A Deep Dive into Equine Regenerative Treatments and NSAID Interactions

Discover how single-dose nonsteroidal anti-inflammatory drugs in horses have no impact on concentrations of cytokines or growth factors in autologous protein solution and platelet-rich plasma as we chat with Kara Brown on Veterinary Vertex. Our conversation navigates the critical nuances of using non-steroidal anti-inflammatory drugs in tandem with cutting-edge regenerative therapies, defying the old-school reliance on corticosteroids. Kara, armed with her latest research, illuminates the negligible impact of a single NSAID dose on the cytokine and growth factor profiles in PRP and APS, considering a strategic six-hour window pre-blood collection. This episode emphasizes the delicate balance of medication and therapy in equine rehabilitation, including the dos and don'ts post-treatment and why evidence-based medicine trumps assumptions. Our discussion offers a peek into the considerations veterinarians face and the guidance horse owners need when NSAIDs are part of the treatment equation.

AJVR article: https://doi.org/10.2460/ajvr.23.11.0258

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Transcript

Speaker 1: 0:00

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Speaker 3: 0:28

You are the one, I want Dogs should be tested for existing heartworm infection prior to starting a preventive. To learn more, visit nextguardpluscliniccom. You're listening to Veterinary Vertex, a podcast of the AVMA Journals. In this episode we chat about NSAIDs in horses and their impact on concentrations of cytokines or growth factors in a autologous solution in platelet-rich plasma with our guest Cara Brown.

Speaker 4: 0:52

Welcome to Veterinary Vertex. I'm Editor-in-Chief Lisa Fortier, and I'm joined by Associate Editor Sarah Wright. Today, we have Cara joining us to talk about one of my most favorite topics of all regenerative medicine. Cara, thank you so much for being here with us today.

Speaker 2: 1:06

Yeah, thank you for inviting me.

Speaker 3: 1:08

Let's canter on over to learn more about regenerative medicine, cara. Your AJVR article discusses how single-dose non-steroidal anti-inflammatory drugs in horses have no impact on concentrations of cytokines or growth factors, an autologous protein solution and platelet-rich plasma. Please share with our listeners the background on this study.

Speaker 2: 1:31

Yeah, so I mean, the profession is really shifting, I think, towards the use of non-corticosteroid products for management of things like musculoskeletal disease, so osteoarthritis, tendonitis, desmitis and orthobiologics are definitely being used with more and more frequency, and blood-based products like platelet-rich plasma so PRP and autologous protein solution, or APS, are becoming really popular.

Speaker 2: 1:58

I certainly use them quite a bit and these products are really based on kind of concentrating certain components of blood. So platelets and leukocytes are white blood cells and these then release proteins like cytokines and growth factors that really we think help with inflammation and healing in musculoskeletal disease specifically, which is, of course, as a sports medicine specialist, kind of my area. But these horses that are lame and kind of have musculoskeletal injuries are often being given other medications.

Speaker 2: 2:26

So, and probably the most common that we see are non-steroidal anti-inflammatory drugs, so phenylbutazone and flunex and megalamine in this area probably being the most common and these types of medications can alter things like platelet function, and in humans we actually know that they can alter the platelet or the composition of cytokines and growth factors in these PRP and kind of other orthobiologic substances. So it's possible that by obtaining blood from horses that had received this medication and then processing it for PRP and APS, that these horses might actually be receiving kind of what would be considered an altered form or maybe even a less effective form of the substance which we really wanted to avoid. And so our goal for this study was really to kind of determine whether or not administering these types of NSAIDs would affect that kind of cytokine and growth factor profile in those products when it was given a single dose, when the horse was administered a single dose. So that's kind of the general background for this project.

Speaker 3: 3:31

Yeah, thank you Really appreciate you providing that information for our listeners. Yeah, of course.

