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1 Large Animal Surgery, Department of Large Animal Sciences, Clinical Institute, Royal Veterinary and Agricultural University of Copenhagen, Denmark
2 School of Veterinary Science, University of Queensland, Australia
3 Department of Large Animal Clinical Studies, Swedish University of Agricultural Sciences, Uppsala, Sweden
Corresponding author: M. B. Thoefner; e-mail: thoefner{at}stofanet.dk.
| ABSTRACT |
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Key Words: bovine laminitis lameness oligofructose
Abbreviation key: PAO = postadministration of oligofructose, PCV = packed cell volume
| INTRODUCTION |
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Analysis of clinical cases precipitated by feeding a large amount of readily fermentable carbohydrate shows that signs of laminitis are often preceded by ruminal acidosis or gastrointestinal disease (Maclean, 1966; Yeruham et al., 1999). Different experimental models have tried to mimic this situation, by the administration of substances into the rumen to cause changes in the gastrointestinal environment. Attempts to induce acute laminitis with intraruminal infusion of lactic acid were reported to be partially successful in sheep (Morrow et al., 1973) but unrewarding in cattle (Andersson, 1981). Several studies have unsuccessfully tried to induce laminitis using an alimentary carbohydrate overload model (Hyldgaard-Jensen and Simesen, 1966; Boosman et al., 1990; Momcilovic et al., 2000). Although 3 of 6 steers showed very early signs of laminitis 12 to 16 h after starch overload (Suber et al., 1979), the clinical signs defining acute laminitis were not specified and it was unclear how comparison between animals was carried out. Christmann et al. (2002) evaluated hemodynamics in the digits of anesthetized steers given a grain overload. A successful induction of acute laminitis was reported without explaining how the criteria used for a positive diagnosis relate to the clinical syndrome.
A relationship between rumen acidosis and detection of endotoxin in the rumen generated the hypothesis of endotoxin being the trigger factor for laminitis. However, endotoxin injections have not been shown to induce clinical signs of acute laminitis in cattle (Boosman et al., 1991; Ohtsuka et al., 1997). Histamine and other vasoactive amines have been suggested as causal factors of laminitis. Nilsson (1963) reported that subcutaneous injections of histamine induced acute laminitis in cattle. Takahashi and Young (1981) were partially successful in their attempts to induce clinical laminitis when grain overload was combined with histamine administration. Unsuccessful attempts to reproduce the model were later reported by Boosman (1990), leaving the role of histamine debatable.
In summary, the reports on the potential of starch to induce clinical laminitis seem conflicting, and it becomes tempting to hypothesize the involvement of other carbohydrates. The results from a recent study undertaken by Pollitt and van Eps (accepted) demonstrated that alimentary oligofructose overload consistently resulted in the development of acute laminitis in horses. Oligofructose, as fructan, is one of the most abundant nonstructural carbohydrates in several plant species including many grasses (Cairns and Longland, 1998). Plants accumulate fructan depending on the prevailing growth conditions. Stressful conditions such as high light intensity and low temperature (comparable to spring and autumn in temperate climates) can result in very high fructan concentrations (Longland and Cairns, 2000).
Therefore, the purpose of the present study was to examine the clinical response of cattle dosed with an alimentary overload of oligofructose, with particular emphasis on development of laminitis.
| MATERIALS AND METHODS |
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Data
Baseline information on the cardiovascular (heart rate, packed cell volume, and standard base excess) and gastrointestinal status (rumen and feces pH, rumen contractions, and rectal temperature) as well as signs of lameness (hoof testing, digital pulse strength, and lameness examination) were recorded before the first priming dose (at 72 h) and during the priming period (at 48 and 24 h). The clinical response was monitored at the time of administration of the main dose, and then at 6-h intervals, starting at 9 h postadministration of oligofructose (PAO), until the heifers were euthanized. Time points for observation are shown in Table 1
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All animals had catheters placed in the jugular vein before the main dose of oligofructose was given. A hand-held blood-gas analyzer (i-STAT; Sensor Devices Incorporated, Waukesha, WI) was used to monitor the resulting metabolic acidosis and degree of dehydration to enable early alleviation with supportive therapy. A pilot study showed that the i-STAT resulted in a slight underestimation of packed cell volume (PCV), and an equation (actual PCV = 0.99 x i-STAT PCV + 3.04, n = 16) was therefore used to adjust the readings. Intravenous fluid therapy was instituted if PCV increased to more than 42%. Sodium bicarbonate was administered orally or i.v. if standard base excess dropped below 8 mmol/L. Signs of lameness were identified by observing the animal standing in the box, walking or trotting in a straight line, and while the animal was turned in small circles on a hard surface. The 3 monitors (all veterinarians), blinded to previous results, recorded the clinical responses of the animals in a nonconsecutive rotation. Lameness was classified as none, mild, moderate, or severe. Mild lameness was recorded if slight lameness was seen when turning the heifers in circles or if the lameness was detectable only in the trot (e.g., head nodding or other uneven or asymmetric movement of hind or front). Moderate lameness was recorded if lameness was obvious when walking and if the animal was reluctant to walk from soft bedding to a hard concrete surface (tender feet). Severe lameness was recorded if lifting of feet was impossible or if animals only could stand for a few minutes.
