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Lavado RA, Lewis J, Montgomery JB. Continuous digital hypothermia for prevention and treatment of equine acute laminitis: A practical review. Vet J 2023; 300-302:106016. [PMID: 37507002 DOI: 10.1016/j.tvjl.2023.106016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 07/13/2023] [Accepted: 07/24/2023] [Indexed: 07/30/2023]
Abstract
Laminitis is a severely debilitating and life-threatening condition that occurs as a consequence of different primary triggering factors. Continuous digital hypothermia (CDH) is recommended in horses at risk of, or diagnosed with, acute laminitis due to its several physiological and biochemical alterations that may be positive for the prevention and early treatment of the condition, representing a low risk of adverse effects. Modulation of the inflammatory response, profound vasoconstriction, and prevention of tissue damage are the most notable protective effects of cryotherapy on the lamellae. This practical review aims to summarize the published literature evaluating CDH efficacy in the prevention and early treatment of acute laminitis in horses, highlighting the most important clinical findings and discussing the best methods to provide cryotherapy. Nineteen publications evaluated different CDH methods, including the use of commercially available ice boots or fluid bags filled with iced water or crushed ice, as well as alternatives to immersion in ice, e.g., frozen gel packs and a perfused cuff prototype. Although some techniques were effective for cooling and maintaining the hooves below the optimal temperature of 10 °C, relevant limitations such as labor intensiveness, reliance on an ice source and price make its use impractical in some clinical situations. Twelve experimental studies assessed the efficacy of CDH on the prevention or early treatment of laminitis, finding multiple positive effects in terms of clinical improvement, immunological and inflammatory modulation, and histological protection. After the analysis of the literature, the clinical importance of CDH in different stages of laminitis remains clear. However, it also highlights the need for a safer, more user-friendly, and more effective method of cryotherapy that can be used both in a hospital and an ambulatory setting.
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Affiliation(s)
- Ronaldo Avella Lavado
- Department of Large Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK S7N 5B4, Canada; Department of Medical Clinic, University of São Paulo, São Paulo, SP 05508-900, Brazil
| | - Jazlynn Lewis
- Department of Large Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK S7N 5B4, Canada; Department of Agriculture, Angelo State University, San Angelo, TX 76909, USA
| | - Julia B Montgomery
- Department of Large Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK S7N 5B4, Canada.
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2
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Bauck AG. Basic Postoperative Care of the Equine Colic Patient. Vet Clin North Am Equine Pract 2023:S0749-0739(23)00022-6. [PMID: 37120332 DOI: 10.1016/j.cveq.2023.03.010] [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: 05/01/2023] Open
Abstract
The 3 time periods around colic surgery (preoperative, operative, and postoperative) are all critical to successful outcomes. Although much focus is often paid to the first 2 time periods, the importance of sound clinical judgment and rational decision-making in the postoperative period cannot be overstated. This article will outline the basic principles of monitoring, fluid therapy, antimicrobial therapy, analgesia, nutrition, and other therapeutics routinely used in patients following colic surgery. Discussions of the economics of colic surgery and expectations for normal return to function will also be included.
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Affiliation(s)
- Anje G Bauck
- Large Animal Surgery, Department of Large Animal Clinical Sciences, University of Florida College of Veterinary Medicine, University of Florida, 2015 Southwest 16th Avenue, Gainesville, FL 32608, USA.
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Luethy D. Cryotherapy Techniques: Best Protocols to Support the Foot in Health and Disease. Vet Clin North Am Equine Pract 2021; 37:685-693. [PMID: 34782099 DOI: 10.1016/j.cveq.2021.07.005] [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: 10/19/2022] Open
Abstract
Treatment of equine laminitis continues to be a challenge despite recent advancements in knowledge of the pathophysiology of laminitis. With more evidence supporting its use, distal limb hypothermia or cryotherapy has become a standard of care for both prevention of laminitis and treatment of the early stages of acute laminitis. Recent studies have demonstrated that cryotherapy reduces the severity of sepsis-related laminitis and hyperinsulinemic laminitis in experimental models and reduces the incidence of laminitis in clinical colitis cases. This article reviews the recent literature supporting the use of distal limb cryotherapy in horses.
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Affiliation(s)
- Daniela Luethy
- Large Animal Medicine, Department of Large Animal Clinical Sciences, University of Florida, College of Veterinary Medicine, PO Box 100136, Gainesville, FL 32610-0136, USA.
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Stokes SM, Burns TA, Watts MR, Bertin FR, Stefanovski D, Medina-Torres CE, Belknap JK, van Eps AW. Effect of digital hypothermia on lamellar inflammatory signaling in the euglycemic hyperinsulinemic clamp laminitis model. J Vet Intern Med 2020; 34:1606-1613. [PMID: 32583504 PMCID: PMC7379000 DOI: 10.1111/jvim.15835] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 06/03/2020] [Accepted: 06/03/2020] [Indexed: 12/25/2022] Open
Abstract
Background Continuous digital hypothermia (CDH) prevents lamellar failure in the euglycemic hyperinsulinemic clamp (EHC) model of laminitis, but the protective mechanisms are unclear. Hypothesis/Objectives To determine if CDH inhibits lamellar inflammatory signaling in the EHC model of laminitis. Animals Eight Standardbred horses. Methods Prospective experimental study. Horses underwent an EHC, with 1 forelimb treated with CDH and the other kept at ambient temperature (AMB). Horses were euthanized 48 hours after initiation of the EHC and lamellar tissue was analyzed via polymerase chain reaction (pro‐inflammatory cytokine and chemokine genes—CXCL1, CXCL6, CXCL8, IL‐6, MCP‐1, MCP‐2, IL‐1β, IL‐11, cyclooxygenase 1 and 2, tumour necrosis factor‐alpha [TNF‐α], E‐selectin, and intercellular adhesion molecule‐1 [ICAM‐1]) and immunoblotting (phosphorylated and total signal transducer and activator of transcription 1 [STAT1] and STAT3). Results Compared to AMB, lamellar messenger ribonucleic acid (mRNA) concentrations of CXCL6 (P =.02), CXCL8 (P = .008), IL‐6 (P = .008), IL‐1β (P = .008), IL‐11 (P = .008), and cyclooxygenase‐2 (P = .008) were decreased in CDH. Cyclooxygenase‐1 (P = .008) was increased in CDH, while CXCL1 (P = .15), MCP‐1 (P = .05), MCP‐2 (P = .46), TNF‐α (P = .05), E‐selectin (P = .15), and ICAM‐1 (P = .15) mRNA were not significantly different. Compared to AMB, lamellar concentration of total STAT3 protein was decreased in CDH (P < .001), but there was no change in phosphorylated STAT3 (P‐STAT3 [S727] P = .19; P‐STAT3 [Y705] P = .05). There was no change in lamellar concentrations of total STAT1 (P = .75) or phosphorylated STAT1 (P‐STAT1 [S727], P = .25; P‐STAT1 [Y701], P = .64). Conclusions and Clinical Importance These data add further support for the use of CDH as a first aid treatment for severe acute laminitis associated with hyperinsulinemia in horses.
