1. 2015-06-09 www.jennyhilldjurklinik.se1 Use of IRAP/ACS in dog Sune Jerre

2. IRAP- orthogen veterinary Gmbh ACS= Autologous conditioned Serum IRAP have been used in horses since 2008 in Sweden Studies in People show that injections with ACS will lower Interleukin levels in the joint and is effective in treatment of Osteoarthritis Studies in horses show that treatment with ACS is Superior in joint treatment compared with hyaluronic acid or cortikosteroids 2015-06-09 www.jennyhilldjurklinik.se2

3. ACS to dogs Julio Reinecke offered me IRAP in april 2010 We decided to threat arthrotic joints with three intraarticular injections 1ml /joint 7-10 days apart I wanted to try IRAP in Chronic arthrosis in elbows that had been arthroscoped 8 of 10. I also treid it in three Shoulder and two stifle joints during first year 2015-06-09 www.jennyhilldjurklinik.se3

4. Selection of dogs for IRAP 2015-06-09 www.jennyhilldjurklinik.se4

5. Blood sampling and handling 2015-06-09 www.jennyhilldjurklinik.se5

6. Extraction of ACS-serum 2015-06-09 www.jennyhilldjurklinik.se6

7. IRAP –Orthogen AG ACS- Autologous conditioned Serum IRAP comes from blood incubated in tubes with glasbols in 37 degrees. IRAP from orthogen 10 ml is incubated 6-9 h. 50ml syringes is incubated for 20-24 h. Timeframe important to get Interleukin antibodies From 10ml blood you get 3ml IRAP-serum Injection of 1ml intraarticular with 7-10days apart. 20 joints treated april 2010 – april 2011 2015-06-09 www.jennyhilldjurklinik.se7

8. During the first year 20 joints where treated 3 Shoulder joints 2 Stifle joints after CCL 15 Elbow joints in 10 dogs. 1-10 years 15 dogs treated with 3 injections in each joint 2015-06-09 www.jennyhilldjurklinik.se8

9. Results of first year Out of three shoulder joints two got perfect and are back to full exercise, one did not response and the dog was eutinised The dogs with elbow arthrosis often needed some support with NSAID and or Neutrasuiticals two dogs where back to full function without adjunctive treatment 2015-06-09 www.jennyhilldjurklinik.se9

10. Results was promising Most cases diagnosed with Arthroscopy Many cases had arthrosis in multiple joints Synovial fluid got more viscous after each inject. Dogs got lame free even with grave arthrosis Treatment often combined with other drugs Decided to have IRAP as a part of my joint treatment 2015-06-09 www.jennyhilldjurklinik.se10

11. MY way to use IRAP in dogs In this presentation I will show the results after IRAP treatment in 105 joints. Each dog got 3 injections with 7-14 days apart in one to four joints. 4 dogs have been treated two times with 3 injections and more than one year apart. Follow up time is 6 month – 3,5 years 2015-06-09 www.jennyhilldjurklinik.se11

12. My experience of IRAP/ACS 44 dogs with 67 elbow joints treated so far 25 dogs with 40 stifle joints treated so far 9 dogs with shoulder problems treated so far 5 dogs treated in hip joints often in combination with other joints 2 dogs treated in the hook 85 dogs and 125 joints have been treated so far 2015-06-09 www.jennyhilldjurklinik.se12

13. Jennyhill djurklinik The most commen injury in the stifle joint of dogs is CCL and it often affects Booth hindlegs We have used IRAP to slow the process of Arthritis after Surgery We use arthroscopy to diagnose and TTA to treat rupture of CCL 2015-06-09 www.jennyhilldjurklinik.se13

14. Arthroscopy 2015-06-09 www.jennyhilldjurklinik.se14 30 of 34 dogs treated in the elbow have been arthroscoped prior to treatment 23 in both elbows 1-10 year of age at treatment We have suggested IRAP treatment for all dogs with elbow arthrosis

