Prevalence and risk factors for hyperinsulinaemia in ponies in Queensland, Australia

Sodium-glucose transport protein 2 inhibitor use in the management of insulin dysregulation in ponies and horses

Laminitis is a common and painful condition of the equine foot and approximately 90% of cases are associated with insulin dysregulation (ID) that is a central feature of the common endocrine disorder equine metabolic syndrome (EMS) and occurs in a subset of animals with pituitary pars intermedia dysfunction. Additional features of EMS include obesity, altered circulating concentrations of adipokines (particularly adiponectin and leptin) and hypertriglyceridaemia. Obesity, ID, hypoadiponectinaemia, hyperleptinaemia and an altered plasma lipid profile are also features of human metabolic syndrome (HMS) alongside hyperglycaemia. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are a novel class of oral hypoglycaemic agents used in combination with lifestyle changes in the management of HMS. SGLT2 receptors are responsible for 90% of the renal glucose reabsorption that occurs in the proximal convoluted tubule. Thus, these drugs increase urinary glucose excretion by suppressing glucose reabsorption from the glomerular filtrate resulting in urinary calorie loss with consequent weight loss and improvements in ID, hyperglycemia, hypoadiponectinaemia and hyperleptinaemia. There are no licenced veterinary drugs available for treating ID and preventing insulin-associated laminitis in horses. Thus, the use of SGLT2i for the control of equine hyperinsulinaemia with the goal of improving recovery from associated active laminitis or preventing future laminitis has recently been advocated. There are a small number of published studies reporting the use of the SGLT2i canagliflozin, ertugliflozin and velagliflozin to aid the management of equine ID. However, the doses used are largely extrapolated from human studies with limited consideration of species-specific variations. In addition, there is limited evaluation of the fundamental differences between ID in horses and humans, particularly the fact that most horses with ID remain hyperinsulinaemic but normoglycaemic such that increased urinary loss of glucose may not explain the beneficial effects of these drugs. Further study of the potential deleterious effects of treatment-associated hypertriglyceridaemia is required together with the effect of SGLT2i therapy on circulating concentrations of adipokines in horses.

Value of measuring markers of lipid metabolism in horses during an oral glucose test

BACKGROUND

Characterizing the lipid response to an oral glucose test (OGT) might improve our understanding of Equine Metabolic Syndrome.

HYPOTHESIS/OBJECTIVES

To describe the effects of an OGT on lipid metabolism and determine the value of measuring triglyceride and nonesterified fatty acid (NEFA) concentrations in hyperinsulinemic (HI) and insulin-resistant (IR) horses.

ANIMALS

Twenty horses including 7 HI-IR horses, 4 HI-non-IR horses, and 9 non-HI-non-IR horses (control).

METHODS

Cross-sectional design. Horses underwent an OGT, with blood samples collected at 0, 60, 90, and 120 minutes. Insulin, glucose, triglyceride, and NEFA concentrations were measured and compared over time and between groups, with P < .05 considered significant.

RESULTS

In all horses, the OGT had a significant effect on triglyceride concentrations (median [interquartile range]: .35 [.30-.50] mmol/L at 0 minute vs .25 [.21-.37] mmol/L at 120 minutes, P = .005) and on NEFA concentrations (.1 [.1-.2] mEq/L at 0 minute vs .05 [.05-.1] mEq/L at 120 minutes, P = .0009). However, horses with HI and IR had higher triglyceride areas under the curve (AUC, 79.46 ± 46.59 vs 33.32 ± 6.75 mmol/L*min, P = .01) as well as NEFA AUC (9.1 ± 2.9 vs 6.0 ± 6.8 mEq/L*min, P = .03) than control horses. No significant difference was detected between control and HI non-IR horses.

CONCLUSIONS AND CLINICAL IMPORTANCE

Determining triglyceride and NEFA concentrations might help assess tissue insulin resistance during an OGT.

Studies in vitro of equine intestinal glucagon-like peptide-2 secretion

Equine insulin dysregulation (ID) is a significant metabolic problem because the hyperinsulinaemia that develops increases the animal's risk of developing laminitis, a debilitating foot condition. The role of gastrointestinal factors, such as incretin hormones, in the pathogenesis of ID and hyperinsulinaemia in horses is poorly understood, particularly in comparison to other species. Glucagon-like peptide-2 (GLP-2) is an intestinotrophic peptide released from L cells in the gastrointestinal tract and is implicated in metabolic dysfunction in other species. The aim of this study in vitro was to establish basic physiological understanding about intestinal secretion of GLP-2 in horses. Basal and glucose-stimulated GLP-2 secretion was measured in post-mortem tissue samples from the duodenum, jejunum, and ileum. We observed that GLP-2 secretion was minimal in samples from the duodenum compared to the jejunum and ileum (5-9-fold higher; P < 0.05). Furthermore, GLP-2 secretion was not responsive to glucose stimulation in the ileum or duodenum but was responsive to glucose in the jejunum. This effect in the jejunum was inhibited by 30 % (P = 0.02) using phlorizin, a selective sodium-glucose cotransporter-1 (SGLT-1) inhibitor, and by 38 % (P = 0.04) using phloretin, a non-selective SGLT-1/GLUT-2 inhibitor. The localisation of glucose-responsive GLP-2 secretion in the jejunum might be relevant to the development of post-prandial hyperinsulinaemia. This study has provided data on GLP-2 secretion from the equine small intestine that will enable more complex and dynamic studies on the pathogenesis of ID.

Obesity and gestation in Criollo mares: endocrine and metabolic profiles

The aim of this study was to determine the effect of body condition score (BCS) on metabolic and endocrine parameters in pregnant Criollo mares (n=41), which were categorized according to their BCS as obese (7 to 9 BCS, n=26) or normal (5 to 7, n=15). Blood samples were taken during gestation in 3 periods: between 3.5 and 5 months (I), 8 and 9 months (II) and in the last month of gestation (III). The data was analyzed in the statistical model by mixed procedures, including BCS, gestational period and their interaction as fixed effects. BCS was only different in period I, as normal mares increased their BCS in the later periods. Leptin concentrations were greater in obese mares when compared to non-obese mares during all sampling periods (P<0.01), while glucose concentrations were also greater in the former group (P<0.01) but only during the first sampling period. Insulin concentrations and homeostatic model assessment for insulin resistance (HOMA-IR) index were greater also in obese mares in periods I and III (P<0.05). Adiponectin concentrations in period I were lower in obese mares (P<0.05). Cholesterol concentrations increased during gestation, and obese mares tended to have greater concentrations than nonobese mares (P<0.1). Triglyceride concentrations were not affected by group or gestational period. This study revealed adaptations in carbohydrate and lipid metabolism during gestation in mares. Several parameters are dependent on the degree of body fat reserves, which are reflected in the concentrations of biomarkers such as leptin and adiponectin. Insulin concentration in obese mares was higher than non-obese mares at the end of gestation, a similar profile was observed for HOMA-IR although cutoff values are yet still to be validated.