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Affiliation(s)
- Simon M Stokes
- Australian Equine Laminitis Research Unit, School of Veterinary Science, The University of Queensland, Gatton, Queensland, Australia
| | - Teresa A Burns
- Department of Veterinary Clinical Sciences, The Ohio State University College of Veterinary Medicine, Columbus, Ohio, USA
| | - Mauria R Watts
- Department of Veterinary Clinical Sciences, The Ohio State University College of Veterinary Medicine, Columbus, Ohio, USA
| | - François-René Bertin
- Australian Equine Laminitis Research Unit, School of Veterinary Science, The University of Queensland, Gatton, Queensland, Australia
| | - Darko Stefanovski
- New Bolton Center, Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, Pennsylvania, USA
| | - Carlos E Medina-Torres
- Australian Equine Laminitis Research Unit, School of Veterinary Science, The University of Queensland, Gatton, Queensland, Australia
| | - James K Belknap
- Department of Veterinary Clinical Sciences, The Ohio State University College of Veterinary Medicine, Columbus, Ohio, USA
| | - Andrew W van Eps
- Australian Equine Laminitis Research Unit, School of Veterinary Science, The University of Queensland, Gatton, Queensland, Australia.,New Bolton Center, Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, Pennsylvania, USA
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Stokes SM, Bertin FR, Stefanovski D, Poulsen L, Belknap JK, Medina-Torres CE, Pollitt CC, van Eps AW. The effect of continuous digital hypothermia on lamellar energy metabolism and perfusion during laminitis development in two experimental models. Equine Vet J 2020; 52:585-592. [PMID: 31793047 DOI: 10.1111/evj.13215] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 10/22/2019] [Accepted: 11/23/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Continuous digital hypothermia (CDH) prevents lamellar failure in the euglycaemic hyperinsulinaemic clamp (EHC) and oligofructose (OF) laminitis models, but the mechanisms remain unclear. OBJECTIVES To evaluate the effects of CDH on lamellar energy metabolism and perfusion in healthy horses and during EHC and OF laminitis models. STUDY DESIGN In vivo experiment. METHODS Archived samples were used from Standardbred geldings that received no treatment (CON) (n = 8) or underwent EHC (n = 8) or OF (n = 6) laminitis models. Both forelimbs were instrumented with a lamellar microdialysis system, and one forelimb was cooled (CDH) with the other maintained at ambient temperature (AMB). Microdialysate was collected every 6 hours and analysed for glucose, lactate and pyruvate concentrations and lactate to pyruvate ratio (L:P). Microdialysis urea clearance was used to estimate lamellar tissue perfusion. Data were analysed using a mixed-effects linear regression model. RESULTS Glucose did not change in CDH limbs relative to AMB in CON (P = .3), EHC (P = .3) or OF (P = .6) groups. There was a decrease in lactate (P < .001) and pyruvate (P < .01) in CDH limbs relative to AMB in all groups. L:P decreased in CON CDH relative to CON AMB (P < .001) but was not different in EHC (P = .6) and OF (P = .07) groups. Urea clearance decreased in CDH limbs relative to AMB in CON (P = .002) and EHC (P < .001), but not in OF (P = .4). MAIN LIMITATIONS The EHC model may not mimic natural endocrinopathic laminitis. CONCLUSIONS CDH caused a marked decrease in lamellar glucose metabolism (CON, EHC and OF) and perfusion (CON and EHC) without affecting lamellar glucose concentration. Although cellular energy failure is not a primary pathophysiological event in EHC and OF laminitis models, CDH may act by limiting energy supply to pathologic cellular processes whilst preserving those critical to lamellar homoeostasis.
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Affiliation(s)
- Simon M Stokes
- Australian Equine Laminitis Research Unit, School of Veterinary Science, The University of Queensland, Gatton, Queensland, Australia
| | - Francois-Rene Bertin
- Australian Equine Laminitis Research Unit, School of Veterinary Science, The University of Queensland, Gatton, Queensland, Australia
| | - Darko Stefanovski
- New Bolton Center, Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, Pennsylvania, USA
| | - Lea Poulsen
- Institute of Veterinary Science, University of Liverpool, Liverpool, UK
| | - James K Belknap
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Carlos E Medina-Torres
- Australian Equine Laminitis Research Unit, School of Veterinary Science, The University of Queensland, Gatton, Queensland, Australia
| | - Christopher C Pollitt
- Australian Equine Laminitis Research Unit, School of Veterinary Science, The University of Queensland, Gatton, Queensland, Australia
| | - Andrew W van Eps
- Australian Equine Laminitis Research Unit, School of Veterinary Science, The University of Queensland, Gatton, Queensland, Australia.,New Bolton Center, Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, Pennsylvania, USA
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Dern K, Burns TA, Watts MR, van Eps AW, Belknap JK. Influence of digital hypothermia on lamellar events related to IL-6/gp130 signalling in equine sepsis-related laminitis. Equine Vet J 2019; 52:441-448. [PMID: 31509270 DOI: 10.1111/evj.13184] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 08/22/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Interleukin-6 (IL-6) is consistently increased in the digital lamellae in different studies of sepsis-related laminitis (SRL). IL-6 signalling through the gp130 receptor activates similar signalling (i.e. mTORC1-related signalling) previously reported to be activated in models of endocrinopathic laminitis. OBJECTIVES To assess the activation state of signalling proteins downstream of IL-6/gp130 receptor complex activation in an experimental model of SRL. STUDY DESIGN Randomised experimental study. METHODS Lamellar phospho-(P) protein concentrations downstream of the IL-6/gp130 receptors were assessed in the oligofructose (OF) model of SRL. Fifteen Standardbred horses were administered water (CON, n = 8) or oligofructose (OF, n = 7) via a nasogastric tube. At 12 h post-OF/water administration, one randomly assigned forelimb was exposed to continuous digital hypothermia (CDH) by placement in ice water (ICE, maintained at <7°C); the other forelimb was maintained at ambient temperature (AMB). Lamellar tissue samples were collected after 24 h of CDH from both ICE and AMB forelimbs and immediately snap-frozen. Lamellar proteins of interest were assessed by immunoblotting and immunofluorescence. RESULTS Immunoblotting revealed increase (P<0.05) in the phosphorylation states of Akt (Ser 473), RPS6 (Ser235/236), RPS6 (Ser240/244), STAT3 (Ser727) and STAT3 (Tyr705) in lamellar tissue from OF-treated animals (AMB OF vs. AMB CON limbs); CDH resulted in decreased (P<0.05) lamellar concentrations of phosphorylated Akt, p70S6K, RPS6 (235/236), RPS6 (240/244) and STAT3 (S727) in OF-treated animals (AMB OF vs. ICE OF). Immunofluorescence showed that activated/phosphorylated forms of RPS6 and STAT3 were primarily localised to lamellar epithelial cells. MAIN LIMITATIONS The nature, sequence and timing of sub-cellular events in this experimental model may differ from those that accompany naturally occurring sepsis. CONCLUSIONS There were increased lamellar concentrations of activated signalling proteins downstream of the IL-6/Gp130 receptor complex in OF-treated horses; CDH inhibited this activation for the majority of the proteins assessed. These results demonstrate similar lamellar signalling (e.g. mTORC1-related signalling) and, therefore, possible therapeutic targets occurring in sepsis-related laminitis as previously reported in models of endocrinopathic laminitis.
