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Hoopes PJ, Tavakkoli AD, Moodie KA, Maurer KJ, Meehan KR, Wallin DJ, Aulwes E, Duval KEA, Chen KL, -Burney MAC, Li C, Fan X, Evans LT, Paulsen KD. Porcine-human glioma xenograft model. Immunosuppression and model reproducibility. Cancer Treat Res Commun 2024; 38:100789. [PMID: 38262125 PMCID: PMC11026118 DOI: 10.1016/j.ctarc.2024.100789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/19/2023] [Accepted: 01/09/2024] [Indexed: 01/25/2024]
Abstract
BACKGROUND Glioblastoma is the most common primary malignant and treatment-resistant human brain tumor. Rodent models have played an important role in understanding brain cancer biology and treatment. However, due to their small cranium and tumor volume mismatch, relative to human disease, they have been less useful for translational studies. Therefore, development of a consistent and simple large animal glioma xenograft model would have significant translational benefits. METHODS Immunosuppression was induced in twelve standard Yucatan minipigs. 3 pigs received cyclosporine only, while 9 pigs received a combined regimen including cyclosporine (55 mg/kg q12 h), prednisone (25 mg, q24 h) and mycophenolate (500 mg q24 h). U87 cells (2 × 106) were stereotactically implanted into the left frontal cortex. The implanted brains were imaged by MRI for monitoring. In a separate study, tumors were grown in 5 additional pigs using the combined regimen, and pigs underwent tumor resection with intra-operative image updating to determine if the xenograft model could accurately capture the spatial tumor resection challenges seen in humans. RESULTS Tumors were successfully implanted and grown in 11 pigs. One animal in cyclosporine only group failed to show clinical tumor growth. Clinical tumor growth, assessed by MRI, progressed slowly over the first 10 days, then rapidly over the next 10 days. The average tumor growth latency period was 20 days. Animals were monitored twice daily and detailed records were kept throughout the experimental period. Pigs were sacrificed humanely when the tumor reached 1 - 2 cm. Some pigs experienced decreased appetite and activity, however none required premature euthanasia. In the image updating study, all five pigs demonstrated brain shift after craniotomy, consistent with what is observed in humans. Intraoperative image updating was able to accurately capture and correct for this shift in all five pigs. CONCLUSION This report demonstrates the development and use of a human intracranial glioma model in an immunosuppressed, but nongenetically modified pig. While the immunosuppression of the model may limit its utility in certain studies, the model does overcome several limitations of small animal or genetically modified models. For instance, we demonstrate use of this model for guiding surgical resection with intraoperative image-updating technologies. We further report use of a surrogate extracranial tumor that indicates growth of the intracranial tumor, allowing for relative growth assessment without radiological imaging.
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Affiliation(s)
- P Jack Hoopes
- Geisel School of Medicine, Dartmouth College, Hanover, NH, USA; Thayer School of Engineering, Dartmouth College, Hanover, NH, USA; Center for Comparative Medicine and Research, Dartmouth College, Lebanon, NH, USA; Dartmouth Cancer Center, Lebanon, NH, USA.
| | | | - Karen A Moodie
- Center for Comparative Medicine and Research, Dartmouth College, Lebanon, NH, USA; Dartmouth Cancer Center, Lebanon, NH, USA
| | - Kirk J Maurer
- Center for Comparative Medicine and Research, Dartmouth College, Lebanon, NH, USA; Dartmouth Cancer Center, Lebanon, NH, USA
| | - Kenneth R Meehan
- Geisel School of Medicine, Dartmouth College, Hanover, NH, USA; Dartmouth Cancer Center, Lebanon, NH, USA
| | | | - Ethan Aulwes
- Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | - Kayla E A Duval
- Thayer School of Engineering, Dartmouth College, Hanover, NH, USA
| | - Kristen L Chen
- Thayer School of Engineering, Dartmouth College, Hanover, NH, USA
| | - Margaret A Crary -Burney
- Geisel School of Medicine, Dartmouth College, Hanover, NH, USA; Center for Comparative Medicine and Research, Dartmouth College, Lebanon, NH, USA
| | - Chen Li
- Thayer School of Engineering, Dartmouth College, Hanover, NH, USA
| | - Xiaoyao Fan
- Thayer School of Engineering, Dartmouth College, Hanover, NH, USA
| | - Linton T Evans
- Geisel School of Medicine, Dartmouth College, Hanover, NH, USA; Dartmouth Cancer Center, Lebanon, NH, USA
| | - Keith D Paulsen
- Geisel School of Medicine, Dartmouth College, Hanover, NH, USA; Thayer School of Engineering, Dartmouth College, Hanover, NH, USA; Dartmouth Cancer Center, Lebanon, NH, USA
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Beasley MJ, Shores A. Perspectives on pharmacologic strategies in the management of meningoencephalomyelitis of unknown origin in dogs. Front Vet Sci 2023; 10:1167002. [PMID: 37234070 PMCID: PMC10205981 DOI: 10.3389/fvets.2023.1167002] [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: 02/15/2023] [Accepted: 04/18/2023] [Indexed: 05/27/2023] Open
Abstract
There are many non-infectious inflammatory diseases, assumed to be immune-mediated in origin, recognized to affect the nervous system in canine patients. Concentrating on meningoencephalomyelitis of unknown origin, we will discuss the medications used to treat the underlying disease process, focusing on their adverse effects, therapeutic monitoring when necessary and effectiveness. The literature overwhelmingly supports the use of a steroid/ Cytosar® or steroid/ cyclosporine treatment protocol with the steroid tapered after the acute phase of the disease, leaving the secondary medication to control the disease long term. The decision on when and how quickly to taper the steroid is clinician dependent as a best practices has not been established in the literature. Also discussed will be the supportive care treatments often needed in the acute phase of these patients' diagnosis and treatment such as anti-edema and anti-epileptic agents.
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Affiliation(s)
- Michaela J. Beasley
- College of Veterinary Medicine, Mississippi State University, Starkville, MS, United States
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Ford KR, Anderson JG, Stapleton BL, Murphy BG, Kumar TKS, Archer T, Mackin AJ, Wills RW. Medical Management of Canine Chronic Ulcerative Stomatitis Using Cyclosporine and Metronidazole. J Vet Dent 2023; 40:109-124. [PMID: 36650996 DOI: 10.1177/08987564221148755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Canine chronic ulcerative stomatitis (CCUS) is a spontaneously occurring, painful, and often debilitating condition of the oral cavity, with a suspected immune-mediated component. The response to pharmacological treatment is generally poor, thus the need to identify more effective medical therapies for this condition. This article describes a prospective clinical trial that was designed to evaluate the efficiency of a combination of cyclosporine and metronidazole in managing CCUS. The hypothesis was that a combination of cyclosporine and metronidazole would effectively minimize clinical signs associated with CCUS. Ten client-owned dogs with a biopsy-confirmed diagnosis consistent with CCUS were prescribed cyclosporine (5 mg/kg) for 1 week, followed by the addition of metronidazole (15-20 mg/kg), both administered orally once daily. The cyclosporine dosage interval was lengthened over time. Dogs were observed for a 6-month period and evaluated using a 32-point Canine Ulcerative Stomatitis Disease Activity Index (CUSDAI). Regular cyclosporine therapeutic drug monitoring was also conducted by the measurement of whole blood cyclosporine levels and the pharmacodynamic assessment of the T-cell expression of IL-2. The results demonstrated that a combination of cyclosporine and metronidazole was effective in minimizing the clinical signs of CCUS and in reducing CUSDAI scores. Neither blood cyclosporine levels nor the T-cell expression of IL-2 predicted improvement in clinical signs and CUSDAI scores, although there was a correlation between blood drug concentrations and the suppression of T-cell IL-2 expression. The evaluation of clinical signs and CUSDAI scores appears to be the most effective means of assessing response to therapy, and therapeutic drug level monitoring does not appear to be routinely indicated.
