Attorney General trying to intimidate witness testifying about live fetal hearts: lawyers – Lifesite

SAN FRANCISCO, California, September 17, 2019 (LifeSiteNews) Lawyers for pro-life journalists David Daleiden and Sandra Merritt are accusing Californias deputy attorney general of trying to intimidate and threaten a critical expert witness.

Dr. Theresa Deisher, an expert in stem cell research at Stanford University, is set to testify for the defense Wednesday.

But Deputy Attorney General Johnette Jauron asked Daleiden on cross-examination Monday if Deisher was party to the undercover operation that led to his and Sandra Merritts criminal prosecution.

Daleiden and Merritt of the Center for Medical Progress (CMP) are charged with 14 felony counts of illegal recording in connection with undercover videos CMP released in 2015 that exposed Planned Parenthoods trafficking in aborted baby body parts. Originally they were charged with 15 felony counts, but one of those charges was dropped Friday.

Daleiden testified that he consulted Deisher only about the science of stem cell research, and that she was not privy to his covert investigation.

In earlier testimony, Daleiden said he asked Deisher and other experts whether a 2102 Stanford study in which aborted baby hearts supplied by StemExpress that were perfused in a Langendorff apparatus would require that the hearts be beating.

Dr. Deisher told me the fetus would have to be alive at the time the organs were harvested for use in the Langendorff apparatus, he told the court.

In light of Jaurons questions, Judge Christopher C. Hite told defense counsel Tuesday that Deisher might need to consult a lawyer regarding her testimony, since the attorney general had raised the possibility of a prosecution against her.

Defense lawyers swiftly rejected the idea.

Its absurd, and a waste of time, Daleidens lawyer Brentford Ferreira told the court.

I believe this is being done to intimidate the witness.

Horatio Mihet of Liberty Counsel, a lawyer for Merritt, also blasted the ridiculousness of the suggestion Deisher needed a lawyer.

Hite, however, told them that he couldnt ignore that they may or may not prosecute and that it was within his discretion as a judge to counsel Deisher to seek legal advice.

When Deisher was sworn in as a witness just before the court adjourned on Tuesday, the judge told her he had information that would compel me to advise you you have the right to seek an attorney.

It is not clear at this time if Deisher has done so.

Nicolai Cocis, a California attorney who is representing Merritt, excoriated the move.

Essentially the attorney general is threatening a critical witness with prosecution if she testifies, he told LifeSiteNews.

They think that David and she conspired, Cocis said. But they havent talked to her directly.

If I, as a defense lawyer, threatened a prosecution witness the way they are threatening our defense witness, I would be facing criminal charges, he added.

Jauron asked Daleiden on cross-examination Tuesday about Deisher being listed as one of his project consultants in his January 2013 proposal for an in-depth undercover investigation into the illegal trafficking in aborted baby body parts.

Deisher was listed in my project for donors as one of my experts in stem cell research, Daleiden said.

She, in fact, consulted with you in anticipation of your investigation, Jauron said.

Daleiden replied that during the time he was preparing himself and his investigative team for the undercover operation, he asked Deisher scientific questions to be thoroughly conversant with the stem cell research and fetal tissue procurement field.

He testified that he met Deisher in 2010, and talked to her on the phone about four times a year from 2010 to 2014. He had a couple more detailed discussions with her about some of the conversations he and Merritt recorded in 2014 before the videos were released.

He believed Deisher was provided with some videos through defense counsel for her role as an expert witness in the case, Daleiden told the court.

Jauron asked Daleiden if he paid Deisher, and he said no.

Deisher is expected to testify Wednesday morning.

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Attorney General trying to intimidate witness testifying about live fetal hearts: lawyers - Lifesite

Global Stem Cell Therapy Market Expects an Extensive Growth in ROI of USD 4759.27 Million By 2024 – News Hours Today

Zion Market Researchpublished a new industry research reportGlobal Stem Cell Therapy Market Set For Rapid Growth, To Reach Around USD 4759.27 Million By 2024in its database.(Sample Copy Here)The global Stem Cell Therapy Market report provides significant information about Stem Cell Therapy Market by fragmenting the market into different segments.This study assists users in decoding the finest distinctions of regional as well as global markets while they enlarge their global reach.The Stem Cell Therapy Market report updates the user about various market growth strategies and management. It states the various terminologies used in the global Stem Cell Therapy Market. The globalStem Cell Therapy Marketreport covers data over the industries and markets, technologies and abilities of the market. It collects the facts and figures over the revenue of the global market and conditions. The report provides the explanation related to the market values and potential market players future scope.

