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Sänger F, Dörfelt S, Giani B, Buhmann G, Fischer A, Dörfelt R. Successful Emergency Management of a Dog with Ventilator-Dependent Acquired Myasthenia Gravis with Immunoadsorption. Animals (Basel) 2023; 14:33. [PMID: 38200764 PMCID: PMC10778221 DOI: 10.3390/ani14010033] [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: 10/31/2023] [Revised: 12/13/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024] Open
Abstract
A one-year-old, female intact Samoyed, 12.5 kg, was presented with coughing for 2 weeks, progressive appendicular and axial muscle weakness, megaesophagus and labored breathing for 5 days. There was no improvement with standard treatment. Acquired myasthenia gravis was suspected and the dog was referred with increasing dyspnea. At presentation, the dog showed a severely reduced general condition, was non-ambulatory and showed abdominal and severely labored breathing. A marked hypercapnia (PvCO2 = 90.1 mmHg) was present in venous blood gas analysis. The serum anti-acetylcholine receptor antibody test was consistent with acquired myasthenia gravis (2.1 nmol/L). The dog was anesthetized with propofol and mechanically ventilated with a Hamilton C1 ventilator. Immunoadsorption was performed with the COM.TEC® and ADAsorb® platforms and a LIGASORB® adsorber to eliminate anti-acetylcholine receptor antibodies. Local anticoagulation was performed with citrate. Treatment time for immunoadsorption was 1.5 h with a blood flow of 50 mL/min. A total plasma volume of 1.2 L was processed. Further medical treatment included intravenous fluid therapy, maropitant, esomeprazole, antibiotic therapy for aspiration pneumonia and neostigmine 0.04 mg/kg intramuscularly every 6 h for treatment of acquired myasthenia gravis. Mechanical ventilation was stopped after 12 h. A percutaneous gastric feeding tube was inserted under endoscopic control on day 2 for further medical treatment and nutrition. A second treatment with immunoadsorption was performed on day 3. Again, a total plasma volume of 1.2 L was processed. Immediately after this procedure, the dog regained muscle strength and was able to stand and to walk. After 6 days, the dog was discharged from the hospital. This is the first report of immunoadsorption for emergency management of a dog with acute-fulminant acquired myasthenia gravis. Immunoadsorption may be an additional option for emergency treatment in dogs with severe signs of acquired myasthenia gravis.
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Affiliation(s)
- Florian Sänger
- LMU Small Animal Clinic, Centre for Clinical Veterinary Medicine, Faculty of Veterinary Medicine, Ludwig-Maximilians-Universität München, 80539 Munich, Germany; (F.S.); (B.G.); (G.B.); (A.F.)
| | | | - Bettina Giani
- LMU Small Animal Clinic, Centre for Clinical Veterinary Medicine, Faculty of Veterinary Medicine, Ludwig-Maximilians-Universität München, 80539 Munich, Germany; (F.S.); (B.G.); (G.B.); (A.F.)
| | - Gesine Buhmann
- LMU Small Animal Clinic, Centre for Clinical Veterinary Medicine, Faculty of Veterinary Medicine, Ludwig-Maximilians-Universität München, 80539 Munich, Germany; (F.S.); (B.G.); (G.B.); (A.F.)
| | - Andrea Fischer
- LMU Small Animal Clinic, Centre for Clinical Veterinary Medicine, Faculty of Veterinary Medicine, Ludwig-Maximilians-Universität München, 80539 Munich, Germany; (F.S.); (B.G.); (G.B.); (A.F.)
| | - René Dörfelt
- LMU Small Animal Clinic, Centre for Clinical Veterinary Medicine, Faculty of Veterinary Medicine, Ludwig-Maximilians-Universität München, 80539 Munich, Germany; (F.S.); (B.G.); (G.B.); (A.F.)
