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Topic:Equine Health

Equine health encompasses the study and management of diseases, disorders, and overall well-being of horses. It involves understanding various physiological systems, preventive care, and treatment strategies to maintain optimal health in equine populations. Common areas of focus include nutrition, infectious diseases, orthopedic conditions, and reproductive health. Research in equine health aims to advance knowledge on diagnostic methods, therapeutic interventions, and management practices that improve horse welfare and performance. This page collects peer-reviewed research studies and scholarly articles that explore the diverse aspects of equine health, offering insights into current findings and advancements in the field.
CKM intron: an appropriate marker for the determination of the genetic relationships among horse populations and breeds.
Animal biotechnology    August 18, 2023   1-9 doi: 10.1080/10495398.2023.2247445
Chen J, Wang H, Li J, Liu S, Li B, Sun Y, Wang H, Manglai D.To date, the origins, domestication, and genetic structure of Chinese Mongolian horses (CMH) are poorly understood. Furthermore, there have been sparse reports on the genetic differences between CMH and Thoroughbred. In order to determine their genetic structure, understand their genetic relationships, and explore their domestication processes, we performed an extensive survey of creatine kinase (muscle isoenzyme; variations among six populations of indigenous CMH, cultivated Sanhe horses, and imported Thoroughbred. Twenty-three single-nucleotide polymorphisms were found among the 343 horse s...
Bovine Papillomavirus Type 1 Infection in an Equine Congenital Papilloma.
Pathogens (Basel, Switzerland)    August 18, 2023   Volume 12, Issue 8 1059 doi: 10.3390/pathogens12081059
Maggi R, De Paolis L, De Santis D, Vellone VG, De Ciucis CG, Fruscione F, Mazzocco K, Ghelardi A, Marruchella G, Razzuoli E.Papillomas are benign epithelial lesions protruding on the epithelial surfaces as finger-like or warty projections. These lesions are often caused by papillomavirus (PV) infection. Congenital papillomas have been reported in foals. However, to date, no evidence of PV infection has been provided. In the present paper, we describe the main clinical-pathological features of a congenital papilloma observed in a foal. In addition, biomolecular tests demonstrated BPV1 infection in the case under study. Such data stimulate further investigations, even on archived samples, aiming to clarifying the eti...
Segmental analysis and long-term monitoring of vadadustat in equine hair for the purpose of doping control.
Journal of analytical toxicology    August 18, 2023   bkad057 doi: 10.1093/jat/bkad057
Ishii H, Shibuya M, Kusano K, Sone Y, Kamiya T, Wakuno A, Ito H, Miyata K, Yamada M, Leung GN.Vadadustat is a newly launched hypoxia-inducible factor stabilizer with anti-anemia and erythropoietic effects; however, its use in horses is expressly forbidden in both racing and equestrian competitions. Following our previous report on the pharmacokinetic study of vadadustat in horse plasma and urine, a long-term longitudinal analysis of vadadustat in horse hair after nasoesophageal administration (3 g/day for 3 days) to three thoroughbred mares is described in this study. Our main objective is to further extend the detection period of vadadustat for the purpose of doping control. Three...
Genetic characterisation of the Connemara pony and the Warmblood horse using a within-breed clustering approach.
Genetics, selection, evolution : GSE    August 17, 2023   Volume 55, Issue 1 60 doi: 10.1186/s12711-023-00827-w
Lindsay-McGee V, Sanchez-Molano E, Banos G, Clark EL, Piercy RJ, Psifidi A.The Connemara pony (CP) is an Irish breed that has experienced varied selection by breeders over the last fifty years, with objectives ranging from the traditional hardy pony to an agile athlete. We compared these ponies with well-studied Warmblood (WB) horses, which are also selectively bred for athletic performance but with a much larger census population. Using genome-wide single nucleotide polymorphism (SNP) and whole-genome sequencing data from 116 WB (94 UK WB and 22 European WB) and 36 CP (33 UK CP and 3 US CP), we studied the genomic diversity, inbreeding and population structure of th...
Assessing the impact of draught load pulling on welfare in equids.
