Treatment of racehorse superficial digital flexor tendonitis: A comparison of stem cell treatments to controlled exercise rehabilitation in 213 cases.
Abstract: Overstrain of the superficial digital flexor tendon (SDFT) is a common Thoroughbred racehorse limb injury requiring treatment. Objective: To determine whether treatment of SDFT lesions in flat Thoroughbred racehorses with autologous bone marrow-derived mesenchymal stem cells (BM-MSCs) or allogenic adipose-derived mesenchymal stem cells (A-MSCs) is associated with improved likelihood of returning to racing, when compared to racehorses managed with a controlled exercise rehabilitation program (CERP) alone. Methods: Retrospective cohort study combining clinical treatment records with race records. Methods: A total of 213 Thoroughbred racehorses were identified. All were prescribed the same 12-month CERP and 66 also received intralesional BM-MSC and 17 A-MSC treatment. Follow-up was a minimum of 2 years after return to full race training. Multivariable logistic regression models were used to investigate associations between the treatments and the likelihood of returning to racing and completing five or more (C5+) races post-injury. Results: Compared to CERP alone, BM-MSC treatment was associated with increased odds of returning to racing (OR 3.19; 95% CI 1.55-6.81) and C5+ races post-injury (OR 2.64; 95% CI 1.32-5.33). Older age and increasing lesion length were associated with a reduced likelihood of returning to racing. Male sex and increased number of pre-injury starts were associated with increased odds of returning to racing. There was no observed increased likelihood of return to racing or C5+ races associated with treatment with A-MSCs compared to CERP alone. Conclusions: Due to the retrospective nature of the study it was not possible to ascertain how strictly the CERP was followed. Due to the novelty of the method, the A-MSC treatment group included a limited number of horses. Conclusions: In the study population, intralesional BM-MSC treatment was significantly associated with an increased likelihood of returning to racing and C5+ races post-injury compared to CERP alone. Intralesional A-MSC showed no significant association between treatment and the two investigated outcomes.
© 2023 EVJ Ltd.
Publication Date: 2023-01-16 PubMed ID: 36604727DOI: 10.1111/evj.13922Google Scholar: Lookup
The Equine Research Bank provides access to a large database of publicly available scientific literature. Inclusion in the Research Bank does not imply endorsement of study methods or findings by Mad Barn.
- Journal Article
Summary
This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.
The research is about a comparison study of the effectiveness of two types of stem cell treatments versus a controlled exercise <a href="/equine-rehabilitation-guide/" title="rehabilitation program, in treating superficial digital flexor tendonitis in racehorses. The study found that treatment with bone marrow-derived mesenchymal stem cells increased the likelihood of racehorses returning to racing and completing subsequent races compared to the exercise program.
Research Background and Objective
- The study focuses on superficial digital flexor tendonitis, a common limb injury in Thoroughbred racehorses.
- The objective is to figure out if treatment of these tendon lesions with autologous bone marrow-derived mesenchymal stem cells (BM-MSCs) or allogenic adipose-derived mesenchymal stem cells (A-MSCs) improves the horse’s chance of returning to racing, compared to those managed with a controlled exercise rehabilitation program (CERP) alone.
Methods
- The researchers conducted a retrospective cohort study, combining clinical treatment records with race records.
- The study included 213 Thoroughbred racehorses. All of them were prescribed the same 12-month CERP, out of which 66 also received intralesional BM-MSC treatment and 17 received A-MSC treatment.
- The horses’ performances were tracked for a minimum of 2 years after they returned to full race training.
- Multivariable logistic regression models were used to find out associations between the treatments and the likelihood of the horses returning to racing and completing five or more races post-injury.
Results
- Compared to the exercise program alone, treatment with BM-MSCs increased the chances of horses returning to racing and completing subsequent races.
- Factors such as older age and increasing lesion length were found to decrease the likelihood of returning to racing. On the other hand, male sex and increased number of pre-injury starts were associated with increased odds of returning to racing.
- No increased likelihood of return to racing or subsequent races was observed with treatment using A-MSCs compared to CERP alone.
