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Li FI, Spence RJ, de Laat MA, Harris PA, Sonntag J, Menzies-Gow NJ, Durham AE, Bailey SR, Sillence MN. Association between insulin dysregulation and adrenocorticotropic hormone in aged horses and ponies with no clinical signs of pituitary pars intermedia dysfunction. Equine Vet J 2023; 55:1003-1011. [PMID: 36641787 DOI: 10.1111/evj.13925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 01/05/2023] [Indexed: 01/16/2023]
Abstract
BACKGROUND High concentrations of adrenocorticotropic hormone (ACTH) are used as an indicator of pituitary pars intermedia dysfunction (PPID), but other factors that may influence ACTH need to be understood, if diagnostic reference ranges for ACTH are to be used with confidence. Insulin dysregulation (ID) could be one such factor, as insulin affects pituitary hormones in other species. OBJECTIVES To test the hypothesis that a relationship exists between high insulin and high ACTH in aged (>15-year-old) animals with no clinical signs of PPID. STUDY DESIGN A cohort study. METHODS Thirteen horses and eleven ponies (17-25 years-old; mares and geldings) were clinically examined for signs of PPID in the spring (November 2020) and autumn (April 2021). On the same day, blood samples were taken before and 2 h after an oral glucose test (OGT). Concentrations of insulin, glucose, ACTH and cortisol were measured. RESULTS There was no association between ACTH and cortisol. However, there was a positive linear correlation between ACTH and post-OGT (insulin in the autumn (r = 0.427, p = 0.04). Two horses and six ponies had ACTH above the cut-off value for PPID diagnosis, and of these eight animals, six also had insulin concentrations above the cut-off value for ID. MAIN LIMITATIONS The cohort was small and thyrotropin-releasing hormone (TRH) stimulation tests were not performed. CONCLUSIONS In autumn, high ACTH was associated with ID, when no clinical signs of PPID were present. Because ACTH is used in PPID diagnosis, further work is required to understand this interaction.
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Affiliation(s)
- Fang I Li
- School of Biology & Environmental Science, Science Faculty, Queensland University of Technology (QUT), Brisbane, Queensland, Australia
| | - Robert J Spence
- School of Biology & Environmental Science, Science Faculty, Queensland University of Technology (QUT), Brisbane, Queensland, Australia
| | - Melody A de Laat
- School of Biology & Environmental Science, Science Faculty, Queensland University of Technology (QUT), Brisbane, Queensland, Australia
| | - Patricia A Harris
- Equine Studies Group, Waltham Petcare Science Institute, Leicestershire, UK
| | - Johanna Sonntag
- Boehringer Ingelheim Vetmedica GmbH, Ingelheim am Rhein, Germany
| | | | | | - Simon R Bailey
- Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Martin N Sillence
- School of Biology & Environmental Science, Science Faculty, Queensland University of Technology (QUT), Brisbane, Queensland, Australia
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2
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Stefaniuk-Szmukier M, Piórkowska K, Ropka-Molik K. Equine Metabolic Syndrome: A Complex Disease Influenced by Multifactorial Genetic Factors. Genes (Basel) 2023; 14:1544. [PMID: 37628596 PMCID: PMC10454496 DOI: 10.3390/genes14081544] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/10/2023] [Accepted: 07/26/2023] [Indexed: 08/27/2023] Open
Abstract
Equine metabolic syndrome (EMS) has become an important issue in modern veterinary medicine and is linked to the common, extremely painful, most-of-the-time performance-terminating hoof laminitis. The growing knowledge in the field of genetic background, inducing environmental factors, diagnosis, treatment and maintenance of affected equines led us to summarise the available information to be used not only for scientific purposes but for fieldwork. In horses, the clinical presentation of EMS includes: obesity or local fat deposition, bilateral lameness or hoof rings attributed to ongoing or previous (pasted) laminitis with the key feature of the occurrence of insulin dysregulation, disturbing the homeostasis within insulin, glucose and lipid metabolism. The management of EMS is based on dietary and fitness discipline; however, intensive research is ongoing in the field of regenerative medicine to develop modern and promising therapies.
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Affiliation(s)
- Monika Stefaniuk-Szmukier
- Department of Animal Molecular Biology, National Research Institute of Animal Production, Krakowska 1, 32-083 Balice, Poland
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3
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de Laat MA, Fitzgerald DM. Equine metabolic syndrome: Role of the enteroinsular axis in the insulin response to oral carbohydrate. Vet J 2023; 294:105967. [PMID: 36858344 DOI: 10.1016/j.tvjl.2023.105967] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 01/17/2023] [Accepted: 02/26/2023] [Indexed: 03/02/2023]
Abstract
Equine insulin dysregulation (ID) comprises amplified insulin responses to oral carbohydrates or insulin resistance, or both, which leads to sustained or periodic hyperinsulinaemia. Hyperinsulinaemia is important in horses because of its clear association with laminitis risk, and the gravity of this common sequela justifies the need for a better understanding of insulin and glucose homoeostasis in this species. Post-prandial hyperinsulinaemia is the more commonly identified component of ID and is diagnosed using tests that include an assessment of the gastrointestinal tract (GIT). There are several factors present in the GIT that either directly, or indirectly, enhance insulin secretion from the endocrine pancreas, and these factors are collectively referred to as the enteroinsular axis (EIA). A role for key components of the EIA, such as the incretin peptides glucagon-like peptide-1 and 2, in the pathophysiology of ID has been investigated in horses. By comparison, the function (and even existence) of many EIA peptides of potential importance, such as glicentin and oxyntomodulin, remains unexplored. The incretins that have been examined all increase insulin responses to oral carbohydrate through one or more mechanisms. This review presents what is known about the EIA in horses, and discusses how it might contribute to ID, then compares this to current understanding derived from the extensive studies undertaken in other species. Future directions for research are discussed and knowledge gaps that should be prioritised are suggested.
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Affiliation(s)
- Melody A de Laat
- School of Biology and Environmental Science, Faculty of Science, Queensland University of Technology, Brisbane 4000, Australia.
| | - Danielle M Fitzgerald
- School of Biology and Environmental Science, Faculty of Science, Queensland University of Technology, Brisbane 4000, Australia
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4
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Pituitary Pars Intermedia Dysfunction (PPID) in Horses. Vet Sci 2022; 9:vetsci9100556. [PMID: 36288169 PMCID: PMC9611634 DOI: 10.3390/vetsci9100556] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/25/2022] [Accepted: 10/04/2022] [Indexed: 12/12/2022] Open
Abstract
Substantial morbidity results from pituitary pars intermedia dysfunction (PPID) which is often underestimated by owners and veterinarians. Clinical signs, pathophysiology, diagnostic tests, and treatment protocols of this condition are reviewed. The importance of improved recognition of early clinical signs and diagnosis are highlighted, as initiation of treatment will result in improved quality of life. Future research should be targeted at improving the accuracy of the diagnosis of PPID, as basal adrenocorticotropic hormone (ACTH) concentration can lack sensitivity and thyrotropin releasing hormone (TRH) used to assess ACTH response to TRH stimulation is not commercially available as a sterile registered product in many countries. The relationship between PPID and insulin dysregulation and its association with laminitis, as well as additional management practices and long-term responses to treatment with pergolide also require further investigation.
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5
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Sillence M, Meier A, de Laat M, Klee R, Reiche D. Demographic, morphologic, hormonal and metabolic factors associated with the rate of improvement from equine hyperinsulinaemia-associated laminitis. BMC Vet Res 2022; 18:49. [PMID: 35042535 PMCID: PMC8764787 DOI: 10.1186/s12917-022-03149-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 01/04/2022] [Indexed: 11/18/2022] Open
Abstract
Background Although several studies have investigated factors associated with the onset and occurrence of hyperinsulinaemia-associated laminitis (HAL), few have examined the factors associated with the rate of improvement during recovery from an acute bout of the disease. This observational study sought to discover if a range of demographic, morphologic, hormonal and metabolic variables are associated with the improvement rate from HAL in 37 naturally-occurring cases identified by 16 clinics across Germany. Each case was evaluated for laminitis severity on the day of inclusion in the trial (d 0), then after 4, 9, 14, 25 and 42 d. The horses were managed according to best clinical practice including restricting exercise and prescribing a diet of hay-only, for a minimum of 9 d. Blood samples were also collected during each evaluation, except on d 9, and analysed for glucose, insulin, ACTH and leptin. Results Based on individual clinical laminitis scores plotted against time, most horses improved markedly within 2 weeks, with a ‘fast group’ (n = 27) having a median (interquartile range) score on a 12-point scale of 0 (0–2) by d 14. However, there was a clear disparity within the total cohort, as ~ 1 in 4 horses demonstrated much slower improvement, with a median score of 5 (4–7) by d 14, or a marked relapse thereafter (‘slow group’, n = 10). Horses in the slow improvement group were younger (12.5 (8.8–16.3) vs 17 (14–24) yr; P = 0.008), but were not more likely to be heavier, male, very fat, to have presented with a previous history of laminitis or elevated ACTH concentrations, or to be receiving pergolide treatment. Of the hormonal and metabolic parameters measured, glucose and insulin concentrations were within the normal range following transition to the hay-only diet, but were higher in the group that failed to improve quickly, with a small but significant difference being evident on d 4, 14 and 25 for glucose (11 to 16%; P < 0.05), and a larger difference for insulin on d 14 and 25 (51 to 55%; P < 0.05). There was no difference between the groups in ACTH or leptin concentrations throughout the study. The main limitations of this study were the small number of slow-improvement horses and an inability to control or measure certain variables, such as feed quality. Conclusions Young age and a modest increase in blood glucose and insulin concentrations are associated with delayed laminitis improvement.
