Stem Cells and IRAP – The Next Generation of Equine Joint Disease Therapy
Joint damage and lameness is one of the biggest causes of retirement and loss of performance in the equine athlete. Unfortunately the signs of osteo-arthritis can present in both young horses or older horses. There has been a vast amount of research performed on the pathology of equine joint disease. For many years now we have had the same products available for the treatment of joint disease. These include: ice therapy, oral bute, Cartrophen/Pentosan, Hyaluronic acid injections and intra-articular corticosteroids. These therapies have been used with success in the management of equine joint disease. In some cases though these therapies do not have the desired response and your horse may not return to normal athletic function.
Joint disease/osteoarthritis is characterized by inflammation within the joint that leads to an inflammatory cascade with the production of a large amount of inflammatory enzymes that cause further joint damage. Often the process of joint disease is characterized by inflammation of the joint capsule followed by progressive destruction of the articular cartilage. These pro-inflammatory enzymes actually delay the body’s own natural healing response within the joint. Interleukin-1 is the main enzyme that is involved in the inflammatory cascade. Production of this enzyme leads to progressive destruction of the joint cartilage.
IRAP is a system that has been developed to stimulate white blood cells to produce anti-inflammatory mediators and enzymes to reduce the inflammatory phase of joint disease. Blood is taken from the jugular vein and incubated for 24 hours in special syringes which induce the blood cells to produce and secrete therapeutic proteins during the incubation period. After 24 hours the blood is centrifuged and all blood cells are removed. This leaves a protein rich serum which is then split into 3ml doses ready for injection into the diseased joint. Typically each collection produces enough serum for between 6-7 injections. The samples not used on the day of treatment can be frozen and used later.
The main anti-inflammatory protein produced is Interleukin-1 Receptor Antagonist Protein (IRAP). This has a direct action on the action of Interleukin-1 which other therapies are unable to do. There are a number of other anti-inflammatory proteins produced during the incubation process which work synergistically with the Interleukin-1 antagonist to reduce the inflammation within the joint and stimulate a regenerative response by the cartilage cells. IRAP is different to other treatments available as it has an anti-inflammatory component which other products have but it also induces a regenerative response unseen in other therapies. This regenerative response is a new addition to our therapeutic ability to manage joint disease.
IRAP Questions and Answers
What does the treatment involve?
The therapy consists of a series of three joint injections at 7 day intervals. Most positive effects are seen after the second and the third treatment. The remaining doses of cytokine rich protein serum are kept frozen and used as follow up treatments at a later date when required.
What cases warrant the use of IRAP?
The cases that generally respond the best are those that have mild to moderate degenerative joint disease visible on radiography (x-rays) and the associated lameness is abolished by the use of intra-articular anaesthesia. Joints which have fragments of bone visible on the radiographs are usually better to have arthroscopic surgery to remove chip fragments prior to commencing therapy. In these cases the anti-inflammatory cytokines and proteins will reduce inflammation within the joint and encourage a regenerative response by the damaged cartilage.
Why use IRAP?
This product is 100% autologous (from the horse’s own body) with the process stimulating the body’s cells to produce an increased number of the cytokines and associated proteins. IRAP is different from other products as it treats the cause of joint disease at the site of action and is aimed at restoring joint lining and cartilage function. Studies performed at Colorado State University show that treated horses have reduced lameness, improved joint histology (cellular make up) and a tendency for cartilage preservation. The product also targets the proteins that are involved in arthritis within the joint.
IRAP has been used for many years in human medicine and recently in Europe and USA for treatments of horses. Results from other veterinary surgeons have been very encouraging.
Racetrack Equine Veterinary Service have been using IRAP for more than 18 months with very impressive results.
IRAP heralds the new generation of treatment options available to manage equine joint disease.
To discuss the potential benefits that IRAP can offer your horse please feel free to contact us.