Here is part 5 of our series of the orthobiologic options we currently used to manage equine osteoarthritis, drawing directly from current veterinary publications. A2M therapy has become a popular biologic treatment option for equine lameness because it uses the horse’s own blood to promote tissue healing rather than just mask pain.
Alpha2 macroglobulin is a protein which baits and traps unwanted protease proteins in inflammed tissues (fig 1 ). It is created by centrifuging anticoagulated whole blood to separate plasma containing this potent anti-inflammatory protein. By binding unwanted protease and metaloproteinases it downregulates the inflammatory cascade and the cytokine storm ithereby reducing cartilage degradation It is also beneficially used in severe corneal infections as well as by regional limb perfusion in acute laminitis cases. As with other orthobiologic options, A2M is often used as part of a multimodal rehabilitation program, with the goal of improving tissue quality, shortening recovery time, and reducing reinjury compared to rest and anti-inflammatory therapy alone.
A2M is most commonly used for inflammatory and early degenerative joint conditions in horses—in situations where the goal is to calm inflammation and support cartilage and soft-tissue healing rather than just relieve pain. While A2M t is generally less effective in cases where severe or advanced joint pathology is seen such as in distal hock joints, it is often a cost effective option as adequate product is often obtained from processing of a a single blood draw. Figure 2 depicting the process below. Best practices for success suggest a 3 day washout period of IV sedatives and a 5 day wash out period of NSAID medications to avoid decreasing the amount of available A2M in your horse's blood draw. No additional medications or local anesthetics should be combined in your horse's A2M injection.
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Chuck Maker DVM Justine Stalnaker DVM
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