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Galinelli NC, Bailey SR, Bamford NJ, Harris PA. Nutritional considerations for the management of equine pituitary
pars intermedia
dysfunction. EQUINE VET EDUC 2021. [DOI: 10.1111/eve.13593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- N. C. Galinelli
- Melbourne Veterinary School The University of Melbourne Parkville Victoria Australia
| | - S. R. Bailey
- Melbourne Veterinary School The University of Melbourne Parkville Victoria Australia
| | - N. J. Bamford
- Melbourne Veterinary School The University of Melbourne Parkville Victoria Australia
| | - P. A. Harris
- Equine Studies Group Waltham Petcare Science Institute Melton Mowbray UK
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Grenager NS. Endocrinopathic Laminitis. Vet Clin North Am Equine Pract 2021; 37:619-638. [PMID: 34674908 DOI: 10.1016/j.cveq.2021.08.001] [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] [Indexed: 11/19/2022] Open
Abstract
Endocrinopathic laminitis (EL) primarily occurs because of insulin dysregulation (ID) mediated through downstream effects of insulin on IGF-1R in lamellar tissues. There is likely contributing vascular and metabolic dysfunction within the lamellae, but EL is relatively non-inflammatory. EL is associated with lamellar stretching, proliferation, and failure, ultimately causing failure of the suspensory apparatus of the distal phalanx. Proper education regarding mitigating risk factors makes this a largely preventable cause of laminitis. Annual hoof evaluation plus screening geriatric horses for pituitary pars intermedia dysfunction and ID, and younger horses for ID, can significantly decrease the incidence of this devastating condition.
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Affiliation(s)
- Nora S Grenager
- Steinbeck Peninsula Equine Clinics, 100 Ansel Lane, Menlo Park, CA 94028, USA.
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Changes Associated with the Peri-Ovulatory Period, Age and Pregnancy in ACTH, Cortisol, Glucose and Insulin Concentrations in Mares. Animals (Basel) 2021; 11:ani11030891. [PMID: 33804751 PMCID: PMC8003915 DOI: 10.3390/ani11030891] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/17/2021] [Accepted: 03/18/2021] [Indexed: 11/17/2022] Open
Abstract
Simple Summary The reproductive cycle of mares is associated with many hormonal changes, but the effects of this cycle and pregnancy on adrenocorticotropic hormone and insulin concentrations are poorly described, which could limit our ability to diagnose pituitary pars intermedia dysfunction and insulin dysregulation. In this study, healthy mares are followed through their reproductive cycle during the physiologic breeding season, and adrenocorticotropic hormone, cortisol, glucose and insulin concentrations are measured to determine the effects of age, pregnancy and the reproductive cycle on analyte concentrations. No significant effect of age, the reproductive cycle or pregnancy is detected on the cortisol, glucose or insulin concentrations; however, adrenocorticotropic hormone concentrations are significantly increased throughout the peri-ovulatory period and during pregnancy. Therefore, knowledge of a mare’s reproductive cycle might be beneficial when interpreting adrenocorticotropic hormone concentrations. Abstract Although there are many hormonal changes associated with reproduction, the effects of ovulation and early pregnancy on adrenocorticotropic hormone (ACTH) and insulin concentrations are poorly described. We hypothesise that both ovulation and early pregnancy will alter ACTH and insulin concentrations in healthy mares. Eighteen mares showing no clinical signs suggestive of, or laboratory findings consistent with, pituitary pars intermedia dysfunction PPID and insulin dysregulation (ID) are enrolled. ACTH, cortisol, insulin and glucose concentrations are measured over their peri-ovulatory period, as determined via ultrasounds and progesterone concentrations. The mares are grouped by age and gestation status, and a two-way repeated-measures ANOVA is used to determine the effects of age and early pregnancy, along with the peri-ovulatory period, on analyte concentrations. No significant effect of age, ovulation or early pregnancy is detected on the mares’ cortisol, insulin or glucose concentrations; however, there is a significant effect of early pregnancy and ovulation on ACTH concentrations (p = 0.04 and p = 0.04 respectively). ACTH concentrations change around ovulation and with early pregnancy. Therefore, knowledge of a mare’s reproductive status might be beneficial when interpreting ACTH concentrations.
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Miller AB, Loynachan AT, Bush HM, Hart KA, Barker VD, Campana-Emard AG, Grubbs ST, Adams AA. Effects of pituitary pars intermedia dysfunction and Prascend (pergolide tablets) treatment on endocrine and immune function in horses. Domest Anim Endocrinol 2021; 74:106531. [PMID: 32942194 DOI: 10.1016/j.domaniend.2020.106531] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 06/19/2020] [Accepted: 07/24/2020] [Indexed: 11/24/2022]
Abstract
It remains unclear how pituitary pars intermedia dysfunction (PPID) and pergolide treatment (Prascend [pergolide tablets]) affect endocrine and immune function in horses. To evaluate these effects, blood was collected regularly from 28 university-owned horses (10 Non-PPID, 9 PPID control [PC], and 9 PPID treatment [PT]) over approximately 15 mo. Pergolide treatment was initiated after Day 0 collections. Analyses included ACTH, insulin, total cortisol, free cortisol, complete blood counts, plasma myeloperoxidase, and cytokine/receptor gene expression in basal whole blood and in vitro stimulations (PMA/ionomycin, heat-inactivated Rhodococcus equi, and heat-inactivated Escherichia coli) of whole blood and peripheral blood mononuclear cells (PBMCs). The results were analyzed using a linear mixed model (SAS 9.4) with significance set at P < 0.05. Significant group (P = 0.0014) and group-by-time (P = 0.0004) effects were observed in resting ACTH such that PT horses differed from Non-PPID horses only at Day 0. PT horses had significantly lower changes in ACTH responses to thyrotropin-releasing hormone stimulation tests than PC horses at non-fall time points only, mid-late February 2018 (P = 0.016) and early April 2018 (P = 0.0172). When PT and PC horses did not differ, they were combined before comparison to Non-PPID horses. No significant group or group-by-time effects were seen in resting insulin, total cortisol, or free cortisol; however, significant time effects were observed in these measures. PPID horses had lower absolute lymphocyte (P = 0.028) and red blood cell (P = 0.0203) counts than Non-PPID horses. In unstimulated whole blood, PPID horses had increased IL-8 expression compared with Non-PPID horses (P = 0.0102). In addition, PPID horses had decreased interferon γ production from PBMCs after stimulation with R. equi (P = 0.0063) and E. coli (P = 0.0057) and showed increased transforming growth factor β expression after E. coli stimulation (P = 0.0399). The main limitations of this study were a limited sample size and an inability to truly randomize the PPID horses into treatment groups. Resting ACTH is likely the best choice for determining successful responses to pergolide. Neither PPID nor pergolide appears to influence insulin, total cortisol, and free cortisol. As measured, systemic immune function was altered in PPID horses, and it is likely that these horses are indeed at increased risk of opportunistic infection. Despite reducing ACTH, pergolide treatment did not appear to influence immune function.
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Affiliation(s)
- A B Miller
- M.H. Gluck Equine Research Center, Department of Veterinary Science, University of Kentucky, Lexington, KY, USA.
| | - A T Loynachan
- Veterinary Diagnostic Laboratory, Department of Veterinary Science, University of Kentucky, Lexington, KY, USA
| | - H M Bush
- Department of Biostatistics, University of Kentucky, Lexington, KY, USA
| | - K A Hart
- Department of Large Animal Medicine, College of Veterinary Medicine, University of Georgia, Athens, GA, USA
| | - V D Barker
- M.H. Gluck Equine Research Center, Department of Veterinary Science, University of Kentucky, Lexington, KY, USA
| | - A G Campana-Emard
- M.H. Gluck Equine Research Center, Department of Veterinary Science, University of Kentucky, Lexington, KY, USA
| | - S T Grubbs
- Boehringer Ingelheim Animal Health USA, Inc, Duluth, GA, USA
| | - A A Adams
- M.H. Gluck Equine Research Center, Department of Veterinary Science, University of Kentucky, Lexington, KY, USA
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Horn R, Stewart AJ, Jackson KV, Dryburgh EL, Medina-Torres CE, Bertin FR. Clinical implications of using adrenocorticotropic hormone diagnostic cutoffs or reference intervals to diagnose pituitary pars intermedia dysfunction in mature horses. J Vet Intern Med 2020; 35:560-570. [PMID: 33368633 PMCID: PMC7848300 DOI: 10.1111/jvim.16017] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 12/09/2020] [Accepted: 12/11/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Diagnosis of pituitary pars intermedia dysfunction (PPID) is problematic because of large variations in ACTH concentrations. HYPOTHESIS/OBJECTIVES Compare the test characteristics of baseline and post-thyrotropin-releasing hormone (TRH) stimulation plasma ACTH concentrations in horses using diagnostic cutoff values (DCOVs) and reference intervals (RIs) and determine the clinical consequences of using each method. ANIMALS One hundred six mature horses: 72 control cases and 34 PPID cases. METHODS Prospective case-controlled study. Horses underwent monthly TRH stimulation tests. Diagnostic cutoff values were determined monthly by receiver operating characteristic curves using the Youden index. Reference intervals were determined monthly by a robust method. For each case age, sex and body condition score (BCS) were recorded. RESULTS Baseline ACTH concentrations varied by month (P < .001) with significant "month × age" (P = .003), "month × sex" (P = .003), and "month × BCS" (P = .007) effects. Baseline ACTH concentrations were accurate to diagnose PPID (0.91 ± 0.06) with DCOVs increasing the test sensitivity (0.61 ± 0.21 to 0.87 ± 0.05, P = .002) and RI increasing test specificity (0.85 ± 0.12 to 0.98 ± 0.01, P = .01). Thyrotropin-releasing hormone stimulation improved test accuracy (0.91 ± 0.06 to 0.97 ± 0.03, P = .004). CONCLUSIONS AND CLINICAL IMPORTANCE ACTH concentrations follow a circannual rhythm and vary with physiological factors. As using DCOVs increases the ability to detect mild cases and using RI decreases the risk of unnecessary treatments, ACTH concentrations should be interpreted within a specific clinical context. The TRH stimulation test improves the diagnosis of PPID.