Frontiers in veterinary science    August 17, 2023   Volume 10 1214015 doi: 10.3389/fvets.2023.1214015
Bukhari SSUH, Parkes RSV.About 112 million working equids are the source of income for 600 million people globally. Many equids are used for pulling loads (up to 15,000 kg per day) to transport goods. Most of them are associated with brick kilns, mining, and agriculture industries in developing countries. They may suffer from welfare issues such as overloading, being beaten, and being forced to work for long periods. These issues may occur due to a poor understanding of load-pulling equids. Understanding their capabilities and the elements that influence them is critical for efficient performance and welfare. The me...
Transcriptomic signature related to poor welfare of sport horses.
Comprehensive psychoneuroendocrinology    August 17, 2023   Volume 16 100201 doi: 10.1016/j.cpnec.2023.100201
Foury A, Mach N, Ruet A, Lansade L, Moisan MP.The improvement of horse welfare through housing conditions has become a real issue in recent years and have highlighted the detrimental effect of individual housing of horses on their health and behaviour. In this new study, we analysed the blood transcriptome of 45 sport horses housed individually that were previously examined for their behaviour and gut microbiota. We performed differential and regression analyses of gene expression, followed by downstream bioinformatic analyses, to unveil the molecular pathways related to the behavioural changes associated with welfare impairment in these ...
The influence of different horseshoes and ground substrates on mid-stance hoof orientation at the walk.
Equine veterinary journal    August 17, 2023   Volume 56, Issue 3 598-606 doi: 10.1111/evj.13990
Reilly PT, van Eps A, Stefanovski D, Pfau T.Horseshoes with modified contact surfaces combined with deformable ground substrates are used to change hoof orientation during mid-stance, for example, for therapeutic reasons. Objective: To measure the effect of horseshoes and ground substrates on sagittal and transverse plane hoof orientation at mid-stance using a dorsal hoof wall mounted triaxial accelerometer. Methods: In vivo experiment, randomised crossover design. Methods: Differences in sagittal and transverse plane angles between standing and mid-stance of the left front hoof of six horses walking with regular horseshoes, egg bar, to...
Survival of formalin intoxication in a 13-year-old Thoroughbred gelding.
Equine veterinary journal    August 16, 2023   doi: 10.1111/evj.13982
Lovett A, Vokes J, Loghides N, Johnstone L, Sykes B.Formalin intoxication via the gastrointestinal route has not been previously reported in the horse. Whereas ingestion of formalin in humans, although rare, is well documented. Majority of human cases are either accidental, suicidal or homicidal and often lead to fatality, with a reported lethal formaldehyde dose equating to 0.12 - 0.16 g/kg bwt. Objective: To describe a single case report of the clinical management of an adult horse referred to a veterinary teaching hospital following accidental administration of 10% formalin via nasogastric tube. Methods: A 13-year-old Thoroughbred gelding or...
Dynamics of training and acute exercise-induced shifts in muscular glucose transporter (GLUT) 4, 8, and 12 expression in locomotion versus posture muscles in healthy horses.
Frontiers in physiology    August 16, 2023   Volume 14 1256217 doi: 10.3389/fphys.2023.1256217
Vidal Moreno de Vega C, Lemmens D, de Meeûs d'Argenteuil C, Boshuizen B, de Maré L, Leybaert L, Goethals K, de Oliveira JE, Hosotani G, Deforce D....Important changes in glucose transporter (GLUT) expression should be expected if the glucose influx plays a pivotal role in fuelling or connecting metabolic pathways that are upregulated in response to exercise. The aim was to assess GLUT4, 8, and 12 dynamics in response to training and acute exercise. Sixteen untrained Standardbred mares (3-4 year) performed an incremental SET at the start and end of 8 weeks harness training. M. pectoralis (PM) and M. vastus lateralis (VL) muscle biopsies were taken before and after each SET, allowing for comparing rest and acute samples in untrained (UT) ...
The Triple-E Model: Advancing Equestrian Research with Perspectives from One Health.
Animals : an open access journal from MDPI    August 16, 2023   Volume 13, Issue 16 2642 doi: 10.3390/ani13162642
Keener MM, Tumlin KI.Equestrian sport has various welfare issues and educational needs. To address these complex interactions, we propose an integrated approach called the Triple-E Model, which focuses on the equine, equestrian, and environmental triad. A literature review of existing models suggests that complexities of these interactions are overlooked, despite the significant impact of equine industries on economics, healthcare, and animal welfare. This paper discusses current models and theories used to evaluate equine-equestrian-environmental interactions and introduces the Triple-E Model to foster multidisci...
