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Topic:Disease Etiology

Disease etiology in horses refers to the study of the causes and development of diseases within equine populations. It encompasses various factors, including genetic predisposition, environmental influences, infectious agents, and nutritional imbalances, that contribute to the onset and progression of diseases in horses. Understanding disease etiology is essential for identifying risk factors and implementing preventative measures in equine health management. This topic includes research on pathogen-host interactions, the impact of management practices on disease incidence, and the role of genetic and environmental factors in disease susceptibility. This page compiles peer-reviewed research studies and scholarly articles that explore the mechanisms, contributing factors, and implications of disease etiology in horses.
Voluntary Surveillance Program for Equine Influenza Virus in the United States during 2008-2021.
Pathogens (Basel, Switzerland)    January 27, 2023   Volume 12, Issue 2 192 doi: 10.3390/pathogens12020192
Chappell DE, Barnett DC, James K, Craig B, Bain F, Gaughan E, Schneider C, Vaala W, Barnum SM, Pusterla N.A voluntary upper respiratory biosurveillance program in the USA received 9740 nasal swab submissions during the years 2008-2021 from 333 veterinarians and veterinary clinics. The nasal swabs were submitted for qPCR testing for six common upper respiratory pathogens:equine influenza virus (EIV), equine herpesvirus-1 (EHV-1), equine herpesvirus-4 (EHV-4), subspecies (), equine rhinitis A virus (ERAV), and equine rhinitis B virus (ERBV). Additional testing was performed for equine gamma herpesvirus-2 (EHV-2) and equine gamma herpesvirus-5 (EHV-5) and the results are reported. Basic frequency s...
A Scoping Review of Non-Structural Airway Disease as a Cause of Poor Performance in Racehorses.
Animals : an open access journal from MDPI    January 27, 2023   Volume 13, Issue 3 429 doi: 10.3390/ani13030429
Cullinane A, Garvey M, Walsh C, Gibbons J, Creighton A.The association between poor performance and respiratory disease in Thoroughbred racehorses that do not have a structural abnormality of the respiratory tract, is often based on anecdotal evidence. The objective of this scoping review was to examine the scientific evidence for such associations. Publications were selected based on a search of three databases (PubMed, Scopus, and CAB Direct), in English and without date restriction, followed by a screening process to exclude non-relevant papers, duplicates, and reviews. This process identified 996 publications of which 20 were analysed using th...
The prevalence of headshaking in horses with primary and secondary dental sinusitis and computed tomographic evidence of infraorbital canal pathology.
Equine veterinary journal    January 26, 2023   Volume 55, Issue 6 1038-1044 doi: 10.1111/evj.13924
Labbe KA, Allshouse KA, Gilmour LJ, Arnold CE, Whitfield-Cargile CM, Griffin CE.Sinusitis is a common disease of horses yet there are a limited number of reports in the literature that describe the prevalence of infraorbital canal (IOC) pathology and headshaking behaviour in horses diagnosed specifically with primary sinusitis and secondary dental sinusitis. Given the impact that these behaviours can have on horses' intended athletic use, investigation is warranted. Objective: To determine the occurrence of IOC pathology in horses with concurrent primary or secondary dental sinusitis based on computed tomography (CT) findings and to assess whether the frequency of headsha...
Diversity of the fecal microbiota in Chinese ponies.
Frontiers in veterinary science    January 26, 2023   Volume 10 1102186 doi: 10.3389/fvets.2023.1102186
Lv S, Zhang Y, Zhang Z, Meng S, Pu Y, Liu X, Liu L, Ma Y, Liu W, Jiang L.The gut microbiomes of equine are plentiful and intricate, which plays an important part in the growth. However, there is a relative lack of information on the microbial diversity in the pony's gut. Unassigned: In this article, 118 fecal samples from DeBa pony, NiQi pony and GuZh horse were studied by 16S rRNA amplicon sequencing. Unassigned: Diversity analysis was used to determine the difference of gut microbiota composition among different breeds. Alpha diversity analysis showed that the gut microbiota of NiQi ponies were abundant and various. Beta diversity analysis showed that the microor...
Right-sided ovarian enlargement in an 8-year-old maiden warmblood mare.
