Regenerative therapy is a specialty of Cave Creek Equine Surgical & Imaging Center, as Dr. Vidal and Dr. Aristizabal have been involved in research studies and published in the equine and human literature on the biology and application of stem cells.
The most common regenerative medicine currently includes stem cell, IRAP, and PRP therapies. These offer the possibility of successful treatment of previously life-threatening or career-ending injuries.
The most common applications for Regenerative therapies in horses are currently soft tissue injuries (tendons and ligaments) and joints. With the development of new intravascular (especially intra-arterial) application techniques of stem cells, the treatment of laminitis and more inaccessible soft tissue injuries, such as those within the hoof, have become possible.
We are firm believers in minimalizing invasive treatment where applicable. Dr. Vidal, Dr. Aristizabal, and Dr. Rich are pioneers in equine stem cell research and administration and there are thousands of success stories regarding the anti-inflammatory effects and accelerated healing provided by stem cell therapy.
Stem Cell Therapy
Stem cell therapy is now a very common regenerative therapy that may employ stem cells from various sources such as bone marrow and fat, dental connective tissue and amniotic fluid. This equine therapy is an effective option for treatment for equine injuries and equine lameness.
We inject stems cells directly into the injured or lesion area to help the horse’s body more effectively stimulate tissue healing. Using stem cells from different sources enables the horse to realize different benefits.
Equine regenerative medicine primarily uses mesenchymal stem cells (MSC), which reside in the bone marrow, as the premise in equine veterinary medicine is to primarily treat soft tissue and joint injuries. These MSCs are found in bone marrow, fat, dental connective tissue, umbilical cord blood and tissue, and many other organs throughout the body. The younger or more immature the stem cell, the more potential they may have. The younger stem cells have an increased ability to heal and regenerate tissue compared to the adult stem cells. This is the reason for the recent interest in storing umbilical cord blood in horses.
Bone marrow-derived stem cells
In equine practice stem cells are commonly derived from bone marrow obtained from the sternum or the tuber coxae. Once the bone marrow has been obtained it is sent to a lab where it is cultured and expanded into millions of stem cells. The typical dose ranges from 10 to 25 million stem cells per treatment. The culture and expansion process takes approximately 3 weeks. The stem cells can then be injected into the affected tendon, ligament or joint.
Fat-derived stem cells
The second source of stem cells is fat. Fat-derived stem cells only contain 2-4% stem cells unless they are cultured and expanded. Adipose-derived stromal fraction is the more appropriate term used to describe this therapy. One of the advantages of the fat-derived product is that immune response in joints and soft tissues are much rarer compared to the bone marrow derived stem cell product.
A product by VetGraft where we’ve seen remarkable results is called PulpCyte®. It is an allograft that is mechanically extracted without tissue processing such as non-marrow derived cells (cell culture) and fat-derived stem cells (fat tissue digestion), screened extensively for potential diseases and subsequently stored. A significant difference is that the PulpCyte allograft contains stem cells which are imbedded in a protein matrix which protects the viability of the cells. The protein matrix contains native growth factors and anti-inflammatory proteins similar to PRP and IRAP but at much greater quantities.
Equine Therapies that Speed Healing
We typically use a combination of the following minimally invasive injection therapies since they complement each other in the healing process.
- IRAP (Interleukin-1 Receptor Antagonist Protein)
- PRP (Platelet Rich Plasma)
- ProStride (a combination of PRP and IRAP)
- Polyacrylamide gel (designed for joint lubrication)
- These tend to overlap in terms of how they work. IRAP is an anti-inflammatory treatment which prevents the interleukin-1 from binding to tissues such as joint cartilage, which causes inflammation.
PRP is used to treat soft tissue (tendon and ligament) injuries and promotes faster healing.
We use ProStride to reduce pain associated with arthritis and slow the degrading of cartilage while improving mobility.
Another osteoarthritis treatment we use is polyacrylamide hydrogel, which can stop the progression of the disease and reduce pain in arthritic joints.
Another therapy commonly used is shockwave. It aids in the quality and speed of healing as well as helps with pain. Shockwave therapy is a non-invasive, high-energy, focused pressure sound wave treatment which we commonly used in conjunction with regenerative medicine to augment their effect.
As you would expect, each of these steps is unique to your horse, their symptoms, and your plans for the horse in terms of activity. We work with you every step of the way to ensure that your horse receives the best care possible.