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Topic:Veterinary Medicine

Veterinary medicine for horses encompasses the study and application of medical practices to diagnose, treat, and prevent diseases in equine species. This field involves a comprehensive understanding of equine anatomy, physiology, pathology, and pharmacology. Veterinary practitioners employ a range of diagnostic tools and therapeutic interventions to address health issues in horses, including lameness, gastrointestinal disorders, respiratory conditions, and infectious diseases. Preventative care, such as vaccination and deworming programs, is also a significant aspect of equine veterinary medicine. This page gathers peer-reviewed research studies and scholarly articles that explore various aspects of veterinary medicine as it pertains to horses, including advancements in diagnostic techniques, treatment protocols, and preventive health strategies.
External transcutaneous ultrasound technique in the equine cricoarytenoideus dorsalis muscle: Assessment of muscle size and echogenicity with resting endoscopy.
Equine veterinary journal    February 6, 2020   Volume 52, Issue 4 500-508 doi: 10.1111/evj.13209
Satoh M, Higuchi T, Inoue S, Miyakoshi D, Kajihara A, Gotoh T, Shimizu Y.Recent studies have assessed the cricoarytenoideus dorsalis muscle (CAD) using transoesophageal ultrasonography in equine recurrent laryngeal neuropathy (RLN). We assessed the CAD using the external transcutaneous ultrasound technique, which may constitute an easier method in horses. Objective: To evaluate ultrasonographic imaging of the left cricoarytenoideus dorsalis muscle (LCAD) and right cricoarytenoideus dorsalis muscle (RCAD) as a diagnostic tool for RLN using the transcutaneous ultrasound technique. Methods: Cross-sectional study. Methods: The axial plane thickness, cross-sectional are...
Using Inductively Coupled Plasma Mass Spectrometry to Assess Essential and Performance-Enhancing Metals in the Urine of Racehorses.
Journal of analytical toxicology    February 6, 2020   Volume 44, Issue 5 490-498 doi: 10.1093/jat/bkaa004
Karakka Kal AK, Perwad Z, K Karatt T, Nalakath J, Subhahar M.Recently, an increased tendency to use various metals has been observed in the sports competition fields. Many of these metals and their organic complexes reportedly have good pharmacologic, therapeutic and performance-enhancement uses; they are banned or recommended as controlled medications in competitive sports. The objective of this research was to determine the concentration of pharmacologically relevant metals in urine samples collected from racehorses at various sport events, develop a method and assess the concentrations of above metals using inductively coupled plasma mass spectrometr...
Complete resection of the alar folds in eight standing horses with a bipolar dividing and vessel-sealing device.
Veterinary surgery : VS    February 6, 2020   Volume 49, Issue 3 521-528 doi: 10.1111/vsu.13383
Kallmyr A, Giving EM, Moen LO, Øverlie M, Holm T, David F.To describe a resection technique of the alar folds in the standing horse. Methods: Retrospective case study. Methods: Eight Standardbred racing trotters. Methods: Horses in which alar fold collapse had been diagnosed between 2017 and 2018 were included in this study. All horses underwent alar fold resection under standing sedation and regional anesthesia with a bipolar electrosurgical open sealer/divider device (LigaSure). Intraoperative and postoperative complications were recorded. A Wilcoxon signed-rank test was used to compare differences in median prize money earning pre-surgery and post...
Phenotypic and genetic analysis of reproductive traits in horse populations with different breeding purposes.
Animal : an international journal of animal bioscience    February 6, 2020   Volume 14, Issue 7 1351-1361 doi: 10.1017/S1751731120000087
Reproductive traits have a major influence on the economic effectiveness of horse breeding. However, there is little information available. We evaluated the use of reproductive traits as selection criteria in official breeding programs to increase the reproductive efficiency of breeding studs, analysing 696 690 records from the pedigree data of eight Spanish horse populations, with different breeding purposes. The reproductive parameters studied in both sexes were age at first foaling (AFF), age at last foaling, average reproductive life and generational interval. In the females, the average ...
Doppler evaluation of renal resistivity index in healthy conscious horses and donkeys.
