EQUINE PRF IN SPORTS MEDICINE
When managing sports horses, orthopedic injuries are one of the top problems. The most frequent equine sports-related issues are tendon or ligament injuries, synovitis, and joint arthritis or arthrosis2–5.
Traditional therapies are typically mid or short-acting steroids, hyaluronic acid, or PSGAG, in combination or as single drugs. These drugs merely manage the symptoms by reducing inflammation and pain and do not aim to cure or reverse the injuries caused by the ongoing degenerative disease.
The latest regenerative therapy introduced in equine sports medicine is platelet-rich fibrin (PRF), particularly the concentrated PRF (C-PRF) derivative.
WHY EQUINE PRF IS THE NATURAL CHOICE
IN EQUINE SPORTS MEDICINE
Autologous Blood Concentrate
Simplicity and ease of use
One huge advantage of Equine PRF is the easy and quick processing of the final product, making it broadly available to even smaller clinics. The treatments are extremely economical based on the simple setup of a centrifuge and proprietary but fairly standardized vacuum tubes.
Safe to use
It is also safe since it´s autologous and without additives. The content of leucocytes furthermore adds to the product’s safety, which is of the greatest importance since iatrogenic infections after joint injections can be a life-threatening condition in horses.
The complete team of regenerative cells
It is also safe since it´s autologous and without additives. The content of leucocytes adds to the product’s safety, which is of the greatest importance since iatrogenic infections after joint injections can be life-threatening in horses. The Equine PRF includes the entire group of white blood cells.
A large part of the growth factors and the majority of the long-term effects of treatment lies specifically in the inclusion and interactions of the white blood cells 11. The white blood cells further contribute to a shortening of the inflammatory phase, jumpstarting the proliferative and, thus, the regenerative phase at an earlier time. In this proliferative phase, the formation of new blood vessels (angiogenesis) contributes to increased and better vascularization of the area. In Equine PRF, the white blood cells, platelets, and various cytokines are all included in a carefully selected fraction, both retained in and stimulated by the fibrin, thereby allowing for the full regenerative potential to be utilized.
A large part of the growth factors and the majority of the long-term effects of treatment lies specifically in the inclusion and interactions of the white blood cells 11. The white blood cells further contribute to a shortening of the inflammatory phase, jumpstarting the proliferative and, thus, the regenerative phase at an earlier time.
In this proliferative phase, the formation of new blood vessels (angiogenesis) contributes to increased and better vascularization of the area. In Equine PRF, the white blood cells, platelets, and various cytokines are all included in a carefully selected fraction, both retained in and stimulated by the fibrin, thereby allowing for the full regenerative potential to be utilized.
Promoting M2-like Macrophage Polarizing
Modulate Macrophage phenotype
PRF can modulate the polarization of tissue-residing macrophages17–22 and initiate a shift from the destructive M1-like phenotype towards the regenerative M2-like phenotype16,23.
Intrinsic growth factors
The activated platelets, leukocytes, and fibrin matrix in PRF release an elevated amount of growth factors and cytokines, simulating a more extensive trauma at the injection site or on lay6–12. In particular, the growth factors PDGF, VEGF, TGF-β, and IGF-1 are important in regeneration and wound healing13,14.
Modulation of inflammation
The release of the growth factors native to the platelets and leucocytes of PRF plays a direct role in the modulation of both acute and chronic inflammation, especially by the modulation of tissue-residing activated macrophage polarization 15,16
Stimulate an acute response
The capacity to modulate inflammation, influence macrophage polarization, and stimulate an acute response leading to accelerated healing and regeneration, puts PRF in a unique position as an autologous biological agent for the treatment of chronic inflammation, pain, and damages in joints and tendons, arising from injuries, arthrosis or arthritis.
Interacts on Inflammation
and the Sensory Pathways of Pain
Pain in joints, tendons, ligaments, and muscles often arises from inflammation affecting the somatosensory nervous system27.
Upon injury, several cell types, including neurons and tissue-residing macrophages, produce soluble pro-inflammatory cytokines and chemokines that activate surrounding cells8,28–31 and recruit circulating leukocytes, including macrophages, to the site of injury32–34.
Macrophages play a central role
Macrophages have especially significant functions in regulating inflammation and are considered to be common peripheral regulators of neuropathic pain30,34,35. Through the release of inflammatory mediators and interactions with neurotransmitters and receptors, the immune cells form an integrated network with the somatosensory system, coordinating the immune response and tissue healing and modulating the sensory pathways of pain32.
