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Riggers DS, Xenoulis PG, Karra DA, Enderle LL, Köller G, Böttcher D, Steiner JM, Heilmann RM. Fecal Calprotectin Concentrations in Cats with Chronic Enteropathies. Vet Sci 2023; 10:419. [PMID: 37505825 PMCID: PMC10385529 DOI: 10.3390/vetsci10070419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/18/2023] [Accepted: 06/27/2023] [Indexed: 07/29/2023] Open
Abstract
Diagnosis of feline chronic inflammatory enteropathies (CIE) and the differentiation from small cell intestinal lymphoma (SCL) can be challenging. Intestinally expressed calprotectin (S100A8/A9 protein complex) appears to be part of the complex pathogenesis of feline chronic enteropathies (FCE). Fecal calprotectin is a non-invasive biomarker for intestinal inflammation in humans and dogs but has not yet been evaluated in cats. We hypothesized that fecal calprotectin (fCal) concentrations are increased in FCE, correlate with clinical and/or histologic disease severity, and distinguish cases of CIE from SCL. This case-control study included fecal samples and patient data from cats with CIE (n = 34), SCL (n = 17), other gastrointestinal (GI) diseases (n = 16), and cats with no clinical signs of GI disease (n = 32). fCal concentrations were measured using the immunoturbidimetric fCal turbo assay (Bühlmann Laboratories). Compared to healthy cats, fCal concentrations were significantly increased in CIE, SCL, and other diseases (all p < 0.0001), but were not different between these three groups (all p > 0.05), or between cats with extra-GI diseases and healthy controls. These findings suggest that fCal may have utility as a clinical biomarker for FCE but not for intestinal disease differentiation. It further supports the role of calprotectin in the pathogenesis of the spectrum of FCE, which includes CIE and SCL.
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Affiliation(s)
- Denise S Riggers
- Department for Small Animals, College of Veterinary Medicine, University of Leipzig, 04103 Leipzig, Germany
| | - Panagiotis G Xenoulis
- Clinic of Medicine, Faculty of Veterinary Science, University of Thessaly, Trikalon 224, 43100 Karditsa, Greece
| | - Dimitra A Karra
- Clinic of Medicine, Faculty of Veterinary Science, University of Thessaly, Trikalon 224, 43100 Karditsa, Greece
| | - Lena L Enderle
- Department for Small Animals, College of Veterinary Medicine, University of Leipzig, 04103 Leipzig, Germany
| | - Gabor Köller
- Department for Large Animals, College of Veterinary Medicine, University of Leipzig, 04103 Leipzig, Germany
| | - Denny Böttcher
- Institute of Veterinary Pathology, College of Veterinary Medicine, University of Leipzig, 04103 Leipzig, Germany
| | - Joerg M Steiner
- Gastrointestinal Laboratory, School of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX 77843-4474, USA
| | - Romy M Heilmann
- Department for Small Animals, College of Veterinary Medicine, University of Leipzig, 04103 Leipzig, Germany
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Marsilio S, Freiche V, Johnson E, Leo C, Langerak AW, Peters I, Ackermann MR. ACVIM consensus statement guidelines on diagnosing and distinguishing low-grade neoplastic from inflammatory lymphocytic chronic enteropathies in cats. J Vet Intern Med 2023; 37:794-816. [PMID: 37130034 PMCID: PMC10229359 DOI: 10.1111/jvim.16690] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 03/10/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND Lymphoplasmacytic enteritis (LPE) and low-grade intestinal T cell lymphoma (LGITL) are common diseases in older cats, but their diagnosis and differentiation remain challenging. OBJECTIVES To summarize the current literature on etiopathogenesis and diagnosis of LPE and LGITL in cats and provide guidance on the differentiation between LPE and LGITL in cats. To provide statements established using evidence-based approaches or where such evidence is lacking, statements based on consensus of experts in the field. ANIMALS None. METHODS A panel of 6 experts in the field (2 internists, 1 radiologist, 1 anatomic pathologist, 1 clonality expert, 1 oncologist) with the support of a human medical immunologist, was formed to assess and summarize evidence in the peer-reviewed literature and complement it with consensus recommendations. RESULTS Despite increasing interest on the topic for clinicians and pathologists, few prospective studies were available, and interpretation of the pertinent literature often was challenging because of the heterogeneity of the cases. Most recommendations by the panel were supported by a moderate or low level of evidence. Several understudied areas were identified, including cellular markers using immunohistochemistry, genomics, and transcriptomic studies. CONCLUSIONS AND CLINICAL IMPORTANCE To date, no single diagnostic criterion or known biomarker reliably differentiates inflammatory lesions from neoplastic lymphoproliferations in the intestinal tract of cats and a diagnosis currently is established by integrating all available clinical and diagnostic data. Histopathology remains the mainstay to better differentiate LPE from LGITL in cats with chronic enteropathy.
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Affiliation(s)
- Sina Marsilio
- Department of Veterinary Medicine and EpidemiologyUC Davis School of Veterinary MedicineDavisCaliforniaUSA
| | - Valerie Freiche
- Ecole Nationale Vétérinaire d'AlfortCHUVA, Unité de Médecine InterneMaisons‐AlfortFrance
| | - Eric Johnson
- Department of Surgical & Radiological SciencesUC Davis School of Veterinary MedicineDavisCaliforniaUSA
| | - Chiara Leo
- Anicura Istituto Veterinario NovaraNovaraItaly
| | | | | | - Mark R. Ackermann
- Oregon Veterinary Diagnostic Laboratory, Oregon State UniversityCorvallisOregonUSA
- Present address:
US Department of AgricultureNational Animal Disease CenterAmesIowaUSA
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3
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Siani G, Mercaldo B, Alterisio MC, Di Loria A. Vitamin B12 in Cats: Nutrition, Metabolism, and Disease. Animals (Basel) 2023; 13:ani13091474. [PMID: 37174511 PMCID: PMC10177498 DOI: 10.3390/ani13091474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 04/18/2023] [Accepted: 04/24/2023] [Indexed: 05/15/2023] Open
Abstract
Cobalamin is a water-soluble molecule that has an important role in cellular metabolism, especially in DNA synthesis, methylation, and mitochondrial metabolism. Cobalamin is bound by intrinsic factor (IF) and absorbed in the ileal tract. The IF in cats is synthesized exclusively by pancreatic tissue. About 75% of the total plasma cobalamin in cats is associated with transcobalamin II, while in this species, transcobalamin I is not present. In cats, the half-life of cobalamin is 11-14 days. Diagnostic biomarkers for B12 status in cats include decreased levels of circulating total cobalamin and increased levels of methylmalonic acid. The reference interval for serum cobalamin concentrations in cats is 290-1500 ng/L, and for the serum methylmalonic acid concentration, it is 139-897 nmol/L. Therapy for hypocobalaminemia mainly depends on the underlying disease. In some cases, subcutaneous or intramuscular injection of 250 μg/cat is empirically administered. In recent years, it has been demonstrated that oral cobalamin supplementation can also be used successfully in dogs and cats as a less invasive alternative to parental administration. This review describes the current knowledge regarding B12 requirements and highlights improvements in diagnostic methods as well as the role of hypocobalaminemia in its associated diseases.
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Affiliation(s)
| | - Beatrice Mercaldo
- Department of Veterinary Medicine and Animal Productions, University Federico II of Napoli, Via F. Delpino 1, 80137 Napoli, Italy
| | - Maria Chiara Alterisio
- Department of Veterinary Medicine and Animal Productions, University Federico II of Napoli, Via F. Delpino 1, 80137 Napoli, Italy
| | - Antonio Di Loria
- Department of Veterinary Medicine and Animal Productions, University Federico II of Napoli, Via F. Delpino 1, 80137 Napoli, Italy
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Bandara Y, Priestnall SL, Chang YM, Kathrani A. Characterization of intestinal fibrosis in cats with chronic inflammatory enteropathy. J Vet Intern Med 2023; 37:936-947. [PMID: 37052621 DOI: 10.1111/jvim.16688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 03/10/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Intestinal fibrosis (IF) is commonly identified on histopathology of intestinal biopsy specimens (IBSp) from cats with chronic inflammatory enteropathy (CIE) however, its clinical relevance is unknown. OBJECTIVES Characterize and determine the clinical relevance of IF in cats with CIE. ANIMALS Sixty-five client-owned cats diagnosed with CIE after gastrointestinal histopathology from a single referral hospital in the United Kingdom. METHODS Medical records were retrospectively searched for cases of CIE on the basis of histopathology of IBSp. The IBSp from eligible cats were re-reviewed by a single board-certified veterinary pathologist for inclusion. Masson's trichrome (MT) stain and immunohistochemical labeling using antivimentin and anticollagen I antibodies to identify IF. For each case, various variables at the time of diagnostic investigation were recorded and referring veterinarians were contacted for follow-up information. RESULTS Mucosal fibrosis was identified in 51% of duodenal and 76% of colonic hematoxylin and eosin (HE)-stained IBSp. Vimentin labeling and MT staining identified additional cases of IF in 65% and 58% of the duodenal biopsy specimens, respectively. Vimentin labeling detected IF in 79% of the colonic biopsy specimens. Positive vimentin labeling and MT staining of the colonic mucosa were associated with decreased likelihood of attaining clinical remission and increased risk of death because of CIE (P < .05). CONCLUSIONS AND CLINICAL IMPORTANCE Additional stains at initial histopathologic examination of IBSp allow for better identification of IF compared to routine HE staining. Identification of IF in colonic biopsy specimens by vimentin immunolabeling and MT staining may provide prognostic information in cats with CIE.
