Helping the Healing Process with Equine Regenerative Medical Devices

How today’s regenerative medicine devices could pave the way to more healing and longer, healthier lives for horses.

Regenerative medicine devices (RMDs) are not new to the market. Universities have been making these types of products in-house for upwards of 20 years. The commercialization of RMDs and their more widespread use began nearly 15 years ago. But in the last 5 to 10 years, there has been a growing number of options available and greater adoption among equine practitioners.

“Every year it seems like veterinarians are using them more and more,” said Liberty Getman, DVM, DACVS, Equine Technical Services, Zoetis.

Historically, veterinarians have treated joint problems with steroids. While steroids may help the horse feel better, they don’t slow the progression of the disease. What has Dr. Getman excited about RMDs is they can treat the underlying problem and help stimulate healing.

“So not only are we getting these areas to heal better, but they’re also going to heal faster,” she said. “We’re letting them heal with less scar tissue. It leads to improved outcomes for problems that, historically, either veterinarians didn’t have a good treatment for, or the treatment would take much longer and require much more downtime.”

RMDs in action

In recent years, Zoetis has made significant investments in collaborative research projects with universities and other institutions to better understand the health benefits of RMD use in horses and other animals. For example, researchers from the University of Pennsylvania’s New Bolton Center investigated the use of nonsteroidal anti-inflammatory drugs (NSAIDs) alongside RMDs.

“Sometimes on the human medicine side, if you want to have one of these regenerative medicine devices or regenerative therapies made, they’ll ask you to stop using NSAIDs because of how they affect human platelets,” Dr. Getman said. “So our veterinarians wanted to know if they had to do the same thing with our equine patients. If you have a horse that’s put on a NSAID, do you have to stop that treatment in order to have a regenerative medicine product made?”

The study examined the concentrations of platelets, leukocytes, cytokines and growth factors in the end output solution of Pro-Stride® APS and Restigen® PRP devices following administration of a single dose of ketoprofen, flunixin meglumine, phenylbutazone or firocoxib (short term), and after 6 days of administration of phenylbutazone or firocoxib (long term) at a routine dosage and interval. Results indicated that the use of NSAIDs, both in the short and long term, does not affect concentrations of cytokines or growth factors generated by the devices when blood is obtained for processing 6 hours after a single dose of these NSAIDs and 24 hours after the last dose of phenylbutazone or firocoxib.

Another study completed in partnership with the New Bolton Center examined the effectiveness of the Pro-Stride APS equine RMD for the alleviation of acute IL-1b-induced synovitis in a tarsocrural joint. The results at 14 days post-treatment revealed that gross and histopathology scores were significantly closer to normal in horses that were treated with the end cell solution provided by the Pro-Stride device versus those joints that were untreated. Injection did not result in significant differences in synovial fluid cytokine parameters or visual lameness scores, researchers noted. Untreated control joints showed significant signs of synovitis, including synovial hypermia, edema discoloration and haemosiderosis compared to Pro-Stride APS-treated joints. The results highlighted a use case for this regenerative medicine treatment early on in the acute inflammatory phase of injury.

“The bottom line is we need to be using something like Pro-Stride much earlier in these cases of lameness versus waiting until the horse isn’t responding to anything else,” Dr. Getman said. “The sooner you use these regenerative medicine devices, the better your long-term outcome is going to be.”

Misconceptions

Traditionally, price has been a stumbling block in the use of RMDs. “Some people think these therapies are exorbitantly expensive, but they really aren’t,” Dr. Getman said. “Yes, they do cost a little bit more than steroids, but honestly the cost is not prohibitive for your average equine client – anything from a backyard horse that does a little bit of trail riding to upper-level performance horses. I think most horse owners are happy to use them if they understand the benefits compared to what they’re already using. Most equine veterinarians understand that RMDs offer a new way of treating lameness and injury, and they see that these regenerative therapies are the way of the future.”

But not all RMDs are created with the same efficacy and standards. Dr. Getman encourages veterinarians to make sure they use RMDs backed by science through peer-reviewed published data about the product and its safety and efficacy.

“This is an area that’s kind of like the Wild West when it comes to regulation because a lot of these things are considered devices and not drugs,” she said. “Sometimes there’s not a lot of oversight and regulation of what comes on the market. Because of that, you see a lot of exaggerated marketing claims and products that come out without any real safety or efficacy data. I would just encourage people to really understand what product they’re bringing into their practice, know whether that product is safe, efficacious, and has the data and peer-reviewed studies to support it.”

RMDs’ potential

The most common conversation Dr. Getman has with horse owners and veterinarians is about their overall desire to keep their horses healthy, happy and competing longer. While steroids are effective at providing pain relief, their long-term use may contribute to cartilage and joint damage in the horse, she said. RMDs provide a more long-term approach to care.

“By switching from steroids to RMDs, you’re not going to cause any more cartilage damage,” she said. “We know that an RMD like Pro-Stride can be protective inside the joint. So for me, the solution is to try to get fewer people using steroids in the joints of horses and more people using RMDs.”

Regenerative medicine therapies have been a game-changer for tendon and ligament soft-tissue injuries, she said. These products have improved the healing of soft-tissue lesions with less scar tissue. That, in turn, makes horses less prone to reinjury.

“It’s all pretty exciting because we can keep our horses going longer,” Dr. Getman said, “even if your horse has a little bit of arthritis. Hopefully we’re extending the athletic careers of these horses and healing some of their injuries quicker with less scar tissue and less chance of reinjury.”

Regenerative terminology

Regenerative medicine

In its simplest terms, regenerative medicine involves using a patient’s blood or bone marrow to create a product that is then injected back into them to help the healing process in a natural way. This can be done in humans, dogs and horses to decrease inflammation. “When you decrease inflammation, you also decrease pain while stimulating healing,” Dr. Getman said. “So these are natural products typically made from the same horse, the same dog, the same person, and then putting them back into that horse, dog or person, amplifying the body’s own response to allow them to heal these problems a little bit better.”

RMDs

Regenerative medicine devices refer to how we make these regenerative medicine products. They are not drugs. “RMDs tend to be something that you’re going to put that blood or bone marrow inside, centrifuge and then collect out a concentrated solution,” Dr. Getman said. “The device really just refers to how we make these regenerative medicine products.”

Photo credit: Iryna Inshyna/MajaMitrovic

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