The Horse

FEB 2019

The Horse:Your Guide To Equine Health Care provides monthly equine health care information to horse owners, breeders, veterinarians, barn/farm managers, trainer/riding instructors, and others involved in the hands-on care of the horse.

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46 February 2019 The Horse | TheHorse.com Success Stories As mentioned, veterinarians have used stem cells predominantly for managing soft-tissue injuries in Thoroughbred race- horses. As such, researchers have gener- ated data on their safety and efficacy in this population, including: ■ In one study, 77-98% of Thoroughbreds with naturally occurring tendinopathy (tendon disease or injury) showed im- provement on ultrasound examination following stem cell treatment. Further, the reinjury rate was less than 30%. ■ For horses with naturally occurring os- teoarthritis, 78% returned to work after treatment. For horses with meniscal in- juries in the stifles (i.e., to the "pillows" of cartilage that cushion the impact between the femur and tibia inside the stifle joint), 76% returned to work. Fortier has also had great success with stem cell therapy. She shares, for instance, a story about Pistol, a 3-year- old colt that arrived into her care with bone damage in his shoulder joint socket, prompting exploratory surgery. During surgery Fortier found bone and cartilage damage suggesting Pis- tol jammed his leg and the ball hit the socket. At the end of surgery, she injected a bone marrow concentrate developed us- ing a process derived in her own labora- tory. The concentrate contains stem cells, anti-inflammatories, proteins, and growth factors that can help repair bone and car- tilage to return the joint to normal. Pistol recovered from surgery and treatment uneventfully and has been doing well. Take-Home Message In her recently published comprehen- sive review of stem cell therapy, Ortved summarizes the benefits of stem cells and attests that this therapy leads to "improved repair of tendon and ligament lesions" in sport horses. However, she reminds owners that in this unique group of athletes, "a tailored rehabilitation program, including con- trolled exercise and adjunctive treatments, is also key to success in cases of tendinitis and desmitis. The nature and severity of injury will dictate that individual horse's tailored rehabilitation plan." As for other potential stem cell uses, we must wait for researchers to disclose what they're learning as they explore the myriad applications. h the maximum bang for your buck (Bar- rachina et al., 2018). Here are some of the many factors your veterinarian consid- ers when planning your horse's biologic needs: 1. Cost. MSC therapy is expensive. To use autologous stem cells, which are collected from your horse, processed, and used to treat his own injury, your veterinarian must sedate the horse and collect and process bone marrow (or fat) according to rigid guidelines using specialized equipment and laborato- ries. The cost of the equipment, sup- plies, and time adds up. 2. Delayed patient treatment. The process of using bone-marrow-derived autolo- gous stem cells is time-consuming. This method requires several weeks of culture to acquire a sufficient number of stem cells for administration. It is possible, however, to inject a subset of concentrated bone marrow cells im- mediately after collecting the marrow, while the remainder of the sample is sent for culture. Further, veterinar- ians can use PRP in the interim so the horse is at least receiving some form of biologic therapy while awaiting the delivery of the cultured cells. 3. Consider allogeneic stem cells. Another way to circumvent delayed treatment times is to use allogeneic stem cells. These are stem cells collected from a different horse ready to inject into the patient. The main concern with allogeneic stem cell usage, our sources say, is that the patient's immune system will view them as "nonself," similar to bacteria and viruses, and attack and destroy them. However, many horses with underlying medical conditions, such as pituitary pars intermedia dysfunction (equine Cushing's disease), equine metabolic syndrome, or insulin dysregulation, cannot use their own stem cells because those cells aren't considered healthy. Thus, veterinarians must rely on allogeneic cells instead (e.g., for managing laminitis). 4. There's no guarantee. As Barrachina et al. noted in their review of stem cell pros and cons, "Although MSCs may be a promising treatment for equine mus- culoskeletal injuries, it is important to highlight that their actual therapeutic potential still remains unclear and that there are still several gaps in the knowl- edge to be investigated." For example, some veterinarians use combinations of stem cells, PRP, and other rehabilitation modalities. Because of this wide array of treatment plans and because equine veterinarians implement and adapt their own protocols to best help each patient, collecting clear data and creating a recipe book for biologic therapy is challenging to say the least. SPORTS MEDICINE STEM CELLS Cells capable of self-renewal and able to become different cell types—a process called "potency" PLURIPOTENT Able to become almost any cell type TOTIPOTENT Able to become any cell type in the body ADULT MSC Usually bone-marrow- or adipose-(fat)-derived BONE MARROW Obtained from the tuber coxae, or hip bone CONCENTRATED Centrifuged to collect the 2-4% of stem cells within the sample, then injected directly into the patient as soon as possible UNIPOTENT Able to become only one type of cell FETAL Derived from umbilical cord tissue or amnion ADIPOSE Commonly obtained from the tailhead, to be concentrated and injected as soon as possible CULTURED Sent to a laboratory to be cultured to produce 1-2 mil- lion stem cells for subsequent injection or even cryo- preservation; this process takes two to four weeks MULTIPOTENT Able to become any cell in a related group of cell types DENTAL/OTHER From dental pulp, synovium, periosteum, etc. TYPES OF STEM CELLS

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