Study To Help Identify Horses At Risk For Catastrophic Injury Moves Into Third Phase

The Kentucky Equine Drug Research Council, a committee of the Kentucky Horse Racing Commission, voted Friday to grant additional funding to an ongoing study at the University of Kentucky's Gluck Equine Research Center into catastrophic injury prevention.

Read more about the science behind the study here.

Dr. Allen Page, researcher at Gluck, presented the EDRC with an update on the first two phases of the three-phase project, which the council has contributed $300,000 to so far.

The goal of the research is to ultimately develop a blood test that will help officials detect horses who may be at elevated risk of a catastrophic injury. While some research has looked at biomarkers for existing injury or disease, this study is looking “upstream” at the messenger RNA responsible for sending instructions that those markers and other proteins be made. The hope is that a horse's blood sample could show warning signs of chronic or building inflammation that is not yet detectable to an observer.

In phase one, Page and fellow researcher Dr. David Horohov gathered blood samples from racetracks in four jurisdictions taken at the time of pre-race TCO2 testing, then examined the samples of horses who ultimately suffered fatal injuries alongside competitors in the same races who did not. The team looked at 21 mRNA markers and found three which were present in different levels in injured versus non-injured horses — IGF-1, MMP-2, and IL1RN.

IGF-1 is known to play a role in bone development and repair, and it was increased in injured horses, suggesting chronic inflammation was present. Matrix metalloproteinase-2, or MMP-2, is thought to assist with tissue repair and fracture remodeling and was also elevated in injured horses. Interestingly, IL1RN is more commonly known as IRAP–a anti-inflammatory material derived from a horse's own blood and given therapeutically by veterinarians to reduce inflammation and aid in healing an injured horse. IRAP was decreased in fatally injured horses, suggesting the body's natural anti-inflammatory process had been disrupted for some reason. Horses with higher levels of IRAP were actually seven times less likely to suffer fatal injuries.

In phase two, Page reported that the team used the university's super computer network to analyze terabytes of data, looking for other significant markers. The data analysis looked at 22,000 different mRNA markers and was able to uncover three new ones which seemed to change significantly depending on a horse's injury status. He could not reveal those markers, since he is hopeful the findings will be published in a peer-reviewed journal, and such publications require key information not be divulged beforehand. He was able to say that two of those mRNA markers were encoded from different chromosomes but appear to play very similar roles in the horse's body. The third has been described in research in humans and horses, but previously the genetic marker's purpose had been unclear.

Page said a blood test looking at all six mRNA markers – the three from phase one of the project, and the three new ones – is now correct 80 percent of the time when trying to identify a horse that will have an injury. Considering that research from pathologists indicates about 90 percent of fatal musculoskeletal breakdowns show signs of chronic damage on necropsy, Page thinks that's a pretty good success rate for the blood test.

“I'm starting to become part of the camp that thinks we can identify a large portion of the horses that may be at risk for a catastrophic injury, but we may not be able to identify all of them,” said Page. “We're certainly making some headway and I'd argue that it's substantially better than anything out there that we have now to detect horses at risk for injury.”

Phase three of the project will involve 15,000 new samples pulled from horses in Southern California in an attempt to validate the work identifying the six mRNA markers. Page does not think the results should be significantly impacted by the fact they'll be coming from a different racing circuit than the phase one samples, and that the possibility the team could end up sampling the same horses multiple times will give them even better opportunities to see how inflammation may change in an individual over time.

When asked about the practical applications of the test on Friday, Page said that currently it takes about 24 to 48 hours to get results, so its use as a screening tool pre-race would need to take that into account. With time and improved testing methods however, it is possible a racetrack could someday analyze the samples more rapidly on-site.

The EDRC approved $40,000 to help fund the project's third and final phase. Industry stakeholders, including Keeneland, The Stronach Group, and the New York Racing Association have already committed to contributing to the project.

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Survey: Two-Thirds Of Vets Concerned About Injecting Horses’ Joints Too Frequently

Joint inflammation and osteoarthritis (OA) are common in athletic horses, frequently resulting in lameness, poor performance, and economic losses. Veterinarians can provide symptomatic relief from joint discomfort caused by OA via intra-articular injections using a variety of medications. Examples include corticosteroids (e.g., triamcinolone acetate, methylprednisolone acetate), hyaluronic acid, polysulfated glycosaminoglyans, and various biologic therapies, such as stem cells, platelet-rich plasma (PRP), autologous conditioned serum (ACS, interleukin-1 receptor antagonist protein, IRAP), and autologous protein solution.