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Affiliation(s)
- K Dern
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Ohio State University, Columbus, Ohio, USA
| | - T A Burns
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Ohio State University, Columbus, Ohio, USA
| | - M R Watts
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Ohio State University, Columbus, Ohio, USA
| | - A W van Eps
- Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - J K Belknap
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Ohio State University, Columbus, Ohio, USA
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Marlin D. Evaluation of the cooling efficacy of different equine leg cooling methods. COMPARATIVE EXERCISE PHYSIOLOGY 2019. [DOI: 10.3920/cep180052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The use of cold therapy or cryotherapy is widespread in human and veterinary medicine and sports medicine and ranges from focal, localised treatment to whole body treatment. In equestrian sport, a variety of methods and commercial products exist for cooling the lower limbs. To date, there have been no studies comparing the relative efficacy of these different cooling methods. Due to the difficulty in standardising techniques for comparing cooling on live horses, a repeatable laboratory method for determining cooling efficacy was developed using a metal flask. The amount of heat removed from the flask by different traditional methods (corrected for the heat lost over 30 min for the flask without treatment) and a variety of commercial cooling products was calculated by measuring the decrease in temperature (in triplicate) within the flask from an initial external temperature of 40.2±0.4 °C and an internal temperature of 42.1±0.9 °C (mean ± standard deviation) over 30 min. The methods compared were: cold hosing (15 °C), standing in ice and water (0 °C), ice-cube packs, instant cold-packs, ice boots, evaporative (water) cooled boots, ice gel and clay. The greatest amount of heat removed in 30 min was 134±4 kJ for standing in ice & water (0 °C). The next highest rates of removal were 66.4±1.3, 57.1±6.1 and 56.9±1.3 kJ for cold hosing (15 °C), Ice Horse (-23 °C) and Cryochaps (-23 °C), respectively. The lowest amount of heat removed was for covered clay (8±1 kJ; initial clay temperature 15 °C). This approach allows different methods of cooling to be compared without the difficulties encountered in standardisation in live horses.
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Affiliation(s)
- D.J. Marlin
- David Marlin Consulting, P.O. Box 187, Cambridge CB21 6AZ, United Kingdom
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Are There Shared Mechanisms in the Pathophysiology of Different Clinical Forms of Laminitis and What Are the Implications for Prevention and Treatment? Vet Clin North Am Equine Pract 2019; 35:379-398. [PMID: 31126692 DOI: 10.1016/j.cveq.2019.04.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Laminitis is a consequence of primary disease processes elsewhere in the body. The key pathophysiologic events are insulin dysregulation in endocrinopathic laminitis, ischemia in supporting limb laminitis, and inflammation in sepsis-related laminitis. These apparently disparate mechanisms converge to cause lamellar attachment failure through epithelial cell adhesion loss and stretch, possibly mediated by common growth factor signaling pathways. Tissue damage through mechanical distraction, inflammation, pain, and a proliferative epithelial healing response are features of acute laminitis regardless of the cause. Preventive and treatment strategies based on knowledge of these unique and common mechanistic events are likely to improve clinical outcomes.
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Stokes SM, Belknap JK, Engiles JB, Stefanovski D, Bertin FR, Medina-Torres CE, Horn R, van Eps AW. Continuous digital hypothermia prevents lamellar failure in the euglycaemic hyperinsulinaemic clamp model of equine laminitis. Equine Vet J 2019; 51:658-664. [PMID: 30636340 DOI: 10.1111/evj.13072] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 01/01/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Continuous digital hypothermia can prevent the development and progression of laminitis associated with sepsis but its effects on laminitis due to hyperinsulinaemia are unknown. OBJECTIVES To determine the effects of continuous digital hypothermia on laminitis development in the euglycaemic hyperinsulinaemic clamp model. STUDY DESIGN Randomised, controlled (within subject), blinded, experiment. METHODS Eight clinically normal Standardbred horses underwent laminitis induction using the euglycaemic hyperinsulinaemic clamp model (EHC). At initiation of the EHC, one forelimb was continuously cooled (ICE), with the other maintained at ambient temperature (AMB). Dorsal lamellar sections (proximal, middle, distal) were harvested 48 h after initiation of the EHC and were analysed using histological scoring (0-3) and histomorphometry. Cellular proliferation was quantified by counting epidermal cell nuclei staining positive with an immunohistochemical proliferation marker (TPX2). RESULTS Severe elongation and disruption of SEL with dermo-epidermal separation (score of 3) was observed in all AMB feet at one or more section locations, but was not observed in any ICE sections. Overall 92% of the AMB sections received the most severe histological score (grade 3) and 8% were grade 2, whereas ICE sections were classified as either grade 1 (50%) or grade 2 (50%). Relative to AMB feet, ICE sections were 98% less likely to exhibit grades 2 or 3 (OR: 0.02, 95% CI 0.001, 0.365; P<0.01). Histomorphometry measurements of total and nonkeratinised primary epidermal lamellar length were significantly increased (P<0.01) in AMB limbs compared with ICE. TPX2 positive cell counts were significantly increased (P<0.01) in AMB limbs compared with ICE. MAIN LIMITATIONS Continuous digital hypothermia was initiated before recognition of laminitis and therefore the clinical applicability requires further investigation. CONCLUSIONS Continuous digital hypothermia reduced the severity of laminitis in the EHC model and prevented histological lesions compatible with lamellar structural failure.
