Regenerative medicine is the use of techniques that will stimulate tissue to make more or new tissue.
In horses there are three different techniques used last years; stem cells, A-Cell and PRP.
Stem cell therapy uses cells from the horse’s own body that have the ability to become new cells of several tissue types. Stem cells can be harvested from the fat around the tail basis or from bone marrow out of the sternum or hip bones.
Sometimes these harvested cells are directly injected into the damaged tissue, but in the non-processed samples not a lot of stem cells are present, so results are mostly disappointing.
There are some laboratories where harvested samples can be processed to make a more concentrated sample of stem cells, but this process and the transport make infection a real risk.
A-Cell is a powdered substrate from pig bladder, containing a lot of collagen. There are no cells in this material. The substrate will act as a scaffolding for cells of the original tissue to develop new tissue in an organized way. This technique is mostly used in tendon injuries.
PRP is an abbreviation for Platelet Rich Plasma. In most cases the patient is used as donor, sometimes a donor horse is used.
Platelets contents some growth factors and growth stimulating substances. When harvested in a proper manner, the platelets are concentrated to 4-5 times the normal concentration in normal plasma. The concentrate then can be injected into the damaged tissue. In human research there are positive results with PRP in regeneration of menisci and cartilage as well as tendons and ligaments. In horses, most PRP is used for tendon and ligament injuries.
Based on the potential side effects of the stem cell therapy and A-cell therapy, Dr van Wessum has run a research project at MSU the past years with PRP.(http://www.cvm.msu.edu/about-the-college/news-events/news/prp-a-new-option-for-treating-injuries-in-the-horse/?searchterm=prp)
The outcome of that study was that in specific cases, where an injury of tendons or ligaments was older and not very reactive anymore, injection of PRP gave a enormous boost to the resting cells to make more tendon or ligament tissue. Overall time of healing was still 4-6 months, as with an ordinary tendon or ligament healing process. The structure and organization of the tissue however was much better than in a control group that did not receive PRP injection.
Restoration of tendons and ligaments with original tissue quality is a major improvement, because there is less scar tissue present in the healed tendon or ligament.
Dr Johnston has a major appointment with a human biotechnology research company that is involved in top-of-the-line human stem cell research, she will bring that experience into the equine field.
At the Equine All-Sports Medicine Center we will asses each case of tendon and ligament injury to evaluate if PRP-treatment would make a difference in the case and the prognosis.
We have excellent experience in the use of this technique, are aware of the fact that case selection is very important (not every case will benefit from PRP-treatment) and have the skills and equipment to deliver the PRP right into the site of injury. Excellent ultrasound equipment, skilled expertise to inject into small anatomical structures under ultrasound guidance and excellent aseptic technique to prevent infection are an important reason to choose for the Equine All-Sports Medicine Center. We have a clinic facility, which is facilitating sterile technique, skilled ultrasonographers with top-notch ultrasound equipment and a board certified surgeon to perform the surgical part of the treatment.
Even with regenerative medicine, rehabilitation is the most important factor for a positive outcome. With regenerative medicine gradual loading of the structures over time is as essential as this is for “normal” tendon healing, emphasizing the need for a rehabilitation program.
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