EMS, PPID Focus of Second Equine Endocrinology Summit
Equine endocrinology researchers gathered in Boston, Mass., Sept. 7-8, for the second Equine Endocrinology Summit, where major topics of discussion included equine metabolic syndrome (EMS) and pituitary pars intermedia disorder (PPID, or equine Cushing's disease).
TheHorse.com caught up with summit organizer Nicholas Frank, DVM, PhD, Dipl. ACVIM, professor of large animal internal medicine and chair of the department of clinical sciences at the Tufts University Cummings School of Veterinary Medicine, in North Grafton, Mass., to hear about highlights from the two-day conference.
On Sept. 7, Ray Geor, BVSc, PhD, Dipl. ACVIM, professor and chairman of Large Animal Clinical Sciences at the College of Veterinary Medicine at Michigan State University, presented the day's keynote lecture, "Equine Metabolic Syndrome in 2012," before researchers presented relevant abstracts and had a roundtable discussion.
"The first day was dedicated to equine metabolic syndrome," Frank said. "The goal of the meeting was to really review where we are now, in 2012, 10 years after the first description of EMS."
Frank said the American College of Veterinary Medicine consensus statement on equine metabolic disease--which he; Geor; Simon R. Bailey, BVMS, PhD; Andy Durham, BSc, BVSc, CertEP, DEIM, Dipl. ECEIM, MRCVS; and Philip J. Johnson, BVSc (Hons), MS, Dipl. ACVIM, ECEIM, MRCVS, wrote in 2010--went under the microscope. The goal was to "update (the statement to reflect) where we are and what the new information is in that area," he said.
On the second day the focus switched back to PPID, the main topic of the 2011 summit. The keynote presentation on Sept. 8 reviewed the results of a research study carried out before Prascend, the FDA-approved pergolide formulation, became available last year. Dianne McFarlane, DVM, PhD, Dipl. ACVIM; Hal Schott II, DVM, PhD, Dipl. ACVIM; and Frank Andrews, DVM, MS, Dipl. ACVIM, co-presented the study review. Further abstract presentations and roundtable discussions completed the summit.
The conference had several important outcomes, Frank said. First, he explained, "We developed some guidelines to give researchers ... an idea of what would be an appropriate approach to studying EMS and the different tests that we would recommend, and the different considerations that we'd ask them to look at if they're going to submit a manuscript on the subject of EMS."
For example, he said, simply identifying and describing the horse breeds affected. "We are now seeing some differences in insulin sensitivity among different breeds, and we'd really want to know what the breed of horse is. It's probably not going to be acceptable anymore to say grade horses or mixed breed horses. We need to know whether those are predominantly Quarter Horses or predominantly Tennessee Walking Horses."
Additionally, attendees concluded that in terms of EMS diagnosis, the oral sugar test appears to provide veterinarians with the most information with which to make a diagnosis.
"The oral sugar test is going to give you that information that's going to go beyond what a fasting insulin concentration is going to say," he explained. "We're interested in how the horse is reacting to the carbohydrates it's getting in the diet. To know that, we have to do more than just a resting blood sample. We have to challenge the horse to ... see what its responses are to sugar in the diet.
"On the PPID side of things, our conclusions were that it's relatively easy to diagnose advanced PPID, but we really have to focus our efforts on detecting early PPID," he continued. "I think the veterinary community and horse community (are) really pushing to get (a PPID diagnosis) as early as possible rather than waiting for the horse to become quite advanced in the disease before instituting proper care and treatment."
In addition to EMS and PPID, Frank said there were some brief discussions about the debilitating hoof disease laminitis. "It wasn't a laminitis meeting but ... when it comes to endocrinopathic laminitis, our interest definitely extends to that because that's often one of the most dramatic consequences of not diagnosing an endocrinopathic disorder properly. If we know (there is a) connection between endocrine disorders and laminitis, it's our responsibility to diagnose the disorders before laminitis arrives rather than waiting for laminitis to drive the diagnostics."
Frank stressed that "the veterinary community is really pushing hard towards the prevention of laminitis, recognizing that it's a disease that's much better prevented than treated." He said there would likely be continued discussion of endocrinopathic laminitis at future endocrinology summits.
Finally, attendees discussed the value of keeping open lines of communication between the laboratories running the assays and the researchers evaluating the data.
"I think we need to maintain a good connection between this group of specialists and those that are providing the results and interpreting the results when samples are sent in," he explained. "That's an ongoing effort to really improve communication and make sure ... people are making good use of it."
Frank said there was some initial concern about whether enough research was ongoing to validate annual conferences; however, "at this point in time an annual meeting is completely acceptable because there's so much work going on. I think that's where the excitement in this group comes from: This is an area of active research with interest from the public and from the scientific community, as well. It's a very healthy and lively organization at the moment because we've got so much going on.
"I think we'll be getting together again next year," Frank laughed. "I think one challenge is to keep incorporating other aspects of equine endocrinology as well. Obviously these aren't the only issues that affect horses, but with EMS and PPID being so common, in all likelihood the meetings will continue to focus on those two major disorders, but still continue the discussion (on other topics)."
Disclaimer: Seek the advice of a qualified veterinarian before proceeding with any diagnosis, treatment, or therapy.
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