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Ji Y, Yang Y, Wu Z. Programming of metabolic and autoimmune diseases in canine and feline: linkage to the gut microbiome. Microb Pathog 2023; 185:106436. [PMID: 37913827 DOI: 10.1016/j.micpath.2023.106436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/26/2023] [Accepted: 10/28/2023] [Indexed: 11/03/2023]
Abstract
Metabolic and autoimmune disorders have long represented challenging health problems because of their growing prevalence in companion animals. The gut microbiome, made up of trillions of microorganisms, is implicated in multiple physiological and pathological processes. Similar to human beings, the complicated microbiome harbored in the gut of canines and felines emerges as a key factor determining a wide range of normal and disease conditions. Evidence accumulated from recent findings on canine and feline research uncovered that the gut microbiome is actively involved in host metabolism and immunity. Notably, the composition, abundance, activity, and metabolites of the gut microbiome are all elements that shape clinical outcomes concerning metabolism and immune function. This review highlights the implications of the gut microbiome for metabolic disorders (obesity, diabetes, and hepatic lipidosis) and autoimmune diseases (inflammatory bowel disease, osteoarthritis, asthma, and myasthenia gravis) in canine and feline animals, providing novel strategies and therapeutic targets for the prevention and treatment of pet diseases.
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Affiliation(s)
- Yun Ji
- State Key Laboratory of Animal Nutrition and Feeding, China Agricultural University, Beijing, 100193, China.
| | - Ying Yang
- State Key Laboratory of Animal Nutrition and Feeding, China Agricultural University, Beijing, 100193, China
| | - Zhenlong Wu
- State Key Laboratory of Animal Nutrition and Feeding, China Agricultural University, Beijing, 100193, China
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Guzman KMH, Harkin K. Suspected Fluoroquinolone-Induced Exacerbation of Myasthenia Gravis in Dogs. J Am Anim Hosp Assoc 2023; 59:249-254. [PMID: 37708471 DOI: 10.5326/jaaha-ms-7353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2023] [Indexed: 09/16/2023]
Abstract
Acquired myasthenia gravis (MG) in dogs can present with focal or generalized weakness and is diagnosed by the presence of circulating antibodies to the acetylcholine receptor. Megaesophagus is the most common focal form of MG. Although exacerbation of MG has been associated with the use of fluoroquinolones in humans, it has not been previously described in dogs. The medical records of 46 dogs diagnosed with MG based on acetylcholine receptor antibody testing from 1997 to 2021 were retrospectively evaluated to identify any dogs who demonstrated exacerbation of MG after the administration of a fluoroquinolone. Exacerbation of MG, from focal to generalized, occurred in a median of 4.5 days after initiation of fluoroquinolone therapy in six dogs. In addition, one dog with generalized MG and megaesophagus developed pyridostigmine resistance subsequent to fluoroquinolone therapy. Marked improvement in generalized weakness was reported 36 hr after discontinuation of fluoroquinolone therapy alone in one dog and in combination with pyridostigmine in two dogs. Fluoroquinolone therapy was never stopped in three dogs who were euthanized because of severe weakness and one dog who died of respiratory arrest.
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Affiliation(s)
- Karen Marina Hernandez Guzman
- From Ryan Veterinary Hospital, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (K.M.H.G.); and
| | - Kenneth Harkin
- Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan, Kansas (K.H.)
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Mignan T, White R, Stee K, Bonanno G, Targett M, Lowrie M. Case report: Immune remission from generalized myasthenia gravis in a dog with a thymoma and cholangiocellular carcinoma. Front Vet Sci 2023; 10:1124702. [PMID: 37008354 PMCID: PMC10063851 DOI: 10.3389/fvets.2023.1124702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 02/24/2023] [Indexed: 03/19/2023] Open
Abstract
A 9-year-old male neutered Cockapoo was presented with an acute and progressive history of exercise induced weakness involving all limbs, and bilateral decreased ability to blink. Investigations revealed generalized myasthenia gravis alongside the presence of a thymoma and a cholangiocellular carcinoma. Symptomatic treatment through pyridostigmine bromide was used to control clinical signs, and complete surgical removal of the thymoma and cholangiocellular carcinoma was performed. Serum acetylcholine receptor antibody concentration was measured serially. Clinical remission defined as resolution of clinical signs alongside discontinuation of treatment was achieved by day 251 (8.2 months). Immune remission defined as normalization of serum acetylcholine receptor antibody concentration alongside resolution of clinical signs and discontinuation of treatment was achieved by day 566 (18.5 months). Neurological examination was normal, and the owners did not report any clinical deterioration during the final follow-up appointment on day 752 (24 months), hence outcome was considered excellent. This is the first report describing the temporal evolution of serum acetylcholine receptor antibody concentration in a dog with thymoma-associated myasthenia gravis which achieved immune remission following thymectomy. Treatment was successfully discontinued without any evidence of clinical deterioration thereafter despite serum acetylcholine receptor antibody concentration not normalizing for another 315 days (10 months).
