In the last several years, equine veterinary medicine has had a very welcome influx of innovative new products come onto the market for support of equine athletes’ inflamed or injured joints, ligaments and tendons. Most fall under the umbrella of “orthobiologics,” meaning that they are derived from the horse’s own blood or other natural biological sources. Orthobiologics promote healing by inhibiting the inflammatory cascade that happens with injury and osteoarthritis and sometimes additionally by providing growth factors that speed and improve the quality of healing.
These have been a game changer for many horses and offer many benefits beyond what our more traditional “cortisone” injections can provide. They are also safer for horses that cannot tolerate traditional injections for various reasons, including Cushing’s Disease/PPID or insulin resistance.
Understanding the plethora of options now available, and the pros and cons of each, is now a tall order for you as a horse owner! This post will briefly introduce the products we most commonly use at Bend Equine Medical Center. For a more complete rundown on which product is best for your horse’s particular needs, call and talk with one of our performance horse veterinarians.
ProStride
ProStride is created from a horse’s own blood with a kit that isolates and purifies several naturally occurring anti-inflammatory proteins (interleukin-1 receptor antagonist/IRAP, sIL-1R, and tumor necrosis factor receptors) that block inflammatory receptors, preventing or slowing the progression of osteoarthritis. The net effect is reduction of pain and protection of cartilage. ProStride also contains a platelet rich plasma (PRP) component; see below for more information on PRP. Recent research also shows ProStride kits can be used to generate Alpha-2-macroglobulin rich plasma.
PRP (Restigen)
Platelet Rich Plasma (PRP) is isolated from a horse’s blood using a special kit. We use the Zoetis Restigen product to optimize the quality and safety of our product; while other kits are available for use, we feel the Restigen product is the best option for our patients. PRP provides growth factors and anti-inflammatory cytokines, which contribute to healing, repair and regeneration of tendon, ligament, muscles and bone. Use of PRP is a way to supercharge the healing process while simultaneously minimizing scar tissue.
Alpha2EQ
Alpha-2-macroglobulin, abbreviated as “a2M” is a naturally occurring large protein within a horse’s blood. The a2M molecule captures degradative enzymes within the joint and breaks them down to inert byproducts, creating a strong anti-inflammatory effect. Its mechanisms of action include protease inhibition, gene regulation and modulation of both cytokines and growth factors. a2M kits concentrate and filter a horse’s blood to provide a concentrated source of these beneficial products.
Note that all the above products are created from your horse’s own blood as a same-day process; residual product that is not needed at that exact time can often be stored frozen for up to 12 months to be used in the future.
Renovo
Renovo is a liquid, acellular, equine amniotic tissue allograft composed of amnion and amniotic fluid. Amnion and amniotic fluid are rich sources of biologically active factors involved in tissue regeneration with reported anti-inflammatory, anti-bacterial, and anti-fibrotic properties. They contain growth factors, hyaluronic acid, and other substances that are key for tissue healing processes. Renovo can be injected directly into an area of injury in a tendon or ligament, or into joints with damaged cartilage.
Noltrex and Arthramid
Noltrex and Arthramid are not orthobiologicals but are polyacrylamide gels which act as synthetic joint lubricants. They reduce friction and improve lubrication. The two products work slightly differently, with Noltrex seeming to aggregate to the cartilage surfaces and Arthramid aggregating more onto the joint capsule. Both products provide the benefits that hyaluronic acid does, but they persist within the joint for a much longer time than HA. Neither product has an anti-inflammatory action, so inflamed joints generally need to have an additional form of treatment for best effect.