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Affiliation(s)
- Remona Horn
- School of Veterinary Science, The University of Queensland, Gatton, Queensland, Australia
| | - Allison J Stewart
- School of Veterinary Science, The University of Queensland, Gatton, Queensland, Australia
| | - Karen V Jackson
- School of Veterinary Science, The University of Queensland, Gatton, Queensland, Australia
| | | | - Carlos E Medina-Torres
- School of Veterinary Science, The University of Queensland, Gatton, Queensland, Australia
| | - François-René Bertin
- School of Veterinary Science, The University of Queensland, Gatton, Queensland, Australia
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11
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Van Den Wollenberg L, Vandendriessche V, van Maanen K, Counotte GHM. Comparison of Two Diagnostic Methods to Detect Insulin Dysregulation in Horses Under Field Conditions. J Equine Vet Sci 2020; 88:102954. [PMID: 32303301 DOI: 10.1016/j.jevs.2020.102954] [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: 04/25/2019] [Revised: 01/29/2020] [Accepted: 02/01/2020] [Indexed: 11/16/2022]
Abstract
Straightforward testing procedures to enable the diagnosis of insulin dysregulation (ID) in horses that are suitable for use in daily veterinary practice are needed because of the risk that ID could result in laminitis. In our study (that included 90 horses), we compared the proportion of horses classified as ID-positive, ID-suspect, and ID-not diagnosed according to the basal insulin concentration (BIC) with the proportion of horses classified as ID-positive or ID-negative according to a practical and feasible version of an oral sugar test (OST). Furthermore, BIC, basal glucose concentration, and insulin and glucose concentration after OST were analyzed and compared. In the total study population, the OST detected significantly more ID-positive cases than the BIC, with cutoffs at equivalent specificities. Receiver operating characteristics analysis showed that at a lower cutoff, the sensitivity of the BIC could be increased, but at the cost of a significantly lower specificity. Taking this into account, we found diagnostic performance of the OST to be considerably better than the BIC and therefore considered it more recommendable for use as a screening test for ID in ambulatory practice. Furthermore, we investigated the relationship between body condition score and breed type with glucose and insulin concentration as determined after our version of the OST. For that purpose, the study group was subdivided into lean, moderate, and obese horses and "easy keeper breeds" versus "non-easy keeper breeds". Results supported the general assumption that obese horses and "easy keeper breeds" are more prone to the development of ID.
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12
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Legere RM, Taylor DR, Davis JL, Bello K, Parker C, Judd RL, Wooldridge AA. Pharmacodynamic Effects of Pioglitazone on High Molecular Weight Adiponectin Concentrations and Insulin Response After Oral Sugar in Equids. J Equine Vet Sci 2019; 82:102797. [PMID: 31732109 DOI: 10.1016/j.jevs.2019.102797] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 07/17/2019] [Accepted: 09/16/2019] [Indexed: 10/26/2022]
Abstract
Chronic insulin dysregulation is challenging to manage with pharmaceuticals in horses. Pioglitazone improves insulin sensitivity in humans, and the pharmacokinetics of pioglitazone have been evaluated in horses. The objectives of this study were to assess the pharmacodynamic effects of oral pioglitazone on morphometric parameters, hepatic enzyme activity and function, adipokines, and enteroinsular response to oral sugar. A prospective pilot study was performed using fifteen adult equids (8 ponies, 7 horses) to evaluate the effects of short-term pioglitazone administration (2 mg/kg PO q 24 hours, 28 days). Oral sugar tests (OST) were performed before and after treatment. Adipokines were measured at day 0, 14, and 28 of administration. Plasma drug concentrations were measured at day 14 and 28 of administration. The subjects were grouped into horses, ponies, and insulin dysregulated (ID) animals. Baseline values for all parameters were compared with values obtained at day 14 and 28 using one-way or two-way analysis of variance. Mild changes were noted in morphometric parameters and hepatic enzymes. No differences were found in leptin concentrations or the blood glucose response to the OST. Significant decreases were found in the insulin response to OST at 90 and 120 minutes time points and the area under the curve after pioglitazone treatment in the pony and ID groups. High-molecular-weight (HMW) adiponectin concentrations were significantly increased in all groups after pioglitazone treatment. Decreased insulin concentrations in response to oral sugar and increased HMW adiponectin concentrations indicate positive effects of pioglitazone for treatment of metabolic derangements in equine metabolic syndrome, which warrant future clinical study.
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Affiliation(s)
- Rebecca M Legere
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, AL
| | - Debra R Taylor
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, AL
| | - Jennifer L Davis
- Department of Biomedical Sciences & Pathobiology, VA-MD College of Veterinary Medicine, Blacksburg, VA
| | - Kaitlyn Bello
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, AL
| | - Caroline Parker
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, AL
| | - Robert L Judd
- Department of Anatomy, Physiology and Pharmacology, College of Veterinary Medicine, Auburn University, Auburn, AL
| | - Anne A Wooldridge
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, AL.
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13
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Breuhaus BA. Glucose and Insulin Responses to an Intravenous Glucose Load in Thoroughbred and Paso Fino Horses. J Equine Vet Sci 2019; 81:102793. [PMID: 31668310 DOI: 10.1016/j.jevs.2019.102793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 07/23/2019] [Accepted: 08/19/2019] [Indexed: 10/26/2022]
Abstract
Certain breeds of horses may be genetically predisposed to developing insulin dysregulation, which is a risk factor for development of endocrinopathic laminitis in horses. This study was performed to test the hypotheses that Paso Fino horses exhibit evidence of insulin dysregulation compared with Thoroughbred horses and that obesity exaggerates the insulin dysregulation. Intravenous glucose tolerance tests were performed in 14 moderate-weight Thoroughbreds, 12 moderate-weight Paso Finos, and 12 overweight Paso Finos. Moderate Paso Finos had greater baseline serum insulin concentrations, area under the insulin concentration curve, peak insulin, insulin-to-glucose ratio, area under the insulin to glucose curve, and modified glucose-to-insulin ratio compared with moderate Thoroughbreds. The reciprocal inverse square of basal insulin (RISQI) and glucose-to-insulin ratio were significantly lower in moderate Paso Finos compared with moderate Thoroughbreds. Overweight Paso Finos had greater baseline insulin concentrations, area under the insulin concentration curve, time to peak insulin, baseline plasma glucose concentration, insulin-to-glucose ratio, and area under the insulin to glucose curve compared with moderate Paso Finos. The RISQI and glucose-to-insulin ratio were significantly lower in overweight Paso Finos compared with moderate Paso Finos. In conclusion, moderate-weight Paso Finos had higher baseline serum insulin concentrations and an excessive hyperinsulinemic response to an intravenous glucose load when compared with moderate-weight Thoroughbreds. Overweight Paso Finos had even greater baseline insulin concentrations and hyperinsulinemic responses to glucose compared with moderate Paso Finos, as well as greater baseline plasma glucose concentrations. Paso Finos exhibit insulin dysregulation compared with Thoroughbreds.
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Affiliation(s)
- Babetta A Breuhaus
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC.
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14
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Hodge E, Kowalski A, Torcivia C, Lindborg S, Stefanovski D, Hart K, Frank N, van Eps A. Effect of thyrotropin-releasing hormone stimulation testing on the oral sugar test in horses when performed as a combined protocol. J Vet Intern Med 2019; 33:2272-2279. [PMID: 31432575 PMCID: PMC6766522 DOI: 10.1111/jvim.15601] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 08/08/2019] [Indexed: 12/31/2022] Open
Abstract
Background The use of parallel dynamic tests to identify insulin dysregulation (ID) and pituitary pars intermedia dysfunction (PPID) in horses could have better diagnostic utility than measuring baseline hormone concentrations, if the tests do not alter diagnostic interpretation of one another. Hypothesis Performing a thyrotropin‐releasing hormone (TRH) stimulation test before an oral sugar test (OST) would not affect results of OST. Animals Twenty‐six healthy university‐owned horses. Methods A prospective randomized placebo‐controlled, crossover design was used to evaluate 3 OST protocols: OST alone, TRH followed by OST (TRH + OST), and placebo followed by OST (placebo + OST). Agreement for plasma insulin concentrations and diagnostic interpretation were assessed with Bland‐Altman and logistic regression analyses, respectively. Results Bland‐Altman analysis of TRH + OST versus OST alone showed good agreement between testing protocols, with bias ± SD for insulin concentrations at baseline 0.4 ± 4.7 μIU/mL (95% limits of agreement [LOA], −8.8 to 9.7), 60 minute −0.5 ± 22.6 μIU/mL (95% LOA, −44.7 to 43.8), and 90 minute 1.9 ± 20.6 μIU/mL (95% LOA, −38.5 to 42.4) after OST, similar to placebo + OST versus OST alone. Diagnostic interpretation (positive/negative) was not different between protocols (TRH + OST versus OST alone [P = .78], placebo + OST versus OST alone [P = .77], or TRH + OST versus placebo + OST [P = .57]). Conclusions and Clinical Importance Concurrent testing for PPID and ID with a TRH stimulation test before an OST is an acceptable diagnostic tool for investigation of endocrinopathies in horses and allows accurate testing to be performed efficiently in 1 visit.
