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Topic:Laminitis

Laminitis is a complex and painful condition affecting the hooves of horses, characterized by inflammation and damage to the laminae, the soft tissue structures that secure the hoof wall to the coffin bone. This condition can lead to severe lameness and, in chronic cases, permanent structural changes within the hoof. Factors contributing to laminitis include metabolic disorders, excessive intake of carbohydrates, and mechanical overload, among others. The condition is diagnosed through clinical signs, radiographic imaging, and sometimes histopathological examination. Management strategies often involve dietary modifications, pain relief, and corrective hoof care. This page compiles peer-reviewed research studies and scholarly articles that explore the pathophysiology, risk factors, diagnostic approaches, and management strategies for laminitis in horses.
Farriery for chronic laminitis.
The Veterinary clinics of North America. Equine practice    August 12, 2010   Volume 26, Issue 2 407-423 doi: 10.1016/j.cveq.2010.04.008
O'Grady SE.Laminitis is considered chronic once the distal phalanx has displaced within the hoof capsule. Chronic laminitis generally occurs as a direct sequel to acute laminitis. Clinical evaluation of chronic laminitis is best performed with a thorough clinical examination and radiography. The mainstay of hoof care is therapeutic farriery. In this article, the goals and principles of hoof care, the appropriate trim and various shoes that form the bulk of farriery for chronic laminitis, and surgical treatments are discussed.
Association of season and pasture grazing with blood hormone and metabolite concentrations in horses with presumed pituitary pars intermedia dysfunction.
Journal of veterinary internal medicine    July 28, 2010   Volume 24, Issue 5 1167-1175 doi: 10.1111/j.1939-1676.2010.0547.x
Frank N, Elliott SB, Chameroy KA, Tóth F, Chumbler NS, McClamroch R.Pituitary pars intermedia dysfunction (PPID) is a risk factor for pasture-associated laminitis, which follows a seasonal pattern. Objective: Hormonal responses to season differ between PPID and unaffected horses. Methods: Seventeen horses aged 8-30 years (14 horses ≥ 20 years of age). Methods: Longitudinal observational study. Blood was collected monthly from August 2007 until July 2008 after pasture grazing and again after overnight stall confinement. Blood hormone and metabolite concentrations were measured and pasture grass samples were analyzed to determine carbohydrate content. Analysis...
The role of activated neutrophils in the early stage of equine laminitis.
Veterinary journal (London, England : 1997)    July 23, 2010   Volume 189, Issue 1 27-33 doi: 10.1016/j.tvjl.2010.06.008
de la Rebière de Pouyade G, Serteyn D.Despite ongoing research and a widening range of treatment options, laminitis remains a severely damaging condition with poorly understood pathophysiology. Results obtained from cytokine regulation studies during the last decade have highlighted the inflammatory nature of laminitis. This review will describe the role of systemic activation and local infiltration of neutrophils in laminar tissues in the induction of laminitis. Particular emphasis is placed on the role of neutrophil activation in subsequent vascular dysfunction and oxidative and proteolysis imbalances that are pathways previousl...
The use of adrenocorticotrophic hormone as a potential biomarker of pituitary pars intermedia dysfunction in horses.
Veterinary journal (London, England : 1997)    June 12, 2010   Volume 185, Issue 1 58-61 doi: 10.1016/j.tvjl.2010.04.014
Lee ZY, Zylstra R, Haritou SJ.Elevated concentrations of plasma adrenocorticotrophic hormone (ACTH) in horses with pituitary disturbances are often associated with dysfunction of the pituitary's pars intermedia. The majority of such animals exhibit an increased susceptibility to laminitis, particularly during the autumn. The 24h plasma ACTH profiles of horses with pituitary pars intermedia dysfunction (PPID), and those of matched controls, were determined in March, June, September and December. Differences in ACTH concentrations between the groups were significant (P<0.0001), regardless of photoperiod, and persisted thr...
Laminitis and the equine metabolic syndrome.
