Integrating clinical and rna-seq findings in a mare with recurrent endocrinopathic laminitis linked to equine metabolic syndrome.

Equine metabolic syndrome (EMS) is characterized by insulin dysregulation and obesity, which increase the risk of the development of hyperinsulinemia-induced laminitis (HAL). The present report describes a case of severe endocrinopathic laminitis associated with EMS, refractory to treatment. A 5-year-old mare with recurrent HAL presented transient relief upon a low nonstructural carbohydrate diet and conventional therapy. An SGLT2 inhibitor was introduced to reduce resting insulin levels, and improvement was observed until October 2024, when the most severe episode started. Despite adding pergolide mesylate and resuming analgesic treatment, the mare's health continued to decline, and euthanasia was performed in November 2024. Necropsy was unable to identify the cause of the uncontrolled metabolic disease. The pancreas was further analyzed by RNA sequencing and compared with a healthy animal, revealing clear transcriptomic differences. Continued research is necessary to better elucidate the mechanisms underlying EMS cases refractory to conventional treatment.