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Affiliation(s)
- Yuvani Bandara
- Royal Veterinary College, University of London, London, UK
| | | | - Yu-Mei Chang
- Royal Veterinary College, University of London, London, UK
| | - Aarti Kathrani
- Royal Veterinary College, University of London, London, UK
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Riggers DS, Gurtner C, Protschka M, Böttcher D, von Bomhard W, Alber G, Winter K, Steiner JM, Heilmann RM. Intestinal S100/Calgranulin Expression in Cats with Chronic Inflammatory Enteropathy and Intestinal Lymphoma. Animals (Basel) 2022; 12:ani12162044. [PMID: 36009635 PMCID: PMC9404432 DOI: 10.3390/ani12162044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/08/2022] [Accepted: 08/09/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Intestinal diseases in cats are complicated diseases in which intestinal inflammation is difficult to distinguish from lymphoma, which is a neoplasm. In this study, the expression of the proteins S100A8/A9 and S100A12 (also called calgranulins) in the intestine is investigated in both diseases and for potential correlations with microscopically visible changes in the intestine or the clinical severity of the disease. Only small differences were seen between healthy and diseased animals, and there were no differences between cats with intestinal inflammation and lymphoma. However, several correlations of cells staining positive for calgranulins and inflammatory changes at the microscopic level and clinical disease severity were shown. This indicates that calgranulins play a role in both gastrointestinal lymphoma and inflammation and would support the recent theory that these two diseases might not be separate disease entities but instead are related. Further insights into the role of the calgranulins in these feline diseases will lead to a better understanding of the disease pathogenesis and, thus, potentially novel diagnostics and treatment avenues. Abstract Diagnosing chronic inflammatory enteropathies (CIE) in cats and differentiation from intestinal lymphoma (IL) using currently available diagnostics is challenging. Intestinally expressed S100/calgranulins, measured in fecal samples, appear to be useful non-invasive biomarkers for canine CIE but have not been evaluated in cats. We hypothesized S100/calgranulins to play a role in the pathogenesis of feline chronic enteropathies (FCE) and to correlate with clinical and/or histologic disease severity. This retrospective case-control study included patient data and gastrointestinal (GI) tissues from 16 cats with CIE, 8 cats with IL, and 16 controls with no clinical signs of GI disease. GI tissue biopsies were immunohistochemically stained using polyclonal α-S100A8/A9 and α-S100A12 antibodies. S100A8/A9+ and S100A12+ cells were detected in all GI segments, with few significant differences between CIE, IL, and controls and no difference between diseased groups. Segmental inflammatory lesions were moderately to strongly correlated with increased S100/calgranulin-positive cell counts. Clinical disease severity correlated with S100A12+ cell counts in cats with IL (ρ = 0.69, p = 0.042) and more severe diarrhea with colonic lamina propria S100A12+ cells with CIE (ρ = 0.78, p = 0.021) and duodenal S100A8/A9+ cells with IL (ρ = 0.71, p = 0.032). These findings suggest a role of the S100/calgranulins in the pathogenesis of the spectrum of FCE, including CIE and IL.
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Affiliation(s)
- Denise S. Riggers
- Small Animals Department, College of Veterinary Medicine, Leipzig University, 04103 Leipzig, Germany
| | - Corinne Gurtner
- Institute of Animal Pathology, Department of Infectious Diseases and Pathobiology (DIP), Vetsuisse Faculty, University of Bern, 3012 Bern, Switzerland
| | - Martina Protschka
- Institute of Immunology/Molecular Pathogenesis, Center for Biotechnology and Biomedicine, College of Veterinary Medicine, Leipzig University, 04103 Leipzig, Germany
| | - Denny Böttcher
- Institute of Veterinary Pathology, College of Veterinary Medicine, Leipzig University, 04103 Leipzig, Germany
| | | | - Gottfried Alber
- Institute of Immunology/Molecular Pathogenesis, Center for Biotechnology and Biomedicine, College of Veterinary Medicine, Leipzig University, 04103 Leipzig, Germany
| | - Karsten Winter
- Institute of Anatomy, Medical Faculty, Leipzig University, 04103 Leipzig, Germany
| | - Joerg M. Steiner
- Gastrointestinal Laboratory, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX 77843, USA
| | - Romy M. Heilmann
- Small Animals Department, College of Veterinary Medicine, Leipzig University, 04103 Leipzig, Germany
- Correspondence:
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EXOCRINE PANCREATIC INSUFFICIENCY-LIKE SYNDROME IN FOUR CAPTIVE TIGERS ( PANTHERA TIGRIS). J Zoo Wildl Med 2021; 52:1079-1083. [PMID: 34687527 DOI: 10.1638/2019-0195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2021] [Indexed: 11/21/2022] Open
Abstract
Exocrine pancreatic insufficiency (EPI) is a condition characterized by a decreased synthesis and secretion of pancreatic enzymes, which results in weight loss, poor hair coat, and diarrhea. The diagnostic test of choice for EPI in domestic cats is feline serum trypsin-like immunoreactivity (fTLI). This paper details four tigers (Panthera tigris) with clinical signs compatible with EPI. On the basis of domestic cat reference ranges, fTLI assays for all four clinically affected tigers were diagnostic for EPI (median 1.0 µg/L; range 0.5-1.2 µg/L). All four tigers had a rapid clinical response to pancreatic enzyme supplementation. Serum from 10 clinically healthy tigers was submitted for the fTLI assay, for comparative purposes. The healthy tigers' fTLI assays were also within range for a diagnosis of EPI in domestic cats (median 3.1 µg/L; range 1.9-4.5 µg/L); however, clinically affected tigers had significantly lower serum fTLI concentrations than healthy tigers (P = 0.0058). Serum cobalamin was below the detection limit in both the affected and healthy tigers (<150 ng/L). Measuring fTLI appears to be a useful tool in the diagnosis of EPI-like syndrome in tigers. As in other species, EPI-like syndrome in tigers may also be associated with cobalamin deficiency.
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7
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Sorrell S. Diagnosing and treating chronic vomiting in cats. IN PRACTICE 2021. [DOI: 10.1002/inpr.98] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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8
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Chatzis MK, Kasabalis D, Steiner JM, Saridomichelakis MN, Suchodolski JS, Xenoulis PG. Serum cobalamin concentrations in dogs with leishmaniosis before and during treatment. Comp Immunol Microbiol Infect Dis 2021; 78:101686. [PMID: 34153612 DOI: 10.1016/j.cimid.2021.101686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 06/14/2021] [Indexed: 10/21/2022]
Abstract
Hypocobalaminemia in dogs is most commonly associated with gastrointestinal disorders leading to impaired absorption and utilization of cobalamin. The objectives of this study were to compare serum cobalamin concentrations between dogs with leishmaniosis and clinically healthy dogs, and to assess possible alterations of serum cobalamin concentrations in dogs with leishmaniosis at different timepoints during treatment. Fifty-five dogs with leishmaniosis and 129 clinically healthy dogs were prospectively enrolled. Diagnosis of leishmaniosis was based on clinical presentation, positive serology and microscopic detection of Leishmania amastigotes in lymph node aspiration smears. Twenty of the dogs with leishmaniosis were treated with a combination of meglumine antimonate and allopurinol for 28 days and serum cobalamin concentrations were measured in blood samples that were collected before initiation of treatment (timepoint 0) and on days 14 and 28. In order to estimate alterations of serum cobalamin concentrations during treatment, cobalamin concentrations were measured in blood samples from 20 out of 55 dogs with leishmaniosis at all timepoints. Serum cobalamin concentrations were significantly lower in dogs with leishmaniosis before treatment (median: 362 ng/L; IQR: 277-477 ng/L) compared to clinically healthy dogs (median: 470 ng/L; IQR: 367-632 ng/L; P = 0.0035). Serum cobalamin concentrations increased significantly in dogs with leishmaniosis on day 14 of treatment compared to timepoint 0 (P = 0.02). In the present study, serum cobalamin concentrations were significantly lower in dogs with leishmaniosis compared to clinically healthy dogs. In addition, there was an increase in serum cobalamin concentrations during treatment. The clinical significance of hypocobalaminemia in dogs with leishmaniosis remains to be determined.
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Affiliation(s)
- M K Chatzis
- Clinic of Medicine, Faculty of Veterinary Science, University of Thessaly, Trikalon Str. 224, 43132, Karditsa, Greece.
| | - D Kasabalis
- Clinic of Medicine, Faculty of Veterinary Science, University of Thessaly, Trikalon Str. 224, 43132, Karditsa, Greece
| | - J M Steiner
- Gastrointestinal Laboratory, Department of Small Animal Clinical Sciences, Texas A&M University, College Station, TX, United States
| | - M N Saridomichelakis
- Clinic of Medicine, Faculty of Veterinary Science, University of Thessaly, Trikalon Str. 224, 43132, Karditsa, Greece
| | - J S Suchodolski
- Gastrointestinal Laboratory, Department of Small Animal Clinical Sciences, Texas A&M University, College Station, TX, United States
| | - P G Xenoulis
- Clinic of Medicine, Faculty of Veterinary Science, University of Thessaly, Trikalon Str. 224, 43132, Karditsa, Greece; Gastrointestinal Laboratory, Department of Small Animal Clinical Sciences, Texas A&M University, College Station, TX, United States
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9
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Marsilio S. Differentiating Inflammatory Bowel Disease from Alimentary Lymphoma in Cats: Does It Matter? Vet Clin North Am Small Anim Pract 2021; 51:93-109. [PMID: 33187624 DOI: 10.1016/j.cvsm.2020.09.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Differentiation of feline inflammatory bowel disease and intestinal small cell lymphoma can be challenging, and some clinicians argue that it is unnecessary because prognosis and treatment are similar. Differentiation of feline inflammatory bowel disease and intestinal small cell lymphoma can be challenging and some clinicians argue that it is unnecessary since prognosis and treatment are similar. Altough the body of research on this topic has increased over time, we still know little about etiopathogenesis, progression, alternative treatment modalities and prognosis of the different forms of FCE. While differentiating IBD from SCL might not alter a single patients' disease course, further research efforts are required to alter the disease course for our feline patient population as a whole.
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Affiliation(s)
- Sina Marsilio
- Department of Veterinary Medicine and Epidemiology, UC Davis School of Veterinary Medicine, Tupper Hall, 1275 Med Science Drive, Davis, CA 95616, USA.
