Myths & Facts about Equine Regenerative Medicine
As with any new technology or medical advancement, myths about regenerative medicine have surfaced. Scientific studies have shown that some forms of regenerative medicine therapies are safe and have been successful in treating horses.
Information provided by Sarah Graham, DVM, DACVS.
Myth: Regenerative medicine can cure lameness by rebuilding torn tendons or ligaments.
FACT: There have been a variety of definitions for regenerative medicine since the inception of the term in 2001. Regenerative Medicine refers to a group of biomedical approaches to clinical therapies that may involve the use of stem cells or other biologic products. Some examples are those therapies that include the use of stems cells, platelet rich plasma, autologous conditioned serum, biofactors, gene therapy and the like. However, rather than replacing an injured structure with one harvested from a donor (as in organ transplantation) or with a newly engineered organ (as in tissue engineering), in Equine Sports Medicine the term Regenerative Medicine is usually used in reference to therapies that stimulate and support the horse’s capacity for self-healing while working to decrease some of the more detrimental processes which might slow or inhibit normal recovery. There have been some studies that show potential improvements in structure, strength and/or speed of healing, but nothing to date that reports actual “rebuilding” of an injured or lost structure.
For example, if we have a horse that has been diagnosed with a cartilage injury to the fetlock joint, one of the recommended therapeutic options may be the use of “biofactors” such as autologous conditioned serum (ACS)(which may also be called IRAP, IRAP II or ACP). While previously described as a treatment that supplies one type of powerful anti-inflammatory molecule it is more likely a “soup” of biologic molecules that reduce and block inflammation, which can be harmful in the long-term. This biologic product is collected from the horse’s blood, amplified in the laboratory and then administered to the affected area on that same horse, so it is essentially using the body to promote it’s own healing.
Myth: Regenerative medicine therapies are expensive.
Fact: Yes, some of the newer, cutting edge therapies have a higher initial price tag than some of the older therapies. However, there is a range of options that are available, and your veterinarian will help to find the best solution for you and your horse that also fits within your budget. The idea behind providing advanced diagnostics and treatment is that when an injury is accurately diagnosed and treated appropriately and early, a reasonable prognosis can be provided to the owner and the chances of return to function are higher. This is important because lameness is the number one health concern for horse owners. When the cost associated with loss of use is factored in, owners spend more money on lameness than on any other type of disease that affects horses.
Myth: Regenerative medicine is not widely practiced because it doesn’t work.
Fact: Regenerative medicine is a relatively new science and there aren’t yet large numbers of clinical studies evaluating its efficacy in horses. However, the body of evidence on appropriate use, effectiveness, safety and available techniques is increasing. One such clinical study was performed in horses with naturally occurring injuries to the superficial digital flexor tendon. Eighty percent of horses whose tendons were treated with bone marrow derived stem cells returned to function and were still in work after 2 years. By comparison, 100% of the non-treated horses had re-injured the same tendon within 4-12 months.
Currently, the use of stem cells, PRP, and ACS is becoming more commonplace and the research demonstrating it’s safety and effectiveness is ongoing. Veterinary practices are using these techniques with greater frequency as well, and veterinarians have had to acquire additional skills, equipment and/or access to a qualified laboratory to be able to provide these therapies.