1. Welcome!

2. IRAP? interleukin 1receptor antagonist proteininterleukin 1receptor antagonist protein brandname of technology used to obtain Autologous Conditioned Serum (ACS)brandname of technology used to obtain Autologous Conditioned Serum (ACS)

3. Osteoarthritis releases cytokines such as: Interleukin 1 (IL-1) Destroys cartilage Reversed by IRAP

4. What does Interleukin1(IL-1) do? Following joint injury there is up regulation of synthesis of IL-1 Following joint injury there is up regulation of synthesis of IL-1 IL-1 drives IL-1 drives PainPain InflammationInflammation DegenerationDegeneration

5. What's The Big Deal? 100% non chemical – uses the body‘s own treatment mechanism 100% non chemical – uses the body‘s own treatment mechanism Effective Effective Safe Safe

6. Irap Syringe

7. Sterile Acquisition IRAP syringe is used to draw fresh venous blood from the horse IRAP syringe is used to draw fresh venous blood from the horse Mild sedation allows a higher yield (proportion of plazma to red cells is higher) Mild sedation allows a higher yield (proportion of plazma to red cells is higher)

8. 24 hour Incubation White blood cells produce therapeutic proteins through their physical contact with the glass beads during incubation at 37°C White blood cells produce therapeutic proteins through their physical contact with the glass beads during incubation at 37°C

9. Centrifugation

10. Sterile Processing

11. Filtering into Syringes & Freezing

12. Injecting into Joint(s)

13. Controlled studies

14. Benefits of ACS 100% autologous 100% autologous antiinflammatory antiinflammatory relieves pain relieves pain regenerative regenerative all components are in physiological concentration only all components are in physiological concentration only all components act synergistically -> more effective all components act synergistically -> more effective safe: so far not a single infection safe: so far not a single infection

15. Horses which have a well diagnosed arthritis condition with no specific pathology such as osteo-chondral bone fragments, OCD lesions, etc. In addition those horses that have had hyaluronic acid (HA) and/or cortico- steroids with little or no improvement. For what type of problems ?

16. Post Arthroscopy Post-Arthroscopy joints with cartilage lesions and scratches but not totally destroyed cartilage areas.

17. Post Surgery Maintenance therapy for those horses with more severe joint disease

18. German Recommendations Amount: 2-8 ml depending on size of joint Amount: 2-8 ml depending on size of joint Frequency: every 4-8 or 8-16 days Frequency: every 4-8 or 8-16 days Repetitions: 0- 3X (i.e. 1-4 injections in a row) Repetitions: 0- 3X (i.e. 1-4 injections in a row) Our experience – stifles require higher volume – 10-15 ml Our experience – stifles require higher volume – 10-15 ml

19. Cost? 1.IRAP syringe, sample acquisition, incubation, centrifugation & filtration into multiple syringes for immediate and future injection. 2.Injection fee: sterile scrub, filtering IRAP, sterile joint injection +/- antibiotic, sedation, bandaging