In the present paper, acute laminitis is defined as a clinical disease with a rapid onset of foot pain and detectable lameness, which is seen shortly after alimentary overload of readily fermentable carbohydrate. Signs of claw inflammation (e.g., warmth and increased pulsation) may be present but no claw lesions can be identified visually (Ossent et al., 1997).
Statistical Analyses
An animal was regarded as having developed clinical laminitis if 2 consecutive positive hoof tests (positive pain reaction) were obtained 6 h apart in the same claw, and lameness was observed independently by at least 2 of the 3 monitors. The null hypothesis of no association between exposure to oligofructose and development of laminitis was examined using one-sided Fishers exact test at a 5% level of statistical significance. The effect of oligofructose on other clinical variables was compared graphically; however, observations obtained between 45 and 72 h PAO for the 2 animals euthanized at 72 h PAO were not used. Results from the 3 groups given different oligofructose dosages were not pooled so that trends in the dose-response relationship could be examined. The mean value of observations in the control group was compared with the mean value in the groups given the 3 doses of oligofructose (GraphPad Prism, version 4.00 for Windows, GraphPad Software, San Diego, CA).
The protocol was approved by the Animal Ethics Committee, The University of Queensland, and animals were inspected by the Animal Welfare Officer during the study (animal ethics approval certificate SVS/125/02/RVA/UC). The heifers were euthanized by captive bolt and exsanguination at the end of the study. A postmortem examination of the gastrointestinal tract was carried out and claw biopsies were processed for histology. Preliminary findings from histopathological examination of claw biopsies are presented in this paper. A detailed characterization will be provided in a separate publication.
| RESULTS |
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38% in all groups). The increase tended to be more pronounced and prolonged in the 2 animals receiving the high dose (Figure 3
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Four animals with high PCV received i.v. fluids, and all animals given oligofructose received 300 to 650 mL of calcium borogluconate (400 g/L, Unical C.B.G., Mavlab, Pty. Ltd., Slacks Creek, Queensland, Australia) i.v. to treat signs of ataxia. Ataxia was observed 15 or 21 h PAO and signs disappeared quickly after infusion of calcium borogluconate.
The results of hoof testing are shown in Table 1
. Five of 6 animals given oligofructose had at least 2 consecutive positive pain reactions in the same claw. All positive pain reactions were strong and were observed at 33 h PAO or later. Positive pain reactions were not observed in control animals. Palpation of digital arteries, in an attempt to detect increased pulse amplitudes during development of laminitis, appeared to be highly variable between observers and animals, and without any obvious relationship to oligofructose exposure (data not shown). Digital pulse amplitude was therefore discarded in further analyses.
Lameness was observed in animals 1, 3, 4, and 6 from 39 h PAO or later. Lame animals were distributed almost equally between the 3 dose groups: 1 of 2 heifers that received 13 g/kg, 2 of 2 that received 17 g/kg, and 1 of 2 that received 21 g/kg. Lameness was obvious on walking in animals 1, 3, and 6, whereas it was only detectable in the trot in animal 4. All lame heifers continued to display lameness at a constant level for the duration of the study. Two heifers given oligofructose showed no signs of lameness. None of the control animals displayed signs of lameness during the study.
Four of the 6 animals given oligofructose had 2 consecutive positive pain reactions in the same claw and displayed signs of lameness. These animals were therefore classified as laminitis positive. Two animals exposed to oligofructose and all 6 animals in the control group were classified as laminitis negative. Fishers exact test (one-sided) showed a significant association between oligofructose exposure and development of laminitis (P = 0.03).
The postmortem examination of the rumen showed that animals given oligofructose had a mild and diffuse red discoloration of the epithelium, confined to the ventral and cranial parts of the rumen. Mild signs of inflammation were also seen in the cecum and upper colon where lesions was more localized and appeared in stripes. No increase in intestinal wall thickness was observed. Histopathological examination of claw biopsies was carried out and preliminary results are presented in Figures 7
and 8
. In summary, clear differences were observed between the lamellar regions of treated and control animals.