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Affiliation(s)
| | | | | | - Brian G Murphy
- Department of Pathology, Microbiology and Immunology, School of Veterinary Medicine, 8789University of California Davis, Davis, CA, USA
| | - T K Santosh Kumar
- Department of Clinical Sciences, College of Veterinary Medicine, 5547Mississippi State University, Mississippi, USA
| | - Todd Archer
- Department of Clinical Sciences, College of Veterinary Medicine, 5547Mississippi State University, Mississippi, USA
| | - Andrew J Mackin
- Department of Clinical Sciences, College of Veterinary Medicine, 5547Mississippi State University, Mississippi, USA
| | - Robert W Wills
- Department of Basic Sciences, College of Veterinary Medicine, 5547Mississippi State University, Mississippi, USA
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Glucocorticoids, Cyclosporine, Azathioprine, Chlorambucil, and Mycophenolate in Dogs and Cats. Vet Clin North Am Small Anim Pract 2022; 52:797-817. [DOI: 10.1016/j.cvsm.2022.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Kristiansen PS, Nielsen LN. Immunomodulatory and immunosuppressive drug protocols in the treatment of canine primary immune thrombocytopenia, a scoping review. Acta Vet Scand 2021; 63:54. [PMID: 34961516 PMCID: PMC8721564 DOI: 10.1186/s13028-021-00620-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 11/18/2021] [Indexed: 11/29/2022] Open
Abstract
Primary immune thrombocytopenia (ITP) is a cause of severe thrombocytopenia in dogs. Immunosuppressive corticosteroid drugs are frequently used in the management of ITP, but treatment failure may occur. Immunomodulatory and non-corticosteroid immunosuppressive drugs might improve outcomes from therapy either alone or in combination with corticosteroids. The objectives of this scoping review were (1) to evaluate the current evidence relating to immunomodulatory and immunosuppressive drug protocols in the treatment of canine ITP, and (2) to answer the clinical question, whether or not therapy with immunomodulatory or non-corticosteroid immunosuppressive drugs alone or in combination with corticosteroids could improve outcome, compared to therapy with corticosteroids alone. A literature search was performed in the electronic databases of Agricola, CAB Abstracts, Embase, Medline and Web of Science for publications in November 2019 and again February 1, 2021. Selection criteria were relatively strict and included peer-reviewed research papers reporting outcome measures from immunomodulatory and immunosuppressive drug protocols in the treatment of canine ITP with a pre-therapeutic mean or median platelet count < 50,000/µL as a strict criterion for inclusion. Studies were evaluated if they had an appropriate diagnostic work up to exclude underlying conditions. Outcome measures and adverse events were compared between drug protocols both within studies and between studies. The search identified 456 studies, with six studies being eligible for inclusion. The studies were mostly case series while two were randomized controlled trials. Level of evidence varied with an overall uncertain subject enrollment, small groups, inadequate description and variable use of drug protocols or outcome measures. For outcomes such as platelet recovery time and duration of hospitalization, an improvement was observed using adjunctive therapy (human intravenous immunoglobulin) compared to therapy with corticosteroids alone. For outcomes of complete platelet recovery time, survival (6-month), mortality and relapse, no improvement was observed using adjunctive drugs compared to corticosteroids alone. Specifically, therapy with mycophenolate mofetil alone and adjunctive azathioprine were associated with more severe adverse events compared to other drug protocols. Evidence relating to immunomodulatory and immunosuppressive drug protocols in the treatment of canine ITP was of variable quality. Future larger case-controlled trials are required for determination of optimal treatment protocols in canine ITP.
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Alberti LR, Vasconcellos LDS, Petroianu A. Cyclosporine reduces the spleen dimensions in rabbits. Acta Cir Bras 2021; 36:e360402. [PMID: 33978094 PMCID: PMC8112103 DOI: 10.1590/acb360402] [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: 12/21/2020] [Accepted: 03/18/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose To assess the influence of prolonged cyclosporine use on the macro- and
microscopic morphology of the spleen. Methods 16 adult rabbits were divided into two groups (n = 8): group 1 – a placebo
group, which was followed-up over a period of nine months; group 2 – which
had taken an oral dose of cyclosporine (10
mg·kg–1·day–1) over nine months. At the end of
this period, the splenic histoarchitecture of all animals was evaluated and
the splenic corpuscles were measured. Results The spleens of the first group presented normal characteristics and
dimensions. The second group, however, had a reduction in all dimensions and
its tissue texture had become soft. The white pulp and the perivascular
sheath had become reduced in size and the number of lymphoid follicles had
also fallen (p = 0.002), manifesting less splenic corpuscles (p = 0.0012)
and lymphocyte nuclear pigments (p = 0.03). Conclusions Prolonged use of cyclosporine reduces the spleen size, transforming it into a
soft organ associated with a decrease in white pulp, perivascular sheath,
lymphoid follicles and nuclear pigments in rabbits.
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Lancellotti BA, Angus JC, Edginton HD, Rosenkrantz WS. Age- and breed-matched retrospective cohort study of malignancies and benign skin masses in 660 dogs with allergic dermatitis treated long-term with versus without oclacitinib. J Am Vet Med Assoc 2021; 257:507-516. [PMID: 32808904 DOI: 10.2460/javma.257.5.507] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To compare the cumulative incidences of malignancies and benign skin masses and the mean age at death or euthanasia in dogs with allergic dermatitis treated long-term with versus without oclacitinib. ANIMALS 660 client-owned dogs. PROCEDURES Medical records were searched to identify dogs with allergic dermatitis treated for ≥ 6 months with oclacitinib (exposed dogs; n = 339) versus other available treatments before the introduction of oclacitinib (nonexposed dogs; 321) and with ≥ 24 months of follow-up information available. Nonexposed dogs were age and breed matched with 321 of the exposed dogs; data for the remained 18 exposed dogs were included in statistical analyses. Results for cumulative incidences of malignancies and other variables were compared between groups, and the effect of daily maintenance dosage of oclacitinib on cumulative incidences of malignancies and other skin masses was evaluated within the exposed group. RESULTS No meaningful differences were detected in the cumulative incidences of malignancies and overall skin masses or the mean age at death or euthanasia for dogs in the exposed group (16.5% [56/339], 56.6% [192/339], and 11.2 years [n = 80], respectively) versus the nonexposed group (12.8% [41/321], 58.3% [187/321], and 11.8 years [71], respectively). There was no association identified between daily maintenance dosage of oclacitinib and odds of malignancy or benign skin masses for dogs in the exposed group. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that long-term treatment with oclacitinib did not pose additional risk for malignancy in dogs; however, veterinarians should continue to observe FDA-approved label warning and precaution statements for oclacitinib and regularly screen for neoplasia in dogs with allergic skin disease treated with or without oclacitinib.
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Sato M, Veir JK, Shropshire SB, Lappin MR. Ehrlichia canis in dogs experimentally infected, treated, and then immune suppressed during the acute or subclinical phases. J Vet Intern Med 2020; 34:1214-1221. [PMID: 32267035 PMCID: PMC7255653 DOI: 10.1111/jvim.15750] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 02/19/2020] [Indexed: 11/30/2022] Open
Abstract
Background Concerns for recrudescence of Ehrlichia canis infection arise when immunosuppressive drugs are used to treat immune‐mediated diseases in dogs previously infected with E. canis. Objectives Determine whether administration of prednisolone and cyclosporine would reactivate E. canis infection in dogs previously treated with doxycycline during the acute or subclinical phases. Animals Seven beagles previously experimentally infected with E. canis and administered doxycycline for 4 weeks were included. Three of the 7 dogs were incidentally concurrently infected with Anaplasma platys and Babesia vogeli and were administered 2 doses of imidocarb 2 weeks apart before enrollment in the current study. Methods Experimental study. Each dog was administered prednisolone and cyclosporine for 6 weeks. Clinical signs, complete blood cell count (CBC), polymerase chain reaction (PCR) assays for E. canis, A. platys, and B. vogeli DNA in blood, E. canis indirect fluorescent antibodies (IFA) titers, and flow cytometry for antiplatelet antibodies were monitored. Results All dogs completed the immunosuppressive protocol. No evidence for recrudescence of E. canis, A. platys, or B. vogeli were detected based on clinical signs or results of CBC, PCR, IFA, and flow cytometry for antiplatelet antibodies. E. canis IFA titers were negative in 5/7 dogs at the end of immunosuppressive protocol and were negative 6 months after the protocol in 5/5 dogs available for testing. Conclusions and Clinical Importance Dogs administered with a 4‐week course of doxycycline with or without imidocarb failed to show evidence of activation of E. canis infection after administration of a commonly used immune suppressive protocol.
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Affiliation(s)
- Masahiko Sato
- Department of Clinical Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Julia K Veir
- Department of Clinical Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Sarah B Shropshire
- Department of Clinical Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Michael R Lappin
- Department of Clinical Sciences, Colorado State University, Fort Collins, Colorado, USA
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Mackin AJ, Riggs C, Beatty T, Mealey K, Boothe D, Archer T. Excessive Cyclosporine-Associated Immunosuppression in a Dog Heterozygous for the MDR1 (ABCB1-1Δ) Mutation. J Am Anim Hosp Assoc 2020; 56:190. [PMID: 32182109 DOI: 10.5326/jaaha-ms-7004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Pharmacodynamic monitoring was used to titrate cyclosporine dosing in a dog with immune-mediated hemolytic anemia. Development of a suspected secondary infection, with subsequent discovery of an unexpectedly high level of T-cell suppression despite a relatively low cyclosporine dose, prompted an investigation into the cause of possible excessive immunosuppression. Blood cyclosporine concentrations were within expected target ranges, and the dog was determined to be heterozygous for the multidrug resistance protein 1 (MDR1; ATP-binding cassette sub family B member 1-1Δ) gene mutation. The MDR1 mutation was suspected to have contributed to the excessive immunosuppression experienced by this patient. This case highlights the need to monitor immunosuppressive therapy in the individual patient, especially when the patient is not responding to therapy at typical dosages or when secondary infections develop at dosages lower than expected to cause significant immunosuppression. Pharmacodynamic monitoring can be used to help identify unexpected excessive immunosuppression in dogs receiving cyclosporine, and MDR1 genotyping should be further explored as a potential method of predicting and preventing its occurrence.
