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Equine veterinary journal2021; 54(3); 513-522; doi: 10.1111/evj.13459

Detection of synovial sepsis in horses using enzymes as biomarkers.

Abstract: Synovial sepsis is a commonly occurring, potentially career-ending or even life-threatening orthopaedic emergency. Diagnosis of synovial sepsis is currently primarily based on synovial fluid analysis, which often leaves diagnostic ambiguity due to overlap of clinicopathological parameters between septic and aseptic inflammatory synovitis. Objective: To evaluate the reliability of lysozyme (LYS), myeloperoxidase (MPO) and elastase (ELT) as biomarkers for synovial sepsis in horses using a photometric assay to measure increased enzyme activity. Methods: Prospective, single-blinded, analytical, clinical study. Methods: Equine synovial samples were assigned to one of three groups: (1) healthy controls (n = 10), (2) aseptic (n = 27) and (3) septic synovitis (n = 30). The enzyme activity assays (LYS, MPO and ELT) were compared with standard synovial fluid parameters and broad-range bacterial 16S rDNA PCR. Results: LYS and MPO activities were significantly different between septic synovial samples, and both aseptic and control samples (P < .001, LYS: confidence interval [CI]: 2.25-3.41, resp., 2.21-3.8, MPO: CI 0.752-1.6, resp., 0.639-1.81). LYS achieved a 100% sensitivity and 100% specificity in differentiating between septic and aseptic (cut-off value 751.4) or control (cut-off: 484.6) samples (P < .001). MPO reached 93.33% sensitivity, 100% specificity for distinguishing septic from control (cut-off value: 0.1254) synovial samples and 93.33% sensitivity, 81.48% specificity for discriminating between septic and aseptic (cut-off value: 0.1305) synovial samples (P < .001). ELT activity could not be measured in any synovial sample. Both the LYS and the MPO measurements showed a highly significant correlation with PCR (LYS r = .79, MPO r = .69), synovial leukocyte count (LYS r = .752, MPO r = .571), % neutrophils (LYS r = .751, MPO r = 0.663) and each other (r = .744, all P < .001). Conclusions: Variation in horses' signalment, affected synovial structures and synovial fluid freezing times may have affected the discriminative power of this study. Conclusions: Increased MPO and LYS activities allow reliable, rapid diagnosis of synovial sepsis with high sensitivity and specificity.
© 2021 The Authors. Equine Veterinary Journal published by John Wiley & Sons Ltd on behalf of EVJ Ltd.
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Publication Date: 2021-06-15 PubMed ID: 33977535PubMed Central: PMC9290786DOI: 10.1111/evj.13459Google Scholar: Lookup
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  • Journal Article

Summary

This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.

This research investigates the effectiveness of using three enzymes, lysozyme (LYS), myeloperoxidase (MPO), and elastase (ELT), as biomarkers for detecting synovial sepsis, a dangerous equine condition, to increase diagnostic accuracy and speed.

Overview of the Study

  • This was a prospective, single-blinded, analytical, clinical study conducted on horses to examine the potential of certain enzymes as biomarkers for synovial sepsis, a serious orthopaedic emergency.
  • The enzymes studied were lysozyme (LYS), myeloperoxidase (MPO), and elastase (ELT).
  • The researchers employed a photometric assay to quantify the enzymatic activity.

Study Design and Methodology

  • Equine synovial fluid samples were categorized into three groups: healthy controls, aseptic, and septic synovitis.
  • The activity of the three enzymes in these samples was then measured and compared with standard synovial fluid parameters and bacterial 16S rDNA PCR (a genetic test for bacteria).

Findings of the Research

  • The study found that LYS and MPO activities were significantly different in septic, aseptic, and healthy synovial samples.
  • The LYS enzyme was particularly effective and had a 100% sensitivity and specificity in distinguishing between septic and both aseptic and control samples. Similarly, MPO also displayed high sensitivity and specificity.
  • The activity of ELT could not be measured in any of the samples, making it of little use in this study.
  • Both LYS and MPO measurements also showed a highly significant correlation with the PCR test results, synovial leukocyte count, percentage neutrophils and with each other, further demonstrating their potential as biomarkers for synovial sepsis.

