March 07, 2016

(Dan) Hey there, welcome to the show. I’m Dr. Dan Thomson. Thanks for joining me today on DocTalk. We’re gonna have a great show. My guest today is Dr. Jim Lillich and we’re gonna talk about something that is here – and futuristic – for medicine. It’s regenerative medicine. It’s going to be a great show, we’re going to learn a lot, stay tuned.

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(Dan) Dr. Lillich welcome to the show. (Jim) Thank you. (Dan) Folks this is Dr. Jim Lillich, he is an Associate Professor here in the Department of Anatomy and Physiology at the College of Veterinary Medicine at Kansas State University. He’s an incredible equine surgeon, does a lot with equine lameness, world renowned. And today we’re going to talk about something that’s really exciting to me and that’s the application of regenerative medicine in horses. (Jim) And where we take it from there. (Dan) Yea. So, kind of give us the rundown. What is regenerative medicine. (Jim) Well, it’s a broad term but basically it’s trying to use what is within the body in order to accelerate or maximize healing potential. So we know that wound healing is very, very complex and orchestrated by a number of different types of cells in the body. And what we’re trying to do is use those cells and what they produce and we can take them outside the body and grow them in the laboratory and then return them to the body so that the body can accelerate its ability to heal and maximize the healing potential, rather than use other medications which really aren’t necessarily designed for those things or help in some regards but let’s be honest, Mother Nature is a whole lot smarter than we are. So, we’re just trying to use what she gives us. Knows a whole lot more about that process to regenerate tissues. From the human side of things the biggest problem is regenerating a spinal cord injury, because it’s a permanent deficit. From animals it could be the same things that we deal with, whether it’s arthritic change in a joint where you are no longer athletically productive or sound if you’re horse. If you’ve got an infection somewhere that you need to beat and that could be within any tissue. And it is not toxic to the body if you use these cells and you use these products. (Dan) So talk to me a little bit about the arthritis and so give me just a little description of what I am gonna do, what kind of tissue are you going to take and…? (Jim) Sure. So every tissue in the body, virtually every tissue in the body has got some way to replace itself. So, we call those generally stem cells and there’s a lot of different terms – mesenchymal cells, or mesenchymal stem cells that are generated from fat. They even can come from muscle. But most of the time we’re generating these from fat. So, we can take a piece of fat from you and the cells that can reproduce in the laboratory underneath conditions that grow them, could then expand and help direct or become or help tissue that is back in the body heal itself. So, we regenerate that tissue by ramping up those little itty bitty cells that are supposed to do the job, we just get more of them. (Dan) OK, so you’re just taking them from one place and putting them where they’re needed. (Jim) Exactly and we know a whole lot more about what they require outside and what they require inside, so that there’s other what are called cytokines, these are signals within the body and proteins within the body that ramp those things up and get them to do their job. (Dan) Well, if you can take some fat off me, which Lord knows I know it’s regenerative, and put it in my knees, I’d be happy. (Jim) Exactly and hopefully we’ll reduce the inflammation or cause the body to get better, help maximize it. (Dan) Alright. We’re gonna take a break folks. When we come back, we’re gonna talk a little bit more about what we do know about regenerative medicine with Dr. Jim Lillich.