The Veterinary clinics of North America. Equine practice    June 9, 2010   Volume 26, Issue 2 239-255 doi: 10.1016/j.cveq.2010.04.004
Johnson PJ, Wiedmeyer CE, LaCarrubba A, Ganjam VK, Messer NT.Although much has been written about laminitis in the context of its association with inflammatory processes, recognition is growing that most cases of laminitis examined by veterinarians in private practice are those associated with pasture grazing, obesity, and insulin resistance (IR). The term 'endocrinopathic laminitis' has been adopted to classify the instances of laminitis in which the origin seems to be more strongly associated with an underlying endocrinopathy, such as either IR or the influence of corticosteroids. Results of a recent study suggest that obesity and IR represent the mos...
Effect of intravenous lidocaine administration on laminar inflammation in the black walnut extract model of laminitis.
Equine veterinary journal    May 22, 2010   Volume 42, Issue 3 261-269 doi: 10.2746/042516409X475760
Williams JM, Lin YJ, Loftus JP, Faleiros RR, Peroni JF, Hubbell JA, Ravis WR, Belknap JK.Laminitis is a serious complication of horses suffering from sepsis/endotoxaemia-related events. Laminitis in horses and organ injury in human sepsis are both reported to involve inflammatory injury to the laminae/organs including early activation of endothelium and leucocytes leading to emigration of neutrophils into the tissue interstitium. In the black walnut extract (BWE) model, systemic inflammatory events coincide with marked increase in laminar mRNA concentrations of inflammatory genes including proinflammatory cytokines (i.e. IL-1beta, IL-6), COX-2, chemokines (i.e. IL-8) and endotheli...
Do horses suffer from irritable bowel syndrome?
Equine veterinary journal    April 14, 2010   Volume 41, Issue 9 836-840 doi: 10.2746/042516409x474284
Hunter JO.Irritable bowel syndrome (IBS) in man is not a single entity but has several causes. One of the most common forms has similarities with colic and laminitis in horses. Undigested food residues may pass from the small intestine into the colon where bacterial fermentation produces chemicals that lead to disease. In horses the consequences may be disastrous, but in healthy humans such malabsorption may not be harmful. After events such as bacterial gastroenteritis or antibiotic treatment, an imbalance of the colonic microflora with overgrowth of facultative anaerobes may arise, leading to malferme...
Black walnut extract: an inflammatory model.
The Veterinary clinics of North America. Equine practice    April 13, 2010   Volume 26, Issue 1 95-101 doi: 10.1016/j.cveq.2009.12.007
Belknap JK.The black walnut extract (BWE) model was developed after the discovery that horses bedded on shavings from black walnut trees commonly developed laminitis. The first investigators that consistently induced laminitis with black walnut shavings established that it was only the heartwood of the tree that induced laminitis. The BWE model of laminitis has allowed investigators to determine many of the early pathologic signaling events likely to occur in the developmental and acute clinical stages of the disease process, and has brought inflammatory injury to the forefront of laminitis research. The...
Pathology of the distal phalanx in equine laminitis: more than just skin deep.
The Veterinary clinics of North America. Equine practice    April 13, 2010   Volume 26, Issue 1 155-165 doi: 10.1016/j.cveq.2009.12.001
Engiles JB.The etiopathogenesis of laminitis is complex and involves multiple tissue types. It may be initiated by biomechanical, traumatic, inflammatory, vascular, toxic, and metabolic factors. Although histopathologic changes occurring within the lamellae of experimental models of laminitis are well described and reported, histopathologic changes occurring in the distal phalanx are not, even though gross and radiographic evidence of disease are often apparent and bony lesions could be considered a significant source of pain. Recent scientific evidence indicates that the microenvironment of bone is an i...
Home care for horses with chronic laminitis.
The Veterinary clinics of North America. Equine practice    April 13, 2010   Volume 26, Issue 1 215-223 doi: 10.1016/j.cveq.2009.12.012
Orsini JA, Wrigley J, Riley P.Home care for horses with chronic laminitis has been discussed rarely in the veterinary literature even though, at any given time, most of us have at least 1 chronic laminitis case in our care that is being managed at home by the owner. Almost all of our knowledge on this aspect of laminitis treatment has been gleaned through experience, by individually working through the medical, ethical, financial, and emotional challenges these cases can present. Much has already been presented on the medical management of the laminitic horse and on strategies for trimming and shoeing the laminitic foot. T...