PloS one    February 6, 2020   Volume 15, Issue 2 e0228741 doi: 10.1371/journal.pone.0228741
The renal resistive index (RRI) is used as a measurement of downstream resistance in arteries. The aim of this study was to assess the RRI of the arcuate arteries by pulsed-wave Doppler ultrasonography in healthy conscious horses and donkeys, and to verify any differences related to age, breed, bodyweight (BW) or body condition (BCS). Thirty-three healthy conscious horses and nine donkeys had their systolic and diastolic flow velocities at the level of the arcuate arteries estimated by pulsed-wave Doppler ultrasound, and the RRI was calculated. The relationship of RRI with age, breed (Trotters...
Accuracy of transcranial magnetic stimulation and a Bayesian latent class model for diagnosis of spinal cord dysfunction in horses.
Journal of veterinary internal medicine    February 6, 2020   Volume 34, Issue 2 964-971 doi: 10.1111/jvim.15699
Rijckaert J, Raes E, Buczinski S, Dumoulin M, Deprez P, Van Ham L, van Loon G, Pardon B.Spinal cord dysfunction/compression and ataxia are common in horses. Presumptive diagnosis is most commonly based on neurological examination and cervical radiography, but the interest into the diagnostic value of transcranial magnetic stimulation (TMS) with recording of magnetic motor evoked potentials has increased. The problem for the evaluation of diagnostic tests for spinal cord dysfunction is the absence of a gold standard in the living animal. Objective: To compare diagnostic accuracy of TMS, cervical radiography, and neurological examination. Methods: One hundred seventy-four horses ad...
A Word of Thanks from the Editors.
The Veterinary clinics of North America. Equine practice    February 6, 2020   Volume 36, Issue 1 xi doi: 10.1016/j.cveq.2020.01.001
DeNotta SL, Stokol T.No abstract available
Ultrasound-guided continuous block of median and ulnar nerves in horses: development of the technique.
Veterinary anaesthesia and analgesia    February 6, 2020   Volume 47, Issue 3 405-413 doi: 10.1016/j.vaa.2019.12.008
Souto MTM, Fantoni DT, Hamaji A, Hamaji M, Vendruscolo CP, Otsuki DA, Pinto ACB, Ambrósio AM.To develop a technique for ultrasound-guided continuous median and ulnar peripheral nerve block in horses. Methods: Anatomical and prospective experimental study. Methods: A total of 16 thoracic limbs from horse cadavers and 18 adult horses. Methods: This study was conducted in three phases. Phase 1: Dissection of median and ulnar nerves in the antebrachial region of two cadaver limbs to identify localizing landmarks. Description of sonoanatomy in 14 cadaver limbs using ultrasound-guided perineural infiltration of a combination of cellulose gel (5 mL), contrast medium (4 mL) and methylene blue...
The Sick Adult Horse: Renal Clinical Pathologic Testing and Urinalysis.
The Veterinary clinics of North America. Equine practice    February 6, 2020   Volume 36, Issue 1 121-134 doi: 10.1016/j.cveq.2019.12.003
Schott HC, Esser MM.Clinicopathologic evaluation of renal function and renal disease in sick adult horses remains grounded in detection of azotemia, assessment of serum and urine electrolyte concentrations, and evaluation of urinalysis findings, including specific gravity, reagent strip analysis, and sediment examination. Because increases in serum or plasma urea nitrogen and creatinine concentrations are insensitive indicators of a decreased glomerular filtration rate, there is considerable interest in identifying novel biomarkers of renal function or injury in blood and urine, with serum symmetric dimethylargin...
Inflamed synovial fluid induces a homeostatic response in bone marrow mononuclear cells in vitro: Implications for joint therapy.
FASEB journal : official publication of the Federation of American Societies for Experimental Biology    February 6, 2020   Volume 34, Issue 3 4430-4444 doi: 10.1096/fj.201902698R
Menarim BC, Gillis KH, Oliver A, Mason C, Werre SR, Luo X, Byron CR, Kalbfleisch TS, MacLeod JN, Dahlgren LA.Synovial inflammation is a central feature of osteoarthritis (OA), elicited when local regulatory macrophages (M2-like) become overwhelmed, activating an inflammatory response (M1-like). Bone marrow mononuclear cells (BMNC) are a source of naïve macrophages capable of reducing joint inflammation and producing molecules essential for cartilage metabolism. This study investigated the response of BMNC to normal (SF) and inflamed synovial fluid (ISF). Equine BMNC cultured in autologous SF or ISF (n = 8 horses) developed into macrophage-rich cultures with phenotypes similar to cells native to no...
