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Spriet M, Vaughan B, Barrett M, Galuppo LD. Advances in Regional Vascular Injection Techniques for the Delivery of Stem Cells to Musculoskeletal Injury Sites. Vet Clin North Am Equine Pract 2023; 39:503-514. [PMID: 37550127 DOI: 10.1016/j.cveq.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023] Open
Abstract
Vascular injections of stem cells are a pertinent alternative to direct intralesional injections when treating multiple or extensive lesions or with lesions impossible to reach directly. Extensive research using stem cell tracking has shown that intra-arterial injections without the use of a tourniquet should be preferred over venous or arterial regional limb perfusion techniques using a tourniquet. The median artery is used for the front limbs and the cranial tibial artery for the hind limbs. Proper efficacy studies are still lacking but early clinical work seems promising.
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Affiliation(s)
- Mathieu Spriet
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, 2112 Tupper Hall, One Shields Avenue, Davis, CA 95616, USA.
| | - Betsy Vaughan
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, 2112 Tupper Hall, One Shields Avenue, Davis, CA 95616, USA
| | - Myra Barrett
- Department of Environmental and Radiological Health Sciences, College of Veterinary Medicine, Colorado State University, 300 West Drake Road, Fort Collins, CO 80523, USA
| | - Larry D Galuppo
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, 2112 Tupper Hall, One Shields Avenue, Davis, CA 95616, USA
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Acutt EV, Zhou T, Mama K, Nelson BB, Selberg KT, Barrett MF. Contrast administration via ultrasound-guided injection of the cranial tibial artery results in contrast enhancement of the soft tissues of the metatarsus in horses undergoing CT. Vet Radiol Ultrasound 2023; 64:904-912. [PMID: 37406620 DOI: 10.1111/vru.13256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 04/02/2023] [Accepted: 04/08/2023] [Indexed: 07/07/2023] Open
Abstract
Delivery of mesenchymal stem cells (MSC) via intravascular techniques to treat diffuse and/or inaccessible soft tissue injuries has grown in popularity. The purpose of the current prospective, analytical pilot study was to utilize CT to validate this novel technique and provide additional evidence to support its use for injectate delivery to specific soft tissue structures. Of particular interest was the proximal suspensory ligament, which presents a challenging injection target. Six adult horses without lameness underwent CT of the distal hindlimbs. Scans were obtained prior to ultrasound-guided catheterization of the cranial tibial artery, in addition to early and delayed scans acquired following intra-arterial contrast administration. Region of interest analysis of the superficial and deep digital flexor tendons and suspensory ligament was used to assess contrast enhancement within these structures. Linear mixed models were used to determine statistical significance. Significant (P < 0.05) mean contrast enhancement was seen in all postinjection time points in all soft tissue structures of interest. This indicates that ultrasound-guided injection of the cranial tibial artery results in perfusion of injectate throughout the distal hind limb, including the major soft tissue structures of the metatarsus. This provides further support for this technique as a method of MSC delivery to multifocal or inaccessible injury of these structures, including the proximal suspensory ligament.
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Affiliation(s)
- Elizabeth V Acutt
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Tianjian Zhou
- Department of Statistics, Colorado State University, Fort Collins, Colorado, USA
| | - Khursheed Mama
- Department of Clinical Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Brad B Nelson
- Department of Clinical Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Kurt T Selberg
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Myra F Barrett
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, Colorado, USA
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Characterization of Equine Chronic Tendon Lesions in Low- and High-Field Magnetic Resonance Imaging. Vet Sci 2022; 9:vetsci9060297. [PMID: 35737349 PMCID: PMC9229038 DOI: 10.3390/vetsci9060297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/02/2022] [Accepted: 06/13/2022] [Indexed: 12/03/2022] Open
Abstract
In equine medicine, experience regarding MRI of chronic tendon lesions is limited, and evidence on the suitability of different sequences in 3 T high-field MRI is scarce. Therefore, macroscopically healthy and altered tendons were examined by histology and in 0.27 T low- and 3 T high-field MRI, focusing on T1-weighted (T1w) sequences to visualize chronic lesions. In high-field MRI, tendons were positioned parallel (horizontal) and perpendicular (vertical) to the magnetic field, acknowledging the possible impact of the magic angle effect. The images were evaluated qualitatively and signal intensities were measured for quantitative analysis. Qualitative evaluation was consistent with the quantitative results, yet there were differences in lesion detection between the sequences. The low-field T1w GRE sequence and high-field T1w FLASH sequence with vertically positioned tendons displayed all tendon lesions. However, the horizontally scanned high-field T1w SE sequence failed to detect chronic tendon lesions. The agreement regarding tendon signal intensities was higher between high-field sequences scanned in the same orientation (horizontal or vertical) than between the same types of sequence (SE or FLASH), demonstrating the impact of tendon positioning. Vertical scanning was superior for diagnosis of the tendon lesions, suggesting that the magic angle effect plays a major role in detecting chronic tendon disease.
