Atypical myopathy in the South‐East of England: Clinicopathological data and outcome in hospitalised horses

An ongoing concern: 20 years of research on equine atypical myopathy

Anne-Christine François, Benoît Renaud, Caroline-Julia Kruse, Christel Marcillaud-Pitel and Dominique-Marie Votion of the Atypical Myopathy Alert Group discuss insights from 20 years of research and surveillance on equine atypical myopathy.

Hypoglycin A in Acer genus plants

Hypoglycin A (HGA) is an amino acid occuring in the Sapindaceae family. Ingestion of certain Acer genus plants belonging to this family has been connected with atypical myopathy (AM) or seasonal pasture myopathy (SPM). To date, all cases of AM/SPM have been associated with sycamore (Acer pseudoplatanus) and boxelder maple (Acer negundo). The aim of this work was to determine and compare HGA in sycamore, boxelder and silver maple (Acer saccharinum), the trees known for HGA content, whose occurence is quite common in the Czech Republic. In sycamore and boxelder maple the effect of location, weather condition and sampling season was evaluated. The other aim was screening for presence of HGA in 12 other species of Acer genus which are grown as ornamental trees in Europe. The determination of HGA was conducted using ultra - high performance liquid chromatography - tandem mass spectrometry (LC/MS). HGA was detected in all samples of sycamore, boxelder and silver maple except for eight leave samples of boxelder maple. In the case of sycamore maple, the highest concentrations of HGA (median) were found in seedlings (770 mg/kg) followed by samaras (130 mg/kg) and by leaves (48 mg/kg) and inflorescences (24 mg/kg). In boxelder maple, significantly higher concentrations of HGA (median) were found in seedlings (550 mg/kg) compared with samaras (45 mg/kg), leaves (14 mg/kg) and inflorescences (24 mg/kg). According to the results the seedlings could pose a significant risk of poisoning, although other factors such as accessibility and palatability of other parts, especially samaras, should be considered. No significant differences of HGA concentrations in silver maple (56 mg/kg) were found between samaras, leaves and inflorescences. HGA was also identified in sugar maple (Acer saccharum), Japanese maple (Acer palmatum), trident maple (Acer buergerianum), paperbark maple (Acer griseum) and Himalayan maple (Acer oblongum). Although silver maple and other ornamental maples have not been reported to cause AM/SPM, the possibility of intoxication in animals can not be excluded.

Dynamics of acylcarnitines, hypoglycin A, méthylènecyclopropylglycine and their metabolites in a Kladruber stallion with atypical myopathy

Equine atypical myopathy (AM also referred to as multiple acyl-CoA dehydrogenases deficiency [MADD]) is thought to be caused by toxins metabolized from hypoglycin A (HGA) and méthylènecyclopropylglycine (MCPrG). HGA is contained in the seeds and seedlings of the sycamore tree (Acer pseudoplatanus); MCPrG has so far only been confirmed in seeds. Among other things, these substances can disrupt the fatty acids β-oxidation pathway with the subsequent accumulation of certain acylcarnitines. The tentative diagnosis is based on anamnesis and clinical signs and can be verified by the detection of elevated creatine kinase activity, specific profile of acylcarnitines and the presence of HGA, MCPrG conjugates and/or their metabolites in peripheral blood and/or urine. Dry blood spots were collected for 15 days from a 3.5-year-old stallion which had been affected by AM and, as a control group, from twelve healthy horses. Two mass spectrometry methods were used for the analysis of 31 acylcarnitines, carnitine, HGA, MCPrG and their metabolites. HGA and six increased acylcarnitines were detected in the patient’s blood throughout the monitoring period. Nine acylcarnitines were strongly correlated with HGA. Multivariate statistical analysis showed a clear separation of samples from the AM horse, where the metabolic profile tended to normalization in the later days after intoxication. Due to the longer persistence in the blood, the detection of HGA and elevated acylcarnitines profile appear to be an appropriate tool to confirm the diagnosis of AM, compared to metabolic products of HGA and MCPrG even in advanced cases.

