Veterinary Vertex
Veterinary Vertex is a weekly podcast that takes you behind the scenes of the clinical and research discoveries published in the Journal of the American Veterinary Medical Association (JAVMA) and the American Journal of Veterinary Research (AJVR). Tune in to learn about cutting-edge veterinary research and gain in-depth insights you won’t find anywhere else. Come away with knowledge you can put to use in your own practice – along with a healthy dose of inspiration to remind you what you love about veterinary medicine.
Veterinary Vertex
Harnessing Mesenchymal Stem Cells: A Revolutionary Turn in Tendon Injury Treatment
Discover cutting-edge advancements in veterinary medicine as we unravel the therapeutic powers of mesenchymal stem cells (MSCs) with the expertise of Dr. Lauren Schnabel. Dive into the intricacies of tendon lesion treatments in horses, a beacon of hope for reducing re-injury rates, and glean insights into the broader applications of MSCs that could transform recovery protocols across different species. Lauren’s invaluable research, featured in JAVMA and AJVR, paves the way for groundbreaking localized stem cell therapy, promising a leap forward in veterinary medicine.
JAVMA article: https://doi.org/10.2460/javma.23.07.0388
AJVR article: https://doi.org/10.2460/ajvr.23.07.0154
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You're listening to Veterinary Vertex, a podcast with AVMA journals. In this episode, we chat about stem cells with our guest Lauren Schnabel. ["law Order"].
Speaker 2:Welcome to Veterinary Vertex. I'm Editor-in-Chief Lisa Fortier, and I'm joined by Associate Editor Sarah Wright. Today we have my very dear friend and colleague, Lauren Schnabel joining us. Lauren, thank you so much for being here with us today. Yes, thanks for having me.
Speaker 1:All right, let's dive right in. So last time you were on the podcast, we chatted about pneumatic compression therapy in horses, and today we're going to discuss your current someone health articles on mesenchymal stem cells. These are paired articles in JAVMON and AJBR. Please share with our listeners the background on these studies.
Speaker 3:Yeah, absolutely so, dr Drew Coe, who unfortunately couldn't make it to the podcast today because he's in surgery, but we worked together on these articles so he did a PhD in my lab and graduated recently and now is at Colorado State University One focus of his PhD work, which is licensing of mesenchymal stem cells, or how we can try to optimize mesenchymal stem cell treatment, and so we had that for the research aspect and for the clinical component. For JAVMA, we worked on a review of kind of what we know about tendon lesions in the horse, why they are such a good model for measuring or evaluating healing using mesenchymal stem cells and how they might be different from other, both veterinary species and humans. So that's how the two pieces came together and they were very fun to write actually.
Speaker 1:Yeah, we appreciate you contributing that knowledge too to JAVMON and AJBR. They're fun for us to read as well. Okay, fun pictures. Yeah, that's the best part. People on social media also really like them.
Speaker 3:Just for the canine part, I mean probably TMI, but I was like, oh, my dog is perfect for this. So the canine ultrasound images are actually one of my pointers. So, yes, very nice, I learned a lot about canine tendon injury the hard way. Yes, I bet.
Speaker 1:And then, what were some of the important insights from these articles?
Speaker 3:Yeah. So in the JAVMA article I think we really tried to share so general overview of anatomy and then so horses specifically get these core lesions or kind of centralized holes for lack of a better word in their tendon and how that's different from some of the other species that get mostly insertional disease or where the tendon actually inserts on the bone. But the way that horses have those core lesions is actually the perfect place to put stem cells because it's like begging for stem cells and this contained area and the cells can be deposited there with needle injection or other methods and it's just a really nice way to study healing that way and also very easy to evaluate on ultrasound and other methods. So the JAVMA article really went over that and then also tips and tricks. We've learned along the way, things not to do.
Speaker 3:I've learned plenty of things not to do in my years in clinical practice which I tried to share in that article as well when treating horses with these core lesions in the superficial digital flexor tendon. Also included some rehab guidelines. Of course it has to be tailored to every specifically, of course, specifically bunch general guidelines for rehab as well. And then the AJDR article. Dr Ko really did a deep dive on what's known about this licensing or stimulating of mesenchymal stem cells for other for the treatment of different diseases that are published in the literature. There's really very little for tendon and that's been the focus of his work. And then what we've done so far for tendon and what the future of that looks like and our goals.
Speaker 2:Yeah, I've done my share of MSCs and these two articles were really fascinating, so replete and insightful, really really great. What specifically stimulated your research interest in MSCs?
