Medicina regenerativa em animais de companhia: aplicação em casos clínicos de células estaminais mesenquimatosas e plasma ou fibrina rica em plaquetas
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2019-12-12
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A medicina regenerativa veterinária tem como objetivo o restauro da forma e função do organismo usando os seus próprios mecanismos biológicos. Assim, os concentrados de plaquetas (PC) e as células estaminais mesenquimatosas (MSC) surgem entre as terapêuticas mais usadas com esse objetivo. Os PC são frequentemente usados como auxiliares da regeneração no sistema músculo-esquelético, enquanto o foco das MSC está neste sistema e nas doenças do foro imunomediado. Após revisão bibliográfica da literatura científica publicada no tema, são apresentados 4 casos clínicos, dois com recurso a terapêutica por MSC e dois com uso de PC. No 1º caso é abordado o tratamento de uma cadela com uma extensa lesão no pavilhão auricular externo, associada a miíase. Nesta situação foi usado uma fibrina rica em plaquetas (PRF) autóloga como adjuvante da cicatrização, depois de observada uma evolução lenta nos primeiros dias. A ferida respondeu favoravelmente à nova terapêutica e encerrou completamente cerca de 15 dias depois do início do tratamento com o PRF. No 2º caso clínico, recorreu-se a células estaminais derivadas do tecido adiposo (ASC) alogénicas obtidas comercialmente como terapêutica para um cão com osteoartrite da articulação coxofemoral. O animal, de 7 anos de idade, vinha gradualmente a perder qualidade de vida e o tutor optou por esta terapêutica inovadora em relação ao tratamento clássico. Foram aplicadas 1,2x107 ASC intra-articularmente. Ao fim de um mês foi reportada uma evolução da Escala de Dor Crónica de Helsínquia (EDCH) de 19 para 6 pontos, com o animal a recuperar a capacidade de realizar movimentos e algumas atividades que já não era capaz de fazer. No 3º caso clínico apresentado, foram usadas ASC alogénicas adquiridas comercialmente para o tratamento do Complexo Gengivite Estomatite Felino (CGEF) de uma gata com cerca de 2 anos de idade. Esta tinha respondido aos tratamentos com fármacos corticoesteróides, mas piorava a sua condição sempre que a dose era reduzida. A tutora optou por este tratamento em opção à extração dentária por pretender uma terapia menos radical. Os resultados foram negativos, com um agravamento da condição clínica da gata ao longo das semanas após a injeção intravenosa de 1,5x107 ASC. Devido a este resultado, foi posteriormente necessário voltar a introduzir a terapêutica corticoesteróide. No 4º e último caso clínico apresentado, é descrito e discutido o tratamento cirúrgico de uma rutura do tendão comum do calcâneo (TCC) com o uso de um plasma rico em plaquetas puro (P-PRP, do inglês pure platelet-rich plasma) como adjuvante da técnica cirúrgica de sutura do tendão. Neste caso, estávamos perante um gato de 11 anos de idade, com uma lesão com mais de 1 mês de duração e que se apresentava com apoio plantígrado do membro afetado. Foi realizada a imobilização da articulação durante 4 semanas com um fixador externo, seguido de mais 2 semanas com um penso imobilizador. O animal recuperou a sua atividade locomotora diária normal e não apresenta claudicação. Em nenhum dos casos descritos foram reportadas reações adversas.