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Affiliation(s)
- S M Stokes
- Australian Equine Laminitis Research Unit, School of Veterinary Science, the University of Queensland, Gatton, Queensland, Australia
| | - J K Belknap
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, the Ohio State University, Columbus, Ohio, USA
| | - J B Engiles
- New Bolton Center, Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, Pennsylvania, USA.,New Bolton Center, Pathobiology, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, Pennsylvania, USA
| | - D Stefanovski
- New Bolton Center, Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, Pennsylvania, USA
| | - F R Bertin
- Australian Equine Laminitis Research Unit, School of Veterinary Science, the University of Queensland, Gatton, Queensland, Australia
| | - C E Medina-Torres
- Australian Equine Laminitis Research Unit, School of Veterinary Science, the University of Queensland, Gatton, Queensland, Australia
| | - R Horn
- Australian Equine Laminitis Research Unit, School of Veterinary Science, the University of Queensland, Gatton, Queensland, Australia
| | - A W van Eps
- Australian Equine Laminitis Research Unit, School of Veterinary Science, the University of Queensland, Gatton, Queensland, Australia.,New Bolton Center, Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, Pennsylvania, USA
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Roszkowska K, Witkowska-Pilaszewicz O, Przewozny M, Cywinska A. Whole body and partial body cryotherapies - lessons from human practice and possible application for horses. BMC Vet Res 2018; 14:394. [PMID: 30541547 PMCID: PMC6292096 DOI: 10.1186/s12917-018-1679-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 10/30/2018] [Indexed: 12/30/2022] Open
Abstract
Whole body and partial body cryotherapies (WBC and PBC) have been successfully used in human medicine, and currently also are being proposed in veterinary practice. In horses, only the partial body cryotherapy provided in cryosauna is considered, due to the technical conditions. These therapies have been dedicated to human patients with rheumatic and inflammatory diseases as well as an assistance during training in athletes. The anti-inflammatory effects have been demonstrated clinically and indicated by the changes in several hematological and immunological parameters, however, various patterns have been described, depending on the protocols and the treating subjects. The numbers of white blood cells and the differential counts either increased or remained unchanged but the cytokine concentrations generally changed towards various anti-inflammatory profiles and the modifications of immunological molecules having paracrine effects have been reported. In equine practice, local cold therapies have been successfully used, so the therapy in cryosauna, which allows for a much shorter procedure with much lower temperature seems promising.
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Affiliation(s)
- K Roszkowska
- Department of Pathology and Veterinary Diagnostics, Faculty of Veterinary Medicine, Warsaw University of Life Sciences, SGGW, Nowoursynowska 159c, Warsaw, Poland
| | - O Witkowska-Pilaszewicz
- Department of Pathology and Veterinary Diagnostics, Faculty of Veterinary Medicine, Warsaw University of Life Sciences, SGGW, Nowoursynowska 159c, Warsaw, Poland
| | - M Przewozny
- EQUI VET SERWIS, Wygoda 6, 64-320, Buk, Poland
| | - A Cywinska
- Department of Pathology and Veterinary Diagnostics, Faculty of Veterinary Medicine, Warsaw University of Life Sciences, SGGW, Nowoursynowska 159c, Warsaw, Poland.
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Burke MJ, Tomlinson JE, Blikslager AT, Johnson AL, Dallap-Schaer BL. Evaluation of digital cryotherapy using a commercially available sleeve style ice boot in healthy horses and horses receiving i.v. endotoxin. Equine Vet J 2018; 50:848-853. [PMID: 29654616 DOI: 10.1111/evj.12842] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 03/26/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Continuous digital cryotherapy experimentally prevents development and reduces severity of sepsis-associated laminitis. A sleeve style ice boot where ice is in direct contact with the skin, and water drains from the boot is being used clinically for distal limb cryotherapy. The degree of cooling achieved by this boot is unknown. OBJECTIVES Evaluate skin and lamellar cooling after application of the ice sleeve in healthy horses, and the same horses during an endotoxaemia model. STUDY DESIGN Prospective study, crossover design. METHODS In eight healthy horses thermocouples were inserted into dorsal lamellae of both front feet, and under skin on both metacarpi. One forelimb received cryotherapy using sleeve style ice boot, with contralateral limb as control. Temperature was recorded on data logging devices at 5 min intervals during each cryotherapy session. Day 1: temperature data was collected for healthy horses. Day 2: data was collected for the same horses during i.v. administration of endotoxin. RESULTS In healthy and endotoxaemic horses, the sleeve style ice boot significantly decreased mean skin (7.2°C and 5.8°C respectively) and lamellar (10.8°C and 9.6°C respectively) temperatures compared with control limbs (P<0.001). Skin and lamellar temperatures in endotoxaemic horses undergoing cryotherapy were significantly colder than in healthy horses (P = 0.01). MAIN LIMITATIONS Order of treatment not randomised. CONCLUSIONS The boot caused significant decreases in lamellar temperatures compared with untreated control limbs in all horses. Endotoxaemic horses had significantly colder lamellae and skin than healthy horses. This study is the first to show that a sleeve style boot, where ice does not cover the hoof, can cause significant decreases in lamellar temperatures through cooling of blood as it travels to the foot.
