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Bayne JE. Pregnancy Toxemia Therapeutic Options. Vet Clin North Am Food Anim Pract 2023; 39:293-305. [PMID: 37032296 DOI: 10.1016/j.cvfa.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023] Open
Abstract
This review covers the treatment options for pregnancy toxemia in small ruminants. Clinical assessment and detection of underlying metabolic and electrolyte derangements direct resuscitation efforts and provide prognostic indications. Treatment programs are dependent on producer goals and case specifics. Options include oral glucogenic precursors (eg, propylene glycol, glycerol), intravenous glucose solutions, insulin, and other supportive care measures. Induction of parturition or C-section is often carried out to minimize ongoing energy deficits, with variable survival rates. Prolonging gestation to maximize fetal viability often requires intensive care in a hospital setting and carries significant risk to both dam and offspring.
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Affiliation(s)
- Jenna E Bayne
- Department of Clinical Sciences, Auburn University College of Veterinary Medicine, 1500 Wire Road, Auburn, AL, USA.
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Pregnancy Toxemia in Ewes: A Review of Molecular Metabolic Mechanisms and Management Strategies. Metabolites 2023; 13:metabo13020149. [PMID: 36837768 PMCID: PMC9961611 DOI: 10.3390/metabo13020149] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 01/09/2023] [Accepted: 01/17/2023] [Indexed: 01/20/2023] Open
Abstract
Pregnancy toxemia is a nutritional metabolic disease during late gestation in small ruminants. The condition is characterized by disorders in carbohydrate and fat metabolism. Obese and multiparous ewes are particularly susceptible to pregnancy toxemia, which may lead to maternal death, abortion, or premature birth. Highly productive multiparous meat ewes are major breeding animals, which has led to an increased incidence of the disease. However, the pathogenesis of pregnancy toxemia remains unclear and adequate disease prevention and treatment strategies are absent. Investigating the pathogenesis of pregnancy toxemia, especially the metabolic pathways of hepatic lipids, is key to an improved understanding of the condition. This review provides a snapshot of the genes that are associated with lipid metabolism in the ovine liver, including genes involved in fatty acid oxidation, acetyl coenzyme metabolism, and triglyceride synthesis; describes the interrelationships between these genes; and summarizes the diagnosis, prevention, and treatment of pregnancy toxemia.
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Histopathological changes in the reproductive organs of does with pregnancy toxaemia and their aborted foetuses. Small Rumin Res 2021. [DOI: 10.1016/j.smallrumres.2021.106363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Mopuri R, Kalyesubula M, Rosov A, Edery N, Moallem U, Dvir H. Improved Folch Method for Liver-Fat Quantification. Front Vet Sci 2021; 7:594853. [PMID: 33511163 PMCID: PMC7835396 DOI: 10.3389/fvets.2020.594853] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 12/14/2020] [Indexed: 12/20/2022] Open
Abstract
Fatty liver represents a significant metabolic pathology of excess intrahepatic fat in domestic animals and humans. Quantification of hepatic-fat content is therefore essential for diagnosis and investigation of liver and metabolic disease. However, the reproducibility of hepatic steatosis analysis is often low due to subjective and technical factors. We hypothesized that improvement in tissue-lipids extraction efficiency would contribute to the accuracy and precision of liver-fat determination. To test it, we investigated the effect of standardized tissue sonication on liver-fat quantification by the Folch method in sheep. Liver samples from grownup lambs of lean (n = 16) and fatty (n = 15) livers, and from pregnant ewes (n = 6) who died from pregnancy toxemia (PT), were used for hepatic-fat content determination with or without tissue sonication. In the grown lambs, an average hepatic-fat content of 6.6% was determined in sonicated compared to 5.1% in non-sonicated specimens (P = 0.0002). Similarly, in ewes with PT, an average of 12.5% was determined with sonication compared to 10.8% without it (P = 0.0006), and the reproducibility was higher with sonication (CV of 3.1 vs. 6.1%, respectively). Thus, tissue sonication improved the efficiency of liver-lipids extraction and was significant to the accuracy and precision of hepatic-fat determination. Enzymatic quantification of triglycerides was moderately correlated with the results obtained gravimetrically (r = 0.632, P < 0.005). The reported data provide reliable reference values for pregnancy toxemic sheep. The significant improvement in liver-fat quantification observed with the reported revised protocol is likely applicable to most mammals and humans.