Factors associated with insulin responses to oral sugars in a mixed-breed cohort of ponies

BACKGROUND

Serum insulin concentration at 60 min (InsulinT60) during an oral sugar test (OST) indicates future laminitis risk and insulin dysregulation (ID). Associations between InsulinT60 and physical and owner-reported variables may help clinicians select individuals for ID testing. Associations between InsulinT60 and other metabolic markers may help elucidate ID pathophysiology.

OBJECTIVES

To describe associations between (A) season, physically-apparent and owner-reported factors and binary InsulinT60 interpretation (initial models) and (B) variables included in the initial models, other metabolic markers and continuous InsulinT60 (full models).

STUDY DESIGN

Prospective longitudinal.

METHODS

Non-laminitic ponies were examined and OSTs (0.3 mL/kg Karo syrup) performed every 6 months (autumn and spring) for ≤4 years. Factors associated with InsulinT60 were determined using mixed-effects models with physical, owner-reported, season and serum/plasma markers as fixed effects and pony and premises identifiers as random effects. Autumn and spring data were analysed separately for full models.

RESULTS

One thousand seven hundred and sixty-three OSTs from 367 ponies were included. High-risk InsulinT60 (>153 μIU/mL) was independently associated with (odds ratio, 95% confidence interval [CI]): age (1.36, 1.16-1.60), body condition score (BCS) (2.38, 1.21-4.69), and bulging supraorbital fatpads (7.25, 2.1-24.98). However, the initial models provided little explanatory power (Nakagawa R2  = 0.1-0.27). LoginsulinT60 was independently associated with (effect estimate, 95% CI): age (0.02, 0.01-0.04), Welsh/Welsh X breed (0.22, 0.05, 0.39), sex (gelding = -0.2, -0.34 to 0.06), BCS (0.16, 0.08-0.23), plasma adiponectin (-0.02, -0.02 to 0.01) and basal insulin (0.01, 0.01-0.01) in spring, and: age (0.03, 0.02-0.04), BCS (0.17, 0.08-0.26), bulging supraorbital fatpads (0.37, 0.2-0.54), turnout score (0.05, 0.02-0.09), plasma adiponectin (-0.01, -0.02 to 0.01), ACTH (per 10 pg/mL) (0.01, 0.00-0.01), triglycerides (0.28, 0.07-0.49) and InsulinT0 (0.01, 0.01-0.01) in autumn.

MAIN LIMITATIONS

Only non-laminitic ponies in one region were included.

CONCLUSIONS

Owner-reported and physically-apparent data were limited InsulinT60 predictors. InsulinT60 is a complex trait, independently associated with numerous variables, some with seasonal interactions.

Epidemiological investigation of insulin dysregulation in Shetland and Welsh ponies in Australia

BACKGROUND

Insulin dysregulation (ID) is central to equine metabolic syndrome. There are limited epidemiological studies investigating dynamic testing of ID in ponies.

OBJECTIVES

To evaluate prevalence and risk factors for ID through dynamic testing of hyperinsulinaemia (DHI) and insulin resistance (IR).

STUDY DESIGN

Cross-sectional.

METHODS

Sex, age, breed, height, cresty neck score (CNS), body condition score (BCS), laminitis, HMGA2:c.83G>A genotype and pituitary pars intermedia dysfunction (PPID) status were documented. Dynamic hyperinsulinaemia was diagnosed with an oral sugar test (OST) and IR with an insulin tolerance test (ITT). Owners completed surveys reporting activity, laminitis history and perception of body condition using a (1-9) visual analogue scale (VASo). Ordinal scores were converted to binary outcomes for CNS (≤2/5 or ≥3/5), BCS and VASo (≤6/9 or ≥7/9). Variables associated with insulin concentrations, glucose reduction after the ITT and laminitis were evaluated with mixed effects regression models accounting for random effects of farms.

RESULTS

Among 167 ponies tested, median (range) age was 9 (4-21) years and BCS was 6 (4-8). Prevalence (95% confidence interval [CI]) of ID was 61 (53-68)%. Factors associated with insulin concentrations (estimate [95% CI]; μIU/mL) 60 min post-OST were: age (1.07 [1.02-1.11]), CNS (≥3/5, 1.52 [1.04-2.23]) and VASo (≥7/9, 1.75 [1.09-2.79]); and 90 min post-OST were: age (1.08 [1.03-1.12]), CNS (≥3/5, 1.80 [1.22-2.64]), VASo (≥7/9, 2.49 [1.52-4.08]) and sex (male, 0.64 [0.45-0.91]). Factors associated with glucose reduction after the ITT (estimate [95% CI]; %) were: age (-1.34 [-2.01 to -0.67]), sex (female, -6.21 [-11.68 to -0.74]) and VASo (≥7/9, -1.74 [-18.89 to -4.78]). Factors associated with laminitis (odds ratio [95% CI]) were DHI (4.60 [1.68-12.58]), IR (3.66 [1.26-10.61]) and PPID (11.75 [1.54-89.40]).

MAIN LIMITATIONS

Single time-point sampling, laminitis definition and diet analysis.

CONCLUSIONS

Ageing, being female and owner-perceived obesity were associated with ID.

Genome-wide association study suggests genetic candidate loci of insulin dysregulation in Finnhorses

Equine metabolic syndrome (EMS) is a common welfare problem in horses worldwide. It is characterized by insulin dysregulation (ID), predisposition to laminitis and often obesity. EMS is multifactorial by nature, with both the environment and genetics contributing to the phenotype. Environmental factors, such as feeding and exercise, can be controlled, thus forming the basis for treatment and prevention. Genetic factors, by contrast, are less well-known and not easily controllable. The aim of this study was to identify potential genetic loci influencing ID/EMS in Finnhorses. A single-breed (Finnhorse) case-control genome-wide association study (GWAS) of ID was conducted with controls that included age-appropriate non-ID horses. ID status was determined with an oral sugar test (OST) for fasted horses. Seventy-one Finnhorses participated (n = 34 ID, n = 37 control). DNA samples (hair roots) were genotyped for 65 157 single-nucleotide polymorphisms (SNPs) with the Illumina Equine SNP70 BeadChip, and these data were analysed for association and FST outliers with genomic tools. P-values that exceeded the suggestive threshold (P = 1.00 ×10-5) were found in SNP BIEC2_383954 (P = 3.45 ×10-6) in chromosome 17 and SNP BIEC2_312374 (P = 1.89 ×10-5) in chromosome 15. Hierarchical and Bayesian FST outlier tests also detected these SNPs. Potential candidate genes associated with the ID close to SNP BIEC2_383954, with functions in carbohydrate metabolism, were Arginine and Glutamate Rich 1 (ARGLU1) and Ephrin-B2 (EFNB2).

