First presented in 1991, the Applied Equine Research Award recognizes outstanding research conducted in a specific field over the previous five years. In 2011, Merial came on board as sponsors for the first time.

 

‘We were delighted to partner with WEVA on an award that has always recognized prestigious scientists and which has grown to become something of a equine veterinary science Hall of Fame,’ says Dr. Silke Birlenbach, Head of Merial Global Strategic Marketing for Equine. ‘The award recognizes people who are committed to innovation and who are working at the frontiers of equine veterinary medicine; people whose values we share.’

 

The guiding theme in 2011 was advances in pain management. ‘Equine practice and research attract passionate and talented people but the sector is relatively small compared to other market segments. So competition for research funding  is intense – both in academia and industry.  At Merial we have  become ruthless at ensuring only the best equine projects go forward and we acknowledge those same qualities when we see them outside the company,’ Silke explains.

 

‘Equine pain management is an area where innovation has been cruelly missing and, therefore, it is important to us to work with the equine scientific community to change this. We were particularly pleased when the WEVA award went to Dr. Blikslager. He is a scientist whose research work we greatly respect.’

 

Dr Anthony Blikslager
Blikslager has enjoyed a prodigious equine research career, producing in excess of 120 peer-reviewed publications. Horses, indeed, run in the blood for the man who grew up on a horse farm south of London. When he emigrated to the US in the early 1980s, it was, unusually, not only with the rest of the family but with four horses in tow. Graduating from veterinary school at Virginia Tech in 1989, he received his PhD in equine gastroenterology in 1997. Today, Professor of Surgery and Gastroenterology in North Carolina State University, he and his wife keep horses in their farm in Raleigh.

 

Research themes
Dr Blikslager’s research focus has been on gastrointestinal physiology with a particular emphasis on mechanisms responsible for the maintenance and restoration of the intestinal barrier.

 

‘The ultimate objective is to pharmacologically restore the mucosal barrier in patients suffering from diseases associated with increased intestinal permeability,’ he explains. This is of particular significance with diseases such as intestinal ischemia/reperfusion injury (commonly associated with colic) and gastric ulcer disease, because of the potential medical complications associated with them.

 

Blikslager says he hopes the award reflects a sense of progress in these interlinked studies, as well as of a continuing journey. ‘There is more research to come from our work.   I think that has been apparent from a number of our papers. We will often say that we don’t quite know how this works but here’s what we have so far.’

 

NSAIDs for inflammation and pain
It was ‘to some degree by luck, but also through circumstances that Blikslager came across NSAIDs for the treatment of inflammation and pain. ‘As it turns out, it’s the pain element that most concerns owners.  But veterinarians want to know also that what we are adequately addressing the underlying condition, that is where the anti-inflammatory element has come under investigation.’

 

One of the primary outputs of this research has been to show selective COX-2 inhibitors are at least equivalent to traditional NSAIDs in their ability to control pain.

 

‘Of course, some might say “that’s fine, but what’s the advantage?” The advantage is when you look at the intestine itself. It is allowed to repair as if nothing was interfering with that process. Whereas, when it was under the influence of the traditional non-selective drugs, it was affected. So there is a dual aspect – on the one side, here is the pain score we might see, albeit subtle in some cases, and here is how leaky the intestine is, and the two match up together.’

 

It will require longer-term studies to determine if selective COX-2 inhibitors actually have an advantage in managing pain in horses but the ability to detect very subtle changes in how leaky or permeable the intestine is will be central to that.

 

‘So, if a horse had an episode of colic, especially a more severe one, then the gut gets injured and we can detect that. Everyone is worried about endotoxins and whether they could ultimately gain access to the circulation and make a horse sicker and more in pain. When our work showed how much phenylbutazone and flunixin had leaked endotoxin, I think it finally got the message home to vets about one of the big advantages of the selective COX-2 inhibitors in terms of overall wellness and speedy recovery after a colic episode or surgery. It’s something that owners recognize and, naturally, value very highly.’ 

 

Time to think about pain control in a different way
If detecting subtle pain has become one of his research team’s capabilities, Dr Blikslager points out that it is in keeping with an increased capacity within veterinary science for detecting pain in general. This also largely follows the profession’s need to keep up with client expectations.

 

Equine veterinarians may need to start thinking about pain control in a different way and consider subtle pain more, pain that owners are often picking up whereas we, as veterinarians, may be ignoring. It is real and we need to be more aware of it.’

Challenging traditional mindsets in the profession may be one of the biggest impediments to progress, but it also makes it an exciting time to be involved in the field of pain management, he says. ‘I have found the younger generation of veterinarians are more likely to seek out information on pain control and new knowledge on approaches that work. What is really satisfying is when a veterinarian comes up to me and says “I didn’t know about this before. I’m really interested and I want to incorporate it in my practice”. That’s what motivates me to go forward.’

 

Research Priorities
Dr Blikslager feels fortunate that the work that has earned him such accolades continues to fascinate him. ‘There are two directions I would like to take. Firstly, I would like to extrapolate our research findings with a phase one randomized control trial and, secondly, on a more basic scientific level, I would like to understand why is it that the selective COX-2 inhibitors allow for more intestinal repair. That’s going to come down to understanding how the prostaglandin they allow to be released into circulation heals up the intestine.’

Taking its cue from human medicine, Blikslager sees one of the biggest changes sweeping across veterinary science is multi-modal pain control, where one drug, attacking different pathways, can be very beneficial.

 

‘The challenge for all of us is to come up with the best possible solution to treating that pain. If you want to put it on a practical level, I would say that what I really want to see is a horse that looks like it’s pain free and that I, as a veterinarian, feel I can send home earlier, so cutting down on the bill for the owner. Finally, when I check up on them, I want to find that they are doing better long term.’