Equine metabolic syndrome

Equine metabolic syndrome (EMS), is an endocrinopathy affecting horses and ponies. It is of primary concern due to its link to obesity, insulin resistance, and subsequent laminitis. There are some similarities in clinical signs between EMS and pituitary pars intermedia dysfunction, also known as PPID or Cushing's disease, and some equines may develop both, but they are not the same condition, having different causes and different treatment. Equine metabolic syndrome (EMS), is an endocrinopathy affecting horses and ponies. It is of primary concern due to its link to obesity, insulin resistance, and subsequent laminitis. There are some similarities in clinical signs between EMS and pituitary pars intermedia dysfunction, also known as PPID or Cushing's disease, and some equines may develop both, but they are not the same condition, having different causes and different treatment. The cells of adipose (fat) tissue synthesizes hormones known as adipokines. In humans, dysfunction of adipose tissue, even in cases without obesity, has been associated with the development of insulin resistance, hypertension, systemic inflammation, and increased risk of blood clots (thrombosis). The inflammation produced by these hormones are thought to inflame adipose tissue, leading to the production of more adipokines and perpetuation of the cycle, and a constant low-level, pro-inflammatory state. Although it is suspected that a similar mechanism occurs in horses, further research is needed. Insulin dysregulation is commonly seen in horses with EMS, and is associated with obesity. This is similar to type II diabetes in humans, where the action of insulin is impaired, despite often elevated concentrations. It is of interest primarily because of its link to laminitis. Horses with EMS will have an increased insulin response after they are given oral sugars, which will cause a subsequent rise in blood insulin levels, or hyperinsulinemia. Hyperinsulinemia results in decreased tissue sensitivity to insulin, or insulin resistance, especially by the skeletal muscle, liver and adipose tissue. Tissue insulin resistance causes increased insulin secretion, which perpetuates the cycle. There does appear to be a strong link between decreased insulin sensitivity in obese animals; however, it is unknown which syndrome is the cause and which is the result. It is possible adipokines and cytokines made in adipose tissue down-regulate insulin pathways. It is also possible that IR occurs when adipocytes are overwhelmed, leading to the accumulation of lipid within other tissues. When certain tissues that are sensitive to insulin, such as skeletal muscle, develop triglyceride deposits, cellular functions are altered, one of which is insulin signaling. EMS is also implicated in the development of laminitis. Prolonged IV insulin administration can induce laminitis, possibly due to its effects on blood flow to the foot, changes of glucose metabolism and secondary matrix metalloproteinase activation, or altered cell function within the foot. However, recent research suggests that the situation is more complex, in that 'compensated insulin resistance is essentially physiological and health sustaining', and only when this compensatory mechanism fails does laminitis ensue. - this may support the argument that EMS is an evolved survival trait. Ponies and horse breeds that evolved in relatively harsh environments with only sparse grass, the proverbial 'easy keeper,' tend to be more prone to EMS and insulin resistance. This possibly occurred as a survival mechanism, where the animal would lay down fat during plentiful times, such as the spring and summer, and maintain their weight more easily during the harsh, cold seasons. EMS appears to be more common in Welsh, Dartmoor, and Shetland ponies, Morgans, Paso Finos, Saddlebreds, Spanish Mustangs, and Warmbloods; and may also been seen in Quarter Horses and Tennessee Walking Horses, although is rarer in breeds such as the Thoroughbred and Standardbred. Most horses are 5–15 years of age when they develop laminitis that can be attributed to EMS. EMS horses tend to become obese very easily, depositing fat in the crest, shoulders, loin, above the eyes, around the tail head, and the mammary glands or prepuce, even when the rest of the body appears to be in normal condition. Some horses may have regional adiposity, and others may even appear normal weight, so obesity is not a definitive clinical sign of a horse with EMS. Horses will be insulin resistant (IR), and may have hyperinsulinemia, have abnormal blood glucose, or abnormal insulin responses to glucose. IR predisposes the animal to laminitis, and horses with EMS may have had previous episodes in their history. Other signs suggesting EMS include elevated blood triglyceride levels and leptin levels, hypertension, and reproductive changes in mares (an increased diestrus period, and a lack of anestrus). Horses also occasionally show anemia and elevated Gamma-glutamyl transpeptidase (GGT) levels. EMS shares similarities to pituitary pars intermedia dysfunction (also known as equine Cushing's disease), which also causes regional adiposity, laminitis, and sometimes insulin resistance. Treatment and management differ between the conditions, making it important to distinguish between the two. However, both diseases may occur simultaneously; horses with EMS may develop PPID.