‘‘Vision 20/20 – Conquer Lami

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� 2010 Published by Elsevier Inc.

doi:10.1016/j.jevs.2010.01.044

FROM THEGUEST EDITOR

74

nitis by

2020’’

A Clarified Vision for the Equine Community toWork Collaboratively and Cooperatively toUnderstand, Embrace, and Achieve!

‘‘They can conquer who believe they can.’’–Virgil

The most famous horse known to the general public tohave developed laminitis may have been Barbaro, but pos-sibly the most famous racehorse, Secretariat, also died asa result of laminitis 20 years ago. To those of you whohave been attending the International Equine Conferenceon Laminitis and Diseases of the Foot (IECLDF; LaminitisConference) from the beginning, Spot Castle might beconsidered even more famous. If it had not been forSpot, and his caretakers, John K. and Marianne Castle(recipients of the 2008 AAEP George Stubbs Award, anhonor that recognizes contributions made to equine veter-inary medicine by individuals other than veterinarians) andtheir love for, commitment to, and connection with Spot,as well as their quixotic passion to do better for our equinefriends, we would very likely not be celebrating the 5th

Laminitis Conference and convening the 2nd AAEP Foun-dation Equine Laminitis Research Workshop in partner-ship with the 5th ICELDF. By continually engagingveterinarians, researchers, farriers, caretakers and thegreater equine community in a collaborative effort toadvance, expand and disseminate knowledge throughresearch and collective experiences to effectively preventand treat equine laminitis, it is hopeful that collectivelywe will move closer to our 20/20 vision of conqueringthis devastating disease by 2020.

Laminitis is not new. Beginning long before Barbaro be-came a household name, equine clinicians and researchershave been battling laminitis. This crippling disease wasrecognized and noted as early as 300 BC. In fact, Aristotleinitially described this debilitating disease as ‘‘Barley Dis-ease’’, a name presumably based upon the developmentof the disease subsequent to excessive ingestion of barley(grain). Another early documented report describinglaminitis was published in 900 AD upon the order of the

Roman emperor Constantine. The publication listedseveral credible causes of laminitis, including traveling onhard surfaces, overeating, and drinking too much coldwater when hot.

Almost from the time of recorded history, and at leastsince diseases of horses have been described and recorded,laminitis has plagued horses and created an emotional andfrequent financial toll on horses’ owners and caregivers. Itaffects horses of any breed, any size, and at any age – andmost commonly occurs in adult horses.

No horse, no matter how valuable or how well cared for,is immune to laminitis. Standardbred stallion Artsplace andhis sire Abercrombie, along with Thoroughbred championSunday Silence, and American Quarter Horse stallion ThisSnow is Royal are just a few of the legendary horses whoselives were cut short by laminitis. Although these are someof the more well-known horses that have succumbed tothe effects of laminitis, many more horses, ranging fromathletes to breeding stock to pets and companions,have been afflicted by and lost the battle with this dreadeddisease.

It is conservatively estimated that 15 percent of horses inthe United States are afflicted by laminitis during their life-times. Up to 75 percent of horses affected with laminitiseventually develop severe or chronic lameness and debilita-tion. Annual monetary losses resulting from laminitis arenot known, but estimated to be at least $13 million associ-ated with the evaluation, treatment and loss of horses aftera diagnosis of laminitis. The prevalence of laminitis amonghorses, combined with the economic and emotional costsand the incomplete understanding of the disease, all con-tribute to the high level of frustration felt by veterinarians,owners, trainers, caregivers and the general public.

Despite substantial research over the last three decadesinvestigating multiple mechanistic pathways involving theonset and development of laminitis and important discov-eries, a complete knowledge and understanding of this dis-ease is still lacking. Therefore, effective preventative andtherapeutic management strategies unfortunately remainelusive, anecdotal and empirical. A complicating factor isthat the focus of the disease process is encased within thehoof and therefore many modern technologies used inother research areas are not easily adaptable and immedi-ately applicable to effectively study this disease. Coupledwith the high cost of developing necessary technologiesrequired to increase our knowledge and understanding ofthis disease, these factors have limited the timeliness ofour advances.

Similar to heart disease, diabetes and cancer research inpeople, biomedical research addressing diseases or syn-dromes such as laminitis in animals is complex. As scien-tists, veterinary practitioners, farriers, podiatrists, ownersand caretakers we must work collectively, cohesively andcollaboratively and in a complimentary fashion to advanceour knowledge of laminitis and provide scientific and clin-ical evidence regarding the effectiveness of preventativeand therapeutic modalities.