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Affiliation(s)
- Elizabeth Hodge
- School of Veterinary Medicine, University of Pennsylvania, Clinical Studies-New Bolton Center, Kennett Square, Chester, Pennsylvania
| | - Alycia Kowalski
- School of Veterinary Medicine, University of Pennsylvania, Clinical Studies-New Bolton Center, Kennett Square, Chester, Pennsylvania
| | - Catherine Torcivia
- School of Veterinary Medicine, University of Pennsylvania, Clinical Studies-New Bolton Center, Kennett Square, Chester, Pennsylvania
| | - Sue Lindborg
- School of Veterinary Medicine, University of Pennsylvania, Clinical Studies-New Bolton Center, Kennett Square, Chester, Pennsylvania
| | - Darko Stefanovski
- School of Veterinary Medicine, University of Pennsylvania, Clinical Studies-New Bolton Center, Kennett Square, Chester, Pennsylvania
| | - Kelsey Hart
- Department of Large Animal Medicine, College of Veterinary Medicine, University of Georgia, Athens, Georgia
| | - Nicholas Frank
- Department of Clinical Sciences, Tufts Cummings School of Veterinary Medicine, North Grafton, Massachusetts
| | - Andrew van Eps
- School of Veterinary Medicine, University of Pennsylvania, Clinical Studies-New Bolton Center, Kennett Square, Chester, Pennsylvania
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15
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de Laat MA, Reiche DB, Sillence MN, McGree JM. Incidence and risk factors for recurrence of endocrinopathic laminitis in horses. J Vet Intern Med 2019; 33:1473-1482. [PMID: 30972832 PMCID: PMC6524073 DOI: 10.1111/jvim.15497] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 03/29/2019] [Indexed: 12/27/2022] Open
Abstract
Background Endocrinopathic laminitis is common in horses and ponies, but the recurrence rate of the disease is poorly defined. Objectives To determine the incidence of, and risk factors for, the recurrence of endocrinopathic laminitis. Animals Privately owned horses and ponies with acute laminitis (n = 317, of which 276 cases with endocrinopathic laminitis were followed up to study completion). Methods This prospective cohort study collected data on veterinary‐diagnosed cases of acute laminitis for 2 years. Each case was classified on acceptance to the study as endocrinopathic or non‐endocrinopathic using data collected in a questionnaire completed by the animal's veterinarian. Follow‐up data were collected at regular intervals to determine whether the laminitis recurred in the 2‐year period after diagnosis. Results The recurrence rate for endocrinopathic laminitis was 34.1%. The risk of recurrence during the 2‐year study period increased with basal, fasted serum insulin concentration (P ≤ .05), with the probability of recurrence increasing markedly as the insulin concentration increased beyond the normal range (0‐20 μIU/mL) to over the threshold for normal (up to approximately 45 μIU/mL). Being previously diagnosed with laminitis (before the study; P = .05) was also a risk factor for recurrent laminitis. Cases with a higher Obel grade of laminitis were likely (P = .05) to recur sooner. Conclusions and clinical importance Knowing that hyperinsulinemia and being previously diagnosed with laminitis are significant risk factors for recurrence will enable clinicians to proactively address these factors, thereby potentially reducing the risk of recurrence of laminitis.
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Affiliation(s)
- Melody A de Laat
- Science and Engineering Faculty, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Dania B Reiche
- Animal Health, Boehringer Ingelheim Vetmedica GmbH, Ingelheim am Rhein, Germany
| | - Martin N Sillence
- Science and Engineering Faculty, Queensland University of Technology, Brisbane, Queensland, Australia
| | - James M McGree
- Science and Engineering Faculty, Queensland University of Technology, Brisbane, Queensland, Australia
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16
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Durham AE, Frank N, McGowan CM, Menzies-Gow NJ, Roelfsema E, Vervuert I, Feige K, Fey K. ECEIM consensus statement on equine metabolic syndrome. J Vet Intern Med 2019; 33:335-349. [PMID: 30724412 PMCID: PMC6430910 DOI: 10.1111/jvim.15423] [Citation(s) in RCA: 135] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 01/11/2019] [Indexed: 12/26/2022] Open
Abstract
Equine metabolic syndrome (EMS) is a widely recognized collection of risk factors for endocrinopathic laminitis. The most important of these risk factors is insulin dysregulation (ID). Clinicians and horse owners must recognize the presence of these risk factors so that they can be targeted and controlled to reduce the risk of laminitis attacks. Diagnosis of EMS is based partly on the horse's history and clinical examination findings, and partly on laboratory testing. Several choices of test exist which examine different facets of ID and other related metabolic disturbances. EMS is controlled mainly by dietary strategies and exercise programs that aim to improve insulin regulation and decrease obesity where present. In some cases, pharmacologic aids might be useful. Management of an EMS case is a long‐term strategy requiring diligence and discipline by the horse's carer and support and guidance from their veterinarians.
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Affiliation(s)
| | - Nicholas Frank
- Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, Massachusetts
| | - Cathy M McGowan
- Institute of Veterinary Science, University of Liverpool, Neston, United Kingdom
| | - Nicola J Menzies-Gow
- Department of clinical sciences and services, Royal Veterinary College, Herts, United Kingdom
| | - Ellen Roelfsema
- Department of Equine Sciences, Utrecht University, Utrecht, The Netherlands
| | - Ingrid Vervuert
- Faculty of Veterinary Medicine, University of Leipzig, Institute of Animal Nutrition, Nutrition Diseases and Dietetics, Leipzig, Germany
| | - Karsten Feige
- Clinic for Horses, University of Veterinary Medicine Hannover, Germany
| | - Kerstin Fey
- Equine Clinic, Internal Medicine, Faculty of Veterinary Medicine, Justus-Liebig-University of Giessen, Giessen, Germany
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17
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Laat MA. Science in brief: Progress in endocrinopathic laminitis research: Have we got a foothold? Equine Vet J 2019; 51:141-142. [DOI: 10.1111/evj.13056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 11/22/2018] [Indexed: 12/21/2022]
Affiliation(s)
- M. A. Laat
- Science and Engineering Faculty Queensland University of Technology Brisbane Australia
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18
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de Laat MA, Sillence MN, Reiche DB. Phenotypic, hormonal, and clinical characteristics of equine endocrinopathic laminitis. J Vet Intern Med 2019; 33:1456-1463. [PMID: 30697823 PMCID: PMC6524085 DOI: 10.1111/jvim.15419] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 01/09/2019] [Indexed: 02/06/2023] Open
Abstract
Background Equine endocrinopathic laminitis is common and can be associated with an underlying endocrinopathy, such as equine metabolic syndrome (EMS), pituitary pars intermedia dysfunction (PPID), pasture consumption, or any combination of these factors. Objectives The aim of the study was to improve the risk assessment capabilities of clinicians, and to inform management strategies, for acute endocrinopathic laminitis by prospectively examining the phenotypic, hormonal, and clinical characteristics of the disease in a large cohort. Animals Privately owned horses and ponies (n = 301) of any age, sex, or breed diagnosed with laminitis by a veterinarian. A history of laminitis was acceptable. Methods This was a prospective cohort study. Veterinarians provided information on each case via an online questionnaire after informed consent from the animal's owner, and all data were de‐identified before analysis. Serum insulin and plasma adrenocorticotrophic hormone concentrations were measured in each case. Results Most cases were recruited in spring (109/301; 36.2%). Concurrent EMS and PPID resulted in higher basal insulin concentrations (49 [21.5‐141]; P < .02) than if an animal had a single underlying cause for their laminitis. The insulin concentration was negatively correlated (r2 = −0.38; P < .001) with the animal's height, being higher in ponies (33[10‐14]; P < .001) than horses (9.5 [3‐25.7]) and was positively correlated (r2 = 0.12; P = .05) with their grade (severity) of laminitis. Conclusions and Clinical Importance Horses and ponies with concurrent endocrinopathies have more marked hyperinsulinemia. Higher basal insulin concentrations were associated with more severe lameness.
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Affiliation(s)
- Melody A de Laat
- School of Earth, Environmental and Biological Sciences, Queensland University of Technology (QUT), Brisbane, Queensland, Australia
| | - Martin N Sillence
- School of Earth, Environmental and Biological Sciences, Queensland University of Technology (QUT), Brisbane, Queensland, Australia
| | - Dania B Reiche
- Animal Health, Boehringer Ingelheim Vetmedica GmbH, Ingelheim am Rhein, Germany
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19
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Horn R, Bamford NJ, Afonso T, Sutherland M, Buckerfield J, Tan RHH, Secombe CJ, Stewart AJ, Bertin FR. Factors associated with survival, laminitis and insulin dysregulation in horses diagnosed with equine pituitary pars intermedia dysfunction. Equine Vet J 2018; 51:440-445. [DOI: 10.1111/evj.13041] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 11/02/2018] [Indexed: 12/29/2022]
Affiliation(s)
- R. Horn
- School of Veterinary Science The University of Queensland Gatton Queensland Australia
| | - N. J. Bamford
- Faculty of Veterinary and Agricultural Sciences The University of Melbourne Werribee Victoria Australia
| | - T. Afonso
- School of Animal and Veterinary Sciences The University of Adelaide Roseworthy South Australia Australia
| | - M. Sutherland
- Gisborne Veterinary Clinic Gisborne Victoria Australia
| | | | - R. H. H. Tan
- College of Public Health, Medical and Veterinary Sciences James Cook University Townsville Queensland Australia
- Samford Valley Veterinary Hospital Samford Queensland Australia
| | - C. J. Secombe
- School of Veterinary and Life Sciences Murdoch University Perth Western Australia Australia
| | - A. J. Stewart
- School of Veterinary Science The University of Queensland Gatton Queensland Australia
| | - F. R. Bertin
- School of Veterinary Science The University of Queensland Gatton Queensland Australia
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20
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The sodium-glucose co-transporter 2 inhibitor velagliflozin reduces hyperinsulinemia and prevents laminitis in insulin-dysregulated ponies. PLoS One 2018; 13:e0203655. [PMID: 30212530 PMCID: PMC6136744 DOI: 10.1371/journal.pone.0203655] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 08/26/2018] [Indexed: 11/19/2022] Open
Abstract
There are no registered veterinary drugs for treating insulin dysregulation and preventing insulin-associated laminitis in horses. Velagliflozin is a sodium-glucose co-transport 2 inhibitor that reduces renal glucose reabsorption, promotes glucosuria, and consequently, decreases blood glucose and insulin concentrations. This study aimed to determine if velagliflozin reduced hyperinsulinemia and prevented laminitis in insulin-dysregulated ponies fed a challenge diet high in non-structural carbohydrates (NSC). An oral glucose test (1 g dextrose/kg BW) was used to screen 75 ponies for insulin dysregulation, of which 49 ponies with the highest insulin concentrations were selected. These animals were assigned randomly to either a treated group (n = 12) that received velagliflozin (0.3 mg/kg BW, p.o., s.i.d.) throughout the study, or a control group (n = 37). All ponies were fed a maintenance diet of alfalfa hay for 3 weeks, before transferring to a challenge diet (12 g NSC/kg BW/d) for up to 18 d. Blood glucose and serum insulin concentrations were measured over 4 h after feeding, on d 2 of the diet. The maximum glucose concentration was 22% lower (P = 0.014) in treated animals, with a geometric mean (95% CI) of 9.4 (8.0–11.0) mM, versus 12.1 (10.7–13.7) mM in the controls. This was reflected by lower (45%) maximum insulin concentrations in the treated group (P = 0.017), of 149 (97–228) μIU/mL, versus 272 (207–356) μIU/mL for controls. The diet induced Obel grade 1 or 2 laminitis in 14 of the 37 controls (38%), whereas no velagliflozin-treated pony developed laminitis (P = 0.011). Velagliflozin was well-tolerated, with no hypoglycemia or any clinical signs of adverse effects. The main limitation of this study was the sample size. Velagliflozin shows promise as a safe and effective compound for treating insulin dysregulation and preventing laminitis by reducing the hyperinsulinemic response to dietary NSC.