Veterinary Regenerative Medicine aims to restore the function and structure of the organisms by using their own mechanisms. Thus, the platelet concentrates (PC) and mesenchymal stem cells (MSC) appear among the most commonly used therapies for that purpose. PCs are often used to help in the regeneration of the musculoskeletal system, while the MSC are not only associated with this system but also with immune-mediated diseases. After a review of the scientific literature published on the theme, a series of cases is presented: two using MSC and another two using PC. The first case refers to the treatment of an extensive wound in a dog’s ear, associated with myiasis. Autologous platelet-rich fibrin (PRF) was used as a healing adjuvant, after a lack of positive progress in the days before. The wound responded well to this new therapy and was completely closed 15 days after the beginning of the treatment with PRF. In the second case, allogeneic adipose-derived stem cells (ASC) obtained commercially were used as therapeutic for a dog with osteoarthritis of the hip joint. The 7-yearold animal had been gradually losing life quality and the tutor chose this innovative therapy over the classical treatment. The ASCs (1.2x107 ) were applied intra-articularly. After a month it was reported an evolution of the Helsinki Chronic Pain Index from 19 to 6 points, with the animal recovering the ability to perform some movements and activities that he was no longer able to do. In the third case presented, commercially obtained allogeneic ASCs were used for the treatment of chronic feline gingivostomatitis in a cat around 2 years-old. The animal had responded to corticosteroid therapy, but worsened its condition whenever the dose was reduced. The tutor didn’t want a radical treatment such as dental extraction, so she opted for this alternative method. The results were not satisfactory, with the cat worsening its clinical condition over the weeks after the intravenous injection of 1.5x107 ASCs. Because of this result it was necessary to re-introduce corticosteroid therapy. In the forth and last of the clinical cases, it is described and discussed the treatment of a common calcaneal tendon (CCT) rupture with the use of pure platelet-rich plasma (P-PRP) as a healing aid, after a surgical tendon suture. In this case, the animal was an 11-year-old cat with an injury more than a month old. The joint was immobilized with an external fixator for 4 weeks, followed by 2 more weeks with a bandage. The animal recovered its normal daily activities and didn’t present any lameness. In none of the cases adverse reactions were reported.
Veterinary Regenerative Medicine aims to restore the function and structure of the organisms by using their own mechanisms. Thus, the platelet concentrates (PC) and mesenchymal stem cells (MSC) appear among the most commonly used therapies for that purpose. PCs are often used to help in the regeneration of the musculoskeletal system, while the MSC are not only associated with this system but also with immune-mediated diseases. After a review of the scientific literature published on the theme, a series of cases is presented: two using MSC and another two using PC. The first case refers to the treatment of an extensive wound in a dog’s ear, associated with myiasis. Autologous platelet-rich fibrin (PRF) was used as a healing adjuvant, after a lack of positive progress in the days before. The wound responded well to this new therapy and was completely closed 15 days after the beginning of the treatment with PRF. In the second case, allogeneic adipose-derived stem cells (ASC) obtained commercially were used as therapeutic for a dog with osteoarthritis of the hip joint. The 7-yearold animal had been gradually losing life quality and the tutor chose this innovative therapy over the classical treatment. The ASCs (1.2x107 ) were applied intra-articularly. After a month it was reported an evolution of the Helsinki Chronic Pain Index from 19 to 6 points, with the animal recovering the ability to perform some movements and activities that he was no longer able to do. In the third case presented, commercially obtained allogeneic ASCs were used for the treatment of chronic feline gingivostomatitis in a cat around 2 years-old. The animal had responded to corticosteroid therapy, but worsened its condition whenever the dose was reduced. The tutor didn’t want a radical treatment such as dental extraction, so she opted for this alternative method. The results were not satisfactory, with the cat worsening its clinical condition over the weeks after the intravenous injection of 1.5x107 ASCs. Because of this result it was necessary to re-introduce corticosteroid therapy. In the forth and last of the clinical cases, it is described and discussed the treatment of a common calcaneal tendon (CCT) rupture with the use of pure platelet-rich plasma (P-PRP) as a healing aid, after a surgical tendon suture. In this case, the animal was an 11-year-old cat with an injury more than a month old. The joint was immobilized with an external fixator for 4 weeks, followed by 2 more weeks with a bandage. The animal recovered its normal daily activities and didn’t present any lameness. In none of the cases adverse reactions were reported.
Descrição
Dissertação de Mestrado em Medicina Veterinária
Palavras-chave
Medicina regenerativa , Células estaminais