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Affiliation(s)
- M J Burke
- Department of Clinical Sciences, North Carolina State University, Raleigh, North Carolina, USA
| | - J E Tomlinson
- Baker Institute, Cornell University College of Veterinary Medicine, Ithaca, New York, USA
| | - A T Blikslager
- Department of Clinical Sciences, North Carolina State University, Raleigh, North Carolina, USA
| | - A L Johnson
- Department of Clinical Studies, University of Pennsylvania, School of Veterinary Medicine, Kennett Square, Pennsylvania, USA
| | - B L Dallap-Schaer
- Department of Clinical Studies, University of Pennsylvania, School of Veterinary Medicine, Kennett Square, Pennsylvania, USA
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13
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Proctor-Brown L, Hicks R, Colmer S, Guilfoyle D, Dallap-Schaer B, Johnson AL, Tomlinson J. Distal limb pathologic conditions in horses treated with sleeve-style digital cryotherapy (285 cases). Res Vet Sci 2018; 121:12-17. [PMID: 30308395 DOI: 10.1016/j.rvsc.2018.09.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 09/04/2018] [Accepted: 09/26/2018] [Indexed: 11/27/2022]
Abstract
Digital cryotherapy (DC) is frequently used as laminitis prophylaxis for horses. While DC with ice-water slurries is reported to be safe for up to 48 h, the safety of sleeve-style digital cryotherapy (SSDC) with ice in direct contact with the distal limb has not been evaluated. Our objective was to determine the incidence of distal limb pathologic conditions (DLPC) among horses treated with SSDC. A retrospective study of cases from 2011 to 2015 identified 285 horses treated with SSDC for a minimum of 12 h. Data collected from medical records included demographic, treatment, diagnostic, and SSDC treatment parameters. Bivariate statistics and a generalized linear regression model were created to evaluate risk factors associated with increased incidence of DLPC. Among horses treated with SSDC, 7% had tissue injury of the distal limb. Increasing duration of SSDC was associated with increased incidence of DLPC. Lesions observed included dermatitis, cellulitis, alopecia, coronitis, tissue necrosis, and distal limb edema. These lesions were similar to frostbite, non-freezing cold injury, and prolonged water immersion injuries seen in other species. While the incidence of DLPC was low, the authors recommend that horses undergoing SSDC with ice in direct contact with the skin should be monitored closely for injury when prolonged cryotherapy is clinically indicated. Further studies to improve safety, efficacy, and convenience of alternative methods of DC for horses are warranted.
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Affiliation(s)
- Lauren Proctor-Brown
- Baker Institute, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853, United States
| | - Rebecca Hicks
- Baker Institute, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853, United States
| | - Sarah Colmer
- Department of Clinical Studies, New Bolton Center, University of Pennsylvania School of Veterinary Medicine, Kennett Square, PA, United States
| | - Danielle Guilfoyle
- Department of Clinical Studies, New Bolton Center, University of Pennsylvania School of Veterinary Medicine, Kennett Square, PA, United States
| | - Barbara Dallap-Schaer
- Department of Clinical Studies, New Bolton Center, University of Pennsylvania School of Veterinary Medicine, Kennett Square, PA, United States
| | - Amy L Johnson
- Department of Clinical Studies, New Bolton Center, University of Pennsylvania School of Veterinary Medicine, Kennett Square, PA, United States
| | - Joy Tomlinson
- Baker Institute, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853, United States.
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14
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Affiliation(s)
- K. Hopster
- Department of Clinical Studies New Bolton Center School of Veterinary Medicine University of Pennsylvania Kennett Square Pennsylvania USA
| | - A. W. Eps
- Department of Clinical Studies New Bolton Center School of Veterinary Medicine University of Pennsylvania Kennett Square Pennsylvania USA
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Freeman DE. Fifty years of colic surgery. Equine Vet J 2018; 50:423-435. [DOI: 10.1111/evj.12817] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 12/05/2017] [Accepted: 01/10/2018] [Indexed: 12/21/2022]
Affiliation(s)
- D. E. Freeman
- Department of Large Animal Clinical Sciences; College of Veterinary Medicine; University of Florida; Gainesville Florida USA
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16
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Morgan J, Stefanovski D, Lenfest M, Chatterjee S, Orsini J. Novel dry cryotherapy system for cooling the equine digit. Vet Rec Open 2018; 5:e000244. [PMID: 29344364 PMCID: PMC5761284 DOI: 10.1136/vetreco-2017-000244] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 11/06/2017] [Accepted: 11/11/2017] [Indexed: 11/14/2022] Open
Abstract
Objectives Digital cryotherapy is commonly used for laminitis prophylaxis and treatment. Currently validated methods for distal limb cryotherapy involve wet application or compression technology. There is a need for a practical, affordable, dry cryotherapy method that effectively cools the digit. The objective of this study was to evaluate the hoof wall surface temperatures (HWSTs) achieved with a novel dry cryotherapy technology. Design Repeated-measures in vivo experimental study. Setting Experimental intervention at a single site. Participants 6 systemically healthy horses (3 mares, 3 geldings). Interventions Cryotherapy was applied to six horses for eight hours with a commercially available rubber and rubber and welded fabricice boot, which extended proximally to include the foot and pastern. Reusable malleable cold therapy packs were secured against the foot and pastern with the three built-in hook-and-loop fastener panels. Primary and secondary outcome measures HWST and pastern surface temperature of the cryotherapy-treated limb, HWST of the control limb and ambient temperature were recorded every five minutes throughout the study period. Results Results were analysed with mixed-effects multivariable regression analysis. The HWST (median 11.1°C, interquartile range 8.6°C–14.7°C) in the cryotherapy-treated limb was significantly decreased compared with the control limb (median 29.7°C, interquartile range 28.9°C–30.4°C) (P≤0.001). Cryotherapy limb HWST reached a minimum of 6.75°C (median) with an interquartile range of 4.1°C–9.3°C. Minimum HWST was achieved 68 minutes after cryotherapy pack application. Conclusions Dry application of cryotherapy significantly reduced HWST and reached minimums below the therapeutic target of 10°C. This cryotherapy method might offer an effective alternative for digital cooling.
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Affiliation(s)
- Jessica Morgan
- Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, Pennsylvania, USA
| | - Darko Stefanovski
- Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, Pennsylvania, USA
| | - Margret Lenfest
- Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, Pennsylvania, USA
| | - Sraboni Chatterjee
- Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, Pennsylvania, USA
| | - James Orsini
- Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, Pennsylvania, USA
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17
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18
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Dern K, van Eps A, Wittum T, Watts M, Pollitt C, Belknap J. Effect of Continuous Digital Hypothermia on Lamellar Inflammatory Signaling When Applied at a Clinically-Relevant Timepoint in the Oligofructose Laminitis Model. J Vet Intern Med 2017; 32:450-458. [PMID: 29282770 PMCID: PMC5787192 DOI: 10.1111/jvim.15027] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 09/06/2017] [Accepted: 11/28/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Although continuous digital hypothermia (CDH) protects lamellae from injury in the oligofructose (OF) model of sepsis-related laminitis (SRL), conflicting results exist from these studies regarding effects of CDH on lamellar inflammatory events. HYPOTHESIS/OBJECTIVES To determine the effect of CDH on lamellar inflammatory events in normal and OF-treated horses when instituted at a clinically relevant time point (onset of clinical signs of sepsis in this model). ANIMALS Standardbred geldings (n = 15) aged 3-11 years were used. METHODS In a randomized, controlled discovery study, animals were administered either OF (OF group, n = 8) or water (CON group, n = 8) by nasogastric tube and CDH was initiated in one forelimb (ICE) 12 hours later. Lamellar tissue samples were collected 24 hours after initiation of CDH (ICE and ambient [AMB] forelimbs). Lamellar mRNA concentrations of inflammatory mediators and lamellar leukocyte numbers were assessed using qPCR and immunohistochemistry, respectively; values from four sample groups (CON AMB, OF AMB, CON ICE, and OF ICE) were analyzed using mixed model linear regression. RESULTS Although lamellar mRNA concentrations of multiple inflammatory mediators (IL-1β, IL-6, CXCL1, MCP2, COX-2) were increased after OF administration (OF AMB group versus CON AMB; P < 0.05), only 2 inflammatory mediators (IL-6 and COX-2) and lamellar leukocyte numbers were decreased with CDH (OF ICE versus OF AMB; P < 0.05). CONCLUSIONS AND CLINICAL IMPORTANCE Continuous digital hypothermia initiated at a time point similar to that commonly used clinically (clinical onset of sepsis) resulted in a more focused inhibition of inflammatory signaling.
