Stem Cells for Kidney Disease in Cats?

I have written about stem cell therapy pretty frequently here for a couple of reasons. I consider it a very promising avenue of investigation based on lab animal and human studies, and I expect someday specific beneficial therapies based on stem cells will be available for dogs and cats. I also believe that stem cell therapies have been marketed aggressively and well beyond the actual evidence concerning risks and benefits. A general rule of medicine, in my opinion, is that any therapy that has real benefits also has real risks, and only rigorous controlled research will elucidate these. A recent review of the current status of research into stem cell therapies for kidney disease in cats illustrates well both the potential benefits and risks of stem cell therapies and the currently inadequate evidence about both that makes use of such treatments only appropriate under experimental conditions.

J.M. Quimby, S.W. Dow. Novel treatment strategies for feline chronic kidney disease: A critical look at the potential of mesenchymal stem cell therapy.  The Veterinary Journal 204 (2015) 241–246.

This review briefly outlines different types of stem-cell therapies, such as bone-marrow-derived cells, fat-derived cells, and cells from the patient or from other donor individuals, and discusses the potential advantages and disadvantages of each. This is useful in reminding us that stem-cell therapy is a complex collection of different processes and interventions, and we need good evidence for each specific intervention to make useful judgments about safety and efficacy.

The authors then briefly review the extensive lab animal evidence, which suggests potential benefit for stem cell therapies in animals with kidney disease. They do point out, however, that there are important differences between experimental disease in rats and natural disease in cats, so such studies can only suggest risks and benefits, not conclusively demonstrate them.

Finally, the review looks at the few small studies done to date in cats. These are interesting in their illustration of potential risks and benefits from stem cell therapies and also the complexity of identifying type of cell, route of administration, dose, and measures of effect to demonstrate real clinical impact from these treatments.

One study of 6 cats (2 healthy and 4 with kidney disease) involved injecting either bone-marrow-derived or fat-derived stem cells directly into the kidneys. Some improvement in measures of renal function were seen. However, the study also illustrated that getting cells from old and ill patients was very difficult and that this, along with the expense and risk of the procedure, would likely make this approach impractical in the real world of clinical medicine even if significant clinical benefits were ultimately found.

Three additional small studies have evaluated different doses and forms of fat-derived stem cells given intravenously to cats with stable chronic kidney disease. One group showed statistically significant changes in some bloodwork values, but these were not judged to be large enough to be clinically meaningful. In the other two groups, no significant change was seen in measures of kidney function. However, in one of these two groups, some undesirable adverse effects were noted in most of the cats, possibly due to inflammatory reactions or small clots caused by the stem-cell injections. This illustrates the general principle that any therapy which has significant effects on the body can cause harmful as well as beneficial effects, and the key to making good therapeutic choices is understanding both risks and benefits and being able to compare them in the context of an individual patient’s situation.

Another study of eight cats, this time with randomization, blinding, and a placebo control, investigated intravenous use of stem cells. Over a short-term followup of 6 weeks, no significant effects, for good or ill, were seen, but the study is still ongoing in order to observe any potential effects over a longer term.

From the various pieces of evidence reviewed, these authors draw a conclusion which seems to me to apply well to many potential uses of stem cell therapies in addition to the treatment of kidney disease in cats:

Although it holds much promise, at this time MSC therapy for CKD in cats should still be considered an experimental and unproven therapy. Notably, none of the studies conducted in cats with CKD by our group has been able to replicate the efficacy of MSC treatment reported in numerous rodent models of experimentallyinduced CKD.. Although rodent studies illustrate the impressive potential of MSC treatment for kidney disease, results of these models should be interpreted with caution for the reasons noted above. A conservative interpretation of the available data from studies in cats with CKD is that the current approach of IV administration of allogeneic MSCs is not likely to exert marked clinical benefit, although more animals should be treated before this conclusion can be firmly established.

There are still many questions to be answered regarding the logistics of MSC therapy. The optimal route of MSC administration, the ideal source of MSCs (allogeneic vs. autologous; culture expanded MSCs vs. SVF) and the impact of tissue donor status (attributes such as age, disease status and sex) on MSC function remain to be determined. Studies are currently under way investigating many of these aspects and additional information is eagerly awaited.

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9 Responses to Stem Cells for Kidney Disease in Cats?

  1. Merozoites says:

    Stem cells transplants may be an effective way to cure kidney disease, but it is not suitable to everyone.

  2. skeptvet says:

    Big generalization. Any evidence at all for this?

  3. pat says:

    Advantages & disadvantages, risk & benefits are the most used words in this writting without and real information either way, makes the adequacy of information very useless, since the writing lacks any information this deems it unuseable to determine any educated decision.

  4. skeptvet says:

    Nonsense. Educated decision-making means understanding the information available and its limits so that one can rationally balances risks and benefits with uncertainty. The bottom line is quite clear: this is an experimental therapy with little evidence to support claims of safety and beneficial effects, so using it is essentially rolling the dice. The details of the research done so far are available in the article I summarized, but what else would a reasonable person base a decision on?

  5. George Wickersham says:

    I watched the TV show Dr. Dee and she used the stem cell extraction from the ill cat and injected it into the cat and gave the impression that it cures kidney disease.

    Thank you for your information.

  6. Gina Carrington says:

    I want to thank you for what looks like a very thorough and carefully considered offering of information on this subject. I have a cat who was diagnosed with CKD. He was a feral rescue, and is very fearful of noise, people, and other animals, so trips to the vet are extremely stressful for him. I needed to know more about stem cell treatment’s efficacy before considering it, so was relieved to find your article.

    And I must disagree with Pat. There are plenty of people with opinions out there, most of them based on personal/professional biases, which often makes their opinions somewhat unreliable. An unbiased presentation of the results of solid research is a more reliable tool for making informed decisions. Your article has helped me very much in making mine.

  7. skeptvet says:

    I’m glad the article was useful. Good luck with your kitty!

  8. David K. Ofsa, D.O. says:

    Thank you SkeptVet for an abjective opinion. I am curious about the costs in this stem cell therapy for cats with CKD. As a human physician, this therapy has the earmarks of a profitable scam for the companies that isolate the stem cells and the veterinarians involved in harvesting the tissue and then readministering it.

  9. skeptvet says:

    Hi David,

    Costs are a difficult thing to pin down since every practice charges quite differently, and it is against the law to confer with other vets about prices. With at least two anesthetic events, tissue harvesting, and costs from the stem cell company for processing, it is certainly not cheap, and a suspect most owners will pay a couple thousand dollars for treatment, though again this likely varies widely. It certainly seems to me we ought to have better evidence it is safe and effective before using it and charging for it.

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