Dynamic nasopharyngeal collapse in horses: What we know so far.

Dynamic nasopharyngeal collapse (NPC) is an obstructive upper airway disease that affects mainly the inspiratory phase of respiration in horses undergoing strenuous exercise. It occurs when the neuromuscular activity of the nasopharynx is overwhelmed by the intense negative pressures generated during exercise. This leads to collapse of at least one of the four components of the nasopharynx which is comprised of the two lateral walls, the dorsal roof and the ventral soft palate. As a result, the airway diameter and thus airflow become compromised. Even small changes in the airway diameter produces profound increases in negative inspiratory pressure, perpetuating the cycle of collapse. Compared to other dynamic upper respiratory tract disorders, the amount of literature on NPC as a disease entity is limited. The exact pathophysiology of NPC is unknown; however, it impacts up to one quarter of high-performance equine athletes presenting for poor performance. There is currently no definitive treatment for this severely performance-limiting condition. Thus, the prognosis for future athletic prognosis is guarded, with most horses being retired from racing or athletic use in general. Further research is warranted in this field to reduce the impact of disease and in turn, reduce the turnover rate and economic loss by enhancing the career longevity of elite equine athletes diagnosed with NPC.

A wireless endoscopy capsule suitable for imaging of the equine stomach and small intestine.

BACKGROUND: Capsule endoscopy offers a new method for visualization of the gastrointestinal mucosa in horses where other imaging technologies have diagnostic limitations. OBJECTIVES: To (1) test the feasibility of using this novel endoscopy capsule to visualize intestinal mucosa in horses, including an objective assessment of image quality, (2) assess how changes in preadministration preparation affect the transit time and the amount of gastrointestinal mucosa visualized, and (3) describe intestinal mucosa lesions in healthy horses. ANIMALS: Five healthy adult horses. METHODS: Three protocols were used in a crossover study design. Protocols varied in time fasted, amount of oral fluid administered, and exercise. Manure was radiographically inspected for capsule recovery. Percentage of visible gastrointestinal mucosa was objectively assessed. RESULTS: Detailed images of the gastrointestinal mucosa were recorded with all 3 protocols, including images of the pylorus, major duodenal papilla, individual villi, and ileocecal junction. Visualization of large intestinal mucosa was poor. Interobserver agreement on image quality was excellent. Capsule administration after feed withholding for 24 hours provided the greatest percentage of visible mucosa in the stomach and small intestine. Total transit time to capsule excretion was 6.5 (3-8.75) days. Of 15 capsules administered, 3 were not recovered. Lesions visualized included mucosal erosion, ulceration and hemorrhage, areas of thickened mucosa, and evidence of parasitism. CONCLUSIONS: This novel endoscopic capsule appears safe, practical, and noninvasive in horses; however, variability in capsule excretion time must be taken into account for clinical application.

Comparison of physiological demands in Warmblood show jumping horses over a standardized 1.10 m jumping course versus a standardized exercise test on a track.

BACKGROUND: A greater understanding of exercise physiology and biochemistry is required for the sport horse disciplines, including show jumping. Conditioning of horses for show jumping is empirical because they are primarily trained on flat ground, however the equivalent workload between jumping and flat work is currently unknown. The objectives of the study were therefore to compare the physiological demands of Warmblood show jumpers over a standardized 1.10 m course vs a 600 m standardized incremental exercise test on flat ground, and to report reference field test values for competitive show jumping horses. In this prospective field study, 21 healthy, actively competing Warmblood show jumping horses were assessed to determine physiological variables after a standardized jumping course at 6.4 m/s (average speed) and track standardized incremental exercise test at 5 m/s, 8 m/s and 11 m/s. Heart rate, velocity, blood lactate, blood pH, pCO2, bicarbonate, PCV and TP concentrations were recorded. V200, V170 and VLa4 were calculated. Parametric statistics were performed on analysis of all 21 horses' variables. RESULTS: Contrary to exercise at 5 m/s and 11 m/s, cantering at 8 m/s did not induce any significant difference in blood lactate, mean heart rate or mean venous blood pH compared to after completion of the jumping course. CONCLUSIONS: Jumping a 1.10 m course demands a statistically similar workload to cantering around a flat track at 8 m/s. This study will help to test fitness and design conditioning programs for Warmblood show jumping horses.

