Can we use biomarkers to predict catastrophic racing injuries in thoroughbreds?

Promising developments in quest to prevent catastrophic racehorse injuries

Promising developments in quest to prevent catastrophic racehorse injuriesUniversity of Kentucky study shows association between mRNA biomarkers and catastrophic injuries in Thoroughbred racehorses—a positive step forward in the development of a pre…

University of Kentucky study shows association between mRNA biomarkers and catastrophic injuries in Thoroughbred racehorses—a positive step forward in the development of a pre-race screening tool.

By Holly Weimers

Catastrophic injuries in Thoroughbred racehorses is a top-of-mind concern for the global racing industry and its fans. That sentiment is shared by researchers at the University of Kentucky and their collaborators, who are working to learn more about changes happening at a cellular level that might indicate an injury is lurking before it becomes career or life ending. 

Could it be possible to identify an early marker or signal in horses at risk of catastrophic injury, allowing for intervention before those injuries happen? And, if so, might this type of detection system be one that could be implemented cost effectively on a large scale?

According to Allen Page, DVM, PhD, staff scientist and veterinarian at UK’s Gluck Equine Research Center, the short answer to both questions is that it looks promising. 

To date, attempts to identify useful biomarkers for early injury detection have been largely unsuccessful. However, the use of a different biomarker technology, which quantifies messenger RNA (mRNA), was able to identify 76% of those horses at risk for a catastrophic injury.  

An abstract of this research was recently presented at the American Association of Equine Practitioners’ annual meeting in December 2020 and the full study published January 12 in the Equine Veterinary Journal (https://beva.onlinelibrary.wiley.com/journal/20423306). In this initial research—which looked at 21 different mRNA markers selected for their roles in encoding proteins associated with inflammation, bone repair and remodeling, tissue repair and general response to injury—three markers showed a large difference in mRNA levels between injured and non-injured horses.

For almost four years, Page and his University of Kentucky colleagues have been analyzing blood samples from almost 700 Thoroughbred racehorses. The samples, collected by participating racing jurisdictions from across the United States, have come from both catastrophically injured and non-injured horses in a quest to better understand changes that might be happening at the mRNA level and if there are any red flags which consistently differentiate horses that suffer a catastrophic injury.

According to Page, the ultimate hope is to develop a screening tool that can be used pre-race to identify horses at increased risk for injury. The results of this study, which was entirely funded by the Kentucky Horse Racing Commission’s Equine Drug Research Council, suggest that analysis of messenger RNA expression could be an economical, effective and non-invasive way to identify individual racehorses at risk for catastrophic injury.

Joining Page in the research from UK’s Gluck Center are Emma Adam, BVetMed, PhD, DACVIM, DACVS, assistant professor, research and industry liaison, and David Horohov, PhD, chair of the Department of Veterinary Science, director of the Gluck Center and Jes E. and Clementine M. Schlaikjer Endowed Chair.

Previous research has shown that many catastrophic injuries occur in limbs with underlying and pre-existing damage, leading to the theory that these injuries occur when damage accumulation exceeds the healing capacity of the affected bones over time. Since many of these injuries have underlying damage, it is likely that there are molecular markers of this that can be detected prior to an injury.

The identification of protein biomarkers for these types of injuries has been explored in previous research, albeit with limited success. The focus of this project, measuring messenger RNA, had not yet been explored, however. The overall objective was to determine if horses that had experienced a catastrophic injury during racing would show increased inflammatory mRNA expression at the time of their injury when compared to similar horses who were not injured.

The genetic acronyms: A primer on DNA, RNA, mRNA and PCR

This research leverages advances made in genetics during the last several decades, both in a greater understanding of the field as well as in applying that knowledge to specific issues facing the equine industry, including catastrophic breakdown in racehorses.

The genetic code of life is made up of genes and regulatory elements encoded by DNA, or deoxyribonucleic acid, which is found in the nucleus of cells in all living organisms. It is arranged in a double helix structure, similar to a twisted ladder. The rungs of that ladder are nucleotide base pairs, and the ordering of those base pairs results in the specific genetic code called a gene. The genetic code in the genes and the DNA tell the body how to make proteins. 

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RNA (ribonucleic acid) is created by RNA polymerases, which read a section of DNA and convert it into a single strand of RNA in a process called transcription. While all types of RNA are involved in building proteins, mRNA is the one that actually acts as the messenger because it is the one with the instructions for the protein, which is created via a process called translation. In translation, mRNA bonds with a ribosome, which will read the mRNA’s sequence. The ribosome then uses the mRNA sequence as a blueprint in determining which amino acids are needed and in what order. Amino acids function as the building blocks of protein (initially referred to as a polypeptide). Messenger RNA sequences are read as a triplet code where three nucleotides dictate a specific amino acid.  After the entire polypeptide chain has been created and released by the ribosome, it will undergo folding based on interactions between the amino acids and become a fully functioning protein. 