The anatomy and physiology of the suspensory apparatus of the distal phalanx.
The Veterinary clinics of North America. Equine practice    April 13, 2010   Volume 26, Issue 1 29-49 doi: 10.1016/j.cveq.2010.01.005
Pollitt CC.The equine hoof capsule protects the softer, more sensitive, structures within. Failure of the connection between hoof and bone (suspensory apparatus of the distal phalanx or SADP) results in the crippling lameness of laminitis. Active basal cell proliferation occurs principally in tubular hoof and proximal and distal lamellae. The remaining lamellae are virtually non-proliferative and the hoof wall moves past the stationary distal phalanx, by controlled activation and inhibition of constituent proteases. The lamellar corium derives most of its blood supply from the branches of the terminal ar...
Seasonal variation in serum concentrations of selected metabolic hormones in horses.
Journal of veterinary internal medicine    April 2, 2010   Volume 24, Issue 3 650-654 doi: 10.1111/j.1939-1676.2010.0500.x
Place NJ, McGowan CM, Lamb SV, Schanbacher BJ, McGowan T, Walsh DM.Determination of adrenocorticotropic hormone (ACTH) concentration is a commonly used test in the evaluation of endocrine causes of equine laminitis, but the concentration in healthy horses can be high at certain times of year, which alters the specificity of the ACTH test. Objective: To determine if circulating concentrations of ACTH, cortisol, glucose, insulin, and thyroxine vary month to month in healthy horses and in horses with equine metabolic syndrome (EMS). Methods: Nine healthy adult horses were studied on their farm/stable over the course of 1 year. After the diagnosis of EMS, 10 lami...
Homeopathic prescribing for chronic conditions in equine veterinary practice in the UK.
The Veterinary record    February 23, 2010   Volume 166, Issue 8 234-238 doi: 10.1136/vr.b4764
Mathie RT, Baitson ES, Hansen L, Elliott MF, Hoare J.Twelve Faculty of Homeopathy veterinarians recorded data systematically at 777 consecutive homeopathic appointments for horses over a period of 12 months. A spreadsheet enabled the recording of information, which included the date of appointment; horse and owner identity (anonymised); sex of horse; main medical problem treated; whether the condition was chronic or acute; whether the appointment was new or a follow-up; owner-assessed clinical outcome on a seven-point scale, ranging from -3 to +3, compared with the first appointment; homeopathic medicine(s) prescribed; and whether any convention...
Medical implications of obesity in horses–lessons for human obesity.
Journal of diabetes science and technology    January 5, 2010   Volume 3, Issue 1 163-174 doi: 10.1177/193229680900300119
Johnson PJ, Wiedmeyer CE, Messer NT, Ganjam VK.There is growing recognition that obesity is common and represents a significant detriment to the health of companion animals in a manner similar to that by which it is affecting the human population. As is the case for other species, obesity appears to promote insulin resistance in horses and it is through this pathophysiological process that many of the adverse medical consequences of obesity are being characterized. Equine medical conditions that have been described in the context of obesity and insulin resistance differ from those in humans. Chronic human conditions that have been attribut...
In vivo and in vitro evidence of the involvement of CXCL1, a keratinocyte-derived chemokine, in equine laminitis.
Journal of veterinary internal medicine    July 1, 2009   Volume 23, Issue 5 1086-1096 doi: 10.1111/j.1939-1676.2009.0349.x
Faleiros RR, Leise BB, Westerman T, Yin C, Nuovo GJ, Belknap JK.C-X-C motif ligand 1 (CXCL1) is an important chemokine of epithelial origin in rodents and humans. Objective: To assess in vivo and in vitro the regulation of CXCL1 in equine laminitis. Methods: Twenty adult horses. Methods: Real-time quantitative polymerase chain reaction (PCR) was used to assess expression of CXCL1 in samples of laminae, liver, skin, and lung from the black walnut extract (BWE) model of laminitis, and in cultured equine epithelial cells (EpCs). Tissue was obtained from control animals (CON, n = 5), and at 1.5 hours (early time point [ETP] group, n = 5), at the onset of leuko...
