Original Research
Autologous Platelet Concentrate as a Treatment for Horses with Refractory Fetlock Osteoarthritis

https://doi.org/10.1016/j.jevs.2013.10.004Get rights and content

Abstract

Osteoarthritis (OA) is one of the most common musculoskeletal pathologies in horses and is a disease capable of halting their athletic career. Clinically, OA can be a difficult problem to deal with, particularly when there is no longer a positive response to corticosteroids or rest. In order to avoid further articular tissue degeneration, which could lead to the loss of the joint function, novel therapies are focusing not only on controlling inflammation and pain but also on tissue healing and repair. Autologous platelet concentrate (PC) growth factors are known to have anabolic and angiogenic properties and a positive effect on synovial epithelium, cartilage, and pain. The aim of this study was to analyze the clinical outcome of horses with OA treated with PC. Selected cases were treated only with PC, and they all belong to the same sport activity. We show here the method for PC preparation, follow-up evaluation, and outcome of 20 cases with refractory OA treated exclusively with autologous PC. After a 1-year follow-up, 80% of patients were able to resume work. According to our results and observations, PC can be used as a safe and low-cost intra-articular therapy for refractory OA in the horse.

Introduction

Chronic osteoarthritis (OA) is the most prevalent cause of diminished performance and halts athletic activity in racing horses [1]. This degenerative disease is characterized by progressive cartilage degeneration, subchondral bone remodeling, synovitis, osteophyte formation, and eventually loss of function [2], [3]. Proinflammatory cytokines are induced during OA, particularly interleukin-1beta (IL-1beta), tumor necrosis factor-α, and matrix metalloproteinase, and these cytokines disrupt the anabolic/catabolic balance to the detriment of growth factors such as insulin-like growth factor-1, transforming growth factor beta (TGF-beta), and basic fibroblast growth factor, provoking a chronic degenerative process of the subchondral bone, cartilage, and/or synovial membrane [2], [4], [5]. Therefore, applying a successful treatment can be a real challenge, particularly in the long term.

Several treatments can be adapted and applied according to the seriousness of the pathology, with intra-articular corticosteroids being the main therapeutic choice [6], [7], [8]. However, repetitive administration of corticosteroids leads to negative secondary effects such as cartilage necrosis and further degeneration [4], [8]. Consequently, other approaches have been developed mainly to avoid repetitive or abusive use of corticosteroid and to allow the tissue to heal. Autologous platelet concentrate (PC), seen as a growth factor source, has been reported as an alternative treatment [9], [10] with even better results than corticosteroids at 1 year after injection [11].

We describe here the outcome of 20 cases of fetlock OA treated with autologous PC and the treatment protocol used. According to synovial fluid analysis, lameness evaluation, and owners' perceptions, PC can be used as a successful and safe treatment for OA that no longer responds to intra-articular corticosteroids or rest.

Section snippets

PC Preparation

PC was prepared as reported previously [9], [12] with some adaptations. After aseptic preparation of the jugular vein, using a butterfly catheter, 80 mL of blood was drawn into sodium citrate (0.129 mol/L) tubes (Vacutainer system; BD). Blood was immediately centrifuged (Eppendorf 5810R) at 120 × g for 5 minutes. Then, the 50% of plasma adjacent to the red cell clot was recovered and centrifuged a second time at 260 × g for 5 minutes. Subsequently, 25% of plasma, at the bottom of the tube, was

Synovial Fluid Quality Improvement in PC-injected Joints

Of the 20 cases in this study, 7 were affected in the right front fetlock and 13 on the left. The PC contained a mean of 560 × 103 platelets/μL ± 62 × 103 platelets /μL, with a majority of platelets and very few leukocytes (Fig. 1). PDGF-BB analysis of PC revealed a mean concentration of 1,280 ± 70.91 pg/mL (Fig. 1). This growth factor represents a major serum mitogen, and it promotes cell migration and proliferation, key events in tissue repair [17]. Analysis of IL-1beta concentrations of the

Discussion

Platelets take part in the early inflammation process when degranulation occurs. They liberate a great number of growth factors contained in the alpha granules that initiate and maintain the healing process, particularly TGF-beta and PDGF-BB. Therefore, PC contains a high concentration of growth factors known to play key roles in the regulation of inflammation and tissue repair [18], [19], [20]. They can stimulate chondrogenic differentiation and enhance chondrocyte proliferation and metabolism

Conclusions

We successfully treated chronic OA that no longer responded to intra-articular steroids or rest. Autologous platelet concentrate is a reliable alternative treatment, which is minimally invasive and allowed the affected joint to recover in most of cases presented here, even in the long term, without any side effects. PC can be considered a safe therapeutic intra-articular substance. In addition to our satisfactory results, this method becomes particularly useful in the rapidity and repeatability

Acknowledgments

The authors thank Patricia Martin for helpful language advice and scientific input and the USC-1043 INSERM/INRA for technical support. Dr. Pichereau analyzed clinical case data and interpretation. Dr. Decory performed laboratory analysis and interpreted data. Dr. Cuevas-Ramos developed and directed the study and analyzed data. All three authors wrote and approved the manuscript. The authors declare no conflicts of interest.

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