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Global Stem Cell Therapy Market Expects an Extensive Growth in ROI of USD 4759.27 Million By 2024 - News Hours Today

Demand for Stem Cell-Derived Cells Market Driven by Shifting Consumer Perceptions and Growing Awareness – My Health Reporter

Stem cell-derived cells are ready-made human induced pluripotent stem cells (iPS) and iPS-derived cell lines that are extracted ethically and have been characterized as per highest industry standards. Stem cell-derived cells iPS cells are derived from the skin fibroblasts from variety of healthy human donors of varying age and gender. These stem cell-derived cells are then commercialized for use with the consent obtained from cell donors. These stem cell-derived cells are then developed using a complete culture system that is an easy-to-use system used for defined iPS-derived cell expansion. Majority of the key players in stem cell-derived cells market are focused on generating high-end quality cardiomyocytes as well as hepatocytes that enables end use facilities to easily obtain ready-made iPSC-derived cells. As the stem cell-derived cells market registers a robust growth due to rapid adoption in stem cellderived cells therapy products, there is a relative need for regulatory guidelines that need to be maintained to assist designing of scientifically comprehensive preclinical studies. The stem cell-derived cells obtained from human induced pluripotent stem cells (iPS) are initially dissociated into a single-cell suspension and later frozen in vials. The commercially available stem cell-derived cell kits contain a vial of stem cell-derived cells, a bottle of thawing base and culture base.

The increasing approval for new stem cell-derived cells by the FDA across the globe is projected to propel stem cell-derived cells market revenue growth over the forecast years. With low entry barriers, a rise in number of companies has been registered that specializes in offering high end quality human tissue for research purpose to obtain human induced pluripotent stem cells (iPS) derived cells. The increase in product commercialization activities for stem cell-derived cells by leading manufacturers such as Takara Bio Inc. With the increasing rise in development of stem cell based therapies, the number of stem cell-derived cells under development or due for FDA approval is anticipated to increase, thereby estimating to be the most prominent factor driving the growth of stem cell-derived cells market. However, high costs associated with the development of stem cell-derived cells using complete culture systems is restraining the revenue growth in stem cell-derived cells market.

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The global Stem cell-derived cells market is segmented on basis of product type, material type, application type, end user and geographic region:

Segmentation by Product Type

Segmentation by End User

The stem cell-derived cells market is categorized based on product type and end user. Based on product type, the stem cell-derived cells are classified into two major types stem cell-derived cell kits and accessories. Among these stem cell-derived cell kits, stem cell-derived hepatocytes kits are the most preferred stem cell-derived cells product type. On the basis of product type, stem cell-derived cardiomyocytes kits segment is projected to expand its growth at a significant CAGR over the forecast years on the account of more demand from the end use segments. However, the stem cell-derived definitive endoderm cell kits segment is projected to remain the second most lucrative revenue share segment in stem cell-derived cells market. Biotechnology and pharmaceutical companies followed by research and academic institutions is expected to register substantial revenue growth rate during the forecast period.

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North America and Europe cumulatively are projected to remain most lucrative regions and register significant market revenue share in global stem cell-derived cells market due to the increased patient pool in the regions with increasing adoption for stem cell based therapies. The launch of new stem cell-derived cells kits and accessories on FDA approval for the U.S. market allows North America to capture significant revenue share in stem cell-derived cells market. Asian countries due to strong funding in research and development are entirely focused on production of stem cell-derived cells thereby aiding South Asian and East Asian countries to grow at a robust CAGR over the forecast period.

Some of the major key manufacturers involved in global stem cell-derived cells market are Takara Bio Inc., Viacyte, Inc. and others.

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Demand for Stem Cell-Derived Cells Market Driven by Shifting Consumer Perceptions and Growing Awareness - My Health Reporter

Major Players of Serum-Free Media Market By Type: protein expression media, stem cell media, hybridoma media, primary cell media, insect cell media -…

This report rigorously investigates the potential of the Serum-Free Media Market in conjunction with primary market challenges.