Speaker 2: 3:47

And what were some of the pivotal findings from this study? Drugs or in the PRP and APS. When the NSAIDs were administered, or when some of them were administered, no drug really significantly altered the concentrations of cytokines and growth factors in that final product of PRP and APS. And so essentially I'd summarize that by saying you know, if we give an NSAID once, or let's say the horse comes in and it's already been given an NSAID by the owner and again I'm specifically kind of referring to Bute or Fircoxib, orally or intravenous, ketoprofen or Flunix and Meglamine, provided that we wait about six hours after administration, we're probably still going to end up with a similar PRP or APSN product than if no NSAID was given, with respect specifically to these kind of important anti-inflammatory proteins.

Speaker 4: 4:42

I think this is a great example, kara, of bedside back to bench. Back to bedside. Yeah, for sure. I've wondered for a long time. Yeah, and it's also so. Thank you for answering it. Of course, it's also lots of lots of us in sports medicine like to give the horse an NSAID after we've blocked them and injected them, so this also says that that'll be okay. Yes, yeah, it's also a really great lesson. Horses are not humans. Yeah, that's very true. You might learn something from their study design, but we still need to redo this in the dog and the horse and all those sorts of things. So thank you for this really important piece of information for equine sports medicine. Yeah, my pleasure.

Speaker 4: 5:26

What sparked your research interest in NSAIDs as they relate to PRP and APS?

Speaker 2: 5:31

Yeah, I mean. So this kind of reflects what you just said. What I find really rewarding about the kind of research that I'm specifically interested in is really being able to answer clinically applicable questions. Administered an NSAID and really just not knowing whether or not obtaining blood and then processing it for PRP or APS was going to be of detriment in some category, to the horse. So that was really what kind of sparked the interest in this type of study.

Speaker 4: 6:06

You can often learn when you give talks right, the most common questions, and now, maybe next, you can answer what's the right dose, what's the right timing, which one is best in which situation? Absolutely, absolutely. You talked to Sarah a little bit earlier about some of the pivotal findings of the study, but anytime we do something like this, we're always like surprised by something like wow, I didn't expect that. What were a couple or one of the most surprising findings from this study?

Speaker 2: 6:36

surprising findings from this study.

Speaker 2: 6:37

Yeah, I mean, I think probably the most surprising and kind of unanticipated finding, at least for me, was that one horse in our study had very consistently higher levels of cytokines, kind of across the board, than other horses and there were really no overt differences in the systemic health of this horse, based on just our physical exams.

Speaker 2: 6:54

The horse was managed very similarly. This is part of our research herd of horses, so they're all managed very similarly and we just don't really know whether this is reflective just of this horse being in a pro-inflammatory state for some reason that we just didn't identify on our evaluations, or whether there was some other factor that was affecting the cytokine profile, so stress or something like that. But just given that kind of high degree of variability in those concentrations between horses that we saw, which is something that's known, maybe it indicates that you know, measuring the concentrations of those proteins and the products before we administer them could be beneficial, although you know, in the end probably or you know, some would feel that the ratios are really the most important. So maybe the concentration itself really isn't that key. But that was something that I was not anticipating, just that one horse was very consistently elevated.

Speaker 3: 7:52

It's always fun to have those findings. It makes you think, hmm, what is that? Can that lead us down another path to more manuscripts? Exactly exactly exactly Yep, always more questions. And for our listeners just joining us, we're discussing NSAIDs in horses and their impact on concentrations of cytokines or growth factors in autologous protein solution and PRP with our guest Kara. So Kara, how did your advanced training prepare you to write this? Manuscripts.

Speaker 2: 8:19

Yeah, that's a great question. I underwent a lot of postgraduate training, as probably a lot of us did. I did, you know, a couple internships, I did a fellowship, I did a residency in sports medicine and rehabilitation and a lectureship prior to my faculty position. And publishing a manuscript is a part of the boarding process for the American College of Veterinary Sports Medicine and Rehabilitation, as it is for a lot of specialty colleges but also so you do get experience with that naturally. But the residency also really heavily focuses on these types of things, so pain medication, strategies for management of pain and musculoskeletal injury, and so it gave me a really in-depth understanding specifically for this project.