 

Which medication(s) veterinarians inject into which joint and how frequently that joint can be medicated are factors ultimately determined by the veterinarian using their own clinical experience. These choices therefore rely heavily on anecdotal evidence rather than scientific guidelines. In other words, there are no hard and fast rules regarding joint injections due to the lack of head-to-head comparisons of the various treatment options.

 

To gain a deeper understanding of how veterinarians are injecting joints, a survey sanctioned by the American Association of Equine Practitioners (AAEP) was conducted in 2019. Those data were subsequently analyzed by Dr. Gustavo Zanotto from the department of large animal clinical sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University. Dr. David Frisbie from the department of clinical sciences, Collage of Veterinary Medicine and Biological Sciences, Colorado State University was co-author of the study.

 

Zanotto recently presented data garnered from that 2019 survey at the 2021 AAEP Annual Convention held in Nashville, TN.

 

In total, 407 equine practitioners participated in the survey, the majority of which worked with racehorses (Thoroughbreds, Quarter Horses) and Warmbloods. Those veterinarians had extensive (>20 years) of clinical experience from which to draw their survey answers from.

 

Here are some of the most important take-away points garnered from the survey applicable to Thoroughbred racehorses.

 

Frequency of Injection

 

Approximately two-thirds of veterinarians were concerned about treating joints too frequently with corticosteroids for fear of causing harm, presumably to the articular cartilage.

 

“About 75% of responding veterinarians said that they believed joints can be damaged by treating too frequently. Most believe you can inject a joint once only every six months, whereas 30% of practitioners say you can do it every three months,” said Zanotto.

 

Despite these beliefs/recommendations suggested by practitioners on the survey, Zanotto says, “There is no strong scientific evidence regarding minimum frequency of joint injections.”

 

Steroid Selection

 

Triamcinolone and methylprednisolone are used most often in high- and low-motion joints by equine veterinarians, respectively. Nonetheless, almost three-quarters of practitioners still feel that triamcinolone is either somewhat likely or very likely to contribute to laminitis. As a result, survey respondents reported using limited amounts of triamcinolone, both in a single joint and as a total dose per horse. Based on the survey, most practitioners reported using 5-10 mg triamcinolone in a single joint and 20-40 mg of methylprednisolone. Most practitioners use less than 40 mg of triamcinolone per horse, and about 50% used no more than 18 mg triamcinolone per horse.

 

Based on scientific evidence, however, Zanotto said, “Triamcinolone does not appear to increase the risk of laminitis in healthy horses, and a safe total body dose has not yet been established.”

 

Antibiotic (Ab)use

 

In this survey, 55.6% of veterinarians admitted to always using an antibiotic such as amikacin when injecting medication into a joint. Perhaps more disquieting was the fact that the number of veterinarians using an antibiotic when medicating a joint actually increased from a similar survey in conducted back in 2009.

 

“This increased use of antibiotics is an alarming finding because there is evidence that amikacin is toxic to cartilage cells, as well as increased concern regarding antibiotic resistance,” explained Zanotto.

 

Reasons that veterinarians cited for using antibiotics intra-articularly were poor environmental conditions and “coincident corticosteroid injections.”

 

Such statements should give us pause for two main reasons. First, Zanotto pointed out that no evidence actually exists supporting the notion that joints medicated with corticosteroids are at an increased risk of infection.

 

Second, there is no evidence that the environmental conditions in which most equine practitioners inject joints contributes to joint infections. In fact, according to Dr. Lynn Pezzanite from Colorado State University, joint infections are exceedingly rare.

 

During her presentation at the 2021 AAEP Annual Convention, Pezzanite relayed data she retrospectively collected from joint injections performed between 2014 and 2018. In total, 3,866 synovial injections were performed on 1112 horses over 1623 sessions. Of those, 643 sessions were performed in the field.

 

Pezzanite's data revealed that the risk of sepsis (infection) was similar between joints injected in the field and hospital and between joints that had or had not been treated with an antibiotic. Overall, the frequency of sepsis was 1 in 967 injections, or about 0.1%.

