ACell Tendonitis Treatment Study
by: Christy West, TheHorse.com Webmaster
April 16 2008, Article # 11680
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"Tendonitis of the superficial digital flexor tendon (SDFT) is a
common injury in horses, especially racehorses and event horses,"
began Ty Wallis, DVM, a third-year resident in equine surgery at
Colorado State University (CSU). "It's usually hyperextension-
related, and affected horses have a prolonged convalescence and high
rate of recurrence."
Wallis discussed tendonitis and a CSU study of acellular urinary
bladder matrix (UBM; ACell Vet Powder) as an intralesional (injected
within the lesion) treatment at the 2007 American Association of
Equine Practitioners Convention, held Dec. 1-5 in Orlando,
Fla. "Proposed actions of UBM include recruitment of growth factors
and cells, promotion of a rapid angiogenic response (growth of new
blood vessels into the lesion), providing a scaffold for collagen,
and minimizing fibrous tissue formation," he said.
Eight sound adult horses had bilateral forelimb SDF tendonitis
induced with a collagenase (enzyme tissue degradation) model, then 4
mL of UBM that was mixed according to the manufacturer'
was injected into one limb's lesion after 14 days (based on lesion
size and time to lesion stabilization from previous studies). The
manufacturer recommends 6 mL per lesion in a clinical case, but for
standardization purposes 4 mL was used in this study to ensure the
lesion was full, but not overfilled. The other limb was injected with
4 mL of saline as a control. Additional treatments included non-
steroidal anti-inflammatory drugs, bandaging, cold hydrotherapy, and
controlled exercise for 84 days. Horses were evaluated clinically and
ultrasonographicall
tissues were evaluated.
Researchers found no significant difference between UBM-treated and
control limbs for any clinical parameters (lameness, limb
circumference, etc.). There were trends toward smaller lesion size,
higher (more severe) gross pathology scores, lower lameness scores,
and smaller cross-sectional area of the tendon in treated limbs.
Treated limbs showed some differences in neovascularization
(establishment of new blood vessels in the lesion), but they were not
significant.
Wallis noted that the 84-day study period might have been too short
and the number of study horses too small to detect a significant
treatment effect.
More to the Story ...
But while this study seemed to find that UBM neither helped nor hurt
horses with tendonitis, Wallis said that perhaps the collagenase
model of tendonitis might not be a suitable model because the lesions
in treated and control limbs continued to enlarge for the first 42
days of the study, including 28 days of treatment.
"This is probably the most concerning data in this study," he
noted. "It suggests that there may have been continued collagenase
activity and degradation of tissue. Therefore, UBM may not have been
an effective treatment for collagenase-
the UBM, which is primarily collagen, may also have been degraded."
He also noted that the collagenase model induces relatively severe
lesions that might be worse than those in the typical traumatic
tendonitis case.
"Tendonitis remains a difficult problem; we have high hopes for some
of the currently available treatment options such as bone-marrow-
derived mesenchymal stem cells (stem cells that can differentiate
into a variety of cell types) and for Dr. Michael Schramme's surgical
lesion creation model (compared to the collagenase model) for
studying potential therapies in the future," he concluded.
Investigators on this study included Wallis; Gary Baxter, VMD, MS,
Dipl. ACVS; Natasha Werpy, DVM, Dipl. ACVR; Gary Mason, DVM, PhD,
Dipl. ACVP; David Frisbie, DVM, PhD, Dipl. ACVS; and Nicolai Jarloev,
DVM, PhD. The study was funded by ACell Europe, Alm Brand Insurance
Company in Denmark, and the Gail Holmes Orthopaedic Research Center
at CSU.
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StemCells subscribers may also be interested in these sites:
Children's Neurobiological Solutions
http://www.CNSfoundation.org/
Cord Blood Registry
http://www.CordBlood.com/at.cgi?a=150123
The CNS Healing Group
http://groups.yahoo.com/group/CNS_Healing
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