For Immediate Release
August 3, 2026
Contact: Nancy Collins
ecirgroup1@gmail.com
Insulin Laminopathy
Eleanor Kellon, VMD
The suffix “-itis” means inflammation. That is not what is going on with insulin.
Johnson, et al., 2004, described changes in the laminae of horses with metabolic syndrome. They were not necessarily obviously sore but the pathology was there nonetheless. These changes consist of cellular proliferation and elongation. This is also seen with toxic and infectious/inflammatory cause of laminitis but is a late change.
At the 2017 NO Laminitis Conference, Dr. Kellon spoke extensively on how EMS and endocrinopathic/insulin related laminitis are different. In 2018, Patterson-Kane, et al., echoed those observations in a pivotal paper entitled “Paradigm shifts in understanding equine laminitis”.
In short, endocrinopathic laminitis, such as that induced by an infusion of insulin, does not show the white blood cell infiltration or enzymatic basement membrane damage that characterize other forms of laminitis.
One thing we know is going on is insulin resistance resulting in endothelin-1 excess and vasoconstriction in the feet. (Gauff, et al., 2013) After years of research proposing then discounting the potential role of IGF-1 (insulin-like growth factor-1), the latest study (Nanayakkara, et al., 2019) suggests insulin stimulating IGF-1 receptors may indeed play a role in causing the cellular elongation and proliferation.
If there is actual physical damage to the hoof, e.g., tearing of weak laminae and rotation, there will be a natural inflammatory reaction to clean up the damage but otherwise laminitis is not what is going on here, and not the initiating event, so laminopathy makes more sense.
Resources
Johnson PJ, Messer NT, Slight SH, Wiedmeyer C, Buff P, Ganjam VK. Endocrinopathic laminitis in the horse. Clinical Techniques in Equine Practice. 3(1):45-56, 2004.
Equine Cushing’s and Insulin Resistance Group Inc. NO Laminitis! Conference Proceedings 2017 https://ecirhorse.org/proceedings-2017.php
Patterson-Kane JC, Karikoski NP, McGowan CM. Paradigm shifts in understanding equine laminitis. Vet J 2018 Jan:231:33-40. doi: 10.1016/j.tvjl.2017.11.011. Epub 201 Nov 22.
Gauff F, Patan-Zugaj B, Licka TF. Hyperinsulinaemia increases vascular resistance and endothelin-1 expression in the equine digit. Equine Vet J, 2013 Sep;45(5):613-8. doi: 10.1111/evj.12040. Epub 2013 Mar 12.
Nanayakkara SN, Rahnam S, Harris PA, Anderson ST, de Laat MA, Bailey S, Sillence MN. Characterization of insulin and IGF-1 receptor binding in equine liver and lamellar tissue: implications for endocrinopathic laminitis. Domest Anim Endocrinol, 2019 Jan:66:21-26. doi: 10.1016/j.domaniend.2018.05.008. Epub 2018 Jun 7.
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About ECIR Group Inc.
Started in 1999, the ECIR Group is the largest field-trial database for PPID and EMS in the world and provides the latest research, diagnosis, and treatment information, in addition to dietary recommendations for horses with these conditions. Even universities do not and cannot compile and follow long term as many in-depth case histories of PPID/EMS horses as the ECIR Group.
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