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10
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Marsilio S. Feline chronic enteropathy. J Small Anim Pract 2021; 62:409-419. [PMID: 33821508 DOI: 10.1111/jsap.13332] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 02/24/2021] [Accepted: 03/05/2021] [Indexed: 01/22/2023]
Abstract
Feline chronic enteropathy is a common disorder, especially in the senior cat population, with rising incidence over the past decade. Feline chronic enteropathy is considered an umbrella term comprising different diseases including food-responsive enteropathy, idiopathic inflammatory bowel disease and alimentary small cell lymphoma. However, differentiation between those diseases is often difficult in practice. This review will discuss the clinical approach to cats with chronic enteropathy, state-of-the-art diagnostic tests and pitfalls thereof as well as current therapeutic approaches. Although, much of the etiopathogenesis is still unknown, increased research efforts in this field have brought new insights into diagnostic and therapeutic options for these cats.
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Affiliation(s)
- S Marsilio
- School of Veterinary Medicine, Department of Medicine and Epidemiology, University of California, One Shields Avenue, Davis, CA, 95616, USA
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11
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Hunt A, Jugan MC. Anemia, iron deficiency, and cobalamin deficiency in cats with chronic gastrointestinal disease. J Vet Intern Med 2020; 35:172-178. [PMID: 33226151 PMCID: PMC7848310 DOI: 10.1111/jvim.15962] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/29/2020] [Accepted: 10/29/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Iron deficiency and cobalamin deficiency, as sequelae to chronic gastrointestinal (GI) disease, could result in anemia and increased morbidity in cats with chronic enteropathies. OBJECTIVE To evaluate iron deficiency in cats with chronic GI disease and its relationship with hypocobalaminemia, anemia, and disease severity. ANIMALS Twenty client-owned cats with primary GI disease. METHODS Prospective, cross-sectional study. Cats were enrolled at the time of evaluation for chronic GI disease, after exclusion of comorbidities. CBC with reticulocyte indices, iron metabolism (serum iron and ferritin concentrations, total iron binding capacity [TIBC]), serum methylmalonic acid (MMA), cobalamin, and folate concentrations, pancreatic lipase and trypsin-like immunoreactivity, and disease severity were evaluated. RESULTS Anemia (hematocrit <30%), iron deficiency, and cobalamin deficiency were diagnosed in 4/20, 7/20, and 8/20 cats, respectively. Hematocrit (rs = -.45; P < .05) and body condition score (rs = -.60; P < .01) negatively correlated with MMA. Median TIBC was lower in cats with increased vs normal MMA (218 μg/mL; range, 120-466 μg/mL vs 288 μg/mL; range, 195-369 μg/mL; P = .02). Hematocrit (rs = .51; P = .02), reticulocyte MCV (rs = .52; P = .02), reticulocyte hemoglobin content (rs = .71; P < .001), and percent transferrin saturation (rs = .79; P < .0001) positively correlated with serum iron concentration. CONCLUSIONS AND CLINICAL IMPORTANCE Functional iron deficiency was common in cats with chronic GI disease. Associations between hypocobalaminemia, iron parameters, and hematologic parameters warrant further investigation on the impact of iron deficiency on chronic GI disease morbidity in cats.
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Affiliation(s)
- Adam Hunt
- Department of Clinical Sciences, College of Veterinary Medicine, The University of Tennessee, Knoxville, Tennessee, USA
| | - Maria C Jugan
- Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan, Kansas, USA
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12
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Parambeth JC, Ross CN, Miller AD, Austad SN, Lidbury JA, Suchodolski JS, Steiner JM. Serum Cobalamin and Folate Concentrations in Common Marmosets ( Callithrix jacchus) with Chronic Lymphocytic Enteritis. Comp Med 2019; 69:135-143. [PMID: 30902119 PMCID: PMC6464084 DOI: 10.30802/aalas-cm-18-000045] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 06/06/2018] [Accepted: 08/23/2018] [Indexed: 12/24/2022]
Abstract
Serum cobalamin and folate concentrations can serve as surrogate markers of gastrointestinal disease in dogs and cats, where they can have diagnostic, therapeutic, and prognostic implications. Chronic disease of the gastrointestinal tract, particularly chronic lymphocytic enteritis (CLE), occurs frequently in captive common marmosets. The aims of this study were to validate a commercially available assay for measuring serum cobalamin and folate concentrations in common marmosets, to establish reference intervals for these analytes in healthy marmosets, and to measure serum concentrations in common marmosets with CLE. The commercial assay was linear, accurate, precise, and reproducible for the measurement of serum cobalamin and folate concentrations in common marmosets. In healthy marmosets, the serum cobalamin concentration ranged from 322 to 2642 pg/mL (n = 35) and serum folate concentration from 54.8 to 786.4 ng/mL (n = 37). Low serum folate concentrations were moderately sensitive (greater than 70%) for CLE, and low serum cobalamin concentrations were moderately (greater than 70%) specific for CLE. Both serum cobalamin and folate concentrations were relatively unchanged in marmosets during 120 to 220 d. Serum cobalamin and folate concentrations were stable for approximately 7 y when samples were stored at -80 °C. Additional studies are warranted to further study the clinical implications of low serum cobalamin and folate concentrations in common marmosets.
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Affiliation(s)
- Joseph Cyrus Parambeth
- Gastrointestinal Laboratory, Department of Small Animal Clinical Sciences, College of Veterinary and Biomedical Sciences, Texas A and M University, College Station, Texas;,
| | - Corinna N Ross
- College of Arts and Sciences, Texas A and M University-San Antonio, San Antonio, Texas
| | - Andrew D Miller
- Department of Biomedical Sciences, Section of Anatomic Pathology, College of Veterinary Medicine, Cornell University, Ithaca, New York
| | - Steven N Austad
- Department of Biology and Nathan Shock Center of Excellence in the Basic Biology of Aging, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jonathan A Lidbury
- Gastrointestinal Laboratory, Department of Small Animal Clinical Sciences, College of Veterinary and Biomedical Sciences, Texas A and M University, College Station, Texas
| | - Jan S Suchodolski
- Gastrointestinal Laboratory, Department of Small Animal Clinical Sciences, College of Veterinary and Biomedical Sciences, Texas A and M University, College Station, Texas
| | - Jörg M Steiner
- Gastrointestinal Laboratory, Department of Small Animal Clinical Sciences, College of Veterinary and Biomedical Sciences, Texas A and M University, College Station, Texas
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13
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McLeish SA, Burt K, Papasouliotis K. Analytical quality assessment and method comparison of immunoassays for the measurement of serum cobalamin and folate in dogs and cats. J Vet Diagn Invest 2019; 31:164-174. [PMID: 30638139 DOI: 10.1177/1040638718824073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Serum cobalamin and folate are often measured in cats and dogs as part of laboratory testing for intestinal disease, small intestinal dysbiosis, or exocrine pancreatic deficiency. We performed an analytical validation of human immunoassays for cobalamin and folate measurement (AIA-900 analyzer, Tosoh Bioscience) and compared results with those obtained using chemiluminescence assays (Immulite 2000 analyzer, Siemens Medical Solutions Diagnostics). Accuracy, precision, total observable error (TEobs%), and σ values were calculated for the immunoassays. Correlation and agreement were evaluated with Deming regression, Passing-Bablok regression, and Bland-Altman analysis. Cobalamin intra-assay and inter-assay CVs were 1.8-9.3% and 2.6-6.8%, respectively. Folate intra-assay and inter-assay CVs were 1.5-9.1% and 3.4-8.1%, respectively. TEobs (%) were ≤19 and ≤31 for cobalamin and folate, respectively. Sigma values were 3.60-11.50 for cobalamin and 2.90-7.50 for folate. Regression analysis demonstrated very high or high correlations for cobalamin [ r = 0.98 (dogs), 0.97 (cats)] and folate [ r = 0.88 (dogs), 0.92 (cats)] but Bland-Altman analysis revealed poor agreement for both. The immunoassays had good analytical performance for measuring cobalamin and folate in both species. Results obtained by the 2 analyzers cannot be used interchangeably and should be interpreted using instrument-specific reference intervals. Further studies are required to establish immunoassay-specific reference intervals and to evaluate the diagnostic performance and clinical utility of the analyzer for these analytes.
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Affiliation(s)
- Susan A McLeish
- Diagnostic Laboratories, Langford Vets, Bristol Veterinary School, University of Bristol, Langford, Bristol, UK (McLeish, Burt).,IDEXX Laboratories Ltd, Grange House, Sandbeck Way, Wetherby, West Yorkshire, UK (Papasouliotis)
| | - Kay Burt
- Diagnostic Laboratories, Langford Vets, Bristol Veterinary School, University of Bristol, Langford, Bristol, UK (McLeish, Burt).,IDEXX Laboratories Ltd, Grange House, Sandbeck Way, Wetherby, West Yorkshire, UK (Papasouliotis)
| | - Kostas Papasouliotis
- Diagnostic Laboratories, Langford Vets, Bristol Veterinary School, University of Bristol, Langford, Bristol, UK (McLeish, Burt).,IDEXX Laboratories Ltd, Grange House, Sandbeck Way, Wetherby, West Yorkshire, UK (Papasouliotis)
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14
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Paulin MV, Couronné L, Beguin J, Le Poder S, Delverdier M, Semin MO, Bruneau J, Cerf-Bensussan N, Malamut G, Cellier C, Benchekroun G, Tiret L, German AJ, Hermine O, Freiche V. Feline low-grade alimentary lymphoma: an emerging entity and a potential animal model for human disease. BMC Vet Res 2018; 14:306. [PMID: 30305106 PMCID: PMC6180644 DOI: 10.1186/s12917-018-1635-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 09/28/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Low-grade alimentary lymphoma (LGAL) is characterised by the infiltration of neoplastic T-lymphocytes, typically in the small intestine. The incidence of LGAL has increased over the last ten years and it is now the most frequent digestive neoplasia in cats and comprises 60 to 75% of gastrointestinal lymphoma cases. Given that LGAL shares common clinical, paraclinical and ultrasonographic features with inflammatory bowel diseases, establishing a diagnosis is challenging. A review was designed to summarise current knowledge of the pathogenesis, diagnosis, prognosis and treatment of feline LGAL. Electronic searches of PubMed and Science Direct were carried out without date or language restrictions. RESULTS A total of 176 peer-reviewed documents were identified and most of which were published in the last twenty years. 130 studies were found from the veterinary literature and 46 from the human medicine literature. Heterogeneity of study designs and outcome measures made meta-analysis inappropriate. The pathophysiology of feline LGAL still needs to be elucidated, not least the putative roles of infectious agents, environmental factors as well as genetic events. The most common therapeutic strategy is combination treatment with prednisolone and chlorambucil, and prolonged remission can often be achieved. Developments in immunohistochemical analysis and clonality testing have improved the confidence of clinicians in obtaining a correct diagnosis between LGAL and IBD. The condition shares similarities with some diseases in humans, especially human indolent T-cell lymphoproliferative disorder of the gastrointestinal tract. CONCLUSIONS The pathophysiology of feline LGAL still needs to be elucidated and prospective studies as well as standardisation of therapeutic strategies are needed. A combination of conventional histopathology and immunohistochemistry remains the current gold-standard test, but clinicians should be cautious about reclassifying cats previously diagnosed with IBD to lymphoma on the basis of clonality testing. Importantly, feline LGAL could be considered to be a potential animal model for indolent digestive T-cell lymphoproliferative disorder, a rare condition in human medicine.
