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 WeightWeight 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 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?