Journal of the American Veterinary Medical Association    January 25, 2023   Volume 261, Issue 4 569-571 doi: 10.2460/javma.22.12.0561
Back B, Mejia S, Hackett E, Byron M, Westermann T, de Amorim MD.No abstract available
Detection of Equine Papillomaviruses and Gamma-Herpesviruses in Equine Squamous Cell Carcinoma.
Pathogens (Basel, Switzerland)    January 23, 2023   Volume 12, Issue 2 179 doi: 10.3390/pathogens12020179
Miglinci L, Reicher P, Nell B, Koch M, Jindra C, Brandt S.Squamous cell carcinoma (SCC) seriously compromises the health and welfare of affected horses. Although robust evidence points to equine papillomavirus type 2 (EcPV2) causing genital lesions, the etiopathogenesis of equine SCC is still poorly understood. We screened a series of SCCs from the head-and-neck (HN), (peri-)ocular and genital region, and site-matched controls for the presence of EcPV2-5 and herpesvirus DNA using type-specific EcPV PCR, and consensus nested herpesvirus PCR followed by sequencing. EcPV2 DNA was detected in 45.5% of HN lesions, 8.3% of (peri-)ocular SCCs, and 100% of g...
Selection signatures for local and regional adaptation in Chinese Mongolian horse breeds reveal candidate genes for hoof health.
BMC genomics    January 19, 2023   Volume 24, Issue 1 35 doi: 10.1186/s12864-023-09116-8
Han H, Randhawa IAS, MacHugh DE, McGivney BA, Katz LM, Dugarjaviin M, Hill EW.Thousands of years of natural and artificial selection since the domestication of the horse has shaped the distinctive genomes of Chinese Mongolian horse populations. Consequently, genomic signatures of selection can provide insights into the human-mediated selection history of specific traits and evolutionary adaptation to diverse environments. Here, we used genome-wide SNPs from five distinct Chinese Mongolian horse populations to identify genomic regions under selection for the population-specific traits, gait, black coat colour, and hoof quality. Other global breeds were used to identify r...
Cutaneous plaques associated with a putative novel papillomavirus type in a horse.
New Zealand veterinary journal    January 12, 2023   Volume 71, Issue 2 100-105 doi: 10.1080/00480169.2022.2157347
Munday JS, Grant K, Orbell G, Vaatstra BL.A 6-year-old Thoroughbred mare developed multiple flat plaques, < 1 cm in diameter, on the left front fetlock. These were treated topically using 5-fluorouracil and resolved after 4 weeks. However, additional similar plaques developed on the left front pastern 5 months later. These lesions resolved within 3 months without treatment. Unassigned: One plaque that developed initially and one plaque that developed later were examined histologically. Both consisted of well-demarcated foci of moderate epidermal hyperplasia. Scattered throughout both plaques were cells showing evidence of papillo...
Could Horse Gait and Induced Pelvic Dynamic Loads in Female Equestrians Be a Risk Factor in Pudendal Neuralgia?
Sports (Basel, Switzerland)    January 10, 2023   Volume 11, Issue 1 16 doi: 10.3390/sports11010016
Murer S, Polidori G, Beaumont F, Bogard F, Hakim H, Legrand F.Pudendal Neuralgia (PN) is a rare, debilitating disease caused by damage to the pudendal nerve, which innervates the anus, rectum, perineum, lower urinary tract, and genitalia. Although its etiology remains scientifically unknown, a number of sports practices, including horse-riding, are reported as triggering and/or aggravating factors. The present work summarizes the experimental measurements of the contact pressure at the interface between the rider and saddle, for a population of 12 experienced female riders. These tests reveal that dynamic horseback-riding leads to high levels of peak pre...
Effect of age at training initiation on hoof morphology and lameness in juvenile American Quarter Horses.
Equine veterinary journal    January 9, 2023   Volume 55, Issue 5 765-776 doi: 10.1111/evj.13913
Kawahisa-Piquini G, Bass LD, Pezzanite LM, Moorman VJ.Lameness, discipline, training intensity, environmental variability, and shoeing are all factors demonstrated to affect hoof loading and therefore act as adaptive stimuli to alter hoof morphology. Objective: To evaluate the effect of age at training initiation on hoof morphology and lameness incidence and determine if specific hoof morphology measurements correlate with lameness in juvenile American Quarter Horses. Methods: Prospective cohort study. Methods: American Quarter Horses (n = 42; 29 two-year-olds, 13 three-year-olds) entering training were monitored for hoof morphology and lamenes...