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22
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Tadros EM, Fowlie JG, Refsal KR, Marteniuk J, Schott HC. Association between hyperinsulinaemia and laminitis severity at the time of pituitary pars intermedia dysfunction diagnosis. Equine Vet J 2018; 51:52-56. [PMID: 29761574 DOI: 10.1111/evj.12963] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 05/04/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Hyperinsulinaemia is the suspected component of insulin dysregulation having the strongest association with laminitis and occurs variably in equids with pituitary pars intermedia dysfunction (PPID). OBJECTIVES We hypothesised that magnitude of hyperinsulinaemia correlates with laminitis severity in PPID-affected equids. Furthermore, we hypothesised that owners can be unaware of chronic endocrinopathic laminitis. STUDY DESIGN Cross-sectional study. METHODS Serum insulin concentrations, owner-reported laminitis history and radiographic evidence of laminitis were determined in 38 client-owned horses and ponies with confirmed PPID. Laminitis severity was classified into four categories (normal [nonlaminitic], mild, moderate or severe laminitis) based on degree of distal phalangeal rotation. Animals were also categorised as normoinsulinaemic (<20 μU/ml), mildly hyperinsulinaemic (20-50 μU/ml) and severely hyperinsulinaemic (>50 μU/ml). One-way ANOVA, t tests and Fisher's exact tests were performed. RESULTS While owners reported laminitis in 37% of animals, 76% were laminitic based on study criteria (P = 0.01). Owners reported laminitis more frequently in hyperinsulinaemic vs. normoinsulinaemic animals; recognition increased with severity of hyperinsulinaemia (P = 0.03). Mean insulin concentrations were higher in equids with moderate to severe radiographic laminitis (geometric mean 74.1, 95% confidence interval (CI) 38.4-143.1 uU/ml) vs. those classified radiographically as normal to mild (31.9, 95% CI 21.1-48.1 uU/ml P = 0.03). MAIN LIMITATIONS Dynamic insulin testing was not performed; some normoinsulinaemic animals might have had subtle insulin dysregulation. CONCLUSIONS Although radiographic abnormalities were present in most animals at the time of PPID diagnosis, chronic laminitis remained unrecognised by many owners. Owner awareness of laminitis increased with severity of hyperinsulinaemia and higher insulin concentrations were detected in association with more severe radiographic changes. The Summary is available in Chinese - See Supporting Information.
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Affiliation(s)
- E M Tadros
- Department of Pathobiology and Diagnostic Investigation, Michigan State University, East Lansing, Michigan, USA
| | - J G Fowlie
- Department of Large Animal Clinical Sciences, Michigan State University, East Lansing, Michigan, USA
| | - K R Refsal
- Department of Pathobiology and Diagnostic Investigation, Michigan State University, East Lansing, Michigan, USA
| | - J Marteniuk
- Department of Large Animal Clinical Sciences, Michigan State University, East Lansing, Michigan, USA
| | - H C Schott
- Department of Large Animal Clinical Sciences, Michigan State University, East Lansing, Michigan, USA
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23
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Secombe CJ, Bailey SR, de Laat MA, Hughes KJ, Stewart AJ, Sonis JM, Tan RHH. Equine pituitary pars intermedia dysfunction: current understanding and recommendations from the Australian and New Zealand Equine Endocrine Group. Aust Vet J 2018; 96:233-242. [DOI: 10.1111/avj.12716] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 03/29/2018] [Accepted: 05/02/2018] [Indexed: 12/25/2022]
Affiliation(s)
- CJ Secombe
- College of Veterinary Medicine, School of Veterinary and Life Sciences; Murdoch University; Murdoch Western Australia Australia
| | - SR Bailey
- Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences; The University of Melbourne; Werribee VIC Australia
| | - MA de Laat
- Science and Engineering Faculty; Queensland University of Technology; Brisbane QLD Australia
| | - KJ Hughes
- School of Animal and Veterinary Sciences; Charles Sturt University; Wagga Wagga NSW Australia
| | - AJ Stewart
- Equine Specialist Hospital, School of Veterinary Science; The University of Queensland; Gatton QLD Australia
| | - JM Sonis
- Veterinary Associates Equine and Farm, Karaka; Auckland New Zealand
| | - RHH Tan
- Samford Valley Veterinary Hospital; Samford, QLD Australia
- Discipline of Veterinary Clinical Sciences, College of Public Health, Medical and Veterinary Sciences; James Cook University; Townsville QLD Australia
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24
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Sandow C, Fugler LA, Leise B, Riggs L, Monroe WT, Totaro N, Belknap J, Eades S. Ex vivo effects of insulin on the structural integrity of equine digital lamellae. Equine Vet J 2018; 51:131-135. [PMID: 29758109 DOI: 10.1111/evj.12964] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 05/05/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND Laminitis has a considerable impact on the equine industry. Endocrinopathic laminitis is the most common form and affected horses often have hyperinsulinaemia due to an underlying metabolic disorder. OBJECTIVES The aim of this study was to determine if insulin weakens the structural integrity of digital lamellae and to develop an ex vivo model for the study of hyperinsulinaemia-induced lamellar failure. STUDY DESIGN Ex vivo experiment. METHODS Biomechanical testing was used to assess the structural integrity of lamellar explants exposed to either medium alone (control) or medium supplemented with insulin. Lamellar explants comprised of hoof wall, lamellar tissue and distal phalanx were harvested from four adult horses with no evidence of inflammatory disease or pre-existing disease of the digit. Following an equilibration period, explants were incubated in medium or medium supplemented with insulin (2.5 μg/ml) for 8 h prior to biomechanical testing to obtain load (N), stress (MPa), elongation to failure (mm), and Young's modulus (MPa) for each explant. Significant differences were assessed using a mixed linear model with horses as a random factor and control or insulin-treated group as a fixed factor. RESULTS Lamellar explants incubated in medium supplemented with insulin failed at significantly lower load (P = 0.0001) and lower stress (P = 0.001) and had greater elongation to failure (P = 0.02). MAIN LIMITATIONS In addition to the ex vivo nature of the study, location-dependent variability in explant structural integrity and variable diffusion of nutrients due to explant size may have been limitations. However, the study design attempted to account for these limitations through random assignment of explants to treatment groups independent of location and by evaluating stress to failure. CONCLUSIONS Insulin weakens the structural integrity of equine lamellar explants and an ex vivo model for evaluation of hyperinsulinaemia-induced lamellar failure was established. The summary is available in Spanish - see Supporting Information.
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Affiliation(s)
- C Sandow
- Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, Louisiana, USA
| | - L A Fugler
- Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, Louisiana, USA
| | - B Leise
- Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, Louisiana, USA
| | - L Riggs
- Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, Louisiana, USA
| | - W T Monroe
- Department of Biological and Agricultural Engineering, Louisiana State University, Baton Rouge, Louisiana, USA
| | - N Totaro
- Department of Biological and Agricultural Engineering, Louisiana State University, Baton Rouge, Louisiana, USA
| | - J Belknap
- Veterinary Clinical Sciences, The Ohio State University College of Veterinary Medicine, Columbus, Ohio, USA
| | - S Eades
- Department of Large Animal Clinical Sciences, Texas A&M University, College of Veterinary Medicine and Biomedical Sciences, College Station, Texas, USA
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Bertin FR, Ruffin-Taylor D, Stewart AJ. Insulin dysregulation in horses with systemic inflammatory response syndrome. J Vet Intern Med 2018; 32:1420-1427. [PMID: 29749643 PMCID: PMC6060318 DOI: 10.1111/jvim.15138] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 02/01/2018] [Accepted: 03/27/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Systemic inflammation is a cause of insulin dysregulation in many species, but the insulin and glucose dynamics in adult horses diagnosed with systemic inflammatory response syndrome (SIRS) are poorly documented. HYPOTHESIS/OBJECTIVES In SIRS in horses, insulin and glucose dynamics will be altered and associated with survival. ANIMALS Adult horses diagnosed with SIRS admitted to a referral hospital. METHODS Prospective study enrolling horses diagnosed with SIRS in which serum insulin and glucose concentrations were measured. Horses were grouped by outcome (survival, hyperinsulinemia, and hyperglycemia) and compared with P < .05 considered significant. RESULTS Fifty-eight horses were included in the study and 36 (62%) survived. At admission, 21 horses (36%) were hyperinsulinemic and 44 horses (88%) were hyperglycemic, with survivors having significantly higher serum insulin and a significantly lower serum glucose concentration. Horses diagnosed with hyperinsulinemia at any time during hospitalization were 4 times more likely to survive whereas horses that were hyperglycemic at any time during hospitalization were 5 times less likely to survive. Serum glucose concentration and presence of hyperglycemia both were associated with severity of disease. Insulin/glucose ratio, reflecting insulin secretion, was significantly higher in survivors whereas glucose/insulin ratio, reflecting peripheral tissue insulin resistance, was significantly lower in nonsurvivors. Only in survivors was there a significant correlation between serum insulin and glucose concentrations. CONCLUSIONS AND CLINICAL IMPORTANCE Hyperinsulinemia and hyperglycemia are common features of SIRS in horses, but those presenting with relative hypoinsulinemia and corresponding hyperglycemia suggestive of endocrine pancreatic dysfunction have a worse prognosis.