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Affiliation(s)
- Thomas Mignan
- Dovecote Veterinary Hospital, CVS Group PLC, Castle Donington, United Kingdom
- School of Veterinary Medicine and Science, The University of Nottingham, Sutton Bonington, United Kingdom
- *Correspondence: Thomas Mignan
| | - Robert White
- School of Veterinary Medicine and Science, The University of Nottingham, Sutton Bonington, United Kingdom
| | - Kimberley Stee
- Dovecote Veterinary Hospital, CVS Group PLC, Castle Donington, United Kingdom
| | - Giuseppe Bonanno
- Dovecote Veterinary Hospital, CVS Group PLC, Castle Donington, United Kingdom
| | - Mike Targett
- School of Veterinary Medicine and Science, The University of Nottingham, Sutton Bonington, United Kingdom
| | - Mark Lowrie
- Dovecote Veterinary Hospital, CVS Group PLC, Castle Donington, United Kingdom
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Žnidaršič N, Štrbenc M, Grgurevič N, Snoj T. Potential revival of cholinesterase inhibitors as drugs in veterinary medicine. Front Vet Sci 2023; 10:1125618. [PMID: 36937006 PMCID: PMC10019356 DOI: 10.3389/fvets.2023.1125618] [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: 12/16/2022] [Accepted: 02/13/2023] [Indexed: 03/06/2023] Open
Abstract
The cholinergic system is involved in the regulation of all organ systems and has acetylcholine (ACh) as almost its only neurotransmitter. Any substance is called cholinergic if it can alter the action of acetylcholine. Cholinesterases (ChEs) are enzymes that enable the hydrolysis of acetylcholine and in this way ensure homeostasis in cholinergic synapses. Cholinesterase inhibitors (ChEi) are a group of indirect-acting cholinergic agonists that influence the activity of the cholinergic system. Several compounds that can inhibit cholinesterases are of importance to veterinary medicine from pharmacological and toxicological perspective. The frequency of their use in veterinary medicine has fluctuated over the years and is now reduced to a minimum. They are mainly used in agriculture as pesticides, and some are rarely used as parasiticides for companion animals and livestock. In recent years, interest in the use of new cholinesterase inhibitors has increased since canine cognitive dysfunction (CCD) became a recognized and extensively studied disease. Similar to Alzheimer's disease (AD) in humans, CCD can be treated with cholinesterase inhibitors that cross the blood-brain barrier. In this review, the mammalian cholinergic system and the drugs that interact with cholinesterases are introduced. Cholinesterase inhibitors that can be used for the treatment of CCD are described in detail.
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Perillo R, Menchetti M, Giannuzzi PA, Marchiori A, Rondena M, Gasparini S. Acquired myasthenia gravis with concurrent polymyositis and myocarditis secondary to a thymoma in a dog. Open Vet J 2021; 11:436-440. [PMID: 34722208 PMCID: PMC8541714 DOI: 10.5455/ovj.2021.v11.i3.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 08/02/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Canine thymomas are associated with multiple paraneoplastic syndromes, among which myasthenia gravis (MG) is the most common. Acquired MG is an autoimmune disease characterized by the presence of antibodies against acetylcholine receptors (ACHRs). ACHRs antibodies are the most commonly formed, but the production of antistriational antibodies binding to skeletal and cardiac muscle proteins has also been recorded both in humans and dogs. An association between the occurrence of antistriational antibodies and a severe form of myocarditis, giant cell myocarditis, has been described in humans. Case Description: A 4-year-old mixed-breed dog was referred because of 1 month history of exercise-induced weakness, hypersalivation, and regurgitation. The neurologic examination was indicative of a neuromuscular junction disease, and MG was suspected. A computed tomographic scan examination showed the presence of a megaoesophagus and a thymic mass. Serum antibodies against ACHRs confirmed the diagnosis of MG. Treatment with pyridostigmine was started, and the thymic mass was surgically excised, and a diagnosis of thymoma was confirmed by histology. 24 hours after surgery, the dog developed a third-degree atrioventricular block. Severe arrhythmia and increased troponin serum levels suggested myocarditis which rapidly led to cardiopulmonary arrest. Histopathologic examination of the heart, esophagus and diaphragm revealed a lymphocytic and macrophagic infiltration, consistent with myocarditis and polymyositis. Scattered rare giant multinucleated cells were also detected in the myocardium. Conclusion: To the author’s knowledge, this is the first report of thymoma-associated MG with concurrent polymyositis and giant cell-like myocarditis in a dog.
