Regenerative Medicine- What's the hype?
Stem cells, platelet rich plasma (PRP), Interleukin-1 receptor antagonist protein (IRAP), and autologous protein solution (APS or ProStride) have all gained exposure over the last decade as effective horse therapies. Although large controlled studies are yet to be published on each modality, there is a growing body of evidence to suggest that these biologics are extremely useful in joint and soft tissue injuries with low risk to the horse. Traditionally, corticosteroids and hyaluronic acid were the only mainstream joint treatments available. Corticosteroid injections carry risk in horses with insulin dysregulation, PPID (Cushing's), and are known to be deleterious to cartilage health over repeated injections.
Stem cells can come from many sources: bone marrow, fat tissue, dental pulp cells, and embryonic tissue. For simplicity sake, we most commonly obtain autologous (from the same patient we're treating) or allogenic (from a different horse) stem cells from bone marrow, fat, or dental pulp cells. What method we decide highly depends on the type of injury diagnosed and the age of the patient, as stem cells lose their efficacy in older animals. Furthermore, we can choose to harvest the stem cells which can take up to 3 weeks, or use bone marrow aspirate concentrate and inject it into the lesion the same day we pull the sample.
PRP and APS (ProStride) can be collected and processed right next to the horse (in the barn, no hauling needed anymore) using newer, portable technology. Blood is pulled after the horse is scrubbed with antiseptic solution, then spun in a centrifuge to concentrate the platelets within the horse's own plasma. This platelet rich fraction has high levels of growth factors and anti-inflammatory cytokines to aid in joint health or soft tissue healing. Various companies are now producing PRP kits and they are not all alike- the platelet concentration factor is important!
IRAP is another biologic product that we use commonly; Interleukin-1 is a pro-inflammatory cytokine that's found in high numbers in arthritic and diseased joints. Injecting IRAP solution into joints decreases the inflammation in the joint and is still fairly convenient in that the horse does not have to haul to a clinic for treatment. IRAP does have to be processed and incubated for up to 24 hours, so treatment with IRAP involves multiple appointments and a loading dose of 3 injections separated by 1-2 weeks each. Both APS and IRAP are great options for joint therapies in horses that cannot tolerate corticosteroids.
At Heritage Equine Clinic, we are proud to offer all the above treatment modalities at your farm. Each of these therapeutics have varying benefits and as clinicians we will customize a treatment plan based on the lesion location, duration, and horse specific factors. Feel free to call us for further information, this is a confusing realm of treatments and research is ever-changing!