Medicine and Horsemanship: The Effects of Equine-assisted Activities and Therapies on Stress and Depression in Medical Students.
Cureus    February 5, 2020   Volume 12, Issue 2 e6896 doi: 10.7759/cureus.6896
Chakales PA, Locklear J, Wharton T.This study examined the use of an equine-assisted brief course module on stress and depression among medical students (n = 28), a demographic known to experience high pressure. Evidence supports that animal-assisted therapies can lead to the improvement of health and quality of life, particularly in terms of cognitive, psychological, and physical benefits. This study used the seven-session Kane Medicine and Horsemanship program; students completed pre- and post-measures one week before and after the course. Participation in the course significantly reduced perceived stress (p: 0.001), depressi...
A Genome-Wide Association Analysis in Noriker Horses Identifies a SNP Associated With Roan Coat Color.
Journal of equine veterinary science    February 5, 2020   Volume 88 102950 doi: 10.1016/j.jevs.2020.102950
Grilz-Seger G, Reiter S, Neuditschko M, Wallner B, Rieder S, Leeb T, Jagannathan V, Mesarič M, Cotman M, Pausch H, Lindgren G, Velie B, Horna M....The roan coat color in horses is characterized by dispersed white hair and dark points. This phenotype segregates in a broad range of horse breeds, while the underlying genetic background is still unknown. Previous studies mapped the roan locus to the KIT gene on equine chromosome 3 (ECA3). However, this association could not be validated across different horse breeds. Performing a genome-wide association analysis (GWAS) in Noriker horses, we identified a single nucleotide polymorphism (SNP) (ECA3:g.79,543.439 A > G) in the intron 17 of the KIT gene. The G -allele of the top associated SNP...
Differences in isolation rate and antimicrobial susceptibility of bacteria isolated from foals with sepsis at admission and after ≥48 hours of hospitalization.
Journal of veterinary internal medicine    February 5, 2020   Volume 34, Issue 2 955-963 doi: 10.1111/jvim.15692
Theelen MJP, Wilson WD, Byrne BA, Edman JM, Kass PH, Mughini-Gras L, Magdesian KG.Antimicrobial treatment protocols for foals with sepsis that do not improve clinically often are adjusted based on bacteriological and antimicrobial susceptibility testing results from samples collected at hospital admission. Objective: To evaluate whether hospitalization for ≥48 hours affects bacteriological and antimicrobial susceptibility testing results. Methods: Two-hundred sixty-seven foals <30 days of age admitted to a neonatal intensive care unit and diagnosed with sepsis. Methods: Medical records were reviewed retrospectively to identify foals with sepsis and positive bacteri...
Betulinic acid shows anticancer activity against equine melanoma cells and permeates isolated equine skin in vitro.
BMC veterinary research    February 5, 2020   Volume 16, Issue 1 44 doi: 10.1186/s12917-020-2262-5
Weber LA, Meißner J, Delarocque J, Kalbitz J, Feige K, Kietzmann M, Michaelis A, Paschke R, Michael J, Pratscher B, Cavalleri JV.Equine malignant melanoma (EMM) is a frequently occurring dermoepidermal tumor in grey horses. Currently available therapies are either challenging or inefficient. Betulinic acid (BA), a naturally occurring triterpenoid, is a promising compound for cancer treatment. To evaluate the potential of BA as a topical therapy for EMM, its anticancer effects on primary equine melanoma cells and dermal fibroblasts and its percutaneous permeation through isolated equine skin were assessed in vitro. Results: BA showed antiproliferative and cytotoxic effects on both primary equine melanoma cells and fibrob...
Description of a rare osteochondrosis lesion of the medial aspect of the distal intermediate ridge of the tibia in seven Thoroughbred horses (2008-2018). Kadic LIM, Rodgerson DH, Newsom LE, Spirito MA.Osteochondritis dissecans (OCD) of the distal intermediate ridge of the tibia (DIRT) is commonly identified on either the lateral to medial (LM) or dorso45°medial-plantarolateral oblique (D45M-PLO) projection of the tarsus. This manuscript describes a retrospective case series out of Hagyard Equine Medical Institute, for which medical records and radiographic projections of the tarsus were reviewed, consistent with Keeneland's repository requirements. This original investigation identified seven yearling Thoroughbred horses between 2008 and 2018 with radiographic signs of atypical osteochondr...