Development of a Web App to Convert Blood Insulin Concentrations among Various Immunoassays Used in Horses

The measurement of the blood insulin concentration, and comparison to cut-offs, is essential in diagnosing insulin dysregulation, a common equine endocrinopathy. However, different insulin assays provide disparate results. We aimed to ease comparison between assays by compiling original and published data into a web app to convert insulin measurements from one assay to another. Data were available for ADVIA Centaur insulin chemiluminescent immunoassay (CLIA), Beckman Coulter insulin radioimmunoassay (RIA), Immulite 1000 CLIA, Immulite 2000 CLIA, Immulite 2000 XPi CLIA, Mercodia equine insulin enzyme-linked immunosorbent assay (ELISA), and Millipore porcine insulin RIA. Linear models were fitted for 13 assay pairs using non-decreasing splines, and integrated into this app. Assay comparisons including data from several studies showed a lower performance. This indicates technical variation between laboratories, which has not been described before, but is relevant when diagnostic measurements and cut-offs are provided by different laboratories. Nevertheless, the models' overall high performance (median r2 = 0.94; range 0.57-1.00) supports their use to interpret results from diagnostic insulin measurements when the reference assay is unavailable, and to compare values obtained from different assays.

Occurrence of equine metabolic syndrome, clinical manifestations, and associated risk factors in Nigeria

Insulin dysregulation (ID) is central to the pathophysiology of equine metabolic syndrome (EMS), putting the horse at risk of laminitis. There is a paucity of information on the status of EMS in Nigeria. This study aimed to determine the occurrence of EMS, clinical manifestations, and associated risk factors in Nigeria. A cross-sectional study was carried out. Selected horses underwent an insulin 2-step response test to ascertain insulin dysregulation; a physical examination was carried out to diagnose laminitis and obesity. Risk factors were assessed using a questionnaire. The overall prevalence of EMS was 43.10%. Breed and sex were significantly associated with EMS, but age was not. Horses diagnosed with laminitis showed two signs of laminitis, namely, divergent hoof rings and widened white lines. Risk factors significantly associated with the prevalence of EMS were as follows: being a West African Barb horse (60.00%), being a stallion (67.86%), being a leisure horse (67.86%), only walking horses during exercise (68.00%), exercising horses once every 5 months (82.76%), tethering horses to a stake in the ground (67.86%), obesity (92.86%), and abnormal neck crest (83.33%). The risk of ID remains higher in obese horses. However, some of the horses with ID were not obese, indicating that there are other possible underlying causes of EMS.

Evaluation of an HMGA2 variant contribution to height and basal insulin concentrations in ponies

BACKGROUND

The HMGA2:c.83G>A variant was identified in Welsh ponies having pleiotropic effects on height and insulin concentration.

OBJECTIVE

Determine whether the HMGA2:c.83G>A variant is associated with decreased height and higher basal insulin concentrations across pony breeds.

ANIMALS

Two hundred thirty-six ponies across 6 breeds.

METHODS

Cross-sectional study. Ponies were genotyped for the HMGA2:c.83G>A variant and phenotyped for height and basal insulin concentrations. Stepwise regression was performed for model analysis using a linear regression model for height and mixed linear model for insulin with farm as a random effect. Coefficient of determination, pairwise comparison of the estimated marginal means and partial correlation coefficients (parcor) were calculated to assess the relationship between HMGA2 genotype and height or insulin.

RESULTS

Breed and genotype accounted for 90.5% of the variation in height across breeds, and genotype explained 21% to 44% of the variation within breeds. Breed, genotype, cresty neck score, sex, age, and farm accounted for 45.5% of the variation in insulin, with genotype accounting for 7.1%. The HMGA2 A allele frequency was 62% and correlated with both height (parcor = -0.39; P < .001) and insulin (parcor = 0.22; P = .02). Pairwise comparisons found A/A ponies were >10 cm shorter than other genotypes. Compared with G/G individuals, A/A and G/A individuals had 4.3 μIU/mL (95% confidence interval [CI]: 1.8-10.5) and 2.7 μIU/mL (95% CI: 1.4-5.3) higher basal insulin concentrations, respectively.

CONCLUSIONS AND CLINICAL IMPORTANCE

These data demonstrate the pleiotropic effects of the HMGA2:c.83G>A variant and its role in identifying ponies at increased risk for insulin dysregulation.

The effects of obesity and insulin dysregulation on mare reproduction, pregnancy, and foal health: a review

Obesity is a growing welfare concern in modern equine populations and predisposes horses to disturbances in energy metabolism such as insulin dysregulation. However, equine metabolic syndrome has only been recognized in recent decades. Functioning energy metabolism is pivotal to normal body homeostasis and affects essentially all organ systems, including reproduction. Previous literature suggests that obesity has an effect not only on the reproductive processes in mares but also on offspring health, predisposing the offspring to later-onset orthopedic and metabolic problems. This review focuses on the effects of obesity, insulin dysregulation and hyperinsulinemia on the reproductive functions of mares and the implications on foal health before and after birth. The points of interest are the cyclicity and ovarian function, uterine environment, gestation, the postpartum period, and the newborn foal. The aim is to review the current state of knowledge, and identify outstanding questions that could stimulate future research. This topic is important not only from the equine industry and production perspective but is also relevant for the welfare of future populations and individuals.

Survey of the knowledge and perceptions of horse owners in Ireland of common clinical conditions and their impact

BACKGROUND

As the primary decision-maker for their horse's health and welfare, owners' knowledge of clinical conditions may impact their horse's health. Anecdotal evidence suggests that the emotional impact of equine illness on the owner can be severe but research is lacking.

OBJECTIVES

To evaluate horse owners' self-declared knowledge of eight common equine health conditions and perceptions of the quality of information available; to ascertain respondents' perceptions of the severity of impact on their horse of the conditions and potential emotional impact on themselves and to establish the factors of greatest concern to owners when their horse has a health condition and influential factors on end-of-life decisions.

STUDY DESIGN

Online survey of horse owners.

METHODS

An online survey comprising three sections was created: respondent demographics; vignettes of clinical conditions; concerns and decision-making regarding illness and euthanasia. Vignettes focused on arthritis; Pars Pituitary Intermedia Dysfunction; Equine Metabolic Syndrome (EMS); gastric ulcers; high intestinal worm burden; dermatophilosis ('mud rash'); quidding and head tossing; and equine asthma. Respondents were self-selecting. The survey was circulated for completion by horse owners residing in Ireland and Northern Ireland obtaining 491 valid responses.

RESULTS

Respondents declared that they had the highest knowledge of mud rash, with 84.1% rating their knowledge as very good compared to 42% of respondents for EMS. There was positive correlation between the perceived impact on their horse and emotional impact on the owner for all conditions ranging from weak (arthritis 0.36, P < 0.001) to strong (EMS 0.62, P < 0.001). Pain, discomfort, and quality of life were reported as the most common concerns when their horse has a medical condition or when considering euthanasia.