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Espinosa-Mur P, Whitcomb MB, Kass PH, Vanslambrouck L, Galuppo LD. Factors affecting successful ultrasound-guided injection into the podotrochlear bursa using a palmarolateral approach. Vet Surg 2021; 50:1624-1633. [PMID: 34431529 DOI: 10.1111/vsu.13713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 07/12/2021] [Accepted: 07/31/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To evaluate potential factors affecting ultrasonographic visibility of the suprasesamoidean region and the success rate of ultrasound-guided injection (USGI) into the podotrochlear bursa (PB). STUDY DESIGN Ex vivo, experimental study. ANIMALS 24 cadaveric forelimbs. METHODS The PB was distended with 0, 1, or 2 ml of iodinated contrast material and saline under radiographic guidance. Ultrasonographic visibility of the suprasesamoidean region and PB was graded before and after distention with the limb loaded in three positions (vertical, cranial and caudal). Two operators with different experience levels performed an USGI into the PB with methylene blue (12 limbs each [four limbs with each of three volumes of PB distension]) using a palmarolateral approach and caudal foot placement. Limbs were frozen and sectioned to assess accuracy. RESULTS Ultrasonographic visibility scores of the suprasesamoidean region (p = .0081) and PB (p < .0001) were improved using a caudal foot placement. Higher visibility grades of the suprasesamoidean region were associated with higher injection success rate (p = .047). The injection success was 75% (9/12) for the experienced versus 41.6% (5/12) for the less experienced operator (p = .14). PB distension improved visibility during caudal foot placement (p = .013) but not injection success rates (p = .78). CONCLUSION Caudal foot placement enhances visibility of the PB and suprasesamoidean region. Limbs with poor visibility of the suprasesamoidean region are more likely to undergo a failed USGI. CLINICAL SIGNIFICANCE The lateral USGI approach should be performed only in cases of optimal visibility. The reported success rates support the technical challenge of PB injections.
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Affiliation(s)
- Pablo Espinosa-Mur
- Department of Clinical Studies, Ontario Veterinary College Health Sciences Center, University of Guelph, Guelph, Ontario, Canada
| | - Mary Beth Whitcomb
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, California, USA
| | - Philip H Kass
- Department of Population Health and Reproduction, School of Veterinary Medicine, University of California, Davis, California, USA
| | | | - Larry D Galuppo
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, California, USA
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5
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Luna SPL, Schoen A, Trindade PHE, Rocha PBD. Penetration Profiles of a Class IV Therapeutic Laser and a Photobiomodulation Therapy Device in Equine Skin. J Equine Vet Sci 2019; 85:102846. [PMID: 31952636 DOI: 10.1016/j.jevs.2019.102846] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 11/05/2019] [Accepted: 11/08/2019] [Indexed: 01/25/2023]
Abstract
Photobiomodulation therapy (PBMT) effects depend on the energy settings and laser penetration. We investigated the penetration time profiles of two different light therapy devices, at the dark and light skin regions in horses. Six light skin and six dark skin adult clinically healthy Arab and Quarter horses were used. A cutometer was used to measure the width of the skin fold from both sides of the cervical area, followed by three measurements of the thickness of the same skin fold by transversal and longitudinal ultrasonography (US). The depth of light penetration was compared based on the percentage of penetration versus power, between a portable PBMT device versus a class IV laser device. The laser mean power output was measured with an optical power meter system for 120 seconds after penetrating the skin. Skin width and laser penetration were compared among equipment by paired "t" test. There was no difference in the width of the skin fold between measurements acquired by the cutometer against either longitudinal or transversal US or between the US measurements at cervical versus metacarpus area. Light penetration was greater in both kinds of skins in the PBMT (0.01303 ± 0.00778) versus class IV laser (0.00122 ± SD 0.00070) (P < .001). The PBMT device provided a greater energy penetration than the class IV laser in unclipped light and dark skin, suggesting that the former may produce a better therapeutic effect. The color of the skin changes penetration profiles of PBMT.
