Notes

http://www.roodandriddle.com/news/regenerative-medicine-understanding-irap-prp-and-stem-cell-therapies.html by Scott A. Hopper, DVM, MS, Diplomate ACVS
IRAP-Interlukin 1- receptor antagonist protein, used in injuries and to treat Osteoarthritis. During inflammatory conditions the body releases cyotkines such as Interlukin 1 causing damage to the joint and surrounding cartilage. IRAP works by preventing IL-1 binding to the IL-1 receptors in the joint therefore blocking the damage and inflammation caused by IL-1. IRAP involves drawing approximately 50 mls of your horse’s blood into a specialized syringe which stimulates the production of the antagonist protein. The blood is incubated in the syringe for 24 hours. After incubation the blood is placed in a centrifuge and the plasma which is rich in the antagonist protein is separated from the blood cells in multiple syringes. IRAP is then injected into the joint once every 7-10 days for 3-5 treatments. Samples are stored in a -80 C freezer until use.

PRP-Platelet rich plasma. Platelets are loaded with numerous growth factors that are released upon platelet activation. Large amounts of transforming growth factor beta (TGF-?) and platelet derived growth factor and smaller amounts of insulin-like growth (IGF), epidermal growth factor (EGF) and TGF-? are released upon activation. These growth factors and others act synergistically to enhance access of healthy inflammatory cells to the area of tissue injury, formation of new blood vessels (angiogenesis), formation of new connective tissue (fibroplasia) and regeneration of skin (re-epithelialization).PRP can be obtained in a matter of minutes. There are currently a variety of PRP kits available. Usually a centrifuge is used to help concentrate the platelets into the plasma which then can be used for treatment. PRP has been most commonly used to treat tendon and ligament injuries. The goal of treatment is to accelerate and improve the quality of healing. Recently veterinarians have begun to use PRP intra-articular to treat osteoarthritis.

Stem Cell Therapy-Stem cells are undifferentiated cells that have the ability to replicate and differentiate into a diverse range of cell types. These cell types include tendon, ligament, cartilage, muscle and bone. There are two basic types of stem cells, hematopoetic and mesenchymal. We are primarily concerned with mesenchymal stem cells (MSC) because they appear to have the best potential for regenerative medicine. These MSC are found in bone marrow, fat, umbilical cord blood and tissue, and many other organs throughout the body. The younger or more immature the stem cell, the more potential they may have. The younger stem cells have an increased ability to heal and regenerate tissue compared to the adult stem cells. This is the reason for the recent interest in storing umbilical cord blood in horses. In equine practice stem cells are commonly derived from bone marrow obtained from the sternum or the tuber coxae. Once the bone marrow has been obtained it is sent to a lab where it is cultured and expanded into millions of stem cells. The typical dose ranges from 10 to 25 million stem cells per treatment. The culture and expansion process takes approximately 3-4 weeks. The stem cells can then be injected into the affected tendon, ligament or joint. Recently, we have also been using stem cells to treat chronic laminitis cases with encouraging results. The multiple uses for stem cells have yet to be determined.The second source of stem cells is fat. Fat derived stem cells only contain 2-4% stem cells unless they are cultured and expanded. Therefore adipose derived stromal fraction is the more appropriate term used to describe this therapy.
Research comparing bone marrow derived to fat derived stem cells indicate that bone marrow derived stem cells are superior to fat derived stem cells.

PRP Flow chart photo http://www.vetmed.vt.edu/emc/clinicalservices/docs/PRP_flow_chart.pdf
Platelets circulate in blood and are responsible for initiating the clotting process and healing following injury. Platelets become “activated” when exposed to a wound which causes them to release substances called growth factors that begin and sustain healing. These growth factors are powerful proteins that recruit healing cells and new blood vessels to sites of injury, and allow the cells to heal the injury. PRP, or platelet rich plasma, is a blood product prepared by concentrating the patient’s platelets in plasma while removing other cells. Therapeutic PRP injections have been shown to enhance and accelerate the body’s own healing mechanism for numerous types of injuries including ligament injuries. PRP is available for horses and dogs through our Regenerative Medicine Service.

Irap The procedure involves sterile removal of approximately 50 ml of blood that is then processed overnight and separated into several samples for multiple injections over a given time span http://www.vetmed.vt.edu/emc/clinicalservices/regenmed.asp

http://www.thehorse.com/articles/36804/current-applications-of-equine-regenerative-medicine
She explained that IRAP is made from white cells in the horse's bloodstream. Veterinarians collect blood from the horse and incubate it in the presence of specially designed glass beads, which amplify IRAP production. When the IRAP has reached the desired level, veterinarians can administer the substance to the injured horse.