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Affiliation(s)
- François-René Bertin
- School of Veterinary Science, The University of Queensland, Gatton, Queensland, Australia
| | - Debra Ruffin-Taylor
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, Alabama
| | - Allison Jean Stewart
- School of Veterinary Science, The University of Queensland, Gatton, Queensland, Australia.,Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, Alabama
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26
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Meier AD, de Laat MA, Reiche DB, Pollitt CC, Walsh DM, McGree JM, Sillence MN. The oral glucose test predicts laminitis risk in ponies fed a diet high in nonstructural carbohydrates. Domest Anim Endocrinol 2018; 63:1-9. [PMID: 29172109 DOI: 10.1016/j.domaniend.2017.10.008] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 10/24/2017] [Accepted: 10/25/2017] [Indexed: 10/18/2022]
Abstract
The aim of this study was to investigate the relationship between laminitis development in ponies and insulin/glucose concentrations in response to the oral glucose test (OGT) and a dietary challenge high in nonstructural carbohydrates (NSCs). After undergoing an OGT (1 g dextrose/kg BW in feed), 37 ponies with 2-h serum insulin concentrations ranging from 22 to 1,133 μIU/mL were subjected to a diet challenge period (DCP), consuming 12 g NSC/kg BW/d for up to 18 d. Insulin and glucose responses were measured on day 2 of the DCP. Clinical laminitis was diagnosed by blinded experts and confirmed radiographically. Basal ACTH levels and clinical signs were assessed to investigate concurrent putative pituitary pars intermedia dysfunction (PPID). The diet induced Obel grade 1 or 2 laminitis in 14 ponies (38%). The ponies that developed laminitis had higher maximum concentrations of blood glucose (P = 0.04) and serum insulin (P = 0.02) in response to the diet. The geometric mean (95% CI) blood glucose concentration for laminitis cases was 14.9 (12.9-17.2) mM, compared to 10.7 (9.2-12.5) mM for ponies who did not develop laminitis. Similarly, the geometric mean (95% CI) for serum insulin was 396 (301-520) μIU/mL for laminitis cases, compared to 216 (148-316) μIU/mL for ponies who did not develop laminitis. Laminitis incidence was likewise associated with insulin concentrations measured during the OGT. Laminitis occurred at frequencies of 0% (0/7) if postdextrose insulin (μIU/mL) was <50; 35% (8/23) if insulin was 50 to 195; and 86% (6/7) if insulin was >195 μIU/mL. Basal ACTH concentrations were above seasonally accepted reference ranges in 16/37 ponies, and 8 of these animals (50%) developed laminitis. This included all 5 ponies in the study that had clinical signs of PPID (100%). In contrast, hyperinsulinemia and laminitis occurred in only 3/11 ponies (27%) with elevated ACTH concentrations and no clinical signs of PPID (P = 0.009). Thus, laminitis occurrence was associated with higher glucose and insulin responses to both the OGT and challenge diet, and the frequency of laminitis can be predicted based on insulin and glucose hyperresponsiveness to these oral carbohydrate challenges.
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Affiliation(s)
- A D Meier
- Earth, Environmental and Biological Sciences School, Queensland University of Technology, Queensland, Australia
| | - M A de Laat
- Earth, Environmental and Biological Sciences School, Queensland University of Technology, Queensland, Australia
| | - D B Reiche
- Boehringer Ingelheim Vetmedica, Ingelheim am Rhein, Germany
| | - C C Pollitt
- Australian Equine Laminitis Research Unit, School of Veterinary Science, University of Queensland, Queensland, Australia
| | - D M Walsh
- Animal Health Foundation, Pacific, Missouri, USA
| | - J M McGree
- School of Mathematical Sciences, Queensland University of Technology, Queensland, Australia
| | - M N Sillence
- Earth, Environmental and Biological Sciences School, Queensland University of Technology, Queensland, Australia.
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Patterson-Kane JC, Karikoski NP, McGowan CM. Paradigm shifts in understanding equine laminitis. Vet J 2017; 231:33-40. [PMID: 29429485 DOI: 10.1016/j.tvjl.2017.11.011] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 10/08/2017] [Accepted: 11/20/2017] [Indexed: 12/29/2022]
Abstract
Laminitis, one of the most debilitating conditions of all equids, is now known to be the result of several systemic disease entities. This finding, together with other recent developments in the field of laminitis research, have provoked a rethink of our clinical and research strategies for this condition. First, laminitis is now considered to be a clinical syndrome associated with systemic disease (endocrine disease, sepsis or systemic inflammatory response syndrome, SIRS) or altered weight bearing rather than being a discrete disease entity. Next, laminitis associated with endocrine disease (endocrinopathic laminitis) is now believed to be the predominant form in animals presenting (primarily) for lameness. Third, the designation of laminitis as a primary and severe basement membrane pathology now requires revision. Instead, current data now proposes a variable subclinical phase associated with gross changes in the hoof capsule, with stretching and elongation of the lamellar cells an early and key event in the pathophysiology. These findings have fuelled new mechanistic hypotheses and research directions that will be discussed, together with their implications for future clinical management.
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Affiliation(s)
| | - N P Karikoski
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, Viikintie49, FIN-00014 Helsinki, Finland
| | - C M McGowan
- Institutes of Veterinary Science and Ageing and Chronic Disease, Faculty of Health and Life Sciences, University of Liverpool, Leahurst CH64 7TE, UK.
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Bertin FR, Laat MA. The diagnosis of equine insulin dysregulation. Equine Vet J 2017; 49:570-576. [DOI: 10.1111/evj.12703] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 05/16/2017] [Indexed: 12/18/2022]
Affiliation(s)
- F. R. Bertin
- School of Veterinary Science The University of Queensland Gatton Queensland Australia
| | - M. A. Laat
- Science and Engineering Faculty Queensland University of Technology Brisbane Queensland Australia
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Abstract
Equine endocrine disease is commonly encountered by equine practitioners. Pituitary pars intermedia dysfunction (PPID) and equine metabolic syndrome (EMS) predominate. The most logical therapeutic approach in PPID uses dopamine agonists; pergolide mesylate is the most common. Bromocryptine and cabergoline are alternative drugs with similar actions. Drugs from other classes have a poor evidence basis, although cyproheptadine and trilostane might be considered. EMS requires management changes as the primary approach; reasonable justification for use of drugs such as levothyroxine and metformin may apply. Therapeutic options exist in rare cases of diabetes mellitus, diabetes insipidus, hyperthyroidism, and critical illness-related corticosteroid insufficiency.
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Affiliation(s)
- Andy E Durham
- Liphook Equine Hospital, Liphook, Hampshire GU30 7JG, UK.
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Morgan RA, Keen JA, Walker BR, Hadoke PWF. Vascular Dysfunction in Horses with Endocrinopathic Laminitis. PLoS One 2016; 11:e0163815. [PMID: 27684374 PMCID: PMC5042533 DOI: 10.1371/journal.pone.0163815] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 09/14/2016] [Indexed: 11/19/2022] Open
Abstract
Endocrinopathic laminitis (EL) is a vascular condition of the equine hoof resulting in severe lameness with both welfare and economic implications. EL occurs in association with equine metabolic syndrome and equine Cushing’s disease. Vascular dysfunction, most commonly due to endothelial dysfunction, is associated with cardiovascular risk in people with metabolic syndrome and Cushing’s syndrome. We tested the hypothesis that horses with EL have vascular, specifically endothelial, dysfunction. Healthy horses (n = 6) and horses with EL (n = 6) destined for euthanasia were recruited. We studied vessels from the hooves (laminar artery, laminar vein) and the facial skin (facial skin arteries) by small vessel wire myography. The response to vasoconstrictors phenylephrine (10−9–10-5M) and 5-hydroxytryptamine (5HT; 10−9–10-5M) and the vasodilator acetylcholine (10−9–10-5M) was determined. In comparison with healthy controls, acetylcholine-induced relaxation was dramatically reduced in all intact vessels from horses with EL (% relaxation of healthy laminar arteries 323.5 ± 94.1% v EL 90.8 ± 4.4%, P = 0.01, laminar veins 129.4 ± 14.8% v EL 71.2 ± 4.1%, P = 0.005 and facial skin arteries 182.0 ± 40.7% v EL 91.4 ± 4.5%, P = 0.01). In addition, contractile responses to phenylephrine and 5HT were increased in intact laminar veins from horses with EL compared with healthy horses; these differences were endothelium-independent. Sensitivity to phenylephrine was reduced in intact laminar arteries (P = 0.006) and veins (P = 0.009) from horses with EL. Horses with EL exhibit significant vascular dysfunction in laminar vessels and in facial skin arteries. The systemic nature of the abnormalities suggest this dysfunction is associated with the underlying endocrinopathy and not local changes to the hoof.