Bronchoalveolar Lavage Cytology in Severe Equine Asthma: Cytocentrifugated versus Sediment Smear Preparations.
Veterinary sciences    August 16, 2023   Volume 10, Issue 8 527 doi: 10.3390/vetsci10080527
Morini M, Gobbo F, Rinnovati R, Romagnoli N, Peli A, Massarenti C, Spadari A, Pietra M.Equine asthma is a common respiratory disease that may affect horses of any age. The diagnosis of severe equine asthma (SEA) (historically referred as recurrent airway obstruction or RAO) is based mainly on the history of the animal and clinical signs, which are further supported by the cytological examination of the bronchoalveolar lavage (BAL). This can also be helpful in monitoring the inflammation of the lower airways in response to environmental management and medication. The cytocentrifugated preparation is usually considered the method of choice for BAL cytological interpretation. The a...
Antibiotic usage in 14 equine practices over a 10-year period (2012-2021).
Equine veterinary journal    August 16, 2023   doi: 10.1111/evj.13988
Tallon RE, Whitt B, Bladon BM.Monitoring antibiotic usage is an important part of tackling antimicrobial resistance. The use of computerised records for monitoring has been previously described in the equine sector but there is currently no consensus on metrics used to report usage. Objective: To document antibiotic use in equine practices in the United Kingdom over a 10-year period using commercially available practice management software. Methods: Retrospective survey. Methods: A custom antibiotic usage report was created using Eclipse® practice management software. Participating practices were given instructions on how...
Flow cytometric detection and identification of different leukocyte subpopulations in stallion semen.
Reproduction in domestic animals = Zuchthygiene    August 16, 2023   doi: 10.1111/rda.14451
Köhne M, Kirch F, Tönissen A, Martinsson G, Rabe U, Sieme H, Schuberth HJ.To improve accuracy in evaluating stallion ejaculates, an antibody-based, flow cytometric assay for the detection and identification of leukocyte subpopulations (CD4-, CD8-, CD21-, CD172a-positive cells) in stallion semen (n = 12) was established. For establishment of the assay, native semen was supplemented with blood leukocytes (control: 20% leukocytes, 80% sperm cells) and analysed by flow cytometry. Adding antioxidants (ascorbic acid and butylated hydroxytoluol) to semen immediately after collection inhibited rapid death of lymphoid cells in sperm leukocyte mixtures. In control set-ups...
Antimicrobial Activity of Plasma Rich in Platelets (PRP) on the Ocular Microbiota of Healthy Horses from Minas Gerais: In Vitro Study.
Veterinary medicine international    August 16, 2023   Volume 2023 2407768 doi: 10.1155/2023/2407768
Torres LEC, Florez CO, Oliveira JG, Vieira GD, Ribeiro IS, Keller KM, Leme FOP, Fantini P, Maranhão RPA.In equine ophthalmology, ulcerative keratitis is among the most common conditions and, in general, arises as a consequence of some trauma suffered. Secondarily, subsequent contamination by pathogenic or resident bacteria of the horse's ocular microbiota may have undesirable consequences. Under physiological conditions, the normal microbiota coexists with the immune status of the host, serving as a barrier, ensuring the health of the ocular surface, and inhibiting the proliferation of pathogens. However, in the imbalance of immune barriers, the normal microbiota can become pathogenic and lead t...
Effect of Lavage Solution Type on Bronchoalveolar Lavage Fluid Cytology in Clinically Healthy Horses.
Animals : an open access journal from MDPI    August 15, 2023   Volume 13, Issue 16 2637 doi: 10.3390/ani13162637
Westermann CM, de Bie AG, Olave C, de Grauw JC, Teske E, Couetil LL.Equine bronchoalveolar lavage (BAL) is usually performed with 250-500 mL of isotonic saline at pH 5.5. The acidic pH of saline may cause an increase in airway neutrophil count 48 h after BAL. Other isotonic solutions such as Ringer's solution, phosphate-buffered saline (PBS) or Plasma-Lyte 148 have a neutral pH of 7.4 and might be a better choice for BAL by not provoking inflammation and the influx of neutrophils into airways. BAL was performed in four healthy horses in four different lung lobes using four different solutions in a randomized crossover design. In each lobe, BAL was performed tw...