(Dan) Hey folks, welcome back to DocTalk. Dr. Dan Thomson here with my friend and colleague Dr. Jim Lillich who is an equine surgeon and he is an Associate Professor here at the College of Veterinary Medicine in the Department of Anatomy and Physiology and he is doing some outstanding research and really cutting edge things in taking human application to equine application and there’s much more we can do. But when we’re talking about regenerative medicine taking cells from one spot in the body, putting them where we need help and where we don’t normally get good regeneration and healing, Dr. Lillich is working on some things. So, what are some things we know? (Jim) Well, regenerative medicine’s been with us for a while. There are some well designed studies out there that document an affect, but we don’t know exactly the metabolic or the exact mechanism of how that’s going on. So, Dr. Weiss, who is in my department as well and tended in the small animal clinic with a couple of the surgeons, and they did some fat cell derived in very damaged or hypoplastic dogs. And the ones that were most severely affected, they seemed to improve and it was statistically significant. So, in the horse realm we think that we can actually get potentially better tendon healing, things that are better for the joint because you know wear and tear, athlete endeavors you pay a penalty for that. So, if we can keep that system going, functioning at a peak, we can get the most use out of it and the quality of life can be better. Clearly that’s what we’re trying to do for people is make their quality of life a lot better. So, what we know is we can take cells, we can put them into certain locations and we can now ramp them up and we can improve the clinical conditions of an arthritis; we can improve a range of motion or we can improve a level of comfort. Do we know exactly what’s causing that yet? That’s difficult to determine. We’re looking at a molecular type thing. It’s down below the cellular level to see, figure out if that is actually what’s causing it. (Dan) So, the signals from these cells, and I’ve got to get things down to kind of my level, the fat cells or the different cells, they actually have the ability to send signals that might trigger the reaction in the cells that are locally worn? (Jim) They’re either directing the traffic… (Dan) OK. (Jim) …or becoming part of the tissue being incorporated. (Dan) OK. (Jim) Because we think that since they’re pluripotent that means that they can go from one cell type to another cell type potentially or fill some of a supportive cellular level role. (Dan) So, we put these tissues in and they either have the signals or the tools that the other cells need to do the job… (Jim) Exactly. (Dan) …or they’re just going to do the job for them and jump right in and become part of that tissue… (Jim) Yea, certainly and some of them can be calling in blood supply, you know we need more blood here. Some of ’em can say, hey we’ve got a lot of inflammation in the area and that’s actually being detrimental. Because inflammation is required for healing, but too much of it could destroy normal tissue or potentially slow the process. And we also know that the other side of the regenerative medicine deal, is if we can get more comfortable, we can start to use the leg better. And if we use it and load it correctly and walk more correctly, quality of life is improved and we’re probably stimulating in that regards. (Dan) Awesome. (Jim) Rehabilitation. (Dan) Awesome. Folks, Dr. Jim Lillich here at the College of Veterinary Medicine. When we come back we’re going to talk about some things we don’t know about regenerative medicine.

(Dan) Hey folks, welcome back to Doc Talk. Dr. Dan Thomson here with Dr. Jim Lillich, who is an Associate Professor in the Department of Anatomy and Physiology here at Kansas State University’s College of Veterinary Medicine and we’re talking about regenerative medicine where Dr. Lillich is an equine surgeon, understands joints, tendons, ligaments, different things that loading the leg and moving and being athletic and you know, while we know some things that regenerative medicine can do what are some questions we still have? (Jim) I think these are solid legitimate questions, how do you know that cell that you’re taking from the fat has now become part of the joint? And that’s a difficult question to answer. (Dan) Right. (Jim) So, how do we know we’re going to be able to cause some to get better and some to get a lot better and some just stay the same. Nothing certainly is thought that we’ve made a horse. So, we want to know what the molecule is. We want to know all the way down to what is that cell doing and making? Because potentially we can recreate that in the laboratory and put that stuff on the shelf. So, it doesn’t necessarily have, if it’s a generic type protein that’s not something the body is going to react to, create immunologic response, something the body is going to react to respond to it. That’s in part how vaccines work. Right? But if we can put that on the shelf then we don’t have to wait for gathering or doing a surgical procedure to harvest the cells. We can use some sort of manufactured process to stimulate the healing. So, if we know then we can get just a little bit better still. (Dan) Yea, so basically like when we were talking about they’re either providing the tools, or they’re incorporating in the tissue. (Jim) Right. (Dan) We’re going to go just get the tools, harvest those from that tissue and then you could use it in an animal or people… (Jim) In people right? And then we wouldn’t have to use other medications. We wouldn’t have to use a steroid because there are toxicities that are associated with the drugs that make us feel better, right? Even from nasal anti inflammatories, to steroids, to let’s be honest, opioids. I mean yes, they’re going to improve quality of life, yes, you’re alleviating pain, but there is still a price that you pay for taking those medications. If we can use something natural then we really don’t necessarily pay the price. So, we don’t know the exact cellular mechanisms. We don’t know what a stem cell might need. We’re getting much better at it. But outside the body, to do and direct it to where it needs to go, hey we would like you to go into this bony area, we’d like to go into the joint, help us repair that, or in the tendon, or in the lung, or heck we could open up the door to the bovine mammary gland, the bovine uterus. Things that we can need to beat infections in the bovine lung… (Dan) Oh I was thinking of respiratory disease would be huge. (Jim) Right? And get away from the use of heavy antibiotics or something along that lines. Certainly better for animal safety, for food safety, better quality of life, doing a better job of managing our resources, being stewards. (Dan) And the big thing is too, is just saving lives. (Jim) Exactly. (Dan) Having a positive outcome and when we are struggling with coming up with some of the answers, I think there’s some incredible opportunities. (Jim) I think that yea, I think that we need to begin to ask those questions, right? Can this be useful, can this be something that we use with cattle. Can we take it from the cattle itself, or from the steer itself and ramp it up and give it back. Or can we make the molecule and put it on the shelf and then it can be dosed or treated in a safe fashion? (Dan) Perfect. Folks, stay with us, we’ll come back with our last segment on regenerative medicine with Dr. Jim Lillich.

