Measurement of skin desmosine as an indicator of altered cutaneous elastin in draft horses with chronic progressive lymphedema

The Estimation of Genetic Parameters for Chronic Progressive Lymphedema and Body Traits in the Rhenish German Draught Horse

Chronic progressive lymphedema (CPL) is a prevalent and progressive disease in Rhenish German draught horses. The objective of our follow-up study was to evaluate the heritability of this disease in Rhenish German draught horses using pedigree-based and genomic relationship matrices. We employed linear and threshold animal models. Models included the random animal effect and effects of breeding association, coat colour, sex, and age within sex, and farm-related factors, on CPL scores. In addition, we estimated heritabilities in models assuming censoring for data when horses were below an age of 1-15 years. The heritabilities of CPL scores across all ages were 0.595 ± 0.131 and 0.482 ± 0.105 in the threshold and linear animal model with pedigree-based relationship matrices, respectively. The restriction of data to horses with a minimum age at examination or accounting for censored data in younger animals showed an increase in heritabilities of CPL scores up to 0.788 ± 0.168 (threshold model) and 0.752 ± 0.153 (linear model) at an age of 7-8 years. Analyses including genomic relationship matrices yielded very similar estimates, but with smaller standard errors than pedigree-based analyses. Heritabilities in threshold models for CPL prevalence (CPL-bin-score) and the number of affected limbs (CPL-bin-sum) were 0.176-0.189 ± 0.061-0.064 and 0.375-0.433 ± 0.164-0.170, respectively. We were able to show moderately to highly positive genetic correlations between the CPL score and cannon bone circumference (0.529-0.825), height at withers (0.338-0.555), and skinfold thickness (0.241-0.517). Using the dichotomous trait for the CPL score and the genomic relationship matrix resulted in corresponding estimates of 0.868, 0.793, and 0.784, respectively. This study showed the great importance of additive genetic variation influencing the expression of chronic progressive lymphedema in Rhenish German draught horses. Therefore, further research is warranted to implement breeding programmes in a small breeding population that exploit the potential of additive genetic differences among animals for reducing the prevalence and severity of lesions of this incurable disease.

Alleviating lesions of chronic progressive lymphedema in Belgian draft horses by successfully treating Chorioptes bovis infestation with moxidectin 0.5% pour-on

The aim of this prospective, randomized, single-blinded, and placebo-controlled clinical trial was to investigate the efficacy of a moxidectin pour-on solution for the treatment of Chorioptes bovis infestation in Belgian draft horses, and in addition, to evaluate the effect of this treatment on the clinical signs and lesions associated with chronic progressive lymphedema (CPL). Nineteen privately owned Belgian draft horses were randomly assigned to either a treatment group (moxidectin pour-on formulation, n = 10) or a placebo group (phosphate-buffered saline (PBS), n = 9). On Day 0, all 19 horses tested positive for the presence of C. bovis in superficial skin scrapings. Prior to treatment, all feathering on the distal limbs of the horses was clipped. Treatment was applied twice (Day 0 and 7). Pour-on moxidectin (Cydectin 0.5% Pour-On; Zoetis) was evenly distributed over the distal legs of the horses at a dose of 1.5 mg moxidectin/kg body weight. Animals in the placebo group were treated with PBS. Pretreatment and follow-up examinations consisted of counting living mites in superficial skin scrapings, scoring pruritus, and scoring mange-associated and CPL-associated lesions (skinfold score and skin lesion score). Horses in the placebo group and moxidectin group were followed up to 8 weeks and 24 weeks after the first treatment, respectively. On Day 14, no living mites were found in any of the horses in the moxidectin group (p = 0.013). These horses continued to remain free of mites, until the final sampling conducted at 24 weeks following the initial application of moxidectin, when three horses again showed living mites in skin scrapings. Treatment with moxidectin resulted in a significant reduction of both CPL-associated skin lesion scores (p = 0.003) and pruritus scores (p = 0.001) after only seven days. By Day 56, still no signs of pruritus (p < 0.0001) were detected, with significant improvement of mange-associated lesions (p < 0.0001). Although the skinfold score did not show a significant reduction by Day 56, the score for skin lesions associated with CPL had significantly improved (p < 0.0001). In conclusion, the results of this study demonstrate that pour-on moxidectin, at a high dose and applied directly to the mite predilection site, was an effective treatment for C. bovis infestation in feathered draft horses, providing positive effects on CPL lesions, pruritus and mange-associated lesions. Furthermore, these findings emphasize the therapeutic significance of addressing mange in the management of CPL-affected draft horses.

