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Elder's Equine is able to provide the following new regenerative medicine therapies
IRAP Therapy (Arthrex)
IRAP, also known as Interleukin 1 Receptor Antagonist Protein, is a therapeutic agent that is developed from the horse’s own blood. IRAP is used to fight chronic inflammation. It is most commonly used for treating horses with arthritis. IRAP is able to control inflammation by interacting with molecules in the horse’s body known as cytokines.
Cytokines are proteins that cells release to communicate with other cells. These cytokines play key roles in how the horse responds to injuries. Most horses will sustain an injury to a joint at some point in their life. Injuries to the joint results in inflammation. When a mild injury occurs, the horse releases pro-inflammatory cytokines to clean the area, removing damaged tissue. This is an important part of healing. After the damaged tissue is removed, anti-inflammatory cytokines take over and will stop tissue removal and allow the injury to heal.
Arthritis in a horse is characterized by a pro-inflammatory state within the affected joint. The inflammation is prolonged due to repetitive injury. During this state, pro-inflammatory cytokines cause excessive tissues to be destroyed. This cycle will continue and the horse will become progressively worse without intervention. The most common form of treatment is steroid injection into the joint. Steroids are anti-inflammatory but they will not work in every case and will not change the underlying disease pathway. IRAP is designed to block pro-inflammatory cytokines and support anti-inflammatory cytokines in an inflamed joint. Decreasing the amount of inflammation in a joint stops the cycle of joint cartilage damage and decreases the pain within the joint. Because IRAP does not heal previously damaged joint cartilage, it is best used in cases of mild arthritis as a preventative measure.
Arthritis may be due to poor conformation, poor hoof care, working the horse on a non-ideal surface, working the horse without proper conditioning or by the demands of today’s horse sports. It can also develop following acute trauma such as a severe cut or fracture involving the joint.
IRAP is developed by taking a blood sample from your horse and exposing it to medical grade glass beads. These beads contain chromium sulfate, which cause the white blood cells to create more anti-inflammatory cytokines. The blood and beads are left together for 24 hours to allow the white blood cells ample time to create new cytokines. After 24 hours the beads are removed from the blood and the blood is centrifuged into its serum and cellular components. The serum is removed and injected into the affected joint or injury. Any extra serum can be frozen for future use in the same horse.
To discuss your horse's options for this therapy, give us a call at (204) 864-2888. We will gladly evaluate your horse to help determine the best course of treatment.
Platelet Rich Plasma (PRP) is a second therapy that can be developed from a horse’s blood. This therapy is focused on concentrating growth factors and other molecules that promote healing.
PRP is best used in acute injuries. This is different from IRAP which is best used to decrease inflammation in chronically inflamed areas. PRP, like IRAP, should not be used in areas that require surgical debridement or stabilization such as chip fractures, slab fractures, or condylar fractures.
How does PRP work? Blood is made up of two main portions: serum and cells. When blood is “spun down” in a centrifuge, the cells settle to the bottom of the test tube, leaving the serum at the top. This serum contains molecules such as proteins and platelets. Platelets are fragments of cells designed to clot when a vessel becomes damaged. This clot seals the vessel and prevents bleeding. Platelets also have many other beneficial effects when activated to clot. These include the release of many cytokines and growth factors to promote healing. The cytokines that platelets release are different than those released by the white blood cells in IRAP therapy. Platelets release cytokines that assist the tissue to begin repairing itself. They stimulate white blood cells to come to the area to clean the injury, a process known as chemotaxis. They then tell the tissues that were injured to begin replicating and filling in the space; this process is known as mitogenesis.
PRP is most useful for injuries to the tendons and ligaments in the horse’s lower limb. The tendons and ligaments in the lower limb of the horse have poor blood supply. This limits the amount of platelets and healing factors that can be delivered naturally. PRP delivers a very high number of platelets directly to the injury. Not only does this decrease the time needed to heal, it helps the horse repair the tendon rather than simply filling in the defect with a fibrous scar.