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Affiliation(s)
- Andrew J Mackin
- From Mississippi State University College of Veterinary Medicine, Starkville, Mississippi (A.J.M., C.R., T.A.); Garden Grove Animal Hospital, Winter Haven, Florida (T.B.); Washington State University College of Veterinary Medicine, Pullman, Washington (K.M.); and Auburn University College of Veterinary Medicine, Auburn, Alabama (D.B.)
| | - Caitlin Riggs
- From Mississippi State University College of Veterinary Medicine, Starkville, Mississippi (A.J.M., C.R., T.A.); Garden Grove Animal Hospital, Winter Haven, Florida (T.B.); Washington State University College of Veterinary Medicine, Pullman, Washington (K.M.); and Auburn University College of Veterinary Medicine, Auburn, Alabama (D.B.)
| | - Todd Beatty
- From Mississippi State University College of Veterinary Medicine, Starkville, Mississippi (A.J.M., C.R., T.A.); Garden Grove Animal Hospital, Winter Haven, Florida (T.B.); Washington State University College of Veterinary Medicine, Pullman, Washington (K.M.); and Auburn University College of Veterinary Medicine, Auburn, Alabama (D.B.)
| | - Katrina Mealey
- From Mississippi State University College of Veterinary Medicine, Starkville, Mississippi (A.J.M., C.R., T.A.); Garden Grove Animal Hospital, Winter Haven, Florida (T.B.); Washington State University College of Veterinary Medicine, Pullman, Washington (K.M.); and Auburn University College of Veterinary Medicine, Auburn, Alabama (D.B.)
| | - Dawn Boothe
- From Mississippi State University College of Veterinary Medicine, Starkville, Mississippi (A.J.M., C.R., T.A.); Garden Grove Animal Hospital, Winter Haven, Florida (T.B.); Washington State University College of Veterinary Medicine, Pullman, Washington (K.M.); and Auburn University College of Veterinary Medicine, Auburn, Alabama (D.B.)
| | - Todd Archer
- From Mississippi State University College of Veterinary Medicine, Starkville, Mississippi (A.J.M., C.R., T.A.); Garden Grove Animal Hospital, Winter Haven, Florida (T.B.); Washington State University College of Veterinary Medicine, Pullman, Washington (K.M.); and Auburn University College of Veterinary Medicine, Auburn, Alabama (D.B.)
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Archer TM, Mulligan C, Narayanan L, Riggs C, Fellman C, Thomason JM, Wills RW, Boothe DM, Cruz-Espindola C, Harmon R, Mackin AJ. Effects of oral administration of 5 immunosuppressive agents on activated T-cell cytokine expression in healthy dogs. J Vet Intern Med 2020; 34:1206-1213. [PMID: 32052895 PMCID: PMC7255661 DOI: 10.1111/jvim.15729] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 01/31/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Dogs are often adminstered >1 immunosuppressive medication when treating immune-mediated diseases, and determining whether these different medications affect IL-2 expression would be useful when performing pharmacodynamic monitoring during cyclosporine therapy. HYPOTHESIS/OBJECTIVES To determine the effects of 5 medications (prednisone, cyclosporine, azathioprine, mycophenolate mofetil, and leflunomide) on activated T-cell expression of the cytokines IL-2 and interferon-gamma (IFN-γ). ANIMALS Eight healthy dogs. METHODS Randomized, cross-over study comparing values before and after treatment, and comparing values after treatment among drugs. Dogs were administered each drug at standard oral doses for 1 week, with a washout of at least 21 days. Activated T-cell expression of IL-2 and IFN-γ mRNA was measured by quantitative reverse transcription polymerase chain reaction. Blood drug concentrations were measured for cyclosporine, mycophenolate, and leflunomide metabolites. RESULTS Least squares means (with 95% confidence interval) before treatment for IL-2 (2.91 [2.32-3.50] ΔCt) and IFN-γ (2.33 [1.66-3.00 ΔCt]) values were significantly lower (both P < .001) than values after treatment (10.75 [10.16-11.34] and 10.79 [10.11-11.46] ΔCt, respectively) with cyclosporine. Similarly, least squares means before treatment for IL-2 (1.55 [1.07-2.02] ΔCt) and IFN-γ (2.62 [2.32-2.92] ΔCt) values were significantly lower (both P < .001) than values after treatment (3.55 [3.06-4.00] and 5.22 [4.92-5.52] ΔCt, respectively) with prednisone. Comparing delta cycle threshold values after treatment among drugs, cyclosporine was significantly different than prednisone (IL-2 and IFN-γ both P < .001), with cyclosporine more suppressive than prednisone. CONCLUSIONS AND CLINICAL IMPORTANCE Prednisone and cyclosporine both affected expression of IL-2 and IFN-γ, suggesting that both have the ability to influence results when utilizing pharmacodynamic monitoring of cyclosporine treatment.
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Affiliation(s)
- Todd M Archer
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Starkville, Mississippi
| | - Charlee Mulligan
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Starkville, Mississippi
| | - Lakshmi Narayanan
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Starkville, Mississippi
| | - Caitlin Riggs
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Starkville, Mississippi
| | - Claire Fellman
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Starkville, Mississippi.,Department of Clinical Sciences, Tufts University, North, MA
| | - John M Thomason
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Starkville, Mississippi
| | - Robert W Wills
- Department of Population and Preventative Medicine, College of Veterinary Medicine, Mississippi State University, Starkville, Mississippi
| | - Dawn M Boothe
- Department of Anatomy, Physiology and Pharmacology, College of Veterinary Medicine, Auburn University, Auburn, Alabama
| | - Crisanta Cruz-Espindola
- Department of Anatomy, Physiology and Pharmacology, College of Veterinary Medicine, Auburn University, Auburn, Alabama
| | - Roy Harmon
- Department of Anatomy, Physiology and Pharmacology, College of Veterinary Medicine, Auburn University, Auburn, Alabama
| | - Andrew J Mackin
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Starkville, Mississippi
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Narayanan L, Mulligan C, Durso L, Thames B, Thomason J, Fellman C, Mackin A, Wills R, Archer T. Recovery of T-cell function in healthy dogs following cessation of oral cyclosporine administration. Vet Med Sci 2020; 6:277-282. [PMID: 31914237 PMCID: PMC7397919 DOI: 10.1002/vms3.230] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 10/30/2019] [Accepted: 12/08/2019] [Indexed: 11/30/2022] Open
Abstract
Cyclosporine is a potent immunosuppressive agent used to treat immune‐mediated disorders in dogs. Secondary infections sometimes necessitate withdrawal of cyclosporine, but it is not known how long it takes for the immune system to recover after cessation of cyclosporine. Our goal was to utilize a validated RT‐qPCR assay in dogs to assess recovery time of the T‐cell cytokines IL‐2 and IFN‐γ after discontinuation of cyclosporine. Six healthy dogs were given oral cyclosporine (10 mg/kg every 12 hr) for 1 week, with samples collected for measurement of cytokine gene expression prior to treatment, and on the last day of therapy. Cyclosporine was then discontinued, and samples were collected daily for an additional 7 days. Results revealed that there was a significant difference in cytokine expression when comparing pre‐treatment and immediate post‐treatment values, corresponding to marked suppression of T‐cell function. There was no significant difference between pre‐treatment values for either cytokine when compared with any day during the recovery period. Cytokine expression, evaluated as a percentage of pre‐treatment baseline samples, demonstrated progressing return of T‐cell function after drug cessation, with full recovery seen in all dogs by Day 4 of the recovery period.