An extensive screening method for the identification and quantitation of ecdysteroids in equine urine and plasma using liquid chromatography coupled with mass spectrometry.
Rapid communications in mass spectrometry : RCM    August 15, 2023   Volume 37, Issue 18 e9611 doi: 10.1002/rcm.9611
Karatt TK, Sathiq MA, Laya S, Ajeebsanu MPM, Karakka Kal AK, Subhahar MB, Perwad Z.Recently, there has been a report suggesting that ecdysteroids can enhance sports performance, making them relevant substances in doping control. Hence, it is imperative to examine the analytical characteristics of ecdysteroids in biological samples to identify their misuse in competitive sports. Methods: To assess the doping of ecdysteroids such as ecdysone, ecdysterone, ponasterone A, turkesterone, and ajugasterone C, a fast and sensitive extraction and detection method was developed, optimized, and validated using equine urine and plasma. Different extraction techniques, namely, solid-phase...
Paneth cells in farm animals: current status and future direction.
Journal of animal science and biotechnology    August 15, 2023   Volume 14, Issue 1 118 doi: 10.1186/s40104-023-00905-5
Cui C, Li L, Wu L, Wang X, Zheng Y, Wang F, Wei H, Peng J.A healthy intestine plays an important role in the growth and development of farm animals. In small intestine, Paneth cells are well known for their regulation of intestinal microbiota and intestinal stem cells (ISCs). Although there has been a lot of studies and reviews on human and murine Paneth cells under intestinal homeostasis or disorders, little is known about Paneth cells in farm animals. Most farm animals possess Paneth cells in their small intestine, as identified by various staining methods, and Paneth cells of various livestock species exhibit noticeable differences in cell shape, ...
Effects of insulin-like growth factor-1 on the proliferation and apoptosis of stallion testicular cells under normal and heat stress culture conditions.
Animal reproduction science    August 15, 2023   Volume 256 107319 doi: 10.1016/j.anireprosci.2023.107319
Shakeel M, Yoon M.This study investigated the effect of heat stress on stallion testicular cells (TCs) and the effect of insulin-like growth factor (IGF)-1 on TC viability, proliferation, and apoptosis, including different stages of germ cells. TCs were divided into control or treatment groups with 0.01, 0.1, 1, 10, and 100 ng/mL of recombinant human IGF-1 (rhIGF-1) for 24 h at 34 °C and 37 °C. The population and viability were measured before and after treatment. The effects of rhIGF-1 on TC viability, proliferation, and apoptosis were determined using RT-qPCR. Proliferating cell nuclear antigen (PCNA) a...
Presence of Equine and Bovine Coronaviruses, Endoparasites, and Bacteria in Fecal Samples of Horses with Colic.
Pathogens (Basel, Switzerland)    August 15, 2023   Volume 12, Issue 8 1043 doi: 10.3390/pathogens12081043
Stummer M, Frisch V, Glitz F, Hinney B, Spergser J, Krücken J, Diekmann I, Dimmel K, Riedel C, Cavalleri JV, Rümenapf T, Joachim A, Lyrakis M....Acute abdominal pain (colic) is one of the major equine health threats worldwide and often necessitates intensive veterinary medical care and surgical intervention. Equine coronavirus (ECoV) infections can cause colic in horses but are rarely considered as a differential diagnosis. To determine the frequency of otherwise undetected ECoV infections in horses with acute colic, fresh fecal samples of 105 horses with acute colic and 36 healthy control horses were screened for viruses belonging to the species by RT-PCR as well as for gastrointestinal helminths and bacteria commonly associated with...
Equine induced pluripotent stem cells are responsive to inflammatory cytokines before and after differentiation into musculoskeletal cell types.
In vitro cellular & developmental biology. Animal    August 15, 2023   doi: 10.1007/s11626-023-00800-3
Palomino Lago E, Jelbert ER, Baird A, Lam PY, Guest DJ.Persistent inflammation is associated with the poor regeneration of musculoskeletal tissues. Embryonic stem cells (ESCs) have an attenuated response to inflammatory cytokines, but there are mixed reports on the response of induced pluripotent stem cells (iPSCs) to inflammation. Horses provide a relevant large animal model for studying musculoskeletal tissue diseases and the testing of novel therapies. The aim of this study was to determine if equine iPSCs are responsive to the inflammatory cytokines IL-1β, TNFα and IFN-γ in their undifferentiated state, or following differentiation into ten...