Limitations and Conclusion

  • The authors noted that factors such as the horses’ breed, age and gender, the specific synovial structures affected, and the freezing time of the synovial fluid might have influenced the discriminating power of their study.
  • Despite these limitations, the study concluded that increased MPO and LYS activities can serve as reliable biomarkers for the rapid and accurate diagnosis of synovial sepsis, which could potentially be life-saving in severe cases.

Cite This Article

APA
Haralambus R, Florczyk A, Sigl E, Gültekin S, Vogl C, Brandt S, Schnierer M, Gamerith C, Jenner F. (2021). Detection of synovial sepsis in horses using enzymes as biomarkers. Equine Vet J, 54(3), 513-522. https://doi.org/10.1111/evj.13459

Publication

Equine veterinary journal
ISSN: 2042-3306
NlmUniqueID: 0173320
Country: United States
Language: English
Volume: 54
Issue: 3
Pages: 513-522

Researcher Affiliations

Haralambus, Rhea
  • Department of Companion Animals and Horses, Equine Surgery Unit, University of Veterinary Medicine Vienna, Vienna, Austria.
Florczyk, Agnieszka
  • Department of Companion Animals and Horses, Equine Surgery Unit, University of Veterinary Medicine Vienna, Vienna, Austria.
Sigl, Eva
  • Qualizyme Diagnostics GmbH & Co KG, Neue Stiftingtalstraße 2, Graz, Austria.
Gültekin, Sinan
  • Department of Companion Animals and Horses, Equine Surgery Unit, University of Veterinary Medicine Vienna, Vienna, Austria.
Vogl, Claus
  • Department of Biomedical Sciences, Institute of Animal Breeding and Genetics, University of Veterinary Medicine Vienna, Vienna, Austria.
Brandt, Sabine
  • Department of Companion Animals and Horses, Equine Surgery Unit, University of Veterinary Medicine Vienna, Vienna, Austria.
Schnierer, Marlies
  • Department of Companion Animals and Horses, Equine Surgery Unit, University of Veterinary Medicine Vienna, Vienna, Austria.
Gamerith, Clemens
  • Qualizyme Diagnostics GmbH & Co KG, Neue Stiftingtalstraße 2, Graz, Austria.
  • Department of Environmental Biotechnology, University of Natural Resources and Life Sciences Vienna, Tulln an der Donau, Austria.
Jenner, Florien
  • Department of Companion Animals and Horses, Equine Surgery Unit, University of Veterinary Medicine Vienna, Vienna, Austria.

MeSH Terms

  • Animals
  • Biomarkers / analysis
  • Horse Diseases / diagnosis
  • Horses
  • Prospective Studies
  • Reproducibility of Results
  • Sepsis / diagnosis
  • Sepsis / veterinary
  • Synovial Fluid / chemistry
  • Synovitis / diagnosis
  • Synovitis / veterinary

Grant Funding

  • 853013 / Austrian Research Promotion Agency
  • 1000054206 / Styrian business promotion agency

Conflict of Interest Statement

E. Sigl is a co‐founder of Qualizyme Diagnostics GmbH & Co KG. C. Gamerith is an employee of this company, which applied for a patent for the biomarker assays.

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Citations

This article has been cited 4 times.
  1. Laus F, Gialletti R, Bazzano M, Laghi L, Dini F, Marchegiani A. Synovial Fluid Metabolome Can Differentiate between Healthy Joints and Joints Affected by Osteoarthritis in Horses. Metabolites 2023 Aug 4;13(8).
    doi: 10.3390/metabo13080913pubmed: 37623857google scholar: lookup
  2. Jacobsen S, Mortensen CD, Høj EA, Vinther AM, Berg LC, Adler DMT, Verwilghen D, van Galen G. Neutrophil Gelatinase-Associated Lipocalin in Synovial Fluid from Horses with and without Septic Arthritis. Animals (Basel) 2022 Dec 21;13(1).
    doi: 10.3390/ani13010029pubmed: 36611638google scholar: lookup
  3. Beggan CP, Panizzi L, Oliver LJ. Efficacy of needle and endoscopic lavage on the recuperation of microspheres from the adult equine metacarpo-/metatarsophalangeal joint and digital flexor tendon sheath. Vet Surg 2025 Aug;54(6):1157-1166.
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  4. Birckhead EM, Das S, Tidd N, Raidal SL, Raidal SR. Visualizing neutrophil extracellular traps in septic equine synovial and peritoneal fluid samples using immunofluorescence microscopy. J Vet Diagn Invest 2023 Nov;35(6):751-760.
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