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Affiliation(s)
- Mathieu V Paulin
- Université Paris-Est, École Nationale Vétérinaire d'Alfort, 7 Avenue du Général de Gaulle, 94700, Maisons-Alfort, France
| | - Lucile Couronné
- Hematology Department, Hôpital Universitaire Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,INSERM UMR 1163, CNRS ERL 8254, Institut Imagine, Paris, France
| | - Jérémy Beguin
- Internal Medicine Department, Université Paris-Est, École Nationale Vétérinaire d'Alfort, 7 Avenue du Général de Gaulle, 94700, Maisons-Alfort, France
| | - Sophie Le Poder
- UMR 1161 Virologie, INRA-ENVA-ANSES, Université Paris-Est, École Nationale Vétérinaire d'Alfort, Maisons-Alfort, France
| | - Maxence Delverdier
- Anatomical Pathology Department, Université de Toulouse, École Nationale Vétérinaire de Toulouse, 23 Chemin des Capelles, 31076, Toulouse Cedex, France
| | - Marie-Odile Semin
- Anatomical Pathology Department, Université de Toulouse, École Nationale Vétérinaire de Toulouse, 23 Chemin des Capelles, 31076, Toulouse Cedex, France
| | - Julie Bruneau
- Pathology Department, Hôpital Universitaire Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris (APHP), Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,INSERM 1163, Institut Imagine, Site Hôpital Universitaire Necker - Enfants Malades, Paris, France
| | - Nadine Cerf-Bensussan
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,UMR 1163, Laboratory of Intestinal Immunity, INSERM, Paris, France
| | - Georgia Malamut
- Gastroenterology Department, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris (APHP), Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,INSERM UMR 1163, Institut Imagine, Paris, France
| | - Christophe Cellier
- Gastroenterology Department, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris (APHP), Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,INSERM UMR 1163, Institut Imagine, Paris, France
| | - Ghita Benchekroun
- Internal Medicine Department, Université Paris-Est, École Nationale Vétérinaire d'Alfort, 7 Avenue du Général de Gaulle, 94700, Maisons-Alfort, France
| | - Laurent Tiret
- Inserm U955-E10 BNMS, IMRB, Université Paris-Est, École Nationale Vétérinaire d'Alfort, 94000, Maisons-Alfort, France
| | - Alexander J German
- Institute of Ageing and Chronic Disease, University of Liverpool, Leahurst Campus, Chester High Road, Neston, CH64 7TE, UK
| | - Olivier Hermine
- Hematology Department, Hôpital Universitaire Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,INSERM UMR 1163, CNRS ERL 8254, Institut Imagine, Paris, France
| | - Valérie Freiche
- Internal Medicine Department, Université Paris-Est, École Nationale Vétérinaire d'Alfort, 7 Avenue du Général de Gaulle, 94700, Maisons-Alfort, France.
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15
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Hill SA, Cave NJ, Forsyth S. Effect of age, sex and body weight on the serum concentrations of cobalamin and folate in cats consuming a consistent diet. J Feline Med Surg 2018; 20:135-141. [PMID: 29172893 PMCID: PMC11129259 DOI: 10.1177/1098612x17699680] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives Multiple feline diseases involving the gastrointestinal tract, pancreas, liver and biliary tract are known to cause abnormal serum cobalamin and folate concentrations. Measuring the serum concentration of these vitamins can therefore be a helpful diagnostic tool. However, factors other than disease, in particular age, have also been suggested to have an effect on the serum concentration of cobalamin and folate. In previous studies, the dietary intake was not standardised, or even known, despite diet being the prinicpal source of both vitamins. Therefore, we evaluated the effect of age, sex and body weight on the serum concentration of folate and cobalamin in cats fed the same diet. Methods The serum cobalamin and folate concentrations were measured in 65 apparently healthy cats in a nutrition colony that had been fed an identical diet. A linear model was used to test the relationship between the serum concentration of cobalamin and folate with the variables age, sex and body weight. Results There was a large variation in the serum concentration of both folate and cobalamin, despite identical intake. Serum cobalamin was inversely associated with age ( P = 0.002), and males had higher concentrations than females ( P = 0.039). Serum folate was positively associated with age ( P = 0.01). Conclusions and relevance Independent of diet, serum cobalamin concentration decreases with age. Changes in gastrointestinal function, microflora or metabolism may be responsible. Older cats may be more susceptible to cobalamin deficiency secondary to inappetence or gastrointestinal disease.
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Affiliation(s)
- Sarah A Hill
- Small Animal Veterinary Teaching Hospital, Massey University, Palmerston North, New Zealand
| | - Nicholas J Cave
- Small Animal Veterinary Teaching Hospital, Massey University, Palmerston North, New Zealand
| | - Sandra Forsyth
- Pathobiology, Massey University, Palmerston North, New Zealand
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16
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Sakai K, Maeda S, Yonezawa T, Matsuki N. Decreased plasma amino acid concentrations in cats with chronic gastrointestinal diseases and their possible contribution in the inflammatory response. Vet Immunol Immunopathol 2017; 195:1-6. [PMID: 29249312 DOI: 10.1016/j.vetimm.2017.11.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 10/27/2017] [Accepted: 11/02/2017] [Indexed: 02/01/2023]
Abstract
In humans, plasma amino acids (AAs) levels are used as dynamic nutritional markers. Moreover, some AAs are associated with chronic inflammation. In this study, we analyzed plasma AA profiles in cats with chronic gastrointestinal (GI) diseases. Eight healthy controls (HCs) and 12 client-owned cats with chronic GI diseases including chronic enteritis (n=8) and neoplasms (n=4) were recruited. Plasma albumin, total protein, and 22 AAs (11 essential and 11 non-essential AAs) levels were estimated. There was no significant difference in plasma albumin and total protein concentrations between the cats with chronic GI diseases and HCs. The plasma concentrations of 7 essential AAs (arginine, histidine, lysine, methionine, phenylalanine, taurine, and tryptophan) and 7 non-essential AAs (asparagine, aspartic acid, glutamic acid, glycine, hydroxyproline, proline, and serine) were significantly decreased in the cats with chronic GI diseases (P<0.05). Moreover, plasma histidine and tryptophan levels were inversely correlated with severity of symptoms (histidine: rs=-0.7781, P<0.005; tryptophan: rs=-0.6040, P<0.05). To examine the contribution of altered AAs levels in the inflammatory response, feline macrophages were stimulated by lipopolysaccharides (LPS) with or without histidine, and the expression of interleukin-8 (IL-8) mRNA was quantified. The expression of IL-8 mRNA was significantly increased in the LPS-stimulated feline macrophages (P<0.05). Histidine almost suppressed the LPS-induced IL-8 expression in the feline macrophages (P<0.05). Our findings suggest that plasma AAs levels are more sensitive nutritional markers than albumin and total protein levels in cats with chronic GI diseases. There is a possibility that the decrease of histidine levels in cats with GI diseases is associated with chronic inflammation.
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Affiliation(s)
- Kosei Sakai
- Department of Veterinary Clinical Pathobiology, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo, Japan
| | - Shingo Maeda
- Department of Veterinary Clinical Pathobiology, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo, Japan.
| | - Tomohiro Yonezawa
- Department of Veterinary Clinical Pathobiology, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo, Japan
| | - Naoaki Matsuki
- Department of Veterinary Clinical Pathobiology, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo, Japan
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17
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Gianella P, Pietra M, Crisi PE, Famigli Bergamini P, Fracassi F, Morini M, Boari A. Evaluation of clinicopathological features in cats with chronic gastrointestinal signs. Pol J Vet Sci 2017; 20:403-410. [PMID: 28865226 DOI: 10.1515/pjvs-2017-0052] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Food-responsive enteropathy (FRE), idiopathic inflammatory bowel disease (IBD), and alimentary tract lymphoma (AL) are often the remaining differentials for cats presenting with chronic gastrointestinal (GI) signs. Differential diagnosis is further complicated by overlapping clinicopathological features and histopathological changes, however. In this study we describe the clinical presentation of cats with chronic GI signs secondary to FRE, IBD, and AL, and evaluate possible associations between clinical, clinicopathological, ultrasonographic findings and diagnosis. The medical records of client-owned cats with chronic GI signs secondary to FRE, IBD, and AL were reviewed. Univariate and multivariate logistic regression models and receiver-operating characteristic curve (ROC) analysis were used for testing the data. Of the 56 cats included in the study, 22 were diagnosed with FRE (mean age, 70 months ± 49), 17 with IBD (mean age, 101 months ± 40), and 17 with AL (mean age, 122 months ± 45). Cats with FRE were younger and presented more often with diarrhea and less frequently with muscle wasting than cats with IBD or AL. In cats with AL, serum cobalamin levels were lower than in those with FRE or IBD (239 ± 190 ng/L vs. 762 ± 408 ng/L and 625 ± 443 ng/L, respectively) and folate levels were higher than in cats with IBD (18.2 ± 4.2 μg/L vs. 9.1 ± 4.7 μg/L, respectively). Multivariate/ROC curve analysis showed increased values of BUN (sensitivity 100, specificity 29.4, criterion >37 mg/dl) and serum folate (sensitivity 80, specificity 100, criterion >15.6 μg/L) and reduced values of cobalamin (sensitivity 100, specificity 62.5, criterion ≤540 ng/L), which suggested a diagnosis of AL versus IBD. Some clinicopathological features evaluated at diagnosis might suggest AL; however, because differentiating AL from IBD is often difficult, definitive diagnosis should be based on invasive diagnostic workup.