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This report focuses on top manufacturers in global market, with production, price, revenue and market share for each manufacturer, coveringThermo Fisher Scientific Inc., Merck KGaA, GE Healthcare, Lonza, Corning Incorporated, Irvine Scientific, STEMCELL Technologies Inc., PAN Biotech, MP Biomedicals, LLC, PromoCell GmbH

By Typeprotein expression media, stem cell media, hybridoma media, primary cell media, insect cell media, immunology media, Chinese hamster cell (CHO) culture media, chemically defined media,

By End userbiopharmaceutical companies, clinical research organizations, academic research centers

The fact that this market report renders details about the major market players along with their product development and current trends proves to be very beneficial for fresh entrants to comprehend and recognize the industry in an improved manner. The report also enlightens the productions, sales, supply, market condition, demand, growth, and forecast of the Serum-Free Media industry in the global markets.

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In the end, the report covers the precisely studied and evaluated data of the global market players and their scope in the market using a number of analytical tools. The analytical tools such as investment return analysis, SWOT analysis, and feasibility study are used to analyze the key global market players growth in the Serum-Free Media industry.

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Major Players of Serum-Free Media Market By Type: protein expression media, stem cell media, hybridoma media, primary cell media, insect cell media -...

Cancer Stem Cell Market Insights on Upcoming Trends 2025 – Spaceflight News

Cancer stem cells (CSCs) refer to the cells obtained from tumor that posses potential to reproduce all types of cancer cells found in a cancer sample. Cancer stem cells are planned to grow in tumors as a separate population and thereby cause deterioration and metastasis of existing tumor through generation of new tumor. Thus, with advancement in technology especially in cancer stem cells research area, therapies specific to targeting cancer stem cells are expected to improve quality of life and survival cases of cancer patients with metastatic diseases.North America was the leading revenue contributor of the cancer stem cells market in 2016 due to presence of a substantial number of organizations engaged in conducting R&D activities related to stem cell therapy. There are several internationally recognized hospitals and medical institutes, such as Cancer Treatment Centers of America at Midwestern Regional Medical Center, which offer stem cell transplant therapies.Asia Pacific is expected to be a promising region in the arena owing to presence of several organizations in the region that focus on R&D of stem cells. Moreover, funding agencies are providing grants to research communities to accelerate their scientific research on cancer stem cells in Asian countries.In 2018, the global Cancer Stem Cell market size was xx million US$ and it is expected to reach xx million US$ by the end of 2025, with a CAGR of xx% during 2019-2025.

This report focuses on the global Cancer Stem Cell status, future forecast, growth opportunity, key market and key players. The study objectives are to present the Cancer Stem Cell development in United States, Europe and China.

The key players covered in this studyThermo Fisher Scientific, Inc.AbbVie, Inc.Merck KGaABionomicsLonzaStemline Therapeutics, Inc.Miltenyi BiotecPromoCell GmbHMacroGenics, Inc.OncoMed Pharmaceuticals, Inc.

Request Sample Report Athttps://www.researchmoz.us/enquiry.php?type=S&repid=2057238&source=atmIrvine ScientificSTEMCELL Technologies Inc.Sino Biological Inc.BIOTIME, Inc.

Market segment by Type, the product can be split intoCell CulturingCell SeparationCell AnalysisMolecular AnalysisOthers

Market segment by Application, split intoStem Cell Based Cancer TherapyTargeted CSCs

Market segment by Regions/Countries, this report coversUnited States

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The study objectives of this report are:To analyze global Cancer Stem Cell status, future forecast, growth opportunity, key market and key players.To present the Cancer Stem Cell development in United States, Europe and China.To strategically profile the key players and comprehensively analyze their development plan and strategies.To define, describe and forecast the market by product type, market and key regions.

In this study, the years considered to estimate the market size of Cancer Stem Cell are as follows:History Year: 2014-2018Base Year: 2018Estimated Year: 2019Forecast Year 2019 to 2025For the data information by region, company, type and application, 2018 is considered as the base year. Whenever data information was unavailable for the base year, the prior year has been considered.

