Fuzapladib in a randomized controlled multicenter masked study in dogs with presumptive acute onset pancreatitis

Multi-Institutional Retrospective Analysis of Prognostic Scoring Systems for Dogs With Acute Pancreatitis (504 Dogs)

BACKGROUND

Acute pancreatitis (AP) in dogs has a broad clinical presentation and variable progression, making prognostication challenging.

HYPOTHESIS/OBJECTIVES

(i) To compare predicted prognosis for death and for prolonged (≥ 5 days) hospitalization across scoring schemes for AP in dogs and (ii) to predict concordance of each scoring scheme with death and for prolonged hospitalization.

ANIMALS

Five hundred four client-owned dogs.

METHODS

Multi-institutional retrospective study. Data extracted from medical records included: signalment, history, physical examination findings, diagnostic results, length of hospitalization, and death. Five prognostic schemes (OS, CSI, APPLEfull, CAPS, MCAI) were calculated for each dog.

RESULTS

Overall concordance was low. Only APPLEfull (p = 0.004) and MCAI (p = 0.01) scores were significantly different between survivors and non-survivors. Overall, APPLEfull had the greatest concordance (0.632, 95% CI: 0.592-0.672) with length of hospitalization. Of the other more pancreatitis-specific schemes, MCAI had the greatest concordance (0.576, 95% CI: 0.567-0.635) with length of hospitalization, while CSI had the lowest concordance with length of hospitalization (0.525, 95% CI: 0.494-0.556).

CONCLUSIONS AND CLINICAL IMPORTANCE

On a population level, APPLEfull and MCAI had the greatest predictive discrimination between dogs of normal and prolonged hospitalization. If an individual dog has any of the 5 prognostic score schemes above the proposed cut-off for death, it should be interpreted with caution because of the low case fatality rate.

The anti-inflammatory effects of Fuzapladib in an endotoxemic porcine model

Endotoxemia is a systemic inflammatory condition caused by lipopolysaccharide (LPS) stimulation, which produces inflammatory cytokines. Fuzapladib (FZP) inhibits the activation of adhesion molecules found on the surface of inflammatory cells, mitigating inflammation. In this study, we evaluated the therapeutic effects of fuzapladib on inflammatory cytokines and cardio-respiratory function using an LPS-induced endotoxemic porcine model. Fifteen pigs were separated into three groups: low-FZP (n=5), high-FZP (n=5), and control (n=5). Pigs were administered LPS under general anesthesia, and complete blood cell count, blood biochemistry, inflammatory cytokines, and cardio-respiratory function were evaluated. Statistical analysis was performed using a linear mixed-effects model and the Steel-Dwass test, with a significance threshold of P<0.05. During the 4 hr experimental period, one pig in the control group and two pigs in the low-FZP group died due to hypoxemia and hypotension. In the early acute changes following LPS administration, the high-FZP group maintained significantly higher arterial oxygen partial pressure and normal blood pressure compared to the control group. Although interleukin-6 levels increased in all groups during the experiment, they were significantly lower in the high-FZP group compared to the control group. Other parameters showed no clinically significant differences. In conclusion, while high-dose fuzapladib did not reduce organ damage in the porcine endotoxemia model, it suppressed interleukin-6 production, delayed the progression of deterioration, and contributed to a reduction in mortality during the observation period.

Allogenic Adipose-Derived Mesenchymal Stem Cell Infusion for the Management of Acute-Onset Pancreatitis in Dogs: A Pilot Study

Mesenchymal stem cells (MSCs) have significant anti-inflammatory properties and are beneficial in rodent models of pancreatitis. The safety and efficacy of MSCs is unknown in dogs with acute pancreatitis (AP). Dogs with AP who were treated with MSCs (n = 4) were identified prospectively for this pilot study from an academic hospital. Serum Spec cPL and C-reactive protein (CRP) concentrations were measured on the day of MSC administration and 2 days later. The clinical severity, via the Modified Clinical Activity Index (MCAI), was also calculated. Two dogs received MSCs shortly after AP diagnosis, while the remaining dogs received MSCs due to clinically refractory disease. Changes in Spec cPL, CRP, and MCAI in the MSC-treated dogs were compared to a control population (n = 7) receiving the standard-of-care treatment for AP. No significant differences were noted between the populations for changes in Spec cPL (p = 0.79), CRP (p = 0.67), or MCAI (p = 0.91). However, subjective clinical improvements were noted within 24 h of MSC infusion in the two dogs with previously refractory disease. MSC infusions appear safe in the management of AP in dogs and may be considered in refractory disease. However, given the nature of this pilot study and its limitations, larger randomized controlled clinical trials are needed to truly evaluate the efficacy of MSC infusions in dogs with AP.