Postoperative sinusitis and pneumonia following exploratory celiotomy for treatment of colic in horses.
The Canadian veterinary journal = La revue veterinaire canadienne    January 4, 2023   Volume 64, Issue 1 76-80 
Tyma JF, Epstein KL.Sinusitis and pneumonia following exploratory celiotomy in horses were studied, evaluating associations between these 2 respiratory complications and selected pre-, peri-, and post-operative variables. The incidence of sinusitis was 2.5% (8/318) and pneumonia 3.5% (11/318). These respiratory complications were associated with peri-operative reflux, longer antimicrobial treatment, and longer hospitalization. . La sinusite et la pneumonie consécutives á une coeliotomie exploratoire chez le cheval ont été étudiées, afin d’évaluer les associations entre ces deux complications respiratoire...
Lethal variants of equine pregnancy: is it the placenta or foetus leading the conceptus in the wrong direction?
Reproduction, fertility, and development    January 3, 2023   Volume 35, Issue 2 51-69 doi: 10.1071/RD22239
Shilton CA, Kahler A, Roach JM, Raudsepp T, de Mestre AM.Embryonic and foetal loss remain one of the greatest challenges in equine reproductive health with 5-10% of established day 15 pregnancies and a further 5-10% of day 70 pregnancies failing to produce a viable foal. The underlying reason for these losses is variable but ultimately most cases will be attributed to pathologies of the environment of the developing embryo and later foetus, or a defect intrinsic to the embryo itself that leads to lethality at any stage of gestation right up to birth. Historically, much research has focused on the maternal endometrium, endocrine and immune responses ...
Quantification of equine stifle passive kinematics.
American journal of veterinary research    January 2, 2023   Volume 84, Issue 2 ajvr.22.10.0171 doi: 10.2460/ajvr.22.10.0171
He H, Palm-Vlasak LS, Chen C, Banks SA, Biedrzycki AH.This study aims to quantitatively characterize the passive kinematics of the healthy, soft tissue-intact equine stifle to establish an objective foundation for providing insights into the etiology of stifle disorders and developing a possible surgical treatment for stifle degenerative disease. Methods: 5 whole-horse specimens. Methods: Reflective markers with intracortical bone pins and a motion capture system were used to investigate the stifle joint kinematics. Kinematics of 5 whole-horse specimens euthanized within 2 hours were calculated for internal/external rotation, adduction/abduction,...
Nipah Virus Disease: Epidemiological, Clinical, Diagnostic and Legislative Aspects of This Unpredictable Emerging Zoonosis.
Animals : an open access journal from MDPI    December 31, 2022   Volume 13, Issue 1 159 doi: 10.3390/ani13010159
Bruno L, Nappo MA, Ferrari L, Di Lecce R, Guarnieri C, Cantoni AM, Corradi A.Nipah virus (NiV) infection is a viral disease caused by a Henipavirus, belonging to the Paramyxoviridae family, responsible for a zoonosis. The course of the disease can be very serious and lead to death. NiV natural hosts are fruit bats (also known as megabats) belonging to the Pteropodidae family, especially those of the genus. Natural infection in domestic animals has been described in farming pigs, horses, domestic and feral dogs and cats. Natural NiV transmission is possible intra-species (pig-to-pig, human-to-human) and inter-species (flying bat-to-human, pig-to-human, horse-to-human)....
Antimicrobial Resistance and Genetic Diversity of Pseudomonas aeruginosa Strains Isolated from Equine and Other Veterinary Samples.
Pathogens (Basel, Switzerland)    December 30, 2022   Volume 12, Issue 1 64 doi: 10.3390/pathogens12010064
Pottier M, Castagnet S, Gravey F, Leduc G, Sévin C, Petry S, Giard JC, Le Hello S, Léon A. is one of the leading causes of healthcare-associated infections in humans. This bacterium is less represented in veterinary medicine, despite causing difficult-to-treat infections due to its capacity to acquire antimicrobial resistance, produce biofilms, and persist in the environment, along with its limited number of veterinary antibiotic therapies. Here, we explored susceptibility profiles to antibiotics and to didecyldimethylammonium chloride (DDAC), a quaternary ammonium widely used as a disinfectant, in 168 strains isolated from animals, mainly Equidae. A genomic study was performed on...