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Affiliation(s)
- Ruth A. Morgan
- University/BHF Centre for Cardiovascular Science, The Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
- Royal (Dick) School of Veterinary Studies, University of Edinburgh, Midlothian, United Kingdom
- * E-mail:
| | - John A. Keen
- Royal (Dick) School of Veterinary Studies, University of Edinburgh, Midlothian, United Kingdom
| | - Brian R. Walker
- University/BHF Centre for Cardiovascular Science, The Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Patrick W. F. Hadoke
- University/BHF Centre for Cardiovascular Science, The Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
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de Laat MA, Hampson BA, Sillence MN, Pollitt CC. Sustained, Low-Intensity Exercise Achieved by a Dynamic Feeding System Decreases Body Fat in Ponies. J Vet Intern Med 2016; 30:1732-1738. [PMID: 27639952 PMCID: PMC5032883 DOI: 10.1111/jvim.14577] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 07/26/2016] [Accepted: 08/22/2016] [Indexed: 12/27/2022] Open
Abstract
Background Obesity in horses is increasing in prevalence and can be associated with insulin insensitivity and laminitis. Current treatment strategies for obesity include dietary restriction and exercise. However, whether exercise alone is effective for decreasing body fat is uncertain. Hypothesis Our hypothesis was that twice daily use of a dynamic feeding system for 3 months would induce sustained, low‐intensity exercise thereby decreasing adiposity and improving insulin sensitivity (SI). Animals Eight, university‐owned, mixed‐breed, adult ponies with body condition scores (BCS) ≥5/9 were used. Methods Two treatments (“feeder on” or “feeder off”) were administered for a 3‐month period by a randomized, crossover design (n = 4/treatment). An interim equilibration period of 6 weeks at pasture separated the 2 study phases. Measurements of body mass (body weight, BCS, cresty neck score [CrNS], and morphometry), body fat (determined before and after the “feeder on” treatment only), triglycerides, and insulin sensitivity (SI; combined glucose‐insulin test) were undertaken before and after treatments. Results The dynamic feeding system induced a 3.7‐fold increase in the daily distance travelled (n = 6), compared to with a stationary feeder, which significantly decreased mean BCS (6.53 ± 0.94 to 5.38 ± 1.71), CrNS (2.56 ± 1.12 to 1.63 ± 1.06) and body fat (by 4.95%). An improvement in SI did not occur in all ponies. Conclusions and Clinical Importance A dynamic feeding system can be used to induce sustained (daily), low‐intensity exercise that promotes weight loss in ponies. However, this exercise may not be sufficient to substantially improve SI.
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Affiliation(s)
- M A de Laat
- Earth, Environmental and Biological Sciences, Queensland University of Technology (QUT), Brisbane, Qld, Australia.
| | - B A Hampson
- Sunshine Coast Equine Podiatry Services, Coolum, Qld, Australia
| | - M N Sillence
- Earth, Environmental and Biological Sciences, Queensland University of Technology (QUT), Brisbane, Qld, Australia
| | - C C Pollitt
- Australian Equine Laminitis Research Unit, School of Veterinary Science, The University of Queensland, Gatton, Qld Australia
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Köller G, Bassewitz K, Schusser GF. [Reference ranges of insulin, insulin like growth factor-1 and adrenocorticotropic hormone in ponies]. Tierarztl Prax Ausg G Grosstiere Nutztiere 2016; 44:19-25. [PMID: 26758970 DOI: 10.15653/tpg-150428] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 11/23/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVES The aim of this study was to validate a chemiluminescence immunometric assay using the IMMULITE 2000® for the determination of adrenocorticotropic hormone (ACTH), insulin and insulin-like growth factor-1 (IGF-1) from which reference ranges were calculated for ponies. MATERIAL AND METHODS Blood samples of 130 ponies aged 3-32 years were collected in the afternoon. The reference ranges were calculated according to the Guideline EP28-A3C of the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) from 2010. RESULTS The determined intraday precision for insulin was 3.28%, for ACTH 3.35% and for IGF-1 1.84%. The interday precision (insulin: 3.45%; IGF-1: 2.89%; ACTH: 9.77%) was determined on three consecutive days, where the samples were stored at 4 °C. There was no significant loss of insulin activity nor of ACTH or IGF-1 concentration during this time. The reference ranges of insulin and IGF-1 (2.0-21.2 mU/l and 50.2-357.2 mU/l, respectively) were age independent, whereas for ACTH, an age-dependent reference range was established. Ponies aged 3-12 years had a significantly lower reference range (4.2-19.8 pg/ml) than ponies aged 13-32 years (5.0-22.6 pg/ml). CONCLUSION The method used is suitable for the determination of ACTH, IGF-1 and insulin in serum of ponies, but the lowest detection limit for insulin is 2.0 mU/l. CLINICAL RELEVANCE The calculated reference ranges of insulin and ACTH are helpful for the diagnosis and clinical monitoring of equine metabolic syndrome and pituitary pars intermedia dysfunction (PPID).
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Affiliation(s)
| | | | - G F Schusser
- Gerald F. Schusser, Medizinische Tierklinik, Veterinärmedizinische Fakultät der Universität Leipzig, An den Tierkliniken 11, 04103 Leipzig, E-Mail:
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de Laat MA, McGree JM, Sillence MN. Equine hyperinsulinemia: investigation of the enteroinsular axis during insulin dysregulation. Am J Physiol Endocrinol Metab 2016; 310:E61-72. [PMID: 26530154 DOI: 10.1152/ajpendo.00362.2015] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 10/25/2015] [Indexed: 12/25/2022]
Abstract
Compared with some other species, insulin dysregulation in equids is poorly understood. However, hyperinsulinemia causes laminitis, a significant and often lethal disease affecting the pedal bone/hoof wall attachment site. Until recently, hyperinsulinemia has been considered a counterregulatory response to insulin resistance (IR), but there is growing evidence to support a gastrointestinal etiology. Incretin hormones released from the proximal intestine, glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic peptide, augment insulin secretion in several species but require investigation in horses. This study investigated peripheral and gut-derived factors impacting insulin secretion by comparing the response to intravenous (iv) and oral d-glucose. Oral and iv tests were performed in 22 ponies previously shown to be insulin dysregulated, of which only 15 were classified as IR (iv test). In a more detailed study, nine different ponies received four treatments: d-glucose orally, d-glucose iv, oats, and commercial grain mix. Insulin, glucose, and incretin concentrations were measured before and after each treatment. All nine ponies showed similar iv responses, but five were markedly hyperresponsive to oral d-glucose and four were not. Insulin responsiveness to oral d-glucose was strongly associated with blood glucose concentrations and oral glucose bioavailability, presumably driven by glucose absorption/distribution, as there was no difference in glucose clearance rates. Insulin was also positively associated with the active amide of GLP-1 following d-glucose and grain. This study has confirmed a functional enteroinsular axis in ponies that likely contributes to insulin dysregulation that may predispose them to laminitis. Moreover, iv tests for IR are not reliable predictors of the oral response to dietary nonstructural carbohydrate.
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Affiliation(s)
- M A de Laat
- Science and Engineering Faculty, Queensland University of Technology, Brisbane, Queensland, Australia
| | - J M McGree
- Science and Engineering Faculty, Queensland University of Technology, Brisbane, Queensland, Australia
| | - M N Sillence
- Science and Engineering Faculty, Queensland University of Technology, Brisbane, Queensland, Australia
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35
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McFarlane D. Pathophysiology and clinical features of pituitarypars intermediadysfunction. EQUINE VET EDUC 2014. [DOI: 10.1111/eve.12237] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- D. McFarlane
- Center for Veterinary Health Sciences; Oklahoma State University; Stillwater USA
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36
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de Laat MA, Clement CK, Sillence MN, McGowan CM, Pollitt CC, Lacombe VA. The impact of prolonged hyperinsulinaemia on glucose transport in equine skeletal muscle and digital lamellae. Equine Vet J 2014; 47:494-501. [DOI: 10.1111/evj.12320] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 06/20/2014] [Indexed: 12/29/2022]
Affiliation(s)
- M. A. de Laat
- Department of Physiological Sciences; Center for Veterinary Health Sciences; Oklahoma State University; Stillwater USA
| | - C. K. Clement
- Department of Physiological Sciences; Center for Veterinary Health Sciences; Oklahoma State University; Stillwater USA
| | - M. N. Sillence
- Earth, Environmental and Biological Sciences; Queensland University of Technology; Brisbane Australia
| | - C. M. McGowan
- Institute of Ageing and Chronic Disease; Faculty of Health and Life Sciences; University of Liverpool; Neston UK
| | - C. C. Pollitt
- Australian Equine Laminitis Research Unit; School of Veterinary Science; The University of Queensland; Gatton Australia
| | - V. A. Lacombe
- Department of Physiological Sciences; Center for Veterinary Health Sciences; Oklahoma State University; Stillwater USA
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37
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Gehlen H, May A, Bradaric Z. Comparison of Insulin and Glucose Metabolism in Horses with Pituitary Pars Intermedia Dysfunction Treated Versus Not Treated with Pergolide. J Equine Vet Sci 2014. [DOI: 10.1016/j.jevs.2013.11.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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38
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Morgan RA, McGowan TW, McGowan CM. Prevalence and risk factors for hyperinsulinaemia in ponies in Queensland, Australia. Aust Vet J 2014; 92:101-6. [PMID: 24673135 DOI: 10.1111/avj.12159] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2013] [Indexed: 01/01/2023]
Affiliation(s)
- RA Morgan
- Philip Leverhulme Equine Hospital; University of Liverpool; Leahurst Campus Neston CH64 7TE United Kingdom
| | - TW McGowan
- Acorn Veterinary Clinic; Willows Veterinary Group; West Kirby UK
| | - CM McGowan
- Philip Leverhulme Equine Hospital; University of Liverpool; Leahurst Campus Neston CH64 7TE United Kingdom
- Institute of Aging and Chronic Disease; University of Liverpool; Neston UK
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39
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Durham AE, McGowan CM, Fey K, Tamzali Y, van der Kolk JH. Pituitarypars intermediadysfunction: Diagnosis and treatment. EQUINE VET EDUC 2014. [DOI: 10.1111/eve.12160] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
| | | | - K. Fey
- Justus-Liebig-Universität; Gießen Germany
| | - Y. Tamzali
- INP-Ecole Vétérinaire de Toulouse; France
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40
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Newkirk KM, Chameroy KA, Tadros EM, Rohrbach BW, Frank N. Pituitary Lesions, Obesity, and Mesenteric Lipomas in Insulin-Resistant Horses. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/ojvm.2014.49022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
Abnormalities of insulin metabolism include hyperinsulinaemia and insulin resistance, and these problems are collectively referred to as insulin dysregulation in this review. Insulin dysregulation is a key component of equine metabolic syndrome: a collection of endocrine and metabolic abnormalities associated with the development of laminitis in horses, ponies and donkeys. Insulin dysregulation can also accompany prematurity and systemic illness in foals. Causes of insulin resistance are discussed, including pathological conditions of obesity, systemic inflammation and pituitary pars intermedia dysfunction, as well as the physiological responses to stress and pregnancy. Most of the discussion of insulin dysregulation to date has focused on insulin resistance, but there is increasing interest in hyperinsulinaemia itself and insulin responses to feeding. An oral sugar test or in-feed oral glucose tolerance test can be performed to assess insulin responses to dietary carbohydrates, and these tests are now recommended for use in clinical practice. Incretin hormones are likely to play an important role in postprandial hyperinsulinaemia and are the subject of current research. Insulin resistance exacerbates hyperinsulinaemia, and insulin sensitivity can be measured by performing a combined glucose-insulin test or i.v. insulin tolerance test. In both of these tests, exogenous insulin is administered and the rate of glucose uptake into tissues measured. Diagnosis and management of hyperinsulinaemia is recommended to reduce the risk of laminitis. The term insulin dysregulation is introduced here to refer collectively to excessive insulin responses to sugars, fasting hyperinsulinaemia and insulin resistance, which are all components of equine metabolic syndrome.