Dietary management of obesity and insulin resistance: countering risk for laminitis.
The Veterinary clinics of North America. Equine practice    March 24, 2009   Volume 25, Issue 1 51-vi doi: 10.1016/j.cveq.2009.02.001
Geor RJ, Harris P.Insulin resistance (IR) and hyperinsulinemia increase risk for development of laminitis in horses and ponies. Obesity also has been associated with heightened risk for laminitis, likely by means of development of IR. Dietary factors, particularly the nonstructural carbohydrate (NSC) load, modulate risk for laminitis in these animals by means of exacerbation of IR or gastrointestinal disturbances that trigger the condition. Specific dietary management strategies to lessen risk for laminitis include caloric restriction to promote weight loss and improve insulin sensitivity in obese animals and s...
Histologic evaluation of the diversity of epidermal laminae in hooves of horses without clinical signs of laminitis.
American journal of veterinary research    February 24, 2009   Volume 70, Issue 2 186-193 doi: 10.2460/ajvr.70.2.186
Kawasako K, Higashi T, Nakaji Y, Komine M, Hirayama K, Matsuda K, Okamoto M, Hashimoto H, Tagami M, Tsunoda N, Taniyama H.To evaluate the histologic diversity of epidermal laminae in hooves from horses without clinical signs of laminitis. Methods: Formalin-fixed samples of stratum internum obtained from the mid region of the dorsal aspect of the hoof wall from the forelimbs of 35Thoroughbred cadavers (including foals [n = 9], yearlings [5], 2 year olds [6], racing horses [5], and mares [10]). Methods: Paraffin-embedded laminar tissues were stained with H&E for the evaluation of architectural variety of primary epidermal laminae (PEL) and secondary epidermal laminae (SEL). For detection of cytokeratin (CK) express...
Development of an intra-lamellar microdialysis method for laminitis investigations in horses.
Veterinary journal (London, England : 1997)    February 14, 2009   Volume 183, Issue 1 22-26 doi: 10.1016/j.tvjl.2009.01.003
Nourian AR, Mills PC, Pollitt CC.Microdialysis (MD) was used for continuous monitoring of the lamellar extracellular fluid (ECF) in six mature healthy Standardbred horses. MD probes were introduced into the lamellar tissue under local anaesthesia. Following intravenous injection of gentamicin (5mg/kg), MD and serum samples were collected for 24h and analysed using a sensitive ELISA test for gentamicin and fluorescence polarization immunoassay for urea concentrations. Calibration of probes was performed through in vivo urea recovery and in vitro gentamicin and urea recovery. Data obtained from different body compartments were ...
Strategies for reducing the complication of orthopedic pain perioperatively.
The Veterinary clinics of North America. Equine practice    February 11, 2009   Volume 24, Issue 3 611-ix doi: 10.1016/j.cveq.2008.10.008
Goodrich LR.Equine orthopedic pain management has become a growing area of interest. Its importance has been emphasized in many studies showing that better pain management results in decreased postoperative complications such as chronic pain, support-limb laminitis, gastric ulceration, and gastrointestinal disease. This review is meant for the surgeon managing orthopedic pain pre-, peri-, and postoperatively.
Matrix metalloproteinases in inflammatory pathologies of the horse.
Veterinary journal (London, England : 1997)    December 3, 2008   Volume 183, Issue 1 27-38 doi: 10.1016/j.tvjl.2008.09.022
Clutterbuck AL, Harris P, Allaway D, Mobasheri A.The extracellular matrix (ECM) of connective tissue is constantly being remodelled to allow for growth and regeneration. Normal tissue maintenance requires the ECM components to be degraded and re-synthesised in relatively equal proportions. This degradation is facilitated by matrix metalloproteinases (MMPs) and their proteolytic action is controlled primarily by the tissue inhibitors of metalloproteinases (TIMPs). Both MMPs and TIMPs exist in a state of dynamic equilibrium, with a slight excess of one or the other depending on the need for either ECM breakdown or synthesis. Long-term disrupti...