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Affiliation(s)
- K Dern
- Department of Veterinary Clinical Sciences, Ohio State University, Columbus, OH, USA
| | - A van Eps
- Australian Equine Laminitis Research Unit, School of Veterinary Science, The University of Queensland, Gatton, Qld, Australia
| | - T Wittum
- Department of Veterinary Preventive Medicine, Ohio State University, Columbus, OH, USA
| | - M Watts
- Department of Veterinary Clinical Sciences, Ohio State University, Columbus, OH, USA
| | - C Pollitt
- Australian Equine Laminitis Research Unit, School of Veterinary Science, The University of Queensland, Gatton, Qld, Australia
| | - J Belknap
- Department of Veterinary Clinical Sciences, Ohio State University, Columbus, OH, USA
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Abstract
There has been great progress in the understanding of basic neurobiologic mechanisms of pain, but this body of knowledge has not yet translated into new and improved analgesics. Progress has been made regarding pain assessment in horses, but more work is needed until sensitive and accurate pain assessment tools are available for use in clinical practice. This review summarizes and updates the knowledge concerning the cornerstones of pain medicine (understand, assess, prevent, and treat). It highlights the importance of understanding pain mechanisms and expressions to enable a rational approach to pain assessment, prevention, and management in the equine patient.
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20
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Dern K, Watts M, Werle B, van Eps A, Pollitt C, Belknap J. Effect of Delayed Digital Hypothermia on Lamellar Inflammatory Signaling in the Oligofructose Laminitis Model. J Vet Intern Med 2017; 31:575-581. [PMID: 28145603 PMCID: PMC5354059 DOI: 10.1111/jvim.14633] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 09/26/2016] [Accepted: 11/10/2016] [Indexed: 01/23/2023] Open
Abstract
Background In the oligofructose (OF) model of sepsis‐related laminitis (SRL), digital hypothermia (“cryotherapy”) initiated before the onset of clinical signs is reported not only to limit lamellar injury, but also to cause marked inhibition of lamellar inflammatory signaling. Hypothesis/Objectives Because hypothermia also has been reported to be protective when not initiated until the onset of lameness in the OF model of SRL, we hypothesized that the lamellar protection conferred by hypothermia is caused by local lamellar inhibition of inflammatory signaling as described when hypothermia was initiated earlier in the disease process. Animals Eight Standardbred geldings aged 3–11 years with no lameness and no abnormalities of the feet detectable by gross or radiographic examination. Methods Using the OF model of SRL, lamellar mRNA concentrations of proinflammatory cytokines, chemokines, and endothelial adhesion proteins were compared between samples from treated limbs (CRYO, submerged in ice water for 36 hour starting at the onset of lameness), untreated limbs (NON‐CRYO, opposite limb from CRYO limbs maintained at ambient temperature), and untreated limbs from normal horses in which laminitis was not induced (CON). Results Although OF administration resulted in increases in lamellar mRNA concentrations of several inflammatory mediators in NON‐CRYO limbs (vs CON), digital hypothermia had no significant effect on these increases. Conclusions and Clinical Importance The lack of inflammatory inhibition in lamellar tissue samples in our study indicates that the protective effects of digital hypothermia instituted at the onset of clinical signs of laminitis do not arise from inhibition of inflammatory pathways.
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Affiliation(s)
- K Dern
- Department of Veterinary Clinical Sciences, Ohio State University, Columbus, OH
| | - M Watts
- Department of Veterinary Clinical Sciences, Ohio State University, Columbus, OH
| | - B Werle
- Department of Veterinary Clinical Sciences, Ohio State University, Columbus, OH
| | - A van Eps
- Australian Equine Laminitis Research Unit, School of Veterinary Science, The University of Queensland, Gatton, Qld, Australia
| | - C Pollitt
- Australian Equine Laminitis Research Unit, School of Veterinary Science, The University of Queensland, Gatton, Qld, Australia
| | - J Belknap
- Department of Veterinary Clinical Sciences, Ohio State University, Columbus, OH
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21
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Godman JD, Burns TA, Kelly CS, Watts MR, Leise BS, Schroeder EL, van Eps AW, Belknap JK. The effect of hypothermia on influx of leukocytes in the digital lamellae of horses with oligofructose-induced laminitis. Vet Immunol Immunopathol 2016; 178:22-8. [PMID: 27496739 DOI: 10.1016/j.vetimm.2016.05.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 04/29/2016] [Accepted: 05/23/2016] [Indexed: 10/21/2022]
Abstract
Sepsis-related laminitis (SRL) is a common complication in the septic/endotoxemic critically-ill equine patient, in which lamellar injury and failure commonly lead to crippling distal displacement of the distal phalanx. Similar to organ injury in human sepsis, lamellar injury in SRL has been associated with inflammatory events, including the influx of leukocytes into the lamellar tissue and markedly increased expression of a wide array of inflammatory mediators at the onset of Obel grade 1 (OG1) laminitis. The only treatment reported both clinically and experimentally to protect the lamellae in SRL, local hypothermia ("cryotherapy"), has been demonstrated to effectively inhibit lamellar expression of multiple inflammatory mediators when initiated at the time of administration of a carbohydrate overload in experimental models of SRL. However, the effect of hypothermia on leukocyte influx into affected tissue has not been assessed. We hypothesized that cryotherapy inhibits leukocyte emigration into the digital lamellae in SRL. Immunohistochemical staining using leukocyte markers MAC387 (marker of neutrophils, activated monocytes) and CD163 (monocyte/macrophage-specific marker) was performed on archived lamellar tissue samples from an experimental model of SRL in which one forelimb was maintained at ambient temperature (AMB) and one forelimb was immersed in ice water (ICE) immediately following enteral oligofructose administration (10g/kg, n=14 horses). Lamellae were harvested at 24h post-oligofructose administration (DEV, n=7) or at the onset of OG1 laminitis (OG1, n=7). Both MAC387-positive and CD163-positive cells were counted by a single blinded investigator on images [n=10 (40× fields/digit for MAC387 and 20x fields/digit for CD163)] obtained using Aperio microscopy imaging analysis software. Data were assessed for normality and analyzed with a paired t-test and one-way ANOVA with significance set at p<0.05. MAC387-positive cells were present in low numbers in the lamellar tissue and were decreased in the hypothermic limbs (vs. AMB limbs, p<0.05) in the OG1 group; no change in CD163-positive cell numbers was noted across the conditions of the model. This study demonstrated that hypothermia of the distal limbs instituted early in the disease process in the horse at risk of SRL significantly attenuates the increase of MAC387-positive leukocytes in the digital lamellae, but has minimal effect on increases in lamellar concentrations of the major leukocyte cell type present in that tissue, CD163-positive mononuclear cells.