15. IRAP is a blood product that have to be handled steril 2015-06-09 www.jennyhilldjurklinik.se15

16. Use of IRAP in Elbow joints 2015-06-09 www.jennyhilldjurklinik.se16 34 dogs and 57 joints where treated 3 times with 7-14 days apart In 6 dogs hip joints or stifle joints where treated at the same time Follow up time 6 – 40 month 8 dogs are dead three because of lameness Results: 2 dogs did not function 5 dogs needed multi- treatment and some lameness 16 dogs had good function but needed supportive treatment 10 function with out medication

17. Use of IRAP in stifle joints 21 dogs and 36 joints All dogs have had stifle Surgery 15 had stifle surgery to both hindlegs We should probable use IRAP more in profylaxis of Stifle arthrosis 2015-06-09 www.jennyhilldjurklinik.se 17 Results: 2 dogs did not have positive effect 5 dogs needed other supportive treatment 8 dogs where back to normal but needed medication 6 dogs back to normal with out medication

18. Use of IRAP in Shoulder joints We have used IRAP in older dogs with shoulder instability and after trauma. Young dogs with shoulder OCD have good prognosis anyway and I have not used IRAP Results: 2 dogs did not come back to good function and was eutinised 5 dogs came back to full function and did not need any further medication. 2015-06-09 www.jennyhilldjurklinik.se18

19. Use of IRAP in Hip joints We used IRAP in 5 dogs with hip artrosis or Hip dysplasia. In 3 dogs multiple joints where injected with IRAP In 2 dogs only Hips where injected No arthroscopy used All dogs functioning good but Neutrasuiticals and Nsaid where used I think a bigger study using IRAP in hip dysplasia after Arthroscopic evaluation are needed 2015-06-09 www.jennyhilldjurklinik.se19

20. Irap 2015-06-09 www.jennyhilldjurklinik.se20

21. Patient material Large breed dogs are commonly getting arthrosis In this material dogs weight are between 15 and 80 kg 34 dogs and 57 joints with elbow arthrosis 21 dogs and 36 joints with stifle arthrosis 7 dogs with shoulder DJD 5 dogs with hip arthrosis 2 dogs with hook arthrosis 2015-06-09 www.jennyhilldjurklinik.se21

22. IRAP – conclussion 65 dogs and 107 joints with a follow up between 6 and 40 month. 11 dogs are dead today 2 because of tumours in the affected limb, 3 because that they did not come back to full function and 6 of unrelated probleme 12 function with other treatment 37 good function but need NSAID 16 perfect function without medication 2015-06-09 www.jennyhwww.jennyh illdjurklinik.se

23. Skalpellen 2 may 2015 At Jennyhill we currently have treated 170 dogs with ACS and more than 400 joints have been treated All joints in the extremities have been treated So far we have not used ACS in back problems Some times especially in joints of lower extremities I combine with Lederspan (korticosteroids) 2015-06-09 www.jennyhilldjurklinik.se23

24. Primary and secondary arthrosis Primary arthrosis are probably less commen One example is primary stifflearthrosis in boxer breed and artrosis in cats Secondary arthrosis : will be the consequence of any joint instability or incongruence. And probably we will end up with some degree of artrosis after all joint operations except Prostesis or panarthodesis 2015-06-09 www.jennyhilldjurklinik.se24

25. When do I use ACS (IRAP) Acute after cruciate operations and other traumatic joint diseases to prevent further artrosis All chronic joint problems especially if there are multiple joints affected We often see Hip artrosis at the time of cruciate surgery and than it is convenient to treat the hip at the same time with IRAP 2015-06-09 www.jennyhilldjurklinik.se25

26. Multimodal treatment of arthrosis Physiotherapy – exersice Surgery Joint diets Nutritional supplements Joint injections Goal of treatments for different patients 2015-06-09 www.jennyhilldjurklinik.se26

27. Questions?? 2015-06-09 www.jennyhilldjurklinik.se27 Sune Jerre DVM, Specialist in Surgery E.mail sune.jerre@telia.com