Richard Markell, DVM, is an equine veterinarian in Rancho Santa Fe, Calif., with a practice focusing on sport horse medicine. He also lectures in the United States and Europe on sport horse and regenerative medicine.
On a plane returning from this year's North American Veterinary Regenerative Medicine Conference, held June 2-4 in Lexington, Ky., I can barely bridle my excitement. I feel as if I have just been part of the future of medicine and science. It was a meeting of brilliant researchers and practitioners who are discovering new frontiers in regenerative medicine and trying to build the scaffold of medical therapy for the next century.
The conference attendees were an eclectic group: academicians from universities, human medical doctors, small animal veterinarians, and equine veterinarians who gathered to share ideas and report research. We have an advantage in the veterinary profession because we are able to use many regenerative therapies in everyday practice that are more tightly regulated (and limited) in the human field. Many in human medicine are looking toward veterinary medicine for clinical responses to therapy they can only dream about trying in their patients.
We must understand how regenerative medicine and the body work before manipulating these therapies for our benefit.
Regenerative medicine by definition is the path to help the body heal itself. Stems cells, for instance, have the capacity to become virtually any type of cell, and platelets appear to play an important role in healing. Nature is an unbelievable director, but we must understand how it works before we can manipulate it for our benefit. We must understand that our therapeutic goal is to make its systems work even better, to help the body heal itself, and to interrupt the path when it goes awry. We must understand how to prevent the misguidance of therapy that can stand in the way of healing. Can we help a nonfunctional pancreas regenerate to cure diabetes; regrow bone that has been removed during cancer surgery; replace cartilage in a damaged osteoarthritis affected joint; or regrow a limb severed by an accident? Many of these are distant possibilities based on potential, while others are practiced in clinics today.
There were moments as a practitioner I was overwhelmed by the science and was challenged to understand the very complicated biochemistry of what makes a stem cell attracted to another stem cell. I watched with awe as a stem cell was coaxed into becoming a heart muscle cell and beat with a pulse. At the risk of being perceived as overly dramatic, it reminded me of the first step on the moon or the start of the Internet … this is a moment in history that might change our future. How exciting we are all a part of that.
Our excitement must be tempered however. It is never going to be as simple as "got a problem; take a pill." Our remarkable advances in treating sports injuries are only partially achieved by regenerative medicine. All the stem cells, PRP (platelet-rich plasma), bone marrow concentrate, IRAP (interleukin-1 receptor antagonist protein), cellular matrix, and hyperbaric chamber treatments aren’t going to work without an accurate diagnosis, good shoeing, physical therapy, horsemanship, and reasonable expectations. Veterinarians and owners must understand that at this juncture in regenerative medical practice our goal is to make the tendon or ligament heal better, but it may not necessarily heal faster. As the great philosopher in the Karate Kid said, "Patience, grasshopper." We must as a covenant remember to read the horse and not just the MRI. We must also be cautious of charlatan practitioners and companies promising products of "miracle cures."
We were reminded at this meeting how complicated nature is. How remarkable that all the systems work together and against each other--all for an important reason. We were astonished how bright young minds are discovering new frontiers of medicine and how progressive practitioners are pursuing thoughtful and innovative treatment paths. I was reminded of the old clichè "the more I know the less I understand."
This conference was a remarkable moment in my career. I have been a veterinarian for 26 years, and I am as enthusiastic about my practice as the day I graduated vet school. To be around such inspirational minds as those at this meeting--both presenters and attendees--was a privilege. This is the future for our horses' health as well as our own. So here's to your health and those patients we care for.
Originally posted in the August 2011 issue.