In cats with refractory feline chronic gingivostomatitis (FCGS) that are clinically stable on corticosteroids +/- Cyclosporine A, how do we introduce mesenchymal stromal / stem cells (MSCs)?
Do immunosuppressants interfere with assessing MSC efficacy?
Should immunosuppressants be tapered if a patient shows improvement after giving MSCs?
Answerprovided by Rebecca Windsor, DVM, DACVIM (Neurology):
Gallant has completed 2 clinical trials evaluating refractory FCGS cats with concurrent medications. One was a long-term safety extension of our pivotal trial. 2/3 of those cats added in intermittent doses of steroids or cyclosporine and we saw no safety or efficacy concerns, and 75% of those were ultimately able to get off all medications.
We also have an ongoing 365 day study in cats where cats did not need to come off medications to enroll, and we saw no effects on safety or efficacy. In fact, those cats did even better.
Diving into the literature, I have found that steroids and cyclosporine can actually be synergistic with MSCs. Our current recommendation is to consider MSC therapy after a cat is at least 2 months post-extraction with ongoing medical management. You can initiate MSCs at that point and don't need to worry about tapering off medications (before). Our hope is that you WOULD be able to gradually taper of medications if the MSCs are effective, but that improvement can take a little time. We recommend giving at least 3 months.
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