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18
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Jugan MC, August JR. Serum cobalamin concentrations and small intestinal ultrasound changes in 75 cats with clinical signs of gastrointestinal disease: a retrospective study. J Feline Med Surg 2016; 19:48-56. [PMID: 26239940 DOI: 10.1177/1098612x15598184] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives The aim of the study was to evaluate ultrasonographic changes in the small intestine of cats with clinical signs of gastrointestinal disease and low or low-normal serum cobalamin concentrations. Methods Records for client-owned cats presenting to the small animal hospital with signs of gastrointestinal disease and in which serum cobalamin concentrations were measured from 2000-2013 were reviewed. Inclusion criteria were cobalamin concentrations <500 ng/l, abdominal ultrasound within 1 month of cobalamin testing and definitive diagnosis. Results Of 751 serum cobalamin measurements, hypocobalaminemia or low-normal cobalamin was identified in 270 cats, abdominal ultrasound was performed in 207 of those cats and a diagnosis was available for 75 of them. Small intestinal ultrasound changes were detected in 49/75 (65%) cats. Abnormalities included thickening, loss of wall layer definition, echogenicity alterations and discrete masses. Serum cobalamin concentrations <500 ng/l were observed with diagnoses of inflammatory disease, neoplasia, infectious disease and normal histopathology. Cobalamin concentration was significantly lower in cats with lymphoma or inflammatory bowel disease compared with other gastrointestinal neoplasia ( P = 0.031). No difference was found between cobalamin concentration and the presence of ultrasound abnormalities, specific ultrasound changes or albumin concentration. Conclusions and relevance One-third of symptomatic cats with hypocobalaminemia or low-normal cobalamin concentrations may have an ultrasonographically normal small intestine. For the majority of cats in this study, histopathologic abnormalities were observed in the small intestine, regardless of ultrasound changes. These findings suggest gastrointestinal disease should not be excluded based on low-normal cobalamin concentrations, even with a concurrent normal ultrasound examination. Additional studies are needed in cats with low-normal serum cobalamin concentrations, as a definitive diagnosis was not pursued consistently in those cats. However, data from this study suggest that careful monitoring, histopathologic evaluation and future cobalamin supplementation may be warranted.
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Affiliation(s)
- Maria C Jugan
- 1 Department of Small Animal Clinical Sciences, The Ohio State University, Columbus, OH, USA
| | - John R August
- 2 Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, USA
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19
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Fragkou FC, Adamama-Moraitou KK, Poutahidis T, Prassinos NN, Kritsepi-Konstantinou M, Xenoulis PG, Steiner JM, Lidbury JA, Suchodolski JS, Rallis TS. Prevalence and Clinicopathological Features of Triaditis in a Prospective Case Series of Symptomatic and Asymptomatic Cats. J Vet Intern Med 2016; 30:1031-45. [PMID: 27296565 PMCID: PMC5089651 DOI: 10.1111/jvim.14356] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 04/26/2016] [Accepted: 05/16/2016] [Indexed: 12/25/2022] Open
Abstract
Background The term triaditis designates the concurrent presence of idiopathic inflammatory bowel disease (IBD), cholangitis, and pancreatitis in cats. Hypothesis/Objectives The histopathology of concurrent, but often subclinical, inflammatory processes in the small intestine, liver, and pancreas of cats is poorly described. We aimed to investigate the frequency of enteritis, cholangitis, pancreatitis, or some combination of these in symptomatic and asymptomatic cats, compare clinicopathological features, and correlate histopathological with laboratory findings. Animals Domestic cats (27 symptomatic, 20 asymptomatic, and 8 normal). Methods Prospective study. Physical examination, laboratory variables (CBC, serum biochemistry profile, serum thyroxine concentration, serum feline trypsin‐like immunoreactivity [fTLI], feline lipase immunoreactivity [fPLI, as measured by Spec fPL®], urinalysis, and fecal analysis), imaging, and histopathological examinations were conducted. Feline liver, pancreas, and small intestine were biopsied during laparotomy. Results Inflammatory lesions were detected in 47 cats (27 symptomatic, 20 asymptomatic). In total, 20 cats had histopathologic lesions of IBD (13/47, 27.7%), cholangitis (6/47, 12.8%), or pancreatitis (1/47, 2.1%) alone, or inflammation involving >1 organ (27/47, 57.4%). More specifically, 16/47 cats (34.0%) had concurrent lesions of IBD and cholangitis, 3/47 (6.4%) of IBD and pancreatitis, and 8/47 cats (17%) of triaditis. Triaditis was identified only in symptomatic cats (8/27, 29.6%). A mild, positive correlation was detected between the severity (score) of IBD lesions and the number of comorbidities (rho = +0.367, P = .022). Conclusions and Clinical Importance Histopathological evidence of IBD or IBD with comorbidities was detected in both symptomatic and asymptomatic cats. The possibility of triaditis should be considered in symptomatic cats with severe IBD.
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Affiliation(s)
- F C Fragkou
- Medicine Unit, Companion Animal Clinic, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - K K Adamama-Moraitou
- Medicine Unit, Companion Animal Clinic, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - T Poutahidis
- Laboratory of Pathology, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - N N Prassinos
- Surgery and Obstetrics Unit, Companion Animal Clinic, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - M Kritsepi-Konstantinou
- Diagnostic Laboratory, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - P G Xenoulis
- Gastrointestinal Laboratory, Texas A&M University, College Station, TX, USA
| | - J M Steiner
- Gastrointestinal Laboratory, Texas A&M University, College Station, TX, USA
| | - J A Lidbury
- Gastrointestinal Laboratory, Texas A&M University, College Station, TX, USA
| | - J S Suchodolski
- Gastrointestinal Laboratory, Texas A&M University, College Station, TX, USA
| | - T S Rallis
- Medicine Unit, Companion Animal Clinic, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
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20
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Grützner N, Knabe D, Lawhorn BD, Dominguez B, Kauffold J, Suchodolski JS, Steiner JM. Analytic validation of commercially available immunoassays for the measurement of serum cobalamin and folate concentrations in pigs. Vet Clin Pathol 2016; 45:311-9. [DOI: 10.1111/vcp.12361] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Niels Grützner
- Gastrointestinal Laboratory; Department of Small Animal Clinical Sciences; College of Veterinary Medicine and Biomedical Sciences; Texas A&M University; College Station TX USA
| | - Darrel Knabe
- Department of Animal Science; Texas A&M University; College Station TX USA
| | - Bruce D. Lawhorn
- Department of Veterinary Large Animal Clinical Sciences; College of Veterinary Medicine and Biomedical Sciences; Texas A&M University; College Station TX USA
| | - Brandon Dominguez
- Department of Veterinary Large Animal Clinical Sciences; College of Veterinary Medicine and Biomedical Sciences; Texas A&M University; College Station TX USA
| | - Johannes Kauffold
- New Bolton Center; School of Veterinary Medicine; University of Pennsylvania; Kennett Square PA USA
| | - Jan S. Suchodolski
- Gastrointestinal Laboratory; Department of Small Animal Clinical Sciences; College of Veterinary Medicine and Biomedical Sciences; Texas A&M University; College Station TX USA
| | - Jörg M. Steiner
- Gastrointestinal Laboratory; Department of Small Animal Clinical Sciences; College of Veterinary Medicine and Biomedical Sciences; Texas A&M University; College Station TX USA
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21
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Geesaman BM, Whitehouse WH, Viviano KR. Serum Cobalamin and Methylmalonic Acid Concentrations in Hyperthyroid Cats Before and After Radioiodine Treatment. J Vet Intern Med 2016; 30:560-5. [PMID: 26934857 PMCID: PMC4913605 DOI: 10.1111/jvim.13918] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 10/24/2015] [Accepted: 02/09/2016] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Hyperthyroidism, the most common endocrine disorder in cats, has been associated with low serum cobalamin concentrations. Whether this is a functional cobalamin deficiency of clinical importance has not been assessed. HYPOTHESIS/OBJECTIVES Cats with hyperthyroidism experience a functional cobalamin deficiency which correlates with their clinical catabolic state and is reversible with return of the euthyroid state. ANIMALS Thirty-nine client-owned hyperthyroid cats. METHODS Prospective observational study. Serum cobalamin, methylmalonic acid, and clinical scores were determined in each hyperthyroid cat at enrollment and when euthyroid (60 days after radioiodine treatment). RESULTS Five of the 39 hyperthyroid cats (13%) had a low serum cobalamin concentration ranging from <150 to 290 ng/L. Serum cobalamin concentrations normalized to >350 ng/L in 2 of the hypocobalaminemic cats once euthyroid. None of the hyperthyroid/hypocobalaminemic cats had increased serum methylmalonic acid concentrations (175-601 nmol/L). In cats with clinical and biochemical hyperthyroidism, there was no correlation between serum cobalamin concentrations with total T4 concentration (P = .12) or clinical scores including body weight (P = .11) and BCS (P = .54). CONCLUSIONS AND CLINICAL IMPORTANCE In this population of hyperthyroid cats, the prevalence of hypocobalaminemia was low. Specifically, hyperthyroid cats, in which concurrent gastrointestinal disease is unlikely. Hypocobalaminemia is not a functional deficiency requiring supplementation in hyperthyroid cats without gastrointestinal disease.