While looking at inflammation often involves measuring proteins, Page and his collaborators opted to focus on mRNA due to the limited availability of reagents available to measure horse proteins and concerns about how limited the scope of that research focus would be. Focusing on mRNA expression, however, is not without issues. 

According to Page, mRNA can be extremely difficult to work with. “A normal blood sample from a horse requires a collection tube that every veterinarian has with them. Unfortunately, we cannot use those tubes because mRNA is rapidly broken down once cells in tubes begin to die. Luckily, there are commercially-available blood tubes that are designed solely for the collection of mRNA,” he said.

“One of the early concerns people had about this project when we talked with them was whether we were going to try to link catastrophic injuries to the presence or absence of certain genes and familial lines. Not only was that not a goal of the study, [but] the samples we obtain make that impossible,” Page said. “Likewise for testing study samples for performance enhancing drugs. The tubes do an excellent job of stabilizing mRNA at the expense of everything else in the blood sample.”

In order to examine mRNA levels, the project relied heavily on the ability to amplify protein-encoding genes using a technique called the Polymerase Chain Reaction (PCR). By using a variety of techniques, samples from the project were first converted back to DNA, which is significantly more stable than mRNA, and then quantified using a specialized machine that is able to determine the relative amount of mRNA initially present in the individual samples. While it is easy to take for granted the abilities of PCR, this Nobel Prize winning discovery has forever changed the face of science and has enabled countless advances in diagnostic testing, including those used in this study.

The research into mRNA biomarkers….

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HBLB Research on Injuries in Flat Racing: Nature versus Nurture

HBLB Research on Injuries in Flat Racing: Nature versus NurtureNote: This research for this article, reprinted from European Trainer, was performed over a 14-year period in Great Britain and therefore only takes into account racing over turf and all…

By Kristien Verheyen & Sarah Rosanowski

Musculoskeletal injuries are an inherent risk of horseracing, and they are the primary cause of thoroughbreds failing to train and race, or even retiring altogether. In addition to the evident equine welfare concerns, racehorse injuries also have economic consequences and impact on jockey safety. The industry remains committed to investigating causes of injury and associated risk factors, which can inform strategies aimed at minimising their occurrence. Advancements in methods of identification, management, and prevention of musculoskeletal disease and injury in Thoroughbreds and improved training and racing environments to enhance the safety, health, and wellbeing of racehorses have long been strategic priorities of the Horserace Betting Levy Board (HBLB)’s veterinary research funding program in Great Britain.

In 2014, the HBLB funded a research team at the Royal Veterinary College in London to undertake a detailed study of injuries and other veterinary events occurring in flat racehorses on race day. The purpose of the project was to establish causes of fatal and non-fatal injuries occurring in British flat racing and to examine associated risk factors. The research also set out to measure heritability of common injury types and conditions, and to investigate genetic and environmental correlations between injury and race performance.

The study team had access to detailed race and performance data from all Thoroughbreds racing on the flat in Great Britain over a 14-year study period from 2000 – 2013. These were then linked to veterinary reports of injury or conditions attended to by a veterinary surgeon on race day over the same time period, provided by the British Horseracing Authority (BHA). Finally, extensive pedigree data were added to enable investigation of heritability of race day injury and genetic correlations between injury types, and between injury and performance.

Descriptive findings

The final 14-year dataset included nearly 68,000 horses making over 800,000 starts in around 77,000 flat races. The majority of races -- 67% of them -- were run on the turf, with 33% of races taking place on all-weather tracks.

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Just under 8,000 veterinary events were recorded over the study period, from which an incidence of nine events per 1000 starts was calculated. The most common incidents requiring veterinary attention on the racecourse were soft tissue injuries other than tendon and ligament injuries, e.g. wounds, lacerations, or muscle strains. Unspecified lameness and respiratory conditions were also common, accounting for around a fifth of veterinary reports each. Less than 10% of veterinary events had a fatal outcome, and the overall incidence of fatality was 0.8 per 1000 starts. Although bone injury was cited in only 14% of the veterinary reports overall, they accounted for the vast majority (77%) of the fatalities.

All-weather racing

Racing on all-weather tracks traditionally carries a higher risk of injury than racing on turf, which was reaffirmed in the current analyses. Therefore, the researchers also specifically investigated risk factors for fatality, distal limb fracture, and epistaxis (nose bleeds) in all-weather racing. These analyses were restricted to the ca. 258,000 all-weather starts in the dataset and included additionally collected information from the racecourse clerks on surface types and maintenance. The fatality incidence in all-weather racing was 0.9 per 1000 starts. Distal limb fracture occurred in around 1 in 1000 starts and epistaxis in 1.6 per 1000 starts. Risk factors varied for each outcome, although some factors were similar across outcomes including the going, racing intensity, horse age, age at first start, and horse and trainer performance variables. Generally, older horses and those that had started racing at an older age were at higher risk of an adverse outcome although for fatality, older horses that had started racing as two-year-olds were at highest risk. This association may be due to accumulation of microdamage in bone, which increases with increasing age as an effect of exercise accumulation over time and can ultimately lead to failure.  

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