Carbohydrate pellets to assess insulin dysregulation in horses.
Journal of veterinary internal medicine    December 30, 2022   Volume 37, Issue 1 302-314 doi: 10.1111/jvim.16621
de Laat MA, Warnken T, Delarocque J, Reiche DB, Grob AJ, Feige K, Carslake HB, Durham AE, Sillence MN, Thane KE, Frank N, Brojer J, Lindase S....A glycemic challenge test is used for the diagnosis of insulin dysregulation (ID) in horses and ponies. Different forms of the test exist where the administrative route and dose of glucose vary, which makes interpretation of results challenging. Objective: To evaluate the palatability of, and blood glucose and insulin responses to, carbohydrate pellets fed as an oral glucose test (OGT), and to establish the diagnostic threshold for ID when using the pellets. Methods: University and privately-owned horses and ponies (n = 157) comprised of 31 breeds and both sexes. Methods: Multicenter cohort ...
Prevalence of equine proliferative enteropathy in Hidaka district, Hokkaido, over five seasons.
Journal of equine science    December 28, 2022   Volume 33, Issue 4 71-74 doi: 10.1294/jes.33.71
Niwa H, Higuchi T, Fujii S, Kinoshita Y, Uchida-Fujii E, Sueyoshi M, Nukada T, Ueno T.Equine proliferative enteropathy (EPE) is an equine infectious disease that can lead to severe weight loss and hyperplasia of the intestinal mucosa due to infection with Lawsonia intracellularis. In this study, we investigated the prevalence of EPE in a major Thoroughbred breeding area: Hidaka district, Hokkaido, Japan. Of the 252 symptomatic horses that we tested, 192 EPE cases (76.2%), including 8 fatal cases, were confirmed from April 2015 to March 2020 by etiological and/or serological investigation. Most of the EPE cases were observed in foals (88.5%), with fewer cases in yearlings (7.3%)...
CT diagnosis of pituitary abscess, suppurative meningitis, and atlanto-occipital septic arthritis in a pony. Vandersmissen M, Wimmer-Scherr CM, Lecoq L, Busoni V, Evrard L.A 15-year-old pony was presented for acute neurological signs. Neurological examination suggested a brainstem lesion, blood laboratory tests detected an active inflammatory process, and upper respiratory endoscopy identified a suppurative lesion at the dorsal aspect of the right guttural pouch. Computed tomography was performed and findings were consistent with pituitary abscess, meningitis, and atlanto-occipital joint septic arthritis. Imaging findings were confirmed based on cerebrospinal and synovial fluid cultures and necropsy. Computed tomography provided important information for identif...
Bacterial identification in cerebrospinal fluid of domestic species with neurologic signs: a retrospective case-series study in 136 animals (2005-2021).
Brazilian journal of microbiology : [publication of the Brazilian Society for Microbiology]    December 26, 2022   Volume 54, Issue 1 449-457 doi: 10.1007/s42770-022-00891-2
Ribeiro MG, Pereira TT, de Lima Paz PJ, de Almeida BO, Cerviño CSA, Rodrigues CA, Santos GTS, de Souza Freire LM, Portilho FVR, Filho MFÁ....Central nervous system (CNS) infections comprise life-threatening clinical conditions in domestic species, and are commonly related to severe sequelae, disability, or high fatality rates. A set of bacterial pathogens have been identified in central nervous infections in livestock and companion animals, although the most of descriptions are restricted to case reports and a lack of comprehensive studies involving CNS-related bacterial infections have been focused on a great number of domestic species. In this scenario, we retrospectively investigated selected epidemiological data, clinical findi...
Differentiating Strongylus vulgaris-associated, non-strangulating intestinal infarctions from idiopathic peritonitis and acute colitis in horses.
The Veterinary record    December 25, 2022   Volume 192, Issue 3 e2538 doi: 10.1002/vetr.2538
Poulsen L, Henriksson FV, Dahl M, Honoré ML, Olsen SN, Leifsson PS, Staerk-Østergaard J, Jacobsen S, Pihl TH.Horses with non-strangulating intestinal infarction (NSII) are often misdiagnosed with idiopathic peritonitis or acute colitis. Early diagnosis is essential to ensure early surgical intervention and improve survival. Clinical and laboratory data from horses admitted to the University of Copenhagen Large Animal Teaching Hospital with NSII, idiopathic peritonitis or acute colitis between 2009 and 2018 were used for univariate comparisons and a multivariable logistic regression model for prediction of NSII. Two hundred and thirty-one horses were included. A multivariable model for the prediction ...
