Dr. Andrew van Eps discussed the three types of laminitis and how far research on the condition has come with dvm360.
“I’ve studied laminitis for nearly 20 years, and I’m finally becoming optimistic,” van Eps told dvm360.
Van Eps is an associate professor of equine musculoskeletal research at the University of Pennsylvania School of Veterinary Medicine’s New Bolton Center. He’s also a member of the International Equine Veterinarian Hall Of Fame and will speak at the 2018 International Hoof-Care Summit in Cincinnati, Ohio.
He’s seen the pain of laminitis first-hand since the beginning of his career — he was originally a resident at the New Bolton Center since Barbaro was infamously stricken with laminitis.
“When I look back at when Barbaro was at New Bolton Center [2007-08], I’m amazed at how little we knew about laminitis,” van Eps says.
“We were just starting to come to grips with the facts that different types of laminitis existed.”
He says that there are three types: endocrinopathic, supporting-limb and sepsis-associated.
Laminitis follows endocrine disorders that cause increased blood insulin, such as equine metabolic syndrome and Cushing’s disease.
“We’re close to identifying why high blood insulin causes the changes in the lamellar tissue of the foot itself, which creates the disease,” van Eps says. “We’re looking at different ways to directly block those processes from happening.”
Control of the endocrine issue is crucial to managing endocrinopathic laminitis.
“If we can address those problems, we can manage laminitis and prevent it from worsening,” he says.
Supporting-limb laminitis is the condition that affected Barbaro.
“A lot of what I do today and much of the research my colleagues have done on supporting-limb laminitis are a result of Barbaro and his owners Roy and Gretchen Jackson,” van Eps says.
Since then, researchers better understand this form of laminitis and are able to intervene.
“We’re garnering convincing evidence that supporting-limb laminitis is a blood perfusion problem associated with load,” van Eps says. “Specifically, the loss of normal limb load cycling patterns appears to be the problem.”
When a horse favors one limb, it interferes with the blood flow. The weight must be cycled on and off the limb to prevent laminitis.
In order to address supporting-limb laminitis, veterinarians can provide “partial, intermittent relief of weight-bearing on the support limb,” according to van Eps. “The key is knowing where the threshold is, how frequently and how much relief we have to provide.”
His team is working to figure that out now, and van Eps is optimistic.
According to van Eps, this type is possibly the most studied, but remains the most ambiguous.
What researchers do know is that cooling the effected horse’s feet can often prevent it.
“It probably has to do with slowing the metabolic rate within the lamellar tissue itself,” van Eps says.
Unfortunately, the cryotherapy is not easy to work with over long periods. According to van Eps, horses that are treated with it effectively are typically in a teaching hospital.
Further, while it used to be held that foot cooling prevented inflammation, newer research shows that this is not always the case.
“The intent has always been to identify exactly why cryotherapy works, and then come up with a practical pharmaceutical intervention.”
While the research is not quite there, van Eps says there have been promising findings.
“In a recently published study, we have evidence that cold therapy slows metabolism in the lamellar tissue of horses in a sepsis-type model, reduces the demand for nutrients and more tightly regulates the energy metabolism of the tissue in a way that protects it from sepsis-induced metabolic dysfunction,” he says.
While there is more yet to be learned, researchers and practitioners can diagnose and treat the three types of laminitis more effectively than ever — and the research continues.
“This is the first time I’ve been so optimistic about finally enabling the equine veterinary profession, as Vision 20/20 states, to ‘conquer the different forms of laminitis by 2020,’” van Eps says.