Atypical myopathy: an update

Assessment of tree-associated atypical myopathy risk factors in Acer pseudoplatanus (sycamore) seeds and leaves

BACKGROUND

Sycamore tree-derived hypoglycin A (HGA) toxin causes atypical myopathy (AM), an acute, equine pasture-associated rhabdomyolysis but incidence fluctuates.

OBJECTIVES

Investigate whether tree or environmental factors influence HGA concentration in sycamore material and are associated with AM relative risk.

STUDY DESIGN

Retrospective and experimental prospective study.

METHODS

UK sycamore population, seed production and AM incidence data were obtained. HGA concentration was measured in seeds from trees from 10 different central UK locations. The effect of tar spot infection, seed maturity, tree trunk girth, location (urban/countryside), AM cases within 130 m, soil type, facing direction of seeds on the tree and year on seed HGA concentration was examined. HGA concentration was compared in whole and homogenated seeds stored in different ways.

RESULTS

HGA concentration in sycamore seeds was not associated with tree tar spot infection, location, trunk girth, seed weight or branch-facing direction but HGA concentration in sycamore seeds varied significantly and in parallel year on year in the same trees. Trees in the same vicinity tended to have similar HGA concentrations in their seeds when compared with those from farther afield. Seed production estimates were positively correlated with regional AM case incidence (τb = 0.3; p = 0.007). HGA sycamore seed concentration remained stable as seeds matured, but HGA declined in leaves as they wilted in autumn. Warmer and wet storage resulted in higher HGA concentrations in seed homogenates but not in whole seeds. HGA was detected in water containing sycamore seeds for 48 h.

MAIN LIMITATIONS

Lack of accurate weather data; sampling restricted to central England.

CONCLUSIONS

Tree factors that were investigated did not affect HGA concentration in sycamore seeds but HGA concentrations varied year on year. AM incidence is related to seed production; conditions that mimic browsing and ingestion increased seed HGA concentration. HGA toxicity could occur from contaminated water sources.

Release of Hypoglycin A from Hypoglycin B and Decrease of Hypoglycin A and Methylene Cyclopropyl Glycine Concentrations in Ruminal Fluid Batch Cultures

The transformation of hypoglycin A (HGA), hypoglycin B (HGB), and methylene cyclopropyl glycine (MCPrG) in ruminal fluid batch cultures was investigated, and the effect of these toxins on the batch culture microorganisms using microbial metabolites was measured. An experiment was conducted using ovine ruminal fluid batch cultures and the ANKOM RF Gas Production System over four runs, each with an incubation period of 48 h. The fermenters contained 200 mg of (i) a substrate mixture (80% cellulose, 20% starch; CSM), (ii) CSM and 1.5 mL of a solution of pure toxins (a mixture of 500 ng/mL HGA and MCPrG each; PCM), or (iii) CSM and 100 mg sycamore maple seeds (SMS). Each fermenter contained 30 mL of inoculum (ruminal fluid and buffer, 1:2 v/v). For control, autoclaved ruminal fluid was incubated with CSM, PCM, and SMS, respectively. Samples were taken from the liquid phase of the fermenters and analyzed using liquid chromatography-tandem mass spectrometry (LC/MS-MS) for sycamore maple toxins and metabolites. Microbial activity was assessed using gas production, short chain fatty acids, and NH3 concentration. Additionally, pH and redox potentials were measured. In PCM, HGA and MCPrG concentrations rapidly decreased (p < 0.05), and were not measurable anymore after a 24 h incubation period. In SMS, the initial concentrations were 4.7 ± 1.4 µg/mL HGA, 19.9 ± 5.41 µg/mL HGB, and 1.2 ± 0.33 µg/mL MCPrG. In SMS, HGA increased in 24 h, coincidently to a decrease in HGB concentration (p < 0.05). We modeled a rapid conversion of HGB to HGA, accompanied by progressive HGA transformation. The concentration of MCPrG was constant until 4 h and decreased afterwards (p < 0.05). In SMS incubations, HGA and MCPrG concentrations of 5.6 ± 1.5 and 0.32 ± 0.090 µg/mL remained after 48 h, respectively. The HGB to HGA conversion and transformation of HGA and MCPrG also occurred in autoclaved ruminal fluid. Gas production and microbial metabolite concentrations were higher in SMS compared to CSM and PCM (p < 0.05), as the seeds were used as an additional substrate by the batch culture microorganisms.