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| DISCUSSION |
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A direct association between oral oligofructose administration and clinical signs of acute laminitis was demonstrated in 4 of 6 animals, whereas no animals in the control group could be classified as laminitis positive. To the best of our knowledge, this is the first time it has been possible to induce acute bovine laminitis in a high percentage of animals, using an alimentary carbohydrate overload model that parallels the clinical engorgement situation. Additionally, the clinical findings present some interesting similarities to the oligofructose model reported to cause acute laminitis in horses (Pollitt and van Eps, accepted). Oligofructose given at doses of 7.5 to 12.5 g/kg caused a transient, watery diarrhea beginning 12 to 16 h PAO that ceased by 36 to 44 h PAO, and which coincided with depression and inappetence. No gas distension of colon or cecum was reported. All horses developed metabolic acidosis, mild dehydration, and a transient fever. At 28 to 32 h PAO, all horses started to show signs of acute laminitis. Thus, despite the differences in hoof anatomy and gastrointestinal function between these 2 species, the similarities in the clinical course of the disease are striking. It therefore seems reasonable to hypothesize that pathogenesis and pathophysiology of oligofructose-induced acute laminitis is similar in both species.
The lameness displayed by 4 of 6 heifers given oligofructose was obvious at the lameness examination, but could easily be overlooked, because animals continued to stand and walk and did not interrupt their eating behavior despite the lameness. In a study of lameness perception, Whay et al. (2002) reported that farmers identified fewer than 25% of lame cows in their herd. Previous attempts to induce laminitis in cattle did not objectively define how acute laminitis was evaluated clinically (Suber et al., 1979; Andersson, 1981; Boosman et al., 1991). Whay (2002) states that in recognizing lameness it is important not to confine identification and examination only to those individuals showing severe signs. An effort to increase the sensitivity of the lameness examination was therefore sought in the present study. In preparation for objective clinical examination, animals were trained 4 wk before experimentation to accept handling without excitement. Hoof testing was carried out to detect low-grade pain in individual claws, and time intervals between clinical examinations were short. The likelihood of false-positive reactions was decreased by the use of 3 observers alternating in a rotation system, and by strictly defining the signs required for a positive classification. The successful detection of low-grade lameness in the present study suggests that the concept of subclinical laminitis (Hoblet et al., 2000), especially when used in a broader scientific context, should be used with caution. Subclinical laminitis implies that signs are below the threshold of clinical detection. Use of the more diligent examination protocol described here puts in doubt the concept of subclinical laminitis and suggests that most subclinical laminitis is in fact clinical.
Mammals do not possess enzymes to digest fructan directly, but rely on the activity of the intestinal microbiota to degrade the fructose polymers (Longland and Cairns, 2000). Fructanolytic activity has been demonstrated in bacteria isolated from the rumen as well as the equine hindgut (Kasperowicz and Michalowski, 2002; Bailey et al., 2003). The sudden availability of excess fructan, acting as a specific substrate to microorganisms, induces a selective and explosive proliferation of gram-positive bacteria. Recent results of in vitro studies, using equine cecal contents and starch or fructan as the carbohydrate source, have shown that Streptococci and Lactobacilli are the main species involved in bacterial overgrowth. Streptococcus bovis and 5 Lactobacilli spp. were identified as having the capacity to decarboxylate certain amino acids to produce vaso-active amines (Bailey et al., 2003). These results support a theory put forward by Baxter et al. (1989) that substances resulting in vasoconstriction could cause lamellar hypoxia and thereby initiate the development of laminitis. However, a second hypothesis on the pathophysiology of equine laminitis suggests that Strep. bovis exotoxins cause the uncontrolled upregulation of matrix metallo-proteinase activity, which results in enzymatic degradation of basement membrane components (Pollitt and Daradka, 1998; Mungall et al., 2001). The loss of basement membrane anchoring filaments and hemidesmosomes leads to a mechanically unstable dermo-epidermal junction. In the horse, detachment of basement membrane is thus followed by displacement of the distal phalanx in the hoof capsule.
A dramatic increase of Strep. bovis (in rumen quantities) was also noted in cattle fed large amounts of concentrates (Tajima et al., 2001). Proliferation of Strep. bovis has been recognized as responsible for excessive production of bacterial mucopolysaccharides, which increases the viscosity of rumen fluid and leads to bloat in feedlot animals (Cheng et al., 1998). In the present study, severe abdominal distension due to bloat was not observed. A few animals experienced a brief, transient, and moderate rumen distension at 9 h PAO, but this coincided with a significant intake of water. Thus, the pathophysiology of the different theories, in relation to bovine and equine laminitis, remains to be investigated. In particular, the extreme complexity of the rumen microbiota and the changes that occur during carbohydrate overload must be addressed.
| CONCLUSIONS |
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| ACKNOWLEDGEMENTS |
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Received for publication October 28, 2003.
| REFERENCES |
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