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Affiliation(s)
- B M Geesaman
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin, Madison, WI
| | - W H Whitehouse
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin, Madison, WI
| | - K R Viviano
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin, Madison, WI
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22
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Affiliation(s)
- Karin Allenspach
- Department of Clinical Sciences and Services, Royal Veterinary College, University of London, Hawkshead Lane, North Mymms, Hatfield AL9 7PT, UK.
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23
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Fat digestibility is reduced in old cats with subnormal cobalamin concentrations. J Nutr Sci 2014; 3:e62. [PMID: 26101630 PMCID: PMC4473153 DOI: 10.1017/jns.2014.59] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 09/21/2014] [Accepted: 10/15/2014] [Indexed: 12/02/2022] Open
Abstract
Fat digestibility is decreased in old cats for unknown reasons. Subclinical gastrointestinal diseases and pancreatic dysfunction, both related to ageing, can affect food digestibility. The aim of the present study was to elucidate the prevalence of subnormal cobalamin concentration and pancreatic disease in old cats and study the relationship between both markers and fat digestibility. A total of sixty-four cats without evident signs of gastrointestinal disease were included and grouped according to age: (1) fifteen middle-aged (MA), aged 3–7 years; and (2) forty-nine old, aged 10–17 years. All cats were tested for serum cobalamin, specific feline pancreatic lipase (fPL) and feline trypsin-like immunoreactivity. Then, sixteen of the old cats were selected and grouped according to cobalamin and fPL concentrations: control (normal cobalamin and fPL); low vitamin B12 (cobalamin <290 ng/l; normal fPL); and high fPL (normal cobalamin; fPL >4 µg/ml). A food digestibility trial with a high-fat diet (21·6 %) was performed. In the old group, cobalamin was lower and fPL higher than in MA cats. Of the old cats (n 49), 14 % had subnormal cobalamin, 8 % had a severe increase in fPL, 2 % had both alterations and 14 % had a slight increase in fPL. By contrast, MA cats did not have cobalamin deficiency or an increase in fPL concentrations. Fat digestibility was lower in low vitamin B12 cats than control cats. Decreased fat digestibility is not present in all old cats but could be a characteristic of subclinical chronic gastrointestinal disease. Cobalamin concentration, as a marker of gastrointestinal disease, could be useful for the routine evaluation of old cats.
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24
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Trehy MR, German AJ, Silvestrini P, Serrano G, Batchelor DJ. Hypercobalaminaemia is associated with hepatic and neoplastic disease in cats: a cross sectional study. BMC Vet Res 2014; 10:175. [PMID: 25103858 PMCID: PMC4236818 DOI: 10.1186/s12917-014-0175-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 07/22/2014] [Indexed: 11/24/2022] Open
Abstract
Background When increased serum cobalamin concentrations are encountered clinically they are usually attributed to parenteral supplementation, dietary factors, or otherwise ignored. However, recently, hypercobalaminaemia has been associated with numerous diseases in humans, most notably neoplastic and hepatic disorders. The aim of this retrospective, observational, cross-sectional study was to determine the significance of increased cobalamin in cats. Results In total, 237 records were retrieved and 174 cats, of various ages and sexes met the inclusion criteria. A total of 42 cats had increased serum cobalamin concentration, and had not received prior supplementation. Multiple logistic regression analysis revealed that increased serum cobalamin concentration was positively related to pedigree breed (pedigree breeds more likely to have increased cobalamin concentration, odds ratio [OR] 4.24, 95% CI 1.78-10.15, P = 0.001), to having liver disease (OR 9.91, 95% CI 3.54-27.68), and to having a solid neoplasm (OR 8.54, 95% CI 1.10-66.45). Conclusions The results of the current study suggest that increased serum cobalamin concentrations should not be ignored in cats with no history of supplementation, and investigation for underlying hepatic or neoplastic disease is warranted.
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Affiliation(s)
| | - Alexander J German
- School of Veterinary Science, University of Liverpool, Leahurst Campus, Chester High Road, Neston CH64 7TE, UK.
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25
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Abstract
Laboratory tests are an important part of the workup of small intestinal diseases in dogs and cats. Especially in chronic cases, when extragastrointestinal causes need to be ruled out, it is important to adhere to a systematic workup. This article details the newest available data on tests to aid this diagnostic process. Once the diagnosis of a chronic enteropathy is made, there are many laboratory tests that can help in monitoring the disease and providing prognostic information. Several new tests being evaluated for clinical usefulness are discussed.
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Affiliation(s)
- Karin Allenspach
- Department of Clinical Sciences and Services, Royal Veterinary College, University of London, Hawkshead Lane, North Mymms, Hatfield AL9 7PT, UK.
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Worhunsky P, Toulza O, Rishniw M, Berghoff N, Ruaux CG, Steiner JM, Simpson KW. The relationship of serum cobalamin to methylmalonic acid concentrations and clinical variables in cats. J Vet Intern Med 2013; 27:1056-63. [PMID: 23875847 DOI: 10.1111/jvim.12152] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 05/09/2013] [Accepted: 06/06/2013] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Serum cobalamin concentration [CBL] suggests CBL deficiency in cats but serum methylmalonic acid concentration [MMA] more accurately indicates CBL deficiency. OBJECTIVE To examine the ability of [CBL] to predict CBL deficiency defined by increased [MMA], and relationships of [CBL] and [MMA] with select clinical and clinicopathological variables. ANIMALS One hundred sixty-three client-owned cats with [CBL] measurements, 114 cats with simultaneous [MMA] measurements; 88 cats with medical information. METHODS Prospectively collected [CBL] and [MMA] were compared using scatter plots, receiver operating characteristic and correlative analyses with historical [CBL] thresholds and those identified in the study. [CBL] and [MMA] were compared retrospectively to specific clinical and clinicopathological variables. RESULTS [CBL] correlated negatively with [MMA] (τ = -0.334, P < .0001). [MMA] ≥ 1,343 nmol/L identified CBL deficiency. [CBL] = 209 pg/mL optimized sensitivity (0.51), specificity (0.96), PPV (0.89), and NPV (0.74) for detecting [MMA] ≥ 1,343 nmol/L. Prevalence of CBL deficiency was 42% (48/114) when defined by [MMA] ≥ 1,343 nmol/L versus 23% (27/114) by [CBL] ≤ 209 pg/mL. Unexpectedly, 23 and 45% of 48 cats with [MMA] ≥ 1,343 nmol/L had [CBL] > 900 pg/mL and 290 pg/mL (historical thresholds). [CBL] correlated with mean corpuscular volume (τ = -0.199, P = .013) and [MMA] with hematocrit (τ = -0.28, P = .006). CONCLUSIONS AND CLINICAL IMPORTANCE Cobalamin deficiency ([MMA] ≥ 1,343 nmol/L) occurred in 42% of cats and is predicted with high specificity by [CBL] ≤ 209 pg/mL. CBL status correlates with microcytosis and anemia. Discordance between [CBL] and [MMA] cautions against relying on any single marker for determining CBL status.
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Affiliation(s)
- P Worhunsky
- College of Veterinary Medicine, Cornell University, Ithaca, NY
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Ruaux CG. Cobalamin in companion animals: diagnostic marker, deficiency states and therapeutic implications. Vet J 2013; 196:145-52. [PMID: 23518469 DOI: 10.1016/j.tvjl.2013.01.025] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Revised: 01/08/2013] [Accepted: 01/17/2013] [Indexed: 11/16/2022]
Abstract
Measurement of the water-soluble vitamin cobalamin has long been of interest as a marker of gastrointestinal disease in companion animals due to the highly localized presence of cobalamin receptors in the ileum. An increasing body of evidence suggests that cobalamin deficiency is an important co-morbidity in many companion animal patients with gastrointestinal and pancreatic disease. Congenital disorders of cobalamin absorption and cellular metabolism are also increasingly recognized in companion animal breeds. The early recognition of these disorders and timely treatment with parenteral cobalamin can be life-saving. In this article, the normal mechanisms of cobalamin absorption, the use of cobalamin as a marker of intestinal disease and data on the prevalence of hypocobalaminemia in a variety of diseases are described. The prognostic impact of and rational therapy for hypocobalaminemia in domestic animals are discussed.
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Affiliation(s)
- C G Ruaux
- Department of Clinical Sciences, Oregon State University, College of Veterinary Medicine, Corvallis, OR 97331, USA.
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Abstract
Practical relevance: Feline idiopathic inflammatory bowel disease (IBD) denotes one form of chronic enteropathy that is immunologically mediated and characterized by persistent or recurrent gastrointestinal (GI) signs and histologic inflammation. Signs of vomiting, diarrhea and weight loss generally predominate, and mucosal inflammation may occur in any portion of the GI tract (especially the small intestine). Affected cats may also have concurrent inflammation in other organs, such as the pancreas and liver, which may impact clinical disease severity. Clinical challenges: The exact etiologies of this heterogeneous group of disorders have yet to be determined, though results from basic science and clinical studies suggest that interplay between genetic factors and enteric bacteria is crucial for disease development. The diagnosis is one of exclusion and requires intestinal mucosal biopsy to characterize the type and severity of the inflammatory infiltrate, and to differentiate IBD from other disorders, including alimentary lymphoma. Controversy exists concerning the relative diagnostic accuracy of endoscopic versus full-thickness specimens for the diagnosis of IBD and its differentiation from alimentary lymphoma. Audience: This article is intended to provide veterinary practitioners with a comprehensive clinical update on idiopathic IBD in cats. It reviews the current evidence-based data, the diagnostic approach, the evolving histologic criteria, and treatment options and outcome for feline patients with this syndrome.