Sepsis-From human organ failure to laminar failure.
Veterinary immunology and immunopathology    November 11, 2008   Volume 129, Issue 3-4 155-157 doi: 10.1016/j.vetimm.2008.11.013
Belknap JK, Moore JN, Crouser EC.The horse with gram negative sepsis is known to be at particular risk of succumbing to laminitis. This review summarizes recent evidence indicating that similar pathologic events relating to inflammatory injury occur in laminar failure in laminitis as occur in organ injury/failure in human sepsis. The discussion also points out some important differences between the laminae and target organs in human sepsis that impact the clinical nature of the disease.
Tissue concentrations of 4-HNE in the black walnut extract model of laminitis: indication of oxidant stress in affected laminae.
Veterinary immunology and immunopathology    November 11, 2008   Volume 129, Issue 3-4 211-215 doi: 10.1016/j.vetimm.2008.11.016
Yin C, Pettigrew A, Loftus JP, Black SJ, Belknap JK.In the septic horse prone to laminitis, a similar activation of the innate immune system appears to occur as reported in the septic human prone to organ failure. Because oxidant injury plays a central role in organ failure occurring due to an overzealous innate immune response in human sepsis, this study was performed to determine whether there was evidence of oxidant stress in the laminar tissue in the early stages of laminitis. 4-Hydroxy-2-nonenal (4-HNE), a lipid aldehyde that forms due to lipid peroxidation occurring during episodes of oxidant stress, readily forms adducts with cellular pr...
Metabolic syndrome-From human organ disease to laminar failure in equids.
Veterinary immunology and immunopathology    November 11, 2008   Volume 129, Issue 3-4 151-154 doi: 10.1016/j.vetimm.2008.11.012
Geor R, Frank N.Obesity, insulin resistance, hyperinsulinemia and hypertriglyceridemia are components of an equine metabolic syndrome phenotype associated with increased laminitis risk in horses. Links between these conditions and laminitis must still be elucidated, but human medicine provides candidate mechanisms for future study, including inflammation associated with obesity, vascular compromise induced by insulin resistance, and endothelial dysfunction. Just as metabolic syndrome has been linked to cardiovascular disease in humans, studies are now required to determine the exact mechanisms responsible for...
Equine laminitis: a journey to the dark side of venous.
Veterinary immunology and immunopathology    November 11, 2008   Volume 129, Issue 3-4 164-166 doi: 10.1016/j.vetimm.2008.11.015
Robertson TP, Bailey SR, Peroni JF.Equine laminitis is a crippling condition that continues to defy repeated efforts to delineate the precise mechanisms involved and develop effective therapeutic strategies for use in the clinic. In this article, the possible role of dysfunction of the laminar vasculature is discussed, with particular emphasis on the venous side of the laminar microvasculature and the possible role(s) that metabolic syndrome and thrombosis may play in the dysfunction observed in the laminar microvasculature during the development of laminitis.
p38 mitogen-activated kinase (MAPK) is essential for equine neutrophil migration.
Veterinary immunology and immunopathology    November 7, 2008   Volume 129, Issue 3-4 181-191 doi: 10.1016/j.vetimm.2008.11.007
Eckert RE, Sharief Y, Jones SL.Equine laminar tissues do not contain resident neutrophils and have less superoxide dismutase (SOD) activity than other equine tissues, which makes them inherently more vulnerable to damage induced by reactive oxygen species (ROS) produced by neutrophils that enter the tissues. In the advanced clinical stages of acute laminitis, pathologic events in affected feet include a breakdown in the basement membrane, neutrophil infiltration, and platelet-neutrophil aggregates in laminar dermal veins, highlighting the contribution of neutrophils to the pathophysiology of the disease. The aim of this stu...
Indices of inflammation in the lung and liver in the early stages of the black walnut extract model of equine laminitis.