It has been shown that horses with tendon injuries treated traditionally with stall rest tend to re-injure the tendon just above the original injury. This is because traditionally, tendon injuries have been left to scar down. When this scar is fully formed, the tendon lacks normal elasticity. With PRP, the healed injury is filled in with less fibrous tissue and tissue more like normal tendon. This allows some elasticity in the lesion and decreases the number of re-injuries above the original tear.
PRP is prepared by taking blood from the injured horse. This blood is placed in a centrifuge and the blood cells are removed by spinning the blood at high speed. The serum stays at the top of the test tube and the cells settle to the bottom. The serum is poured off and placed into another test tube. The blood cells are discarded. The serum is then placed back into the centrifuge and spun again at a rotational speed selective to concentrating platelets. The concentrated portion of the serum is then collected and injected into a lesion. PRP can be collected and injected on the same day.
If you would like further information or to discuss your horse's case with one of our trained equine veterinarians, give us a call at (204) 864-2888
Stem Cell Therapy
The final aspect of regenerative medicine in this series is Stem Cell Therapy. Stem Cell Therapy is a very promising area of research for both human and equine regenerative therapies.
Stem Cells are found in two major forms, embryonic and adult. Embryonic stem cells, as the name suggests, are found in the tissues of embryos while developing inside the mare. Embryonic stem cells are a very versatile type of cell; they have the potential to develop into virtually any type of tissue with the proper laboratory environment and cytokine stimulation. However, there are many ethical issues surrounding the collection and use of embryonic tissues for regenerative medicine. For this reason, adult stem cell research is further developed and used more commonly.
Adult stem cells also have the ability to develop into a variety of cell types such as ligament cells, tendon cells, muscle cells and bone cells. These properties make them suitable for treating equine injuries. Adult stem cells have two major sources- adipose (fat) and bone marrow. Stem cells from each source have different properties and therefore different applications.
Bone marrow stem cells are collected from bone marrow, the tissue inside the horse’s bones that produces blood cells. The most common sampling site is from the sternum. An area of the horse is prepped for surgery and a local anesthetic is used to desensitize the skin. A large needle is then placed into the bone and the marrow aspirated out. Stem cells are isolated in a lab and then undergo an expansion phase. During this phase, laboratory technicians isolate, culture and add growth factors and cytokines to the stem cells to aid in their reproduction and development towards a specific cell type, such as a joint cartilage cell. Bone marrow stem cells are more labor intensive and take a period of 3-4 weeks before they are ready to treat the horse. However, they have been shown to produce cells similar in structure and function to cartilage cells. Cartilage cells, also known as chondrocytes, do not regrow naturally after an injury. Instead the horse develops fibrocartilage, making the horse prone to arthritis. In horses with damage to the cartilage, bone marrow stem cells are an excellent treatment choice.
Stem cells have a variety of uses. At this time, musculoskeletal issues are the best-studied application of stem cells.
Typically choose an adipose-based stem cell suspended in platelet rich plasma. This suspension is then injected directly into the injury with the guidance of an ultrasound. The result is a more elastic healed tendon or ligament with structure more similar to the original tissue. This tissue is more elastic and much less prone to re-injury than without treatment.
Typically choose a bone marrow-based stem cell suspended in hyaluronic acid and injected directly into the joint or implanted into the joint cartilage. It is much easier on both the horse and veterinarian to inject the stem cells into the joint pouch rather than implanting the stem cells, but more research is currently being done to decide which technique results in better cartilage healing.
Stem cell therapy is a growing area of regenerative medicine. At this time there are research projects evaluating their use in wounds, sepsis in foals, and other surgical and medical conditions.
If you believe your horse would benefit from stem cell therapy or you would like to know more about any of these treatments, including the most recent study projects please call our equine vets at (204) 864-2888
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