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Affiliation(s)
- Raffaella Perillo
- San Marco Veterinary Clinic and Laboratory, Neurology and Neurosurgery Division, Veggiano (PD), Italy
| | - Marika Menchetti
- San Marco Veterinary Clinic and Laboratory, Neurology and Neurosurgery Division, Veggiano (PD), Italy
| | - Pasquale A Giannuzzi
- San Marco Veterinary Clinic and Laboratory, Neurology and Neurosurgery Division, Veggiano (PD), Italy
| | - Angela Marchiori
- San Marco Veterinary Clinic and Laboratory, Oncology Division, Veggiano (PD), Italy
| | - Marco Rondena
- San Marco Veterinary Clinic and Laboratory, Pathology Division Veggiano (PD), Italy
| | - Stefania Gasparini
- San Marco Veterinary Clinic and Laboratory, Pathology Division Veggiano (PD), Italy
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Forgash JT, Chang YM, Mittelman NS, Petesch S, Benedicenti L, Galban E, Hammond JJ, Glass EN, Barker JR, Shelton GD, Luo J, Garden OA. Clinical features and outcome of acquired myasthenia gravis in 94 dogs. J Vet Intern Med 2021; 35:2315-2326. [PMID: 34331481 PMCID: PMC8478050 DOI: 10.1111/jvim.16223] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 06/25/2021] [Accepted: 07/12/2021] [Indexed: 12/22/2022] Open
Abstract
Background Factors known to be associated with outcome of acquired myasthenia gravis (MG) in dogs are limited. Hypothesis/Objectives Of dogs with MG, advancing age and comorbid neoplasia are associated with poor long‐term prognosis and low rates of remission. Animals Ninety‐four client‐owned dogs with MG diagnosed by acetylcholine receptor antibody (AChR Ab) assay between 2001 and 2019 from a university clinic and 3 private clinics in the United States. Methods Cases were retrospectively evaluated and data were collected to determine clinical signs, treatment, and response to therapy defined by means of a clinical scoring rubric. Immunological remission was defined as a return of the AChR Ab concentration to <0.6 nmol/L. Multivariable binary logistic regression analysis was used to identify clinical criteria predicting remission. Results An anticholinesterase drug was used to treat 90/94 (96%) dogs, which in 63/94 (67%) was the sole treatment; other drugs included immune modulators. Clinical remission (lack of clinical signs ≥4 weeks after treatment cessation) was observed in 29 (31% [95% confidence interval (CI): 22.4‐40.8%]) dogs, clinical response (lack of clinical signs on treatment) in 14 (15% [95% CI: 9.0‐23.6%]) dogs, clinical improvement (on treatment) in 24 (26% [95% CI: 17.8‐35.2%]) dogs, and no clinical improvement in 27 (29% [95% CI: 20.5‐38.6%]) dogs. Immunological remission was observed in 27/46 (59%) dogs, with clinical remission in all 27. Younger age (P = .04) and comorbid endocrine disease (P = .04) were associated with clinical remission. Initial AChR Ab concentration (P = .02) and regurgitation (P = .04) were negatively associated with clinical remission. Conclusions and Clinical Importance Clinical remission in MG is less likely in older dogs and dogs presenting with regurgitation or high initial AChR Ab concentration, but more likely in younger dogs and dogs with comorbid endocrine disease.