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Affiliation(s)
- Albert E Jergens
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, IA 50011, USA
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Maunder CL, Day MJ, Hibbert A, Steiner JM, Suchodolski JS, Hall EJ. Serum cobalamin concentrations in cats with gastrointestinal signs: correlation with histopathological findings and duration of clinical signs. J Feline Med Surg 2012; 14:686-93. [DOI: 10.1177/1098612x12447730] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aims of this study were to investigate the prevalence of hypocobalaminaemia in UK cats presented for referral investigation of gastrointestinal signs and to ascertain whether the duration of clinical signs or severity of disease (based on WSAVA Gastrointestinal Standardization histopathological grading) related to cobalamin concentration. The study population comprised 39 cats, of which 11 (28.2%) had hypocobalaminaemia. Eight of these cats were diagnosed with a single cause of gastrointestinal signs: intestinal inflammation (five); alimentary lymphoma (two); and cholangitis (one). Two or more concurrent diseases were diagnosed in the three remaining cases. Alimentary lymphoma and the most severe grade of histological intestinal inflammation were associated most commonly with concurrent hypocobalaminaemia, but there was no statistically significant correlation between serum cobalamin concentrations and histopathological score or duration of clinical signs.
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Affiliation(s)
- Christina L Maunder
- Department of Clinical Veterinary Science, Division of Companion Animal Studies, Small Animal Hospital, University of Bristol, Bristol, UK
| | - Michael J Day
- Department of Clinical Veterinary Science, Division of Companion Animal Studies, Small Animal Hospital, University of Bristol, Bristol, UK
| | - Angie Hibbert
- Department of Clinical Veterinary Science, Division of Companion Animal Studies, Small Animal Hospital, University of Bristol, Bristol, UK
| | - Jörg M Steiner
- Department of Pathology, Infection and Immunity, University of Bristol, Bristol, UK
| | - Jan S Suchodolski
- Gastrointestinal Laboratory, Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, A&M University, Texas, TX, USA
| | - Edward J Hall
- Department of Clinical Veterinary Science, Division of Companion Animal Studies, Small Animal Hospital, University of Bristol, Bristol, UK
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Laflamme DP, Xu H, Cupp CJ, Kerr WW, Ramadan Z, Long GM. Evaluation of canned therapeutic diets for the management of cats with naturally occurring chronic diarrhea. J Feline Med Surg 2012; 14:669-77. [PMID: 22577048 DOI: 10.1177/1098612x12446906] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Dietary therapy plays an important role in the management of most gastrointestinal disorders. This study was designed to test the efficacy of a new therapeutic diet for cats with diarrhea, compared to the top selling brand. Sixteen adult cats with chronic diarrhea were grouped and assigned to diet X (Hill's Prescription Diet i/d Feline) or diet Y (Purina Veterinary Diets EN Gastroenteric Feline Formula). Following baseline evaluations, cats were fed their assigned test diet for 4 weeks. Fecal scores (FS; 7=very watery; 1=extremely dry and firm) were recorded daily during the last week on each diet. Each cat was then switched to the alternate test diet and the procedure was repeated. Fifteen cats completed the study. Both therapeutic diets resulted in a significant improvement in average FS and diet Y also resulted in significantly better results compared with diet X. Average FS improved at least one unit in 40% of the cats while fed diet X and in 67% of the cats while fed diet Y, resulting in normal stools (average FS≤3) in 13.3% of cats fed diet X and 46.7% of cats fed diet Y. This study confirms the value of dietary change in the management of chronic diarrhea in cats.
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Taylor AR, Barr JW, Hokamp JA, Johnson MC, Young BD. Cytologic Diagnosis of Disseminated Histoplasmosis in the Wall of the Urinary Bladder of a Cat. J Am Anim Hosp Assoc 2012; 48:203-8. [DOI: 10.5326/jaaha-ms-5735] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A 10 yr old domestic longhair presented with a 2.5 mo history of recurrent hematuria. Abdominal ultrasound examination demonstrated a thickened urinary bladder, abdominal lymphadenopathy, and a thickened and rounded spleen. Cytologic examination of fine-needle aspirate samples revealed Histoplasma capsulatum organisms in the urinary bladder wall and spleen. The cat was treated with itraconazole (10 mg/kg per os q 24 hr for 2.5 wk). The cat was euthanized after 19 days of treatment because of lack of improvement. To the authors’ knowledge, this is the first documented case of feline disseminated histoplasmosis diagnosed in the urinary bladder wall.
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Affiliation(s)
- Amanda R. Taylor
- James L. Voss Veterinary Teaching Hospital, Colorado State University, Fort Collins, CO (A.T.); and Veterinary Teaching Hospital, Texas A&M University, College Station, TX (J.B., J.H., M.J., B.Y.)
| | - James W. Barr
- James L. Voss Veterinary Teaching Hospital, Colorado State University, Fort Collins, CO (A.T.); and Veterinary Teaching Hospital, Texas A&M University, College Station, TX (J.B., J.H., M.J., B.Y.)
| | - Jessica A. Hokamp
- James L. Voss Veterinary Teaching Hospital, Colorado State University, Fort Collins, CO (A.T.); and Veterinary Teaching Hospital, Texas A&M University, College Station, TX (J.B., J.H., M.J., B.Y.)
| | - Mark C. Johnson
- James L. Voss Veterinary Teaching Hospital, Colorado State University, Fort Collins, CO (A.T.); and Veterinary Teaching Hospital, Texas A&M University, College Station, TX (J.B., J.H., M.J., B.Y.)
| | - Benjamin D. Young
- James L. Voss Veterinary Teaching Hospital, Colorado State University, Fort Collins, CO (A.T.); and Veterinary Teaching Hospital, Texas A&M University, College Station, TX (J.B., J.H., M.J., B.Y.)
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Simpson K, Battersby I, Lowrie M. Suspected acquired hypocobalaminaemic encephalopathy in a cat: resolution of encephalopathic signs and MRI lesions subsequent to cobalamin supplementation. J Feline Med Surg 2012; 14:350-5. [DOI: 10.1177/1098612x12439358] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Presenting signs and initial investigations: An 8-year-old female spayed British shorthair cat was presented with a history of waxing and waning neurological signs. Neuroanatomical localisation was consistent with a diffuse forebrain disease. Blood ammonia concentration was increased. Abdominal ultrasonography and a bile acid stimulation test were normal. Magnetic resonance imaging (MRI) revealed hyperintense, bilaterally symmetrical, diffuse lesions on T2-weighted sequences, predominantly, but not exclusively, affecting the grey matter. Serum cobalamin (vitamin B12) concentration was low. Hypocobalaminaemia resulting in a urea cycle abnormality was considered a likely cause of the hyperammonaemia. Treatment: Daily cobalamin injections resulted in a rapid clinical improvement. Eight weeks into treatment neurological examination was unremarkable and there was complete resolution of the MRI lesions. Clinical importance: This is the first reported case of acquired feline hypocobalaminaemia resulting in an encephalopathy. Additionally, this case is unique in describing reversible brain MRI abnormalities in a cobalamin-deficient companion animal.
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Affiliation(s)
- Katherine Simpson
- Davies Veterinary Specialists, Manor Farm Business Park, Higham Gobion, Hitchin SG5 3HR, UK
| | - Ian Battersby
- Davies Veterinary Specialists, Manor Farm Business Park, Higham Gobion, Hitchin SG5 3HR, UK
| | - Mark Lowrie
- Davies Veterinary Specialists, Manor Farm Business Park, Higham Gobion, Hitchin SG5 3HR, UK
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Digestive System, Liver, and Abdominal Cavity. THE CAT 2012. [PMCID: PMC7158306 DOI: 10.1016/b978-1-4377-0660-4.00023-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Dossin O. Laboratory tests for diagnosis of gastrointestinal and pancreatic diseases. Top Companion Anim Med 2011; 26:86-97. [PMID: 21596348 PMCID: PMC7104967 DOI: 10.1053/j.tcam.2011.02.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Accepted: 02/28/2011] [Indexed: 11/11/2022]
Abstract
The panel of laboratory tests available for diagnosis of gastrointestinal (GI) diseases in dogs and cats is wide, and, recently, several new tests have been developed. This article will focus on advances in laboratory tests that are available for the general practitioner for diagnosis of GI diseases. Laboratory tests for diagnosis of gastric and intestinal infectious diseases include fecal parasite screening tests, enzyme-linked immunosorbent assays for parvoviral enteritis, and some specific bacterial tests like fluorescent in situ hybridization for identification of specific bacteria attached to the intestinal epithelial cells. Serum concentrations of folate and cobalamin are markers of intestinal absorption, but are also changed in exocrine pancreatic insufficiency and intestinal bacterial overgrowth. Hypocobalaminemia is common in GI and pancreatic disease. Decreased serum trypsin-like immunoreactivity is a very sensitive and specific test for the diagnosis of exocrine pancreatic insufficiency in dogs and cats. Serum pancreatic lipase is currently the most sensitive and specific test to identify pancreatic cell damage and acute pancreatitis. However, serum canine pancreas-specific lipase is less sensitive in canine chronic pancreatitis. Increased serum trypsin-like immunoreactivity is also specific for pancreatic damage but is less sensitive. It is very likely that further studies will help to better specify the role of these new tests in the diagnosis of canine and feline pancreatic diseases.
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Affiliation(s)
- Olivier Dossin
- Internal Medicine, Department of Clinical Sciences, National Veterinary School, Toulouse, France.
