Basic HTML Version
3)
Autologous Conditioned
Serum (ACS)
Commercially known as Irap
®
, ACS is
primarily used to treat joint inflammation.
Treatment involves taking a blood sample
into a syringe which contains chromium
sulphate coated beads. This sample is
then incubated for 24 hours. After this
time, the sample is centrifuged and
the serum ‘soup’ that is present at the
top of the sample is removed. This
conditioned serum ‘soup’ is very high
in anti-inflammatory proteins and growth
factors and is injected into inflamed or
damaged joints. It can also be frozen
for later use.
6)
Bone Marrow Aspirate
Concentrate (BMAC)
BMAC is bone marrow that has been
centrifuged to concentrate the growth
factors present, and then injected into
the damaged area under treatment.
7)
Individual Growth Factors
(GF)
Individual growth factors such as
‘insulin-like-growth-factor-I (IGF-I)’ have
occasionally been used but are less
commonly used in isolation today, as
many of the above options are
considered superior.
4)
Urinary Bladder Matrix
(UBM)
Commercially known as ACell
®
, UBM
is a product made from pig’s bladder.
The aim of this product is to provide
the scaffold for tissue repair and is a
powder that is reconstituted in saline
and injected directly into damaged
tendon or ligament lesions.
5)
Bone Marrow (BM)
BM can be harvested in the same way as
for stem cell collection, and then injected
straight back into a damaged tendon or
ligament.
SUMMER 2014 ISSUE
EQUINE MATTERS
6
REGENERATIVE MEDICINE
Blood sampling prior to PRP filtration
Irap
®
filtration prior to joint injection
PRP kits are commercially available and
allow filtering to be performed ‘horse-side’
So, where and how are we
using these techniques today?
Stem cells are used frequently in the treatment
of tendon injuries. Tendon lesions lend
themselves to this treatment very well as a
core lesion in a tendon holds the cells in
place very well. Generally with tendon
injuries we still require a full rehabilitation
program and stem cells don’t actually shorten
this recovery period. However, there is good
evidence that the injection of stem cells into
superficial digital flexor tendon lesions within
one month of injury, has been shown to
significantly improve the outcome when
compared with rest alone. This greatly
reduces the rate of re-injury in National Hunt
horses. PRP is also now being used with
greater frequency in tendon injuries and is
currently the treatment of choice for the
majority of ligament injuries, such as
suspensory ligament damage.
ACS (Irap
®
) is predominantly used to aid
treatment of early inflammatory joint disease.
It helps to suppress the inflammatory cycle
and assists healing in the joint. Unlike
repeated injections of steroids, ACS may
be used repeatedly without any possible
detrimental effects to the cartilage. ACS is
frequently used after arthroscopic surgery to
assist in the healing of joint tissues. Normally
three joint injections would be given two
weeks apart. PRP can also be used in a joint
but it should be remembered that it will be
supplying more growth factors to assist
healing and less of a direct anti-inflammatory
effect. Indeed PRP and ACS can be used
together in joint disease treatment and not just
used separately. It is very important that if PRP
is used in a joint that the preparation has to
be exact and must minimise the number of
white blood cells (WBC’s) that may be left
in the sample. WBC’s will have a negative
effect in the joint. Stem cells have been used
much less in joints but have been used with
success in tendon sheaths and bursae after
surgical debridement, notably in the
navicular bursae.
As more and more cases are treated
using these biological regenerative
techniques we will inevitably develop
better understanding as to which
technique is best for which injuries,
which horses, which disciplines and
what the ultimate long term benefits
truly are.