Speaker 3:Yeah. So I think from way back at Cornell, just way back now I'm getting old, but looking for a better way to heal these tendon injuries. So tendon injuries are incredibly common in the horse. Of course resources are sort of overrepresented, but they occur in all different disciplines of horses. They're common and they're super debilitating and, most importantly, they have a huge re-injury rate. So up to almost 70% in resources and that's really devastating for both the horse and the rider slash, owner, trainer. So to go through a year potentially of rehab and then have a 70% chance of that tendon being re-injured, so really exciting to think about ways that we could reduce that re-injury rate and heal tendons more effectively and more optimally. That was super exciting to me. And then I also love the comparative medicine aspect, so like thinking about how the horse compares to both human athletes and other species and how we can learn from each other.
Speaker 2:Yeah, thank you. We talked about the broad idea of regenerative medicine. What inspired you to narrow down and write these specific articles?
Speaker 3:Yeah, so I think it was very timely, with Dr Co's defense as well. So we were really we've had some very exciting results in the lab with MSC or mesenchymal stem cell licensing, so stimulating the stem cells in the lab with certain cytokines and then looking at what they secrete and how that can affect tendon healing. And Drew had done all the in vitro work and we're actually doing the in vivo study now. So it was just very timely. We were super excited about that. So we were like let's focus on that as our for the, especially the research aspect, and then tie that into what we know clinically how we're treating the horses clinically now, but what we would want to improve on in the clinic as well.
Speaker 2:Yeah, I think when you write these types of review manuscripts, you still always learn something, whether it's somebody else's manuscript or it gives you time to ponder, as you just said, what do we want to do in the future? So what were the most surprising insights that you gained from writing these two articles? Yeah, that's a great question.
Speaker 3:So I think it was great actually to do an anatomy review as silly as that sounds not of the horse but of the other like really how. So we think about the superficial digital flexor tendon. It's a model for Achilles tendon in people and very similar to the dog, the gastrocnemius tendon and the common cocconeal tendon and superficial digital flexor tendon. It's a little more complicated but it was great for me to review that anatomy and how they're similar and different. That can help me writing some NIH grants in the future probably. And I teach an animal models part of an animal models course here for the graduate school and I do tendon, so I've gone through some of that before. But it was actually great to do another deep dive into that.
Speaker 3:I quite enjoyed that in writing the canine aspects and just really thinking critically about how they are different from each other both in good and bad ways as far as treatment and the load that the superficial digital flexor tendon has to undergo in the horse is pretty tremendous. And then for the you know. And then the licensing article was great. I mean that do it because Drew and I have been talking about it, but still going back through what's been demonstrated with licensed stem cells for the treatment of other diseases is pretty impressive the results that they've seen in some of those models. So there's cardiac models, GI colitis models and it's really exciting to think, if the same could hold true for tendon, how much we could actually optimize our stem cell treatment.
Speaker 1:And for our listeners discerning us, we're discussing on cells with Lauren Schnabel. Lauren, how did your advanced training prepare you to write this article?
Speaker 3:Yeah, so I think these two articles are a perfect example of clinician scientists. So my whole goal, and what excites me about coming to work every day, is bringing what we do in the lab down to the clinic and translating that and have that benefit certainly are equine patients, but hopefully as well potentially canine patients and then maybe people at some point down the road, and I love that. So I feel like these two articles really highlight how those two can be combined and how what you learn in the clinic goes into the lab and then what you go learn in the lab goes back to the clinic. So, yeah, I thought that these were perfect for that.
Speaker 1:Very nice. This next set of questions is really important for our listeners. The first one is going to be more about the veterinarian, the second one from the client. So, for the veterinarian, what is one piece of information that should be known before discussing this topic with the client?
Speaker 3:Yeah, so these two go together a little bit. I have to think about how to answer them totally separately. I think for veterinarians it's really important to know we still there's no magic bullet for these tendon injuries. So we have really nice evidence in the literature now with two long-term clinical studies on resources, and they're highlighted in that JAVM article that these stem cells do have a very important effect on tendon healing, both reduction in re-injury rate, return to racing or return to sport, athletic use.
Speaker 3:But one thing I always want to highlight and both the veterinarians and owners or trainers is that this doesn't mean the horse gets back to work in less time.
Speaker 3:Two months through you're still looking at the full rehab and that rehab is critical.
Speaker 3:You cannot skip steps or try to cheat on time.
