Research into laminitis, the disease that doomed Barbaro, showing great progress

Andrew van Eps was a resident at the New Bolton Center in Kennett Square when Barbaro arrived the night of the 2006 Preakness with that shattered right hind leg. He was there as  Dean Richardson did everything possible to save the colt. And he remained at the hospital on Jan 29, 2007, when the decision was made that Barbaro, suffering from acute laminitis, the No. 2 killer of horses behind colic, would be euthanized.

Van Eps, a native of Australia and a University of Queensland graduate, has spent much of his career at his alma mater. He returned to New Bolton last December to do extensive research into the causes, prevention, and treatment of laminitis, a painful and often fatal hoof disease that in its chronic form can change the structure of a horse's hoof or hooves and becomes very difficult to treat once it starts to cascade.

The doctor was already a laminitis researcher during the Barbaro case and "developed a frustration,'' he said June 28 in New Bolton's Woerner Auditorium, the same facility where Richardson first explained the extent of Barbaro's injuries 18 hours after the colt had been injured in Baltimore. There was very little research on what is called "supporting limb'' laminitis then. But van Eps and Richardson have done quite a bit of it in the intervening years, tje research funded by the Grayson Jockey Club Research Foundation, a charity that relies on donations.

The legendary Secretariat was put down in 1989 because of laminitis complications. The 1973 Triple Crown winner set a Kentucky Derby time record that still stands. One could make a pretty strong case that Barbaro's Derby performance was the best since Secretariat's.

Secretariat's Derby:

Barbaro's Derby:

Secretariat sired 1988 Preakness and Belmont Stakes winner Risen Star as well as champion Lady's Secret. Barbaro, sadly, never got the chance to become a stallion.

Asked for an update on the progress being made in search of the elusive cure for laminitis, van Eps spoke for more than nine minutes without pause.

"Research on laminitis has been my focus for almost 20 years, scarily,'' said van Eps, who graduated from veterinary school in 1999.

One of the professors at the university was Chris Pollitt, described by van Eps as a pioneer of laminitis research.

"He kind of challenged a lot of the dogma that had been around for a long time,'' van Eps said. "At that point, in the late '90s, early 2000s, we still felt like all laminitis was the same. Most people felt it was a problem with blood flow no matter if it was a sick horse, a fat pony out on pasture, or whether it was a horse like Barbaro with an injury in one leg. We all thought it was all the same mechanism and it was a low-blood-flow problem.''

According to van Eps, Pollitt "challenged that notion and I was lucky to have him as a professor.''

When Barbaro was at New Bolton, it really started to percolate that there were different forms of laminitis requiring different approaches.

At Queensland, it was determined that high levels of insulin could cause laminitis. In fact, most laminitis cases are insulin-related. The doctor explained that diabetics run out of insulin. Horses don't run out of insulin, but can continue to make too much of it.

Van Eps said that they are "getting some handle on the cellular signals'' relating to the overproduction of insulin and its effects on the hoof, and that he is working with  Jim Belknap at Ohio State on a collaborative project "looking at a drug to specifically inhibit that process.''

Bottom line, "what's come to light over the last 10 years is there are three ways they get it,'' van Eps said.

Barbaro had supporting-limb laminitis, which appears to be a low-blood-flow problem, according to van Eps. The other types are endocrinopathic (insulin-related) laminitis and sepsis-associated laminitis.

In horses such as Barbaro, it is a weight-shifting problem, so they are developing mechanisms to intervene for it. When a horse puts too much weight on one leg, it interferes with the normal blood flow to the foot and can lead to laminitis.

According to van Eps, "foot cooling'' has become a valued technique as a prevention for sick horses and treatment for laminitis once it manifests itself. The cooling device, which is very labor-intensive, can be a boot or sleeve.

"Simple solutions are not quite there yet,'' van Eps said.

New Bolton's new robotic imaging center has the potential to give researchers such as van Eps views of weight-bearing horses' feet that they have never had. If a case such as Barbaro's presented itself today, van Eps thinks new techniques in treatment would give that horse a better chance at survival.

"The biggest thing would be the tracking of limb movement,'' van Eps said. "[Barbaro] didn't look that uncomfortable, and he still developed it. Why did he develop it? I think it can be quite subtle.''

There will be no cure for laminitis because, according to van Eps, "the tissue is such an intricate tissue. … Once it gets disturbed, it can never go back. There's degrees of that. So curing it, besides transplanting a normal leg, it's probably never going to happen.''

But they are getting very close to  prevention and/or stopping its progression.

If horses are sick, cooling has an effect. In the insulin cases, there are drugs and management techniques that can be used to improve the underlying condition. In the supporting-limb cases, van Eps said, "it's always going to be a bad deal. It's so rapidly progressive. They still have an injury in the opposite leg. Prevention is always going to be the key for them. I don't see how we are ever going to be able to fix them once they've got it.''

And that is a huge part of his research.

"To prevent it from ever happening in the first place, that is the Holy Grail,'' van Eps said.