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Affiliation(s)
- Jennifer T Forgash
- Department of Clinical Sciences & Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Yu-Mei Chang
- Research Support Office, Royal Veterinary College, University of London, London, United Kingdom
| | - Neil S Mittelman
- Department of Clinical Sciences & Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Scott Petesch
- Department of Clinical Sciences & Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Leontine Benedicenti
- Department of Clinical Sciences & Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Evelyn Galban
- Department of Clinical Sciences & Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - James J Hammond
- Department of Neurology and Neurosurgery, Pieper Memorial Veterinary Center, Middletown, Connecticut, USA
| | - Eric N Glass
- Section of Neurology and Neurosurgery, Red Bank Veterinary Hospital, Tinton Falls, New Jersey, USA
| | - Jessica R Barker
- Department of Neurology and Neurosurgery, Bush Veterinary Neurology Service, Springfield, Virginia, USA
| | - G Diane Shelton
- Department of Pathology, School of Medicine, University of California San Diego, La Jolla, California, USA
| | - Jie Luo
- Department of Clinical Sciences & Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Oliver A Garden
- Department of Clinical Sciences & Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Bongers J, Gutierrez‐Quintana R, Stalin CE. External ophthalmoparesis as part of generalised myasthenia gravis in a dog: are there more similarities to the human counterpart than originally thought? VETERINARY RECORD CASE REPORTS 2021. [DOI: 10.1002/vrc2.48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Jos Bongers
- School of Veterinary Medicine University of Glasgow Glasgow UK
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Wu Y, Chang YM, Lawson BS, Galban EM, Mittelman NS, Benedicenti L, Petesch SC, Carroll AB, Punt JA, Luo J, Garden OA. Myeloid-derived suppressor cell and regulatory T cell frequencies in canine myasthenia gravis: A pilot study. Vet J 2020; 267:105581. [PMID: 33375962 DOI: 10.1016/j.tvjl.2020.105581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 11/15/2020] [Accepted: 11/23/2020] [Indexed: 01/21/2023]
Abstract
Myasthenia gravis (MG) is a T cell-dependent, B cell-mediated autoimmune disease. Little is known about its cellular pathogenesis in dogs. This study provides the first preliminary assessment of the frequency of myeloid-derived suppressor cells (MDSCs) and regulatory T cells (Tregs) in the peripheral blood of dogs with seropositive generalized MG. No alteration in frequency of either MDSCs or Tregs in dogs with MG was observed when compared to those in either seronegative dogs with diagnoses other than MG, or healthy dogs. A longitudinal study in three dogs with MG revealed no correlation between the relative numbers of either population and the clinical course of disease. Neither the frequency of MDSCs nor of Tregs showed a correlation with anti-AChR antibody titer in dogs with MG. These findings suggest that aberrations in the frequency of either immunosuppressive population do not occur in MG, but they need to be validated in large-scale prospective studies.
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Affiliation(s)
- Ying Wu
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
| | - Yu-Mei Chang
- Research Support Office, Royal Veterinary College, London NW1 0TU, UK
| | - Brandon S Lawson
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
| | - Evelyn M Galban
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
| | - Neil S Mittelman
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
| | - Leontine Benedicenti
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
| | - Scott C Petesch
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
| | - Alicia B Carroll
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
| | - Jennifer A Punt
- Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
| | - Jie Luo
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
| | - Oliver A Garden
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
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10
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Vitalo A, Buckley G, Londoño L. Therapeutic plasma exchange as adjunct therapy in 3 dogs with myasthenia gravis and myasthenia-like syndrome. J Vet Emerg Crit Care (San Antonio) 2020; 31:106-111. [PMID: 33217167 DOI: 10.1111/vec.13022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 04/01/2019] [Accepted: 04/08/2019] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To describe the use of therapeutic membrane-based plasma exchange (TPE) for treatment of clinical signs associated with suspected acquired myasthenia gravis (MG) in 3 dogs. CASE SERIES SUMMARY Three dogs presented with clinical signs consistent with acquired MG. All 3 dogs were medically managed prior to being treated with TPE. Two of the 3 dogs had increased acetylcholine receptor antibody titers that decreased after TPE. One dog diagnosed with primary MG became clinically normal after 2 sessions of TPE and continued to do well with medical management several months later. The second dog was diagnosed with a suspect thymoma, and TPE was performed as a bridge to surgery, with marked improvement of clinical signs after TPE. The dog was ultimately diagnosed with a thymic carcinoma. The third dog had a positive acetylcholine antibody titer and was ultimately diagnosed with hemangiosarcoma (spleen and liver) and invasive mediastinal thymoma. This dog developed severe pneumonia, was ventilator dependent, and died of multiple organ dysfunction. No immediate complications were observed secondary to TPE. All 3 dogs were concurrently treated with either immunosuppressive agents, anticholinesterase drugs, or both. NEW OR UNIQUE INFORMATION PROVIDED The use of TPE in dogs with MG appears to be well tolerated and safe. It may be a reasonable adjunct therapy to acetylcholinesterase drugs in cases that are not responding to medical management alone. Therapeutic plasma exchange might also be considered preoperatively to prevent postoperative complications in dogs with severe MG, although further studies should be performed.