Evaluation of the caudal cervical articular process joints by using a needle arthroscope in standing horses.
Veterinary surgery : VS    February 5, 2020   Volume 49, Issue 3 463-471 doi: 10.1111/vsu.13388
Pérez-Nogués M, Vaughan B, Phillips KL, Galuppo LD.To determine the safety and efficacy of caudal cervical articular process joint arthroscopy by using needle arthroscopy in standing sedated horses. Methods: Prospective experimental case series. Methods: Six adult horses. Methods: Three horses underwent exploration of bilateral C5-6 vertebral articular process joints and three bilateral C6-7 articular process joints by using a 1.2 × 65-mm needle arthroscope under standing sedation. The 16-gauge arthroscopic trocar and canula assembly was inserted in the desired articular process joint under ultrasonographic guidance without distention of ...
Critical Evaluation of Whole-Body Cryostimulation Protocol in Race Horses.
Journal of equine veterinary science    February 4, 2020   Volume 88 102944 doi: 10.1016/j.jevs.2020.102944
Bogard F, Bouchet B, Murer S, Filliard JR, Beaumont F, Polidori G.Cold therapy is commonly used to relieve pain and inflammation and to aid in muscle recovery after exercise in human medicine. A number of applications have also been observed in veterinary practice. In this article, a critical evaluation of equine protocol applied with a new commercial concept of equine whole-body cryostimulation (WBC) was made. With this new concept of WBC, the protocol usually utilized for relieving pain and discomfort in humans has been extended to horses. The investigations described herein focus on the reduction of horse skin temperature when applying human WBC protocols...
Cell engraftment, vascularization, and inflammation after treatment of equine distal limb wounds with endothelial colony forming cells encapsulated within hydrogel microspheres.
BMC veterinary research    February 4, 2020   Volume 16, Issue 1 43 doi: 10.1186/s12917-020-2269-y
Winter RL, Tian Y, Caldwell FJ, Seeto WJ, Koehler JW, Pascoe DA, Fan S, Gaillard P, Lipke EA, Wooldridge AA.Endothelial colony forming cells (ECFCs) may be useful therapeutically in conditions with poor blood supply, such as distal limb wounds in the horse. Encapsulation of ECFCs into injectable hydrogel microspheres may ensure cell survival and cell localization to improve neovascularization and healing. Autologous ECFCs were isolated from 6 horses, labeled with quantum nanodots (QD), and a subset were encapsulated in poly(ethylene) glycol fibrinogen microspheres (PEG-Fb MS). Full-thickness dermal wounds were created on each distal limb and injected with empty PEG-Fb MS, serum, ECFCs, or ECFCs enca...
Agreement of stall-side and laboratory major crossmatch tests with the reference standard method in horses.
Journal of veterinary internal medicine    February 4, 2020   Volume 34, Issue 2 941-948 doi: 10.1111/jvim.15710
Fenn MS, Bortsie-Aryee AD, Perkins GA, Mann S, Tomlinson JE, Wood EM, Mix SE, Stokol T.Crossmatching is used to prevent life-threatening transfusion reactions in horses. Laboratory methods are laborious and technically challenging, which is impractical during emergencies. Objective: Evaluate agreement between a stall-side crossmatch kit (KIT) and a laboratory method (LAB) in horses with known and unknown blood types. Methods: Twenty-four blood-typed and alloantibody-screened healthy adult horses (Aim 1) and 156 adult horses of unknown blood type (Aim 2). Methods: Prospective, blinded study. Expected positive (n = 35) and negative (n = 36) crossmatches among 24 antibody and blood...
In vivo metabolism of the designer anabolic steroid hemapolin in the thoroughbred horse.
Drug testing and analysis    February 4, 2020   Volume 12, Issue 6 752-762 doi: 10.1002/dta.2769
Waller CC, Weththasinghe SA, McClure L, Cawley AT, Suann C, Suann E, Sutherland E, Cooper E, Heather A, McLeod MD.Hemapolin (2α,3α-epithio-17α-methyl-5α-androstan-17β-ol) is a designer steroid that is an ingredient in several "dietary" and "nutritional" supplements available online. As an unusual chemical modification to the steroid A-ring could allow this compound to pass through antidoping screens undetected, the metabolism of hemapolin was investigated by an in vivo equine drug administration study coupled with GC-MS analysis. Following administration of synthetically prepared hemapolin to a thoroughbred horse, madol (17α-methyl-5α-androst-2-en-17β-ol), reduced and dihydroxylated madol (17α-me...
