“Vision 20/20 – Conquer Laminitis by 2020”

A Clarified Vision for the Equine Community to Work Collaboratively and Cooperatively to Understand, Embrace, and Achieve!

“They can conquer who believe they can.”

--Virgil

The most famous horse known to the general public to have developed laminitis may have been Barbaro, but possibly the most famous racehorse, Secretariat, also died as a result of laminitis 20 years ago. To those of you who have been attending the International Equine Conference on Laminitis and Diseases of the Foot (IECLDF; Laminitis Conference) from the beginning, Spot Castle might be considered even more famous. If it had not been for Spot, and his caretakers, John K. and Marianne Castle (recipients of the 2008 AAEP George Stubbs Award, an honor that recognizes contributions made to equine veterinary medicine by individuals other than veterinarians) and their love for, commitment to, and connection with Spot, as well as their quixotic passion to do better for our equine friends, we would very likely not be celebrating the 5th Laminitis Conference and convening the 2nd AAEP Foundation Equine Laminitis Research Workshop in partnership with the 5th ICELDF. By continually engaging veterinarians, researchers, farriers, caretakers and the greater equine community in a collaborative effort to advance, expand and disseminate knowledge through research and collective experiences to effectively prevent and treat equine laminitis, it is hopeful that collectively we will move closer to our 20/20 vision of conquering this devastating disease by 2020.

Laminitis is not new. Beginning long before Barbaro became a household name, equine clinicians and researchers have been battling laminitis. This crippling disease was recognized and noted as early as 300 BC. In fact, Aristotle initially described this debilitating disease as “Barley Disease”, a name presumably based upon the development of the disease subsequent to excessive ingestion of barley (grain). Another early documented report describing laminitis was published in 900 AD upon the order of the Roman emperor Constantine. The publication listed several credible causes of laminitis, including traveling on hard surfaces, overeating, and drinking too much cold water when hot.

Almost from the time of recorded history, and at least since diseases of horses have been described and recorded, laminitis has plagued horses and created an emotional and frequent financial toll on horses' owners and caregivers. It affects horses of any breed, any size, and at any age – and most commonly occurs in adult horses.

No horse, no matter how valuable or how well cared for, is immune to laminitis. Standardbred stallion Artsplace and his sire Abercrombie, along with Thoroughbred champion Sunday Silence, and American Quarter Horse stallion This Snow is Royal are just a few of the legendary horses whose lives were cut short by laminitis. Although these are some of the more well-known horses that have succumbed to the effects of laminitis, many more horses, ranging from athletes to breeding stock to pets and companions, have been afflicted by and lost the battle with this dreaded disease.

It is conservatively estimated that 15 percent of horses in the United States are afflicted by laminitis during their lifetimes. Up to 75 percent of horses affected with laminitis eventually develop severe or chronic lameness and debilitation. Annual monetary losses resulting from laminitis are not known, but estimated to be at least $13 million associated with the evaluation, treatment and loss of horses after a diagnosis of laminitis. The prevalence of laminitis among horses, combined with the economic and emotional costs and the incomplete understanding of the disease, all contribute to the high level of frustration felt by veterinarians, owners, trainers, caregivers and the general public.

Despite substantial research over the last three decades investigating multiple mechanistic pathways involving the onset and development of laminitis and important discoveries, a complete knowledge and understanding of this disease is still lacking. Therefore, effective preventative and therapeutic management strategies unfortunately remain elusive, anecdotal and empirical. A complicating factor is that the focus of the disease process is encased within the hoof and therefore many modern technologies used in other research areas are not easily adaptable and immediately applicable to effectively study this disease. Coupled with the high cost of developing necessary technologies required to increase our knowledge and understanding of this disease, these factors have limited the timeliness of our advances.

Similar to heart disease, diabetes and cancer research in people, biomedical research addressing diseases or syndromes such as laminitis in animals is complex. As scientists, veterinary practitioners, farriers, podiatrists, owners and caretakers we must work collectively, cohesively and collaboratively and in a complimentary fashion to advance our knowledge of laminitis and provide scientific and clinical evidence regarding the effectiveness of preventative and therapeutic modalities.

Gone are the days when anecdotal and empirical treatments suffice; now we must make sound evidence-based medical decisions, which requires collecting and analyzing relevant data through objective, unbiased observation using standard criteria and outcome assessments. Additionally, scientific data collected through controlled and blinded experimental studies needs to be critically evaluated. The new knowledge and technology and discoveries ultimately must be effectively disseminated to scientists, clinicians, farriers and caretakers for the desired impact. All stakeholders are in this together and must work collectively to advance the health and well-being of horses predisposed to and affected by laminitis.

Regardless of the field or discipline, research and discovery drives progress. Progress in understanding diseases of the equine foot, especially laminitis, requires advanced knowledge and expertise obtained through acquisition of evidence-based medicine. Biomedical research, in particular, is expensive and requires meaningful funding and people with bright minds and a passion for discovery. We must be strategic in utilizing and optimizing the limited resources available for laminitis research, including research funding, animals, tissues and samples, and personnel. Importantly, we must be willing to share the information and knowledge gained through research and clinical experience, as well as being committed to working in a collaborative, cooperative and unselfish manner.

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

(1) Financial support at academic institutions in support of research infrastructure, training tomorrow's scientists (stipends and fellowship), and faculty research programs are shockingly inadequate and unacceptably low; and (2) Funding for conducting equine research is immensely insufficient and extremely competitive. Theoretically, healthy competition improves quality and leads to better science, but when competition for a small amount of funding becomes excessive, the individuals with a passion for research and discovery will often move into other areas of scientific investigation where funding is more plentiful.