Showing Promising Results
in Cartilage Regeneration,
Meniscus and Tendon Repair
Cartilage and tendons are two of the most avascular and low cell-density tissues found in animals and thus have a minimal potential for repair and regeneration. Left untreated, defects often do not heal and stay in a chronic inflammatory state.
The capacity to modulate inflammation, influence macrophage polarization, and stimulate an acute response leading to accelerated healing and regeneration, puts PRF in a unique position as an autologous biological agent for the treatment of inflammation, pain, and damages in joints and tendons, arising from injuries, arthrosis or arthritis.
The introduction of the additive-free liquid PRF, which forms a fibrin clot upon injection, has been a proposed method for the regeneration of cartilage 24,40 and for accelerating the healing of tendons 26.
Drop-by-Drop release – Combination of White Cells, Platelets
and Fibrin ensures a timely release of growth factors
In PRF, the delivery of cytokines and growth factors is done at a biologically relevant rate and responds to the needs of the environment17–23. The function of fibrin has, in this sense, been compared to an irrigation system, where you do not want to drown the plants with large amounts of water in a single shot but aim at delivering a biologically suitable amount of water and nutrients in a slow and adapted manner.
PDGF, VEGF, TGF-β EGF, fFGF, IGF-1, TGF-α, PAF, thrombospondin, platelet thromboplastin, coagulation factors, serotonin, histamine, hydrolytic enzymes and endostatin
Platelet-Derived Growth Factors
PDGFs (Platelet-Derived Growth Factors) are a family of essential and potent growth factors and chemotactic agents with an important role in wound healing36,37.
Recombinant PDGF is used in medicine to help heal chronic ulcers and in orthopedic surgery and periodontics as an alternative to bone autograft to stimulate bone regeneration and repair.
Vascular Endothelial Growth Factor
PDGF and VEGF (Vascular Endothelial Growth Factor) work together to establish and increase the blood supply of worn down and ischemic tissue by promoting the formation of new blood vessels (angiogenesis) .
Transforming Growth Factor Beta
TGF-β (Transforming Growth Factor Beta) is a multi-functional factor important for, amongst other things, the regulation of the inflammatory response. It controls many things, from cell division, differentiation, and controlled cell death of many different cell types along with IGF-1   to the stimulation of fibroblast production of hyaluronic acid (HA)  and collagen .
Next Generation PRF Solution
Equine PRF offers you the next level in blood-derived regenerative medicine. We are offering you solutions with significantly increased cell content and distribution and a wast extension of PRF resorption time, all based on state-of-the-art research and technology.
Concentrated PRF (C-PRF), the new benchmark
As we have gained insight into how cells distribute across a fibrin clot, a new protocol was formulated to increase the number of leukocytes and Platelets 10-fold from the standard injectable PRF protocols. The C-PRF protocol sets a new benchmark in what to expect from a liquid PRF product and forms the foundation of exciting new products like bio-graft, bio-bone, and bio-filler.
PRF membranes for wound healing
The insight gained from the novel method for evaluating and quantifying cell types in platelet-rich fibrin has led to a fibrin clot with 4 times higher cell concentration than standard fixed-angle centrifugation systems and protocols. This allows for more potent wound healing using PRF membranes.
Denaturation, extending the resorption properties
One of PRF’s main limitations is it’s short in vivo turnover rate. However, by combining knowledge about how the heating of platelet-poor plasma (PPP) denatures and reorganizes albumin with the C-PRF protocol, our research team created the heating technology setup that vastly widens the potential of PRF in regenerative medicine by extending resorption properties for up to 4–6 months.
Equine PRF Protocols
and Future Perspectives
– a highly concentrated form of injectable PRF(10x), allowing even larger amounts of regenerative cells to be injected into joints and tendons.
– autologous fibrin membranes encapsulating vast amounts of regenerative cells, slowly releasing pro-angiogenic cytokines to accelerate the healing of even problematic leg ulcers.
– utilizing a denaturation process to create an autologous carrier of concentrated regenerative cells – extend the resorption properties of PRF from 2-3 weeks to 3-6 months
PRF Cornea membrane
– Adding an autologous cellular matrix for ophthalmic surgery, combining a reservoir of regenerative cells with suturable properties.
– Combination enabling the production of PRF membranes of various sizes. These membranes are flexible and can be sutured, offering new perspectives in wound healing and e.g., Gastrogastrointestinal surgery.
– a slowly resorbable platelet-rich fibrin filler loaded with regenerative cells offering a fascinating new perspective in Equine Sports Medicine and beyond as a carrier of medicine for filling cavities or prolonging the effect of joint injections.
See Research Papers & Literature
To get an overview of the ongoing research in PRF, please follow this link and see published articles in progress.
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