 

Biologic Therapies Gaining a Foothold

 

Perhaps due to equine practitioners' ever-increasing familiarity with the various commercially available biologic therapies available as well as the perceived benefits of such therapies, their use is increasing. According to the survey, IRAP is the most popular biologic therapy, followed by PRP, autologous protein solution, stem cells, then bone marrow aspirate/concentrate. Cost is a major determinant of which biologic is ultimately used.

 

In sum, despite how frequently joint injections are being performed there is still a profound lack of evidence-based guidance regarding frequency of injection and recommended doses, particularly for corticosteroids. One of the more alarming findings, however, is the rampant and unnecessary overuse of antibiotics in routine joint injections for prophylactic purposes.

Dr. Stacey Oke is a seasoned freelance writer, veterinarian, and life-long horse lover. When not researching ways for horses to live longer, healthier lives as athletes and human companions, she practices small animal medicine in New York. A busy mom of three, Stacey also finds time for running, hiking, tap dancing, and dog agility training. 

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Woodbine’s Five Furlongs With Gary Boulanger: That Time Clint Eastwood Called

Born in Edmonton, Alberta, on November 19, 1967, Gary Boulanger began his riding career in Washington State and won three straight jockey titles at Longacres in Seattle, breaking Gary Stevens' meet record with 247 wins in 1991. He also netted two riding crowns at Calder Race Course in 1994 and 1995. Boulanger returned to Canada, specifically Woodbine, in June 2000 and won 78 races, six stakes and more than $4 million in purses. He has been associated with Sovereign Award champions including Dancethruthedawn, who won the Queen's Plate and Woodbine Oaks in 2001. Boulanger's career appeared to be over following a 2005 spill at Gulfstream but after a brief stint as a trainer he made a remarkable comeback after an eight-year absence. Boulanger was the recipient of the 2017 Avelino Gomez Memorial Award for contributions to racing on and off the track. His career totals show 3,655 wins for purses over $82 million (USD).

Who is your favourite actor and why?

“Clint Eastwood. I actually got to meet him when I won a race on a horse that was named after him. When he was the mayor of Carmel at the time, I was riding at Stockton, and I rode a horse named Eastwood. The sire of the horse was named Dirty Harry, and the owners had to get permission from Paramount to name the horse that. When they named the horse Eastwood, they had to get Clint's approval. And he gave it. The horse was an Appaloosa. The race was a Derby, and you had to qualify for it. I get this phone call in the jocks' room and the voice says, 'Are you riding a horse named Eastwood tomorrow?' I said that I was and the person says, 'Do you think you can win?' I told him that I liked the horse a lot and thought I had a good shot. 'Did you know the horse was named after me?' I thought it was a joke. I asked, 'Are you Clint Eastwood?' And he said that he was and wanted to know if he should come. I thought someone was punking me, but he ends up showing up at the track, coming to the jocks' room. So, I got to meet him, shake his hand and have a quick chat. The horse won, and he came to the winner's circle. I had always liked him as an actor, so it's cool to have that connection.”    

Design your own jockey silks.

“They would be blue with silver or black trim. The logo would be a circle, either a black or silver ball. Blue is my favourite colour.”

If you had to write a book about your life, what would it be called?

“I think I'd go with The Comeback Kid. I had to deal with a lot of ups and downs in my career, some life-threatening injuries and other serious ones too. So, I think that title would be appropriate.”

Most embarrassing moment as a jockey?

“I'm pretty hardcore, so it's tough to think of a particular moment. I used to be really shy, just talking to people was tough. I think if I was to look at something embarrassing, it would be learning about public speaking. When I first started doing well, I was in Seattle, and when I would do interviews, I'd turn red. I was really shy and not forward. That was my biggest embarrassment, that I was so nervous around people early on in my career. The Clerk of Scales in Seattle, his son worked for Boeing. He prepared CEOs for presentations. He told me that I had to get used to speaking in public, so I went to his house for a BBQ and met him. He gave me a simple exercise. He said to go to a stoplight, stop, look left, look right, and the first person I see, stare at them until they look at you, and when they look at you, don't turn away and smile. A big fear is when people look at you, that you turn away and break that eye contact. He said that when I can learn to do that, it can help you move on to the next step. And it did help me.”

How are your karaoke talents?

