Continuous digital hypothermia prevents lamellar failure in the euglycaemic hyperinsulinaemic clamp model of equine laminitis.
Authors: Stokes S M, Belknap J K, Engiles J B, Stefanovski D, Bertin F R, Medina-Torres C E, Horn R, van Eps A W
Journal: Equine veterinary journal
Summary
# Editorial Summary Insulin-associated laminitis represents a significant clinical challenge, yet evidence supporting preventative interventions remains limited. Stokes and colleagues investigated whether continuous digital hypothermia—a therapeutic strategy previously demonstrated to mitigate sepsis-related laminitis—could protect against lamellar damage in the euglycaemic hyperinsulinaemic clamp model, using eight horses with one forelimb cooled throughout induction and the contralateral limb maintained at ambient temperature. Cooling proved remarkably effective: whilst all control feet exhibited severe lamellar separation (92% grade 3 histological lesions), cooled feet remained largely unaffected, with 50% graded as only mild changes and none showing structural failure; additionally, cooled sections demonstrated significantly reduced epidermal elongation and cellular proliferation markers compared to control limbs. The findings suggest digital hypothermia may interrupt the lamellar inflammatory cascade triggered by hyperinsulinaemia, potentially offering a preventative window during high-risk periods such as spring pasture exposure in susceptible horses. However, the authors appropriately caveat that cooling was initiated before clinical laminitis became apparent, leaving the practical timing and duration of therapeutic application in field conditions to be determined through further research before widespread clinical recommendation.
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Practical Takeaways
- •Digital cooling may be an effective preventive intervention for hyperinsulinaemia-related laminitis, though timing of initiation before clinical signs appear limits current clinical applicability
- •The dramatic protective effect (preventing any structural failure in cooled limbs) suggests ice therapy warrants further investigation as a therapeutic strategy in insulin-associated laminitis cases
- •Results support the biological plausibility of cryotherapy for laminitis prevention, but clinical protocols for when and how to apply cooling in practice remain to be determined
Key Findings
- •Continuous digital hypothermia prevented severe lamellar structural failure (dermo-epidermal separation) in all cooled feet while 100% of ambient temperature control feet developed grade 2-3 lesions
- •Cooled feet were 98% less likely to exhibit severe histological changes (grades 2-3) compared to ambient feet (OR: 0.02, P<0.01)
- •Histomorphometry showed significantly increased lamellar elongation and disruption in ambient feet versus cooled feet (P<0.01)
- •Cellular proliferation markers (TPX2-positive cells) were significantly elevated in ambient feet compared to cooled feet (P<0.01)