A2M - A New Biologic Joint Therapy

As horse people, we all want to do what is best for our equine partners.  My job is to provide you the best options possible.  At this time, I am one of the few equine veterinarians in the Bay Area that can offer one of the newest and most effective joint treatments, A2M or Alpha 2 Macroglobulin. 

Joint disease is among the most common lameness issues affecting performance and pleasure horses.  Joint disease ranges from inflammation (synovitis) to degenerative changes (Osteoarthritis).  I often say I make a living injecting hocks and that is only partially tongue in cheek.

A2M is proving to be perhaps the most potent of the biological treatments such as PRP, Prostride, and IRAP.   A2M can be prepared stall side in about a half hour.  One preparation can produce 30 cc of purified product.  That is enough to treat multiple joints or for multiple repetitive injections of the same joint.  After purifying blood into injectable doses of A2M, these doses can be frozen maintaining effectiveness for up to 12 months.  Later these doses can be thawed to use for future injections.

 
 

A2M can also be administered in regional limb profusion for conditions such as navicular disease or for laminitis.

A2M proves valuable in multiple situations including:

  • In horses that fail to respond to typical first-line treatment with a combination of hyaluronic acid and corticosteroids.
     

  • In horses which require multiple joints treated all at once such as needing hocks, coffin joints, and stifles treated at the same time.
     

  • In horses that need to be injected close to a competition, using HA with corticosteroids would be prohibited. 
     

  • In horses requiring joint injections that has Cushing’s disease and so you want to avoid any injections with corticosteroids.

A2M is a big protein normally produced by the liver and present in the blood.  A2M is concentrated using a special filtering kit where we take blood from your own horse and spin it through the filter with a centrifuge. 

Once in a joint, A2M grabs and disables inflammatory proteins called proteases reducing inflammation as well as inhibiting matrix metalloproteinases and other enzymes responsible for cartilage degradation.  A2M inhibits cytokines responsible for inflammation.   A2M also up-regulates the genes responsible for building up the joint and down-regulates genes responsible for breaking down joints.

Introduced in humans in 2013 and in horses in 2019, A2M has already shown to be very effective. 

In one referral center that treated over 180 joints with no additional treatment such as shockwave or pain medication.  This resulted in  78.9% of coffin joint cases responding and 85.7% of hocks treated had a reduction in flexion test response.

One of the more remarkable cases I have treated was a horse involved in a trailer accident resulting in the opening of the knee joint.  After we finished treating the wound, x-rays showed severe arthritis of the knee and he was lame at the walk.

When treated with a combination of A2M and Shockwave therapy this horse went from lame at the walk to sound at the walk and all but sound at the trot.   It has been an outstanding response.

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