Treponema spp. spirochetes and keratinopathogenic fungi isolated from keratomas in donkeys.
Veterinary pathology    December 24, 2022   Volume 60, Issue 2 190-198 doi: 10.1177/03009858221144730
Paraschou G, Cook JM, Priestnall SL, Evans NJ, Staton GJ, Paterson GK, Winkler B, Whitbread TJ.Keratoma is an aberrant keratin mass thought to originate from epidermal horn-producing cells interposed between the stratum medium of the hoof wall and the underlying third phalanx. The cause is unknown, although the presence of keratomas is frequently associated with chronic irritation, focal infection, or trauma. A total of 167 donkeys with keratomas were presented in this study. The diagnosis of a keratoma was based on clinical signs, radiography, and histopathologic examination. Surgical excision was attempted on all donkeys with lameness unless euthanasia was advised. Histopathologic exa...
Gene Expression Profiles of the Immuno-Transcriptome in Equine Asthma.
Animals : an open access journal from MDPI    December 20, 2022   Volume 13, Issue 1 4 doi: 10.3390/ani13010004
Padoan E, Ferraresso S, Pegolo S, Barnini C, Castagnaro M, Bargelloni L.Mild equine asthma (MEA) and severe equine asthma (SEA) are two of the most frequent equine airway inflammatory diseases, but knowledge about their pathogenesis is limited. The goal of this study was to investigate gene expression differences in the respiratory tract of MEA- and SEA-affected horses and their relationship with clinical signs. Methods: Clinical examination and endoscopy were performed in 8 SEA- and 10 MEA-affected horses and 7 healthy controls. Cytological and microbiological analyses of bronchoalveolar lavage (BAL) fluid were performed. Gene expression profiling of BAL fluid wa...
Synovial Fluid Analysis and Microscopic Assessment of Macrophage Quantities and Morphology in Equine Septic Arthritis.
Tierarztliche Praxis. Ausgabe G, Grosstiere/Nutztiere    December 14, 2022   Volume 50, Issue 6 377-385 doi: 10.1055/a-1956-5245
Strootmann T, Spitzbarth I, Della Tommasa S, Brehm W, Köller G, Troillet A.Research and provision of data on macrophages by cytological synovial fluid analysis and light microscopy in horses with septic arthritis MATERIAL AND METHODS: Records of 167 synovial fluid samples were evaluated and subdivided into different groups: (1) non-septic, (2) haematogenous septic arthritis in foals and (3) traumatic/iatrogenic septic arthritis. The effect of joint lavage on synovial fluid cytology and on the occurrence of macrophage phenotypes was investigated. Results: Regardless of aetiology and age of the horse, macrophage concentrations in synovial sepsis are decreased to a medi...
Egg reappearance periods of anthelmintics against equine cyathostomins: The state of play revisited.
International journal for parasitology. Drugs and drug resistance    December 13, 2022   Volume 21 28-39 doi: 10.1016/j.ijpddr.2022.12.002
Macdonald SL, Abbas G, Ghafar A, Gauci CG, Bauquier J, El-Hage C, Tennent-Brown B, Wilkes EJA, Beasley A, Jacobson C, Cudmore L, Carrigan P, Hurley J....Cyathostomins are the most common and highly prevalent parasites of horses worldwide. Historically, the control of cyathostomins has mainly relied on the routine use of anthelmintic products. Increasing reports on anthelmintic resistance (AR) in cyathostomins are concerning. A potential method proposed for detecting emerging AR in cyathostomins has been estimating the egg reappearance period (ERP). This paper reviews the data available for the ERP of cyathostomins against the three major classes of anthelmintics, macrocyclic lactones, tetrahydropyrimidines, and benzimidazoles. Published peer-r...
Retrospective Evaluation of the Most Frequently Observed Histological Changes in Duodenal and Rectal Mucosal Biopsies in Horses with Recurrent Colic.
