Here is part 4 of our summary of the orthobiologic options currently used to manage equine osteoarthritis, drawing directly from current veterinary publications.   Bone marrow derived mesenchymal stem cells (BMSC) have  become a popular biologic treatment for equine lameness because the modality utilizes the horse’s own progenitor cells to promote tissue healing rather than just masking pain.

The production of BMSCs begin by aseptically drawing 60 cc or bone marrow from a patients sternum or hip bone.   Hip aspirations are preferred but sternal aspirates are often used due to depth of penetration in the hip in older populations.

This sample is processed either in house at Alpine Equine in a Centrate device or sent to a lab overnight where mesemchymal stem cells are identified and expanded resulting in millions of progenitor pluripotent cells.  While the number of cells obtained in the later procedure is much higher than when processed with a centrate device, industry research is ongoing as to the benefits of both methods (Zoetis-Centrate and ART at CSU).  We have seen success using both methods treating significant high hind suspensory ligament injuries and tendon core lesions (pict below).  In the event of in house processing, the cells are available for immediate injection into the patient done under ultrasound guidance.  In the event of  off site expansion, the bone marrow asiprate is packaged and sent to CSU's ART lab to be expanded into millions of cells over a 3-4 week period.  These cells are then cryopreserved in 10 million cell aliquots and  shipped, thawed and injected into soft tissure (tendon or ligament) or intraarticularly during arthroscopic procedures.  They can also be administered into the patient using a procedure known as regional limb perfusion when indicated.

Stem cells are thought to have their primary effect by regulating the cellular messaging cascade augmenting the body's healing response.  When injected into injured tendons, ligaments, joints, BMSCs, as with PRP aim to enhance the body’s natural repair processes. In horses with lameness, BMSC are most often used as part of a multimodal rehabilitation program in severe soft tissue ligament or tendon injuries, with the goal of improving tissue quality, shortening recovery time, and reducing reinjury compared to rest and anti-inflammatory therapy alone. The use of progenitor cells is thought to promotoe more normal healing of tendons and ligaments (structure and function).  Clinically there use in soft tissue injuries appears to result in a shortened time to healing with les scar tissue (image of SDFT injury pre and post injury below)  

Image: Centrate devise for in house stall side stem cell/progenitor cell collection:

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Chuck Maker DVM   Justine Stalnaker DVM