Efficacy of dexamethasone, salbutamol, and reduced respirable particulate concentration on aerobic capacity in horses with smoke-induced mild asthma.

BACKGROUND: Mild asthma in horses decreases racing performance and impairs gas exchange. The efficacy of treatment on performance is unknown. HYPOTHESIS: Treatment targeting lung inflammation improves V ˙ O2 peak in horses with mild asthma. ANIMALS: Thoroughbred polo horses (n = 12) with smoke-induced mild asthma. Horses were exposed to increased ambient particulate matter (35.51 µg/m3 [PM2.5 ]; day mean, centrally measured) from day -33 to 0, from bushfire smoke (natural model). METHODS: Prospective, randomized, placebo-controlled, double-blinded clinical trial. All horses completed 3 V ˙ O2 peak tests, measuring aerobic and anaerobic variables: day 0 -baseline; day 16 -after dexamethasone (20 mg IM q24h; DEX, n = 6) or saline treatment (SALINE, n = 6), under improved ambient PM2.5 concentrations (7.04 µg/m3 ); day 17-15-30mins after inhaled salbutamol (1500 µg). Bronchoalveolar lavage and mucus scoring were performed on day -8 and day 20. Linear mixed effects models were used to examine the effects of timepoint and treatment group on BAL differential cell counts, mucus scores, aerobic and anaerobic variables. RESULTS: Horses' mucus scores improved significantly from day -8 to 20 by 1.27 ± .38 (P = .01). There was a significant increase in V ˙ O2 peak of 15.5 ± 4.0 mL(min.kg)-1 from day 0 to 17 (P = .002), representing an average (mean) increase in V ˙ O2 peak of 13.2%. There was no difference in V˙O2 peak between treatment groups (SALINE versus DEX) at any timepoint. CONCLUSIONS AND CLINICAL IMPORTANCE: This study highlighted the key role of improved air quality on functionally important airway inflammation. Evidence provided is central to increasing owner compliance regarding improved air quality for the treatment and prevention of mild asthma.

Effects of nebulized dexamethasone on the respiratory microbiota and mycobiota and relative equine herpesvirus-1, 2, 4, 5 in an equine model of asthma.

BACKGROUND: Prolonged exposure to environmental antigens or allergens elicits an immune response in both healthy horses and those with mild asthma. Corticosteroids often are used to treat lower airway inflammation. OBJECTIVE: To investigate the changes in equine herpesvirus (EHV)-1,2,4,5 glycoprotein B gene expression and changes in respiratory bacterial and fungal communities after nebulized dexamethasone treatment of horses with asthma. ANIMALS: Horses with naturally occurring mild asthma (n = 16) and healthy control horses (n = 4). METHODS: Prospective, randomized, controlled, blinded clinical trial. Polymerase chain reaction amplification of EHV-1,2,4,5 in bronchoalveolar lavage fluid, and 16S (microbiome) and ITS2 (mycobiome) genes with subsequent sequencing was performed on DNA extracted from nasal swabs and transendoscopic tracheal aspirates before and after 13 days treatment with nebulized dexamethasone (15 mg q24h) and saline (control). RESULTS: Nebulized dexamethasone treatment decreased microbial diversity; relative abundance of 8 genera in the upper respiratory tract were altered. For both the microbiota and the mycobiota, environment had a dominant effect over treatment. Alternaria, an opportunistic pathogen and allergen in humans recognized as a risk factor for asthma, asthma severity, and exacerbations, was increased with treatment. Treatment affected relative quantification of the equine gamma herpesviruses (EHV-2 and -5); EHV-2 DNA levels increased and those of EHV-5 decreased. CONCLUSIONS: Nebulized dexamethasone treatment affected the upper respiratory tract microbiota, but not the mycobiota, which was overwhelmed by the effect of a sustained dusty environment.

Effect of injected dexamethasone on relative cytokine mRNA expression in bronchoalveolar lavage fluid in horses with mild asthma.

