Revolutionizing equine sports medicine: An overview of regenerative therapies

Can animals harness their intrinsic abilities to adapt and heal after an injury? Dr. Mark Revenaugh, veterinarian and owner of Northwest Equine Performance in Mulino, Oregon, joins the Ag Future podcast to discuss the science behind regenerative therapy and what it means for equestrians. 

The following is an edited transcript of the Ag Future podcast episode with Dr. Mark Revenaugh hosted by Tom Martin. Click below to hear the full audio or listen to the episode on Apple Podcasts, Spotify or Google Podcasts.

Tom:            Welcome to Ag Future, presented by Alltech. Join us from the 2022 Alltech ONE Conference as we explore opportunities within agri-food, business and beyond.

                     Regenerative therapies have been rapidly expanding in the horse market. These treatments of joint disease, as well as soft tissue and musculoskeletal injuries, are revolutionizing equine sports medicine. They are (also), at the same time, raising many questions.

                     I'm Tom Martin for the Alltech Ag Future podcast series, and joining us is Dr. Mark Revenaugh, the veterinarian owner of Northwest Equine Performance in Mulino, Oregon, and a leading expert in the diagnosis and treatment of lameness and performance-related issues. For more than 20 years, Dr. Revenaugh has served as a U.S. Equestrian Team or assistant team veterinarian, selecting, treating and advising elite-level professionals in the equine industry on maintaining health and maximizing performance. Thanks for joining us, Mark.

Mark:            Thank you very much. Great to be here.

Tom:            Would you mind explaining for us what regenerative medicine is and how it works as a healing therapy?

Mark:            Sure. Regenerative medicine is really an entirely new branch of medicine. What we're doing is we're looking into harnessing the body's own intrinsic abilities to adapt, to heal and to strengthen. We're finding that those signals are all there; we're just in the process of learning how to best utilize those processes that are already existing.

Tom:            This is a recurring theme, and the conversations we're having in the field of neurogastronomy, in the field of genetics — that we're equipped for many of these ailments, and, of course, our animals are as well — (are related to topics) that we've addressed in other ways for generations.

Mark:            Yeah, that's absolutely correct. I think the pendulum swings in most industries, as it has in medicine, over into (the) pharmacy, to be the answer to the afflictions of our horses and our people. But it turns out that there might be a better way — or, certainly, another way — that we can be modifying and impacting our (horses). You know, I work with athletes, primarily. They have very, very high demands on them. We're always looking for ways that we can keep our athletes healthy and strong and in the game.

Tom:            Well, what sorts of injuries or ailments can be successfully treated with regenerative therapies?

Mark:            Well, we're still trying to figure that all out. I would tell you, at this stage, there's a lot of experience and quite a bit of research behind it (related to its) use in treating joints, injured joints (and) inflamed joints, to a lesser extent, but also there's a fairly robust research base behind the use of these products for soft-tissue injuries. Those are very, very common, and those are, I would say, the lion's share of what we're using them for — although there are exciting new areas where (regenerative therapies are used in the) treatment of lung problems and even spinal cord injury. I know that's a bigger deal for human orthopedics, but it does happen. Nerve and nerve-root and spinal-cord problems do also occur in horses. It's a frontier at this stage for us.

Tom:            Well, Dr. Revenaugh, what brought you around to this approach? How were you persuaded that it holds beneficial promise?

Mark:            Well, sports are really, really competitive, and we're always looking for ways to do things better and to get a better end result. This line of thinking really started in the late '90s. Our industry has struggled to keep up with the rapidly changing body of research and the rapidly changing body of clinical experience. Interestingly, clinical experience, actually, is probably leading the way. We have tremendously high numbers of case experiences. There's so much to read and so much to try and keep track of that it can be really difficult to stay on top of it, because as soon as you learn something, there's something else new to replace it.

                     But it's driven by results in the end. At first, it's driven by the hype. There's a hyperbole when there's something new and everyone thinks it's going to cure everything and that doesn't work out. But once you're through the hype, you can really realize where some of these products can be helpful. Like I said, at this stage, we just are doing more and more. It's done by request by the client from (their) firsthand experience with some of their other patients.