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Affiliation(s)
- Lakshmi Narayanan
- Department of Clinical Sciences, Mississippi State University College of Veterinary Medicine, Mississippi State, MS, USA
| | - Charlee Mulligan
- Department of Clinical Sciences, Mississippi State University College of Veterinary Medicine, Mississippi State, MS, USA
| | - Lisa Durso
- Department of Clinical Sciences, Mississippi State University College of Veterinary Medicine, Mississippi State, MS, USA
| | - Brittany Thames
- Department of Clinical Sciences, Mississippi State University College of Veterinary Medicine, Mississippi State, MS, USA
| | - John Thomason
- Department of Clinical Sciences, Mississippi State University College of Veterinary Medicine, Mississippi State, MS, USA
| | - Claire Fellman
- Department of Clinical Sciences, Mississippi State University College of Veterinary Medicine, Mississippi State, MS, USA
| | - Andrew Mackin
- Department of Clinical Sciences, Mississippi State University College of Veterinary Medicine, Mississippi State, MS, USA
| | - Robert Wills
- Department of Pathobiology and Population Medicine, Mississippi State University College of Veterinary Medicine, Mississippi State, MS, USA
| | - Todd Archer
- Department of Clinical Sciences, Mississippi State University College of Veterinary Medicine, Mississippi State, MS, USA
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Cridge H, Kordon A, Pinchuk LM, Wills RW, Thomason JM, Mackin AJ, Archer TM. Effects of cyclosporine on feline lymphocytes activated in vitro. Vet Immunol Immunopathol 2019; 219:109962. [PMID: 31710907 DOI: 10.1016/j.vetimm.2019.109962] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 10/18/2019] [Accepted: 10/22/2019] [Indexed: 10/25/2022]
Abstract
Cyclosporine A (CsA) is a calcineurin inhibitor that is known to decrease lymphocyte expression of NFAT-regulated cytokines in humans, dogs and cats, and thereby depress lymphocyte function. Less is known about the effects of CsA on lymphocytes in cats than in other species. Peripheral blood mononuclear cells (PBMCs) were isolated from 6 healthy cats. PBMCs were exposed to i) no treatment, ii) 5 μg/ml concavalin A (ConA), iii) 500 ng/ml CsA and iv) 5 μg/ml ConA and 500 ng/ml CsA. The effects of CsA on cell proliferation were assessed via live and necrotic cell counts from day 1 to day 6. Additionally, flow cytometry was utilized to determine the effect of CsA on apoptosis in feline lymphocytes at day 1 and day 5. ConA exposure resulted in increases in cell counts from day 1 to 6, peaking at day 5. CsA inhibited cell proliferation, indicated via decreased live lymphocyte cell counts in the cell cultures exposed to ConA and CsA, compared to the cell cultures exposed to ConA only. Furthermore, CsA induced early and late apoptotic changes in feline PBMCs. Differences in these responses may influence an individual cat's response to cyclosporine therapy.
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Affiliation(s)
- Harry Cridge
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, MS, 39762, USA.
| | - Adef Kordon
- Department of Basic Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, MS, 39762, USA
| | - Leysa M Pinchuk
- Department of Basic Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, MS, 39762, USA
| | - Robert W Wills
- Department of Pathobiology and Population Medicine, College of Veterinary Medicine, Mississippi State University, Mississippi State, MS, 39762, USA
| | - John M Thomason
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, MS, 39762, USA
| | - Andrew J Mackin
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, MS, 39762, USA
| | - Todd M Archer
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, MS, 39762, USA
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Ullal T, Ambrosini Y, Rao S, Webster CRL, Twedt D. Retrospective evaluation of cyclosporine in the treatment of presumed idiopathic chronic hepatitis in dogs. J Vet Intern Med 2019; 33:2046-2056. [PMID: 31393054 PMCID: PMC6766481 DOI: 10.1111/jvim.15591] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 07/23/2019] [Indexed: 12/16/2022] Open
Abstract
Background The etiology of idiopathic chronic hepatitis (ICH) in dogs is poorly understood, but evidence supports an immune‐mediated pathogenesis in some dogs. Objectives To describe a case series of dogs with presumed ICH treated with cyclosporine (CsA) with or without concurrent medications and to document the incidence of biochemical remission and factors associated with failure to attain remission. Animals Forty‐eight client‐owned dogs diagnosed with presumed ICH, treatment of which included CsA. Methods Two‐institution, retrospective case series of dogs between 2010 and 2017. All dogs were treated with CsA with or without concurrent medications for ≥2 weeks. Data were collected from medical records. Results Biochemical remission (<1.1 times the upper limit of normal for alanine aminotransferase activity) was attained in 79% of dogs (38/48). Median dose of CsA at remission was 7.9 mg/kg/d (range, 2.5‐12.7 mg/kg/d) and median time to remission was 2.5 months (range, 0.75‐18 months). Concurrent hepatoprotectant treatment was not associated with likelihood of remission. Clinical score, ascites, hypoalbuminemia, hyperbilirubinemia, prolonged coagulation times, dose, and duration of treatment were not associated with the probability of remission or time to remission. Common adverse effects of CsA were gastrointestinal signs in 38% (18/48) and gingival hyperplasia in 25% (12/48) of treated dogs. Conclusion and Clinical Importance A treatment regimen including CsA and frequent hepatoprotectant use resulted in biochemical remission of ICH in most dogs. None of the evaluated factors, including hepatoprotectant use, were significantly associated with likelihood of remission. Future prospective studies are indicated to evaluate CsA monotherapy in ICH dogs.
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Affiliation(s)
- Tarini Ullal
- Colorado State University, Fort Collins, Colorado
| | - Yoko Ambrosini
- Cummings School of Veterinary Medicine at Tufts University, Grafton, Massachusetts
| | - Sangeeta Rao
- Colorado State University, Fort Collins, Colorado
| | - Cynthia R L Webster
- Cummings School of Veterinary Medicine at Tufts University, Grafton, Massachusetts
| | - David Twedt
- Colorado State University, Fort Collins, Colorado
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Effects of cyclosporine and dexamethasone on canine T cell expression of interleukin-2 and interferon-gamma. Vet Immunol Immunopathol 2019; 216:109892. [PMID: 31446206 DOI: 10.1016/j.vetimm.2019.109892] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 10/07/2018] [Accepted: 07/08/2019] [Indexed: 12/12/2022]
Abstract
Cyclosporine and glucocorticoids are powerful immunosuppressive agents used to treat many inflammatory diseases in dogs. Cyclosporine inhibits calcineurin-dependent pathways of T cell activation and resultant T cell cytokine production, and glucocorticoids directly inhibit genes coding for cytokines. Little work has been done comparing the effects of these agents on T cell cytokine production in dogs. Our study measured T cell interleukin-2 (IL-2) and interferon-gamma (IFN-γ) production using flow cytometry and T cell IL-2 and IFN-γ gene expression using quantitative reverse transcription polymerase chain reaction (qRT-PCR) in activated canine T cells incubated with cyclosporine and dexamethasone in vitro. For flow cytometric assays, diluted whole blood was cultured for 7 h in the presence of cyclosporine (10, 100, 500, and 1000 ng/mL) or dexamethasone (10 ng/mL, 100 ng/mL, 1 μg/mL, and 10 μg/mL). For qRT-PCR, whole blood was cultured for 5 h with the same drugs at the same concentrations, and RNA was then extracted from leukocytes. Flow cytometry and qRT-PCR both demonstrated inhibition of IL-2 and IFN-γ that was concentration-dependent in response to cyclosporine, and was more variable for dexamethasone. Quantitative RT-PCR but not flow cytometry documented significant reduction of IL-2 expression after dexamethasone treatment, while both methods showed concentration-dependent suppression of IFN-γ. Quantitative RT-PCR also revealed additional cytokine suppression at higher cyclosporine concentrations, an effect not found using flow cytometry, and may therefore be the preferred method for cytokine determination in dogs. Suppression of IL-2 and IFN-γ in activated T cells may have potential as an indicator of the efficacy of cyclosporine and glucocorticoids in suppressing canine T cell function in vivo, and may therefore be of value for characterizing the immunosuppression induced by these drugs in clinical patients.
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15
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Colombo S, Sartori R. Ciclosporin and the cat: Current understanding and review of clinical use. J Feline Med Surg 2019; 20:244-255. [PMID: 29478396 DOI: 10.1177/1098612x17748718] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Practical relevance: Ciclosporin (CsA) is a systemic immuno-modulatory drug widely used to treat immune-mediated diseases in humans and veterinary species. CsA was registered for use in cats in the USA and Europe in 2011, and is indicated for the treatment of chronic allergic dermatitis at a recommended daily dose of 7 mg/kg PO. AUDIENCE This review will be of interest to all veterinarians working with cats, given the wide range of potential applications of CsA and its safety profile. Although the drug is currently only licensed to treat chronic allergic dermatitis in cats, a small number of reports describe its use in non-dermatological conditions. Evidence base: This article reviews the mechanism of action, pharmacokinetics, drug interactions, adverse effects and clinical use of CsA, both for the licensed indication and for off-label use in the feline patient. Information presented has been summarised from the existing literature on CsA, with specific interest in studies carried out in cats. For its licensed indication, chronic allergic dermatitis, evidence provided includes randomised, placebo or prednisolone-controlled studies (EBM grade I) and prospective or retrospective open trials.