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X4 Pharmaceuticals Appoints Renato Skerlj, Ph.D. as Senior Vice President of Research and Development – Business Wire

CAMBRIDGE, Mass.--(BUSINESS WIRE)--X4 Pharmaceuticals, Inc. (Nasdaq: XFOR), a clinical-stage biopharmaceutical company focused on the development of novel therapeutics for the treatment of rare diseases, today announced the appointment of Renato Skerlj, Ph.D., as Senior Vice President, Research and Development. Dr. Skerlj has twenty-five years of experience leading the discovery and development of small molecule drugs to treat rare diseases, cancer, infection and neurodegenerative diseases. In addition, he was one of the original founders of X4 Pharmaceuticals.

Renatos deep scientific expertise in the research and development of innovative, genetically-targeted treatments, combined with his foundational knowledge of X4 and our novel CXCR4 platform, will be invaluable as we advance our pre-clinical product candidates and further expand our rare disease pipeline, said Paula Ragan, Ph.D., President and Chief Executive Officer of X4 Pharmaceuticals. We are thrilled to have Renato join our senior leadership team given his instrumental role in the founding of X4.

I am very pleased to become a part of X4s dedicated team of experienced and thoughtful leaders, especially during this exciting period of X4s R&D expansion and corporate growth. I look forward to leading our Vienna-based research team and applying my decades of strategic scientific experience to advance and deliver novel therapeutic options to patients with rare diseases, commented Dr. Skerlj.

Most recently, Dr. Skerlj held drug discovery and development leadership roles at Cambridge-based Lysosomal Therapeutics, Inc. Prior to that, he was interim Head of Small Molecule Discovery at Genzyme, and was part of the executive team at AnorMED, a publicly-traded company that was acquired by Genzyme in 2006. Dr. Skerlj is an inventor of both plerixafor, a stem cell mobilizer approved by the U.S. Food and Drug Administration (FDA) in 2008, and ertapenem, an anti-bacterial approved by the FDA in 2001, and has been responsible for delivering multiple drug candidates into early clinical research. He has authored 65 publications and holds 50 patents. Dr. Skerlj received his Ph.D. in Synthetic Organic Chemistry from the University of British Columbia and completed postdoctoral fellowships at the University of Oxford and Ohio State University.

About X4 Pharmaceuticals

X4 Pharmaceuticals is developing novel therapeutics designed to improve immune cell trafficking to treat rare diseases, including primary immunodeficiencies and certain cancers. The companys oral small molecule drug candidates antagonize the CXCR4 pathway, which plays a central role in immune surveillance. X4s most advanced product candidate, mavorixafor (X4P-001), is in a global Phase 3 pivotal trial in patients with WHIM syndrome, a rare, inherited, primary immunodeficiency disease, and is currently also under investigation in combination with axitinib in the Phase 2a portion of an open-label Phase 1/2 clinical trial in clear cell renal cell carcinoma (ccRCC). X4 is also planning to commence clinical trials of mavorixafor in Severe Congenital Neutropenia (SCN) and Waldenstrms macroglobulinemia (WM) in 2019. X4 was founded and is led by a team with extensive biopharmaceutical product development and commercialization expertise and is committed to advancing the development of innovative medicines on behalf of patients with limited treatment options. X4 is a global company that is headquartered in Cambridge, Massachusetts with research offices based in Vienna, Austria. For more information, please visit http://www.x4pharma.com.

Forward-Looking Statements

This press release contains forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995, as amended. The words may, will, could, would, should, expect, plan, anticipate, intend, believe, estimate, predict, project, potential, continue, target and similar expressions are intended to identify forward-looking statements, although not all forward-looking statements contain these identifying words. Forward-looking statements include, but are not limited to, statements regarding X4s business strategy, including its clinical development plans. These statements are subject to various risks and uncertainties, actual results could differ materially from those projected, and X4 cautions investors not to place undue reliance on the forward-looking statements in this press release. These risks and uncertainties include, without limitation, the risk that any one or more of X4s product candidates will not be successfully developed, approved or commercialized, the risk that X4s ongoing or planned clinical trials and studies may be delayed, the risk that prior results, such as signals of safety, activity or durability of effect, observed from preclinical studies or clinical trials will not be replicated or will not continue in ongoing or future studies or trials involving X4s product candidates and the risk that costs required to develop X4s product candidates or to expand its operations will be higher than anticipated. Any forward-looking statements in this press release are based on management's current expectations and beliefs and are subject to a number of risks, uncertainties and important factors that may cause actual events or results to differ materially from those expressed or implied by any forward-looking statements contained in this press release, including, without limitation, the risks and uncertainties described in the section entitled Risk Factors in X4s most recent Annual Report on Form 10-K filed with the Securities and Exchange Commission (SEC), as updated by X4s Current Report on Form 8-K filed with the SEC on April 11, 2019, and in other filings X4 makes with the SEC from time to time. X4 undertakes no obligation to update the information contained in this press release to reflect subsequently occurring events or circumstances.

