Being the most abundant structural protein of vertebrates extracellular matrix, type-I collagen always aroused great interest in the field of life-science and bioengineering, thanks to its intrinsic favorable structural properties and bioactivity. Commonly used sources of collagen are represented by bovine and swine but the zoonosis transmission risks, the immune response and the religious constrain limited their use. Thus, type-I collagen isolated from horse recently gained increasing interest as an attractive alternative, so that, although bovine and porcine derived collagens still remain the most common ones, more and more companies started to bring to market several equine collagen-based products for healthcare applications. For this reason, in the last five decades equine collagen behavior and reactivity started to be in-depth studied in order to manufacture different types of medical products. Advanced investigation techniques (e.g. HPLC-MS, AFM, DSC, CD, TEM, WAXS, SAXS, FT-IR) allowed to highlight the peculiarities of this type of collagen compared to the others on the micro-, nano- and atomic scale and to control its hierarchical organization at all processing steps (from collagen extraction to the device final sterilization) in order to develop collagen-based devices with finely controlled application-related end-properties besides enhanced bioactivity. Thus, our aim is to stress the advantages and disadvantages deriving from the use of equine collagen for the manufacture of Tissue Engineering Medical Products (TEMPs)followed by a brief insight on the requirements that a medical device must meet before being commercialized, supported by our evidences and ten-years know-how. Lastly, clinical trials and current uses in the biomedical field will be argued.
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