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BattLab
Newsletter 04/2018
We are pleased to welcome you to the monthly BattLab newsletter. This newsletter will bring you the latest news and information about our laboratory and all tests that we can offer to all our clients.
BATTLAB SEMINAR – THANK YOU
 
Thanks to all the vets that joined us tonight for the third of our evening seminars, this time focused on platelets and regenerative medicine. We had a full house again. Below a short summary of the talk about regenerative medicine, kindly provided by Joanna Miller from Cell Therapies. Next BattLab evening seminar will be in June. Stay tuned!

Platelet Rich Plasma & Mesenchymal Stem Cells

What is Platelet Rich Plasma?
PRP is a plasma based concentrated suspension of platelets that provides an autologous reservoir of growth factor, nutrients and proteins derived from the patient’s own blood. The growth factors are naturally released when the platelets are activated (usually at the site of an injury) and are important in tissue repair and healing. When activated, PRP is able to form a platelet rich clot which provides a localized and immobilized source of these growth factors. Stem cells are attracted towards PRP clots where they work together and contribute towards tissue healing.

What are Mesenchymal Stem Cells?
MSCs are adult stromal cells that occur naturally in the body and have the ability of self-renewal and the potential to change into a range of different cell types. These regenerative cells are essentially the body’s own repair kit. They act to reduce inflammation and pain and co-ordinate the process of tissue repair.

How important is quality?
There are many different commercial systems for preparing PRP and several different suppliers of veterinary MSCs. Generally, it is important to ensure that PRP contains as few blood cells as possible. Preparations of MSCs should involve culture expansion because this is the only way of providing a quality controlled and microbiologically tested suspension of several million MSCs per injection.

How can they be used?
PRP is increasingly used to enhance healing in soft tissue injuries, osteoarthritis (as an intra-articular injection and corneal ulcers. MSCs are more specifically used as intra-articular injections into osteoarthritic joints.

What is the evidence of efficacy?
Fahie et al have shown that there is a statistically significant improvement in lameness of dogs with OA treated with PRP as compared with saline control. Many other studies have shown similar results. MSCs have been shown to cause a significant improvement in lameness in dogs with OA as compared with saline control (Harman 2016). Our own research in small cohorts of dogs with OA and lumbosacral disease has also shown significant improvements in clinical symptoms as assessed by vet and owner questionnaires (Abstracts at BSAVA 2016). In addition, a case series of 52 dogs presented as a poster at BSAVA 2018 resulted in a 98% clinical improvement with 60% evaluated as having an excellent response.

References are available on the Cell Therapy Sciences website at www.celltherapysciences.co.uk/published-evidence-2/
 
ALL ABOUT TOXOPLASMOSIS: from the clinical presentation to the diagnosis.
 
This month’s main article is focused on Toxoplasmosis, a protozoal infection that can cause clinical disease in domestic animals, and in particular to the diagnostic tests that can be requested at BattLab to diagnose the infection and monitor treatment.
 
Epidemiology. Toxoplasma gondii is a protozoan parasite that infects people and other warm-blooded animals, including birds and marine mammals. Felids are the only definitive hosts of T. gondii and serve as the main reservoir of infection. There are three infectious stages of T. gondii: tachyzoites (rapidly multiplying form), bradyzoites (tissue cyst form), and sporozoites (in oocysts). T gondii is transmitted by consumption of infectious oocysts in cat faeces, consumption of tissue cysts in infected meat, and by transplacental transfer of tachyzoites from mother to foetus. Oocysts are first seen in the faeces at 3 days after infection and the shedding period is generally less than 21 days. Therefore, detection of oocysts in feline faeces is uncommon.
 
Clinical signs. In adult immunocompetent animals, toxoplasmosis is usually a subclinical illness. However, in puppies and kittens, tachyzoites spread systemically and cause interstitial pneumonia, myocarditis, hepatic necrosis, meningoencephalomyelitis, chorioretinitis, lymphadenopathy, and myositis.
 
Diagnosis of toxoplasmosis. The diagnosis of T. gondii infection or toxoplasmosis may be established by serologic tests, polymerase chain reaction (PCR) and histologic demonstration of the parasite.
Figure 1. Liver aspirate from a cat: a round grouping of Toxoplasma zoites is observed.Wright Stain, 100x.
1. Serologic testing
  • IgM antibodies appear sooner after infection than IgG antibodies but generally do not persist past 3 months after infection. Therefore, increased IgM titers are consistent with recent infection. Persistent IgM titers (>4 months) have been documented in cats coinfected with FIV and in cats with ocular toxoplasmosis. Usually, IgM antibodies have a higher positive predictive value than IgG for clinical feline toxoplasmosis.
  • IgG antibodies appear by the fourth week after infection and may remain increased for years during subclinical infection. To be useful, IgG titers must be measured in paired sera from the acute and convalescent stages (3–4 weeks apart) and must show at least a 4-fold increase in titer. Additionally, CSF and aqueous humor may be analysed for the presence of tachyzoites or anti-T gondii antibodies. By the time IgG antibodies are detected in feline sera, the oocyst shedding period has usually been completed.
Antibody test results alone cannot be used to make a diagnosis of toxoplasmosis. However, the following combination can be used to make a presumptive antemortem diagnosis:
  • ​Demonstration of antibodies in serum, which suggests infection by T. gondii
  • Demonstration of an IgM titer 1:64 or a 4-fold or greater increase in IgG titer, which suggests recent or active infection.
  • Clinical signs of disease referable to toxoplasmosis
  • Exclusion of other common causes of the clinical syndrome.
  • Positive response to appropriate treatment.
2. PCR testing
The detection of T. gondii DNA by PCR is appealing, due to high sensitivity and specificity of this method. The presence of a parasitaemia is seldom detected, therefore, PCR of aqueous humor and CSF is preferred over blood PCR. A positive result detects the presence of the organism in infected animals but will not necessarily distinguish acute from chronic subclinical encysted infection. In the case of a positive PCR result, Toxoplasma is the probable cause of the clinical signs with appropriate clinical history, haematological, biochemical and/or cytological findings.
 
3. Cytology and histology
Post-mortem, tachyzoites may be seen in both cytological and histological samples However, T gondii is morphologically similar to other protozoan parasites and therefore it must be differentiated from Sarcocystis species and Neospora caninum by other diagnostic tests (serology, PCR).
BSAVA CONGRESS – 2018
 
Many thanks to everyone who visited the BattLab stand at the BSAVA congress in Birmingham. We were very pleased to see and meet a lot of our current clients and new faces that showed interested in our laboratory services. Next appointment London Vet Show in November.
Hey everyone! Don't forget to join our BattLab Facebook page! We will be posting information about our activities on there, along with interesting cases and articles.
Yours sincerely,
The BattLab team
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