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35
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Laflamme DP, Xu H, Long GM. Effect of diets differing in fat content on chronic diarrhea in cats. J Vet Intern Med 2011; 25:230-5. [PMID: 21281349 DOI: 10.1111/j.1939-1676.2010.0665.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Fat-restricted diets have been advocated for dogs with diarrhea for many years. Recommendations for cats with diarrhea have varied between low-fat and high-fat diets, but there have been no published studies to support either recommendation. OBJECTIVES The objective of this study was to compare the clinical responses of cats with chronic diarrhea to dietary management using either a high fat or a low fat, highly digestible diet. ANIMALS Sixty pet cats with chronic diarrhea were recruited; 55 cats completed the study. METHODS Randomized, double-blinded, controlled clinical trial. Upon completion of baseline measures, cats were fed 1 of 2 diets for 6 weeks, during which the owners recorded fecal scores daily using an illustrated fecal score chart ranging from 0 (very watery) to 100 (firm and dry). After 6 weeks, cats were reevaluated by the attending veterinarians. RESULTS Fecal scores improved significantly, with 78.2% of cats improving by at least 25 points on the 100-point scale or having a final fecal score of at least 66. Over one third of the cats developed normal stools. There were no differences in clinical responses between the diets. Clinical improvement was noted within the 1st week, and maximized within 3 weeks. CONCLUSIONS AND CLINICAL IMPORTANCE These results show that dietary management can be helpful in cats with chronic diarrhea, but dietary fat content does not appear to affect the outcome. Cats that do not respond within 3 weeks should be evaluated further.
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Affiliation(s)
- D P Laflamme
- Nestlé Purina PetCare Research, St Louis, MO, USA.
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36
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Cook AK, Suchodolski JS, Steiner JM, Robertson JE. The prevalence of hypocobalaminaemia in cats with spontaneous hyperthyroidism. J Small Anim Pract 2011; 52:101-6. [DOI: 10.1111/j.1748-5827.2010.01027.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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37
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Thompson KA, Parnell NK, Hohenhaus AE, Moore GE, Rondeau MP. Feline exocrine pancreatic insufficiency: 16 cases (1992–2007)⋆. J Feline Med Surg 2009; 11:935-40. [PMID: 19553151 DOI: 10.1016/j.jfms.2009.04.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2009] [Indexed: 10/20/2022]
Abstract
Medical records of 16 cats diagnosed with exocrine pancreatic insufficiency (EPI) were reviewed. The diagnosis was confirmed with either a serum feline trypsin-like immunoreactivity (fTLI) concentration ≤12 μg/l or a fecal proteolytic activity (FPA) <6 mm for three consecutive days. The majority of cats were castrated male domestic shorthairs. The median age of cats affected was 7 years. The most common clinical sign was weight loss followed by diarrhea, polyphagia and vomiting. Concurrent disease was present in 10/16 (63%) cats. The most common laboratory abnormalities were normocytic normochromic anemia, lymphopenia, neutrophilia, increased alanine transferase activity, hyperglycemia and increased bilirubin concentrations. All 10 cats that were tested for serum cobalamin levels were found to be deficient. All 10 cats that were tested for serum folate concentrations had normal or increased levels. Ten out of 11 cats had at least a partial response to treatment. All cats were discharged from the hospital alive. Results suggest that EPI should be considered a differential diagnosis in any cat with weight loss or poor growth after more common diseases have been ruled out. Concurrent disease is common in feline EPI. Cobalamin deficiency is common in cats with EPI and cats should receive cobalamin supplementation to improve response to treatment. Cats in this study had a good prognosis.
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Affiliation(s)
- Kelley A. Thompson
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Purdue University, West Lafayette, IN 47907–2026, USA
| | - Nolie K. Parnell
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Purdue University, West Lafayette, IN 47907–2026, USA
| | - Ann E. Hohenhaus
- Department of Medicine, The Bobst Hospital, The Animal Medical Center, 510 E 62nd Street, New York, NY 10021–8302, USA
| | - George E. Moore
- Comparative Pathobiology, School of Veterinary Medicine, Purdue University, West Lafayette, IN 47907–2026, USA
| | - Mark P. Rondeau
- Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104–6010, USA
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Barron PM, Mackie JT, Evans NA, Langer N. Serum cobalamin concentrations in healthy cats and cats with non-alimentary tract illness in Australia. Aust Vet J 2009; 87:280-3. [PMID: 19573153 DOI: 10.1111/j.1751-0813.2009.00449.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine a reference range for serum cobalamin concentration in healthy cats in Australia using a chemiluminescent enzyme immunoassay and to prospectively investigate the prevalence of hypocobalaminaemia in cats with non-alimentary tract disease. DESIGN Prospective study measuring serum cobalamin concentrations in clinically healthy cats and cats with non-alimentary tract illness. PROCEDURE Blood was collected from 50 clinically healthy cats that were owned by staff and associates of Veterinary Specialist Services or were owned animals presented to Creek Road Cat Clinic for routine vaccination. Blood was collected from 47 cats with non-alimentary tract illness presented at either clinic. Serum cobalamin concentration was determined for each group using a chemiluminescent enzyme immunoassay. RESULTS A reference range for Australian cats calculated using the central 95th percentile in the 50 clinically healthy cats was 345 to 3668 pg/mL. Median serum cobalamin concentration in 47 cats with non-alimentary tract illness (1186 pg/mL; range 117-3480) was not significantly different to the median serum cobalamin of the 50 healthy cats (1213 pg/mL, range 311-3688). Using the calculated reference range one sick cat with non-alimentary tract illness had a markedly low serum cobalamin concentration. CONCLUSION Although hypocobalaminaemia is uncommon in sick cats with non-alimentary tract illness in Australia, its occurrence in this study warrants further investigation.
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Affiliation(s)
- P M Barron
- Veterinary Specialist Services, Shop 14, Hometown, Cnr Lexington and Logan Rd, Underwood, Queensland 4119, Australia.
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Caney S. Weight Loss in the Elderly Cat: Appetite is Fine, and Everything Looks Normal …. J Feline Med Surg 2009; 11:738-46. [DOI: 10.1016/j.jfms.2009.07.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Practical relevance Improvements in general health care and nutrition have meant that more cats are living to an advanced age. Weight loss is one of the most common presenting signs in the older cat. Many causes of weight loss in older cats are at least amenable to supportive care and some are curable. Clinical challenges Weight loss is a non-specific change and, while often a sensitive indicator of ill health, does not readily point to the diagnosis. Careful history taking and physical examination may indicate a specific cause but, as discussed in this article, further tests are generally required to confirm the diagnosis. In those cats where common causes of weight loss have been eliminated by initial tests, it is often harder to reach a diagnosis. A logical approach to case-solving is required, making use of imaging and advanced laboratory tests. Occult gastrointestinal disease should be suspected and investigated in cats where another cause of weight loss cannot be found. Patient group While the average lifespan of a pet cat is probably around 13–14 years, many will live longer than this if well cared for, and some considerably longer. Recently, the life stages have been redefined to help predict the changes that might be occurring in terms of a cat's physical and mental health. Cats are considered ‘senior’ at 11–14 years old and ‘geriatric’ at 15 years and above. Audience Geriatric medicine is forming an increasing part of the case load of first opinion and many referral veterinarians. Weight loss is common in older cats and is often the result of several, sometimes interacting, conditions.
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Affiliation(s)
- Sarah Caney
- Cat Professional Ltd, Midlothian Innovation Centre, Pentlandfield, Roslin EH25 9RE, UK
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Ruaux CG, Steiner JM, Williams DA. Relationships between low serum cobalamin concentrations and methlymalonic acidemia in cats. J Vet Intern Med 2009; 23:472-5. [PMID: 19422473 DOI: 10.1111/j.1939-1676.2009.0308.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Serum cobalamin concentrations below reference range are a common consequence of gastrointestinal disease in cats. Serum cobalamin <or= 100 ng/L is associated with methylmalonic acidemia. OBJECTIVES To determine the prevalence of cobalamin deficiency, defined by elevated serum methylmalonic acid (MMA), in cats with serum cobalamin <or= 290 ng/L, and the optimum serum cobalamin concentration to predict cobalamin deficiency in cats. SAMPLE SET: Residual serum samples (n = 206) from cats with serum cobalamin <or= 290 ng/L. METHODS Retrospective, observational study. Serum cobalamin and folate were measured with automated assays. Serum MMA was determined by gas chromatography-mass spectrometry. Cobalamin deficiency was defined as serum MMA > 867 nmol/L. Sensitivity and specificity of serum cobalamin concentrations <or=290 ng/L for detecting MMA > 867 nmol/L were analyzed using a receiver-operator characteristic curve. RESULTS There was a negative correlation between serum cobalamin and MMA concentrations (Spearman's r=-0.74, P < 0.0001). The prevalence of MMA >or= 867 nmol/L in cats with serum cobalamin <or= 290 ng/L was 68.4%. Serum cobalamin <or= 160 ng/L had a 74% sensitivity and 80% specificity for detecting MMA > 867 nmol/L. No significant difference in serum folate concentrations was detected between affected and unaffected cats. CONCLUSIONS AND CLINICAL IMPORTANCE Elevated MMA concentrations, suggesting cobalamin deficiency, are common in cats with serum cobalamin <or= 290 ng/L. Cobalamin deficiency is clinically significant, and supplementation with parenteral cobalamin is recommended for cats with gastrointestinal disease and low serum cobalamin concentrations.
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Affiliation(s)
- C G Ruaux
- Gastrointestinal Laboratory, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, USA.
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Trepanier L. Idiopathic Inflammatory Bowel Disease in Cats: Rational Treatment Selection. J Feline Med Surg 2009; 11:32-8. [DOI: 10.1016/j.jfms.2008.11.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Practical relevance Inflammatory bowel disease (IBD) is a common diagnosis in cats with chronic gastrointestinal signs. Its management presents clinical challenges, not least because rational therapy relies on a definitive diagnosis, and current understanding of the underlying pathogenesis has, to date, limited the development of specific therapies. The mainstays of treatment remain dietary manipulation and immunosuppressive therapy, but treatment failures are not uncommon. A logical clinical approach is important and there are a number of alternative or adjunctive treatments that can prove useful in refractory cases. Evidence base This article draws on data from clinical trials in humans, in vitro studies, prospective and retrospective studies in cats with naturally occurring IBD, and clinical experience to discuss the work-up and treatment selection for cats with idiopathic IBD. Patient group IBD affects young adult to geriatric cats of both sexes. Audience Companion animal and feline practitioners are at the front line when it comes to managing these often challenging cases.
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Affiliation(s)
- Lauren Trepanier
- University of Wisconsin-Madison, School of Veterinary Medicine, 2015 Linden Drive, Madison, WI, USA
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