MAIN LIMITATIONS

Potential bias among respondents towards computer literate owners, with good literacy and interest in equine health conditions.

CONCLUSIONS

Knowledge of equine health conditions, perceived impact of conditions on the horse and emotional impact on their owners varied significantly between conditions.

Effect of Dose and Fasting on Oral Sugar Test Responses in Insulin Dysregulated Horses

The oral sugar test (OST) is frequently used to identify insulin dysregulated (ID) equines. The effect of fasting and varying sugar dose for the OST has been investigated in the pony but little work has been done in the horse. This study aimed to investigate (1) an OST response with access to forage continued until the time of the OST or prevented for 3 hours prior to the OST and (2) responses of ID and non-insulin dysregulated (NID) horses to two different OST doses. Twenty-one mixed-breed horses (14.8 ± 3.2 years; 574.3 ± 83.3 kg) were used in two randomized crossover studies. Seven ID and seven NID horses were used in study A, and eight ID and eight NID in study B. Study A horses underwent an OST (0.15 mL/kg BW) either after a fast (FA) or directly off pasture (FE). Study B horses received either a low (LD; 0.15 mL/kg BW) or high dose (HD; 0.45 mL/kg BW) OST on one occasion each. Blood was collected at basal (T0), and post-60 minute (T60) for later determination of insulin (RIA). Data were analyzed via ANOVA with repeated measures. ID horses had significantly (P < 0.05) greater insulin responses than NID for all OSTs. There was no statistical difference between LD versus HD mean insulin concentrations (T0, T60, delta insulin) for either ID or NID horses. ID had higher T0 (P < 0.01) for FE compared to FA; however, FE and FA did not significantly affect T60 or delta insulins (DI) concentrations.

Variation in insulin response to oral sugar test in a cohort of horses throughout the year and evaluation of risk factors for insulin dysregulation

BACKGROUND

The oral sugar test (OST) is commonly used to diagnose insulin dysregulation (ID) and equine metabolic syndrome; however, possible seasonal changes in OST results have not been evaluated.

OBJECTIVE

To determine the possible variation in insulin response to OST throughout the year and risk factors associated with maximum insulin concentration (InsMax) and ID.

STUDY DESIGN

Prospective, longitudinal cohort study.

METHODS

The OST was performed on 29 Finnhorses every other month six times. Serum total adiponectin concentration and phenotypic variables related to obesity were also measured. Changes in InsMax, adiponectin, scale weight, body condition score, cresty neck score (CNS), and fasting glucose concentration were assessed. Risk factor analyses were performed on InsMax and ID status, and ID groups were compared with each other.

RESULTS

Fourteen horses were categorised with non-ID each time and 15 as having ID at least once during the follow-up period. The ID status of 12 horses varied throughout the year, but neither the insulin variables measured during the OST nor adiponectin expressed significant seasonal variation. Increasing age and CNS, and decreasing adiponectin were observed as risk factors for a high InsMax after OST. The risk of ID was higher in horses with no exercise compared to horses with exercise (OR 7.6, 95% CI 1.2-49.3, P = .03). Horses with ID had lower serum adiponectin concentrations, longer neck circumference and larger height than horses in the non-ID group.

MAIN LIMITATIONS

The environmental conditions (feeding, exercise) were not constant for all horses throughout the study and only one breed was used.

CONCLUSIONS

Neither OST results nor adiponectin varies with season; however, there were a substantial number of horses with variable ID status throughout the year, in which repeated OSTs may be beneficial. Lack of exercise was a risk factor for ID.

Endocrinopathic Laminitis

Endocrinopathic laminitis (EL) primarily occurs because of insulin dysregulation (ID) mediated through downstream effects of insulin on IGF-1R in lamellar tissues. There is likely contributing vascular and metabolic dysfunction within the lamellae, but EL is relatively non-inflammatory. EL is associated with lamellar stretching, proliferation, and failure, ultimately causing failure of the suspensory apparatus of the distal phalanx. Proper education regarding mitigating risk factors makes this a largely preventable cause of laminitis. Annual hoof evaluation plus screening geriatric horses for pituitary pars intermedia dysfunction and ID, and younger horses for ID, can significantly decrease the incidence of this devastating condition.

The Influence of Diet Change and Oral Metformin on Blood Glucose Regulation and the Fecal Microbiota of Healthy Horses

Simple Summary

Horses are susceptible to a condition known as Equine Metabolic Syndrome (EMS), which is somewhat similar to metabolic syndrome and type II diabetes in people, and is characterized by elevated insulin levels and increased susceptibility to other adverse health outcomes. Common treatments, including change to an all-hay diet and a drug called metformin, may provide benefits through modulation of intestinal bacteria, collectively known as the gut microbiota. In the studies reported here, horses undergoing such a diet change, regardless of the presence of metformin, showed a significant expansion in their fecal microbiota of a specific, poorly characterized group of bacteria. Notably, this phylum is distantly related to the bacteria found to expand in the fecal microbiota of mice and humans following metformin administration, suggesting removal from pasture to reduce the caloric intake may exert effects on the equine microbiota similar to those seen in other host species treated with metformin.

Abstract

Common treatments for Equine Metabolic Syndrome (EMS) and associated conditions include removal from pasture and adoption of an all-hay diet. Pharmacological treatments for EMS include metformin, a biguanide antihyperglycemic agent also administered to people to help improve glucose tolerance and insulin sensitivity. Both treatments may work, at least partially, through the gut microbiota, yet little is known regarding these effects in the equine host. To determine the influence on the fecal microbiota of this diet change and administration of metformin, six healthy horses were removed from pasture and switched to an all-hay diet, with four of those horses also receiving oral metformin for seven days. Control horses (n = 24) remaining on pasture and receiving no metformin were sampled at the beginning and end of one week. All samples were subjected to 16S rRNA sequencing, and horses undergoing the diet change were subjected to an oral sugar test twice, one week apart. Characteristic changes in the microbiota following diet change included the significant expansion of the phylum Kiritimatiellaeota. As Kiritimatiellaeota are related to Verrucomicrobia, found to expand in the microbiota of mice and humans in response to metformin, this taxon may represent the cognate microbes in equine hosts.

Changes Associated with the Peri-Ovulatory Period, Age and Pregnancy in ACTH, Cortisol, Glucose and Insulin Concentrations in Mares

Simple Summary

The reproductive cycle of mares is associated with many hormonal changes, but the effects of this cycle and pregnancy on adrenocorticotropic hormone and insulin concentrations are poorly described, which could limit our ability to diagnose pituitary pars intermedia dysfunction and insulin dysregulation. In this study, healthy mares are followed through their reproductive cycle during the physiologic breeding season, and adrenocorticotropic hormone, cortisol, glucose and insulin concentrations are measured to determine the effects of age, pregnancy and the reproductive cycle on analyte concentrations. No significant effect of age, the reproductive cycle or pregnancy is detected on the cortisol, glucose or insulin concentrations; however, adrenocorticotropic hormone concentrations are significantly increased throughout the peri-ovulatory period and during pregnancy. Therefore, knowledge of a mare’s reproductive cycle might be beneficial when interpreting adrenocorticotropic hormone concentrations.