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Affiliation(s)
- Amber Vitalo
- Department of Small Animal Clinical Sciences, University of Florida College of Veterinary Medicine, Gainesville, Florida
| | - Gareth Buckley
- Department of Small Animal Clinical Sciences, University of Florida College of Veterinary Medicine, Gainesville, Florida
| | - Leonel Londoño
- Department of Small Animal Clinical Sciences, University of Florida College of Veterinary Medicine, Gainesville, Florida
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11
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Mignan T, Targett M, Lowrie M. Classification of myasthenia gravis and congenital myasthenic syndromes in dogs and cats. J Vet Intern Med 2020; 34:1707-1717. [PMID: 32668077 PMCID: PMC7517852 DOI: 10.1111/jvim.15855] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 06/22/2020] [Accepted: 06/26/2020] [Indexed: 12/19/2022] Open
Abstract
Myasthenia, a syndrome of impaired neuromuscular transmission, occurs as either an acquired or congenital condition. Myasthenia gravis (MG) is an acquired autoimmune disorder with autoantibodies against the neuromuscular junction (NMJ) of skeletal muscle whereas congenital myasthenic syndromes (CMSs) are a clinically heterogeneous group of genetic disorders affecting the NMJ with a young age of onset. Both conditions are diseases for which recognition is important with regard to treatment and outcome. We review the published literature on MG and CMSs in dogs and cats, and by comparison with published classification used in humans, propose a classification system for MG and CMSs in dogs and cats. Myasthenia gravis is first classified based on focal, generalized, or acute fulminating presentation. It then is subclassified according to the autoimmune disease mechanism or seronegativity. Autoimmune disease mechanism relates to the presence or absence of a thymoma, or administration of thiourylene medication in cats. Congenital myasthenic syndromes are classified according to the affected NMJ component, the mechanism of the defect of neuromuscular transmission, the affected protein, and ultimately the mutated gene responsible. In proposing this categorization of MG and CMSs, we hope to aid recognition of the disease groups for both conditions, as well as guide treatment, refine prognosis, and provide a framework for additional studies of these conditions.
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Affiliation(s)
| | - Mike Targett
- School of Veterinary Medicine and Science, University of Nottingham, Leicestershire, UK
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12
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Heffner GG, Cavanagh A, Nolan B. Successful management of acute bilirubin encephalopathy in a dog with immune‐mediated hemolytic anemia using therapeutic plasma exchange. J Vet Emerg Crit Care (San Antonio) 2019; 29:549-557. [DOI: 10.1111/vec.12876] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 07/13/2017] [Accepted: 08/11/2017] [Indexed: 12/17/2022]
Affiliation(s)
- Geoff G. Heffner
- Department of Clinical Sciences, Colorado State University Fort Collins CO
- Alpenglow Veterinary Specialty and Emergency Center Boulder CO
| | - Amanda Cavanagh
- Department of Clinical Sciences, Colorado State University Fort Collins CO
- Alpenglow Veterinary Specialty and Emergency Center Boulder CO
| | - Benjamin Nolan
- Department of Clinical Sciences, Colorado State University Fort Collins CO
- Alpenglow Veterinary Specialty and Emergency Center Boulder CO
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13
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Klotsman M, Sathyan G, Anderson WH, Garden OA, Shivanand P. Mycophenolic acid in patients with immune-mediated inflammatory diseases: From humans to dogs. J Vet Pharmacol Ther 2018; 42:127-138. [PMID: 30375004 DOI: 10.1111/jvp.12731] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 10/02/2018] [Accepted: 10/03/2018] [Indexed: 12/26/2022]
Abstract
Mycophenolic acid (MPA), a noncompetitive, selective and reversible inhibitor of inosine 5'-monophosphate dehydrogenase (IMPDH), is an immunosuppressive agent that has a long history in medicine. Mechanistically, the inhibition of IMPDH leads to the selective and eventual arrest of T- and B-lymphocyte proliferation. Mycophenolate mofetil (MMF), the first MPA-based product to receive marketing approval over two decades ago, was originally indicated for the prophylaxis of organ rejection in human transplant patients. Given its broad immunosuppressive properties and ability to selectively inhibit lymphocyte division and effector functions, the clinical utility of MPA was subsequently explored in a host of autoimmune diseases. Human clinical studies have shown MPA to be safe and effective and support its off-label administration for immune-mediated diseases such as lupus, myasthenia gravis and atopic dermatitis. MMF became generically available in the United States in 2008, and its clinical utility is increasingly being explored as a treatment option for dogs with immune-mediated diseases. This review summarizes the available literature for MPA pharmacokinetics and pharmacodynamics, and the current status of MPA as a treatment for client-owned dogs diagnosed with immune-mediated diseases.