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Affiliation(s)
- Ramgopal Mopuri
- Volcani Center-Agricultural Research Organization, Institute of Animal Science, Rishon LeZion, Israel
| | - Mugagga Kalyesubula
- Volcani Center-Agricultural Research Organization, Institute of Animal Science, Rishon LeZion, Israel.,Department of Animal Science, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Alexander Rosov
- Volcani Center-Agricultural Research Organization, Institute of Animal Science, Rishon LeZion, Israel
| | - Nir Edery
- Pathology Laboratory, Kimron Veterinary Institute, Veterinary Services, Rishon LeZion, Israel
| | - Uzi Moallem
- Volcani Center-Agricultural Research Organization, Institute of Animal Science, Rishon LeZion, Israel
| | - Hay Dvir
- Volcani Center-Agricultural Research Organization, Institute of Animal Science, Rishon LeZion, Israel
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Alon T, Rosov A, Lifshitz L, Dvir H, Gootwine E, Moallem U. The distinctive short-term response of late-pregnant prolific ewes to propylene glycol or glycerol drenching. J Dairy Sci 2020; 103:10245-10257. [PMID: 32921457 DOI: 10.3168/jds.2020-18227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 06/17/2020] [Indexed: 11/19/2022]
Abstract
Pregnancy toxemia is the most frequent metabolic disorder of ewes in late pregnancy. Although propylene glycol (PG) and glycerol (GLY) are common glucogenic supplements for treating pregnancy toxemia in ewes, the relative benefit of these 2 supplements is not entirely clear. Therefore, the objectives of the present study were to determine the changes during 24 h in key blood metabolites and insulin in response to PG or GLY drenching in prolific ewes. To this end, 36 multiparous late-pregnant Afec-Assaf ewes (∼132.4 d pregnant) bearing 2 to 4 fetuses, divided into 2 blocks (18 ewes in each block), with a blood β-hydroxybutyrate (BHB) concentration of 0.5 to 1.6 mmol/L were included. Ewes were divided into 3 groups (12 ewes each; 6 ewes in each experimental day), according to their BHB levels, expected litter size, body weight, and body condition score, and were drenched with the following: (1) control group (CTL), 55 mL of water; (2) PG, 106 mL of PG (100% PG, 448 calories); or (3) GLY, 108 mL of Koforin 80 (80% GL; 448 calories). Blood samples were taken before drenching and every hour after drenching for 24 h. Plasma concentration of glucose, BHB, nonesterified fatty acids, lactate, glycerol, and insulin were determined. Because there were no effects of treatments after 12 h in the first block, the data were analyzed for 12 h after drenching rather than 24 h. The plasma glucose concentration during the first 5 h after drenching was the highest in the GLY, BHB concentration was the lowest in the PG, and the nonesterified fatty acid levels were lower in the PG compared with the CTL ewes during the first 5 h after drenching. However, glucose concentration was higher in the PG ewes at 9, 11, and 12 h after drenching than in CTL or GLY ewes. The mean lactate concentration in plasma for 12 h was 2.5- and 1.9-fold higher in the PG compared with the CTL and GLY ewes, respectively, and except at 11 h after drenching, it was significantly higher at each time point. The insulin concentration was higher in the GLY than in both other groups at 2 to 5 h after drenching. These results suggest that during the first few hours after drenching the effect of PG was more effective in reducing the BHB concentration, whereas the GLY effect was more effective in enhancing glucose concentration. The increased concentration in lactate following PG treatment suggests that the PG contribution to gluconeogenesis is mediated through its metabolism to lactate. In contrast, the lack of an effect on lactate, and the faster increase in blood glucose in response to GLY suggest that GLY has a more advanced entry point to gluconeogenesis, which influences the immediate response in enhancing the glucose blood concentration.
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Affiliation(s)
- T Alon
- Department of Ruminant Science, Institute of Animal Sciences, The Volcani Center, 68 HaMaccabim Road, Rishon LeZion 7505101, Israel; Department of Animal Science, the Robert H. Smith Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, Rehovot 76100, Israel
| | - A Rosov
- Department of Ruminant Science, Institute of Animal Sciences, The Volcani Center, 68 HaMaccabim Road, Rishon LeZion 7505101, Israel
| | - L Lifshitz
- Department of Ruminant Science, Institute of Animal Sciences, The Volcani Center, 68 HaMaccabim Road, Rishon LeZion 7505101, Israel
| | - H Dvir
- Department of Ruminant Science, Institute of Animal Sciences, The Volcani Center, 68 HaMaccabim Road, Rishon LeZion 7505101, Israel
| | - E Gootwine
- Department of Ruminant Science, Institute of Animal Sciences, The Volcani Center, 68 HaMaccabim Road, Rishon LeZion 7505101, Israel
| | - U Moallem
- Department of Ruminant Science, Institute of Animal Sciences, The Volcani Center, 68 HaMaccabim Road, Rishon LeZion 7505101, Israel.