Abstract

Although there are many hormonal changes associated with reproduction, the effects of ovulation and early pregnancy on adrenocorticotropic hormone (ACTH) and insulin concentrations are poorly described. We hypothesise that both ovulation and early pregnancy will alter ACTH and insulin concentrations in healthy mares. Eighteen mares showing no clinical signs suggestive of, or laboratory findings consistent with, pituitary pars intermedia dysfunction PPID and insulin dysregulation (ID) are enrolled. ACTH, cortisol, insulin and glucose concentrations are measured over their peri-ovulatory period, as determined via ultrasounds and progesterone concentrations. The mares are grouped by age and gestation status, and a two-way repeated-measures ANOVA is used to determine the effects of age and early pregnancy, along with the peri-ovulatory period, on analyte concentrations. No significant effect of age, ovulation or early pregnancy is detected on the mares’ cortisol, insulin or glucose concentrations; however, there is a significant effect of early pregnancy and ovulation on ACTH concentrations (p = 0.04 and p = 0.04 respectively). ACTH concentrations change around ovulation and with early pregnancy. Therefore, knowledge of a mare’s reproductive status might be beneficial when interpreting ACTH concentrations.

Metabolic impact of weight variations in Icelandic horses

Background

Insulin dysregulation (ID) is an equine endocrine disorder, which is often accompanied by obesity and various metabolic perturbations. The relationship between weight variations and fluctuations of the insulin response to oral glucose tests (OGT) as well as the metabolic impact of ID have been described previously. The present study seeks to characterize the concomitant metabolic impact of variations in the insulin response and bodyweight during repeated OGTs using a metabolomics approach.

Methods

Nineteen Icelandic horses were subjected to five OGTs over one year and their bodyweight, insulin and metabolic response were monitored. Analysis of metabolite concentrations depending on time (during the OGT), relative bodyweight (rWeight; defined as the bodyweight at one OGT divided by the mean bodyweight across all OGTs) and relative insulin response (rAUC_ins; defined accordingly from the area under the insulin curve during OGT) was performed using linear models. Additionally, the pathways significantly associated with time, rWeight and rAUC_ins were identified by rotation set testing.

Results

The results suggested that weight gain and worsening of ID activate distinct metabolic pathways. The metabolic profile associated with weight gain indicated an increased activation of arginase, while the pathways associated with time and rAUC_ins were consistent with the expected effect of glucose and insulin, respectively. Overall, more metabolites were significantly associated with rWeight than with rAUC_ins.

Variations in haematological and biochemical parameters in healthy ponies

Background

Breed specific reference ranges for selected blood parameters are recommended for proper interpretation of blood tests, but there are only few reports dealing with ponies. The purpose of this study was to investigate if blood parameters differ among ponies’ classes and to check if general normal values for equine species are applicable to ponies.

Results

All, except total protein concentration, biochemical parameter significantly (p < 0.05) differed among ponies’ classes. The most pronounced difference was noted in blood lactate concentrations, higher (p < 0.001) in the smallest ponies (class A). In all groups of ponies muscle enzymes (aspartate aminotransferase and creatine kinase) and urea were high when compared to normal values for equine species, but triglycerides and creatinine were low. Blood lactate concentration was high in comparison with normal values for horses only in class A ponies’.

Conclusions

In healthy ponies, blood lactate concentration significantly differs between height classes. Normal values for equine species should not be directly applied to interpret the lactate, triglycerides, aspartate aminotransferase and creatine kinase values in ponies.

Metabolic changes induced by oral glucose tests in horses and their diagnostic use

Background

Little is known about the implications of hyperinsulinemia on energy metabolism, and such knowledge might help understand the pathophysiology of insulin dysregulation.

Objectives

Describe differences in the metabolic response to an oral glucose test, depending on the magnitude of the insulin response.

Animals

Twelve Icelandic horses in various metabolic states.

Methods

Horses were subjected to 3 oral glucose tests (OGT; 0.5 g/kg body weight glucose). Basal, 120 and 180 minutes samples were analyzed using a combined liquid chromatography tandem mass spectrometry and flow injection analysis tandem mass spectrometry metabolomic assay. Insulin concentrations were measured using an ELISA. Analysis was performed using linear models and partial least‐squares regression.

Results

The kynurenine : tryptophan ratio increased over time during the OGT (adjusted P‐value = .001). A high insulin response was associated with lower arginine (adjusted P‐value = .02) and carnitine (adjusted P‐value = .03) concentrations. A predictive model using only baseline samples performed well with as few as 7 distinct metabolites (sensitivity, 86%; 95% confidence interval [CI], 81%‐90%; specificity, 88%; 95% CI, 84%‐92%).

Conclusions and Clinical Importance

Our results suggest induction of low‐grade inflammation during the OGT. Plasma arginine and carnitine concentrations were lower in horses with high insulin response and could constitute potential therapeutic targets. Development of screening tools to identify insulin‐dysregulated horses using only baseline blood sample appears promising.

Equine metabolic syndrome in UK native ponies and cobs is highly prevalent with modifiable risk factors

BACKGROUND

The epidemiology of equine metabolic syndrome (EMS) is poorly described.

OBJECTIVES

To estimate the prevalence of EMS in native UK ponies and cobs in England and Wales and identify associated risk factors.

STUDY DESIGN

Cross-sectional study.

METHODS

Breeders registered with UK native pony breed societies and registered riding schools and livery yards within a set radius were invited to participate. All native UK ponies and cobs aged 3-14 years and not diagnosed or being treated for conditions likely to affect insulin regulation at participating premises were eligible. Animals underwent a clinical examination and an oral glucose test while their owner or keeper completed a questionnaire by face-to-face interview. Data were analysed by multilevel uni- and multivariable modelling using insulin concentration and EMS diagnosis as outcomes.

RESULTS

A total of 354 animals were examined at 64 properties (19 studs, 19 livery yards, 26 riding schools). The overall prevalence of EMS adjusted for clustering within yard was 23.3% (95%CI 17.9%-29.8%). Risk factors associated with a diagnosis of EMS included age, being female, more sedentary main activity, obesity, and shorter periods on pasture during the summer. Compared to the Welsh section A, the other Welsh, Connemara and cob breeds all had decreased odds of EMS. Clinical manifestations of hoof growth ring and supraorbital fat scores of 3/3 were more frequent in EMS ponies and animals with a history of laminitis within the last 5 years (9.7%) were 14.4 (95% CI 5.9-35.3) times more likely to be positive for EMS than those without.

MAIN LIMITATIONS

Results may not be transferable to other breeds or age groups.

