Chuck Maker DVM
17776 Highway 82
Carbondale, CO 81623
Phone: 970-379-7100 Fax: 970-510-7332
Comprehensive lameness treatment services at Alpine Equine Hospital:
Autologous sem cells, Platelet Rich Plasma, IRAP, Alpha 2 Macroglobulin,and Bone Marrow aspirate therapies at Alpine Equine
Equine tendon, ligament, and joint injuries are some of the most frequently seen problems in clinical veterinary practice leading to joint instability, soft tissue injuries and/or 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.
Many horse owners us oral supplements (MyristolTM and Platinum performance-CFTM) that contain glucosamine, chondrotin sulfate, MSM, acetyl Myristolate and/or avocado extract are also commonly administered.
Conventional joint therapies have involved intra-articular medications such as hyaluronic acid, Noltrex and/or corticosteroids, rest, NSAIDS (bute, banamineTM, SurpassTM, EquioxxTM), focused shockwave therapy, polysulfated glycosaminoglycans (PSGAG such as Adequan) and intravenous hyaluronic acid (Legend).
Alpine Equine hospital offers the latest regeneartive modalities to help get your equine athlete get back in the show pen. Here are some of the options we offer:
Adult derived stem cells is an effective means of treating certain acute and chronic tendon injuries, suspensory and collateral ligament injuries and osteoarthritis in our horse patients. Cells obtained 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 Equine for ultrasound guided injection into the damaged ligament or tendon 2 ½ -3 weeks later. Subsequent stem cell treatments if deemed necessary 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 in certain types of sub-acute and chronic joint, 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.
Another Orthobiologics used at Alpine Equine is Alpha-2-macroglobulin (α2M) or Alpha2Eq. Alpha 2 M Eq is derived from natural substances found in the body used to promote healing. When trauma occurs to joints and soft tissue, it triggers the inflammatory cascade. This includes the release of protease enzymes and pro-inflammatory cytokines. Left unchecked these proteases and cytokines advance further tissue damage.
Alpha-2-macroglobulin (α2M) is a naturally occurring protein within the blood. The molecule has the ability to block the destructive effect of these enzymes by capturing them in a “trap” when the enzymes cleave the molecule’s amino acid “bait” region. α2M has a unique multimodal mechanism of action: non-specific protease inhibition, gene regulation, as well as cytokine and growth factor modulation.
FInally we are also bone marrow aspirates to harness the regenerative benefits of stems cells found in your horse's bone marrow to help rehabilitate horses with orthopedic injuries. Alpine utilizes the CenTrate® BMA device rto obtain regenerative cells from the horse’s own bone marrow to help initiate the healing process of cartilaginous lesions, boney defects and tendon injuries. CenTrate BMA is primarily used in helping manage moderate to severe chronic osteoarthritis and soft tissue injuries.1 It is also often used after surgery to facilitate recovery. The concentrated bone marrow aspirate is often combined with platelet rich plasma and is introduced to the injury site where the cells provide the key initiation of the healing process based on the environment they’re placed in.
Orthobiologics are state of the art steroid-free alternatives that can help ensure a better recovery from the types of injuries we see in our equine athletes These novel regenerative treatment options allow us to approach and better combat orthopedic injuries and osteoarthritis in your horses. 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 Equine hospital. Please give us a call if you have questions or wish to discuss how we can ensure your horse's optimal recovery.