Umbilical Stem Cells Show Promise in Pilot Study at Rood and Riddle Equine Hospital Podiatry Center

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.

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)

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.

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.

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.

 This photo was taken at six weeks post stem cell treatment. Note the new, healthy wall growing from the coronary band. (Scott Morrison image)

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.

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.
 

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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.

Winter Worry: Icelandic Horses Fell Through the Ice

Today's video is from the "greatest hits" vault here at Hoofcare & Lameness. Back in 2009, a near-tragic event in Iceland was captured on film: eleven champion Icelandic horses and riders plunged into a lake when the ice cracked and broke beneath them. The water was just deep enough that the horses could not get themselves out.

What happened next makes this video all the more worth watching. Luckily a film crew was on hand, and the footage was edited into an Animal Planet report.

Animal Planet asked for commentary from our friend Professor Hilary Clayton, BVMS, PhD, DACVSMR, MRCVS. At the time, Professor Clayton was the Mary Anne McPhail Dressage Chair in Equine Sports Medicine at Michigan State University's College of Veterinary Medicine, and she was probably the only academic expert in the gaits of Icelandic horses in the USA at that time. She'll be a familiar face to many on this video.

Many apologies for the quality of this video; it was the only version available, but it should be good enough for you to see what happened. Uncut footage can be seen (and heard in Icelandic) on YouTube from the original tape.

What's the lesson to be learned here? They did measure the ice before the horses arrived, but perhaps not in the right spot. It is well-known that Icelandic horses are shod with studs and/or studded nails for these ice tolts, as they are called, but it's doubtful that the shoes caused the ice to crack and break.  Perhaps the sunny day and the combined weight and impact of the line of horses was simply too much for the ice.

To learn more:

Read about a seminar on Icelandic horseshoeing at Cornell vet school

Click here to learn more about HoofSearch, the monthly live-linked directory of new peer-reviewed research on hoof science and equine lameness.

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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.

No Farrier, No MRI: Diagnostic Imaging Sessions Begin With Careful Un-Shoeing

If you’re a farrier or horse owner who is new to equine MRI, you might be surprised to learn that most horses couldn’t have an MRI without the help of farrier skills.

That’s because horses that are shod must have their shoes removed before the MRI process can begin. This could be done before the horse leaves home, but it is usually done at the vet clinic where the MRI will be done, since the horse may need to be trotted or lunged as part of the diagnostic process.

An MRI session begins long before the horse's limb is scanned. It begins with an exam and the removal of both front or hind shoes, if the horse is shod.

For advice on the gentle art of shoe removal, Hoofcare + Lameness went to one of the world’s best authorities, Dave Duckett FWCF. A former farrier instructor at the national schools in Great Britain and Ireland, Dave is an undisputed expert analyst on the fine points of shoeing and unshoeing a horse, as his many world championships and other titles attest.

Duckett reminds us that a lame horse that is having an MRI may have some resistance to standing on three legs during shoe removal. It may also resent having its hoof walls tapped with the hammer to cut the clinches. For this reason, it may be safest to do the work at the vet clinic.

  Pulloffs should be used from the heel forward, gently removing the shoe without harming the hoof wall, but it is best to remove the nails with a creased nail puller. (Michael Wildenstein file photo)

Normally, a farrier might rasp off the clinches and an apprentice would go to work loosening the nails and then wrenching the shoe off the foot. With the shoe will come the nails, but farriers know full well that some may break. It may not happen often, but nail fragments can remain in the foot.

When and if this happens on the day an MRI is scheduled, the fragment will need to be found and removed, since any metal might disturb the magnetic function of the scanning system.

There are many reasons that nails break off. Duckett remarked that nails commonly corrode and break in the feet of horses that have been standing in urine-soaked bedding or manure-filled pens. The longer a shoe has been on, the more likely the nails are to break on any shoe, he added.

The design of the shoe itself can cause a nail to break off; the shape of the nail hole may be wrong for the size or style of nail that was used, so the nail fractures under the head. If the nail hole is too small, the edges of the hole shear the side of the nail as it passes through, weakening the shank, increasing the likelihood of fracture, and possibly creating soft steel dust particles that are carried up into the hoof wall. “The shoe doesn’t give, the nail does,” Duckett said, “and it usually fractures under the head.”

Cross-section of toe nails in foot, showing clinches (Michael Wildenstein file photo)

Duckett also warned about machine-made shoes that are hot fit, then quenched before nailing. This hardens the steel of the shoe around the hole, so the soft steel of the nail is likely to shear more as it passes through.

The constant expansion and contraction of the horse’s foot causes stress to the nail inside the wall, and can also lead to nail fatigue and even breakage, usually on the inside heel or both heels, according to Duckett.

It's safer to cut the clinches and pull the nails through the wall rather than rasping the clinches off and thinning the hoof wall of a horse that may already be lame. (Michael Wildenstein file photo)

So, instead of rasping off the clinches, or even just bending them back, the clinches should be cut off; this can be a challenge for someone not accustomed to finding the clinches in a recently shod foot, especially on the inside wall.