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Affiliation(s)
- Stelio Pacca Loureiro Luna
- School of Veterinary Medicine and Animal Science (FMVZ), São Paulo State University (Unesp), Botucatu, São Paulo, Brazil.
| | - Allen Schoen
- Center for Integrative Animal Health, Salt Spring Island, British Columbia, Canada
| | | | - Paula Barreto da Rocha
- School of Veterinary Medicine and Animal Science (FMVZ), São Paulo State University (Unesp), Botucatu, São Paulo, Brazil
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Ahrberg AB, Horstmeier C, Berner D, Brehm W, Gittel C, Hillmann A, Josten C, Rossi G, Schubert S, Winter K, Burk J. Effects of mesenchymal stromal cells versus serum on tendon healing in a controlled experimental trial in an equine model. BMC Musculoskelet Disord 2018; 19:230. [PMID: 30021608 PMCID: PMC6052633 DOI: 10.1186/s12891-018-2163-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 06/28/2018] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Mesenchymal stromal cells (MSC) have shown promising results in the treatment of tendinopathy in equine medicine, making this therapeutic approach seem favorable for translation to human medicine. Having demonstrated that MSC engraft within the tendon lesions after local injection in an equine model, we hypothesized that they would improve tendon healing superior to serum injection alone. METHODS Quadrilateral tendon lesions were induced in six horses by mechanical tissue disruption combined with collagenase application 3 weeks before treatment. Adipose-derived MSC suspended in serum or serum alone were then injected intralesionally. Clinical examinations, ultrasound and magnetic resonance imaging were performed over 24 weeks. Tendon biopsies for histological assessment were taken from the hindlimbs 3 weeks after treatment. Horses were sacrificed after 24 weeks and forelimb tendons were subjected to macroscopic and histological examination as well as analysis of musculoskeletal marker expression. RESULTS Tendons injected with MSC showed a transient increase in inflammation and lesion size, as indicated by clinical and imaging parameters between week 3 and 6 (p < 0.05). Thereafter, symptoms decreased in both groups and, except that in MSC-treated tendons, mean lesion signal intensity as seen in T2w magnetic resonance imaging and cellularity as seen in the histology (p < 0.05) were lower, no major differences could be found at week 24. CONCLUSIONS These data suggest that MSC have influenced the inflammatory reaction in a way not described in tendinopathy studies before. However, at the endpoint of the current study, 24 weeks after treatment, no distinct improvement was observed in MSC-treated tendons compared to the serum-injected controls. Future studies are necessary to elucidate whether and under which conditions MSC are beneficial for tendon healing before translation into human medicine.
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Affiliation(s)
- A B Ahrberg
- Department of Orthopedics, Traumatology and Plastic Surgery, University of Leipzig, Liebigstr. 20, 04103, Leipzig, Germany. .,Translational Center for Regenerative Medicine (TRM), University of Leipzig, Leipzig, Germany.