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X4 Pharmaceuticals Appoints Renato Skerlj, Ph.D. as Senior Vice President of Research and Development - Business Wire

Pathogenic Escherichia coli | Nature Reviews Microbiology

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Pathways to Stem Cell Science | Pluripotent Stem Cell …

Interested in a stem cell career but lack the relevant hands-on skills? Already working with stem cells but experiencing problems your mentor can't solve? Want to expand your skill set and appeal to future employers by learning widely sought-after stem cell techniques? Pathways to Stem Cell Science's Pluripotent Stem Cell Techniques Course is the program for you!

What are human pluripotent stem cells (hPSCs) and why should college students learn to work with them? hPSCs are unique and widely used cells with the capacity to generate any type of cell in the adult human body. They can be isolated from any person and are employed extensively throughout the world in a variety of down-stream applications from research, to therapeutics to diagnostic testing. hPSCs are extremely difficult to grow and manipulate, even for experienced scientists with prior stem cell experience. They can only be handled following extensive training by stem cell experts, like the scientists at Pathways to Stem Cell Science. hPSC culture is an is an advanced 21st century skill that very few college students acquire. Professional training in cutting edge techniques like stem cell culture, can help college students to build their resumes and stand out to future employers.

Originally developed in 2009 at the USC Stem Cell Core, the Pluripotent Stem Cell Techniques Course at Pathways to Stem Cell Science, provides comprehensive training in validated techniques for culturing, freezing and manipulating hPSCs. Our well-established five-day course has helped hundreds of students to gain advanced stem cell skills for laboratory positions in college and professional employment. Participating students learn optimized techniques for culturing human embryonic and induced pluripotent stem cells, following streamlined protocols designed to plug into any hPSC program. We also provide guidance with laboratory set up and regulatory compliance in addition to ongoing support troubleshooting problems once you are working in a stem cell laboratory.

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What are the unique properties of stem cells – answers.com

Stem cells differ from other kinds of cells in the body. All stem cells-regardless of their source-have three general properties: they are capable of dividing and renewing themselves for long periods; they are unspecialized; and they can give rise to specialized cell types.

Stem cells are capable of dividing and renewing themselves for long periods. Unlike muscle cells, blood cells, or nerve cells-which do not normally replicate themselves-stem cells may replicate many times, or proliferate. A starting population of stem cells that proliferates for many months in the laboratory can yield millions of cells. If the resulting cells continue to be unspecialized, like the parent stem cells, the cells are said to be capable of long-term self-renewal.

Scientists are trying to understand two fundamental properties of stem cells that relate to their long-term self-renewal:

Discovering the answers to these questions may make it possible to understand how cell proliferation is regulated during normal embryonic development or during the abnormal cell division that leads to cancer. Such information would also enable scientists to grow embryonic and non-embryonic stem cells more efficiently in the laboratory.

The specific factors and conditions that allow stem cells to remain unspecialized are of great interest to scientists. It has taken scientists many years of trial and error to learn to derive and maintain stem cells in the laboratory without them spontaneously differentiating into specific cell types. For example, it took two decades to learn how to grow human embryonic stem cells in the laboratory following the development of conditions for growing mouse stem cells. Therefore, understanding the signals in a mature organism that cause a stem cell population to proliferate and remain unspecialized until the cells are needed. Such information is critical for scientists to be able to grow large numbers of unspecialized stem cells in the laboratory for further experimentation.

