Interleukin 1 Receptive Antagonist Protein (IRAP)
Interleukin 1 receptor antagonist protein or IRAP (also known as autologous conditioned serum) is a blood serum product proven to decrease joint inflammation. Interleukin-1( Il-1) is a chemical in the body that is is responsible for causing inflammation in an injured joint. If left untreated, chronic or severe acute inflammation leads to the eventual destruction of the joint. IRAP blocks (antagonizes) the production of Il-1 in an injured joint. IRAP is a produced by obtaining blood (without an anti-coagulant) from the horse into a special syringe containing numerous glass beads. The blood is incubated at 37 degrees C for 24 hours. After incubation, the syringe is centrifuged at high speed to separate the serum from the clot. The serum is removed and filtered into small individual syringes that can then be frozen for storage.
Usually IRAP is injected into a joint alone or in combination with other regenerative cell therapies such as PRP. It is re-injected at 2 week intervals for 3-6 treatments depending on the severity of the injury, degree of inflammation, and the response to each treatment.
Platelet rich plasma, or PRP (also known as autologous conditioned plasma), consists of platelets that have been separated from other cells in the blood and concentrated for injection back into the horse. Within each platelet cell there are many growth factors which have been recognized to initiate, improve and even shorten healing. Among these growth factors are platelet derived growth factor (PDGF), transforming growth factor beta (TGF-b), fibroblast growth factor (FGF), insulin-like growth factor 1 & 2 (IGF), vascular endothelial growth factor (VEGF), and epidermal growth factor (EGF).
The procedure itself is very straight forward. Blood is drawn from the horse and mixed with an anticoagulant. The is either put into a centrifuge or a complex filter system to separate the platelets. It is not possible to achieve a “pure” population of platelets, and some red and white blood cells are expected in the final PRP solution. This process is relatively fast, taking only about 15 minutes with most PRP systems. It is then ready for injection. After the PRP solution is injected into the injured tissue or joint, the platelets degranulate or release their growth factors. The growth factors serve as chemical signals to the body which sets in motion events to decrease inflammation, begin the growth of new capillaries, and calls for stem cells to enter the area. I favor the use of PRP to treat injuries to tendons and ligaments as well as joint trauma, and have had success with its use alone or in combination with other regenerative cell therapies such as stem cells and IRAP.