| | - C Horstmeier
- Translational Center for Regenerative Medicine (TRM), University of Leipzig, Leipzig, Germany.,Saxon Incubator for Clinical Translation (SIKT), University of Leipzig, Leipzig, Germany.,University Equine Hospital, University of Leipzig, Leipzig, Germany
| | - D Berner
- Department of Clinical Science and Services, The Royal Veterinary College, University of London, London, UK
| | - W Brehm
- Translational Center for Regenerative Medicine (TRM), University of Leipzig, Leipzig, Germany.,Saxon Incubator for Clinical Translation (SIKT), University of Leipzig, Leipzig, Germany.,University Equine Hospital, University of Leipzig, Leipzig, Germany
| | - C Gittel
- University Equine Hospital, University of Leipzig, Leipzig, Germany
| | - A Hillmann
- Translational Center for Regenerative Medicine (TRM), University of Leipzig, Leipzig, Germany.,Saxon Incubator for Clinical Translation (SIKT), University of Leipzig, Leipzig, Germany
| | - C Josten
- Department of Orthopedics, Traumatology and Plastic Surgery, University of Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - G Rossi
- School of Biosciences and Veterinary Medicine, University of Camerino, Camerino, Italy
| | - S Schubert
- Translational Center for Regenerative Medicine (TRM), University of Leipzig, Leipzig, Germany.,Saxon Incubator for Clinical Translation (SIKT), University of Leipzig, Leipzig, Germany.,Institute of Veterinary Physiology, University of Leipzig, Leipzig, Germany
| | - K Winter
- University Equine Hospital, University of Leipzig, Leipzig, Germany.,Institute of Anatomy, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - J Burk
- Translational Center for Regenerative Medicine (TRM), University of Leipzig, Leipzig, Germany.,Saxon Incubator for Clinical Translation (SIKT), University of Leipzig, Leipzig, Germany.,Institute of Veterinary Physiology, University of Leipzig, Leipzig, Germany.,Department of Biotechnology, University of Natural Resources and Life Sciences, Vienna, Austria
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Abstract
Laser biostimulation involves applying a laser beam to the tissue to facilitate healing and regenerative processes. Laser therapy is one of the most important physical methods used in human physiotherapy. In veterinary medicine, laser therapy is a new and so far poorly examined method. The results of studies conducted so far are very promising, yet the positive effect of laser light, especially that of class IV, has yet to be confirmed. This article presents an overview of the available literature on the effect of laser treatment on the human and animal organism.
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Espinosa P, Spriet M, Sole A, Walker NJ, Vaughan B, Galuppo LD. Scintigraphic Tracking of Allogeneic Mesenchymal Stem Cells in the Distal Limb After Intra-Arterial Injection in Standing Horses. Vet Surg 2016; 45:619-24. [DOI: 10.1111/vsu.12485] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 02/16/2016] [Indexed: 12/01/2022]
Affiliation(s)
- Pablo Espinosa
- Veterinary Medical Teaching Hospital, School of Veterinary Medicine; University of California; Davis Davis, California
| | - Mathieu Spriet
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine; University of California; Davis Davis, California
| | - Albert Sole
- Veterinary Medical Teaching Hospital, School of Veterinary Medicine; University of California; Davis Davis, California
| | - Naomi J. Walker
- Department of Pathology, Microbiology and Immunology, School of Veterinary Medicine; University of California; Davis Davis, California
| | - Betsy Vaughan
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine; University of California; Davis Davis, California
| | - Larry D. Galuppo
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine; University of California; Davis Davis, California
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Longitudinal Cell Tracking and Simultaneous Monitoring of Tissue Regeneration after Cell Treatment of Natural Tendon Disease by Low-Field Magnetic Resonance Imaging. Stem Cells Int 2016; 2016:1207190. [PMID: 26880932 PMCID: PMC4736965 DOI: 10.1155/2016/1207190] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 09/24/2015] [Accepted: 10/20/2015] [Indexed: 12/12/2022] Open
Abstract
Treatment of tendon disease with multipotent mesenchymal stromal cells (MSC) is a promising option to improve tissue regeneration. To elucidate the mechanisms by which MSC support regeneration, longitudinal tracking of MSC labelled with superparamagnetic iron oxide (SPIO) by magnetic resonance imaging (MRI) could provide important insight. Nine equine patients suffering from tendon disease were treated with SPIO-labelled or nonlabelled allogeneic umbilical cord-derived MSC by local injection. Labelling of MSC was confirmed by microscopy and MRI. All animals were subjected to clinical, ultrasonographical, and low-field MRI examinations before and directly after MSC application as well as 2, 4, and 8 weeks after MSC application. Hypointense artefacts with characteristically low signal intensity were identified at the site of injection of SPIO-MSC in T1- and T2∗-weighted gradient echo MRI sequences. They were visible in all 7 cases treated with SPIO-MSC directly after injection, but not in the control cases treated with nonlabelled MSC. Furthermore, hypointense artefacts remained traceable within the damaged tendon tissue during the whole follow-up period in 5 out of 7 cases. Tendon healing could be monitored at the same time. Clinical and ultrasonographical findings as well as T2-weighted MRI series indicated a gradual improvement of tendon function and structure.