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Affiliation(s)
| | | | - Wayne H Anderson
- Okava Pharmaceuticals, San Francisco, California.,Pulmonary and Critical Care Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Oliver A Garden
- Clinical Sciences & Advanced Medicine, University of Pennsylvania School of Veterinary Medicine, Philadelphia, Pennsylvania
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Sherman R, Karagiannis M. Aspiration Pneumonia in the Dog: A Review. Top Companion Anim Med 2017; 32:1-7. [PMID: 28750782 DOI: 10.1053/j.tcam.2017.05.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 05/10/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To review the human and veterinary literature pertaining to aspiration pneumonitis and pneumonia. MATERIAL AND METHODS Data sources included scientific reviews and original research publications from the human and veterinary literature. All reviews and studies that added to the understanding of aspiration pneumonia were included. RESULTS Compared to human medicine, aspiration pneumonia can be difficult to diagnose in the canine patient and is often a diagnosis of presumption. Multiple risk factors exist increasing the likelihood of aspiration pneumonia and a thorough understanding of these can aid in prevention. Treatment recommendations center primarily on supportive care, oxygen therapy and antibiotic administration. CLINCIAL SIGNIFICANCE Aspiration pneumonia is a common finding in the canine patient and a thorough understanding of the disease will lead to better treatment outcomes. Further studies on treatment and prevention in veterinary medicine are warranted.
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15
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Nagata N, Miyoshi T, Otake Y, Suzuki H, Kagawa Y, Yamagami T, Irie M. Temporal deterioration of neurological symptoms and increase of serum acetylcholine receptor antibody levels after thymectomy: a case report of a cat with myasthenia gravis. J Vet Med Sci 2016; 78:1893-1896. [PMID: 27593682 PMCID: PMC5240771 DOI: 10.1292/jvms.16-0134] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Neurological signs and serum acetylcholine receptor antibody (AChR-Ab) levels
before and after thymectomy were monitored in a 6-year-old male cat with acquired
Myasthenia Gravis (MG) as a paraneoplastic syndrome of thymoma. Soon after surgery, the
neurological symptoms relapsed, and the cholinesterase inhibitor was administered to
control them. The AChR-Ab levels increased postoperatively until 90 days after surgery.
This is the first report on long term measurements of serum AChR-Ab levels in a cat with
MG. Although thymectomy is valuable for the removal of thymoma, it may not resolve MG
symptoms, neurological signs and serum AChR-Ab levels, without medication early after
surgery. Also, this case report indicates that the AChR-Ab level might be a guide to
detect a deterioration of MG symptoms.
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Affiliation(s)
- Nao Nagata
- Shikoku Veterinary Medical Center, 3308-5 Ikenobe, Miki-cho, Kida-gun, Kagawa 761-0701, Japan
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16
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Hill PB, Brain P, Collins D, Fearnside S, Olivry T. Putative paraneoplastic pemphigus and myasthenia gravis in a cat with a lymphocytic thymoma. Vet Dermatol 2013; 24:646-9, e163-4. [DOI: 10.1111/vde.12086] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2013] [Indexed: 12/27/2022]
Affiliation(s)
- Peter B. Hill
- Companion Animal Health Centre; School of Animal and Veterinary Sciences; University of Adelaide; Roseworthy SA 5371 Australia
| | - Phil Brain
- Small Animal Specialist Hospital; Level 1 1 Richardson Place North Ryde Sydney NSW 2113 Australia
| | - David Collins
- Small Animal Specialist Hospital; Level 1 1 Richardson Place North Ryde Sydney NSW 2113 Australia
| | - Steve Fearnside
- Small Animal Specialist Hospital; Level 1 1 Richardson Place North Ryde Sydney NSW 2113 Australia
| | - Thierry Olivry
- Department of Clinical Sciences; College of Veterinary Medicine; Center for Comparative Medicine and Translational Research; North Carolina State University; 1060 William Moore Drive Raleigh NC 27607 USA
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