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Affiliation(s)
- Silvia Colombo
- Servizi Dermatologici Veterinari, via Felice Musazzi 24, Legnano (MI), 1-20025, Italy
| | - Roberta Sartori
- Servizi Dermatologici Veterinari, via Felice Musazzi 24, Legnano (MI), 1-20025, Italy
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16
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Riggs C, Narayanan L, Mulligan C, Wills R, Mackin A, Fellman C, Thomason J, Archer T. Alterations in activated T-cell cytokine expression in healthy dogs over the initial 7 days of twice daily dosing with oral cyclosporine. J Vet Pharmacol Ther 2019; 42:385-391. [PMID: 30933369 DOI: 10.1111/jvp.12762] [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] [Received: 11/02/2018] [Revised: 02/08/2019] [Accepted: 02/20/2019] [Indexed: 01/10/2023]
Abstract
Cyclosporine is a powerful T-cell inhibitor used in the treatment of immune-mediated and inflammatory diseases in the dog. There is limited information on how to best monitor patients on cyclosporine therapy. Currently, pharmacokinetic and pharmacodynamic assays are available. Pharmacokinetic assays that measure the concentration of cyclosporine in the blood are used to assess if an appropriate drug concentration has been achieved; however, target blood drug concentrations have not been shown to reliably correlate with suppression of T-cell function in the dog. In human transplant recipients, therapeutic drug monitoring has shifted to include pharmacodynamic-based monitoring. Our laboratory has validated a RT-qPCR assay to measure the pharmacodynamic effects of cyclosporine in the dog. In this study, activated T-cell expression of IL-2 and IFN-γ was measured using RT-qPCR daily for 7 consecutive days in 8 healthy Walker hounds receiving oral cyclosporine at a dosage of 10 mg/kg every 12 hr. Cytokine production was found to be markedly decreased within 24 hr after the initiation of cyclosporine and remained significantly decreased for the duration of the project. Based on these results, cyclosporine causes a rapid drop in T-cell cytokine production that is sustained with continued dosing in healthy dogs. Although performed in healthy dogs, this study demonstrated a marked decrease in cytokine suppression within 24 hr of drug administration, suggesting that pharmacodynamic monitoring of cyclosporine's effects on T cells could be considered within several days of commencing therapy in dogs suffering from life-threatening immune-mediated disorders.
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Affiliation(s)
- Caitlin Riggs
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, MS
| | - Lakshmi Narayanan
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, MS
| | - Charlee Mulligan
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, MS
| | - Robert Wills
- Department of Pathobiology and Population Medicine, College of Veterinary Medicine, Mississippi State University, Mississippi State, MS
| | - Andrew Mackin
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, MS
| | - Claire Fellman
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, MS
| | - John Thomason
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, MS
| | - Todd Archer
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, MS
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17
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Craven MD, Washabau RJ. Comparative pathophysiology and management of protein-losing enteropathy. J Vet Intern Med 2019; 33:383-402. [PMID: 30762910 PMCID: PMC6430879 DOI: 10.1111/jvim.15406] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 11/30/2018] [Indexed: 12/17/2022] Open
Abstract
Protein‐losing enteropathy, or PLE, is not a disease but a syndrome that develops in numerous disease states of differing etiologies and often involving the lymphatic system, such as lymphangiectasia and lymphangitis in dogs. The pathophysiology of lymphatic disease is incompletely understood, and the disease is challenging to manage. Understanding of PLE mechanisms requires knowledge of lymphatic system structure and function, which are reviewed here. The mechanisms of enteric protein loss in PLE are identical in dogs and people, irrespective of the underlying cause. In people, PLE is usually associated with primary intestinal lymphangiectasia, suspected to arise from genetic susceptibility, or “idiopathic” lymphatic vascular obstruction. In dogs, PLE is most often a feature of inflammatory bowel disease (IBD), and less frequently intestinal lymphangiectasia, although it is not proven which process is the true driving defect. In cats, PLE is relatively rare. Review of the veterinary literature (1977‐2018) reveals that PLE was life‐ending in 54.2% of dogs compared to published disease‐associated deaths in IBD of <20%, implying that PLE is not merely a continuum of IBD spectrum pathophysiology. In people, diet is the cornerstone of management, whereas dogs are often treated with immunosuppression for causes of PLE including lymphangiectasia, lymphangitis, and crypt disease. Currently, however, there is no scientific, extrapolated, or evidence‐based support for an autoimmune or immune‐mediated mechanism. Moreover, people with PLE have disease‐associated loss of immune function, including lymphopenia, severe CD4+ T‐cell depletion, and negative vaccinal titers. Comparison of PLE in people and dogs is undertaken here, and theories in treatment of PLE are presented.
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Affiliation(s)
- Melanie D Craven
- Small Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Robert J Washabau
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, Minnesota
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18
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Peace AC, Kumar S, Wills R, Mackin A, Hoh CM, Archer T. Pharmacodynamic evaluation of the effects of oral melatonin on expression of the T‐cell cytokines interleukin‐2 and interferon gamma in the dog. J Vet Pharmacol Ther 2019; 42:278-284. [DOI: 10.1111/jvp.12749] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 09/24/2018] [Accepted: 12/25/2018] [Indexed: 11/30/2022]
Affiliation(s)
| | - Santosh Kumar
- Department of Clinical SciencesCollege of Veterinary MedicineMississippi State University Mississippi State Mississippi
| | - Robert Wills
- Department of Pathobiology and Population MedicineCollege of Veterinary MedicineMississippi State University Mississippi State Mississippi
| | - Andrew Mackin
- Department of Clinical SciencesCollege of Veterinary MedicineMississippi State University Mississippi State Mississippi
| | - Crystal M. Hoh
- BluePearl Veterinary Partners Overland Park Kansas
- Heart of Texas Veterinary Specialty Center Round Rock Texas
| | - Todd Archer
- Department of Clinical SciencesCollege of Veterinary MedicineMississippi State University Mississippi State Mississippi
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19
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Dandrieux JRS, Narayanan L, Firestone S, Archer TM, Mansfield CS. Effect of immunosuppressive drugs on cytokine production in canine whole blood stimulated with lipopolysaccharide or a combination of ionomycin and phorbol 12-myristate 13-acetate. Vet Med Sci 2019; 5:199-205. [PMID: 30663866 PMCID: PMC6498811 DOI: 10.1002/vms3.143] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
A pharmacodynamic assay has been previously developed to monitor ciclosporin treatment in dogs by assessing inhibition of cytokine transcription after whole blood stimulation with 12-myristate 13-1 acetate and ionomycin (PMA/I). In this study, whole blood stimulation with either PMA/I or lipopolysaccharide (LPS) was used to assess the effect of multiple drugs (azathioprine, ciclosporin, mycophenolate, leflunomide and prednisone) after a 7-day treatment course on production of cytokines measured with a multiplex assay in healthy dogs (n = 4 for each treatment). Interleukin-10 (IL-10), interferon gamma (IFNγ) and tumour necrosis factor alpha (TNFα) were significantly activated by PMA/I stimulation and IL-6, IL-10 and TNFα by LPS stimulation, in the absence of immunosuppressive drugs. After ciclosporin treatment, IL-10, IFNγ and TNFα production was significantly reduced after stimulation with PMA/I compared to pre-treatment. After prednisone treatment, TNFα production was significantly reduced after stimulation with PMA/I or LPS compared to pre-treatment. No significant change was observed after treatment with azathioprine, leflunomide or mycophenolate. This methodology may be useful to monitor dogs not only treated with ciclosporin, but also with prednisone or a combination of both. Further studies are needed to assess the use of this assay in a clinical setting.
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Affiliation(s)
- Julien R S Dandrieux
- Department of Veterinary Clinical Sciences, Faculty of Veterinary and Agricultural Sciences, Melbourne Veterinary School, University of Melbourne, Werribee, Vic, Australia
| | - Lakshmi Narayanan
- Department of Sustainable Bioproducts, Mississippi State University, Starkville, MS, USA
| | - Simon Firestone
- Faculty of Veterinary and Agricultural Sciences, Asia-Pacific Centre for Animal Health, University of Melbourne, Parkville, Vic, Australia
| | - Todd M Archer
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, MS, Mississippi
| | - Caroline S Mansfield
- Department of Veterinary Clinical Sciences, Faculty of Veterinary and Agricultural Sciences, Melbourne Veterinary School, University of Melbourne, Werribee, Vic, Australia
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20
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Dedeaux A, Grooters A, Wakamatsu-Utsuki N, Taboada J. Opportunistic Fungal Infections in Small Animals. J Am Anim Hosp Assoc 2018; 54:327-337. [DOI: 10.5326/jaaha-ms-6768] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
ABSTRACT
Opportunistic fungal infections have long been recognized as rare causes of disease in immunocompetent dogs and cats. Recently, the escalating use of multiagent immunosuppression protocols (especially those that include cyclosporine) has resulted in an increased number of patients with opportunistic fungal infection encountered by small animal practitioners and has altered the typical case phenotype. Based on histologic and cytologic features such as pigmentation, hyphal diameter, and distribution in tissue, these opportunistic mycoses can be placed into categories such as phaeohyphomycosis, hyalohyphomycosis, and eumycotic mycetoma. This review aims to summarize the clinical presentations, methods for diagnosis, treatment recommendations, and prognosis for both immunocompetent and immunosuppressed patients with opportunistic fungal infections. An example case description is included to illustrate the most common current clinical presentation.