BACKGROUND: Mild equine asthma is a common inflammatory airway disease of the horse. The primary treatment of mild equine asthma is corticosteroids. The purpose of this study was to investigate the effects of injected dexamethasone on relative IL-1ß, IL-4, IL-5, IL-6, IL-8, IL-10, IL-12p35, IL-17, IL-23, IFN-γ, Eotaxin-2 and TNF-α mRNA expression in bronchoalveolar lavage (BAL) fluid in healthy Thoroughbred horses (n = 6), and those with mild equine asthma (n = 7). RESULTS: Horses with mild equine asthma had a significantly greater bronchoalveolar lavage mast cell percentage than healthy horses both before and after treatment. Mild equine asthma was associated with a 4.95-fold up-regulation of IL-17 (p = 0.026) and a 2.54-fold down-regulation of IL-10 (p = 0.049) compared to healthy horses. TNF-α was down-regulated in response to dexamethasone treatment in both healthy horses (3.03-fold, p = 0.023) and those with mild equine asthma (1.75-fold, p = 0.023). IL-5 was also down-regulated in horses with mild asthma (2.17-fold, p = 0.048). CONCLUSIONS: Horses with mild equine asthma have a lower concentration of IL-10 in BAL fluid than healthy controls which concurs with human asthmatics. The marked up-regulation of IL-17 in horses with mild asthma suggests these horses had a true tendency of "allergic" airway inflammation in response to environmental allergens. Dexamethasone administration exerted anti-inflammatory effects associated with down-regulation of TNF-α in all horses, and decreased levels of IL-5 mRNA expression in horses with mild equine asthma. The inhibition of the Th-2 response, without any alterations to the airway cytology, indicates that maintained exposure to environmental allergens perpetuates airway inflammation.

Assessment of two methods to determine the relative contributions of the aerobic and anaerobic energy systems in racehorses.

A prospective, randomized, controlled study was designed to determine relative aerobic and anaerobic (lactic and alactic) contributions at supramaximal exercise intensities using two different methods. Thoroughbred racehorses (n = 5) performed a maximal rate of oxygen consumption (V̇o2max) test and three supramaximal treadmill runs (105, 115, and 125% V̇o2max). Blood lactate concentration (BL) was measured at rest, every 15 s during runs, and 2, 5, 10, 20, 30, 40, 50, and 60 min postexercise. In method 1, oxygen demand was calculated for each supramaximal intensity based on the V̇o2max test, and relative aerobic and anaerobic contributions were calculated from measured V̇o2 and the accumulated oxygen deficit. In method 2, aerobic contribution was calculated using the trapezoidal method to determine V̇o2 during exercise. A monoexponential model was fitted to the postexercise V̇o2 curve. Alactic contribution was calculated using the coefficients of this model. Lactate anaerobic contribution was calculated by multiplying the peak to resting change in BL by 3. Linear mixed-effects models were used to examine the effects of exercise intensity and method (as fixed effects) on measured outcomes (P ≤ 0.05). Relative aerobic and anaerobic contributions were not different between methods (P = 0.20). Horses' mean contributions were 81.4, 77.6, and 72.5% (aerobic), and 18.5, 22.3, and 27.4% (anaerobic) at 105, 115, and 125% V̇o2max, respectively. Individual alactic anaerobic energy was not different between supramaximal exercise intensities (P = 0.43) and was negligible, contributing a mean of 0.11% of the total energy. Relative energy contributions can be calculated using measured V̇o2 and BL in situations where the exercise intensity is unknown. Understanding relative metabolic demands could help develop tailored training programs. NEW & NOTEWORTHY Relative energy contributions of horses can be calculated using measured V̇o2 and BL in situations where the exercise intensity is unknown. Horses' mean contributions were 81.4, 77.6, and 72.5% (aerobic), and 18.5, 22.3, and 27.4% (anaerobic) at 105, 115, and 125% of V̇o2max, respectively. Individual alactic capacity was unaltered between supramaximal exercise intensities and accounted for a mean contribution of 0.11% of energy use.

Upper and lower respiratory tract microbiota in horses: bacterial communities associated with health and mild asthma (inflammatory airway disease) and effects of dexamethasone.