Creased nail pullers allow careful remove of each nail; the jaws can get down into the crease of the shoe. (Michael Wildenstein file photo)

Once the clinches are cut, each nail should be gently pulled through the foot with the creased nail pullers with a continuous pull, not a yank. Vet clinic farriers quickly learn to count their nails, check each one for its full length, and keep them in a little tray or cup to account for each foot’s nails.

Duckett pointed out that some clinches, if not cut, will break off occasionally and be lost inside the foot. This can be an inconvenience if a horse is scheduled for an MRI. He said that an experienced farrier will be able to pop a nail into the old hole and extricate the lost bit of metal.

The unshod foot will be cleaned and examined. As Hallmarq’s Nick Bolas pointed out, metallic dust can also be created by a rasp or by rust from shoes or the horse’s environment.

And that just won’t do for a horse that has a date with a huge magnet. Any sort of metal residue on the hoof wall or inside needs to be removed before the scanning begins.

Nail holes can be flushed with a cleaner—I fully expect a special product to enter the market any day now! A product like Life Data Labs’ Hoof Disinfectant is probaby found in most farriers' trucks and will do the job.

  Even the tiniest artifacts show up and can be magnified in an MRI scan. In this image, you can see a few glitches along the hoof wall. (Hallmarq MRI image)

10 TIPS FOR MRI SHOE REMOVAL SUCCESS

Working with Hallmarq Veterinary Imaging Systems, Hoofcare + Lameness came up with these tips for horse owners, clinics and farriers for pre-MRI hoof prep:

1. Owner: ask the vet clinic who will be pulling the shoes. Some owners may prefer to schedule a farrier appointment and make sure that the horse's regular farrier does the work. The owner should make sure that this farrier knows what s/he is expected to do so the correct tools will be on hand. It is most convenient to have the work done at the clinic.

2. Owner: Make sure that a farrier with Hallmarq MRI prep experience will be doing the work so that the procedure described above will be followed. The horse owner may also need some supplies. Some owners may prefer to leave the shoe pulling to the farrier working at the vet clinic.

3. Owner: Make an appointment for the horse to be re-shod after the Hallmarq MRI is completed; this can be done at the vet clinic if the farrier is accustomed to working there or makes arrangements in advance. If a diagnosis is expected that might affect the shoeing, delay the re-shoeing in expectation of changes to be made.

4. Owner: Consider the use of padded boots like Soft-Ride Equine Comfort Boots during transport to and from the clinic if the horse is sore without shoes. At the very least, cover the feet with vet-wrap or duct tape to keep them clean. If the horse is traveling to the vet hospital, the feet with be cleaned again but remove any caked-on mud and debris and comb out any feathers and the mane and tail to make sure no metal is hidden in any of the horse's hair.

5. Owner: Do not use hoof polish, gels, sealers or any topical medications on the horse’s legs for 24 hours before the scheduled appointment. 

6. Owner: Don’t clip the pasterns unless directed to do so by the veterinarian or Hallmarq MRI technician. The vet clinic staff will usually clip any hair that is in the way.

7. Clinic: Clean the shoes with a wire brush and rinse under running water to remove any dirt and manure. Store them in a plastic zipper-top bag and mark them with the horse’s and/or owner’s name. Sometimes a veterinarian or consulting farrier will ask to see the shoe that was removed from a lame foot to check how the horse “wore” the shoe. Always be careful to properly dispose of nails.

8. Owner: After the shoes are removed and the feet are clean is a good time to take record-keeping photographs of the horse’s feet.

9. Owner: A horse with its shoes newly removed may be a little sore so give plenty of time to load and unload from trailers. If using a commercial service to pick up the horse, make sure they are aware of this. Farriers: make sure that owners or trainers know that this mild soreness after unshoeing is a specific side effect and not part of the horse’s larger lameness issue. Depending on clinic policy and arrangements made in advance, owners should be prepared to receive a partially-unshod horse after the MRI is complete.

10. Clinic, owner, farrier: Education is critically important to the success of the horse’s MRI scan. Learning how to properly use farrier tools and which farrier procedures are considered Best Practices in the preparation of a horse for MRI scanning is a new area where we all have a lot to share and learn from each other.

A carefully unshod horse whose clinches were cut (not rasped) and whose nails were removed with a creased nail puller is a welcome sight to the farrier who will be re-shoeing the horse; if he or she needs to re-use the nail holes, the wall won't be rasped away and if the shoes are re-used, it is not likely to be twisted in the heels. (Gary Huston photo)

In this age of MRI, Hallmarq recognizes that farriers are both needed in this important first step in preparation of the horse for MRI, and that farriers will be involved throughout the process of caring for the horse during its rehabilitation from the lameness that the MRI should help diagnose. For this reason, Hallmarq Veterinary Imaging is dedicated to including farriers in education programs and studies.

Content and photos © 2011 Hoofcare Publishing

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Watch for more in the Hallmarq-sponsored article series on The Hoof Blog, and check their social media system and especially their info-deep web site for lots more information.