Animals : an open access journal from MDPI    December 13, 2022   Volume 12, Issue 24 doi: 10.3390/ani12243527
Siwińska N, Żak-Bochenek A, Paszkowska M, Karczewski M, Długopolska D, Haider W.Colic, a condition affecting the gastrointestinal tract of horses, manifests as severe pain and may be a life-threatening condition. It is possible to distinguish between an acute, disposable process, as well as recurrent colic symptoms (abdominal pain) caused by an ongoing chronic inflammatory process. This paper presents a retrospective analysis of the histopathological findings of duodenal and rectal samples taken from horses with recurrent colic, with the aim to determine the frequency and extent of inflammation. The samples, i.e., duodenal biopsy (60 samples) and rectal biopsy (17 samples...
Does lesion type or severity predict outcome of therapy for horses with equine glandular gastric disease? – A retrospective study.
Veterinary medicine and science    December 10, 2022   Volume 9, Issue 1 150-157 doi: 10.1002/vms3.1034
Pratt SL, Bowen M, Hallowell GH, Shipman E, Bailey J, Redpath A.Equine glandular gastric disease (EGGD) is a common condition of the horse. Misoprostol is reported to be superior to oral omeprazole and sucralfate for treatment. Long-acting intramuscular injectable omeprazole (LAIOMEP) is a novel treatment shown to be effective in a small population. This study aimed to determine LAIOMEP efficacy compared to misoprostol and oral omeprazole and identify characteristics that predict treatment outcome. All horses that underwent gastroscopy between 2012 and 2019 were reviewed. Lesions were characterised by 4 blinded observers, all of whom are diplomates in equi...
A seasonal idiopathic hepatitis syndrome in horses presented to a Midwestern veterinary teaching hospital.
Journal of the American Veterinary Medical Association    December 7, 2022   Volume 261, Issue 2 266-272 doi: 10.2460/javma.22.08.0368
Taylor SD, Kritchevsky JE, Huang P, Olave C, Waxman SJ, Miller MA.To report history, clinical examination findings, clinicopathologic findings, diagnostic test results, treatment, and outcome in horses with a novel idiopathic hepatitis syndrome. 13 client-owned horses. Medical records of horses that were presented with fever and increased blood liver enzyme activity over a 16-month period were reviewed (December 1, 2020, to April 1, 2022). Collected data included signalment, history, clinical and clinicopathologic findings, diagnostic test results, treatment, clinical progression, and short-term outcome. Affected horses were presented between December and Ap...
Equine disease surveillance: quarterly update.
The Veterinary record    December 3, 2022   Volume 191, Issue 11 e2511 doi: 10.1002/vetr.2511
No abstract available
Early embryonic death in equines and camelids.
Open veterinary journal    December 1, 2022   Volume 12, Issue 6 903-909 doi: 10.5455/OVJ.2022.v12.i6.16
Ashraf R, Rashid S, Rasheed I, Asif S.This paper includes the study of early embryonic death (EED), predisposing factors of EED and treatment. EED refers to the fetal mortality which varies in mare and camelids but most probably not later than 50 days of gestation. This duration may be divided into very early mortality, early mortality and late embryonic mortality. This also varies in mare and camelids. There are different embryonic, maternal, environmental/external, and infectious and noninfectious factors which lead to early embryonic loss. Diagnosis is very difficult as in most of the cases resorption of fetus occurs but it is ...
Expression of matrix metalloproteinases (MMPs)-2/-7/-9/-14 and tissue inhibitors of MMPs (TIMPs)-1/-2 in bovine cutaneous fibropapillomas associated with BPV-2 infection.
Frontiers in veterinary science    November 28, 2022   Volume 9 1063580 doi: 10.3389/fvets.2022.1063580
Daraban Bocaneti F, Altamura G, Corteggio A, Tanase OI, Dascalu MA, Pasca SA, Hritcu O, Mares M, Borzacchiello G.Bovine papillomaviruses -1/-2 (BPVs) are small non-enveloped double-stranded DNA viruses able to infect the skin of bovids and equids, causing development of neoplastic lesions such as bovine cutaneous fibropapillomas and equine sarcoid. Matrix metalloproteinases (MMPs) are a group of zinc-dependent endopeptidases that degrade basal membrane and extracellular matrix, whose function is essential in physiological processes such as tissue remodeling and wound healing. MMPs activity is finely regulated by a balancing with expression of tissue inhibitors of MMPs (TIMPs), a process that is impaired ...
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