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Spriet M, Buerchler S, Trela JM, Hembrooke TA, Padgett KA, Rick MC, Vidal MA, Galuppo LD. Scintigraphic tracking of mesenchymal stem cells after intravenous regional limb perfusion and subcutaneous administration in the standing horse. Vet Surg 2014; 44:273-80. [PMID: 25307554 DOI: 10.1111/j.1532-950x.2014.12289.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Accepted: 08/01/2014] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To assess distribution, uptake, and persistence of radiolabeled mesenchymal stem cells (MSC) using scintigraphy after intravenous regional limb perfusion (RLP) and subcutaneous injections in standing, sedated horses. STUDY DESIGN Experimental study. ANIMALS Horses (n = 12). METHODS Six horses had RLP performed through the cephalic vein on 1 limb and subcutaneous injection in the metacarpal area in the opposite limb. The other 6 horses had RLP performed through the lateral palmar digital vein and subcutaneous injection in the coronary band. A pneumatic tourniquet was used for the RLP. MSC were labeled with technetium-HMPAO. Scintigraphic images were obtained at the time of injection, 1, 6, and 24 hours later. Results of RLP were compared with results from previous studies where similar injections were performed in anesthetized horses. RESULTS Both RLP techniques led to greater variability, lower uptake, lower persistence, and poorer distribution when compared to results previously reported for horses under general anesthesia. The subcutaneous injections in the metacarpal area and coronary band resulted in MSC loss to the general circulation but no evidence of local migration. CONCLUSION Due to partial or complete failure of the tourniquet, RLP performed in the standing horse as described is less efficient than performed under general anesthesia. Further work is needed to optimize the use of tourniquets to perform RLP for MSC administration in standing patients. The subcutaneous injections did not result in local migration in these normal horses.
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Affiliation(s)
- Mathieu Spriet
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California Davis, Davis, California
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Spriet M, Trela JM, Galuppo LD. Ultrasound-guided injection of the median artery in the standing sedated horse. Equine Vet J 2014; 47:245-8. [PMID: 24612194 DOI: 10.1111/evj.12260] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 02/26/2014] [Indexed: 12/01/2022]
Abstract
REASONS FOR PERFORMING STUDY Injection of the median artery of horses leads to better distribution and persistence of mesenchymal stem cells than i.v. regional limb perfusion. Due to technical difficulties, intra-arterial injections thus far have only been performed under general anaesthesia. OBJECTIVES To assess the feasibility of injection of the median artery in standing sedated horses. STUDY DESIGN Experimental study. METHODS Six horses were included in the study. After median and ulnar regional analgesia, radiographic contrast material was injected in the median artery of both front limbs, using a catheter in one limb and a direct needle injection in the other. Ultrasound guidance was used for catheter and needle placement. Radiographs were obtained for confirmation of successful injection. Post procedural ultrasound examination was performed to assess vascular compromise. RESULTS Catheter placement was successful in all 6 limbs, but in one limb injection was not possible due to arterial spasm. Movement of the limbs after the initial injection resulted in loss of functionality of the catheter in 2 other horses. Direct needle injection was successful on all 6 limbs, with periarterial extravasation observed in 2 limbs. No clinical complications were observed. CONCLUSIONS Injection of the median artery can be performed in standing horses under sedation. Direct needle injection is a more practical technique than catheterisation, as it is easier to perform and less likely to induce arterial spasm. Periarterial extravasation remains a possible limitation of the technique. Intra-arterial injections may be useful for administration of therapeutic agents such as mesenchymal stem cells on standing sedated horses.