Conclusions
- Due to the fact that the study is retrospective, it wasn’t possible to ascertain how strictly the prescribed CERP was followed.
- Also, the novelty of the A-MSC treatment method meant that only a limited number of horses were treated with it, limiting the data available on its efficacy.
- In conclusion, the study found that intralesional BM-MSC treatment significantly increased the likelihood of racehorses returning to racing and finishing more than five races post-injury compared to the exercise program alone. In contrast, A-MSC treatment didn’t show a significant association with the pursued outcomes.
Cite This Article
APA
Salz RO, Elliott CRB, Zuffa T, Bennet ED, Ahern BJ.
(2023).
Treatment of racehorse superficial digital flexor tendonitis: A comparison of stem cell treatments to controlled exercise rehabilitation in 213 cases.
Equine Vet J, 55(6), 979-987.
https://doi.org/10.1111/evj.13922 Publication
Researcher Affiliations
- REC Equine Specialists, Sydney, New South Wales, Australia.
- Elliott Equine Veterinary Sports Medicine, Ballina, New South Wales, Australia.
- Bristol Veterinary School, University of Bristol, Bristol, UK.
- School of Biodiversity, One Health and Veterinary Medicine, University of Glasgow, Glasgow, UK.
- School of Veterinary Science, University of Queensland, Gatton, Queensland, Australia.
References
This article includes 42 references
- Williams RB, Harkins LS, Hammond CJ, Wood JL. Racehorse injuries, clinical problems and fatalities recorded on British racecourses from flat racing and National Hunt racing during 1996, 1997 and 1998.. Equine Vet J 2001;33(5):478-86.
- Avella CS, Ely ER, Verheyen KL, Price JS, Wood JL, Smith RK. Ultrasonographic assessment of the superficial digital flexor tendons of National Hunt racehorses in training over two racing seasons.. Equine Vet J 2009;41(5):449-54.
- Goodship AE, Birch HL, Wilson AM. The pathobiology and repair of tendon and ligament injury.. Vet Clin North Am Equine Pract 1994;10(2):323-49.
- Clegg PD, Pinchbeck GL. Evidence-based medicine and stem cell therapy: how do we know such technologies are safe and efficacious?. Vet Clin North Am Equine Pract 2012;27(2):373-82.
- Godwin EE, Young NJ, Dudhia J, Beamish IC, Smith RK. Implantation of bone marrow-derived mesenchymal stem cells demonstrates improved outcome in horses with overstrain injury of the superficial digital flexor tendon.. Equine Vet J 2012;44(1):25-32.
- Carvalho AM, Alves ALG, Gomes de Oliveira PG, Álvarez LEC, Amorim RL, Hussni CA. Use of adipose tissue-derived mesenchymal stem cells for experimental tendinitis therapy in equines.. J Equine Vet Sci 2011;31:26-34.
- Dyson SJ. Medical management of superficial digital flexor tendonitis: a comparative study in 219 horses (1992-2000).. Equine Vet J 2004;36(5):415-9.
- O'Meara B, Bladon B, Parkin TD, Fraser B, Lischer CJ. An investigation of the relationship between race performance and superficial digital flexor tendonitis in the thoroughbred racehorse.. Equine Vet J 2010;42(4):322-6.
- Van Loon VJ, Scheffer CJ, Genn HJ, Hoogendoorn AC, Greve JW. Clinical follow-up of horses treated with allogeneic equine mesenchymal stem cells derived from umbilical cord blood for different tendon and ligament disorders.. Vet Q 2014;34(2):92-7.
- Smith RK, Werling NJ, Dakin SG, Alam R, Goodship AE, Dudhia J. Beneficial effects of autologous bone marrow-derived mesenchymal stem cells in naturally occurring tendinopathy.. PLoS One 2013;8(9):e75697.
- Burk J, Berner D, Brehm W, Hillmann A, Horstmeier C, Josten C. Long-term cell tracking following local injection of mesenchymal stromal cells in the equine model of induced tendon disease.. Cell Transplant 2016;25(12):2199-211.