Journal of Equine Veterinary Science � Vol 30, No 2 (2010)

FROM THE GUEST EDITOR � Vol 30, No 2 (2010) 75

Gone are the days when anecdotal and empirical treat-ments suffice; now we must make sound evidence-basedmedical decisions, which requires collecting and analyzingrelevant data through objective, unbiased observationusing standard criteria and outcome assessments. Addi-tionally, scientific data collected through controlled andblinded experimental studies needs to be critically evalu-ated. The new knowledge and technology and discoveriesultimately must be effectively disseminated to scientists,clinicians, farriers and caretakers for the desired impact.All stakeholders are in this together and must workcollectively to advance the health and well-being of horsespredisposed to and affected by laminitis.

Regardless of the field or discipline, research and discov-ery drives progress. Progress in understanding diseases ofthe equine foot, especially laminitis, requires advancedknowledge and expertise obtained through acquisition ofevidence-based medicine. Biomedical research, in particu-lar, is expensive and requires meaningful funding andpeople with bright minds and a passion for discovery. Wemust be strategic in utilizing and optimizing the limitedresources available for laminitis research, includingresearch funding, animals, tissues and samples, and person-nel. Importantly, we must be willing to share the informa-tion and knowledge gained through research and clinicalexperience, as well as being committed to working ina collaborative, cooperative and unselfish manner.

Two vital issues threaten the future of equine researchand both are directly related to funding:

(1) Financial support at academic institutions in sup-port of research infrastructure, training tomorrow’s scien-tists (stipends and fellowship), and faculty researchprograms are shockingly inadequate and unacceptablylow; and (2) Funding for conducting equine research isimmensely insufficient and extremely competitive. Theo-retically, healthy competition improves quality and leadsto better science, but when competition for a smallamount of funding becomes excessive, the individualswith a passion for research and discovery will oftenmove into other areas of scientific investigation wherefunding is more plentiful.

The AAEP Foundation and the Equine ResearchCoordination Group released a white paper titled BarbaroHighlights Need for Laminitis Research in August2006. This paper can be accessed on the Internet via thefollowing link: http://www.aaep.org/press_room.php?term=2006&id=242. One of Barbaro’s major contribu-tions was to bring attention to and raise public awarenessabout the importance and impact of laminitis on horses,the equine industry, and consequently to highlight theneed to increase research funding. Although the totalfunds raised as a result of Barbaro are unknown to the au-thor, substantial research dollars were obtained by severalorganizations and institutions as a result of his courageous

battle with and his ultimate death from postoperative com-plications, an important one being laminitis. Still, the totalfunding available for scientifically-based studies of equinediseases such as laminitis is sadly lacking.

Despite all the bad news, there are some bright spots thatdeserve mention.� Since Barbaro’s death, the Laminitis Institute was estab-

lished at Penn Vet (www.laminitisinstitute.org).� The National Thoroughbred Racing Association

(NTRA) Charities has funded at least two cycles of lam-initis research grants through the Barbaro Fund.

� A 2009 AAEP membership survey revealed that laminitisremains the highest priority for research funding andinvestigation.

� Laminitis research continues to be one of the areas offocus or priority for funding by the United StatesDepartment of Agriculture – National Research Initia-tive, Animal Health and Well-Being.

� Funding agencies such as Morris Animal Foundation,Grayson-Jockey Club Research Foundation, Inc., Amer-ican Quarter Horse Association Foundation, and theUnited States Department of Agriculture have fundedlaminitis research over the last several years. Otheragencies and organizations such as the American Associ-ation of Equine Practitioners (AAEP) and HavemeyerFoundations, and equestrian and equine health publica-tions have raised public awareness about laminitisthrough press releases, white papers, publications andthe organization and funding of laminitis research work-shops.

� The Laminitis Discovery Database is established atPenn’s Laminitis Institute, and serves as a worldwide re-source for laminitis investigators.

� This 2nd AAEP Foundation Equine Laminitis ResearchWorkshop immediately follows the 2009 IECLDF.Some 40 scientists at the workshop will immerse them-selves in laminitis research presentations, discussionsand brainstorming sessions with the objective of estab-lishing achievable goals for the near future that willmove us closer to our vision of conquering laminitis by2020.In addition to increasing funding for equine research,

steps need to be implemented to maximize existing andfuture funds for the greatest impact. This is not an easytask since there are many organizations and agencies ‘‘com-peting’’ for research dollars. The basic organizationalstructure and philosophy of some foundations andagencies dictates that they are unable or unwilling to joinforces with ‘‘outside’’ groups or pool research dollars.Some scientists argue against the approach of pooling dol-lars, therefore increasing opportunities to submit grants,albeit for smaller amounts. My view is that organizationsand foundations should consider combining laminitisresearch dollars to fund the best science with the best

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chance of a positive impact on laminitis. Together witha united mission and unwavering commitment to solvingthe mysteries and overcoming the challenges, we canprevail in ‘‘stomping out’’ laminitis.