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Affiliation(s)
- Jennifer D Godman
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Ohio State University, Columbus, OH 43210, United States
| | - Teresa A Burns
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Ohio State University, Columbus, OH 43210, United States
| | - Carlin S Kelly
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Ohio State University, Columbus, OH 43210, United States
| | - Mauria R Watts
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Ohio State University, Columbus, OH 43210, United States
| | - Britta S Leise
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Louisiana State University, Baton Rouge, LA, United States
| | - Eric L Schroeder
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Ohio State University, Columbus, OH 43210, United States
| | - Andrew W van Eps
- Australian Equine Laminitis Research Unit, School of Veterinary Science, Faculty of Science, The University of Queensland, Gatton Campus, Gatton, QLD 4343, Australia
| | - James K Belknap
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Ohio State University, Columbus, OH 43210, United States.
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Holl HM, Gao S, Fei Z, Andrews C, Brooks SA. Generation of a de novo transcriptome from equine lamellar tissue. BMC Genomics 2015; 16:739. [PMID: 26432030 PMCID: PMC4592545 DOI: 10.1186/s12864-015-1948-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 09/22/2015] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Laminitis, the structural failure of interdigitated tissue that suspends the distal skeleton within the hoof capsule, is a devastating disease that is the second leading cause of both lameness and euthanasia in the horse. Current transcriptomic research focuses on the expression of known genes. However, as this tissue is quite unique and equine gene annotation is largely derived from computational predictions, there are likely yet uncharacterized transcripts that may be involved in the etiology of laminitis. In order to create a novel annotation resource, we performed whole transcriptome sequencing of sagittal lamellar sections from one control and two laminitis affected horses. RESULTS Whole transcriptome sequencing of the three samples resulted in 113 million reads. Overall, 88 % of the reads mapped to the equCab2 reference genome, allowing for the identification of 119,430 SNPs. The de novo assembly generated around 75,000 transcripts, of which 36,000 corresponded to known annotations. Annotated transcript models are hosted in a public data repository and thus can be easily accessed or loaded into genome browsers. RT-PCR of 12 selected assemblies confirmed structure and expression in lamellar tissue. CONCLUSIONS Transcriptome sequencing represents a powerful tool to expand on equine annotation and identify novel targets for further laminitis research.
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Affiliation(s)
- Heather M Holl
- Department of Animal Sciences, University of Florida, Gainesville, FL, 32611, USA.
| | - Shan Gao
- Boyce Thompson Institute for Plant Research, Cornell University, Ithaca, NY, 14853, USA.
| | - Zhangjun Fei
- Boyce Thompson Institute for Plant Research, Cornell University, Ithaca, NY, 14853, USA.
| | - Caroline Andrews
- Laboratory of Molecular Immunoregulation, National Cancer Institute, Bethesda, MD, 20892, USA.
| | - Samantha A Brooks
- Department of Animal Sciences, University of Florida, Gainesville, FL, 32611, USA.
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23
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Underwood C, Pollitt CC, Metselaar JM, Laverman P, van Bloois L, van den Hoven JM, Storm G, van Eps AW. Distribution of technetium-99m PEG-liposomes during oligofructose-induced laminitis development in horses. Vet J 2015; 206:218-25. [PMID: 26403954 DOI: 10.1016/j.tvjl.2015.07.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2014] [Revised: 04/08/2015] [Accepted: 07/12/2015] [Indexed: 12/16/2022]
Abstract
Liposomes are phospholipid nanoparticles used for targeted drug delivery. This study aimed to determine whether intravenous liposomes accumulate in lamellar tissue during laminitis development in horses so as to assess their potential for targeted lamellar drug delivery. Polyethylene-glycol (PEG) coated liposomes were prepared according to the film hydration method and labelled using (99m)Tc-hexamethyl-propylene-amine-oxime. Six horses received 10 g/kg oligofructose via nasogastric tube to induce laminitis, and four control horses received water via nasogastric tube. All horses received 300 µmol (99m)Tc-PEG-liposomes (5.5 GBq) plus 5.5 µmol/kg PEG-liposomes by slow intravenous infusion. Scintigraphic imaging was performed at 0, 6 and 12 h post-infusion. Technetium-99m liposome uptake was measured in regions of interest over the hoof, fetlock and metacarpus. At the study end-point horses were euthanased, tissue samples collected and tissue liposome levels were calculated as the percentage of the injected dose of (99m)Tc-liposomes per kilogram of tissue. Data were analysed non-parametrically. All horses receiving oligofructose developed clinical and histological signs of laminitis. Technetium-99m liposome uptake in the hoof increased with time in laminitis horses (P = 0.04), but decreased with time in control horses (P = 0.01). Technetium-99m liposome levels in lamellar tissue from laminitis horses were 3.2-fold higher than controls (P = 0.02) and were also higher in laminitis vs. control skin, muscle, jejunum, colon, and kidney (P < 0.05). Liposomes accumulated in lamellar tissue during oligofructose-induced laminitis development and demonstrated potential for targeted lamellar drug delivery in acute laminitis. This study provides further evidence that lamellar inflammation occurs during laminitis development. Liposome accumulation also occurred in the skin, muscle, jejunum, colon and kidneys, suggesting systemic inflammation in this model.
