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British Hunt Racer Comes Back After Tendon Stem Cell Treatment

Knowhere charges home after a long, grueling jump race...notice how clean his right front leg looks, in spite of a serious bow in his past. Photo © Trevor Meeks/Horse & Hound/IPC+ Syndication.Thanks for the loan!

A horse with the intriguing name of Knowhere won the Cheltenham Gold Cup Trial (brush-type jumps) last week over favorite Our Vic. The celebration extended out of the winner’s enclosure and into a nearby veterinary hospital.

Three years ago, Knowhere was, literally, nowhere. After two wins in novice hurdle company, his promising four-year-old race career ended when he injured the superficial flexor tendons of both front legs. The left fore showed low grade tendonitis while the right fore had a significant percentage of fiber rupture—what we call a “bow”.

Knowhere’s connections opted for stem cell therapy and a long layoff, in hopes of returning him to the top races on the National Hunt circuit. He was treated by Tim Beauregard MRCVS of Summerhill Farm in Gloucestershire, west of London.

Bone marrow samples were collected from Knowhere’s sternum. The marrow was then processed in a laboratory over a five week period to generate millions of stem cells. Knowhere was sedated, the tendon area was anesthetised and then the leg was surgically clipped and disinfected The stem cells which had been suspended in serum obtained from the original bone marrow sample, were then injected using ultrasound guidance, into the core of the damaged area of the tendon fibers.

For the first week after the implantation, Knowhere was kept in his stall to allow the cells to adapt to their new environment. Each day after this he was given walking exercise in order to stimulate the activity of the stem cells, encouraging them to differentiate into tendon cells and form into strong tendon fibers. The amount of exercise was incrementally increased, building up over a three-month period from five minutes each day to 45 minutes twice a day.

By the autumn of 2005 both of Knowhere’s tendons had healed very well and showed good fiber pattern on ultrasonography. He was re-introduced to the racetrack the following year and of the 15 or so races he has been in since then he has finished in the frame on eight occasions and has amassed some £175,000 (US$345,000) in winnings.

Vet Tim Beauregard concludes: “Knowhere’s successful return to the track has been exciting and immensely satisfying to follow and he showed particularly brilliant form in the Cotswold Chase. It remains to be seen whether he will be heading for the Ryanair Chase, the (Cheltenham) Gold Cup or the Grand National (three top jump races in the UK) but all involved will be hoping for the best.”

Note to American readers: the procedure used on Knowhere is different from the Vet-Stem system commonly used in the US, which extracts fat cells at the tail head and harvests stem cells from the fat. The procedure detailed in this post is a specific treatment program from the Vetcell company in the UK, developed at the Royal Veterinary College of London.

Why Horses and Bicycles Never Mixed Well

Veterinarians and farriers shared a hatred for bicycles and bicyclists in the 19th century.

Kirkpatrick MacMillan, a 19th centuary Scottish blacksmith from the border county of Dumfries, is credited with the invention of the two-wheeled rear-propelled bicycle.

MacMillan’s first bicycle was made of wood and had iron wheels. But it didn’t make him popular with other smiths.

In the 1800s and early 1900s, there were anti-bicycle protests, with farriers leading the protest line. Bicycles frightened horses they said, but in reality, the problems opened by bicycles were worrisome on another level: they provided inexpensive transportation that replaced horses and also caused a drop in value of saddle horses. And they were ridden by "dandies", the precursor of today's metrosexual male, who demanded smoother manmade roads that would make the automobile a more viable option.

An interesting twist of urban history is the role that the railroads played in the horse populations and value of horses in urban society. If farriers hated bicycles, they loved railroads. Every city needed an army of freight horses to serve the docks and railway yards. Every store and factory relied on horses to get their goods into the hands of customers or onto waiting ships or trains. Horses pulled the street cars, the hearses and the snowplows.

Both farriers and veterinarians felt the pinch caused by bicycles. In 1850, only 46 people in the United States census said that they were "veterinarians"; and 20 of them lived in New York City. By 1910, more than 11,000 veterinary surgeons practiced primarily urban equine medicine in the USA. And they weren't pleased about the popularity of bicycles.

Oddly, the popularity of the bicycle is benchmarked as heralding the migration of veterinarians into specialization in species other than horses. In 1897, an article in the American Veterinary Review claimed that horse values had dropped so sharply because of bicycles that owners were letting horses die rather than seek treatment.

