Abstract
To assess if injection of allogeneic dental pulp tissue particles would improve lameness in horses with naturally occurring osteoarthritis (OA) or soft tissue (ST) injury. Prospective, randomized, blinded, and controlled clinical trial and client survey assessment. Forty lame client-owned horses. Sterile dental pulp, recovered from otherwise healthy foals that perish during dystocia, was processed under good manufacturing processing to produce mechanically manipulated, unexpanded pulp tissue particles containing viable cells surrounded in extracellular matrix. Forty lame client-owned horses with confirmed OA (n = 20), or ST injury (desmitis or tendonitis) received a 2 mL intra-articular (n = 20 OA) or intra-lesional (n = 20) injection of control transport vehicle (n = 20) or 10 × 106 dental pulp tissue particles (n = 20). Acclimatized horses had baseline measurements performed and were then injected on day 0. Horses were treadmill exercised for 2 weeks, evaluated by clinical parameters, lameness score, edema (score and circumference), pain on flexion (OA) or pressure (ST), and clients' scores for pain and discomfort before and through 45 days after pulp injection. Twenty horses were available for >2.5-year follow-up. Pulp-treated horses showed decrease in lameness compared to baseline (P < 0.009) or placebo controls (P < 0.013) for at least 2 weeks. Client assessments of comfort were improved between before and 45 days after pulp injection (P < 0.001). Clinical improvement with ST injury was significantly greater than OA (P < 0.001). At >2.5-year follow-up, at least 10 horses were in work. Dental pulp tissue particles can be considered as a treatment option for equine lameness due to OA, desmitis, or tendonitis.
Highlights
Tissue allografts and decellularized extracellular matrix allografts have been used to support osteochondral defects, soft tissue (ST) healing, as well as vascular and ligament replacement for decades [1,2,3]
The results showed an increase in synovial fluid white blood cell (WBC) count on days 1 and 2 after injection, greater than in normal horses (Figure 2)
Forty client-owned horses, meeting inclusion and exclusion criteria, and diagnosed with painful OA (n = 20), suspensory desmitis (n = 14), or tendonitis (n = 6) of the distal limb were enrolled in the study between December 2013 and June 2014
Summary
Tissue allografts (fresh or frozen) and decellularized extracellular matrix allografts have been used to support osteochondral defects, soft tissue (ST) healing, as well as vascular and ligament replacement for decades [1,2,3]. Successful efficacy for cartilage repair has been demonstrated with allogeneic MSCs and chondrocytes [6, 8, 9, 12,13,14,15] Success of these cell-based biologic products has been ascribed to viable progenitor cells that could migrate, engraft, differentiate, and facilitate tissue regeneration [16], but more recently it has been recognized that MSC have anti-inflammatory [17, 18], immunomodulatory [5, 19, 20], and pain-relieving effects [21,22,23]. Due to reported success of MSC in these painful lameness conditions in horses, we focused our lameness population to cartilage degeneration and tendonitis/desmitis as target diseases with the primary outcome of lameness relief
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