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Regenerative therapy for Equine musculoskeletal injuries

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Sofia Elzaabalawy

on 5 November 2013

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Transcript of Regenerative therapy for Equine musculoskeletal injuries

Regenerative therapy for Equine musculoskeletal injuries
Regenerative therapy
It's the use of biologics to promote the body's own healing, restoring the structural architecture and biomechanical function of the injured tissue
Presented by:

Under the supervision of :

In the Equine field it includes the use of:
Stem cells of different sources
Blood-derived prodcuts ex. Platelet-rich plasm and autologous conditioned serum
Bone marrow aspirates and concentrates
Regenerative therapy vs. conventional methods of treatment
A 2003 study suggested that 60% of lameness problems in horses are related to osteoarthritis
Articular cartilage
Devoid of innervation, organization and lymphatic vessels Reduced inflow of blood progenitor cells and limited reparatory mechanism
The newly-formed tissue is composed exclusively of
which affects the morphological and functional recovery of the tissue
The outcome of using the conventional methods of treatment
Weakened tissue which doesn't respond to the locomotor demands and is more prone to re-injury
Regenerative therapy
Healthy tissue regeneration
Better performance
Reduction in recurrence rate
Unspecialized cells having the capacity of:

Differentiation into one or more cell/tissue types
Classification of stem cells according to their sources
stem cells
stem cells
stem cells
stem cells
Mesenchymal stem cells
Can be isolated from bone marrow, fat and other sources
Reparative mechanism: Secrete Cytokines, trans differentiation and fusion with host cells
Adipose-derived mesenchymal stem cells
Found in abundant quantities
Harvested with a minimally invasive technique
Can be differentiated along multiple cell lineage pathways
Can be safely and effectively transplanted to the host
No ethical or moral issues
Non-expanded adipose-derived autologous preparation: STROMAL VASCULAR FRACTION
Autologous conditioned serum ( aka Interleukin-1 receptor antagonist protein)
An anti-inflammatory used to treat joint injuries like synovitis, capsulitis and mild to moderate osteoarthritis.
Mechanism of action
In osteoarthritis, IL-1 is
produced in large amounts
and binds to receptor sites
on the cartilage signaling
cell destruction
In the ACS ,
monocytes bind to the beads stimulating the regenerative and anti-inflammatory proteins during incubation
Intra-articular injection of the prepared ACS

The ACS has high concentrations of regenerative and inhibitory proteins that block the effects of destructive proteins like IL-1, by filling the receptors on the cartilage with IL-1Ra
Platelet-rich plasma (PRP)
Commonly used to augment healing
PRP is obtained after centrifugation of whole blood
Autologous in nature
Rapid preparation
Non-invasive collection process
Enhances processes of clotting and wound repair
Stimulate tissue regeneration
Stimulate chemotaxis of macrophages, angiogeneis, proliferation and migration of fibroblasts and collagen synthesis
Alpha granules in the platelet cytoplasm degranulate on activation
Release growth factors that participate in healing
Evaluation of the regenerative potential of ADSVF and ACS in the treatment of osteoarthritis
Comparing the therapeutic effect of intra-articular injection of ADSVF and ACS therapies
Estimating the appropriate time of interference by the regenerative therapies through observing the effect of treatment of different grades of osteoarthritis
Comparing the therapeutic effects of regenerative therapies and conventional methods used in treatment of osteoarthritis
Sofia Elzaabalawy
Prof. Dr. Ashraf Abu-Seida
Dr. Ahmed Ismael

Experimental Study
Evaluation of the different regenerative therapies through treatment of experimentally induced osteoarthritis
Clinical Study
Experimental animals and treatments groups
Induction of osteoarthritis will be carried out chemically using intra-articular injection of
Sodium Monoiodoacetate
of two diagonal fetlock joints (
Right fore and left hind fetlock joints
Induction of OA in all horses
Treatment of subgroups A
Regenerative therapy group
: 3 horses will receive both regenerative therapies, one in each OA-affected joint
Control group
: 2 horses will be treated with the conventional methods of treatment
Treatment of subgroups B
Regenerative therapy group
: 3 horses will receive both regenerative therapies, one in each OA-affected joint
Control group
: 2 horses will be treated with the conventional methods of treatment
End of study and euthanasia of
subgroups A
End of study and euthanasia of
subgroups B
Harvest of adipose tissue
Lab processing
Single intra-articular
Blood collection
24h incubation and
lab processing
Intra-articular injection once a week for 4 weeks
Injection in combination with the other two therapies
Collection of blood
Lab processing
Clinical examination
Biweekly from prior to day 0
Joint range of motion
Palpation to detect joint effusion
Radiographic evaluation
Prior to inclusion
Prior inducton of OA
Following induction of OA
At the termination of the study
Synovial fluid analysis
Regular routine and biochemical analysis starting day 0
Ultrasonographic evaluation
Joint space and joint capsule will be examined for synovitis, joint effusion, thickening of joint capsule and cartilage surface evaluation
Histopathological evaluation
Following euthanasia at the end of the study (90 days following interference with the therapies)
Evaluation both macroscopically and microscopically
In this study, we will evaluate the following therapies
10 horses will be included in the study
Each of the treatments groups will be subdivided into:

1. Subgroup A: treatment on day 60

2. Subgroup B: treatment on day 120
The horses will be randomly assigned to one of these treatments groups:

1. Regenerative therapies group

2. Positive control group

Day 0
Day 60
Day 120
Day 150
Day 210
Thank you
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