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Affiliation(s)
- M Spriet
- Department of Surgical and Radiological Sciences, University of California Davis, Davis, California, USA
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Trela JM, Spriet M, Padgett KA, Galuppo LD, Vaughan B, Vidal MA. Scintigraphic comparison of intra-arterial injection and distal intravenous regional limb perfusion for administration of mesenchymal stem cells to the equine foot. Equine Vet J 2013; 46:479-83. [PMID: 23834199 DOI: 10.1111/evj.12137] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Accepted: 06/29/2013] [Indexed: 12/26/2022]
Abstract
REASONS FOR PERFORMING STUDY Intra-arterial (i.a.) and intravenous (i.v.) regional limb perfusions (RLP) through the median artery and cephalic vein, respectively, have been previously investigated for administration of mesenchymal stem cells (MSCs) to the equine distal limb. Limitations due to thrombosis of the arteries after i.a. RLP and poor distribution of MSCs to the foot with i.v. RLP were observed. These techniques need to be modified for clinical use. OBJECTIVES Evaluate the distribution, uptake and persistence of radiolabelled MSCs after i.a. injection through the median artery without a tourniquet and after i.v. RLP through the lateral palmar digital vein. STUDY DESIGN In vivo experimental study. METHODS (99m) Tc-HMPAO-labelled MSCs were injected through the median artery of one limb and the lateral palmar digital vein of the other limb of 6 horses under general anaesthesia. No tourniquet was used for the i.a. injection. A pneumatic tourniquet was placed on the metacarpus for i.v. injection. Scintigraphic images were obtained up to 24 h after injection. RESULTS Intra-arterial injection resulted in MSCs retention within the limb despite the absence of a tourniquet and no thrombosis was observed. Both i.a. injection and i.v. RLP led to distribution of MSCs to the foot. The i.a. injection resulted in a more homogeneous distribution. The MSC uptake was higher with i.v. RLP at the initial timepoints, but no significant difference was present at 24 h. CONCLUSIONS Both i.a. injection through the median artery without a tourniquet and i.v. RLP performed through the lateral palmar digital vein under general anaesthesia are safe and reliable methods for administration of MSCs to the equine foot. The i.a. technique is preferred owing to the better distribution, but is technically more challenging. The feasibility of performing these techniques on standing horses remains to be investigated.
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Affiliation(s)
- J M Trela
- Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California, Davis, USA
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13
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Sole A, Spriet M, Padgett KA, Vaughan B, Galuppo LD, Borjesson DL, Wisner ER, Vidal MA. Distribution and persistence of technetium-99 hexamethyl propylene amine oxime-labelled bone marrow-derived mesenchymal stem cells in experimentally induced tendon lesions after intratendinous injection and regional perfusion of the equine distal limb. Equine Vet J 2013; 45:726-31. [PMID: 23574488 DOI: 10.1111/evj.12063] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2012] [Accepted: 01/27/2013] [Indexed: 12/25/2022]
Abstract
REASONS FOR PERFORMING STUDY Intralesional (i.l.) injection is currently the most commonly used technique for stem cell therapy in equine tendon injury. A comparison of different techniques of injection of mesenchymal stem cells for the treatment of tendon lesions is required. OBJECTIVES We hypothesised that vascular perfusion of the equine distal limb with mesenchymal stem cells (MSCs) would result in preferential distribution of MSCs to acute tendon injuries. STUDY DESIGN In vivo experimental study. METHODS Lesions were surgically induced in forelimb superficial digital flexor tendons of 8 horses. Three or 10 days after lesion induction, technetium-99 hexamethyl propylene amine oxime-labelled MSCs were injected via i.v. or intra-arterial (i.a.) regional limb perfusion (RLP) at the level of the distal antebrachium and compared to i.l. injection. Mesenchymal stem cell persistence and distribution within the forelimb and tendon lesions was assessed with scintigraphy for 24 h. RESULTS Lesion uptake was higher with i.l. injection than with RLP, but MSC persistence decreased similarly over time in all 3 techniques. Intra-arterial RLP resulted in a better distribution of MSCs and a higher uptake at the lesion site than i.v. RLP. Limbs perfused i.a. on Day 10 showed greater accumulation of MSCs in the lesion than limbs perfused on Day 3. Arterial thrombosis occurred in 50% of the i.v. RLP limbs and in 100% of the i.a. RLP limbs, which led to clinical complications in one horse. CONCLUSIONS AND POTENTIAL RELEVANCE Compared with i.l. injection, RLP results in lower uptake but similar persistence of MSCs at the site of tendon lesions. A time dependent accumulation of MSCs was identified with i.a. RLP. The i.a. RLP appears more advantageous than the i.v. RLP in terms of distribution and uptake. However, the described i.a. technique produced arterial thrombosis and thus cannot currently be recommended for clinical use.
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Affiliation(s)
- A Sole
- Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California, USA
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