An Evaluation of Lymphedema Using Optical Coherence Tomography: A Rat Limb Model Approach

Lymphedema is a pathology caused by poor lymphatic flow which may lead to complete disability. Currently, precise, non-invasive techniques for quantifying lymphedema are lacking. In this paper, the results of an in vivo assessment of lymphedema via a developed small-animal model using the hindlimbs of rats and an optical coherence tomography (OCT) technique are presented. This model of lymphedema was based on a surgical lymph node resection and subsequent two-step X-ray exposure. The development of lymphedema was verified via the histological examination of tissue biopsies. The properties of the lymphedematous skin were analyzed in vivo and compared with healthy skin via OCT. The main differences observed were (1) a thickening of the stratum corneum layer, (2) a thinning of the viable epidermis layer, and (3) higher signal attenuation in the dermis layer of the lymphedematous skin. Based on the distribution of the OCT signal's intensity in the skin, a machine learning algorithm was developed which allowed for a classification of normal and lymphedematous tissue sites with an accuracy of 90%. The obtained results pave the way for in vivo control over the development of lymphedema.

Chronic Progressive Lymphedema in Belgian Draft Horses: Understanding and Managing a Challenging Disease

Chronic progressive lymphedema (CPL) in draft horses is characterized by increased dermal thickness and fibrosis, with the development of skinfolds and nodules, hyperkeratosis, and ulcerations on the distal limbs of affected horses. Secondary bacterial, fungal, or parasitic infections frequently complicate and aggravate the lesions, as well as the progression of this disease. CPL has a particularly high prevalence of up to 85.86% in the Belgian draft horse breed. Due to the disease's progressive and incurable nature, affected horses are often euthanized prematurely. The treatment options are solely symptomatic, aimed at improving the horse's quality of life. Despite the severity of this condition, many uncertainties about its etiology and pathogenesis still remain to date. The established scientific research on CPL is rather limited, although there is an urgent need for strategies to tackle this disease. This review summarizes the available knowledge, serving as a guideline for practitioners, and provides perspectives for future research programs.

Prevalence of Chronic Progressive Lymphedema in the Rhenish German Draught Horse

Chronic progressive lymphedema (CPL) is a common disease in Rhenisch German draught horses. The objective of our study was to evaluate the prevalence of this disease and its progression with age in 493 Rhenish German draught horses from different regions in Germany. We employed generalized linear models with binomial, multinomial, and normal distributions to analyse the effects of breeding association, coat colour, sex and age within sex, time of examination, limb on which CPL was recorded, and farm-related factors on disease scores. The occurrence and severity of CPL were significantly influenced by breeding area, sex, coat colour, and interaction of age by sex. Males had significantly higher CPL-scores than geldings (1.92-fold) and females (5.02-fold) as well as a faster (1.85-fold) disease progression per year of life than females (1.44-fold) and geldings (1.25-fold). Regression on age within sex was still significant when age was restricted to a minimum of 7 years in the analysis. Bay horses exhibited 1.77-fold and 2.19-fold higher CPL-scores than chestnut and black horses. Keeping horses on pasture and keeping bedding clean reduced CPL-scores, whereas feeding of hay silage and concentrates during winter increased CPL-scores. Our analysis revealed significant regression coefficients of cannon bone circumference on CPL-scores. Relationships with hoof measures and skinfold diameter at the neck were not found. In conclusion, differences among breeding districts and sexes by age had the largest impact on CPL prevalence and scores. Disease progression was evident up to a mean age of 16 years in males and 20 years in females. The identification of risk factors and their effects on CPL should help to reduce the occurrence and progression of CPL.

Chronic progressive lymphoedema in a Friesian horse: clinical aspects and diagnostic approach - case report

ABSTRACT Chronic Progressive Lymphoedema (CPL) is a disabling disease of draft horses that affects lymphatic system function typically in the distal limbs. Deformities of distal limbs, especially of the pastern, with fibrosis and skin nodular lesions are consequences of disease progression. A 15-year-old Friesian stallion presented for evaluation with history of forelimb enlargement and nodule formations distal to the carpus for four years. Simple radiographs showed soft tissue nodular lesions and venous contrasted radiography showed intense enlargement of II common digital palmar vein of both forelimbs. Tissue culture tests revealed Streptococcus equi and Proteus mirabilis isolation and skin scraping test identified Chorioptes bovis mites. Histological examination revealed perivasculitis and lymph vessels distention. History, clinical and histological findings, and complementary exams suggested CPL diagnosis. We were unable to find previously published cases describing this disease in Brazil, where the increasing number of draft horses requires attention to this problem. The correct and early diagnosis substantially delays disease progression. Therefore, we highlight the need for nationwide propagation of these data to ensure better diagnosis and early treatment of future CPL cases.