CONCLUSIONS

Equine metabolic syndrome is highly prevalent in UK native ponies and cobs with modifiable risk factors including obesity and sedentary activities. Modifying risk factors could help reduce the risk of laminitis in susceptible animals.

Insulin dysregulation in a population of Finnhorses and associated phenotypic markers of obesity

Background

Obesity and insulin dysregulation (ID) predispose horses to laminitis. Determination of management practices or phenotypic markers associated with ID may benefit animal welfare.

Objectives

Determine ID status of a population of Finnhorses using an oral sugar test (OST) and compare phenotypes and management factors between ID and non‐ID Finnhorses.

Animals

One hundred twenty‐eight purebred Finnhorses ≥3 years of age.

Methods

Owners were recruited using an online questionnaire regarding signalment, history, feeding, and exercise of their horses. Selected contributing stables within a predefined area were visited. Phenotypic markers of obesity and the weight of each horse were recorded. After fasting overnight, horses received 0.45 mL/kg corn syrup PO. Serum samples before and at 60 and 90 minutes after syrup administration were analyzed for insulin by chemiluminescent assay. Horses met ID criteria if insulin concentrations were ≥33 μIU/mL at T0, ≥66 μIU/mL at T60 or T90 or some combination thereof. Associations between phenotypic markers, feeding and exercise variables, and ID were examined using mixed effects logistic regression modeling.

Results

Several phenotypic markers of obesity were significant on univariable analysis but in the final multivariable model, only obesity (body condition score  ≥8) was associated with ID (P = .04). Over half of the horses (60% [95% confidence interval (CI), 51%‐68%]) were considered overweight or obese whereas 16% (95% CI, 10%‐23%) were classified as having ID.

Conclusions and Clinical Importance

Because obesity is associated with ID in cold‐blooded type horses, objective monitoring of phenotypic markers by owners may be beneficial for health outcomes.

Comparison of fasted basal insulin with the combined glucose-insulin test in horses and ponies with suspected insulin dysregulation

Fasting horses for measurement of basal serum insulin concentration (fasting insulin; FI) has been recommended to standardise testing for insulin dysregulation (ID), yet limited data exist comparing it to dynamic tests. This study aimed to compare FI with the combined glucose-insulin test (CGIT) in horses suspect for ID. We hypothesised that FI would have poor sensitivity for detecting ID compared to CGIT using conventional cut-offs. Records were retrieved from CGITs performed in horses fasted for approximately 8h. Serum insulin and glucose concentrations were measured before and for 150min following an IV bolus of glucose followed by insulin. Correlations between FI and CGIT values were assessed. Youden's index analysis was used to determine the optimal cut-off for FI. Logistic regression and Mann-Whitney U tests were used to determine factors affecting the results. CGITs (n=130) from 62 horses were evaluated. Compared to CGIT, sensitivity and specificity of FI for diagnosis of ID were 14.6% and 100% at a cut-off of 20μIU/mL and 63.4% and 87.2% at a cut-off of 5.2μIU/mL, respectively. FI was significantly correlated with insulin at 45min (r_s=0.66) and 75min (r_s=0.72); area under the curve for insulin (AUC_insulin; r_s=0.67); glucose at 45min (r_s=0.53); and AUC_glucose (r_s=0.50). Obesity was significantly associated with increased odds of a positive CGIT and horses with a positive CGIT were significantly older (P<0.05). In conclusion, FI correlated well with CGIT results and had adequate sensitivity and specificity at lower cut-offs, despite poor sensitivity at conventional cut-off values. Further research to derive cut-off values relevant to the fasting period is warranted.

ECEIM consensus statement on equine metabolic syndrome

Equine metabolic syndrome (EMS) is a widely recognized collection of risk factors for endocrinopathic laminitis. The most important of these risk factors is insulin dysregulation (ID). Clinicians and horse owners must recognize the presence of these risk factors so that they can be targeted and controlled to reduce the risk of laminitis attacks. Diagnosis of EMS is based partly on the horse's history and clinical examination findings, and partly on laboratory testing. Several choices of test exist which examine different facets of ID and other related metabolic disturbances. EMS is controlled mainly by dietary strategies and exercise programs that aim to improve insulin regulation and decrease obesity where present. In some cases, pharmacologic aids might be useful. Management of an EMS case is a long‐term strategy requiring diligence and discipline by the horse's carer and support and guidance from their veterinarians.

The sodium-glucose co-transporter 2 inhibitor velagliflozin reduces hyperinsulinemia and prevents laminitis in insulin-dysregulated ponies

There are no registered veterinary drugs for treating insulin dysregulation and preventing insulin-associated laminitis in horses. Velagliflozin is a sodium-glucose co-transport 2 inhibitor that reduces renal glucose reabsorption, promotes glucosuria, and consequently, decreases blood glucose and insulin concentrations. This study aimed to determine if velagliflozin reduced hyperinsulinemia and prevented laminitis in insulin-dysregulated ponies fed a challenge diet high in non-structural carbohydrates (NSC). An oral glucose test (1 g dextrose/kg BW) was used to screen 75 ponies for insulin dysregulation, of which 49 ponies with the highest insulin concentrations were selected. These animals were assigned randomly to either a treated group (n = 12) that received velagliflozin (0.3 mg/kg BW, p.o., s.i.d.) throughout the study, or a control group (n = 37). All ponies were fed a maintenance diet of alfalfa hay for 3 weeks, before transferring to a challenge diet (12 g NSC/kg BW/d) for up to 18 d. Blood glucose and serum insulin concentrations were measured over 4 h after feeding, on d 2 of the diet. The maximum glucose concentration was 22% lower (P = 0.014) in treated animals, with a geometric mean (95% CI) of 9.4 (8.0–11.0) mM, versus 12.1 (10.7–13.7) mM in the controls. This was reflected by lower (45%) maximum insulin concentrations in the treated group (P = 0.017), of 149 (97–228) μIU/mL, versus 272 (207–356) μIU/mL for controls. The diet induced Obel grade 1 or 2 laminitis in 14 of the 37 controls (38%), whereas no velagliflozin-treated pony developed laminitis (P = 0.011). Velagliflozin was well-tolerated, with no hypoglycemia or any clinical signs of adverse effects. The main limitation of this study was the sample size. Velagliflozin shows promise as a safe and effective compound for treating insulin dysregulation and preventing laminitis by reducing the hyperinsulinemic response to dietary NSC.