To learn more about Hallmarq Veterinary Imaging and standing MRI technology for horses:

• Become a fan  of the new Hallmarq Equine MRI Facebook page;

• Follow @HallmarqMRI on Twitter;

• Subscribe to the hallmarqvetimaging channel on YouTube.com;

• Watch for a growing equine distal limb Hallmarq MRI image gallery on Flickr.com;

• Visit the Hallmarq.net web site. (Plan to spend some time there!)

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New Oklahoma State Board Would Make Veterinary vs Husbandry Decisions for Professional Practices

There have probably been simpler times to be in the animal care field. Now you not only have to know what you're doing, but if you can legally do it.

As states continue to grapple with definitions of what the practice of veterinary medicine actually entails compared to the routine practice of animal husbandry, national attention turns again to the state of Oklahoma, which was recently wrenched by a battle over whether floating teeth and other aspects of what has come to be known as equine dentistry should or could legally be done by non-veterinarians in the state.  That fight spilled over to other routine practices, particularly related to animal reproduction, that are performed at livestock facilities in the state.

It was a short-lived victory for ranchers who don't want to have to hire veterinarians for routine artificial insemination procedures, or for non-veterinarian professionals in the state who wanted the assurance that they were performing their work legally; the governor quickly signed emergency rules proposed by the Oklahoma State Board of Veterinary Medical Examiners to prevent non-veterinarians from performing some tasks.

http://www.oklahomafarmreport.com/wire/news/2011/01/02677_Rehash3202AnimalHusbandry01212011_064424.php

This audio report from the Oklahoma Farm Report summarizes steps that led up to this week's action in the Oklahoma legislature.

To the state lawmakers and vet board's credit, a compromise has been put forward in the form of House Bill 1310, which would create a new board, tentatively called the Animal Technology Advisory Committee, made up of three veterinarians and three non-veterinarians, and chaired by a non-voting veterinarian. This board would examine procedures and decide whether they fall under the practice of veterinary medicine or animal husbandry.

HB 1310 passed out of committee yesterday and now is headed to a vote by the entire legislature.

The legislature has not made the text of HB 1310 available to the public on their web site yet.

The composition of state veterinary boards varies from state to state. In some states, the board includes non-veterinary members. In Oklahoma and Florida, five of six members are listed as veterinarians; in Ohio, four of six; in Massachusetts, four of four; in California, four of eight.

 © 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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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.

Necropsy Report: British Horses Died of Cardiac Arrest; Signs Consistent with Electrical Shock from Leaking Cable Under Paddock

The British Horseracing Authority has provided a summary statement following the completion of necropsy studies on the bodies of two horses that died at Newbury Racecourse in Berkshire, England on Saturday. The horses collapsed and died as the jockeys were preparing to mount; two other horses fell but were able to recover.

Professor Tim Morris, Director of Equine Science and Welfare for the British Horseracing Authority, issued this prepared statement today:

“The Authority has been officially informed that there was leakage of electricity from a cable under the parade ring in the area where the incident occurred. There was immediate veterinary attention, and our enquiry on the day noted the racecourse veterinary surgeons felt a tingling sensation when examining the horses, and that the veterinary surgeons noted particular clinical signs such as muscle contractions.

“Both horses that died, Marching Song and Fenix Two, have undergone postmortem examinations which showed sudden cardiac arrest as the cause of death. Samples taken from the horses affected have shown no evidence of substances that could have caused this incident. These findings are all consistent with the cause of death being accidental electrocution and at this stage we are not investigating any other cause of death.

“I can also confirm that, contrary to speculation, no evidence of any burn marks around the mouth was found on post mortem examination, neither were such marks found by the veterinary surgeons on the horses at the start.”

The necropsies were performed by pathologists at the University of Liverpool’s School of Veterinary Science with additional services from the British Horseracing Authority contractor HFL Sport Science.

Much speculation has surrounded whether the horses' shoes were part of the formula that led to their death. Metal horseshoes are known to conduct electricity; horses are especially susceptible to electrical shock. Some people have speculated that the fact that the horses who died were shod with steel shoes, while the horses who survived were shod with aluminum, may have been a factor in the tragedy.

So far, there is no proof that that is the case.

 © 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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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.

A Hoofcare and Lameness Valentine to You

The richest source of old advertising art featuring horseshoes is not from a horseshoe company at all. Many people think that Drummond Horseshoe brand was meant for a horse's hoof, but it was actually a tobacco company from St. Louis, Missouri.

Fortunately for us, the company employed some of the best advertising illustrators of their day, and they left a rich archive of ads showing horseshoes, farriers, and horses' hooves. Someone should do an exhibit of their art!

So, thanks to some long-gone artist who created this cherub at the anvil long ago. Maybe he or she would be happy to know that, a century later, some of still appreciate the artistry in the company's ads.

And to all of you, enjoy your champagne, chocolates and roses, all around the world!

 © 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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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.