BACKGROUND: The microbial composition of the equine respiratory tract, and differences due to mild equine asthma (also called Inflammatory Airway Disease (IAD)) have not been reported. The primary treatment for control of IAD in horses are corticosteroids. The objectives were to characterize the upper and lower respiratory tract microbiota associated with respiratory health and IAD, and to investigate the effects of dexamethasone on these bacterial communities using high throughput sequencing. RESULTS: The respiratory microbiota of horses was dominated by four major phyla, Proteobacteria (43.85%), Actinobacteria (21.63%), Firmicutes (16.82%), and Bacteroidetes (13.24%). Fifty genera had a relative abundance > 0.1%, with Sphingomonas and Pantoea being the most abundant. The upper and lower respiratory tract microbiota differed in healthy horses, with a decrease in richness in the lower airways, and 2 OTUs that differed in abundance. There was a separation between bacterial communities in the lower respiratory tract of healthy and IAD horses; 6 OTUs in the tracheal community had different abundance with disease status, with Streptococcus being increased in IAD horses. Treatment with dexamethasone had an effect on the lower respiratory tract microbiota of both heathy and IAD horses, with 8 OTUs increasing in abundance (including Streptococcus) and 1 OTU decreasing. CONCLUSIONS: The lower respiratory tract microbiota differed between healthy and IAD horses. Further research on the role of Streptococcus in IAD is warranted. Dexamethasone treatment affected the lower respiratory tract microbiota, which suggests that control of bacterial overgrowth in IAD horses treated with dexamethasone could be part of the treatment strategy.

Expression of T helper cell-associated inflammatory mediator mRNAs in cells of bronchoalveolar lavage fluid samples and oxygen concentration in arterial blood samples from healthy horses exposed to hyperbaric oxygen.

OBJECTIVE To evaluate the mRNA expression of T helper (Th)1, Th2, and Th17 cell-associated inflammatory mediators in cells of bronchoalveolar lavage fluid samples collected from healthy horses exposed to hyperbaric oxygen (HBO) and to monitor blood oxygen concentration during and following HBO therapy. ANIMALS 8 healthy horses. PROCEDURES In a randomized controlled crossover design study, each horse was exposed (beginning day 1) to 100% oxygen at a maximum of 3 atmospheres absolute (304 kPa) daily for 10 days or ambient air at atmospheric pressure in the HBO chamber for an equivalent amount of time (control). Bronchoalveolar lavage fluid samples were collected on days 0 and 10. After validation of candidate reference genes, relative mRNA expressions of various innate inflammatory, Th1 cell-derived, Th2 cell-derived (including eotaxin-2), Th17 cell-derived, and regulatory cytokines were measured by quantitative PCR assays. For 3 horses, arterial blood samples were collected for blood gas analysis during a separate HBO session. RESULTS The optimal combination of reference genes was glyceraldehyde-3-phosphate dehydrogenase, hypoxanthine ribosyltransferase, and ribosomal protein L32. Compared with day 0 findings, expression of eotaxin-2 mRNA was significantly lower (0.12-fold reduction) and the percentage of neutrophils in bronchoalveolar lavage fluid samples was significantly lower on day 10 when horses received HBO therapy. Values of Pao2 rapidly increased (> 800 mm Hg) but immediately decreased to pretreatment values when HBO sessions ended. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that HBO therapy does not increase mRNA expression of inflammatory cytokines, but reduces eotaxin-2 mRNA transcription. The Pao2 increase was transient with no cumulative effects of HBO.

FEASIBILITY FOR ULTRASOUND-GUIDED INJECTION OF THE COLLATERAL LIGAMENTS OF THE DISTAL INTERPHALANGEAL JOINT IN HORSES.

Desmitis of the collateral ligament of the distal interphalangeal joint is a cause of lameness in performance horses. The objective of this prospective, experimental, ex vivo feasibility study was to evaluate the success of ultrasound-guided injection of the collateral ligaments of the distal interphalangeal joint in the equine forelimb. Seventy-six ultrasound-guided dye injections of the collateral ligament of the distal interphalangeal joint were performed on horses' cadaver limbs. The hooves were sectioned transversely to verify the location of the dye relative to the collateral ligaments and surrounding structures. Evaluations of transverse sections were performed independently by two experienced observers. A scoring system was used to assess injection of the collateral ligament of the distal interphalangeal joint at the proximal, middle, and distal aspect over the length of the ligament. The collateral ligament was injected at any point in 97.4% of cases. The ligament was injected over the entire scored length in 43.2% of cases (32/74), over two scored length areas in 45.9% of cases (34/74), and in one area in 10.8% of cases (8/74). The distal interphalangeal joint and the common digital extensor tendon were also injected in 81.6% (62/76) and 43.4% (33/76) of the cases, respectively. Use of the ultrasound had a positive and negative predictive value of 98% and 9%, respectively. In this study, ultrasound guidance was useful for confirming injection of the collateral ligament of the distal interphalangeal joint but did not prevent injecting the distal interphalangeal joint and the common digital extensor tendon.