Broad-Host Dissemination of Plasmids Coharboring the fos Operon for Fructooligosaccharide Metabolism with Antibiotic Resistance Genes.
Applied and environmental microbiology    August 14, 2023   Volume 89, Issue 8 e0037123 doi: 10.1128/aem.00371-23
Nohejl T, Palkovicova J, Nesporova K, Valcek A, Lausova J, Dolejska M.The operon encoding short-chain fructooligosaccharide (scFOS) utilization enables bacteria of the family to grow and be sustained in environments where they would struggle to survive. Despite several cases of the detection of the operon in isolates of avian and equine origins, its global distribution in bacterial genomes remains unknown. The presence of the plasmid-harbored operon among resistant bacteria may promote the spread of antibiotic resistance. A collection of 11,538 antimicrobial-resistant isolates from various sources was screened for the gene encoding the scFOS transporter. O...
Genetic architecture and polygenic risk score prediction of degenerative suspensory ligament desmitis (DSLD) in the Peruvian Horse.
Frontiers in genetics    August 14, 2023   Volume 14 1201628 doi: 10.3389/fgene.2023.1201628
Momen M, Brauer K, Patterson MM, Sample SJ, Binversie EE, Davis BW, Cothran EG, Rosa GJM, Brounts SH, Muir P. Spontaneous rupture of tendons and ligaments is common in several species including humans. In horses, degenerative suspensory ligament desmitis (DSLD) is an important acquired idiopathic disease of a major energy-storing tendon-like structure. DSLD risk is increased in several breeds, including the Peruvian Horse. Affected horses have often been used for breeding before the disease is apparent. Breed predisposition suggests a substantial genetic contribution, but heritability and genetic architecture of DSLD have not been determined. To identify genomic regions associated with DSLD, we recr...
Animal model for tendinopathy.
Journal of orthopaedic translation    August 14, 2023   Volume 42 43-56 doi: 10.1016/j.jot.2023.06.005
Luo J, Wang Z, Tang C, Yin Z, Huang J, Ruan D, Fei Y, Wang C, Mo X, Li J, Zhang J, Fang C, Li J, Chen X, Shen W.Tendinopathy is a common motor system disease that leads to pain and reduced function. Despite its prevalence, our mechanistic understanding is incomplete, leading to limited efficacy of treatment options. Animal models contribute significantly to our understanding of tendinopathy and some therapeutic options. However, the inadequacies of animal models are also evident, largely due to differences in anatomical structure and the complexity of human tendinopathy. Different animal models reproduce different aspects of human tendinopathy and are therefore suitable for different scenarios. This rev...
Glanders and Melioidosis
   August 14, 2023  
Nguyen HN, Smith ME, Hayoun MA.Glanders is an infectious disease caused by Burkholderia mallei, a gram-negative aerobic nonmotile bacterium. Melioidosis is an infectious disease caused by Burkholderia pseudomallei, a gram-negative aerobic, motile bacterium. The two bacteria are closely related, and both can cause disease in animals and humans. Historically, glanders was a common disease of horses, donkeys, and mules. Melioidosis was first described as a case series of 38 patients in Rangoon, Burma, by pathologist Alfred Whitmore in 1912.
Protein Evaluation of Feedstuffs for Horses.
Animals : an open access journal from MDPI    August 14, 2023   Volume 13, Issue 16 2624 doi: 10.3390/ani13162624
Bockisch F, Taubert J, Coenen M, Vervuert I.The German Society of Nutrition Physiology has proposed a new protein evaluation system for horse feeds to estimate pre-cecally digestible crude protein (pcdCP) and amino acids (pcdAA) from chemical properties. A total of 71 feeds for horses were chemically tested and evaluated according to the new protein evaluation system. A feeding trial with eight horses tested whether differences in estimated pcdAA and neutral detergent soluble CP (NDSCP) in the diet were reflected by post-prandial (ppr) kinetics of plasma lysine (Lys) by feeding a complementary feed (control = CTRL) with 1.02 g Lys/100 k...
Genome-Wide Single-Nucleotide Polymorphism-Based Genomic Diversity and Runs of Homozygosity for Selection Signatures in Equine Breeds.
