Chuck Maker DVM
Chad Roeber DVM
Louise Shuman DVM
Martha Rideout DVM
Darlene Berkovitz DVM
David Gurbacki DVM
17776 Highway 82
Carbondale, CO 81623
Phone: 970-963-2371 Fax: 970-963-2372
Stem cell, PRP & IRAP biologic therapies at AAH
Equine tendon, ligament, and joint injuries are some of the most frequently seen problems in clinical veterinary practice leading to joint instability, degenerative joint disease, and reduced performance. Osteoarthritis also known as degenerative joint disease (DJD) is one of the main causes of lameness in horses. Osteoarthritis occurs when the cartilage surrounding the joints deteriorates or is destroyed leading to pain and inflammation. Areas that are affected the most are knee, hock, fetlock, pastern and coffin joints. Conventional therapies involve intra-articular medications such as hyaluronic acid and/or steroids, rest, NSAIDS (bute, banamineTM, SurpassTM, EquioxxTM), shockwave therapy, polysulfated glycosaminoglycans (PSGAG such as Adequan), intravenous hyaluronic acid (Legend). Oral supplements (MyristolTM and Platinum performance-CFTM) that contain glucosamine, chondrotin sulfate, MSM, acetyl Myristolate and/or avocado extract are also commonly administered. Alpine Animal hospital offers the use of adult derived stem cells as a means of treating acute and chronic tendon injuries, suspensory and collateral ligament injuries and osteoarthritis in their horse and companion animal patients. Superior to commercially available porcine derived preparations (A-cellTM), adult derived stem cells are concentrated and autologous to the patients in which they are used. Stem cells offer regeneration of injured tissues that can result in a higher likelihood of return to their previous level of performance. The process begins with the harvesting of 20-30 cc or bone marrow aspirate from the sternum or point of the hip under IV sedation ( see picture at right). This aspirate is then shipped overnight to Advanced regenerative technoilogies in Fort Collins where the cells are filtered and expanded or processed for pleuripotential stem cells. These stem cells are then packaged for injection and sent back to Alpine Animal Hospital for ultrasound guided injection into the damaged ligament or tendon 2 ½ -3 weeks later. Subsequent stem cell treatments if deemed necessary based on ultrasound examinations can be performed without any additional surgical procedures using stem cell stored from the original sample.
PRP stands for Platelet Rich Plasma, or blood plasma with concentrated platelet content. Platelets are derived from stem cells in the patient’s bone marrow. As platelets come into contact with the damaged collagen and endothelial cells, a fibrin clot forms and growth factors are recruited and released. Two are of particular interest in dealing with orthopedic injuries. Platelets contain a number of growth factors (transforming growth factor beta and platelet derived growth factor) within them that are released upon activation at an injured site. These growth factors and others act synergistically to enhance access of healthy inflammatory cells to the area of tissue injury, formation of new blood vessels (angiogenesis), formation of new connective tissue (fibroplasia) and regeneration of skin (re-epithelialization).
Injection of PRP is a recommended treatment option for both sub-acute and chronic tendon and ligament injuries. The procedure is done in the standing horse under sedation and a local nerve block. Whole blood is obtained from the horse in a special syringe, and once processed, the PRP is injected into the injured site. The limb is bandaged for three days. The horse returns to a controlled exercise protocol based on the ultrasound findings and degree of lameness. Re-examination with ultrasonography is conducted every 30-60 days over the first four months, then every 60 to 90 days during the remaining healing period.
Treatment with Interleukin-1 Receptor Antagonist Protein (IRAP) utilizes progressive gene therapy to combat osteoarthritis in your horse. It has also been used in dogs and cats. Interleukin-1 (IL-1) is a cytokine (messenger protein) that is secreted by many types of cells. Cytokines are chemicals secreted by the cells of the immune system to signal the attack of infected, damaged or dying cells. IL-1 is an important part of the inflammatory response but in the case of your horse’s joints sometimes can be detrimental. In the arthritic joint interleukin-1 plays an important role in the inflammatory cascade and accelerates the deterioration of tissues like joint cartilage. Interleukin-1 Receptor Antagonist Protein (IRAP) blocks IL-1 from binding to tissues and inhibits the damaging consequences of IL-1.
The IRAP process begins with drawing 60 cc of blood from the horse into a special syringe. The syringe is specially prepared with glass beads that stimulate production of the antagonist protein (Il-1a) and an anticoagulant. The process of harvesting, incubating and centrifuging the blood to separate the plasma (abundant with IRAP) from the blood takes 24 hrs. Typically, IRAP treatments are every 8-10 days for three treatments.
These three new treatment options are novel approaches to combat osteoarthritis in your horses, dogs and cats. These approaches are exciting in part due to their potential long-term effect on battling osteoarthritis. Stem cells, platelet rich plasma and IRAP attack the inflammatory processes and assist healing in new ways not offered with conventional therapies. Though the research in this field is ongoing and the results have been very encouraging. We will continue to try and provide you the best of what medicine has to offer at Alpine Animal hospital. Please call us if you think that your horse is a candidate or have any questions on how to manage osteoarthritis.