Concerted efforts are being made through the EquineResearch Coordination Group (ERCG) to move towardcollaborative funding of equine research projects, whichmay include laminitis. The ERCG, formed several yearsago, is administered through the AAEP Foundation, andincludes many of the agencies, organizations, foundationsand institutions involved in some capacity with equine re-search. The mission of the ERCG is ‘‘To advance the healthand welfare of horses by promoting the discovery and shar-ing of new knowledge, enhancing awareness of the need fortargeted research, educating the public, expanding fund-raising opportunities, and facilitating cooperation amongfunding agencies.’’ For more information on the ERCG,please visit http://www.aaep.org/equine_research_co_group.htm.

Clinicians and scientists with an interest in laminitis havebeen convening for years to share ideas and disseminateknowledge and advances. In 2004, a group of more thanforty national and international equine researchers and cli-nicians convened in Louisville, Kentucky, at an AAEPFoundation-organized Equine Laminitis Research Meet-ing and Panel to focus on addressing key scientific issues re-garding laminitis, to share knowledge and ideas on how toattract the needed resources to effectively answer pressingquestions about this disease, and to develop reliable preven-tative and therapeutic methods. And in May 2007, a similargroup convened at a Havemeyer Equine Laminitis ResearchWorkshop to discuss progress, needs and strategies. Thesefocused research groups are extremely important for discus-sion, debating current thinking, and to foster useful andproductive collaborations on laminitis. The outcomes ofthese workshops will be the foundation for the SecondAAEP Foundation Equine Laminitis Research Workshop,and will guide and clarify the objectives to pursue in reach-ing the goal of conquering laminitis by 2020.

Progress will be made through an integrated approachand a combination of (1) well-designed observationaland epidemiological studies of naturally acquired sponta-neous laminitis; (2) well-documented experiences of clini-cians and farriers working cohesively in caring for horseswith laminitis based on objective criteria; (3) blinded andcontrolled clinical trials, including multicenter studies, in-volving horses with naturally-acquired laminitis; and (4)well-designed, scientifically sound studies using in vitrocell culture techniques, laminar tissue explants, cadavericbiomechanical studies, experimentally-induced models oflaminitis and leading-edge molecular and cellular ap-proaches. The interdisciplinary, multi-institutional and in-tercontinental collaborations that have been fostered mustcontinue in order to advance discoveries and disseminate

meaningful information that will have an impact andmake a difference in the onset and progression of laminitisand the health, well-being and lives of horses and theircaretakers.

For the sake of Barbaro and Secretariat, probably the twomost famous horses to die as a result of laminitis, all of themany laminitis-stricken horses who have passed beforethem, and the numerous horses that will continue to be af-flicted by this disease, collectively the laminitis supportcommunity must work collaboratively and cooperativelyto unravel the remaining mysteries to conquer this dreadeddisease.

Please share the message about the challenges and needsfor critical funding for laminitis research, and the vision forconquering this disease through scientific breakthroughsand clinical discoveries. Just like it takes a team to manageevery horse plagued with laminitis, it will take a team toconquer laminitis. This devoted team, effectively namedthe ‘‘Laminitis Conquerors’’, must be comprised of veter-inary practitioners/clinicians/research scientists, farriers/equine podiatrists/veterinary technicians/nursing staff,owners/caretakers and the entire equine industry workingtogether in a collaborative and cooperative manner. Likea rowing team, everyone has to be rowing in the same di-rection and synchronized to be effective. It is up to us tohelp Barbaro stomp out his and everyone’s frustration byfirmly embedding his footprints on laminitis! What morenoble and meaningful legacy could we impart to this cou-rageous horse and many others that put a name and face tolaminitis among the public worldwide?

Although a bold vision, perhaps the headline in the year2020 will read: A Vision Realized –Laminitis Conquerors’Collaborative and Cooperative Team Effort Solves DiseasePuzzle. When pursuing goals of this magnitude, it neverhurts to be forward thinking, optimistic, committed, andhaving perseverance. The goal of conquering laminitismust be envisioned to be realized, and that vision mustbe a united one!

So by the end of the 2nd AAEP Foundation Equine Lam-initis Research Workshop on the 20th anniversary of Secre-tariat’s death resulting from laminitis, our collective visionswill hopefully be even more focused into a singular 20/20vision that will keep our eyes on the goal of makingsubstantial and meaningful progress toward conqueringlaminitis by 2020.

Rustin M. Moore, DVM, PhD, DACVSChair, Department of Veterinary Clinical Sciences

Acting Director, Veterinary HospitalBud and Marilyn Jenne Professor

Department of Veterinary Clinical SciencesCollege of Veterinary Medicine

The Ohio State UniversityColumbus, OH