Stem Cell-PRP Combination Effective in Treating Lesions

Stem Cell-PRP Combination Effective in Treating Lesions

Treatment with a combination of stem cells (seen here) and PRP allowed 11 of 13 horses in the current study to return to their previous high level of work.

Photo: The Horse Staff

Stem cell therapy combined with platelet-rich plasma (PRP) therapy could be more effective than either therapy alone for treating "overuse" injuries in competition horses, according to an Italian research team that recently completed a study on the topic.

"Literature shows that stem cells are a promising tool in regenerative medicine ... especially for tendon and ligament injuries, alone or in association with PRP," said Paola Torricelli, ScB, researcher in the laboratory of preclinical and surgical studies at the Rizzoli Orthopaedic Institute in Bologna, and primary author of the study. "So we expected to obtain better results from the combined therapy (as compared to PRP treatment alone)."

In a clinical trial simulating an approach already used for human athletes, researchers extracted autologous bone marrow mononuclear cells (BMMNCs, stem cells derived from the horse's own body rather than those collected from another animal) and PRP from competition horses that suffered from a suspensory ligament desmopathy (ligament disease) or a superficial flexor tendinopathy (tendon disease) as a result of stress from the high level of work they did. (For an overview of how stem cells help injured tissue heal, take a look at Stem Cells and Tissue Healing in Horses.)

The BMMNCs and PRP were prepared before being injected directly into the musculoskeletal injury site, which was located via ultrasound examination. All 13 study horses returned to "high level training" within a year of the procedure, Torricelli noted.

Eleven of the horses returned to competition after stem cell and PRP treatment, despite the fact their injuries had not healed under traditional therapies such as steroid therapy, rest, and hyaluronic acid injections. The two horses that did not return to competition had received relatively low BMMNCs and platelet levels compared to the other study horses, which would prove to be crucial in lesion healing.

"Among all the factors studied, the platelet concentration predicted the healing time," the team noted. Horses that received a larger amount of platelets (via PRP) had a significantly faster recovery than those that received lower doses.

Caution must be taken in interpreting these results because it's still unknown if the lesions healed because of the PRP alone, said Jorge Carmona, MVZ, MSc, PhD, associate professor in the school of veterinary medicine at the University of Caldas in Columbia. In a letter to the editor of International Orthopaedics, he argued that the study was lacking a control group.

"The PRP technique is easy and noninvasive, but bone marrow aspiration is an invasive procedure that isn't risk-free," Carmona noted. "Without a double-blind randomized study, (Torricelli's) conclusions could not be clinically recommended."

Contrary to traditional bone marrow stem cell isolation, which take weeks (for in-vitro--in the live horse--cell expansion before transplantation), Torricelli's study made use of a "one-step method" which takes only an hour (for stem cell-carrying mononuclear cell isolation/transplantation), she said.

The study is primarily meant to "increase the knowledge on this biological treatment," but additional, specifically designed, controlled studies are necessary, Torricelli said.

The study, "Regenerative medicine for the treatment of musculoskeletal overuse injuries in competition horses," was published in the October 2011 edition of International Orthopaedics. The abstract is available online.

About the Author

Christa Lesté-Lasserre, MA

Christa Lesté-Lasserre is a freelance writer based in France. A native of Dallas, Texas, Lesté-Lasserre grew up riding Quarter Horses, Appaloosas, and Shetland Ponies. She holds a master’s degree in English, specializing in creative writing, from the University of Mississippi in Oxford and earned a bachelor's in journalism and creative writing with a minor in sciences from Baylor University in Waco, Texas. She currently keeps her two Trakehners at home near Paris. Follow Lesté-Lasserre on Twitter @christalestelas.

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