Sports Medicine

Regenerative medicine involves maximizing the body’s own capacity to heal damaged tissue and more specifically, to replace such injured tissue with tissue identical to the original.  Various cell-based therapies have been developed for this purpose and are available at Anglesey Lodge. Most commonly these cell-based therapies are used to treat tendon and ligament injuries (e.g. superficial digital flexor tendonitis, suspensory ligament desmitis) and osteoarthritis particularly those cases which have ceased to respond to the more conventional corticosteroid based treatments due to advanced cartilage and joint damage. As our knowledge has improved with ongoing research, we are now more frequently using cell-based therapies before irreversible damage occurs, particularly in horses with joint pain.

Stem cells are immature cells which possess the ability to replicate and differentiate (change) into any cell type in the body such as tendon, ligament, bone or cartilage forming cells to name but a few. Two main types of stem cells exist namely hematopoietic and mesenchymal stem cells, of which the later form is of most interest to us in equine regenerative medicine. Mesenchymal stem cells have been traditionally harvested in three forms each of which has pros and cons, which can be discussed in detail on a case-by-case basis.

• Umbilical Cord Blood

In this form blood is harvested from the umbilical cord of the foal at the time of birth. This blood is then stored in a stem cell bank for the life of the horse and may be used at a later date if required. Umbilical cord blood derived stem cells have generated a lot of interest in recent years as they are one of the most immature forms of stem cell available to us and thus, may offer an increased ability to regenerate damaged tissue over other forms.

• Bone Marrow Derived Stem Cells

These cells are harvested from either the sternum or hip bone in the standing horse. The harvested bone marrow then undergoes specialist processing in the laboratory for three to six weeks to expand the cell numbers before they are injected into the damaged structure.

• Adipose Derived Stem Cells

Adipose (fat) derived stem cells are harvested from fat that has been collected from either side of the horses tail head. This procedure can now be performed in a similar manner to liposuction in humans. The fat cells are rapidly processed (45 minutes to two days) before they are injected into the damaged structure

Platelet rich plasma treatment involves harvesting a small volume of the horses own blood. This sample is then processed in a specially designed centrifuge, located in house. During this process the platelets and beneficial growth factors are separated from other cell types present in blood. The processed sample is then injected, usually under ultrasound guidance into the damaged structure (tendon, ligament or joint). Once within the injured structure, platelets release numerous growth factors and chemicals, which promote tissue repair and attract local stem cells already within the body. Growth factors act to initiate and orchestrate the complex process of healing. The reported benefits of PRP include:

• Accelerated healing
• Production of growth factors
• Reduced time of new tissue maturation
• Improved bone density
• Reduced pain

Interleukin-1 is believed to be the major driver of inflammatory joint conditions such as osteoarthritis. Such inflammatory conditions lead to pain and thus lameness and poor performance in the horse. Interleukin-1 receptor antagonist protein (IRAP) is a naturally derived protein in blood that acts to block the action of interleukin-1 and hence prevent pain and lameness.

Interleukin-1 receptor antagonist protein is obtained by collecting a small quantity of blood into a specially designed vial containing medical grade coated glass beads. This vial is then incubated for 18-24 hours, which greatly increases the concentration of IRAP in the final product. The processed IRAP is then divided into multiple doses, which can be injected into affected joints as needed. Any excess IRAP can be frozen for use at a later date.

The reported benefits of IRAP include:

• Stimulates the multiplication of various cells such as stem cells, bone and cartilage producing cells
• Enhances the production of cartilage components
• Reduces the production of enzymes which damage cartilage
• Stimulates the growth of new blood vessels
• Attracts local stem cells