Feline chronic gingivitis and stomatitis: an update

Abstract

Feline chronic gingivitis stomatitis part 1 – what it is and managing expectations: Feline chronic gingivostomatitis (FCGS) is a painful oral mucosal inflammatory disease presented in cats. The observable characteristics of FCGS is ulcerative and/or proliferative mucosal inflammation in the area lateral to the palatoglossal folds with or without gingival inflammation. The cause of feline gingivostomatitis is currently elusive, but it can be inferred that a chronic antigenic stimulation, such as a viral infection, results in an inappropriate immune response. Full-mouth tooth extraction is the current standard of care to treat FCGS. About 70% of affected cats will have significant improvement with this dental procedure, but approximately 30% of cats will not respond and will have a poor quality of remaining life. Non-responding cats will need lifelong medical management and severely affected cats will often be euthanized. Therefore, managing client expectations is a very important aspect of managing the disease. This lecture covers current evidence-based knowledge on FCGS as well as therapeutic approaches. Feline chronic gingivitis stomatitis part 2 – stem cell therapy: FCGS is an immune mediated oral mucosal disease. In that context, cats affected by FCGS demonstrate systemic elevation of cytotoxic T cells (CD8 cells) and other abnormalities indicating an aberrant immune system. Mesenchymal stem cells (MSC) are multipotent stem cells. MSC reside in most organs and tissues such as bone marrow, adipose, and periodontal ligament. Furthermore, MSC has a profound regenerative ability attributed in part to their ability modulate both innate and adaptive immunity. Hence, a therapeutic approach was designed whereby mesenchymal stem cells (MSCs) capable of immunomodulation and significant regenerative capacity were administered systemically to cats that did not respond to extraction therapy. MSCs immune modulatory properties include decreased T-cell and B cell proliferation and function and altered lymphocytes phenotypes. The efficacy of MSCs for the treatment of non-responsive FCGS has been an ongoing study, for the past 9 years, tested in several clinical trials. In these clinical trials, approximately 60-70% of cats had a positive response rate. This lecture discusses the general concept of MSC immunomodulation therapy as well as the clinical outcome of MSC therapy for cats with FCGS and future directions.