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
Advancements in Veterinary Regenerative Medicine
Ever wondered how regenerative medicine could revolutionize veterinary medicine? Join us as we explore the groundbreaking insights from the June JAVMA supplemental issue with Guest Editor Dr. Kyla Ortved. Kyla shares insight into the world of regenerative treatments for various species, including cats, dogs, and even zoo animals. Discover how veterinarians are not only using regenerative medicine to advance animal health but also contribute to human medicine, all under the One Health concept.
Learn about the latest regenerative therapies available for animals, particularly horses, and the benefits of treatments like mesenchymal stem cells for conditions such as superficial digital flexor tendon injuries. Hosts Sarah Wright and Lisa Fortier add a personal touch with their anecdotes, making this episode both informative and engaging. Don't miss out on staying updated with the latest advancements in veterinary regenerative medicine and be sure to leave your feedback on Apple Podcasts!
Editorial: https://doi.org/10.2460/javma.262.s1.s4
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You're listening to Veterinary Vertex, a podcast of the AVMA Journals. In this episode we chat about the June JAVMA supplemental issue on regenerative medicine with our guest, kyla Orgved.
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 dear friend and colleague, kyla joining us to talk about her really cool supplemental issue on a topic that is near and dear to my heart regenerative medicine. Thank you, kyla, for taking time again to help us out and be here with us today.
Speaker 3:Of course, my pleasure Thanks for having me.
Speaker 1:All right, let's explore what readers can expect from the June Supplements Issue on Regenerative Medicine. So, Kyla, as the guest editor for the Java Supplemental Issue, the current state of veterinary regenerative medicine. How did you identify the topics for this supplemental issue?
Speaker 3:That's a great question. So obviously regenerative medicine is a broad topic. We hear a lot about it in all aspects now veterinary human health. What I thought was really cool when I first started talking to you guys about putting this supplemental edition together was how broadly this expands across so many veterinary species. Now I'm very familiar with the equine regenerative world and the equine regenerative researchers, but I knew there was a lot more out there and it was really interesting to sort of dig into what's going on in other species.
Speaker 3:You can see in the edition there are several articles on regenerative medicine in cats, several in dogs and then even some in zoo medicine, which I thought was really interesting. And then the other thing that I've always been fairly passionate about is the translation or the idea of one health between veterinary species and human medicine, and you can see as well from several of the articles really address that and are using either naturally occurring diseases in animals or different models of animal disease to inform the human health world about. I think it's really cool and I think it's. I think in regenerative medicine, veterinarians and veterinary researchers are really having a huge impact in the field in general, not only in our own patients but also across across the medical field as a one health, as a one health idea as well.
Speaker 2:I think that's a great way to put it, kyla. I love that veterinarians are leading in a lot of those spaces. Regenerative medicine touches every body, organ type and every species, so well done to try and balance the species and the different body systems.
Speaker 3:Yeah, lisa, I did. That's a great point, because I didn't even I forgot to say that I'm so focused again like you are, on musculoskeletal regenerative medicine and there's obviously so much more and you can see in several of these manuscripts and papers using regenerative medicine to address a really wide range of diseases, everything from cancer, neurodegenerative diseases, renal disease and then, of course, musculoskeletal disease. But it was really interesting to see all of that.
Speaker 2:Yeah, we definitely have a shared passion for musculoskeletal. What sparked your interest in regenerative medicine?
Speaker 3:Partially you. So when I was a resident with Lisa back at Cornell, there was a lot of focus on regenerative medicine, not only in Lisa's hands and in Lisa's lab but also in Alan Nixon's lab, which is where I did my PhD and I honestly didn't know I mean I didn't know that much about really anything at that point. But I didn't know that much about regenerative medicine and what I thought was really interesting about it was that, with my interest in joints and cartilage and knowing that there are still few treatments that can really improve the health of cartilage or sort of reverse damage or trauma, to the articular cartilage.
Speaker 3:the idea of looking into things that would offer sort of a better disease modifying effect for the joint was exciting to me and I felt like regenerative medicine was sort of at that edge and starting to push that field forward. The other thing that was really, I think, really appealed to me was that we were also using regenerative medicine in clinical patients, and that was, oh my, I don't even want to say it, it was like 20 years ago now when I was a resident. But so so to see, to see what we were doing in clinical patients, to see therapeutic benefit in clinical patients, but then also to be working in the background through some of more of the basic and translational science of it was just it was. It was a really cool thing to be a part of. And then and then I just I don't know I fell in love with it, I guess, and kept going with it.
Speaker 2:Yeah, I think it was around the time you were there, carla. When we transitioned from you know, we diagnosed or localized the lameness to, let's say, the metacarpophalangeal joint, we didn't reach for steroids anymore. Our first line of treatment became regenerative medicine and, like you said, disease modifying rather than symptom modifying. So it's been really fun to take that journey together.