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Liu H, Yang X, Wu S, Zhang M, Parkin S, Cao S, Li T, Yu F, Long S. An investigation of the polymorphism of a potent nonsteroidal anti-inflammatory drug flunixin. CrystEngComm 2020. [DOI: 10.1039/c9ce01619h] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Flunixin, a potent nonsteroidal anti-inflammatory drug widely used in veterinary medicine, was found to exist in at least two crystal forms, in contrast to clonixin which exists in four solvent-free forms and multiple solvates.
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Affiliation(s)
- Hao Liu
- Key Laboratory for Green Chemical Process of Ministry of Education
- Hubei Key Laboratory of Novel Reactor and Green Chemical Technology
- Hubei Engineering Research Center for Advanced Fine Chemicals
- School of Chemical Engineering and Pharmacy
- Wuhan Institute of Technology
| | - Xing Yang
- Key Laboratory for Green Chemical Process of Ministry of Education
- Hubei Key Laboratory of Novel Reactor and Green Chemical Technology
- Hubei Engineering Research Center for Advanced Fine Chemicals
- School of Chemical Engineering and Pharmacy
- Wuhan Institute of Technology
| | - Shanyu Wu
- Computational Center for Molecular Science
- College of Chemistry
- Nankai University
- Tianjin
- China
| | - Mingtao Zhang
- Computational Center for Molecular Science
- College of Chemistry
- Nankai University
- Tianjin
- China
| | - Sean Parkin
- Department of Chemistry
- University of Kentucky
- Lexington
- USA
| | - Shuang Cao
- Key Laboratory for Green Chemical Process of Ministry of Education
- Hubei Key Laboratory of Novel Reactor and Green Chemical Technology
- Hubei Engineering Research Center for Advanced Fine Chemicals
- School of Chemical Engineering and Pharmacy
- Wuhan Institute of Technology
| | - Tonglei Li
- Department of Industrial and Physical Pharmacy
- Purdue University
- West Lafayette
- USA
| | - Faquan Yu
- Key Laboratory for Green Chemical Process of Ministry of Education
- Hubei Key Laboratory of Novel Reactor and Green Chemical Technology
- Hubei Engineering Research Center for Advanced Fine Chemicals
- School of Chemical Engineering and Pharmacy
- Wuhan Institute of Technology
| | - Sihui Long
- Key Laboratory for Green Chemical Process of Ministry of Education
- Hubei Key Laboratory of Novel Reactor and Green Chemical Technology
- Hubei Engineering Research Center for Advanced Fine Chemicals
- School of Chemical Engineering and Pharmacy
- Wuhan Institute of Technology
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Kalyesubula M, Rosov A, Alon T, Moallem U, Dvir H. Intravenous Infusions of Glycerol Versus Propylene Glycol for the Regulation of Negative Energy Balance in Sheep: A Randomized Trial. Animals (Basel) 2019; 9:ani9100731. [PMID: 31561613 PMCID: PMC6826570 DOI: 10.3390/ani9100731] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 09/18/2019] [Accepted: 09/25/2019] [Indexed: 02/01/2023] Open
Abstract
Negative energy balance (NEB) is a state of insufficient dietary-energy consumption, characterized by the breakdown of adipose fat to meet the physiological energy expenditure. Extensive NEB, as common in high-yielding transitioning ruminants, drives significant metabolic disturbance and pathologies such as pregnancy toxemia and ketosis. Strategies to minimize the severity of NEB include the use of energy-dense feed supplements, like glycerol and propylene glycol (PG), or IV glucose infusion during severe hypoglycemia. PG and glycerol have been studied mainly by oral or ruminal administration, which exposes them to substantial metabolism in the digestive system. To investigate their direct benefits to mitigating NEB, we intravenously infused them into sheep induced into NEB by feed restriction. Sixteen 5-month-old ewe lambs at NEB were IV-treated with 170 mL isotonic saline containing 15% glycerol or 15% PG. Both PG and glycerol effectively reduced hyperketonemia by 57% and 61%, and inhibited adipose lipolysis by 73.6% and 73.3%, respectively. Surprisingly, only glycerol was glucogenic (p < 0.0001) and insulinotropic (p < 0.0075), while PG was primarily utilized for production of lactate (p < 0.0001). Tissue-damage biomarkers indicated hemolytic activity for PG. This study revealed glycerol as a superior IV treatment for effective relief of NEB. Since it carries no risk of glucose overloading, glycerol IV infusion may also have clinical advantages over glucose for treatment of pregnancy toxemia and ketosis.