- Crovace A, Lacitignola L, Rossi G, Francioso E. Histological and immunohistochemical evaluation of autologous cultured bone marrow mesenchymal stem cells and bone marrow mononucleated cells in collagenase-induced tendinitis of equine superficial digital flexor tendon.. Vet Med Int 2010;2010:250978.
- Schnabel LV, Lynch ME, van der Meulen MC, Yeager AE, Kornatowski MA, Nixon AJ. Mesenchymal stem cells and insulin-like growth factor-I gene-enhanced mesenchymal stem cells improve structural aspects of healing in equine flexor digitorum superficialis tendons.. J Orthop Res 2009;27(10):1392-8.
- Smith RK. Mesenchymal stem cell therapy for equine tendinopathy.. Disabil Rehabil 2008;30(20-22):1752-8.
- Fortier LA, Smith RK. Regenerative medicine for tendinous and ligamentous injuries of sport horses.. Vet Clin North Am Equine Pract 2008;24(1):191-201.
- Chong AK, Ang AD, Goh JC, Hui JH, Lim AY, Lee EH. Bone marrow-derived mesenchymal stem cells influence early tendon-healing in a rabbit achilles tendon model.. J Bone Joint Surg Am 2007;89(1):74-81.
- Richardson LE, Dudhia J, Clegg PD, Smith R. Stem cells in veterinary medicine-attempts at regenerating equine tendon after injury.. Trends Biotechnol 2007;25(9):409-16.
- Taylor SE, Smith RK, Clegg PD. Mesenchymal stem cell therapy in equine musculoskeletal disease: scientific fact or clinical fiction?. Equine Vet J 2007;39(2):172-80.
- Pezzanite LM, Fortier LA, Antczak DF, Cassano JM, Brosnahan MM, Miller D. Equine allogeneic bone marrow-derived mesenchymal stromal cells elicit antibody responses in vivo.. Stem Cell Res Ther 2015;6(1):54.
- Colbath AC, Dow SW, McIlwraith CW, Goodrich LR. Mesenchymal stem cells for treatment of musculoskeletal disease in horses: relative merits of allogeneic versus autologous stem cells.. Equine Vet J 2020;52(5):654-63.
- Rowland AL, Miller D, Berglund A, Schnabel LV, Levine GJ, Antczak DF. Cross-matching of allogeneic mesenchymal stromal cells eliminates recipient immune targeting.. Stem Cells Transl Med 2021;10(5):694-710.
- Joswig AJ, Mitchell A, Cummings KJ, Levine GJ, Gregory CA, Smith R 3rd. Repeated intra-articular injection of allogeneic mesenchymal stem cells causes an adverse response compared to autologous cells in the equine model.. Stem Cell Res Ther 2017;8(1):42.
- Rantanen N, Jorgenson J, Genovese R. Ultrasonographic evaluation of the equine limb: technique.. In: Ross M, Dyson S, editors. Diagnosis and Management of Lameness in the Horse. 1st ed. St. Louis, MO: W.B. Saunders Co.; 2003. p. 166-88.
- Smith RK, Korda M, Blunn GW, Goodship AE. Isolation and implantation of autologous equine mesenchymal stem cells from bone marrow into the superficial digital flexor tendon as a potential novel treatment.. Equine Vet J 2003;35(1):99-102.
- Dohoo IR, Martin SW, Stryhn H. Veterinary epidemiologic research.. University of Prince Edward Island, Charlottetown, Prince Edward Island: AVC Inc.; 2003.
- le Cessie S, van Houwelingen JC. A goodness-of-fit test for binary regression models, based on smoothing methods.. Biometrics 1991;47:1267-82.
- R Core Team. R: a language and environment for statistical computing.. Vienna, Austria: R Foundation for Statistical Computing; 2021 https://www.R-project.org/..
- Bagley SC, White H, Golomb BA. Logistic regression in the medical literature: standards for use and reporting, with particular attention to one medical domain.. J Clin Epidemiol 2001;54:979-85.