Speaker 3:Yeah, and I think too, it's really amazing to see the arc of regenerative medicine and I am not just saying this because we're veterinarians, but I do think that veterinarians have played a large role in moving the field forward and sort of bringing it into more of a mainstream usage. And I think in terms of equine regenerative medicine, it's interesting to see now in some of the small animal clinical uses of regenerative medicine they're really starting to employ a lot of what we have done. So things like interarticular injections, intertendinous, interligamentous injections of regenerative medicine is becoming much more common in the canine world as well, and even the feline world. So it's been a trajectory and it's pretty amazing to think back to before we had regenerative medicine.
Speaker 2:Yeah, fantastic. You just answered my next question of what other areas can people be considering, and it is tendinopathies, opso, repro and across all species. So you know, do you see a role for AI, artificial intelligence, at all in regenerative medicine?
Speaker 3:It's funny because that was it was. Ai is like obviously everywhere now. I mean you just, you just do a Google search and the first thing populates with an AI message. Now, and I've thought about it in in relation to regenerative medicine and I I can't and it's possible that I just don't know enough about AI or have don't have enough experience with it, but I can't yet see a good place other than analyzing big data, and I hope that there's lots of people that are sort of working towards the collection of larger groups of data that would help, especially clinical data that would help resolve some of the variability that we see, which is obviously a huge thing in the clinical use of regenerative medicine. So, potentially, analysis of big data and application of it. But other than that, I'm still I don't know, I don't see a huge role for it, but that also could just be me, because I just don't know that much about it.
Speaker 2:No, I think you're exactly right and, as an editor, what we're trying to encourage authors to do is to include their actual data, right? As veterinarians, we always suffer Every study suffers from being underpowered. Yeah, so if you include your data, then eventually somebody or something an AI bot can do a real meta-analysis, if that data is there. So, yeah, I agree with that. Yeah, absolutely.
Speaker 1:So, kyla, how did your advanced training prepare you to be the guest editor for this supplemental issue?
Speaker 3:This was my first role, being a guest editor, and I actually I was a little intimidated when I was first asked, but I also knew that I was going to say yes. I guess it's prepared me in a couple ways. So being familiar with the field, so obviously I did my PhD within this. I also have done I did a surgical residency in equine and large animal in which I employed a lot of these techniques, so I had a good familiarity with that. My current lab is actually named the orthopedic regenerative medicine lab, so it's definitely something that we're still very much focused on.
Speaker 3:So being familiar with the field and being familiar with other researchers in the field, I think really helped to sort of think about what we wanted to put together. Some of the, some of the especially the small animal folks that are, or the small animal papers in the supplement. I've met those people through, either through the university of Pennsylvania, where there's some researchers at the small animal hospital here, or again at larger regenerative medicine conferences where we're bringing together all species. It's not just equine focus, but things like the North American regenerative medicine association. It's an amazing conference where all those people get together and share ideas. So a lot of the people in this supplement. A lot of the authors in the supplement are people I met through that as well. So I think that I think that I hope that answers your question. But I think it was a mixture of the training I received and then staying within the field and having the opportunity to meet different people through different events that really kind of brought together a group of really interesting articles.
Speaker 1:You never know who you're going to meet at conferences.
Speaker 3:It's so true, never cease to amaze me.
Speaker 1:Now this next set of questions is going to be really important for our listeners. What is one piece of information the veterinarian should know before discussing regenerative medicine with the client?
Speaker 3:One piece, um, I'm going to. It's one piece but broken down into A, B, c, d, e, um. So I what what I'm currently doing? So I I lecture. I do a lot of the lectures on regenerative medicine in the vet school curriculum and I'm one of my goals and it's hard because it's a really complex um and uh. It has a lot of information in this field.
Speaker 3:But one of my goals for people graduating and going out into first year veterinary practice is trying to have a basic understanding of the different categories of regenerative medicine and then how they potentially can be applied to what diseases and then some of the more subtle differences between different products.
Speaker 3:And, for example, there's so many autologous blood-based products.
Speaker 3:So, and it's all based on the same thing, you take blood from an animal, you process it somehow and then you put it back in the animal and I think some, especially new grads, get they feel a little bit stressed trying to make those decisions. So I try to give them sort of a basic understanding of what each one is and then, if they need more information, they know how to go down that pathway. This is platelet-rich plasma. I understand the sort of general idea of platelet-rich plasma. I'm going to be able to find more information if I need it to give to my client or to best understand what is most beneficial to the horse or to the animal. So I guess I didn't answer your question at all, but I do think it is. With so many options available, I do think it is really important to try to have enough of an understanding that you can help your client differentiate between the different options and that you can help guide them to choose the best regenerative medicine therapy for the animal that you're currently looking at.
Speaker 2:Yeah, the one thing I might add to that, kyla, is if people aren't taught that by you and me or a conference, they wait until it's way too late and steroids and everything else has failed and expect it to like regrow cartilage. Yeah, so I think that's a really important thing for veterinarians. And the next question that Sarah will ask you about clients is like this isn't going to regrow a joint that needs a total knee replacement.