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Affiliation(s)
- Andrea Dedeaux
- From the Department of Veterinary Clinical Sciences (A.D., A.G., J.T.) and Department of Pathobiological Sciences (N.W-U.), Louisiana State University, Baton Rouge, Louisiana
| | - Amy Grooters
- From the Department of Veterinary Clinical Sciences (A.D., A.G., J.T.) and Department of Pathobiological Sciences (N.W-U.), Louisiana State University, Baton Rouge, Louisiana
| | - Nobuko Wakamatsu-Utsuki
- From the Department of Veterinary Clinical Sciences (A.D., A.G., J.T.) and Department of Pathobiological Sciences (N.W-U.), Louisiana State University, Baton Rouge, Louisiana
| | - Joseph Taboada
- From the Department of Veterinary Clinical Sciences (A.D., A.G., J.T.) and Department of Pathobiological Sciences (N.W-U.), Louisiana State University, Baton Rouge, Louisiana
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21
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Kulling PM, Olson KC, Olson TL, Hamele CE, Carter KN, Feith DJ, Loughran TP. Calcitriol-mediated reduction in IFN-γ output in T cell large granular lymphocytic leukemia requires vitamin D receptor upregulation. J Steroid Biochem Mol Biol 2018; 177:140-148. [PMID: 28736298 PMCID: PMC5775933 DOI: 10.1016/j.jsbmb.2017.07.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 07/06/2017] [Accepted: 07/12/2017] [Indexed: 02/06/2023]
Abstract
Constitutively activated STAT1 and elevated IFN-γ are both characteristic of T cell large granular lymphocytic leukemia (T-LGLL), a rare incurable leukemia with clonal expansion of cytotoxic T cells due to defective apoptosis. Interferon gamma (IFN-γ) is an inflammatory cytokine that correlates with worse progression and symptomology in multiple autoimmune diseases and cancers. In canonical IFN-γ-STAT1 signaling, IFN-γ activates STAT1, a transcription factor, via phosphorylation of tyrosine residue 701 (p-STAT1). p-STAT1 then promotes transcription of IFN-γ, creating a positive feedback loop. We previously found that calcitriol treatment of the TL-1 cell line, a model of T-LGLL, significantly decreased IFN-γ secretion and p-STAT1 while increasing the vitamin D receptor (VDR) protein. Here we further explore these observations. Using TL-1 cells, IFN-γ decreased starting at 4h following calcitriol treatment, with a reduction in the intracellular and secreted protein levels as well as the mRNA content. A similar reduction in IFN-γ transcript levels was observed in primary T-LGLL patient peripheral blood mononuclear cells (PBMCs). p-STAT1 inhibition followed a similar temporal pattern and VDR upregulation inversely correlated with IFN-γ levels. Using EB1089 and 25(OH)D3, which have high or low affinity for VDR, respectively, we found that the decrease in IFN-γ correlated with the ability of EB1089, but not 25(OH)D3, to upregulate VDR. However, both compounds inhibited p-STAT1; thus the reduction of p-STAT1 is not solely responsible for IFN-γ inhibition. Conversely, cells treated with VDR siRNA exhibited decreased basal IFN-γ production upon VDR knockdown in a dose-dependent manner. Calcitriol treatment upregulated VDR and decreased IFN-γ regardless of initial VDR knockdown efficiency, strengthening the connection between VDR upregulation and IFN-γ reduction. Our findings suggest multiple opportunities to further explore the clinical relevance of the vitamin D pathway and the potential role for vitamin D supplementation in T-LGLL.
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Affiliation(s)
- Paige M Kulling
- University of Virginia Cancer Center, University of Virginia, Charlottesville, VA, 29908, USA; Department of Medicine, Division of Hematology/Oncology, University of Virginia, Charlottesville, VA, 29908, USA; Department of Pathology, University of Virginia, Charlottesville, VA, 29908, USA
| | - Kristine C Olson
- University of Virginia Cancer Center, University of Virginia, Charlottesville, VA, 29908, USA; Department of Medicine, Division of Hematology/Oncology, University of Virginia, Charlottesville, VA, 29908, USA
| | - Thomas L Olson
- University of Virginia Cancer Center, University of Virginia, Charlottesville, VA, 29908, USA; Department of Medicine, Division of Hematology/Oncology, University of Virginia, Charlottesville, VA, 29908, USA
| | - Cait E Hamele
- University of Virginia Cancer Center, University of Virginia, Charlottesville, VA, 29908, USA; Department of Medicine, Division of Hematology/Oncology, University of Virginia, Charlottesville, VA, 29908, USA
| | - Kathryn N Carter
- University of Virginia Cancer Center, University of Virginia, Charlottesville, VA, 29908, USA; Department of Medicine, Division of Hematology/Oncology, University of Virginia, Charlottesville, VA, 29908, USA
| | - David J Feith
- University of Virginia Cancer Center, University of Virginia, Charlottesville, VA, 29908, USA; Department of Medicine, Division of Hematology/Oncology, University of Virginia, Charlottesville, VA, 29908, USA
| | - Thomas P Loughran
- University of Virginia Cancer Center, University of Virginia, Charlottesville, VA, 29908, USA; Department of Medicine, Division of Hematology/Oncology, University of Virginia, Charlottesville, VA, 29908, USA.
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In vivo effects of aspirin and cyclosporine on regulatory T cells and T-cell cytokine production in healthy dogs. Vet Immunol Immunopathol 2018; 197:63-68. [DOI: 10.1016/j.vetimm.2018.01.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 01/06/2018] [Accepted: 01/09/2018] [Indexed: 11/20/2022]
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23
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McAtee BB, Cummings KJ, Cook AK, Lidbury JA, Heseltine JC, Willard MD. Opportunistic Invasive Cutaneous Fungal Infections Associated with Administration of Cyclosporine to Dogs with Immune-mediated Disease. J Vet Intern Med 2017; 31:1724-1729. [PMID: 28887897 PMCID: PMC5697195 DOI: 10.1111/jvim.14824] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 06/29/2017] [Accepted: 08/03/2017] [Indexed: 02/05/2023] Open
Abstract
Background Opportunistic invasive fungal infections (OIFIs) occur in dogs administered immunosuppressive medications. However, the epidemiology of OIFIs among dogs undergoing immunosuppressive treatment is poorly understood. The aims of this study were to (1) estimate the incidence of OIFIs among dogs diagnosed with certain immune‐mediated diseases and treated with immunosuppressive drugs, and (2) determine if administration of particular drug(s) was a risk factor for OIFIs. Hypothesis Dogs receiving cyclosporine treatment (alone or as part of a multidrug protocol) are at higher risk of developing OIFIs. Animals One hundred and thirteen client‐owned dogs diagnosed with select immune‐mediated diseases: 42 with IMHA, 29 with ITP, 34 with IMPA, and 8 with Evans syndrome. Methods Retrospective cohort study. Medical records of dogs presenting to the Texas A&M University, Veterinary Medical Teaching Hospital between January 2008 and December 2015, and treated for 1 or more of IMHA, IMPA, ITP, or Evans syndrome were retrospectively reviewed. Dogs that did not develop an OIFI were excluded if they died, were euthanized, or were lost to follow‐up within 120 days of initiation of immunosuppressive treatment. Results Fifteen dogs of 113 (13%) were diagnosed with an OIFI based on 1 or more of cytology, culture, or histopathology. The odds of developing an OIFI were greater among dogs that were treated with cyclosporine (OR = 7.1, P = 0.017; 95% CI, 1.5–34.4) and among male dogs (OR = 5.1, P = 0.018; 95% CI, 1.4–17.9). Conclusions and Clinical Importance OIFIs were significantly more likely in male dogs and those receiving cyclosporine. It is important to consider OIFIs as a potential complication of immunosuppressive treatment, particularly cyclosporine.
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Affiliation(s)
- B B McAtee
- Texas A&M University, College Station, TX
| | | | - A K Cook
- Texas A&M University, College Station, TX
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24
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Fujimura M, Nakatsuji Y, Ishimaru H. Cyclosporin A Treatment in Intrinsic Canine Atopic Dermatitis (Atopic-like Dermatitis): Open Trial Study. Pol J Vet Sci 2016; 19:567-572. [DOI: 10.1515/pjvs-2016-0071] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
In this study, dogs were separated into two groups and treated with immunosuppressant (Cyclosporin A: CsA). The first group was the canine atopic dermatitis (CAD) group, which is similar to extrinsic atopic dermatitis (AD) in humans (treated with a CsA dose of 2.5-5.5 mg/kg, n=8), and the second group was the canine atopic-like dermatitis (ALD) group, which is similar to intrinsic AD in humans (treated with a CsA dose of 2.5-6.5 mg/kg, n=14). The canine atopic dermatitis extent and severity index (CADESI)-4 was evaluated before treatment (PRE) and after treatment (POST) to assess the effectiveness of CsA for the two groups. In the CAD group, CADESI-4 showed no change (PRE:79±29, POST:77±28) and out of the eight dogs, no dogs showed complete remission, three dogs showed partial remission, and five dogs showed no effect. Whereas in the ALD group, CADESI-4 showed a significant reduction (PRE: 61±42, POST: 32±25, p<0.01) and out of the 14 dogs, 11 dogs showed complete remission, two dogs showed partial remission, and one dog showed no effect. The results indicate that the immunosuppressant showed effectiveness for the dogs diagnosed with ALD. One dog had to be treated for a year and eight months, which was the longest period in the study, this dog presented with hyperplasia of the lymphoidgland and mammary tumor.