Stem cells are unspecialized. One of the fundamental properties of a stem cell is that it does not have any tissue-specific structures that allow it to perform specialized functions. For example, a stem cell cannot work with its neighbors to pump blood through the body (like a heart muscle cell), and it cannot carry oxygen molecules through the bloodstream (like a red blood cell). However, unspecialized stem cells can give rise to specialized cells, including heart muscle cells, blood cells, or nerve cells.

Stem cells can give rise to specialized cells. When unspecialized stem cells give rise to specialized cells, the process is called differentiation. While differentiating, the cell usually goes through several stages, becoming more specialized at each step. Scientists are just beginning to understand the signals inside and outside cells that trigger each stem of the differentiation process. The internal signals are controlled by a cell's genes, which are interspersed across long strands of DNA, and carry coded instructions for all cellular structures and functions. The external signals for cell differentiation include chemicals secreted by other cells, physical contact with neighboring cells, and certain molecules in the microenvironment. The interaction of signals during differentiation causes the cell's DNA to acquire epigenetic marks that restrict DNA expression in the cell and can be passed on through cell division.

Many questions about stem cell differentiation remain. For example, are the internal and external signals for cell differentiation similar for all kinds of stem cells? Can specific sets of signals be identified that promote differentiation into specific cell types? Addressing these questions may lead scientists to find new ways to control stem cell differentiation in the laboratory, thereby growing cells or tissues that can be used for specific purposes such as cell-based therapies or drug screening.

Adult stem cells typically generate the cell types of the tissue in which they reside. For example, a blood-forming adult stem cell in the bone marrow normally gives rise to the many types of blood cells. It is generally accepted that a blood-forming cell in the bone marrow-which is called a hematopoietic stem cell-cannot give rise to the cells of a very different tissue, such as nerve cells in the brain. Experiments over the last several years have purported to show that stem cells from one tissue may give rise to cell types of a completely different tissue. This remains an area of great debate within the research community. This controversy demonstrates the challenges of studying adult stem cells and suggests that additional research using adult stem cells is necessary to understand their full potential as future therapies.

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Squamous Cell Carcinoma in Dogs and Cats – Vet360

Any tumour growing within (dermal), on (epidermal) or even under the skin (subdermal) should be considered a skin tumour. Some skin tumours are benign (i.e., slow-growing, completely curable with complete resection and dont spread) while others are malignant (faster growing, invasive, sometimes incurable, and may spread to other organs). In order to classify what type of tumour you are dealing with, you will need to make a fine needle aspirate or take a biopsy A biopsy can either be incisional or excisional. Whichever course is taken, a microscopic diagnosis must always, always be obtained.

No two tumours of the same kind look the same, but very different cancers can appear similar When tumours are inflamed or infected, the underlying pathology can be masked. This information is very important. If its a cytological or incisional, this information can help guide you as the best approach to cure not only the obvious lump but also manage the precancerous lesions that surround the obvious tumour. Not all skin tumours are best removed surgically! Only very small (1 2 cm on the body or neck, and <1 cm elsewhere) should be removed by excision.

Many clients and vets try to economise by removing small lumps instead of taking the extra step this can drastically alter prognosis, by spreading tumour cells.

Although theoretically any tumour can occur in the skin, we classically think of just a few types when we say skin cancer squamous cell carcinomas (SCC), melanomas, haemangiosarcomas (HSA) and mast cell tumours (MCT).

Actinic Keratosis

Actinic keratosis (AK), also known as solar keratosis or senile keratosis, is a very common lesion occurring in susceptible humans as a result of prolonged and repeated solar exposures. The action of ultraviolet radiant energy, principally UVB, results in damage to the keratinocytes and produces single or multiple, discrete, dry, rough, adherent scaly lesions. These premalignant lesions may, in time, progress to squamous cell carcinomas.

This is very important as a warning sign and should be the first thing you teach clients about. A couple of veterinary-specific manifestations of AK are the comedones or blackheads seen on cats noses (fig 1) and dogs ventra. These lesions can be managed with protection, (fig 2) imiquimod or Photodynamic Therapy (PDT). More on these modalities later.

Squamous Cell Carcinomas

Squamous Cell Carcinomas are the classical skin tumours, caused primarily by long-term to exposure to UV-B radiation. The animals most afflicted white or part-white cats and dogs. Bull Terriers, Staffies, Pit Bulls, Bulldogs and Jack Russells are amongst the dog breeds most often affected. These ex-British breeds enjoy our long, glorious South African summer sun, and tan day after day.