Speaker 1:Yeah, so, as Lisa teed me up on the other side of the relationship, what's one thing clients should consider around regenerative medicine?
Speaker 3:Well, I think Lisa gave a very nice lead into this. So I think regenerative medicine, what regenerative medicine offers us is the opportunity to treat different diseases, to try to modulate the host, the host's immune and healing system, in a way that you're going to get a better repair tissue than if you did not treat with a regenerative medicine product. What I mean by that is that all of the regenerative medicine products we use, they have a different mixture each, each unique mixture, but of different signaling cytokines, different growth factors that try to optimize healing in in the organ, in the tissue that you are trying to address. And, for example, we know that when you treat a superficial digital flexor tendon in a horse as your first line of treatment, which Lisa just mentioned. So if you treat a superficial digital flexor tendon injury in a horse with a regenerative medicine therapy, there's a lot of really good, not only experimental, but now quite a lot of clinical data using mesenchymal stem cells for those lesions. Using mesenchymal stem cells for those lesions, the you get an you, the end product, the healed end product, is biomechanically stronger and more resistant to re-injury than if you had left that, that ligament or that tendon alone.
Speaker 3:So I think that has it, like Lisa said, the, the cells for mesenchymal stem cells or the blood-based products. They're not going in and magically making new tissue. They are basically working with the body. The body wants to repair itself, but they're working with the body's repair system to guide it in a way that's going to make a better healed tissue.
Speaker 3:And with that I'm going to back up one step, but with that I think some of the and with that I'm going to back up one step, but with that I think some of the deleterious side effects or deleterious effects that we see with some other treatments. I'm not going to knock corticosteroids because I still love them and I use them for things every now and then, but we do see some negative side effects with things like repeated injection of corticosteroids and joints side effects. With things like repeated injection of corticosteroids and joints, especially in in the equine world, we see we are recognizing that can be quite problematic, especially in the horses that have metabolic derangements. So with that, with the regenerative medicine products, there's there's very few negative side effects and I think that really sort of we're thinking okay, we are putting something into a tissue that is going to improve, repair, decrease inflammation and lead us to a better end product, without having too many, without having really any negative side effects.
Speaker 2:I love that you brought in the metabolic horse. I think that's something we really need to pay more and more and more attention to. I know this is way off topic regenerative medicine but I think every I mean I have a horse that loves to be fat we're in a bit of a drought this year, so it's basically has a grazing muzzle, so he's not getting any grass because there isn't any, but every spring I think every horse should have an insulin run on it. I just we're just learning the tip of the iceberg about it.
Speaker 3:Oh yeah, absolutely.
Speaker 2:All right, Kyla, as we wind down, one personal question. And Kyla, for those of you that may or may not know, is an equine orthopedic surgeon, as you heard, has a passion for regenerative medicine. So I think I know the answer, but I love being wrong as well. When you complete a puzzle, do you start with the interior exterior pieces?
Speaker 3:I'm interested. Well, I'm going to answer and I'm interested to know what you think. I always start with the outside yes yes, yes, all the straight lines.
Speaker 3:you make the entire edge and then you go based on color patterns that you put the piles of puzzle pieces into. Then you start working on your, on your patterns and put them together. I will also tell you that I recently quit doing puzzles because I became so obsessive about them to the point where I was developing a back injury from leaning over puzzles because I wouldn't stop. And so I I had a little talk with myself and I was like I think it it's time to it's time to take a break At the AVMA office.
Speaker 2:I'm with you, kyla, my oldest daughter and I. I'll put them on the formal kitchen dining room which, like most houses, nobody uses for anything except puzzles and other things, and we would get up in the morning and be like God, dang it. My daughter starts on the inside. It drives me crazy. I'm like I've never even considered that.
Speaker 3:How can you do that?
Speaker 2:And then I'll rearrange. And then she does it. She doesn't arrange her piles by color, so then I'll rearrange her piles. It's like this puzzle competition, but at the AVMA, a floor above Sarah and I, there's these like stand-up desk areas and they have puzzles around there. So we should grab one of those, sarah, and see who migrates to the puzzles.
Speaker 1:We should. That would be very interesting. Like I feel like maybe the copy editors would also be similar, like starting with like the like edge pieces and just being very monocle about it. Yeah, that would be a cool thing to test out actually. Yeah, that'd be great. Well, thank you so much, carla. We really appreciate you being here today to share insight into the supplemental issue and also for being our guest editor.
Speaker 3:Thank you for both of those opportunities. It's been fantastic.
Speaker 1:And to our listeners. You can read the June Javma Regenerative Medicine Supplemental Issue in print or online using your favorite search engine. I'm Sarah Wright with Lisa Fortier. 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 podcast. Whatever platform you listen to,