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25
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Letters to the Editor. J Am Vet Med Assoc 2016; 248:875. [DOI: 10.2460/javma.248.8.875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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26
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Fellman CL, Archer TM, Stokes JV, Wills RW, Lunsford KV, Mackin AJ. Effects of oral cyclosporine on canine T-cell expression of IL-2 and IFN-gamma across a 12-h dosing interval. J Vet Pharmacol Ther 2015; 39:237-44. [PMID: 26676223 DOI: 10.1111/jvp.12280] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 11/04/2015] [Indexed: 12/01/2022]
Abstract
The duration of immunosuppressive effects following oral cyclosporine in dogs is unknown. This study used flow cytometry and quantitative reverse transcription-polymerase chain reaction (qRT-PCR) to evaluate the effects of high-dose oral cyclosporine across a 12-h dosing interval. Expression of interleukin-2 (IL-2) and interferon-gamma (IFN-γ) was compared before and after 8 days of cyclosporine at 10 mg/kg every 12 h in six healthy dogs. Samples were collected at 0, 2, 4, and 8 h postdosing for analysis of unactivated and activated T-cell and whole blood cytokine expression using flow cytometry and qRT-PCR, respectively, and at 0, 2, 4, 6, 8, and 10 h postdosing for measurement of cyclosporine concentrations. Flow cytometry and qRT-PCR both demonstrated significant marked reductions in IL-2 and IFN-γ levels at 0, 2, 4, and 8 h after dosing compared to pretreatment levels (P < 0.05) for activated samples, with less consistent effects observed for unactivated samples. Both flow cytometry and qRT-PCR are viable techniques for measuring cyclosporine pharmacodynamics in dogs, yielding comparable results with activated samples. Two hours postdrug administration is the preferred time for concurrent assessment of peak drug concentration and cytokine expression, and T-cell activation is needed for optimal results.
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Affiliation(s)
- C L Fellman
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, MS, USA
| | - T M Archer
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, MS, USA
| | - J V Stokes
- Department of Basic Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, MS, USA
| | - R W Wills
- Department of Pathobiology and Population Medicine, College of Veterinary Medicine, Mississippi State University, Mississippi State, MS, USA
| | - K V Lunsford
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, MS, USA
| | - A J Mackin
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, MS, USA
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27
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Dowling SR, Webb J, Foster JD, Ginn J, Foy DS, Trepanier LA. Opportunistic fungal infections in dogs treated with ciclosporin and glucocorticoids: eight cases. J Small Anim Pract 2015; 57:105-109. [PMID: 25988822 DOI: 10.1111/jsap.12367] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 02/05/2015] [Accepted: 03/09/2015] [Indexed: 12/01/2022]
Abstract
Glucocorticoids are the standard of care for the treatment of immune-mediated disorders, and ciclosporin is increasingly being used off-label as an adjunct immunosuppressive drug in dogs. However, opportunistic infections can develop during combination immunosuppressive regimens. This case series describes atypical fungal infections in eight dogs treated with immunosuppressive dosages of glucocorticoids and ciclosporin. The median duration of combined treatment prior to the identification of fungal infection was 31 (range, 13 to 201) days, although two dogs received glucocorticoids for prolonged periods prior to the addition of ciclosporin. The estimated prevalence of serious fungal infections with this drug combination appears to be low (approximately 1 · 67%), but these infections led directly or indirectly to death or euthanasia in five of eight (63%) dogs. These cases highlight the need for frequent clinical monitoring of dogs receiving immunosuppressive dosages of glucocorticoids and ciclosporin.
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Affiliation(s)
- S R Dowling
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, 53706, USA
| | - J Webb
- Department of Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, 53706, USA
| | - J D Foster
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, 53706, USA
| | - J Ginn
- Department of Internal Medicine, Wheat Ridge Animal Hospital, Wheat Ridge, CO, 80033, USA
| | - D S Foy
- Department of Internal Medicine, Wheat Ridge Animal Hospital, Wheat Ridge, CO, 80033, USA
| | - L A Trepanier
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, 53706, USA
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28
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Pucheu-Haston CM, Bizikova P, Marsella R, Santoro D, Nuttall T, Eisenschenk MNC. Review: Lymphocytes, cytokines, chemokines and the T-helper 1-T-helper 2 balance in canine atopic dermatitis. Vet Dermatol 2015; 26:124-e32. [DOI: 10.1111/vde.12205] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2015] [Indexed: 02/03/2023]
Affiliation(s)
- Cherie M. Pucheu-Haston
- Department of Veterinary Clinical Sciences; School of Veterinary Medicine; Louisiana State University; 1909 Skip Bertman Drive Baton Rouge LA 70803 USA
| | - Petra Bizikova
- Department of Clinical Sciences; College of Veterinary Medicine; North Carolina State University; 1060 William Moore Drive Raleigh NC 27607 USA
| | - Rosanna Marsella
- Department of Small Animal Clinical Sciences; College of Veterinary Medicine; University of Florida; 2015 SW 16th Avenue Gainesville FL 32610 USA
| | - Domenico Santoro
- Department of Small Animal Clinical Sciences; College of Veterinary Medicine; University of Florida; 2015 SW 16th Avenue Gainesville FL 32610 USA
| | - Tim Nuttall
- Royal (Dick) School of Veterinary Studies; Easter Bush Veterinary Centre; University of Edinburgh; Roslin EH25 9RG UK
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29
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Abstract
Itch is the most common clinical problem seen in dogs with skin diseases. Although an etiological classification of canine pruritus does not yet exist, most causes would likely fall into the IFSI class I (dermatological) itch. One of the most common causes of canine itch is that associated with atopic dermatitis, and there is randomized controlled trial grade evidence of the efficacy of several antipruritic interventions. At this time, the mainstay of treatment of canine atopic itch relies principally on the use of topical and/or oral glucocorticoids and oral cyclosporine. Type 1 receptor antihistamines are notorious in their inconsistency in reducing pruritus in atopic dogs. A new Janus kinase (JAK)-1 inhibitor has recently been approved for treatment of allergic itch in dogs, and its onset of efficacy is remarkably fast. Modeling itch in dogs can be achieved by allergen sensitization (fleas, house dust mites), and challenges that elicit pruritic manifestation can be used for mechanistic studies as well as for testing of novel anti-itch modalities.
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Affiliation(s)
- Thierry Olivry
- Department of Clinical Sciences, College of Veterinary Medicine, NC State University, Raleigh, NC, USA,
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30
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Riggs C, Archer T, Fellman C, Figueiredo AS, Follows J, Stokes J, Wills R, Mackin A, Bulla C. Analytical validation of a quantitative reverse transcriptase polymerase chain reaction assay for evaluation of T-cell targeted immunosuppressive therapy in the dog. Vet Immunol Immunopathol 2014; 156:229-34. [PMID: 24422229 DOI: 10.1016/j.vetimm.2013.09.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Cyclosporine is an immunosuppressive agent that inhibits T-cell function by decreasing production of cytokines such as interleukin-2 (IL-2) and interferon-γ(IFN-γ). In dogs, there is currently no reliable analytical method for determining effective cyclosporine dosages in individual patients. Our laboratory has developed a quantitative reverse transcriptase polymerase chain reaction (RT-qPCR) assay that measures IL-2 and IFN-γ gene expression, with the goal of quantifying immunosuppression in dogs treated with cyclosporine. This study focuses on analytical validation of our assay, and on the effects of sample storage conditions on cyclosporine-exposed samples. Heparinized whole blood collected from healthy adult dogs was exposed to a typical post-treatment blood concentration for cyclosporine(500 ng/mL) for 1 h, and then stored for 0, 24, and 48 h at both room temperature and 4 ◦C.The study was then repeated using a cyclosporine concentration of 75 ng/mL, with sample storage for 0, 24, and 48 h at 4 ◦C. Cytokine gene expression was measured using RT-qPCR,and assay efficiency and inter- and intra-assay variability were determined. Storage for upto 24 h at room temperature, and up to 48 h at 4 ◦C, did not significantly alter results compared to samples that were processed immediately. Validation studies showed our assay to be highly efficient and reproducible and robust enough to be feasible under standard practice submission conditions.
