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Basics

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BASICS

Overview!!navigator!!

LWFS (ileocecocolonic aganglionosis) is a fatal heritable syndrome of horses with white patterning occurring most frequently in foals of overo–overo Paint crosses. Failure of proper development of neural crest-derived cells results in a lack of dermal melanocytes and myenteric ganglion cells in the caudal GI tract. Affected foals are completely white (or almost so) and show signs of colic within 24 h of birth. The syndrome is inherited as an autosomal recessive trait and is invariably fatal. A genetic test is available to identify heterozygous carriers.

Signalment!!navigator!!

  • Neonatal foals of overo–overo American Paint Horse cross-breeding
  • Signs of colic usually noted by 12–24 h of age
  • White coloration
  • No sex predisposition

Signs!!navigator!!

  • White color, often with blue eyes
  • Typically normal, vigorous foals that stand and nurse
  • Failure to pass meconium
  • Progressive signs of colic noted within 12–24 h of birth (exacerbated with enteral feeding)
  • Progressive abdominal distention
  • Death within 48–72 h of birth
  • May also have congenital deafness

Causes and Risk Factors!!navigator!!

  • LWFS is caused by a mutation in the EDNRB gene, which results in problems with migration of neural crest-derived cells, particularly melanocytes and the cells of many autonomic ganglia. Failure of neural crest cells to migrate and mature properly results in the characteristic phenotype (a nonpigmented foal with functional ileus due to an abnormal enteric nervous system)
  • Affected foals are homozygous for the mutation, while their parents are heterozygous. The gene is likely involved, or linked closely, with white patterning and deafness in horses. The heterozygous carrier state appears to be highest among overo Paint horses, especially frame overos

Diagnosis

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DIAGNOSIS

Differential Diagnosis!!navigator!!

  • Meconium retention/impaction
  • Congenital atresia of the GI tract
  • Intussusception
  • Mesenteric volvulus
  • Enterocolitis
  • Neonatal maladjustment syndrome
  • Rupture of the urinary bladder

CBC/Biochemistry/Urinalysis!!navigator!!

Often within normal limits. Not diagnostic.

Other Laboratory Tests!!navigator!!

Genetic testing to detect mutation (affected horses and carriers)—whole blood or hair (with roots) can be submitted.

Imaging!!navigator!!

Abdominal radiographs may reveal gas distention of the cranial GI tract, and barium contrast studies may be useful to rule out congenital atresia. Imaging studies are rarely required to make the diagnosis.

Other Diagnostic Procedures!!navigator!!

Exploratory laparotomy confirms the diagnosis but is rarely indicated. The diagnosis is usually made on the basis of clinical findings.

Pathologic Findings!!navigator!!

  • Hypoplasia of the ileum, cecum, and the ascending and descending colons with transverse and descending colons most severely affected. Affected segments are very small and contain no ingesta. The more orad regions of the GI tract are grossly normal but may be distended with gas and/or ingesta
  • Histologically, absence of myenteric and submucosal ganglia characterizes the abnormal intestine; the enteric nervous system is normal in the stomach and proximal small intestine

Treatment

TREATMENT

LWFS is inevitably fatal with no known viable treatment options. Humane euthanasia is recommended if the syndrome is strongly suspected.

Medications

MEDICATIONS

None

Follow-up

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FOLLOW-UP

Prevention/Avoidance!!navigator!!

A genetic test is available for use in breeding stock. Any horse that is a product of white-patterned horses, or itself is a white-patterned horse, is a potential carrier (including solid-colored “breeding stock” Paint horses). As LWFS is inherited as an autosomal recessive trait, the offspring of 2 carriers has a 1:4 chance of being affected. Carriers should either not be bred or bred only to noncarriers to avoid the production of a lethal white foal.

Expected Course and Prognosis!!navigator!!

Affected foals inevitably die within 48–96 h of birth (most within 48 h). Although surgical intervention has been attempted, no reports of successfully treated foals exist. Humane euthanasia is recommended.

Miscellaneous

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MISCELLANEOUS

Age-Related Factors!!navigator!!

Congenital syndrome—signs are seen soon after birth.

Abbreviations!!navigator!!

  • EDNRB = endothelin-B receptor
  • GI = gastrointestinal
  • LWFS = lethal white foal syndrome

Suggested Reading

Parry NMA. Overo lethal white foal syndrome. Compend Contin Educ Pract Vet 2005;27:945950.

Author(s)

Author: Teresa A. Burns

Consulting Editor: Margaret C. Mudge