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Affiliation(s)
- Mugagga Kalyesubula
- Institute of Animal Science, Volcani Center-ARO, 68 Hamakkabim Rd., Rishon LeZion 7528809, Israel
- Department of Animal Science, the Hebrew University of Jerusalem, Rehovot 7610001, Israel
| | - Alexander Rosov
- Institute of Animal Science, Volcani Center-ARO, 68 Hamakkabim Rd., Rishon LeZion 7528809, Israel
| | - Tamir Alon
- Institute of Animal Science, Volcani Center-ARO, 68 Hamakkabim Rd., Rishon LeZion 7528809, Israel
- Department of Animal Science, the Hebrew University of Jerusalem, Rehovot 7610001, Israel
| | - Uzi Moallem
- Institute of Animal Science, Volcani Center-ARO, 68 Hamakkabim Rd., Rishon LeZion 7528809, Israel
| | - Hay Dvir
- Institute of Animal Science, Volcani Center-ARO, 68 Hamakkabim Rd., Rishon LeZion 7528809, Israel.
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Özalp G, Yavuz A, Seker İ, Udum-Küçükşen D, Rişvanlı A, Korlu Y. Evaluation of an alternative treatment protocol by aglepristone to induce parturition in ewes with an experimental model of early pregnancy toxemia. Theriogenology 2018; 116:112-118. [DOI: 10.1016/j.theriogenology.2018.04.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 04/26/2018] [Accepted: 04/26/2018] [Indexed: 11/24/2022]
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Molasses-based supplement improved the metabolic status of late-pregnant ewes bearing multiple fetuses. Anim Feed Sci Technol 2016. [DOI: 10.1016/j.anifeedsci.2016.06.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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McLennan KM, Rebelo CJ, Corke MJ, Holmes MA, Leach MC, Constantino-Casas F. Development of a facial expression scale using footrot and mastitis as models of pain in sheep. Appl Anim Behav Sci 2016. [DOI: 10.1016/j.applanim.2016.01.007] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Doré V, Dubuc J, Bélanger AM, Buczinski S. Definition of prepartum hyperketonemia in dairy goats. J Dairy Sci 2015; 98:4535-43. [PMID: 25935248 DOI: 10.3168/jds.2014-9172] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Accepted: 03/26/2015] [Indexed: 11/19/2022]
Abstract
A prospective cohort study was conducted on 1,081 dairy goats from 10 commercial herds in Québec (Canada) to define prepartum hyperketonemia based on optimal blood β-hydroxybutyrate acid threshold values for the early prediction of pregnancy toxemia (PT) and mortality in late-gestation dairy goats. All pregnant goats had blood sampled weekly during the last 5wk of pregnancy. The blood was analyzed directly on the farm for β-hydroxybutyrate acid quantification using a Precision Xtra meter (Abbott Diabetes Care, Saint-Laurent, QC, Canada). Body condition scores on the lumbar region and sternum were noted. Each goat was classified as being at low (n=973) or high risk (n=108) of having PT by producers based on a standardized definition. The optimal threshold for predicting a PT diagnosis or mortality for each week before kidding was determined based on the highest sum of sensitivity and specificity. The association between hyperketonemia and subsequent PT was tested using a multivariable logistic regression model considering hyperketonemia at wk 4 prepartum, litter size, and body condition score at wk 4 prepartum as covariates, and herd and parturition cohort as random effects. The association between mortality and hyperketonemia was also tested using a logistic regression model accounting for the presence or absence of treatment during the last month of pregnancy. The hyperketonemia definition based on PT varied between ≥0.4 and ≥0.9mmol/L during the last 5wk prepartum. Goats affected by hyperketonemia at wk 4 prepartum and with a large litter size (≥3 fetuses) had 2.1 and 40.5 times the odds, respectively, of subsequent PT than other goats. Hyperketonemia definitions based on mortality varied between ≥0.6 and ≥1.4mmol/L during the last 4wk prepartum, and was ≥1.7mmol/L during the first week postpartum. Goats affected by hyperketonemia and treated by producers had 3.4 and 11.8 times the odds, respectively, of subsequent mortality than did other goats. These results showed that prepartum hyperketonemia could be defined in dairy goats using subsequent risks of PT or mortality during the last month of pregnancy.