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31
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Nuttall T, Reece D, Roberts E. Life-long diseases need life-long treatment: long-term safety of ciclosporin in canine atopic dermatitis. Vet Rec 2014; 174 Suppl 2:3-12. [PMID: 24682696 PMCID: PMC3995266 DOI: 10.1136/vr.102471] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Ciclosporin (Atopica; Novartis Animal Health) has been licensed for canine atopic dermatitis (AD) since 2002. Adverse events (AEs) have been reported in 55 per cent of 759 dogs in 15 clinical trials, but are rare in pharmacovigilance data (71.81 AEs/million capsules sold). Gastrointestinal reactions were most common, but were mild and rarely required intervention. Other AEs were rare (≤1 per cent in clinical trials; <10/million capsules sold). Hirsutism, gingival hyperplasia and hyperplastic dermatitis were rarely significant and resolved on dose reduction. Ciclosporin decreases staphylococcal and Malassezia infections in AD, and at the recommended dose is not a risk factor for other infections, neoplasia, renal failure or hypertension. The impact on glucose and calcium metabolism is not clinically significant for normal dogs. Concomitant treatment with most drugs is safe. Effects on cytochrome P450 and MDR1 P-glycoprotein activity may elevate plasma ciclosporin concentrations, but short-term changes are not clinically significant. Monitoring of complete blood counts, urinalysis or ciclosporin levels is not justified except with higher than recommended doses and/or long-term concurrent immunosuppressive drugs. Ciclosporin is not a contraindication for killed (including rabies) vaccines, but the licensed recommendation is that live vaccination is avoided during treatment. In conclusion, ciclosporin has a positive risk-benefit profile for the long-term management of canine AD.
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Affiliation(s)
- Tim Nuttall
- Royal (Dick) School of Veterinary Studies, The University of Edinburgh, Easter Bush Campus, Roslin, UK
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32
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Archer TM, Boothe DM, Langston VC, Fellman CL, Lunsford KV, Mackin AJ. Oral cyclosporine treatment in dogs: a review of the literature. J Vet Intern Med 2013; 28:1-20. [PMID: 24341787 PMCID: PMC4895546 DOI: 10.1111/jvim.12265] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 09/02/2013] [Accepted: 10/28/2013] [Indexed: 11/30/2022] Open
Abstract
Cyclosporine is an immunomodulatory drug used to treat an increasing spectrum of diseases in dogs. Cyclosporine is a calcineurin inhibitor, ultimately exerting its inhibitory effects on T-lymphocytes by decreasing production of cytokines, such as interleukin-2. Although, in the United States, oral cyclosporine is approved in dogs only for treatment of atopic dermatitis, there are many other indications for its use. Cyclosporine is available in 2 oral formulations: the original oil-based formulation and the more commonly used ultramicronized emulsion that facilitates oral absorption. Ultramicronized cyclosporine is available as an approved animal product, and human proprietary and generic preparations are also available. Bioavailability of the different formulations in dogs is likely to vary among the preparations. Cyclosporine is associated with a large number of drug interactions that can also influence blood cyclosporine concentrations. Therapeutic drug monitoring (TDM) can be used to assist in attaining consistent plasma cyclosporine concentrations despite the effects of varying bioavailability and drug interactions. TDM can facilitate therapeutic success by guiding dose adjustments on an individualized basis, and is recommended in cases that do not respond to initial oral dosing, or during treatment of severe, life-threatening diseases for which a trial-and-error approach to dose adjustment is too risky. Pharmacodynamic assays that evaluate individual patient immune responses to cyclosporine can be used to augment information provided by TDM.
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Affiliation(s)
- T M Archer
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, MS
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33
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Haraschak JL, Langston VC, Wang R, Riggs C, Fellman C, Ross MK, Bulla C, Lunsford K, Mackin A, Archer T. Pharmacokinetic evaluation of oral dantrolene in the dog. J Vet Pharmacol Ther 2013; 37:286-94. [PMID: 24219828 DOI: 10.1111/jvp.12089] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 10/04/2013] [Indexed: 11/29/2022]
Abstract
The pharmacokinetics of dantrolene and its active metabolite, 5-hydroxydantrolene, after a single oral dose of either 5 or 10 mg/kg of dantrolene was determined. The effects of exposure to dantrolene and 5-hydroxydantrolene on activated whole-blood gene expression of the cytokines interleukin-2 (IL-2) and interferon-γ (IFN-γ) were also investigated. When dantrolene was administered at a 5 mg/kg dose, peak plasma concentration (Cmax ) was 0.43 μg/mL, terminal half-life (t1/2 ) was 1.26 h, and area under the time-concentration curve (AUC) was 3.87 μg·h/mL. For the 10 mg/kg dose, Cmax was 0.65 μg/mL, t1/2 was 1.21 h, and AUC was 5.94 μg·h/mL. For all calculated parameters, however, there were large standard deviations and wide ranges noted between and within individual dogs: t1/2 , for example, ranged from 0.43 to 6.93 h, Cmax ratios ranged from 1.05 to 3.39, and relative bioavailability (rF) values ranged from 0.02 to 1.56. While activated whole-blood expression of IL-2 and IFN-γ as measured by qRT-PCR was markedly suppressed following exposure to very high concentrations (30 and 50 μg/mL, respectively) of both dantrolene and 5-hydroxydantrolene, biologically and therapeutically relevant suppression of cytokine expression did not occur at the much lower drug concentrations achieved with oral dantrolene dosing.
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Affiliation(s)
- J L Haraschak
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, MS, USA
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34
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Jung DI, Lee HC, Ha J, Jung HW, Jeon JH, Moon JH, Lee JH, Kim NH, Sur JH, Kang BT, Cho KW. Unsuccessful cyclosporine plus prednisolone therapy for autoimmune meningoencephalitis in three dogs. J Vet Med Sci 2013; 75:1661-5. [PMID: 23955394 PMCID: PMC3942949 DOI: 10.1292/jvms.12-0503] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A 4-year-old female Maltese (case 1), a 9-year-old castrated male shih tzu (case 2) and
2-year-old female Pomeranian (case 3) presented with neurological signs, such as head
tilt, ataxia, circling and paresis. The three cases were tentatively diagnosed as having
meningoencephalitis of unknown etiology based on computed tomography scan and
cerebrospinal fluid analysis. All patients were managed with cyclosporine plus
prednisolone therapy. The survival times of the three patients were 170, 70 and 21 days,
respectively. After the cases died, we performed necropsy and histopathological
examination for definitive diagnosis. Based on the necropsy, histopathological and
immunohistochemical examinations, cases 1, 2 and 3 were definitely diagnosed as having
necrotizing meningoencephalitis, necrotizing leukoencephalitis and granulomatous
meningoencephalitis, respectively. This case report demonstrated the clinical findings,
brain CT characteristics and histopathological and immunohistochemical features of NME,
NLE and GME in dogs and discussed the reason for the relatively short survival times under
cyclosporine plus prednisolone therapy.
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Affiliation(s)
- Dong-In Jung
- Research Institute of Life Sciences, College of Veterinary Medicine, Gyeongsang National University, Jinju 660-701, South Korea
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35
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Abstract
Treatment of immune-mediated disease in dogs and cats continues to evolve as new therapies are introduced or adapted from human medicine. Glucocorticoids remain the first-line therapy for many of the immune-mediated or inflammatory diseases of cats and dogs. The focus of this article is to provide an update on some of the common immunosuppressive therapies used in small animal veterinary medicine. The goals of therapy are to induce disease remission through the inhibition of inflammation and the modulation of lymphocyte function.
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Affiliation(s)
- Katrina R Viviano
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin, Madison, WI, USA.
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36
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Thomason J, Lunsford K, Stokes J, Pinchuk L, Wills R, Langston C, Pruett S, Mackin A. The Effects of Cyclosporine on Platelet Function and Cyclooxygenase Expression in Normal Dogs. J Vet Intern Med 2012; 26:1389-401. [DOI: 10.1111/j.1939-1676.2012.01025.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Revised: 08/10/2012] [Accepted: 09/10/2012] [Indexed: 11/29/2022] Open
Affiliation(s)
- J. Thomason
- Department of Clinical Sciences, College of Veterinary Medicine; Mississippi State University; Mississippi State; MS
| | - K. Lunsford
- Department of Clinical Sciences, College of Veterinary Medicine; Mississippi State University; Mississippi State; MS
| | - J. Stokes
- Department of Basic Sciences, College of Veterinary Medicine; Mississippi State University; Mississippi State; MS
| | - L. Pinchuk
- Department of Basic Sciences, College of Veterinary Medicine; Mississippi State University; Mississippi State; MS
| | - R. Wills
- Department of Pathobiology and Population Medicine; College of Veterinary Medicine, Mississippi State University; Mississippi State; MS
| | - C. Langston
- Department of Clinical Sciences, College of Veterinary Medicine; Mississippi State University; Mississippi State; MS
| | - S. Pruett
- Department of Basic Sciences, College of Veterinary Medicine; Mississippi State University; Mississippi State; MS
| | - A. Mackin
- Department of Clinical Sciences, College of Veterinary Medicine; Mississippi State University; Mississippi State; MS
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