Glucose and Insulin Response of Horses Grazing Alfalfa, Perennial Cool-Season Grass, and Teff Across Seasons

Elevated nonstructural carbohydrate (NSC) values in pasture forages can cause adverse health effects in some horses (Equus caballus L.). The objectives of this study were to determine the impact of different forage species on blood glucose and insulin concentrations of horses throughout the grazing season. Research was conducted in July (summer) and September (fall) in St. Paul, MN. Alfalfa (Medicago sativa L.), mixed perennial cool-season grasses (CSG), and teff (Eragrostis tef [Zucc.] Trotter) pastures were grazed by six horses (24 ± 2 years) that were randomly assigned to one of three forage types in a replicated Latin-square design. Jugular catheters were inserted 1 hour before the start of grazing and horses had access to pasture each day from 08:00 to 16:00 hours. Jugular venous blood samples were collected from each horse before being turned out (0 hours) and then at 2-hour intervals following turnout. Plasma and serum samples were collected and analyzed for glucose and insulin, respectively. Corresponding forage samples were taken by hand harvest. Seasons were analyzed separately and data were analyzed using the MIXED procedure in SAS with P ≤ .05. Teff generally had lower (P ≤ .05) equine digestible energy, crude protein, and NSC compared to the other forages. Differences in peak insulin were observed between horses grazing CSG and teff during the fall grazing (P ≤ .05). These results suggest grazing teff could lower the glucose and insulin response of some horses.

Incidence of laminitis and survey of dietary and management practices in pleasure horses and ponies in south-eastern Australia

OBJECTIVES

The aims of this study were to (1) report the incidence of laminitis among a population of horses and ponies attending Pony Clubs in Victoria, Australia, and (2) describe the dietary and management practices of the sample population.

METHODS

Researchers visited 10 Pony Clubs over a 10-month period. Horse and pony owners completed a questionnaire to provide information on management relating to diet and exercise. Owners were also asked to report their animal's history of laminitis, if any.

RESULTS

From a survey population of 233 horses and ponies, 15.0% of animals (35 individuals) were reported to have suffered from at least one episode of laminitis. Of the animals that had suffered from laminitis, more than half had experienced multiple episodes. The majority of previously laminitic horses and ponies (71.4%) had not experienced an episode of laminitis within the past 12 months; however, 14.2% had experienced an incident within the past month. The proportion of ponies affected by laminitis (31/142; 21.8%) was significantly higher (P < 0.001) than the proportion of horses affected by laminitis (4/91; 4.4%). The incidence of laminitis within the pony group sampled was 6.5 cases per 100 pony years, while the incidence in horses was 0.55 cases per 100 horse years.

CONCLUSION

This study provided information on the incidence of laminitis in the general population of pleasure horses and ponies in south-eastern Australia. It also provided an overview of dietary and management practices. Given the high incidence of animals that had been affected by laminitis (and the associated welfare implications), this study highlights the importance of owner education regarding appropriate feeding and management strategies to reduce the risk of laminitis.

Vascular Dysfunction in Horses with Endocrinopathic Laminitis

Endocrinopathic laminitis (EL) is a vascular condition of the equine hoof resulting in severe lameness with both welfare and economic implications. EL occurs in association with equine metabolic syndrome and equine Cushing’s disease. Vascular dysfunction, most commonly due to endothelial dysfunction, is associated with cardiovascular risk in people with metabolic syndrome and Cushing’s syndrome. We tested the hypothesis that horses with EL have vascular, specifically endothelial, dysfunction. Healthy horses (n = 6) and horses with EL (n = 6) destined for euthanasia were recruited. We studied vessels from the hooves (laminar artery, laminar vein) and the facial skin (facial skin arteries) by small vessel wire myography. The response to vasoconstrictors phenylephrine (10⁻⁹–10^-5M) and 5-hydroxytryptamine (5HT; 10⁻⁹–10^-5M) and the vasodilator acetylcholine (10⁻⁹–10^-5M) was determined. In comparison with healthy controls, acetylcholine-induced relaxation was dramatically reduced in all intact vessels from horses with EL (% relaxation of healthy laminar arteries 323.5 ± 94.1% v EL 90.8 ± 4.4%, P = 0.01, laminar veins 129.4 ± 14.8% v EL 71.2 ± 4.1%, P = 0.005 and facial skin arteries 182.0 ± 40.7% v EL 91.4 ± 4.5%, P = 0.01). In addition, contractile responses to phenylephrine and 5HT were increased in intact laminar veins from horses with EL compared with healthy horses; these differences were endothelium-independent. Sensitivity to phenylephrine was reduced in intact laminar arteries (P = 0.006) and veins (P = 0.009) from horses with EL. Horses with EL exhibit significant vascular dysfunction in laminar vessels and in facial skin arteries. The systemic nature of the abnormalities suggest this dysfunction is associated with the underlying endocrinopathy and not local changes to the hoof.

Prospective cohort study evaluating risk factors for the development of pasture-associated laminitis in the United Kingdom

BACKGROUND

Certain individuals appear to be predisposed to recurrent pasture-associated laminitis. Previous studies have predominantly investigated risk factors only after disease occurrence.

OBJECTIVES

To investigate risk factors for pasture-associated laminitis prior to disease occurrence.

STUDY DESIGN

Prospective cohort study.

METHODS

Non-laminitic ponies aged ≥7 years were recruited. Body condition score (BCS), height, weight, crest height and thickness were measured and an overnight dexamethasone suppression test performed. Plasma or serum adiponectin, leptin, triglyceride, basal insulin, insulin post-dexamethasone, insulin-like growth factor 1 (IGF-1), IGF binding protein 1 (IGFBP-1), IGFBP-3, C-reactive protein, von Willebrand's factor, soluble E-selectin and P-selectin concentrations were assayed. Follow-up data were obtained from owners annually for 3 years to ascertain occurrences of veterinarian-diagnosed pasture-associated laminitis. Data were analysed by multivariate logistic regression. Receiver operating characteristic (ROC) curves analysis was performed for significant risk factors and cut-off values determined.

RESULTS

A total of 446 animals with a median (interquartile range) age of 15 (10-20) years were recruited. Of these, 50.4% were mares and 49.6% were geldings. The most common breeds were Welsh (36.4%), Shetland (17.0%) and cob (9.4%). Overall, 72.2% of animals were overweight/obese (BCS 7-9/9), 27.3% were of ideal weight (BCS 4-6/9) and 0.5% were underweight (BCS 1-3/9). After 1, 2 and 3 years, respectively, 18 (4.0%), 30 (6.7%) and 44 (9.9%) animals were reported to have had laminitis. Plasma adiponectin, and serum basal (insulin) and (insulin) post-dexamethasone levels were significantly (P ≤ 0.05) associated with laminitis occurrence cumulatively after 1, 2 and 3 years. Use of the area under the ROC curves to distinguish animals that did and did not develop laminitis showed good (basal [insulin] after 1 year), fair (all others) or poor ([insulin] post-dexamethasone) levels of accuracy.

MAIN LIMITATIONS

Animals were evaluated at a single time point and biomarkers were assayed using single assays.

CONCLUSIONS

Risk factors for future laminitis prior to disease occurrence include low plasma adiponectin and high serum basal insulin or insulin post-dexamethasone concentrations.