Management of postoperative dysphagia after prosthetic laryngoplasty or arytenoidectomy.
Veterinary surgery : VS    February 4, 2020   Volume 49, Issue 3 529-539 doi: 10.1111/vsu.13389
Luedke LK, Cheetham J, Mohammed HO, Ducharme NG.To evaluate the efficacy of various treatments for dysphagia after laryngeal surgery. Methods: Retrospective. Methods: Horses treated for dysphagia after laryngeal surgery. Methods: Medical records of horses treated for dysphagia after prosthetic laryngoplasty (PLP) or partial arytenoidectomy (PA) were reviewed. Signalment, prior surgery, preoperative videoendoscopic diagnosis, and surgical treatments were recorded. Short- and long-term follow-up were obtained. Chi-square and logistical regression were performed to correlate independent variables and outcomes. Results: Forty-four percent of ho...
Histologic Comparison of the Dura Mater among Species.
Comparative medicine    February 3, 2020   Volume 70, Issue 2 170-175 doi: 10.30802/AALAS-CM-19-000022
Kinaci A, Bergmann W, Bleys RL, van der Zwan A, van Doormaal TP.The biocompatibility, biodegradation, feasibility, and efficacy of medical devices like dural sealants and substitutes are often evaluated in various animal models. However, none of these studies explain the rationale for choosing a particular species, and a systematic interspecies comparison of the dura is not available. We hypothesized that histologic characteristics of the dura would differ among species. We systematically investigated basic characteristics of the dura, including thickness, composition, and fibroblast orientation of the dura mater, in 34 samples representing 10 animal speci...
Characterization of the normal equine conjunctival bacterial community using culture-independent methods.
Veterinary ophthalmology    February 3, 2020   Volume 23, Issue 3 480-488 doi: 10.1111/vop.12743
LaFrentz S, Abarca E, Mohammed HH, Cuming R, Arias CR.The equine conjunctival microbiota has often been reported to be dominated by Gram-positive species such as Staphylococcus sp., Bacillus sp., and Corynebacterium sp. However, traditional culture-based methods can only recover a fraction of the bacterial species present in the sample. Objective: This pilot study aimed at exploring the diversity of the equine conjunctival microbiota using culture-independent methods. Methods: Eight horses were included in this study, and only eyes with normal ophthalmic examination (n = 15 eyes) were sampled. Methods: Conjunctival biopsies (culture-independent...
Effects of transportation on gastric pH and gastric ulceration in mares.
Journal of veterinary internal medicine    February 3, 2020   Volume 34, Issue 2 922-932 doi: 10.1111/jvim.15698
Padalino B, Davis GL, Raidal SL.Transportation has been suggested as a risk factor for gastric ulceration in horses, but limited evidence supports this assumption. Methods: Twenty-six Standardbred, Thoroughbred, and Warmblood mares from a university teaching herd. Methods: Twelve mares were confined for 12 hours, overnight, in reproductive stocks with indwelling nasogastric tubes (NGTs) to assess pH of gastric fluid (GF). Gastric ulceration was assessed endoscopically before and after confinement. Subsequently, 26 horses were transported for 12 hours, overnight, in 2 consignments. During transportation, GF was aspirated ...
Ex vivo study of minimally invasive procedures for cartilage removal from the metacarpophalangeal or metatarsophalangeal joint and for fetlock tension band application.
Veterinary surgery : VS    February 3, 2020   Volume 49 Suppl 1 O45-O53 doi: 10.1111/vsu.13374
Farfan M, Genton M, Rossignol F.To describe reliable minimally invasive procedures for (1) removing cartilage by joint distraction and articular drilling for equine metacarpophalangeal (MCP)/metatarsophalangeal (MTP) arthrodesis; (2) applying a palmar/plantar tension band without MCP/MTP joint luxation. Methods: Experimental study. Methods: Cadaveric equine limbs (n = 12). Methods: All limbs were used to evaluate the drilling technique. First the MCP/MTP joint was distracted with a 5.5-mm cortical screw. Then, through four stab incisions, articular cartilage was removed with a 4.5-mm drill. Six randomly chosen limbs were the...