The AAEP Foundation and the Equine Research Coordination Group released a white paper titled Barbaro Highlights Need for Laminitis Research in August 2006. This paper can be accessed on the Internet via the following link: http://www.aaep.org/press_room.php?term=2006&id=242. One of Barbaro's major contributions was to bring attention to and raise public awareness about the importance and impact of laminitis on horses, the equine industry, and consequently to highlight the need to increase research funding. Although the total funds raised as a result of Barbaro are unknown to the author, substantial research dollars were obtained by several organizations and institutions as a result of his courageous battle with and his ultimate death from postoperative complications, an important one being laminitis. Still, the total funding available for scientifically-based studies of equine diseases such as laminitis is sadly lacking.

Despite all the bad news, there are some bright spots that deserve mention.

In addition to increasing funding for equine research, steps need to be implemented to maximize existing and future funds for the greatest impact. This is not an easy task since there are many organizations and agencies “competing” for research dollars. The basic organizational structure and philosophy of some foundations and agencies dictates that they are unable or unwilling to join forces with “outside” groups or pool research dollars. Some scientists argue against the approach of pooling dollars, therefore increasing opportunities to submit grants, albeit for smaller amounts. My view is that organizations and foundations should consider combining laminitis research dollars to fund the best science with the best chance of a positive impact on laminitis. Together with a united mission and unwavering commitment to solving the mysteries and overcoming the challenges, we can prevail in “stomping out” laminitis.

Concerted efforts are being made through the Equine Research Coordination Group (ERCG) to move toward collaborative funding of equine research projects, which may include laminitis. The ERCG, formed several years ago, is administered through the AAEP Foundation, and includes many of the agencies, organizations, foundations and institutions involved in some capacity with equine research. The mission of the ERCG is “To advance the health and welfare of horses by promoting the discovery and sharing of new knowledge, enhancing awareness of the need for targeted research, educating the public, expanding fundraising opportunities, and facilitating cooperation among funding 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 have been convening for years to share ideas and disseminate knowledge and advances. In 2004, a group of more than forty national and international equine researchers and clinicians convened in Louisville, Kentucky, at an AAEP Foundation-organized Equine Laminitis Research Meeting and Panel to focus on addressing key scientific issues regarding laminitis, to share knowledge and ideas on how to attract the needed resources to effectively answer pressing questions about this disease, and to develop reliable preventative and therapeutic methods. And in May 2007, a similar group convened at a Havemeyer Equine Laminitis Research Workshop to discuss progress, needs and strategies. These focused research groups are extremely important for discussion, debating current thinking, and to foster useful and productive collaborations on laminitis. The outcomes of these workshops will be the foundation for the Second AAEP Foundation Equine Laminitis Research Workshop, and will guide and clarify the objectives to pursue in reaching the goal of conquering laminitis by 2020.

Progress will be made through an integrated approach and a combination of (1) well-designed observational and epidemiological studies of naturally acquired spontaneous laminitis; (2) well-documented experiences of clinicians and farriers working cohesively in caring for horses with laminitis based on objective criteria; (3) blinded and controlled clinical trials, including multicenter studies, involving horses with naturally-acquired laminitis; and (4) well-designed, scientifically sound studies using in vitro cell culture techniques, laminar tissue explants, cadaveric biomechanical studies, experimentally-induced models of laminitis and leading-edge molecular and cellular approaches. The interdisciplinary, multi-institutional and intercontinental collaborations that have been fostered must continue in order to advance discoveries and disseminate meaningful information that will have an impact and make a difference in the onset and progression of laminitis and the health, well-being and lives of horses and their caretakers.

For the sake of Barbaro and Secretariat, probably the two most famous horses to die as a result of laminitis, all of the many laminitis-stricken horses who have passed before them, and the numerous horses that will continue to be afflicted by this disease, collectively the laminitis support community must work collaboratively and cooperatively to unravel the remaining mysteries to conquer this dreaded disease.

Please share the message about the challenges and needs for critical funding for laminitis research, and the vision for conquering this disease through scientific breakthroughs and clinical discoveries. Just like it takes a team to manage every horse plagued with laminitis, it will take a team to conquer laminitis. This devoted team, effectively named the “Laminitis Conquerors”, must be comprised of veterinary practitioners/clinicians/research scientists, farriers/equine podiatrists/veterinary technicians/nursing staff, owners/caretakers and the entire equine industry working together in a collaborative and cooperative manner. Like a rowing team, everyone has to be rowing in the same direction and synchronized to be effective. It is up to us to help Barbaro stomp out his and everyone's frustration by firmly embedding his footprints on laminitis! What more noble and meaningful legacy could we impart to this courageous horse and many others that put a name and face to laminitis among the public worldwide?

Although a bold vision, perhaps the headline in the year 2020 will read: A Vision Realized –Laminitis Conquerors' Collaborative and Cooperative Team Effort Solves Disease Puzzle. When pursuing goals of this magnitude, it never hurts to be forward thinking, optimistic, committed, and having perseverance. The goal of conquering laminitis must be envisioned to be realized, and that vision must be a united one!

So by the end of the 2nd AAEP Foundation Equine Laminitis Research Workshop on the 20th anniversary of Secretariat's death resulting from laminitis, our collective visions will hopefully be even more focused into a singular 20/20 vision that will keep our eyes on the goal of making substantial and meaningful progress toward conquering laminitis by 2020.