IRAP Equine Lameness Therapy: Two Veterinarians, Two Videos to Show and Tell the Treatment's Story

Interleukin-1 Receptor Antagonist Protein therapy (IRAP™) for equine lameness came on the scene a few years ago and seemed to be the province of university and referral hospitals. It was first discussed on this blog back in May of 2007, in New Lameness Treatments: IRAP™ Therapy.

Fast forward to 2011 and IRAP has become a word you'll overhear trainers using at the racetrack, and dressage riders quipping about as they compare notes on their horses' injuries. IRAP may not be an overnight sensation, but it would be close to the equivalent and if you haven't had first-hand experience with a case yet, just hang on--you will. Or, you may even be around horses that have undergone IRAP therapy and you didn't even know it: there are no scars, no bandages, no clipped hair.

But horse owners still call here and ask for advice: what is it? what can go wrong? who's had it done? It's true; some owners can't quite catch the name or the concept, and think of IRAP as just a very expensive joint injection. But they are usually pretty happy with the results.

IRAP isn't a treatment with a lot of drama or big equipment or flashing lights. It is simply a treatment of a sample of the horse's own blood, creating an enriched serum which contains anti-inflammatory proteins. These proteins are very specifically targeted to block the harmful effects of interleukin-1, an inflammatory mediator that accelerates the destruction of cartilage.

Will IRAP help every horse? Will it reverse the degenerative effects of years of arthritis? As the numbers of treatments increase, veterinarians are becoming more specific about ideal cases and potential benefits.

For the horse, the treatment consists of just two injections: first the drawing of a vial of blood, then the enriched serum is injected back into the horse at the site of the injury. Because the serum is autologous, or derived from the horse’s own blood, there is only a minimal risk of an adverse reaction.

When I went looking for a video about IRAP, I thought I would share two instead of one, because together they tell a good deal about IRAP. The two videos are similar, but show a lot of details about the process. Dr. McKee of McKee Pownall Equine Services has a Standardbred racehorse on hand as a patient, while Dr. Charlene Cook of Central Georgia Equine Services has a pleasure horse on the cross ties.

This may seem like too much information...until the day comes when you need to know about IRAP. 

Melissa McKee DVM of McKee Pownall Equine Services in Ontario, Canada leads the horse world through the demystification of many horse diseases and problems through her practice's YouTube channel. In this video, Dr McKee's straightforward explanation of IRAP should put horseowners at ease when their vets recommend the treatment. Thanks to McKee Pownall for their ongoing excellence in client education. Via YouTube and Facebook, they are educating many more of us than just their clients!

If you or one of your clients would like to read more about IRAP on paper, we have a link to an excellent document download, IRAP Therapy for Equine Osteoarthritis, created by Amanda House DVM of the University of Florida's College of Veterinary Medicine's Extension Service.

© Fran Jurga and Hoofcare Publishing; Fran Jurga's Hoof Blog is a between-issues news service for subscribers to Hoofcare and Lameness Journal. Please, no use without permission. You only need to ask. This blog may be read online at the blog page, checked via RSS feed, or received via a digest-type email (requires signup in box at top right of blog page). To subscribe to Hoofcare and Lameness (the journal), please visit the main site, www.hoofcare.com, where many educational products and media related to equine lameness and hoof science can be found. Questions or problems with this blog? Send email to blog@hoofcare.com.
 

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New Lameness Treatments: IRAP™ Therapy

One of several new high-tech treatments for equine lameness is the creation of an enriched serum injection for horses with potential joint damage. "IRAP" is not a new hip-hop group; it's a therapy that has quickly made its own place at the table of equine therapy, especially for sport horses and racehorses whose owners expect a return to the previous level of soundness and performance...in the shortest possible length of time.

Interleukin-1 Receptor Antagonist Protein (IRAP™) therapy works like this: the veterinarian, often a surgeon or lameness specialist, injects a horse’s affected joint with serum that contains anti-inflammatory proteins that block the harmful effects of Interleukin-1 (IL-1), an inflammatory cytokine that has been shown to accelerate destruction of cartilage during osteoarthritis. (A cytokine is a chemical secreted by the immune system to attack infections and damaged or dying cells.)

What makes the process a little complicated is that Interleukin-1 (IL-1) is a quite normal part of the horse's inflammatory response but it can sometimes be detrimental to a horse's joints and accelerate damage to cartilage there. IRAP™ creates a barrier that prevents IL-1 from having its damaging effect.

Since the serum sample is derived from the horse’s own blood, there is minimal risk of an adverse reaction. The incubated serum also does not contain any drugs.

The treatment process consists of drawing a blood sample using a special syringe containing glass beads. The blood is incubated for 24 hours and a centrifuge separates the serum from the red blood cells. The serum, now enriched with Interleukin-1 receptor antagonist protein, is divided into three or four doses. The horse receives one dose injected into the affected joint once weekly for three to five weeks.

A quick check around the web found that quite a few vet clinics are promoting IRAP therapy. Here are some comments from veterinarians:

Dr. Laura Werner of The Equine Center in San Luis Obispo, California: "The reason IRAP is so exciting is its potential for a long-term effect on battling osteoarthritis. Whereas some of the therapies might only have short-term effect, IRAP has the potential to stop the cartilage matrix from being degraded and increase healing. IRAP has the ability to stop the inflammation cycle and bring comfort to your horse. The research on IRAP is ongoing but the results have been very encouraging."

Dr. Laurie Tyrrell of Virginia Equine Imaging: "IRAP can also be used as maintenance therapy throughout a competition season to reduce the amount of steroid use. IRAP therapy is not for every horse. There are some factors that make a horse a less successful candidate; however the therapy shows great promise for horses that have become refractory to traditional management of osteoarthritis, as well as offering an alternative therapy for those worried about excessive use of corticosteroids."

According to the web site of Steinbeck Country Equine Clinic in Salinas, California: "Coffin joints and stifles that don’t respond well to steroid injections seem to be the most popular condition to treat (with IRAP therapy). Reactions are uncommon largely due to the fact that it is the patient’s own serum."

IRAP is one of the many therapies and treatments that will be on the program of the 4th International Equine Conference on Laminitis and Diseases of the Foot to be held in West Palm Beach, Florida, from November 2-4.