Platelet Rich Plasma, Stem Cell & IRAP Therapy
These three new treatment options are novel approaches to combat osteoarthritis in horses and can be used with other animals such as dogs and cats. These approaches are exciting in part due to their potential longterm 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.
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.
Alpine Animal hospital is offering the use of adult derived stem cells as a means of treating acute and chronic tendon injuries, suspensory and collateral ligament injuries and osteoarthritis. 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 either by the collection and storage of umbilical cord blood in a foal or by harvesting 20-40 cc of bone marrow from the sternum or hip under standing sedation in adults. These samples are in turn sent overnight to a commercial laboratory in Fort Collins (Advanced Regenerative Therapies http://www.art4dvm.com/ where they are processed into pleuripotent stem cells. Ultrasound guidance allows for the injection of cells back into the patient approximately 3 weeks later. Stem cells can also be cryo-preserved and used for subsequent regenerative therapy treatments, dependent on the initial cell yield.
Platelet rich plasma (PRP), or blood plasma with concentrated platelet content. Platelets are derived from stem cells in the patient’s bone marrow and contain a number of growth factors that are released upon activation at an injured site. These growth factors act synergistically to enhance access of healthy inflammatory cells to the area of tissue injury, formation of new blood vessels, formation of new connective tissue and regeneration of skin.
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. Reexamination 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. 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.
IRAP 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.
Please call us if you think that your horse is a candidate or have any questions on how to manage osteoarthritis.