Upregulation of CRISP-3 and kallikrein in stallion seminal plasma is associated with poor tolerance of cooled storage.
Reproduction in domestic animals = Zuchthygiene    February 3, 2020   Volume 55, Issue 4 496-502 doi: 10.1111/rda.13643
Kareskoski AM, Palviainen M, Johannisson A, Katila T.For unknown reasons, stallion fertility and sperm longevity during cooled storage of semen vary markedly between individuals. Spermatozoa from individual stallions react differently to the presence, or the removal, of seminal plasma (SP). The aim was to evaluate differences in protein content in stallion seminal plasma with either a positive or a negative effect on sperm chromatin integrity during storage. Stallion semen samples from different ejaculate fractions were stored at 5°C for 24 hr. Sperm survival was assessed after storage using a sperm chromatin structure assay. Protein expressio...
The intravenous pharmacokinetics of butorphanol and detomidine dosed in combination compared with individual dose administrations to exercised horses.
Journal of veterinary pharmacology and therapeutics    February 3, 2020   Volume 43, Issue 2 162-170 doi: 10.1111/jvp.12838
Paine SW, Bright J, Scarth JP, Hincks PR, Pearce CM, Hannan C, Machnik M, Hillyer L.In equine and racing practice, detomidine and butorphanol are commonly used in combination for their sedative properties. The aim of the study was to produce detection times to better inform European veterinary surgeons, so that both drugs can be used appropriately under regulatory rules. Three independent groups of 7, 8 and 6 horses, respectively, were given either a single intravenous administration of butorphanol (100 µg/kg), a single intravenous administration of detomidine (10 µg/kg) or a combination of both at 25 (butorphanol) and 10 (detomidine) µg/kg. Plasma and urine concentratio...
Nasogastric Intubation as Health and Safety Risk in Equine Practice-A Questionnaire.
Journal of equine veterinary science    February 1, 2020   Volume 88 102951 doi: 10.1016/j.jevs.2020.102951
Drozdzewska K, Potocnik E, Schwarz B.Placing a nasogastric tube can be a life-saving act for a horse but is considered an occupational hazard for veterinarians. An online questionnaire was performed to assess and specify potential risks. 123 equine veterinarians completed the survey, and the majority admitted using the mouth to handle the end of the nasogastric tube (sucking or blowing air) and having accidentally swallowed or aspirated stomach content or medications. This can potentially lead to aspiration pneumonia or pneumonitis. Mineral oil seems to be especially dangerous as aspiration may be asymptomatic at the beginning an...
Detection and Pharmacokinetics of Etoricoxib in Thoroughbred Horses.
Journal of equine veterinary science    February 1, 2020   Volume 88 102942 doi: 10.1016/j.jevs.2020.102942
Subhahar MB, Singh J, Albert PH, Kadry AM.Etoricoxib, a selective inhibitor of cyclooxygenase-2, is used in the treatment of many inflammatory diseases and dental pain in humans. The aim of this study was to determine the pharmacokinetics and metabolism of etoricoxib in horses. Six horses weighing an average of 475 ± 25 kg were administered a single oral dose of etoricoxib at 1 mg/kg body weight. The results show that the drug reached a maximum concentration of 505.2 ± 67.8 ng/mL in 48 minutes after administration. The elimination half-life was calculated to be 10.20 ± 1.30 hours. Mass spectrometric analysis confirmed that eto...
Treatment With Platelet Lysate Inhibits Proteases of Synovial Fluid in Equines With Osteoarthritis.
Journal of equine veterinary science    February 1, 2020   Volume 88 102952 doi: 10.1016/j.jevs.2020.102952
Perrone G, Lastra Y, González C, Caggiano N, Giménez R, Pareja R, De Simone E.Osteoarthritis (OA) is the most prevalent arthropathy in sport horses. The administration of a platelet lysate (PL) is an alternative method for the treatment of musculoskeletal conditions. The mechanisms by which PL exerts its beneficial effects have not been determined, and less is known about its effect on the activity of the proteolytic enzymes of the synovial fluid of equines with OA. In this work, the effect of the administration of PL to horses with OA was analyzed both clinically and molecularly by determining the levels of matrix metalloproteinase-2 (MMP-2), matrix metalloproteinase-9...