THE USE OF STEM CELLS AS A REGENERATIVE THERAPY FOR CHRONIC LAMINITIS

Nikki Engwall

Penn State University

Overview- Laminitis

Caused by: Endocrinatic diseases Systemic infections Non-weight bearing lameness

Symptoms include lameness, heat in affected foot, reluctance to walk, change in stance, change in hoof shape

Distal Phalanx Displacement Inflammation damages laminar

attachments, causing distal phalanx to displace

Scar tissue sometimes forms between displaced coffin bone and hoof wall, called the laminar wedge, measured by hoof laminar zone (HLZ)

Types of displacement Rotation Sinking

Distal Phalanx

Laminar Wedge

Hoof Wall

Deep Digital Flexor Tendon

Pull from DDFT

Deep Digital Flexor Tendon

Compressed Digital Cushion

Distal Phalanx

Laminar Wedge

Weight

HLZ

Common Treatments

NSAIDS and analgesics Corrective padding and shoeing Dorsal wall resection Deep digital flexor tenotomy

Regardless of treatment, success rates are low with chronic laminitis cases

Regenerative Therapy

Use of pluripotent mesenchymal stem cells (MSC) to repair musculoskeletal tissue

Harvested from horse’s blood, bone marrow, or fat cells

Inhibit scar formation and cell death, increase blood flow, stimulate growth of new cells, release growth factors and anti-inflammatory proteins

Use in Treating Laminitis

Study at Rood and Riddle Equine Hospital in Kentucky tested MSC treatment in 30 horses, age 2-20 diagnosed with chronic laminitis Six classified as severe rotation with

moderate bone disease, six with rotation and severe bone disease, and 18 as sinking

Each received 20-30 million MSC in each affected foot in one month intervals

Average 3-4 treatments per horse

Results of Study

Treatment found to be successful if horse was pasture sound without maintenance or heavy medication for one year 21 of the 30 cases were successful (70%) 15 of the 18 sinkers were successful (83%)

(Dryden, Vernon C et al. Using stem cells in clinical cases. Journal Equine Veterinary Sci. Oct 2013)

Results continued

The sooner the horse received treatment, the better Median time to first treatment was 71.5 days

13 of the 15 horses treated before 71.5 days were successful (87%)

8 of the 15 treated later were successful (53%)

(Dryden, Vernon C et al. Using stem cells in clinical cases. Journal Equine Veterinary Sci. Oct 2013)

Results continued

Growth of laminar wedge has negative effect Scar tissue generally forms around 90 days 11 of the 16 horses first treated before 90 days

had improved HLZ (69%) 2 of the 12 horses treated after formation of the

laminar wedge showed improved HLZ (17%) Similar to earlier study published in 2011 In

JEVS, 83% found successful using allogenic MSCs

(Dryden, Vernon C et al. Using stem cells in clinical cases. Journal Equine Veterinary Sci. Oct 2013)

Future applications

Questions still remain How should the stem cells be given for optimum

results? Where is the best place to give stem cells? What is the best kind of stem cells to use?

Lack of information on long term effects Safety concerns and possible interactions

with other biological molecules.

In Conclusion…

Stem cell therapy has been known to be successful in treating various orthopedic injuries, but only recently has been studied in treating laminitis

Recent work has shown positive results in treating laminitis

Early intervention is key

References

Dryden, Vernon C et al. Using stem cells in clinical cases. Journal Equine Veterinary Sci. Oct 2013

Morrison, Scott. Successful use of allogenic umbilical cord-derived stem cells in nonresponsive chronic laminitic cases. Journal Equine Veterinary Sci. Oct 2011

Schnabel, Lauren V et al. Therapeutic use of stem cells in horses: Which type, how, and when?. The Veterinary Journal. Sept 2013

Thank You!

Are there any questions?