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| What's underneath that hoof cast? The latest laminitis therapy is virtually invisible to the observer, and may often covered with a foot cast. |
The following article is provided by the Rood and Riddle Equine Hospital Podiatry Clinic in Lexington, Kentucky.
Background
Laminitis can be a devastating and expensive disease to treat. Today there is no true cure for the disease. However cases can often be rehabilitated back to varying degrees with the aid of therapeutic shoeing, foot management, and medical therapies. Although special foot management can in some cases return horses back to previous athletic use, others remain severely compromised and lame. Once the lamina detaches and the pedal bone displaces, each case heals back with varying degrees of stability. The tissue that heals the separated lamina is a combination of scar tissue, dysfunctional disorganized horn tissue (epithelial cells) and healthy lamina.
Additionally, these cases can suffer permanent damage to the growth centers of the foot such as the coronary band and the sensitive sole, further limiting their ability to heal. The degree of future stability most likely is dependent upon the type of tissue that heals the diseased region.
What are stem cells? What is regenerative medicine?
Stem cells are cells that have the ability to replicate themselves and regenerate tissue. They play an important role in embryonic and fetal development as well as repairing damaged tissue. Isolating these cells and using them for a targeted treatment with the intention to heal a specific area is the principle behind their potential use.
Stem cell therapy or
regenerative medicine is an exciting, but relatively new area which has sparked great interest. Its potential use to influence the type of tissue that heals a diseased or damaged area is a great interest to the veterinary community.
How is Rood and Riddle approaching stem cell therapy for laminitis patients?
Rood and Riddle Equine Hospital is currently working on clinical-based research using stem cells on severe laminitic patients which have proven unresponsive to other treatments. The clinical use of stem cells is still in its early stages, but results appear promising and worth further investigation.
Since many laminitis cases can be rehabilitated with other modalities, it was determined to limit our clinical study to those cases which have been unresponsive to all other treatments. These cases failed to show sole or wall growth after shoeing, foot casting, slinging and, in many cases, after deep digital flexor tenotomy.
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| Stem cell therapy is an adjunctive therapy, used in conjunction with extensive medical and mechanical treatments. To date, Rood and Riddle's laminitis-specialist veterinarians selected cases based on poor response to the disease's normal treatment protocols at the clinic. (Fran Jurga photo) |
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To date we have used stem cell therapy on twelve cases as an adjunctive treatment. All but one case has responded with significant sole and wall growth in the affected feet. Typically signs of growth were evident within two weeks.
The one case that did
not respond was a severe acute “sinker” (lamellar failure or detachment occurs around the entire hoof capsule causing the coffin bone to “sink”) ; the horse was sloughing the hoof and had severe soft tissue necrosis before treatment.
It is important to note that stem cell therapy alone will most likely offer little benefit in the unstable cases. As with all therapies these feet will require special management (shoeing, casting, sling, and DDF tenotomy) to help stabilize and support the foot while it is healing.
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| The stem cells used in Rood and Riddle's clinical laminitis research are harvested and cultured from the blood in umbilical cords of foals. (Joanna8555 photo) |
Umbilical stem cells from newborn foals
Rood and Riddle's Stem Cell Lab is currently harvesting cells from the umbilical cord blood of newborn foals. Umbilical cord blood is collected at the time of birth, which provides a pool of stem cell which can be cultured and expanded for clinical use.
When these cells are used as a treatment on another horse, they are considered
allogenic (from a donor) with the possible risk of rejection. However, no reactions in our cases have been noticed.
Stem cells can also be collected from fat or bone marrow and used specifically for that horse if needed. The best source of cells, timing, dose, administration, and route still need to be determined.
Case Study from Rood and Riddle Equine Hospital's Podiatry Clinic
The following case is a severe bilateral front foot sinker. This case had a deep digital flexor tenotomy, foot cast, and partial hoof wall resection. She failed to show any signs of wall or sole growth over a two-month period of time.
Stem cell therapy and foot casts were applied on both front feet as a last effort to save her. Within two weeks she showed signs of healthy wall and sole growth and improving her comfort level. Currently this mare is doing well; it has now been six months since treatment and she is turned out in a small paddock.
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| Left and right foot radiographs before treatment. Stem cell therapy was begun at this time along with foot casts and antibiotics. Two weeks later the coronary band and sole began to show healthy growth.(Scott Morrison images) |
These are radiographic images of a 10 year old thoroughbred mare with severe sinking of both front feet before and after stem cell therapy. The mare was treated with deep digital flexor tenotomy, foot casts and partial wall resections. The foot did not show any signs of improvement for over 2 months.
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| This photo was taken at six weeks post stem cell treatment. Note the new, healthy wall growing from the coronary band. (Scott Morrison image) |
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| Left and right feet six months after therapy with umbilical stem cells. (Scott Morrison images) |
Watch for more news about the use of umbilical and other stem cells in horse foot problems.
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| Rood and Riddle Podiatry Clinic veterinarians working on the stem cell treatment cases mentioned in this article are (from left to right) clinic director Dr Scott Morrison, Dr Vern Dryden and Dr Raul Bras. |
TO LEARN MORE: The Second Annual North American Veterinary Regenerative Medicine Conference (NAVRMC) is scheduled for June 2-4, 2011, at the Marriott Griffin Gate Resort in Lexington, Kentucky. Held in collaboration with the University of California at Davis Center for Equine Health, Alamo Pintado Equine Medical Center and Rood & Riddle Equine Hospital, the NAVRMC is a three-day working meeting consisting of scientific presentations and discussion sessions on all aspects of stem cell therapy and regenerative medicine in horses and small animals.
The conference will bring together researchers and practitioners to discuss and apply this promising area of veterinary medicine. Topics will be a blend of research and practical application discussions.
New to the NAVRMC in 2011 is a special session for horsemen. The half-day forum, set for June 4, is open to all horse owners, trainers, and equine professionals who are interested in learning more about this rapidly growing area of veterinary science.
For complete NAVRMA sponsorship information, membership fees, and conference registration please visit
www.navrma.org.
© 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.
Disclosure of Material Connection: I have not received any direct compensation for writing this post. I have no material connection to the brands, products, or services that I have mentioned, other than Hoofcare Publishing. I am disclosing this in accordance with the Federal Trade Commission’s 16 CFR, Part 255: Guides Concerning the Use of Endorsements and Testimonials in Advertising.