Endocrine, morphometric, and ultrasonographic characterization of neck adiposity in Andalusian horses

Equine metabolic syndrome (EMS) can be diagnosed by hormonal measurements; however, it would be important to find simpler measurements that allow easy identification of affected or at risk individuals. In horses, the dorsal neck region is one of the most frequent anatomical sites for fat deposition and neck obesity has been linked to EMS. The aim of this study was to evaluate the association of hormonal markers of obesity (leptin) and insulin resistance (insulin) with morphometric and ultrasonographic neck measurements in Andalusian horses. Plasma leptin and insulin concentrations were measured by RIA in 127 Andalusian horses. Neck circumferences (NC) were measured at 3 equidistant locations at 25%, 50%, and 75% of neck length (NC-25%, NC-50%, and NC-75%). At the same 3 locations, subcutaneous fat thickness (SFT-25%, SFT-50%, and SFT-75%) was measured ultrasonographically. In the population under study, a tendency to adiposity was confirmed by the elevated plasma leptin levels (7.47 ± 5.03 ng/mL). However, plasma insulin concentrations (4.05 ± 3.74 μIU/mL) were within normal range in most horses. Our results indicate that NC showed significant sexual dimorphism and did not correlate well with hormonal measurements. Ultrasonographic assessment of fat thickness at the base of the neck (SFT-75%) was significantly correlated with both plasma leptin and insulin and did not show differences between males and females. Thus, in the search for a single objective parameter which can be used in large populations, SFT-75% is a potential candidate and may be a meaningful parameter to predict EMS.

Serum insulin concentration in horses: Effect of storage and handling

Serum insulin concentration is commonly measured during investigation of suspected endocrinopathic disease in horses, but immediate analysis is frequently unavailable. The aim of this study was to examine the effect of storing samples at room temperature for 72 h as serum and as whole blood, compared to immediate separation and freezing. Samples from 14 horses were evaluated. Correlation was excellent for all comparisons (≥0.992). Bland-Altman plots revealed a negative bias (mean difference 2.16 µIU/mL) in samples stored as whole blood compared to serum, but this difference was not considered clinically significant. At two commonly used diagnostic cut-offs, there was no effect of storage on result. This study indicates that storage at room temperature for 72 h, either as serum or whole blood, has minimal effect on measured serum insulin concentration in horses.

Equine metabolic syndrome

Laminitis is one of the most common and frustrating clinical presentations in equine practice. While the principles of treatment for laminitis have not changed for several decades, there have been some important paradigm shifts in our understanding of laminitis. Most importantly, it is essential to consider laminitis as a clinical sign of disease and not as a disease in its own right. Once this shift in thinking has occurred, it is logical to then question what disease caused the laminitis. More than 90 per cent of horses presented with laminitis as their primary clinical sign will have developed it as a consequence of endocrine disease; most commonly equine metabolic syndrome (EMS). Given the fact that many horses will have painful protracted and/or chronic recurrent disease, a good understanding of the predisposing factors and how to diagnose and manage them is crucial. Current evidence suggests that early diagnosis and effective management of EMS should be a key aim for practising veterinary surgeons to prevent the devastating consequences of laminitis. This review will focus on EMS, its diagnosis and management.

Lamellar pathology in horses with pituitary pars intermedia dysfunction

REASONS FOR PERFORMING STUDY

Hoof lamellar pathology in horses with pituitary pars intermedia dysfunction (PPID) has not been described previously.

OBJECTIVES

To describe the histomorphometry and pathological lesions in hoof lamellar tissue of animals that had PPID with or without concurrent laminitis, with reference to age-matched controls. We hypothesised that lamellar lesions consistent with laminitis would be associated with PPID, even in animals without current or historical laminitis.

STUDY DESIGN

Prospective case-control study.

METHODS

Mid-dorsal hoof histological sections were obtained post mortem from the forelimbs of 16 PPID-affected animals either with (n = 6) or without laminitis (n = 10) and 10 age- and breed-matched controls. Sections were examined by a blinded veterinary pathologist. The length and width of 10 primary epidermal lamellae were measured using image analysis software. The morphology and pathology of primary and secondary epidermal lamellae were then typed or graded in axial, middle and abaxial regions. Fasting serum insulin, plasma adrenocorticotropin and blood glucose concentration were measured from blood samples taken prior to euthanasia.

RESULTS

All animals with PPID and laminitis had fasting hyperinsulinaemia (median 74.1 miu/l, interquartile range 49.9-349.5 miu/l) whereas PPID animals without laminitis had serum insulin concentrations below the upper limit of the reference range (<20 miu/l). Lamellar pathology in PPID animals with laminitis was variable in severity and unrelated to the reported duration of laminitis (range 2 months-5 years). Most lesions were located abaxially within the lamellar tissue and included increased length and width of the lamellae, chronic abnormal keratinisation, interlamellar epidermal bridging and cell death with more acute lamellar tearing in some cases. The lamellae of PPID animals without laminitis were normal referent to the relevant control group.

CONCLUSIONS

Whether PPID and hyperinsulinaemia have a causal inter-relationship or not, it may only be the hyperinsulinaemia that is associated with lamellar morphological alteration and pathology consistent with laminitis.

Assessing the seasonal prevalence and risk factors for nuchal crest adiposity in domestic horses and ponies using the Cresty Neck Score

BACKGROUND

Nuchal crest adiposity in horses and ponies has been associated with an enhanced risk of metabolic health problems. However, there is no current information on the prevalence of, and risk factors specific to, nuchal crest adiposity in horses and ponies. In addition, the cresty neck score has not previously been utilised across different seasons within a UK leisure population, it is not know whether nuchal crest adiposity shows the same seasonal trends as general obesity.

RESULTS

A Cresty Neck Score (CNS, 0-5) was given to 96 horses with access to pasture (>6 h per day) at the end of winter and at the end of summer in order to obtain two prevalence estimates. Risk factors were assessed using the single outcome cresty neck/no cresty neck in either season (binary), from owner questionnaires and analysed using a mixed effects logistic regression model (outcome variable CNS <3 or CNS ≥3/5). Agreement between winter and summer scores was assessed using weighted Kappa methods. Winter CNS values were significantly higher than summer CNS values (p = 0.002) indicating a systematic bias. The prevalence of a CNS ≥ 3/5 was 45.83% at the end of winter, falling to 33.33% at the end of summer and was higher in ponies (<14.2 hh) than horses (≥14.2 hh) in both seasons. This may reflect a real winter increase in regional fat deposition, or an increased difficulty in obtaining an accurate estimate of regional adiposity in winter months. Breed was the strongest risk factor for CNS ≥3/5 in both seasons, with native UK breeds appearing to be most at risk (p < 0.001). In a separate, small validation study, the CNS showed good inter-observer reliability.

CONCLUSIONS

The prevalence of a CNS ≥3/5 was higher at the end of winter than at the end of summer, which was the opposite pattern seasonal variation to that observed for general obesity. Further studies are required to investigate the potential influence of time of year upon CNS interpretation and studies utilising the CNS should consider potential seasonal variability in nuchal crest adiposity.