UV-B radiation damages DNA and this damage is cumulative and only partially repairable or reversible. Squamous cell carcinomas can look like nothing more than non-healing crusts, pimples or scabs, or they can form large, raised, ulcerating plaques.

PROGNOSIS

It is important to treat according to the stage presented:

Primary Tumour:

T0 = no tumour

T in situ = Pre-invasive carcinoma (scale, crust)

T1 = tumour <2cm diameter, superficial or exophytic

T2 = tumour 2 5 cm diameter, OR with minimal invasion irrespective of size

T3 = tumour > 5cm diameter, or with invasion of subcutis irrespective of size

T4 = invading fascial, muscle, bone or cartilage, regardless of size

Regional lymph nodes:

N0 = no involvement

N1 = lymphnodeinvolvement

Distant metastasis:

M0 = no metastasis

M1 = evidence of metastasis

Ulceration of the primary tumour is associated with a biologically more aggressive lesion and a poorer prognosis. It is not known why ulcerated primaries have a more aggressive biologic nature. It is not likely due to underestimation of the thickness due to the ulcer crater. Ulcerated lesions tend to be thicker and have a nodular growth pattern, but the increased thickness does not account for the poorer prognosis. However, the depth or width of surface ulceration has been significantly correlated with survival. Other histologic prognosticators include the mitotic indices, whirling and the presence or absence of lymphatic or blood vessel invasion are relevant to prognosis.

Tumours in situ look like nothing more than scaly, scabby skin and offer another earlier warning sign, the best opportunity for cure, and are a wake up call. My preference for this is to use immunotherapy with imiquimod cream, or photodynamic therapy for T in situ and T1 tumours.

T2 tumours which are large but NON invasive (T2 large) also respond well to PDT or radiotherapy, but those that are T2 invasive require surgery or aggressive PDT (only to 5mm depth maximum). Once it gets to T2 invasive or T3+, cure rates using any technique drop to below 40% (from >85%) so teach your pet owners about skin cancer and early aggressive intervention from the first vaccination!

T3 and T1-4N/(any) M0/1 must be referred to a specialist for management. I see huge disasters when GPs approach these with surgery. Dogs are disfigured and then referred when they could have kept penises, mobility or faces with a proper approach from the beginning. An integrated approach using multiple modalities and an understanding of tissue tolerances, treatment sequencing and proper patient surveillance are beyond the scope of general practice. Managing such a patient is often possible, but is an 8 20 week process.

More extensive tumours may require additional surgery, chemotherapy or radiation to achieve good results. Their main importance is that they recur because skin of the ventral abdomen, ears or nose have been damaged. (fig 3) Cutting out squamous cell carcinomas can be like the little Dutch boy plugging the hole in the dyke with a finger another often just pops up elsewhere.

Recurrent SCC may require specialist attention to get under control or cure. In any event, thoracic radiographs should be performed. SCC of the feet (pedal SCC) is far more aggressive and spreads to the lungs earlier than other SCC of the skin, so always attend to any non-healing wound or lump of >1 weeks duration by having it checked using histopathology.

Treatment

Figure 1. White cat with nasal SCC this is the earliest stage the presence of discharge and slight scaling around the nose and eyelids. If treated appropriately at this stage, the prognosis for cure is close to 100%

Figure 2. UV suit UV-resistant suits (obtained from Dr Georgina Crewe), protect the healthy or precancerous skin and are an essential part of post-treatment management

Photodynamic Therapy (PDT) (fig 4) is a technique using the application or injection of photosensitising agents in different concentrations. They accumulate in certain tumours and when subjected to high-fluence (200-300 W/cm2) light of a specific frequency, keyed to the particular molecule being used, the molecules aggregate into unstable complexes that then restabilise by release of various oxygen radicals which cause lipid membrane, protein and DNA damage. Over-treatment causes regional vasoconstriction and side effects, without increase in toxicity; undertreatment achieves little, but aggravates the inflammation. This treatment is effective only in lesions <5mm thick. Treatment is once a monthly, for 1 3 treatments, depending on severity and extent. Pre-cancerous actinic keratosis can also be successfully managed using this technique.