Do Poisonous Plants in Pastures Communicate Their Toxicity? Meta-Study and Evaluation of Poisoning Cases in Central Europe

One of the possible roles of secondary plant metabolites, including toxins, is facilitating plant-animal communication. Lethal cases of pasture poisoning show that the message is not always successfully conveyed. As the focus of poisoning lies in the clinical aspects, the external circumstances of pasture poisoning are widely unknown. To document poisoning conditions in cattle, sheep, goats, and horses on pastures and to compile a checklist of plants involved in either poisoning or co-existence (zero poisoning), published case reports were evaluated as primary sources. The number of affected animal individuals was estimated within abundance classes from 0 to more than 100. The checklist of poisonous plants comprised 52 taxa. Of these, 13 taxa were deemed safe (no reference was found indicating poisoning), 11 taxa were associated with evidence-based zero poisoning (positive list), and 28 taxa were associated with poisoning (negative list). Nine plant taxa caused poisoning in more than 100 animal individuals. Zero poisoning accounted for 40% and poisoning accounted for 60% of a total of 85 cases. Poisoning was most often associated with a limited choice of feed (24.7%), followed by overgrazing (12.9%), seasonally scarce feed (10.6%), and co-ingestion of grass (4.7%). Hunger interferes with plant-animal co-existence, while zero poisoning improves it. In conclusion, poisonous plants in pastures may communicate their toxicity if the animals have enough alternative feed plants. An individual animal might utterly perceive the communication of toxicity by the plant species but be forced to ignore the message owing to a limited choice of feed options.

Hypoglycin A absorption in sheep without concurrent clinical or biochemical evidence of disease

BACKGROUND

Hypoglycin A (HGA) intoxication after ingestion of Acer spp. tree material has never been confirmed in domesticated ruminants despite their similar grazing habitats.

OBJECTIVES

To investigate whether sheep have low HGA bioavailability caused by rumen HGA breakdown.

ANIMALS

Stomach and rumen fluid samples from 5 adult horses and 5 adult sheep respectively. Residual serum samples from 30 ewes and lambs.

METHODS

Experimental and retrospective cohort study. Hypoglycin A concentration was quantified in horse gastric and sheep ruminal samples after in vitro incubation with Acer pseudoplatanus seeds. Serum samples from grazing sheep (n = 20) and nursing lambs (n = 10) obtained before and after their release onto pastures with and without Sycamore seedlings were analyzed for HGA and methylenecyclopropyl-acetic acid carnitine, and serum biochemistry.

RESULTS

Neither ovine rumen nor equine gastric fluid affected HGA content in samples incubated for up to 2 hours. Despite HGA's detection in serum from sheep (n = 13/15; median, 23.71 ng/mL; range, 5.62-126.4 ng/mL) grazing contaminated pastures and in their nursing lambs (n = 2/5; median, 12.5 ng/mL; range, 8.82-15.67 ng/mL), there was no apparent clinical or subclinical disease.

CONCLUSIONS AND CLINICAL IMPORTANCE

Any reduced sensitivity to HGA intoxication in sheep seems unrelated to ruminal degradation. Serum HGA concentrations in sheep were similar to those of subclinically affected atypical myopathy horses. Any reduced sensitivity of sheep to HGA might be related to greater metabolic resistance rather than selective grazing habits or lower bioavailability. Hypoglycin A was found in nursing lambs, suggesting that HGA is excreted in milk.

Equine atypical myopathy: consumption of sycamore maple seedlings (Acer pseudoplatanus) by pastured horses is driven by seedling maturity and might be associated with phenolic compounds

BACKGROUND

Poisoning with Acer pseudoplatanus L. in horses contradicts the hypothesis of coexistence between plants and vertebrate herbivores being mediated through antipastoral traits as toxins. However, incidental observations showed that horses evaded Acer seedlings with primary leaves. The objective of the present cross-discipline study was (i) to analyse whether developmental stages of A. pseudoplatanus L. differed as to phenolics hypothesised as antipastoral traits, and (ii) to observe systematically the selection behaviour of pastured horses towards A. pseudoplatanus seedlings.

METHODS

Phenolic profiles of five developmental stages from fruits to seedlings of progressing age up to adult leaves of A. pseudoplatanus and Acer campestre L. were characterised. Video recordings of grazing behaviour of 29 pastured horses towards seedlings of A. pseudoplatanus resulted into 117 sequences as additional field data.