Comparison of Fecal Microbiota of Horses Suffering from Atypical Myopathy and Healthy Co-Grazers

Equine atypical myopathy (AM) is caused by hypoglycin A (HGA) and methylenecyclopropylglycine (MCPG) intoxication resulting from the ingestion of seeds or seedlings of some Acer tree species. Interestingly, not all horses pasturing in the same toxic environment develop signs of the disease. In other species, it has been shown that the intestinal microbiota has an impact on digestion, metabolism, immune stimulation and protection from disease. The objective of this study was to characterize and compare fecal microbiota of horses suffering from AM and healthy co-grazers. Furthermore, potential differences in fecal microbiota regarding the outcome of diseased animals were assessed. This prospective observational study included 59 horses with AM (29 survivors and 30 non-survivors) referred to three Belgian equine hospitals and 26 clinically healthy co-grazers simultaneously sharing contaminated pastures during spring and autumn outbreak periods. Fresh fecal samples (rectal or within 30 min of defecation) were obtained from all horses and bacterial taxonomy profiling obtained by 16S amplicon sequencing was used to identify differentially distributed bacterial taxa between AM-affected horses and healthy co-grazers. Fecal microbial diversity and evenness were significantly (p < 0.001) higher in AM-affected horses as compared with their non-affected co-grazers. The relative abundance of families Ruminococcaceae, Christensenellaceae and Akkermansiaceae were higher (p ≤ 0.001) whereas those of the Lachnospiraceae (p = 0.0053), Bacteroidales (p < 0.0001) and Clostridiales (p = 0.0402) were lower in horses with AM, especially in those with a poor prognosis. While significant shifts were observed, it is still unclear whether they result from the disease or might be involved in the onset of disease pathogenesis.

Answers to the Frequently Asked Questions Regarding Horse Feeding and Management Practices to Reduce the Risk of Atypical Myopathy

Simple Summary

Equine atypical myopathy is a severe intoxication of grazing equids resulting from the ingestion of samaras or seedlings of trees from the Acer species. The sycamore maple (Acer pseudoplatanus) is involved in European cases whereas the box elder (Acer negundo) is recognized as the cause of this seasonal pasture myopathy in the Unites States of America. In Europe, young and inactive animals with a thin to normal body condition and no feed supplementation, except for hay in autumn, are at higher risk. The risk is also associated with full time pasturing in a humid environment. Indeed, dead leaves piling up in autumn as well as, the presence of trees and/or woods presumably exposes the horses to the sycamore maple. This manuscript answers the most frequently asked questions arising from the equine field about feeding and management of equines to reduce the risk of atypical myopathy. All answers are based on data collected from 2006 to 2019 by the “Atypical Myopathy Alert Group” (AMAG, Belgium) and the “Réseau d’épidémiosurveillance en Pathologie équine” (RESPE, France) as well as on a review of the most recent literature.

Abstract

In 2014, atypical myopathy (AM) was linked to Acer pseudoplatanus (sycamore maple) in Europe. The emergence of this seasonal intoxication caused by a native tree has raised many questions. This manuscript aims at answering the five most frequently asked questions (FAQs) regarding (1) identification of toxic trees; reduction of risk at the level of (2) pastures and (3) equids; (4) the risk associated with pastures with sycamores that have always been used without horses being poisoned and (5) the length of the risk periods. Answers were found in a literature review and data gathered by AM surveillance networks. A guide is offered to differentiate common maple trees (FAQ1). In order to reduce the risk of AM at pasture level: Avoid humid pastures; permanent pasturing; spreading of manure for pasture with sycamores in the vicinity and avoid sycamore maple trees around pasture (FAQ2). To reduce the risk of AM at horse level: Reduce pasturing time according to weather conditions and to less than six hours a day during risk periods for horses on risk pasture; provide supplementary feeds including toxin-free forage; water from the distribution network; vitamins and a salt block (FAQ3). All pastures with a sycamore tree in the vicinity are at risk (FAQ4). Ninety-four percent of cases occur over two 3-month periods, starting in October and in March, for cases resulting from seeds and seedlings ingestion, respectively (FAQ5).