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Affiliation(s)
- N Frank
- Department of Clinical Sciences, Tufts Cummings School of Veterinary Medicine, North Grafton, Massachusetts, USA; Division of Veterinary Medicine, School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington, Leicestershire, UK
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de Laat MA, Clement CK, McGowan CM, Sillence MN, Pollitt CC, Lacombe VA. Toll-like receptor and pro-inflammatory cytokine expression during prolonged hyperinsulinaemia in horses: implications for laminitis. Vet Immunol Immunopathol 2013; 157:78-86. [PMID: 24246153 DOI: 10.1016/j.vetimm.2013.10.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Revised: 10/12/2013] [Accepted: 10/18/2013] [Indexed: 12/31/2022]
Abstract
Equine laminitis, a disease of the lamellar structure of the horse's hoof, can be incited by numerous factors that include inflammatory and metabolic aetiologies. However, the role of inflammation in hyperinsulinaemic laminitis has not been adequately defined. Toll-like receptor (TLR) activation results in up-regulation of inflammatory pathways and the release of pro-inflammatory cytokines, including interleukin-6 (IL-6) and tumour necrosis factor-alpha (TNF-α), and may be a pathogenic factor in laminitis. The aim of this study was to determine whether TLR4 expression and subsequent pro-inflammatory cytokine production is increased in lamellae and skeletal muscle during equine hyperinsulinaemia. Standardbred horses were treated with either a prolonged, euglycaemic hyperinsulinaemic clamp (p-EHC) or a prolonged, glucose infusion (p-GI), which induced marked and moderate hyperinsulinaemia, respectively. Age-matched control horses were treated simultaneously with a balanced electrolyte solution. Treated horses developed clinical (p-EHC) or subclinical (p-GI) laminitis, whereas controls did not. Skeletal muscle and lamellar protein extracts were analysed by Western blotting for TLR4, IL-6, TNF-α and suppressor of cytokine signalling 3 (SOCS3) expression. Lamellar protein expression of TLR4 and TNF-α, but not IL-6, was increased by the p-EHC, compared to control horses. A significant positive correlation was found between lamellar TLR4 and SOCS3. Skeletal muscle protein expression of TLR4 signalling parameters did not differ between control and p-EHC-treated horses. Similarly, the p-GI did not result in up-regulation of lamellar protein expression of any parameter. The results suggest that insulin-sensitive tissues may not accurately reflect lamellar pathology during hyperinsulinaemia. While TLR4 is present in the lamellae, its activation appears unlikely to contribute significantly to the developmental pathogenesis of hyperinsulinaemic laminitis. However, inflammation may have a role to play in the later stages (e.g., repair or remodelling) of the disease.
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Affiliation(s)
- M A de Laat
- Department of Physiological Sciences, Center for Veterinary Health Sciences, Oklahoma State University, Stillwater, OK 74078, USA
| | - C K Clement
- Department of Physiological Sciences, Center for Veterinary Health Sciences, Oklahoma State University, Stillwater, OK 74078, USA
| | - C M McGowan
- Institute of Ageing and Chronic Disease, Faculty of Health and Life Sciences, University of Liverpool, Neston, CH64 7TE, UK
| | - M N Sillence
- Earth, Environmental and Biological Sciences, Queensland University of Technology, Brisbane, Queensland, 4001, Australia
| | - C C Pollitt
- Australian Equine Laminitis Research Unit, School of Veterinary Science, The University of Queensland, Gatton, Queensland, 4343, Australia
| | - V A Lacombe
- Department of Physiological Sciences, Center for Veterinary Health Sciences, Oklahoma State University, Stillwater, OK 74078, USA.
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44
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Katz LM, Bailey SR. A review of recent advances and current hypotheses on the pathogenesis of acute laminitis. Equine Vet J 2013; 44:752-61. [PMID: 23106629 DOI: 10.1111/j.2042-3306.2012.00664.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
With the increasing number of studies being published on the different experimental models used to induce and study acute laminitis, the pathophysiological events associated with these various models (i.e. starch overload, oligofructose overload, black walnut extract and hyperinsulinaemia) can be compared more realistically. Within this review, the mechanisms for metabolic vs. inflammatory laminitis are discussed, and the question of how pasture laminitis may fit into any of the proposed mechanisms is addressed.
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Affiliation(s)
- L M Katz
- School of Veterinary Medicine, University College Dublin, Dublin, Ireland.
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45
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Schreiber CM, Stewart AJ, Kwessi E, Behrend EN, Wright JC, Kemppainen RJ, Busch KA. Seasonal variation in results of diagnostic tests for pituitary pars intermedia dysfunction in older, clinically normal geldings. J Am Vet Med Assoc 2012; 241:241-8. [PMID: 22765372 DOI: 10.2460/javma.241.2.241] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine whether seasonal variations exist in endogenous plasma ACTH, plasma α-melanocyte-stimulating hormone (α-MSH), serum cortisol, and serum insulin concentrations and in the results of a dexamethasone suppression test for older, clinically normal geldings in Alabama. DESIGN Cohort study. ANIMALS 15 healthy mixed-breed geldings (median age, 14 years). PROCEDURES Sample collection was repeated monthly for 12 months. Dexamethasone (0.04 mg/kg [0.02 mg/lb], IM) was administered and cortisol concentrations were determined at 15 and 19 hours. Radioimmunoassays were used to measure ACTH, α-MSH, cortisol, and insulin concentrations at each testing time. Hormone concentrations were compared between months via repeated-measures ANOVA and correlated with age within each month. RESULTS A significant time effect was found between months for α-MSH and insulin concentrations. Endogenous cortisol and ACTH concentrations remained within existing reference ranges. Significant correlations were detected between age and ACTH concentration for several fall and winter months and between age and insulin concentration for September. CONCLUSIONS AND CLINICAL RELEVANCE Older horses have higher ACTH concentrations in several fall and winter months and higher insulin concentrations in September than do younger horses. Seasonally specific reference ranges are required for α-MSH and insulin concentrations, with significantly higher concentrations detected in the fall. Practitioners should be advised to submit samples only to local laboratories that can provide such reference ranges for their local geographic region.
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Affiliation(s)
- Christopher M Schreiber
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, AL 36849, USA
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46
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Affiliation(s)
- N. Menzies-Gow
- Department of Veterinary Clinical Science; Royal Veterinary College; North Mymms; UK
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47
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Spelta CW, Axon JE. Case series of equine pituitary pars intermedia dysfunction in a tropical climate. Aust Vet J 2012; 90:451-6. [DOI: 10.1111/j.1751-0813.2012.00997.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2012] [Indexed: 11/30/2022]
Affiliation(s)
- CW Spelta
- Townsville Vet Clinic; 32-34 Anne St; Aitkenvale; Queensland; 4814; Australia
| | - JE Axon
- Scone Equine Hospital; Scone; New South Wales; Australia
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48
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49
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de Laat MA, Patterson-Kane JC, Pollitt CC, Sillence MN, McGowan CM. Histological and morphometric lesions in the pre-clinical, developmental phase of insulin-induced laminitis in Standardbred horses. Vet J 2012; 195:305-12. [PMID: 22884985 DOI: 10.1016/j.tvjl.2012.07.003] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Revised: 06/07/2012] [Accepted: 07/04/2012] [Indexed: 01/16/2023]
Abstract
Lamellar pathology in experimentally-induced equine laminitis associated with euglycaemic hyperinsulinaemia is substantial by the acute, clinical phase (∼48h post-induction). However, lamellar pathology of the developmental, pre-clinical phase requires evaluation. The aim of this study was to analyse lamellar lesions both qualitatively and quantitatively, 6, 12 and 24h after the commencement of hyperinsulinaemia. Histological and histomorphometrical analyses of lamellar pathology at each time-point included assessment of lamellar length and width, epidermal cell proliferation and death, basement membrane (BM) pathology and leucocyte infiltration. Archived lamellar tissue from control horses and those with acute, insulin-induced laminitis (48h) was also assessed for cellular proliferative activity by counting the number of cells showing positive nuclear immuno labelling for TPX2. Decreased secondary epidermal lamellar (SEL) width and increased histomorphological evidence of SEL epidermal basal (and supra-basal) cell death occurred early in disease progression (6h). Increased cellular proliferation in SELs, infiltration of the dermis with small numbers of leucocytes and BM damage occurred later (24 and 48h). Some lesions, such as narrowing of the SELs, were progressive over this time period (6-48h). Cellular pathology preceded leucocyte infiltration and BM pathology, indicating that the latter changes may be secondary or downstream events in hyperinsulinaemic laminitis.
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Affiliation(s)
- Melody A de Laat
- Australian Equine Laminitis Research Unit, School of Veterinary Science, The University of Queensland, Gatton, Queensland 4343, Australia.
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50
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MCGOWAN TW, PINCHBECK GP, MCGOWAN CM. Prevalence, risk factors and clinical signs predictive for equine pituitary pars intermedia dysfunction in aged horses. Equine Vet J 2012; 45:74-9. [DOI: 10.1111/j.2042-3306.2012.00578.x] [Citation(s) in RCA: 118] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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