Local inhibition of elastase reduces EMILIN1 cleavage reactivating lymphatic vessel function in a mouse lymphoedema model

Lymphatic vasculature critically depends on the connections of lymphatic endothelial cells with the extracellular matrix (ECM), which are mediated by anchoring filaments (AFs). The ECM protein EMILIN1 is a component of AFs and is involved in the regulation of lymphatic vessel functions: accordingly, Emilin1^−/− mice display lymphatic vascular morphological alterations, leading to functional defects such as mild lymphoedema, lymph leakage and compromised lymph drainage. In the present study, using a mouse post-surgical tail lymphoedema model, we show that the acute phase of acquired lymphoedema correlates with EMILIN1 degradation due to neutrophil elastase (NE) released by infiltrating neutrophils. As a consequence, the intercellular junctions of lymphatic endothelial cells are weakened and drainage to regional lymph nodes is severely affected. The local administration of sivelestat, a specific NE inhibitor, prevents EMILIN1 degradation and reduces lymphoedema, restoring a normal lymphatic functionality. The finding that, in human secondary lymphoedema samples, we also detected cleaved EMILIN1 with the typical bands of an NE-dependent pattern of fragmentation establishes a rationale for a powerful strategy that targets NE inhibition. In conclusion, the attempts to block EMILIN1 degradation locally represent the basis for a novel ‘ECM’ pharmacological approach to assessing new lymphoedema treatments.

The EMILIN/Multimerin family

Elastin microfibrillar interface proteins (EMILINs) and Multimerins (EMILIN1, EMILIN2, Multimerin1, and Multimerin2) constitute a four member family that in addition to the shared C-terminus gC1q domain typical of the gC1q/TNF superfamily members contain a N-terminus unique cysteine-rich EMI domain. These glycoproteins are homotrimeric and assemble into high molecular weight multimers. They are predominantly expressed in the extracellular matrix and contribute to several cellular functions in part associated with the gC1q domain and in part not yet assigned nor linked to other specific regions of the sequence. Among the latter is the control of arterial blood pressure, the inhibition of Bacillus anthracis cell cytotoxicity, the promotion of cell death, the proangiogenic function, and a role in platelet hemostasis. The focus of this review is to highlight the multiplicity of functions and domains of the EMILIN/Multimerin family with a particular emphasis on the regulatory role played by the ligand-receptor interactions of the gC1q domain. EMILIN1 is the most extensively studied member both from the structural and functional point of view. The structure of the gC1q of EMILIN1 solved by NMR highlights unique characteristics compared to other gC1q domains: it shows a marked decrease of the contact surface of the trimeric assembly and while conserving the jelly-roll topology with two β-sheets of antiparallel strands it presents a nine-stranded β-sandwich fold instead of the usual 10-stranded fold. This is likely due to the insertion of nine residues that disrupt the ordered strand organization and forma a highly dynamic protruding loop. In this loop the residue E933 is the site of interaction between gC1q and the α4β1 and α9β1 integrins, and contrary to integrin occupancy that usually upregulates cell growth, when gC1q is ligated by the integrin the cells reduce their proliferative activity.

Equine clinical genomics: A clinician's primer

The objective of this review is to introduce equine clinicians to the rapidly evolving field of clinical genomics with a vision of improving the health and welfare of the domestic horse. For 15 years a consortium of veterinary geneticists and clinicians has worked together under the umbrella of The Horse Genome Project. This group, encompassing 22 laboratories in 12 countries, has made rapid progress, developing several iterations of linkage, physical and comparative gene maps of the horse with increasing levels of detail. In early 2006, the research was greatly facilitated when the US National Human Genome Research Institute of the National Institutes of Health added the horse to the list of mammalian species scheduled for whole genome sequencing. The genome of the domestic horse has now been sequenced and is available to researchers worldwide in publicly accessible databases. This achievement creates the potential for transformative change within the horse industry, particularly in the fields of internal medicine, sports medicine and reproduction. The genome sequence has enabled the development of new genome-wide tools and resources for studying inherited diseases of the horse. To date, researchers have identified 11 mutations causing 10 clinical syndromes in the horse. Testing is commercially available for all but one of these diseases. Future research will probably identify the genetic bases for other equine diseases, produce new diagnostic tests and generate novel therapeutics for some of these conditions. This will enable equine clinicians to play a critical role in ensuring the thoughtful and appropriate application of this knowledge as they assist clients with breeding and clinical decision-making.

Antibodies to elastin peptides in sera of Belgian Draught horses with chronic progressive lymphoedema

REASONS FOR PERFORMING STUDY

Chronic progressive lymphoedema (CPL) is a recently recognised disease of the lymphatic system characterised by lesions in the skin of the lower legs in several draught horse breeds, including the Belgian Draught hourse. Clinical signs slowly progress and result in severe disfigurement of the limbs. Ideally, supportive treatment should be started early in the disease process. However early diagnosis and monitoring progression of CPL is still a challenge.