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Affiliation(s)
- Claire Underwood
- Australian Equine Laminitis Research Unit, School of Veterinary Science, University of Queensland, Gatton, QLD 4343, Australia.
| | - Christopher C Pollitt
- Australian Equine Laminitis Research Unit, School of Veterinary Science, University of Queensland, Gatton, QLD 4343, Australia
| | - Josbert M Metselaar
- Department of Experimental Molecular Imaging, University Clinic and Helmholtz Institute for Biomedical Engineering, RWTH-Aachen University, Aachen, Germany
| | - Peter Laverman
- Radboud University Medical Centre Nijmegen, The Netherlands
| | - Louis van Bloois
- Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences (UIPS), University of Utrecht, The Netherlands
| | | | - Gert Storm
- Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences (UIPS), University of Utrecht, The Netherlands
| | - Andrew W van Eps
- Australian Equine Laminitis Research Unit, School of Veterinary Science, University of Queensland, Gatton, QLD 4343, Australia
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Abstract
The current understanding of pathology as it relates to common diseases of the equine musculoskeletal system is reviewed. Conditions are organized under the fundamental categories of developmental, exercise-induced, infectious, and miscellaneous pathology. The overview of developmental pathology incorporates the new classification system of juvenile osteochondral conditions. Discussion of exercise-induced pathology emphasizes increased understanding of the contribution of cumulative microdamage caused by repetitive cyclic loading. Miscellaneous musculoskeletal pathology focuses on laminitis, which current knowledge indicates should be regarded as a clinical syndrome with a variety of possible distinct mechanisms of structural failure that are outlined in this overview.
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Affiliation(s)
- Frances J Peat
- Equine Orthopaedic Research Center, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, 300 West Drake Rd, Fort Collins, CO 80523, USA
| | - Christopher E Kawcak
- Equine Orthopaedic Research Center, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, 300 West Drake Rd, Fort Collins, CO 80523, USA.
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25
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Medina-Torres CE, Underwood C, Pollitt CC, Castro-Olivera EM, Hodson MP, Richardson DW, van Eps AW. Microdialysis measurements of lamellar perfusion and energy metabolism during the development of laminitis in the oligofructose model. Equine Vet J 2015; 48:246-52. [DOI: 10.1111/evj.12417] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 01/02/2015] [Indexed: 12/31/2022]
Affiliation(s)
- C. E. Medina-Torres
- Australian Equine Laminitis Research Unit, School of Veterinary Science; The University of Queensland; Gatton Queensland Australia
| | - C. Underwood
- Australian Equine Laminitis Research Unit, School of Veterinary Science; The University of Queensland; Gatton Queensland Australia
| | - C. C. Pollitt
- Australian Equine Laminitis Research Unit, School of Veterinary Science; The University of Queensland; Gatton Queensland Australia
| | - E. M. Castro-Olivera
- Australian Equine Laminitis Research Unit, School of Veterinary Science; The University of Queensland; Gatton Queensland Australia
| | - M. P. Hodson
- Metabolomics Australia - Queensland Node, Australian Institute for Bioengineering and Nanotechnology; The University of Queensland; St Lucia Queensland Australia
| | - D. W. Richardson
- New Bolton Center, Department of Clinical Studies, School of Veterinary Medicine; University of Pennsylvania; Kennett Square Philadelphia USA
| | - A. W. van Eps
- Australian Equine Laminitis Research Unit, School of Veterinary Science; The University of Queensland; Gatton Queensland Australia
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26
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van Eps AW, Orsini JA. A comparison of seven methods for continuous therapeutic cooling of the equine digit. Equine Vet J 2015; 48:120-4. [PMID: 25385194 DOI: 10.1111/evj.12384] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 11/06/2014] [Indexed: 11/27/2022]
Abstract
REASONS FOR PERFORMING STUDY Digital hypothermia may be effective for laminitis prophylaxis and therapy, but the efficacy of cooling methods used in clinical practice requires evaluation. OBJECTIVES To use hoof wall surface temperature (HWST) to compare several cooling methods used in clinical practice. STUDY DESIGN Experimental crossover design with a minimum washout period of 72 h. METHODS Seven cooling methods (commercially available ice packs, wraps and boots) and one prototypical dry-sleeve device were applied to a single forelimb in 4 horses for 8 h, during which HWST of the cooled forelimb and the uncooled (control) forelimb was recorded hourly. Results were analysed descriptively. RESULTS The median (range) HWST from 2-8 h was lowest for the ice and water immersion methods that included the foot and extended proximally to at least include the pastern: 5.2°C (range: 4.8-7.8°C) for the fluid bag and 2.7°C (2.4-3.4°C) for the ice boot. An ice boot that included the distal limb but not the foot resulted in a median HWST of 25.7°C (20.6-27.2°C). Dry interface applications (ice packs) confined to the foot only resulted in a median HWST of 21.5°C (19.5-25.5°C) for the coronet sleeve and 19.8°C (17.6-23°C) for a commercial ice pack. For the dry interface applications that included the foot and distal limb, the median HWST was much higher for the ice pack device, 19.9°C (18.7-23.1°C), compared with the perfused cuff prototype of 5.4°C (4.2-7°C). CONCLUSIONS Immersion of the foot and at least the pastern region in ice and water achieved sustained HWST <10°C as did a prototype perfused cuff device with a dry interface. Variation between cooling methods may have a profound effect on HWST and therefore efficacy in clinical cases where laminitis prophylaxis or therapy is the goal.
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Affiliation(s)
| | - J A Orsini
- New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, USA
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Mitchell CF, Fugler LA, Eades SC. The management of equine acute laminitis. VETERINARY MEDICINE-RESEARCH AND REPORTS 2014; 6:39-47. [PMID: 30101095 PMCID: PMC6067769 DOI: 10.2147/vmrr.s39967] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Laminitis is an extremely painful condition resulting in damage to the soft tissues anchoring the third phalanx to the hoof, which can result in life-threatening debilitation. Specific therapy is not available. The most important principles of therapy include aggressive nutritional and medical management of primary disease processes, cryotherapy, anti-inflammatory therapy, pain management, and biomechanical support. This review focuses on the principles of evidenced-based therapies.
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Affiliation(s)
- Colin F Mitchell
- Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA, USA,
| | - Lee Ann Fugler
- Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA, USA,
| | - Susan C Eades
- Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA, USA,
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28
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Orsini JA. Science-in-brief: Equine laminitis research: Milestones and goals. Equine Vet J 2014; 46:529-33. [DOI: 10.1111/evj.12301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- J. A. Orsini
- New Bolton Center; School of Veterinary Medicine; University of Pennsylvania; USA
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