Speaker 2: 9:04

But also, I'd say you know, spending this much time at an academic institution kind of naturally allows you to observe and participate in a lot of research and kind of learn how to perform these well-controlled studies. And one of the most beneficial is probably being in journal clubs for the last 10 years, right weekly, where you know we're really constantly critically evaluating how the research in these studies is performed and presented and we really explore and look for limitations in the data, which I think really helps when you're preparing a manuscript to be able to kind of understand and then accurately present the information that you've obtained and then kind of draw reasonable conclusions from it and understand what limitations there are naturally in the data, of which there is always, you know, probably many. But I have to say too, you know, I've I've really benefited from the advice and mentorship of some really amazing clinicians throughout my years of training and that's been really immensely helpful in preparing to write these types of manuscripts.

Speaker 3: 10:13

Yeah, I think journal club is great. It definitely prepared me to to be an associate editor, picking apart the manuscripts, figuring out what's important. Yeah, I got. Yeah, very thankful for that yeah now this next set of questions can be really important for our listeners. The first one is going to be about the veterinarian's perspective with respect to when horses are also going to have blood drawn for the processing of APS or PRP. What is one piece of information the veterinarian should know before discussing NSAIDs in horses with the client?

Speaker 2: 10:43

Yeah. So my piece of advice would be that, as a veterinarian, if you're considering treating a horse with PRP or APS, that, based on the results of this study, if the horse has received a single dose of any of the four NSAIDs that we looked at within those dosages, then you can be relatively reassured that the final products that you're getting, as long as they've been prepared six hours or so after administration, are probably not going to be significantly affected by those medications.

Speaker 3: 11:15

And then on the other side of the relationship, also with respect to when horses are going to have blood drawn for the processing of APS or PRP, what's one thing clients should consider around NSAID use in our equine patients?

Speaker 2: 11:27

Yeah. So I think this is another really important reason why clients should consider always discussing administration of NSAIDs with their veterinarian prior to giving them, because we don't really know how higher doses of these medications or more prolonged doses might affect these products and your veterinarian, at least based on the results of this study, will be able to recommend an appropriate dosage and kind of time frame, while also being able to obtain blood for PRP and APS for management of whatever musculoskeletal injury they've identified.

Speaker 4: 12:03

Yeah, thank you again, cara, for all that really valuable, super clinically important information and for sharing it with us at AJVR. Yes, cara, as we wind down the podcast, we'd like to find out a little bit more about you, so the question I would like to know from Kara Brown today is what is the first concert you attended?

Speaker 2: 12:22

Yeah, so the first big concert I attended was actually a John Mayer concert in Vancouver, bc, for my 16th birthday and, as a very dedicated John Mayer fan, at that time I waited outside of his trailer for him and got him to sign something for me. So embarrassing, but true.

Speaker 3: 12:43

Yeah, I love Vancouver. I did my fellowship at the Vancouver. Oh really, it's a great city.

Speaker 2: 12:48

I'm from Washington State, so it was not that far of a drive, but I miss that area.

Speaker 3: 12:55

Very nice. Yeah, I'll be back up in that area for May for a conference.

Speaker 1: 12:59

Oh cool.

Speaker 3: 12:59

Yeah, looking forward to that, yeah, but just thank you so much, kara. We really appreciate your contribution to AJVR and for sharing this valuable information with our listeners today.

Speaker 2: 13:09

My pleasure. Thank you so much for the invitation.

Speaker 3: 13:12

You can read Kara's open access article online using your favorite search engine. I'm Sarah Wright with Lisa48. We want to thank each of you for joining us on this episode of the Veterinary Vertex podcast. We love sharing cutting edge veterinary research with you and we want to hear from you. Be sure to leave us a rating and review on Apple Podcasts or whatever platform you listen to.