HYPOTHESIS

Elastin changes, characterised by morphological alterations as well as increased desmosine levels, in the skin of the distal limbs of horses affected with CPL are probably associated with a marked release of elastin degradation products, which elicit production of circulating anti-elastin antibodies (AEAbs) in the serum. An enzyme-linked immunosorbent assay (ELISA) for detection of serum AEAbs may document elastin breakdown.

METHODS

An ELISA technique was used to evaluate levels of AEAbs in sera of 97 affected Belgian Draught horses that were clinically healthy except for possible skin lesions, associated with CPL in their distal limbs. The horses were divided into 5 groups according to the severity of these skin lesions: normal horses (Group 1, n = 36), horses with mild lesions (Group 2, n = 43), horses with moderate lesions (Group 3, n = 8), horses with severe lesions (Group 4, n = 10) and, as a control, healthy Warmblood horses, unaffected by the disease (Group 5, n = 83).

RESULTS

Horses with clinical signs of CPL had significantly higher AEAb levels compared to clinically normal Belgian Draught horses and to healthy Warmblood horses. These levels correlated with severity of lesions.

CONCLUSIONS

CPL in draught horses is associated with an increase of serum AEAbs.

POTENTIAL RELEVANCE

Evaluation of serum levels of AEAbs by ELISA might be a useful diagnostic aid for CPL. Pathological degradation of elastic fibres, resulting in deficient support of the distal lymphatics, is proposed as a contributing factor for CPL in Belgian Draught horses.

Emilin1 deficiency causes structural and functional defects of lymphatic vasculature

Lymphatic-vasculature function critically depends on extracellular matrix (ECM) and on its connections with lymphatic endothelial cells (LECs). However, the composition and the architecture of ECM have not been fully taken into consideration in studying the biology and the pathology of the lymphatic system. EMILIN1, an elastic microfibril-associated protein, is highly expressed by LECs in vitro and colocalizes with lymphatic vessels in several mouse tissues. A comparative study between WT and Emilin1-/- mice highlighted the fact that Emilin1 deficiency in both CD1 and C57BL/6 backgrounds results in hyperplasia, enlargement, and frequently an irregular pattern of superficial and visceral lymphatic vessels and in a significant reduction of anchoring filaments. Emilin1-deficient mice also develop larger lymphangiomas than WT mice. Lymphatic vascular morphological alterations are accompanied by functional defects, such as mild lymphedema, a highly significant drop in lymph drainage, and enhanced lymph leakage. Our findings demonstrate that EMILIN1 is involved in the regulation of the growth and in the maintenance of the integrity of lymphatic vessels, a fundamental requirement for efficient function. The phenotype displayed by Emilin1(-/-) mice is the first abnormal lymphatic phenotype associated with the deficiency of an ECM protein and identifies EMILIN1 as a novel local regulator of lymphangiogenesis.

Evaluation of the rate of development of septic arthritis after elective arthroscopy in horses: 7 cases (1994–2003)

OBJECTIVE

To determine the rate of development of septic arthritis after elective arthroscopy and evaluate associations between various factors and development of this complication in horses.

DESIGN

Retrospective case series.

ANIMALS

682 horses that underwent arthroscopic procedures at the University of Illinois Veterinary Teaching Hospital from 1994 to 2003.

PROCEDURES

Information pertaining to signalment, joints treated, whether antimicrobials were administered, and development of postoperative septic arthritis was collected from medical records. Horses with a primary problem of septic arthritis or wounds involving joints were excluded. The following factors were evaluated to determine their roles in joint sepsis: breed, sex, joint, and preoperative and intra-articular administration of antimicrobials. Telephone interviews with clients were used to determine whether unreported septic arthritis had developed.

RESULTS

8 of 932 (0.9%) joints in 7 of 682 (1.0%) horses that underwent arthroscopy developed postoperative septic arthritis. Follow-up information after discharge from the hospital was available for 461 of the 682 horses, and of those, 8 of 627 (1.3%) joints in 7 of 461 (1.5%) horses developed septic arthritis. Breed and joint treated were significant risk factors for development of postoperative septic arthritis, with draft breeds and tibiotarsal joints more likely than others to be affected. Sex, preoperatively administered antimicrobials, and intra-articularly administered antimicrobials were not associated with development of postoperative septic arthritis.

CONCLUSIONS AND CLINICAL RELEVANCE

Results can be used for comparison with data from other institutions and surgical facilities. Additional precautions should be undertaken when arthroscopic surgery involves draft breeds and tibiotarsal joints.