Regenerative Medicine – Biological Treatments

Regenerative Medicine - Biological Treatments

Biological treatments are part of the regenerative medicine which aim to stimulate the body’s own repair mechanisms to aim to bring them back to function. These treatments have been improved and refined since they were first used in the 70’s and help both humans and animals in injury recovery.

Before we dive into the pros and cons of the regenerative medicine options for horses it’s important to be clear that the first step is to make a diagnosis. Once a diagnosis is reached there will be individual options of management and treatment and its important to understand that some recommendations such as exercise management, shoeing, and physical therapies could proportionally make more of a difference in the recovery/rehabilitation.

 

1. PRP - Platelet Rich Plasma

Platelets are part of the blood of the horse. They are considered as the first response to injury and they also produce certain growth factors that enhance the healing. 

There are different procedures and kits available to obtain platelet rich plasma; in essence we obtain it from the horse’s own blood (autologous).  We then filter or centrifuge so we can concentrate these platelets and then we inject them locally (5-8 times the normal concentration from blood), after we stimulate them chemically so they can release all the growth factors.  

Platelet Rich Plasma has been commonly used for tendon or ligament injuries especially in areas where the poor natural vasculature decreases the chances of healing. One of the limitations of the treatment is that it is very short-lived (of approximately 14 days) and these treatments may need to be repeated to be most effective. This treatment has to be done in the earlier stages of injury ideally.

Obtaining autologous blood from a horse

2. Autologous Conditioned Serum (aka IRAP)

IRAP or ACS aims to block inflammation.  

Joints are privileged anatomical structures where there are minimal blood cells in healthy joints. When there is a joint inflammation there is release of these cells and their mediators (around 100 chemical mediators including Interleukin-1). Inflammation can lead to a spiral of ongoing joint degeneration and IRAP or ACS is used to counteract the destructive effects of IL-1 by blocking it to the receptors and therefore decreasing the inflammation.

 

The IRAP is obtained from autologous blood in special tubes that amplify the effects of the components of the blood for this purpose. IRAP and ACS, if they are used in joints as an articular therapy, and as a biological treatment, there are no foreign chemical substances that will be tested in doping.

3. Stem Cells

There have been numerous studies that have suggested the potential of the use of mesenchymal stem cells injected intra-lesionally for the functional regeneration of tendons and ligaments.
 
Stem cells can be retrieved from different sources such as bone marrow (BM), adipose tissue (AT) and other places. There are also currently stem cells non autologous, produced in a lab and licensed specifically for intra-articular use (made by Boehringer Ingelheim). 
 

Once the stem cells are injected it is thought that these cells, will theoretically transform into the tissue that they are in contact with. For example, if they are injected into a cavity lesion of a tendon, the stem cells will transform into tendon tissue. The reality is that they have been positive results but still needs refinement. It is thought that the injection of stem cells from the bone marrow are superior to other stem cells in specialising in that particular anatomical tissue.

Stem cells from bone marrow are obtained through needle aspiration of bone marrow from the sternum or the ileum. These cells are isolated in the lab and they are purified and cultured and the end result is injected into the lesion. This process can take around 2-4 weeks time and can be costly. There have been occasions where the aspiration of bone marrow hasn’t led necessarily to an adequate concentration of stem cells, therefore making the process void.

Stem cells – Arti-Cell Forte is a cell-based veterinary medicine obtained from peripheral blood of donor horses. They are allogenic (to prevent rejection when implanted) and favor chondrogenic-induced properties, which means they aim to repair cartilage. The results have been encouraging and showed evidence of healing in joint problems. It is only licensed to be used in joint degeneration/inflammation such as DJD (Degenerative Joint Disease).

4. Lipogems

This is a technology that has been brought from human patients. It is not strictly stem cells obtained from adipose tissue but rather a specific cell around the vasculature from adipose tissue called mesenchymal stromal cells that have the ability to repair tissue quite effectively. They don’t specialise in any particular cells such as tendon or ligament but they encourage rapid healing. 

The procedure involves obtaining the fat from the tail head of the patient and, using a special kit, the fat tissue is prepared to be implanted in an affected area. It can be a “general healer” and can be used in ligaments, tendons, as well as joints and it has great potential for injuries that have historically been difficult to treat. The procedure is fairly short and can be done in one visit.

5. Bone marrow

Direct injections of bone marrow have proven a very cost-effective procedure. It involves obtaining bone marrow (with it risks), and following an easy quick processing of the bone marrow, it is injected directly on the lesions. Bone marrow has a mixture of different components such as stem cells and other healing factors that can promote healing.

It is generally used as a less costly alternative than harvesting stem cells from bone marrow during a few weeks and has the advantage to be performed on the same visit. They generally aim to treat any ligament or tendon lesions.