, that is.

The group of nine specialists I informally polled for this post are not experts in this field, but all veterinarians are being asked to take a close look at VSRC and decide whether it might be a good approach for their patients.

All but one specialist expressed profound skepticism of the potential benefits: The clinical pathologist who works directly with joint fluids on a daily basis. The veterinary surgeons who cut into joints when necessary. And the internists and neurologist who may soon see Vet-Stem therapies apply to their cases as well. All had good reason to have heard about Vet-Stem. And they mostly weighed in on the side of “Voo-doo.”

One surgeon held out, believing the long-term stats would tell, explaining that anything presented as novel and unproven to a bunch of scientists would likely meet with the kind of attitudes I’d been treated to on the subject. “Sure, it sounds like ‘Voo-doo.’ But who knows? If the risks to the animal are small [reportedly the same as for a small mass removal and any joint injection—less than for joint surgery] why not give it a go? People are desperate for pain relief. Why not try it?”

Indeed, about 250 veterinary surgeons have completed coursework to learn the procedures the therapy requires. According to the company, it’s been used in more than 2,500 horses and more than 300 dogs. Theoretically, it works in cats, too, they say. But owners aren’t always aware of cat pain like they are with dogs and horses—and they’re historically willing to shell out less for their care.

Predictably, the equine world is more abuzz with news on this treatment. That’s where the big money lies. Equine health insurance companies are paying for it. Our own pet insurance carriers may cover it, too. Check with your policy, they urge.

And here’s where I come to my last question: How much does it cost? The company’s response: “Vet-Stem’s patients’ health statuses vary, and the cost to the client is difficult to estimate. Vet-Stem recommends pet owners talk to their veterinarians about the costs.”

Hmmmm…one hundred, one million? Gimme a ballpark, guys. After talking to some others involved in the process I got some broad answers to my question: The costs are roughly comparable to those for joint surgery.

Remember, there are three separate procedures involved: surgical fat retrieval, stem cell isolation and joint or tendon injection. It’s bound to be pricey.

So how about it? Now that you know more, would you go for it?

(Stay tuned for the full interview later today.)