Naida was found on the street and brought to our clinic with a dull trauma of the abdomen, elbow bent low, dorsally curved paw and inability to step on her front right leg.
The examination reviewed a lack of surface sensitivity in the rostral part of the limb and loss of deep sensitivity. Our work diagnosis was injured radial nerve.
The condition is more common in dogs than in cats and is often a consequence from trauma. In the case of Naida, etiology of the problem was unclear as she was living on the street.
Radiographs of the limb were taken in orthogonal projection in order to visualize and locate any site of injury or rupture of the nerve, but fortunately or not there were no fractured bones.
The approaches in these cases are few:
- Attempt to locate the torn nerve and its surgical repair /at this stage in veterinary medicine, this approach is highly questionable forecast/
- Attaching a functioning nerve and muscle to the non-functional muscle
- Carpal spinal fusion
Regeneration of axons in nerve progresses by about 1 mm. per day if nerve sheath is intact. If the axon must grow over 20 cm regeneration is unlikely because it would take about eight months, and nerve sheath shrinks and disappears over time. For this reason, if the muscular activity is not back until eight months is believed that this will never happen.
Owners did not reconciled with the thought of a possible amputation of limbs and wanted to try everything before we get to that point.
Then we proposed an option for treatment with stem cells. Although still used for experimental purposes, the method gives very good results in various application areas.
In the following we will present some of the characteristics of stem cells and the treatment options they provide us:
Stem cells have two important characteristics that distinguish them from other types of cells. First, they are unspecialized cells that renew for long periods through cell division. Second, under certain physiologic or experimental conditions, they can be induced to become cells with special functions: contractile cells of the heart muscle, insulin producing cells of the pancreas or cells that form a tendon or cartilage. Therefore, the stem cells can serve as a kind of “regeneration system” of the body. Theoretically they can divide indefinitely and “fix” the affected tissues.
There are two types of stem cells: embryonic stem cells and mature stem cells. Embryonic stem cells are obtained from embryos. They can differentiate into many different cell types, but this process is difficult to control. Therefore, there can always be a concern that embryonic stem cells may lead to unwanted cell types or tumors when injected into animals.
Stem cells are undifferentiated cells found among differentiated cells in a tissue or organ of live born animals. They can proliferate and differentiate to yield the major types of specialized cells of the tissue or organ. The primary role of the mature stem cells in a living organism are to maintain and regenerate tissues in which they are located. They can be used in an autologous manner (i.e., an animal is treated with his own cells). Thus avoiding transmission of pathogens and possible rejection of the cells.
The main sources from which can be derived adult stem cells are bone marrow, fat, umbilical cord, etc. Bone marrow contains at least two types of stem cells. One population, called hematopoietic stem cells (all forming blood cells in the body) and a second population called mesenchymal stem cells (or stromal cells) that generates bone, cartilage, tendons, ligaments, fat and others. Adipose tissue is a rich and easily accessible source of mesenchymal stem cells.
Stem cell therapy.
Regenerative medicine aims to replace and/ or regenerate damaged or dysfunctional tissues or organs.
The goal of treatment with stem cells is to provide a tissue regeneration without scar formation and with less inflammation. Healed tissue has better biomechanical and structural capabilities than connective tissue.
Stem cells are regenerating cells of the body. They have the ability to divide and to differentiate into various types of cells based on where they are needed in the body. Mesenchymal stem cells (MSC) promote regeneration of the damaged tissue in more than one way:
- STRUCTURE: structural contribution to tissue repair via their Multilinear capacity of differentiation based on the microenvironment (tissue) in which they are necessary/ placed.
GOAL DIFFERENTIATION TISSUE THERAPEUTIC IND. Chondrogenesys Chondrocyte Cartilage Joint disorders Osteogenesis Osteocytes Bone Bone fractures and diseases Myogenesis Myocyte Muscle Muscle diseases Thendo
T/L Fibroblast Tendon/ Ligament Injuries of gemesys tendons and ligaments Neurogenesis Neuroblasts Nervous Injuries of nerves, paresis and paralysis Other Adipocytes,
Connective tissue Wound healing
- TROPHIC: through direct (cell-cell) and indirect (growth factors) interactions modulating the local environment
– stimulating the local wound tissue
– anti apoptotic
– increasing the proliferation, migration and differentiation of endogenous stem cells in most tissues of the body
– neo-angiogenesis by increasing blood flow
And here’s what happened with Naida
After adequate anesthesia and standard preoperative preparation a piece of fat from the abdomen is taken.
The piece is placed in a special container with a suitable transport medium.
Pre-arranged amount of blood is collected, which together with adipose tissue is sent to a lab in Belgium.
There – cells are grown and differentiated in this case in neuroblasts, then sent back for implantation. Work have to be done in a completely sterile environment. The cells are injected around the nerve. The expected improvement may occur after one to eight months.
Postoperative physiotherapy was started with massage and passive movements. Acupuncture and electrostimulation would be a pretty good approach, but unfortunately the temperament of the patient did not allow us to include them to our rehabilitation protocol.
2 weeks after implantation of mesenchymal stem cells in Naida we indicated (although minimal) surface and deep sensation in the limb. She began to bend the elbow, indicating a recovery n. musculocutaneus.
We are still not jumping to the permanent conclusions, but continue to follow this case and hope for the full recovery of Naida.
We want to express special thanks to Dr. Peter Evtimov who helped for whole process!