Speaker 3:Our goal with the stem cells is to heal with tissue that's more normal, more functional, that's stronger, more elastic, so that they don't re-injure, so that they heal with tissue that's more close to normal tendon.
Speaker 3:So I always point that out because I feel like people have a misconception that stem cells can do everything or they're perfect and I do all these things and they do a lot of things, but we still have to be realistic about there's a lot of other important aspects the management of the horse, the rehab is actually absolutely critical. Then I did try to highlight in the JAVM article we talked a little bit about it briefly, but things that I've screwed up in the past, which are many, but even something as simple as injection techniques, so just not forcing a large volume of stem cells or any regenerative or the biologic into a core lesion. So it actually holds really truly a very small volume and as soon as you feel back pressure you should say, okay, that's good, because if you force a large volume it can actually split the fibers of the tendon and cause a little more inflammation, etc. So I tried to incorporate things like that that I've learned along the way.
Speaker 1:That's great. Just a little plug here. If you ever want to show veterinarians the proper technique, we do have a technical tutorial video in the description Perfect. If you ever feel inspired, let me know I can help you. Then the other side of the relationship. What is one thing clients should consider around stem cells?
Speaker 3:Yeah, so I think it is. Some of the things I said are very applicable to clients as well. So I always want to highlight the benefits that we know from those long-term studies about re-injury rate but that in the lab we're still seeking how to even optimize therapies further. But a lot of clients actually don't know that stem cells are often covered by insurance. It will depend, of course, on which policy you have, but most of them that cover orthobiologics or cover shockwave cover at least a fair amount of the stem cell amount. So that makes it much more accessible to people, especially if their horses are insured. So that might be another thing that I would just throw in there. But then the same applies that again, just not to have the misconception that my horse had stem cells. Now I can go back to doing this right away or I don't have to do these other things. It's still a very comprehensive treatment approach for any especially significant tendon injury.
Speaker 2:Very good, I learned a lot reading them. Thanks, lauren, andrew, yes, Andrew.
Speaker 2:We're talking about MSCs and I'd be remiss if I didn't mention that. A true legend in the field, arnie Kaplan, passed away recently. Professor from Case Western, it really inspired many, many of us. He was the first to isolated, for tissue engineering purposes, mscs from Bone Marrow. They were called stem cells and then stromal cells. Arnie very funnily called them most sexy Kaplan cells for MSCs, medicinal signaling cells, all kinds of things. Really, just a true gentleman. Rest in peace, arnie. Yes, finally, lauren, as we switch it's not really switching gears, but winding down, I wanted to ask you I don't even actually know this about you, despite all the years we've known each other what was the first concert you ever attended?
Speaker 3:Yeah, I'm not sure it may not been the first, but the first really memorable concert I can think of was Prince on Jones Beach. Yeah, no, I mean, prince is an amazing concert, but it was also that, if anyone so. Jones Beach is on Long Island, which I grew up, but it's an amazing venue. The stage is in the water, this whole thing but Prince was incredible.
Speaker 2:Wow, I'm super jealous. Prince anywhere but Prince on Jones Beach is amazing. Haches would be truly amazing.
Speaker 3:Yeah, it was awesome. What was yours Get to turn the question back.
Speaker 2:Huey Lewis in the news. Oh, that's awesome. And Rick Springfield was at the same. One who I just saw was Turin. Again, I was like you were Turin in the early 80s, buddy.
Speaker 3:There's a lot of like revival tours right now. I know they should stay home.
Speaker 1:I'm not going.
Speaker 2:Sarah, are you going to date yourself and tell us yours?
Speaker 1:I was debating but I said it's another episode, so some of our listeners may know this already, but my first one was Justin Bieber. I went to the B96 Jingle Bash in the Chicagoland area and it was like a bunch of artists but he was like the headliner and it was. I don't always play like 13 or 14 or something. I was around the same age.
Speaker 3:I think that makes us feel old. Justin Bieber is like a new thing.
Speaker 1:Yeah, it was a fun time, definitely, but just thank you again, lauren. We really appreciate your contribution to our journals, so thank you, thanks so much for having me and to our listeners. You can read Lauren and Drew's manuscripts in print Javma and on our journals website. I'm Sarah Wright with Lisa48. We want to thank each of you for joining us on this episode of the Veterinary Vertex Podcast. We love sharing cutting edge veterinary research with you and we want to hear from you. Be sure to leave us a rating and review on Apple Podcasts or whatever platform you listen to.