“I sing a lot of karaoke songs. I've sung some crazy ones. George Strait is my favourite artist and I Cross My Heart is my top song. As for my singing voice, I was always the one who didn't care about getting up there and singing first. [Former jockey] Shane Sellers is one of my best friends and he actually cut an album. He was hardcore karaoke… he had a whole sound system in his basement. He didn't do any voice training, but he has a good voice. The thing is, he never wanted to go up first for karaoke. So, I'd go up first. I broke the ice. I'd walk in there and just step up to the mic. Shane would go up there and sound like Pavarotti compared to me, so I'd like to get my songs out of the way first.”

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Hong Kong Racing Study Guide: Don’t Sleep On California Spangle, Even With A Step Up In Class

Not only will the blazing-fast California Spangle stretch out beyond 1,200 meters for the first time in the Hong Kong Classic Mile when he tries 1,600 meters but it will be his first start against stakes company. It seems to be a lot to ask but so far, all he has done is provide answers.

California Spangle began his career on June 13 last year in a Griffin race going five furlongs at Sha Tin. After an awkward start, he quickly seized command in the first 400 meters and streaked down the straight of the 1,000-meter sprint. An easy winner by a length, his time of 55.33 seconds was a class record for the distance. Back on July 4 against the same class but stretched out to 1200 meters, he romped by 2 ¼ lengths in 1:08.47 seconds with his last 400 meters in 22.64. Did I mention he carried 133 pounds?

So, after his summer break, Tony Cruz brought him out in a class 3 handicap going 1,200 meters on Oct. 24. From post 12, he was used hard to get over to the inside and ran his first 400 meters in 23.00. While that might not seem fast at first glance, remember that the races are automatically timed and there is not a run-up to a timing pole like we have. Twenty-three flat is the fastest first 400 meters run this year in 1,200-meter races at Sha Tin and California Spangle paid the price in the final yards when Rock Ya Heart nailed him on the wire.

He only picked up one pound off the loss and even from post 13, he came back four weeks later and won easily. With his rating now 82, Cruz moved him up to class 2 where he got in with a feathery 116 pounds. After setting a much slower pace, Fantastic Way put a nose in front but California Spangle kicked back in and drew off to win by a length while covering his last 400 meters in a blistering 22.35 seconds.

Carrying 124 pounds off that win, Tony Cruz kept him in class 2 at 1,200 meters and did not look the gift horse in the mouth. Even though it was the easiest of wins, he showed more gears in this effort as Zac Purton used him to make the lead, got him to switch off, went to the whip in the homestretch, then eased him up nearing the wire. His final time of 1:08.34 seconds was his fastest yet.

Now, he will try to negotiate another 400 meters down the long backstretch at Sha Tin. But it is his blazing speed that gives me confidence that he will be able to do it. The Classic Mile has big implications for the field. The purse of HK$12,000,000 is five times more than any of them have raced for. Knowing what California Spangle brings to the table, I'm not sure how many will wish to sacrifice their chances by engaging in a pace duel.

When I watch the replays of California Spangle's races, I see a fast horse. I do not see a headstrong horse. Once he gets away from the starting gate, it is his cruising speed that dominates. One-turn middle-distance races are often dominated by the horse with the best cruising speed. Run at level weights carrying 126 pounds, the Classic Mile should be right up his alley.

California Spangle's pedigree is another reason to think he can get the distance. Starspangledbanner was a group-one stakes winner in Australia going 5 ½ furlongs but upset the Caulfield Guineas (G1) at 12-1 going a mile over So You Think and Denman.

Brought to Europe and switched to Aidan O'Brien, he beat 23 others in the Golden Jubilee Stakes (G1) then came back to win the July Cup (G1); both at six furlongs. After his first stud career failed to get enough mares in foal, he came back two years later but could only finish second in a group three sprint at the Curragh.

Yes, he mostly sires sprinters but California Spangle's dam is by High Chaparral who won the 1 ½-mile Epsom Derby (G1), Irish Derby (G1) and back-to-back runnings of the Breeders' Cup Turf (G1). He has sired numerous group stakes winners going long including a winner of the two-mile Melbourne Cup (G1).

So California Spangle has the genetic ability to get the distance of the Classic Mile. And he is trained by Tony Cruz who has masterfully prepped him for the 1600 meters with four, 1200 meter races in around 100 days. If he can't win the Hong Kong Classic Mile, it won't be from not being fit enough.

 

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