RESULTS

The horses ingested 19.1 per cent of juvenile seedlings with cotyledons (1.65 mg total phenolics/g fresh weight (FW), 82 compounds, 0.02 mg total gallic acid/g FW) yet only 5.46 per cent of older seedlings with primary leaves (8.48 mg total phenolics/g FW, 120 compounds, 3.13 mg total gallic acid/g FW).

CONCLUSION

Horses distinguished between seedlings in distinct stages that could be chemically distinguished, too. Acer seedlings with primary leaves provide a strong, but not complete antipastoral effect that correlates with dramatic changes in phenolic compounds.

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).

Atypical myopathy-associated hypoglycin A toxin remains in sycamore seedlings despite mowing, herbicidal spraying or storage in hay and silage

BACKGROUND

Several pasture management strategies have been proposed to avoid hypoglycin A (HGA) intoxication in horses, but their efficacy has never been investigated.

OBJECTIVES

To evaluate the effect of mowing and herbicidal spraying on HGA content of sycamore seedlings and the presence of HGA in seeds and seedlings processed within haylage and silage.

STUDY DESIGN

Experimental study.

METHODS

Groups of seedlings were mowed (n = 6), sprayed with a dimethylamine-based (n = 2) or a picolinic acid-based herbicide (n = 1). Seedlings were collected before intervention, and at 48 h, 1 and 2 weeks after. Cut grass in the vicinity of mowed seedlings was collected pre-cutting and after 1 week. Seeds and seedling (n = 6) samples processed within haylage and silage were collected. HGA concentration in samples was measured using a validated LC-MS-based method.

RESULTS

There was no significant decline in HGA content in either mowed or sprayed seedlings; indeed, mowing induced a temporary significant rise in HGA content of seedlings. HGA concentration increased significantly (albeit to low levels) in grass cut with the seedlings by 1 week. HGA was still present in sycamore material after 6-8 months storage within either hay or silage.

MAIN LIMITATIONS

Restricted number of herbicide compounds tested.

CONCLUSIONS

Neither mowing nor herbicidal spraying reduces HGA concentration in sycamore seedlings up to 2 weeks after intervention. Cross contamination is possible between grass and sycamore seedlings when mowed together. Mowing followed by collection of sycamore seedlings seems the current best option to avoid HGA toxicity in horses grazing contaminated pasture. Pastures contaminated with sycamore material should not be used to produce processed hay or silage as both seedlings and seeds present in the bales still pose a risk of intoxication.

Atypical myopathy in Père David's deer (Elaphurus davidianus) associated with ingestion of hypoglycin A

From 2004 until 2016, 21 Père David's deer (Elaphurus davidianus) have died for unknown reason at Zoo Duisburg. These deer, also known as milu, have succumbed from a myopathy that occurred seasonally in autumn and in spring. The clinical signs shown by the animals closely resembles those of a disease called equine atypical myopathy (EAM), which is formerly known in horses. The cause for EAM in Europe was found in the ingestion of hypoglycin A, contained in samaras and seedlings of the sycamore maple tree (Acer pseudoplatanus). To test the hypothesis that the mortality of milus was caused by ingestion of hypoglycin A, 79 sera from all zoos and wildlife parks that have kept milus in Germany and Austria, including 19 diseased and 60 healthy animals, were used. Selected biochemical values and additionally hypoglycin A, methylenecyclopropyl acetic acid-carnitine (MCPA-carnitine), and acylcarnitines, which have been found in horses suffering from EAM, were determined. The results showed greater values of serum activities of creatine kinase (P < 0.001) and aspartate aminotransferase (P < 0.001) in diseased milus comparing to healthy ones confirming a myopathy in affected animals. Moreover, hypoglycin A and MCPA-carnitine were found in the blood of Père David's deer and thus, hypoglycin A intoxication was considered to be a potential cause for the myopathies by ingestion of sycamore maple samaras that were present in the enclosure of the affected animals. Hypoglycin A values were greater in diseased animals (P < 0.01) as well as MCPA-carnitine levels (P < 0.05). Additionally, affected milus showed greater C5-OH-carnitine (P < 0.01) and C6-carnitine (P < 0.001) values. Until now hypoglycin A intoxication was only known in the family of Equidae, in humans, and in laboratory rats, and it has not been previously described in other zoological families. Comparing to horses, ruminants do have a different digestive tract and it will need further investigation to find out if several factors are involved to trigger an outbreak in ruminants.