(Dan) Hey folks, welcome back to DocTalk. We’re talking about regenerative medicine. It’s something that is cutting edge, that’s the future. It’s here and it’s the future and this is Dr. Jim Lillich who knows quite a bit about it. He’s an Associate Professor in Anatomy and Physiology here at the College of Veterinary Medicine at Kansas State University. He’s an equine surgeon, world renowned equine surgeon. We’re lucky to have him on our faculty and we’re lucky to have him here on the show. So, what are we gonna do? (Jim) That’s a good question for veterinary medicine and certainly they have poured a lot of money into regenerative medicine on the human side of things. Harvard has a $2 billion dollar facility, so that’s…I mean billion. And where we’re headed in on the animal side of things, and I think we need to open the door more for the small animal side of things cause we know we know a whole lot more about what the horses are doing with that. And whether that is helpful for the equine athlete. But for the companion animal, the animal that’s ridden a weekend for fun or lives in the house with us, the dog, and especially I think we’re going to begin to use their condition and prospectively treat them. Can we harvest certain cells? Can we help those dysplastic dogs. And if we can find a way to make them feel better, they’re in turn going to give us the information that’s potentially going to help us. Certainly our life spans are much longer than theirs, but an aged dog at 15 is like a 75 year old person, potentially, or 85. There’s a big need to know that in human medicine. And certainly our pets are going to provide that for us, the information for us, those clinical trials, that means something. (Dan) And then there’s some things that we can do with comparative medicine in this, so we can learn on animals and apply it to humans. (Jim) Exactly. And hopefully if we can use what we know about the human stuff in the petri dish or in the laboratory or what we grow the cells, then we can use that information back to help our companion animals as well. So, we have to ask those questions, hopefully we’ll get the funded research to get the questions in the molecular avenues that we see, that we need to know about and then take us to the next step. And that is more clinical trials, more directed therapy. Refine it to the point where it’s a known entity in what we’re doing. Know all the mechanisms that are involved. (Dan) That’s awesome. Well folks, regenerative medicine is something that is here. It is something that is going to change the future of both human and animal health. We have researchers like Dr. Jim Lillich here at Kansas State University that’s working on it on a day-to-day basis, him and Mark Weiss. Tremendous research potential. We appreciate you watching DocTalk. Remember always work with your local veterinarian. And if you want to know more about what we do here on the show, you can find us at Thanks for watching DocTalk today folks. I’m Dr. Dan Thomson at Kansas State University. And I’ll see you down the road.

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