Veterinary immunology and immunopathology    November 7, 2008   Volume 129, Issue 3-4 254-260 doi: 10.1016/j.vetimm.2008.11.001
Stewart AJ, Pettigrew A, Cochran AM, Belknap JK.The liver and lung are not only described as "target organs" in sepsis in most species, but are purported to be sources of circulating inflammatory mediators central to the systemic inflammatory response syndrome (SIRS). As we have recently reported an inflammatory response in the laminar tissue in laminitis similar to that described in "target organs" in human sepsis, we investigated the inflammatory response of the lung and liver in the black walnut extract (BWE) model of equine laminitis to determine (1) if a similar systemic inflammatory response occurs in this laminitis model as described...
Effect of a single dose of dexamethasone on glucose homeostasis in healthy horses by using the combined intravenous glucose and insulin test.
Journal of animal science    September 26, 2008   Volume 87, Issue 1 131-135 doi: 10.2527/jas.2008-1179
Haffner JC, Eiler H, Hoffman RM, Fecteau KA, Oliver JW.Sustained dexamethasone administration to horses results in insulin resistance, which may predispose them to laminitis. A single dose of dexamethasone is commonly used as a diagnostic aid, yet the effect of a single dose of dexamethasone on glucose homeostasis in horses is not well defined. The objective of this study was to characterize the change in glucose dynamics over time in response to a single dose of dexamethasone. A combined glucose-insulin tolerance test (CGIT) was performed on 6 adult geldings before and at 2, 24, and 72 h postdexamethasone (40 microg/kg of BW, i.v.); a minimum of ...
Endothelin mediated contraction of equine laminar veins.
Equine veterinary journal    May 20, 2008   Volume 40, Issue 5 488-492 doi: 10.2746/042516408X313634
Keen JA, Hillier C, McGorum BC, Nally JE.Endothelin-1 (ET-1) may be a key mediator in the pathogenesis of laminitis, but endothelin-mediated responses in the venous microcirculation of the equine foot have yet to be fully characterised. Objective: To characterise the response of equine laminar veins to ET-1 and evaluate the ET-1 receptor subtypes that mediate this response. Methods: Small veins (150-500 microns) draining the equine digital laminae from healthy horses and ponies subjected to euthanasia at an abattoir were investigated using wire myography. Concentration response curves were constructed for ET-1 in the presence of ETA ...
The effect of metformin on measurements of insulin sensitivity and beta cell response in 18 horses and ponies with insulin resistance.
Equine veterinary journal    May 17, 2008   Volume 40, Issue 5 493-500 doi: 10.2746/042516408X273648
Durham AE, Rendle DI, Newton JE.Laminitis in equids is a very common debilitating disease, and insulin resistance (IR) and hyperinsulinaemia are increasingly recognised as important predisposing factors. Pharmacological modification of IR and hyperinsulinaemia might reduce the risk of laminitis. Objective: Metformin, a drug commonly prescribed for treatment of human IR, may also decrease IR in equids. Methods: Eighteen horses and ponies with IR and recurrent laminitis were treated with 15 mg/kg bwt metformin per os q. 12 h. Each animal served as its own control by comparing pre- and post treatment proxies for IR, insulin sen...
Determination of the source of increased serotonin (5-HT) concentrations in blood and peritoneal fluid of colic horses with compromised bowel.
Equine veterinary journal    March 7, 2008   Volume 40, Issue 4 326-331 doi: 10.2746/042516408X293583
Delesalle C, van de Walle GR, Nolten C, Ver Donck L, van Hemelrijck A, Drinkenburg W, de Bosschere H, Claes P, Deprez P, Lefere L, Torfs S....Increased plasma (5-HT) concentrations are reported in horses predisposed to develop laminitis and after i.v. infusion of endotoxins. In the equine jejunum contractile 5-HT1A-like receptors show tachyphylaxia upon prolonged activation with 5-HT. Therefore, increased systemic 5-HT release in colic horses could play a possible role in the pathophysiology of ileus. Objective: To investigate possible increased systemic release of 5-HT in colic horses with compromised bowel and to identify the source of 5-HT overload. Methods: Concentrations of 5-HT were determined in plasma and peritoneal fluid (P...