Tom:            Sounds like the old (adage), “The more you know, the more you know you don't know.”

Mark:            Yeah, absolutely.

Tom:            Well, last year, I know that you in the high-performance sports group offered a series of courses where top-level horse vets, academic veterinarians and MDs specializing in regenerative treatments got together to compare notes about this field. What's the most current clinical thinking about its applications in veterinary medicine?

Mark:            Wow, that's a very broad question. I would say that the reason that we organized this virtual summit was because we're looking to see what different perspectives we're finding. And until that point, largely, the MD world, the human regenerative field, was running parallel with the veterinary regenerative field without an awful lot of communication between the two different groups. It's fascinating and has been an amazing process to see (and) kind of compare notes on all levels — not only (in terms of) results but how things are being validated, how we measure success. I mean, some of the real fundamental, important pillars of determining whether something does or doesn't work, I would say, at this stage, are coming back into question for us.

Tom:            Well, I know that you have not shied away from making investments in advanced technologies and cutting-edge therapies. That requires a certain amount of tolerance of risk. What's your view of the value of risk in this area?

Mark:            Risk is — anytime you intervene at all, you have to consider that there's some risk associated with your intervention. You don't want your intervention — you don't want the cure to be worse than the disease, as the saying goes. But I think it's very easy to be so risk-averse that you don't (try new things) or that you miss out on some really, really valuable and important new options that are out there.

                     Literally, for me, when I'm wanting to consider a new product, we've developed a network of clinicians and academicians that we can run some ideas by and kind of get a collective experience base (from). This is our data-tracking program also. The idea is that if we collaborate — say I see 100 cases in a year of a certain injury, and there's another practice that sees 100 in a year, and you get 10 practices (together). All of a sudden, if you've really worked together and compared notes and tracked your data, you've just gotten 10 times or more (of the original) experience base and an awful lot more objective (data). Because, hopefully, each of us — bias is also a really big problem in medicine in general. Hopefully, by having different perspectives, we really try to cancel out some of the bias as best as possible. But bias is also a really big factor, and one that we always have to try to keep in check.

                     That's a long answer for your risk question because, in order to calculate risk, you have to know what the risk is. In many instances, we really don't know. If you're talking about treating 10 cases and they all went well, that doesn't mean it's (necessarily) a safe thing to do. It means that one in 10 (of those cases), it's safe on. So, it's interesting. The industry is pivoting away from just looking at small numbers of cases in a perfect environment to getting bigger numbers of cases in a less-perfect environment. But just the sheer number of cases that you’re tracking, theoretically, will give us a better read on how safe, certainly, or effective a product is.

Tom:            Well, I'm wondering what you're seeing here. In your opinion, what are, as yet, (the) unrealized but achievable potentials of regenerative medicine in equine therapy?

Mark:            Well, what I've talked about today at my meeting (at the 2022 Alltech ONE Conference) were some of the common things that we have been using and continue to use. But there are — if you look into the real hardcore science, the regenerative field is going to be able to reproduce or recreate kidneys and things of that nature, which is really a completely different conversation than what I'm talking about at this stage. Really, it's kind of open season on where this whole thing can go. But it's important to say that just because it's new doesn't mean it's better. Like I said earlier, there's kind of a hyperbole or a hype that happens, and we really have to kind of keep ourselves in check — that we're not using a new product just because it's a new product.

Tom:            This interview is happening in Lexington, Kentucky. We bill ourselves as the horse capital of the world — and now, home of this year's Kentucky Derby phenomenon, Rich Strike. We will never let the world forget that. I'm betting you're quite familiar with many a clinic, barn and stable in this area.

Mark:            That's true.

Tom:            Dr. Mark Revenaugh, owner of Northwest Equine Performance in Mulino, Oregon, and a leading expert in the diagnosis and treatment of lameness and performance-related issues. Thank you so much for joining us.

Mark:            Thank you so much. It's been a pleasure.

Tom:            For the Alltech Ag Future podcast series, I'm Tom Martin. Thank you for joining us. Be sure to subscribe to Ag Future wherever you listen to podcasts.