Immunotherapy using Imiquimod (Aldara; 3M), animidazoquinolinamine, is an immune system modulator and possesses both potent antiviral and antitumor activity in animal models and humans. Current theories suggest that imiquimod acts both directly by inducing apoptosis and by inducing secretion of pro-inflammatory cytokines. Imiquimod activates macrophages and other cells via binding to cell surface receptors, such as Toll receptor 7, and thereby induces secretion of pro-inflammatory cytokines such as interferon-a (IFN-a), tumour necrosis factor-a (TNF-a), and interleukin-12 (IL- 12). These cytokines bias towards a Th1-dominant immune response, which in general is associated with inflammation and tissue injury through activated inflammatory leukocytes and with cytolytic activity through CD8+-lymphocytes (Abbas et al 1996). Imiquimod can also induce apoptosis directly in a Bcl- 2-family-dependent manner by downregulating anti-apoptotic genes such as hurpin and HAX-1.

Treatment is applied to lesions Monday to Friday, once daily, for 6 12 weeks; inflammation caused by the treatment can occasionally be severe and require NSAIDs.

I reserve this for small/early/superficial lesions in cats due to the cost of the cream. Clients must wear gloves to protect themselves. Efficacy is reported as about 75%, with a median survival time of 1189 days, although recurrent lesions do seem to respond to the therapy.

5-Fluorouracil use in animals: this drug is rapidly and fatally neurotoxic in cats even as eye drops. In dogs, the tolerance is also very low and if licked it can trigger fatal mucosal sloughing. Dont use in veterinary practice.

CRYOTHERAPY is outdated, painful, disfiguring and has a lower success rate than other therapies mentioned. Do not use this. Poor technique is a major reason for treatment failure; it requires training and experience and is potentially hazardous to the operator.

RADIATION THERAPY: the use of a linear accelerator to deliver high-voltage (4 20 MeV) electrons or photons for the treatment of surface tumours is called teletherapy. This technique has the potential for extreme harm if improperly performed, and all such cases are specialist cases and must be referred to a person with the relevant training. Theres a reason its an entire field of speciality in itself in the US and Europe. It requires a knowledge of radiation physics, radiation biology and management of radiation side effects that cannot be gleaned from a few lectures.

The role of surgery in managing skin tumours.

Surgery is an important part of management of these conditions. For some tumours e.g. BCC, HA/HSA, MCT, a properly-performed excision can be curative. In others, e.g. SCC, the surrounding skin is often also on an anaplastic march that is unstoppable by surgery alone. Surgery then helps debulk larger masses that would not respond as well to wider-field but lower-intensity therapies e.g. imiquimod, PDT, RT. The timing and planning is critical. Discuss this with a specialist BEFORE radiation or PDT PLEASE! Post-surgical fibrosis decreases the efficacy of other modalities! (fig 5)

Figure 3. SCC ear pinna removal This is the degree of surgery required for more advanced SCC of the pinna, and is to be avoided if possible, by appropriate education of the client at first vaccination of the kitten. This sort of cat may be allowed out at night, but not during the daytime.

Figure 4. PDT Patient undergoing photodynamic therapy at Inanda Vets. Basal Cell Carcinomas

Basal cell tumours are a benign tumour that look very similar to SCC, and are quite common in cats in other parts of the world. In dogs, they typically occur around the head and are not unlike canine cutaneous histiocytoma (hence the need for a tissue diagnosis). They are usually single, raised, ulcerated button-like tumours. Surgery alone is normally curative. They can be diagnosed by cytology or histopathology. BCC and SCC are classed together as the Keratinocytic Skin Cancers.

Figure 5. Multiple raised SCC on the ventrum of a dog; the previous surgeries have contributed to scar tissue formation, which makes radiation less effective, and future surgeries more difficult. The widespread nature of the disease means a novel approach must be taken if control is to be achieved. Patients arriving at this stage are major challenges to cure.

References

BERGMAN, P. J. 2007. Anticancer vaccines. Vet Clin North Am Small Anim Pract, 37, 1111-9; vi-ii.

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Photos: Courtesey Inanda Vet (Dr Anthony Zambeli)

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Squamous Cell Carcinoma in Dogs and Cats - Vet360