Resentment toward the bicycle was shared by both vets and farriers. In this 19th century illustration kindly on loan from Scotland’s Wellcome Library, you see a veterinary surgeon and farrier have just smashed a bicycle and the vet is dosing the dandy cyclist. Double-click on the image to view it at a larger size.

Statistics quoted in this article are from the interesting new book The Horse in the City: Living Machines in the 19th Century by Clay McShane and Joel Tarr. The authors have created a trove of facts and figures about the role played by horses in urban life.

New Treatment for Pain of Lam-"Mint"-Itis?

Researchers at the University of Edinburgh's Royal (Dick) Veterinary College in Scotland are turning to ancient medical traditions to help horses deals with the pain of laminitis.

Professor Sue Fleetwood-Walker, with researcher Rory Mitchell, is taking a clear, scientific look into Chinese and Greek traditions using mint to treat pain, in hopes that mint therapy might be key to the nerve-damage pain that is part of the complex response that horses have to the damage in their feet when laminitis strikes.

Previous research by Fleetwood-Walker, also conducted at Edinburgh and published in the journal Pain, chronicled evidence for a neuropathic component to the chronic pain state associated with equine laminitis, indicating that anti-neuropathic analgesic treatment may well have a role in the management of laminitic horses. In that study, electron micrographic analysis of the digital nerve of laminitic horses showed "peripheral nerve morphology to be abnormal, as well as having reduced numbers of unmyelinated (43.2%) and myelinated fibers (34.6%) compared to normal horses", according to the study's abstract.

Fleetwood-Walker has researched "phantom" pain in human amputation patients and also horn pain response in small mammals; her team discovered that cooling chemicals with the same properties as mint oil had powerful painkilling effects when applied in small doses to the skin.

The receptor molecule TRPM8 is responsible for the sensation of moderate cold and it has long been known that cooling eases pain. However, the Edinburgh researchers have shown that this receptor acts to induce a pathway of responses that ease the crippling effects of neuropathic chronic pain which is very different from the acute pain associated with direct trauma. Substances such as icilin or menthol, known activators of TRPM8 which mimics the sensation of cooling, may then be used to treat neuropathic chronic pain.

The compounds were likely to have minimal toxic side effects, being applied externally, and were likely to prove ideal for patients with chronic pain who found conventional painkillers ineffective. The next test is to find a way to test mint medications on horses with laminitis.

This research is funded by The Horse Trust, a leading British horse charity.

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French Study Compares DOD in Thoroughbred, Standardbred and Warmblood Foals

An example of a French warmblood sport horse; photo provided by the national stud system of France.

A new study from France compares developmental orthopedic disease (DOD) in three breeds of horses raised with similar environmental and farming conditions. Warmblood, Standardbred, and Thoroughbred foals were compared. The study’s authors include Hoofcare and Lameness Journal consulting edition Jean-Marie Denoix of the CIRALE Center in Normandy, France. The study is published in the February issue of ANIMAL, The International Journal of Animal Biosciences.

Developmental orthopedic disease (DOD) affects all breeds and is a common cause of pain and lameness for horses in sports. The authors remark that no comparison studies have ever been conducted between breeds that included consideration of the conditions on the breeding farms.

The study examined the limb joints of 392 weaning-age foals from 21 participating stud farms. The foals were radiographed on the front- and hind-limb digit, carpus, hock and stifle joints. X-ray data were analyzed by three experienced equine veterinarians who gave a common assessment about the entity and the severity of radiographic findings.

Distribution of breeds in the study was 25.0% Warmblood, 41.1% Standardbred and 33.9% Thoroughbreds.

To quote the authors in the findings of the study:

“DOD was present in 66.3% of the foals (95% confidence interval = 61.6% to 71.0%). The most severely affected sites were the proximal part of the hock and the femoro-patellar joint (of the stifle region) for Warmblood and Standardbred foals, and the fore fetlock and the distal part of the hock for Thoroughbred foals.”

Finding such prevalence in the breeds of horses should make it easier for veterinarians to confidently use radiographs of specific sites to monitor growing horses for developmental problems.

Perhaps the most shocking news of the study was that two-thirds of the foals showed evidence of DOD, in the first place.