- Tomlinson JE, Jager M, Struzyna A, Laverack M, Fortier LA, Dubovi E. Tropism, pathology, and transmission of equine parvovirus-hepatitis.. Emerg Microbes Infect 2020;9(1):651-63.
- Vidal MA, Kilroy GE, Lopez MJ, Johnson JR, Moore RM, Gimble JM. Characterization of equine adipose tissue-derived stromal cells: adipogenic and osteogenic capacity and comparison with bone marrow-derived mesenchymal stromal cells.. Vet Surg 2007;36(7):613-22.
- Frisbie DD, Smith RK. Clinical update on the use of mesenchymal stem cells in equine orthopaedics.. Equine Vet J 2010;42(1):86-9.
- Ricco S, Renzi S, Del Bue M, Conti V, Merli E, Ramoni R. Allogeneic adipose tissue-derived mesenchymal stem cells in combination with platelet rich plasma are safe and effective in the therapy of superficial digital flexor tendonitis in the horse.. Int J Immunopathol Pharmacol 2013;26(1 Suppl):61-8.
- Beerts C, Suls M, Broeckx SY, Seys B, Vandenberghe A, Declercq J. Tenogenically induced allogeneic peripheral blood mesenchymal stem cells in allogeneic platelet-rich plasma: 2-year follow-up after tendon or ligament treatment in horses.. Front Vet Sci 2017;26(4):158.
- Bosch G, René van Weeren P, Barneveld A, van Schie HT. Computerised analysis of standardised ultrasonographic images to monitor the repair of surgically created core lesions in equine superficial digital flexor tendons following treatment with intratendinous platelet rich plasma or placebo.. Vet J 2011;187(1):92-8.
- Kasashima Y, Takahashi T, Smith RK, Goodship AE, Kuwano A, Ueno T. Prevalence of superficial digital flexor tendonitis and suspensory desmitis in Japanese thoroughbred flat racehorses in 1999.. Equine Vet J 2004;36(4):346-50.
- Takahashi T, Kasashima Y, Ueno Y. Association between race history and risk of superficial digital flexor tendon injury in thoroughbred racehorses.. J Am Vet Med Assoc 2004;225(1):90-3.
- Reardon RJ, Boden LA, Mellor DJ, Love S, Newton JR, Stirk AJ. Risk factors for superficial digital flexor tendinopathy in thoroughbred racehorses in hurdle starts in the UK (2001-2009).. Equine Vet J 2012;44(5):564-9.
- Alzola R, Easter C, Riggs CM, Gardner DS, Freeman SL. Ultrasonographic-based predictive factors influencing successful return to racing after superficial digital flexor tendon injuries in flat racehorses: a retrospective cohort study in 469 thoroughbred racehorses in Hong Kong.. Equine Vet J 2018;50(5):602-8.
- Genovese R, Longo K, Berthold B, Jorgenson J. Quantitative sonographic assessment in the clinical management of superficial digital flexor injuries in thoroughbred racehorses.. Proc Am Assoc Equine Practitioners 1997;43:285-90.
- Marr CM, McMillan I, Boyd JS, Wright NG, Murray M. Ultrasonographic and histopathological findings in equine superficial digital flexor tendon injury.. Equine Vet J 1993;25(1):23-9.
- Reef VB. Superficial digital flexor tendon healing: ultrasonographic evaluation of therapies.. Vet Clin North Am Equine Pract 2001;17(1):159-78.
- Gillis CL. Rehabilitation of tendon and ligament injuries.. Proc Am Assoc Equine Practitioners 1997;7(43):306-9.
Citations
This article has been cited 10 times.Use Nutrition Calculator
Check if your horse's diet meets their nutrition requirements with our easy-to-use tool Check your horse's diet with our easy-to-use tool
Talk to a Nutritionist
Discuss your horse's feeding plan with our experts over a free phone consultation Discuss your horse's diet over a phone consultation
Submit Diet Evaluation
Get a customized feeding plan for your horse formulated by our equine nutritionists Get a custom feeding plan formulated by our nutritionists