Genes    August 14, 2023   Volume 14, Issue 8 doi: 10.3390/genes14081623
Bhardwaj A, Tandon G, Pal Y, Sharma NK, Nayan V, Soni S, Iquebal MA, Jaiswal S, Legha RA, Talluri TR, Bhattacharya TK, Kumar D, Rai A, Tripathi BN.The horse, one of the most domesticated animals, has been used for several purposes, like transportation, hunting, in sport, or for agriculture-related works. Kathiawari, Marwari, Manipuri, Zanskari, Bhutia, Spiti, and Thoroughbred are the main breeds of horses, particularly due to their agroclimatic adaptation and role in any kind of strong physical activity, and these characteristics are majorly governed by genetic factors. The genetic diversity and phylogenetic relationship of these Indian equine breeds using microsatellite markers have been reported, but further studies exploring the SNP d...
Determination of optimal storage time and temperature for the detection of red blood cell and platelet surface-associated immunoglobulin by flow cytometry in healthy horses.
Veterinary immunology and immunopathology    August 14, 2023   Volume 263 110643 doi: 10.1016/j.vetimm.2023.110643
Frohlich M, Knights K, Springer NL.Differentiating immune-mediated causes from other causes of anemia and thrombocytopenia can be challenging. Flow cytometry can detect surface-associated immunoglobulin (sIg) on red blood cells (RBC) and platelets (PLT) in dogs and horses. Sample storage parameters for ideal assay performance has not been evaluated in horses. The study objective is to identify optimal storage time and temperature of equine whole blood for the detection of RBC-sIg and PLT-sIg via flow cytometry. Both assays were performed on samples at time 0, 4, 24, 48, and 72 h post collection. RBC-sIg samples were stored at ...
Retained efficacy of ivermectin against cyathostomins in Swedish horse establishments practicing selective anthelmintic treatment.
Veterinary parasitology    August 14, 2023   Volume 322 110007 doi: 10.1016/j.vetpar.2023.110007
Alm YH, Osterman-Lind E, Martin F, Lindfors R, Roepstorff N, Hedenström U, Fredriksson I, Halvarsson P, Tydén E.Cyathostominae are ubiquitous to grazing horses and regarded the most prevalent internal parasite in the horse. Unfortunately, decades of indiscriminate use of anthelmintic drugs have resulted in the development of resistance in cyathostomins to all currently available drug groups, the most recent being a documented lack of efficacy to the macrocyclic lactones (ML). In vivo determination of anthelmintic resistance in horses most often utilises the faecal egg count reduction test (FECRT). Further, a shortened egg reappearance period (ERP) can indicate a change in response to the applied treatme...
Perivascular wall tumour presenting as pastern mass in a Standardbred gelding.
Australian veterinary journal    August 13, 2023   doi: 10.1111/avj.13280
Stutsel M, Gimeno M, Young A, Bell JW, Horadagoda N.A 2-year-old Standardbred gelding was referred for a mass on the palmaromedial right front pastern which was accompanied by progressively worsening lameness. The mass was firm to palpation and covered by normal skin. Ultrasonographically, a smooth encapsulated mass was present, medial to the flexor tendons and palmar to the neurovascular bundle. Because of a poor prognosis for future athletic performance without surgical or chemotherapeutic intervention and economic constraints preventing further diagnostics and treatment, the horse was euthanised. Post-mortem magnetic resonance imaging, histo...
Lymphocyte immunophenotyping and concentration of MMP-9 in transudates and exudates in horses.
Veterinary immunology and immunopathology    August 12, 2023   Volume 263 110645 doi: 10.1016/j.vetimm.2023.110645
Hamouzová P, Dobešová O, Řeháková K, Stehlíková Š, Čížek P, Drábková Z, Jahn P, Doubek J.This study is the first to provide information on the lymphocyte subpopulations in peritoneal effusions in horses. Peritoneal transudates (n = 12), peritoneal exudates (n = 6) and a pleural exudate (n = 1) were analyzed. The total nucleated cell count (TNCC), total protein (TP) and matrix metalloproteinase-9 (MMP-9) concentration determined by ELISA were measured and routine cytological evaluation was performed. CD3, CD4, CD8 and CD21 positive cells were detected by flow cytometry. A higher percentage of neutrophils (P < 0.05) and higher MMP-9 (P < 0.01) levels were found in ex...