ALPHA 2 MACROMOLECULE (α2M) 

Alpha 2EQ is one of the most effective steroid free, intra articular therapies available for equine arthritis.  It concentrates the alpha 2 macromolecule (A2M) from the blood. When this enzyme is injected into inflamed or traumatized joints it anti-inflammatory actions effectively stop the inflammatory process and secondary cartilage breakdown and slows the progression of arthritis.

Alpha 2EQ isolates, and concentrates by filtration, the Alpha 2 macromolecule (α2M). This macromolecule is then used as a molecular intervention in joints affected by osteoarthritis. Osteoarthritis is a common term used to describe degenerative changes of the joint that ultimately result in pain and limited motion of the joint. It is a common sequel to joint injury or repetitive trauma.  This trauma and injury results in an upregulation (increased production) and release of proteases, pro-inflammatory cytokines and catabolic (breakdown) genes which cause the release of multiple inflammatory mediators (including interleukin-1 (IL-1) and tumor necrosis factor (TNF-αt)t hat cause extracellular matrix breakdown, resulting in articular cartilage damage and loss and joint injury.  Unchecked, this cycle continues in an ever-worsening spiral of cartilage damage and loss, and joint injury resulting in bony changes and pain. Targeting the catabolic enzymes can potentially stop these adverse events and preserve joint health

The Alpha 2 Macromolecule stops this inflammatory cycle and removes the catabolic enzymes responsible for damaging the cartilage.  Α2M is a large, acute phase protein synthesized mainly by the liver.  There is a small amount of production by the synoviocytes (synovial membrane cells) within the joints, but the volume is negligible.  Most of the molecule is circulating in the horse’s blood stream.  The molecule itself moves around the bloodstream in an ‘open’ fashion.  When it comes in contact with an inflammatory protein it folds the protein within itself, creating a cage around the inflammatory protein.  The α2M ‘cage’ together with the trapped protein are removed from circulation by the body.  If this occurs within the joint, they are removed from the joint.  The α2M molecule, by binding to and removing these proteins, functions to  

  • Bind and inhibit

    • all 4 classes of proteases 

    • matrix metalloproteinases (MMP)

    • disintegrin and metalloproteinase thrombospondin motif (ADAMTS),

  • modulate cytokines;  including  interlukion-1 (IL-1) and tumor necrosis factor α (TNFα).  Both negative components of the inflammatory process

The molecule also up regulates the anabolic (regenerative) processes including the gene expression of cartilage matrix proteins.  It also down regulates the catabolic (break down, degradation) processes

A2M has been approved by the FDA and used in human treatment for back/disc pain since 2013.  Since then, it has now been investigated in the treatment of tumors, sepsis, neurodegenerative diseases, and general osteoarthritis in people.  Due to its success in people, it has been evaluated in horses for its ability to target and remove the catabolic enzymes associated with inflammation and trauma and for its ability to potentially arrest these adverse events and preserve joint health in horses. The studies have proven it to be highly effective and safe

Alpha 2EQ can be processed and injected on site in one treatment, often requiring less than an hour. The horses’ blood is drawn and processed on site through centrifugation to isolate the platelet poor plasma.  This is then filtered to yield a solution containing over 95% of  α2M. The remaining 5% may contain a small amount of albumin.  One blood draw and sample processing yields on average 30-35ml of concentrated α2M.  This may be injected into as many joints as required.  There is no limitation due to final steroid volume because the product is injected steroid free.

Its anti-inflammatory effects are seen within 3-5 days, similar to the joints response to steroid injection; but there are no negative side effects to the cartilage.   The inflammatory process is shut down and inflammatory products removed from the joint itself by the A2M.  The actual volume of α2M yielded from the blood draw depends upon the amount of circulating α2M in the bloodstream.  To increase the circulating volume, NSAIDS (Banamine, Phenylbutazone or Equioxx) should not be used for 3 days prior to the sampling.  Lite exercise may increase the volumes, but strong work should be avoided just prior to sample collection since that, like NSAIDS, will drop the circulating blood levels of α2m.

Any volume not administered at the time of processing can be frozen and injected into the necessary joints later, when required.  The frozen sample remains effective for up to 1 year; however it loses all effectiveness if it is thawed and refrozen.  It must be kept frozen in a sterile environment until its next use.

The potent anti-inflammatory properties of A2M have proven to be highly effective in treating synovitis of any duration (acute or chronic) in all the joints from the distal interphalangeal joint (coffin) joint to the sacro-iliac joints in the pelvis.  The clinical results have been a quick, massive resolution of synovial effusion.  Less than 10% of the horses treated in the studies required a second treatment to gain effect.  The lameness grades, flexion grades and synovitis grades improved more than 1 grade; better than either PRP or steroid treated joints.  The molecule can also be used to treat synovial sheath effusions and soft tissue inflammation in flexor tendons and suspensory ligaments. Joints with early cartilage disease also benefit from the highly concentrated molecule volumes that upregulate the cartilage matrix proteins while removing the proinflammatory mediators and creating a healthy environment to regenerate.  

We have been pleased with our patients’ responses to A2M treatments and are pleased to be able to offer a highly effective anti-inflammatory, intra-articular treatment that facilitates cartilage health and eliminates all negative side effects associated with steroid treatments and their competition withdrawal times.  If you have any questions or think your horse would benefit from Alpha 2EQ please contact Henderson Equine Clinic.  You may also visit the ASTARIA global website at https://astariaglobal.com for more information