Comments on Torricelli et al.: regenerative medicine for the treatment of musculoskeletal overuse injuries in competition horses.

The article discusses concerns regarding Torricelli et al.’s research on the use of regenerative medicine for treating musculoskeletal overuse injuries in competition horses, arguing that the study’s assumption may not have a sufficient scientific basis.

Concerns with the Study

• The authors of the commentary express concern that Torricelli et al.’s study does not include a control group or a group only receiving platelet-rich plasma (PRP). They suggest it lacks responsibility to recommend the combined biological treatment without a comprehensive study design that assesses the differences between each potential treatment and its effects.

Sensitivity of BMMNCs to High Calcium Concentrations

• The commentary notes that bone marrow mononucleated cells (BMMNCs), which were administered to the horses along with PRP, are highly sensitive to high calcium concentrations. They argue that the 10% calcium chloride solution that the study used to activate PRP may have resulted in the death or metabolic impairment of the BMMNCs, potentially explaining why there was no correlation between the concentration of these cells and clinical benefits in the study.

Questioning the Benefit of BMMNCs

• The authors of the commentary question whether the use of BMMNCs actually provides any additional benefits beyond those realised from the use of PRP alone. They suggest that the individual clinical effects observed in the study could be attributed solely to PRP, thereby rendering the need for bone marrow aspiration, and the associated costs for the horse owners, unnecessary.

Call for More Considered Use of Regenerative Therapies

• The commentary concludes with a call for a more careful and considered use of regenerative therapies in treating horses with musculoskeletal overuse injuries, based on the potential flaws and gaps they have identified in Torricelli et al.’s study.