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Affiliation(s)
- V Doré
- Département de Sciences Cliniques, Faculté de Médecine Vétérinaire, C.P. 5000, Université de Montréal, Saint-Hyacinthe, Québec, J2S 7C6, Canada
| | - J Dubuc
- Département de Sciences Cliniques, Faculté de Médecine Vétérinaire, C.P. 5000, Université de Montréal, Saint-Hyacinthe, Québec, J2S 7C6, Canada
| | - A M Bélanger
- Département de Sciences Cliniques, Faculté de Médecine Vétérinaire, C.P. 5000, Université de Montréal, Saint-Hyacinthe, Québec, J2S 7C6, Canada
| | - S Buczinski
- Département de Sciences Cliniques, Faculté de Médecine Vétérinaire, C.P. 5000, Université de Montréal, Saint-Hyacinthe, Québec, J2S 7C6, Canada.
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Navarre CB, Baird A, Pugh D. Diseases of the Gastrointestinal System. SHEEP AND GOAT MEDICINE 2012. [PMCID: PMC7152351 DOI: 10.1016/b978-1-4377-2353-3.10005-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Moallem U, Rozov A, Gootwine E, Honig H. Plasma concentrations of key metabolites and insulin in late-pregnant ewes carrying 1 to 5 fetuses. J Anim Sci 2012; 90:318-24. [DOI: 10.2527/jas.2011-3905] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- U. Moallem
- Department of Ruminant Science, Institute of Animal Sciences, Volcani Center, PO Box 6, Bet-Dagan 50250, Israel
| | - A. Rozov
- Department of Ruminant Science, Institute of Animal Sciences, Volcani Center, PO Box 6, Bet-Dagan 50250, Israel
| | - E. Gootwine
- Department of Ruminant Science, Institute of Animal Sciences, Volcani Center, PO Box 6, Bet-Dagan 50250, Israel
| | - H. Honig
- Department of Ruminant Science, Institute of Animal Sciences, Volcani Center, PO Box 6, Bet-Dagan 50250, Israel
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Mini review: breeding Awassi and Assaf sheep for diverse management conditions. Trop Anim Health Prod 2011; 43:1289-96. [PMID: 21512726 DOI: 10.1007/s11250-011-9852-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2011] [Indexed: 10/18/2022]
Abstract
The Local Awassi, a triple-purpose breed for meat, milk, and carpet-wool production, is a low-prolific, hardy breed that is well adapted to the unfavorable conditions of the Middle East, where it is managed under traditionally extensive to semi-extensive conditions. Breeding work with the Awassi has included within-breed selection, crossbreeding, and gene introgression. Those efforts resulted in a variety of Awassi-derived genotypes that successfully occupy semi-intensive as well as intensive production systems. Thus, within-breed selection resulted in development of the "Improved Awassi"-a dairy-type Awassi strain which, under intensive management, produces over 500 l milk/ewe annually; crossbreeding with the East Friesian breed led to the development of the Assaf dairy breed, which exceeds the Improved Awassi in prolificacy and in year-round breeding activity, and introgression of the B allele of the FecB locus into the Awassi and Assaf breeds resulted in the formation of the prolific Afec Awassi and Afec Assaf strains, with prolificacies of 1.9 and 2.5 lambs born per ewe lambing, respectively. Advanced molecular genetics tools have enabled a better understanding of how the Awassi breed was formed during domestication and have uncovered differences in its genetic structure compared to other breeds. Implementing large-scale selection schemes that implement emerging new information on the sheep genome, overcoming threats of inbreeding depression, and further breeding for high uterine capacity are the new breeding goals for the Awassi, Assaf, and their derivatives.
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Brozos C, Mavrogianni VS, Fthenakis GC. Treatment and Control of Peri-Parturient Metabolic Diseases: Pregnancy Toxemia, Hypocalcemia, Hypomagnesemia. Vet Clin North Am Food Anim Pract 2011; 27:105-113. [DOI: 10.1016/j.cvfa.2010.10.004] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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