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Petrucci GN, Magalhães TR, Dias M, Queiroga FL. Metronomic chemotherapy: bridging theory to clinical application in canine and feline oncology. Front Vet Sci 2024; 11:1397376. [PMID: 38903691 PMCID: PMC11187343 DOI: 10.3389/fvets.2024.1397376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 05/22/2024] [Indexed: 06/22/2024] Open
Abstract
Veterinary oncology has experienced significant evolution over the last few decades, with chemotherapy being currently applied to several neoplasms with therapeutic success. Traditionally, chemotherapy protocols are based on classic cytostatic drugs under the concept of maximum tolerated dose (MTD), which has been associated with a greater risk of toxicity and resistance. Thus, new therapeutic alternatives have emerged, such as metronomic chemotherapy (MC), introducing a new paradigm in cancer treatment. MC consists of administering low doses of chemotherapy drugs continuously over a long period of time, modulating the tumour microenvironment (TME) due to the combination of cytotoxic, antiangiogenic and immunomodulatory effects. This multi-targeted therapy has been described as a treatment option in several canine and feline cancers since 2007, with positive results already published in the literature, particularly in mammary carcinomas and soft tissue sarcomas in dogs. The aim of this review article is to describe the current knowledge about the use of MC in small animal oncology, with emphasis on its mechanisms of action, the most commonly used drugs and clinical outcome.
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Affiliation(s)
- Gonçalo N. Petrucci
- Onevet Hospital Veterinário do Porto, Porto, Portugal
- Animal and Veterinary Department, University Institute of Health Sciences, CESPU, CRL, Gandra, Portugal
- Animal and Veterinary Research Centre (CECAV), University of Trás-os-Montes and Alto Douro, Vila Real, Portugal
- Department of Veterinary Sciences, Center for Investigation Vasco da Gama (CIVG), Vasco da Gama University School (EUVG), Coimbra, Portugal
| | - Tomás Rodrigues Magalhães
- Animal and Veterinary Research Centre (CECAV), University of Trás-os-Montes and Alto Douro, Vila Real, Portugal
- Department of Veterinary Sciences, University of Trás-os-Montes and Alto Douro, Vila Real, Portugal
- Associate Laboratory for Animal and Veterinary Sciences (AL4AnimalS), University of Trás-os-Montes and Alto Douro, Vila Real, Portugal
| | - Márcia Dias
- Department of Veterinary Sciences, University of Trás-os-Montes and Alto Douro, Vila Real, Portugal
| | - Felisbina Luísa Queiroga
- Animal and Veterinary Research Centre (CECAV), University of Trás-os-Montes and Alto Douro, Vila Real, Portugal
- Department of Veterinary Sciences, University of Trás-os-Montes and Alto Douro, Vila Real, Portugal
- Associate Laboratory for Animal and Veterinary Sciences (AL4AnimalS), University of Trás-os-Montes and Alto Douro, Vila Real, Portugal
- Centre for the Study of Animal Science, CECA-ICETA, University of Porto, Porto, Portugal
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O'Connell K, Thomson M, Morgan E, Henning J. Procarbazine, prednisolone and cyclophosphamide (PPC) oral combination chemotherapy protocol for canine lymphoma. Vet Comp Oncol 2022; 20:613-622. [PMID: 35338560 DOI: 10.1111/vco.12814] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 03/02/2022] [Accepted: 03/22/2022] [Indexed: 11/29/2022]
Abstract
Orally administered daily chemotherapy offers a novel treatment approach for canine lymphoma in a population of dogs that have failed or not tolerated maximum tolerable dose chemotherapy. A multidrug oral chemotherapy protocol was designed and implemented for the treatment of fifty dogs with multicentric lymphoma with minimal side effects. The protocol consisted of oral procarbazine, prednisolone and cyclophosphamide (PPC) administered daily. Efficacy and toxicity were evaluated by clinical and laboratory evaluation. An overall response rate of 70% was achieved, with 24% and 46% of dogs having a partial and complete response, respectively, to treatment with the PPC protocol. Response to the PPC protocol (complete or partial) and age were the only factors identified as prognostic for time from initiation of the PPC chemotherapy until death. Overall, the protocol was very well tolerated with only one dog requiring protocol discontinuation due to grade 4 thrombocytopenia. Eight dogs recorded gastrointestinal toxicities, seven grade I and one grade II toxicity. These findings demonstrate that the administration of a continuous oral combination chemotherapy can provide comparable survival times in the rescue setting in dogs with multicentric lymphoma with minimal side effects.
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Affiliation(s)
- Kathleen O'Connell
- Animal Referral Hospital Brisbane, 532 Seventeen Mile Rocks Road, Sinnamon Park QLD 4073
| | - Maurine Thomson
- Animal Referral Hospital Brisbane, 532 Seventeen Mile Rocks Road, Sinnamon Park QLD 4073
| | - Elizabeth Morgan
- Animal Referral Hospital Brisbane, 532 Seventeen Mile Rocks Road, Sinnamon Park QLD 4073
| | - Joerg Henning
- School of Veterinary Science, The University of Queensland, Gatton, QLD, Australia
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European Mistletoe ( Viscum album) Extract Is Cytotoxic to Canine High-Grade Astrocytoma Cells In Vitro and Has Additive Effects with Mebendazole. Vet Sci 2022; 9:vetsci9010031. [PMID: 35051115 PMCID: PMC8782024 DOI: 10.3390/vetsci9010031] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/04/2022] [Accepted: 01/11/2022] [Indexed: 02/04/2023] Open
Abstract
Malignant gliomas are associated with extremely poor clinical outcomes in both humans and dogs, and novel therapies are needed. Glioma-bearing canine patients may serve as promising preclinical models for human therapies, including complementary medicine. The objective of this study was to evaluate the effects of mistletoe extract (Viscum album) alone and in combination with mebendazole in an in vitro model of canine high-grade astrocytoma using the cell line SDT-3G. SDT-3G cells were exposed to a range of concentrations of mistletoe extract alone to obtain an IC50. In separate experiments, cells were exposed to mebendazole at a previously determined IC50 (0.03 µM) alone or in conjunction with varying concentrations of mistletoe extract to determine the additive effects. The IC50 for mistletoe alone was 5.644 ± 0.09 SD μg/mL. The addition of mistletoe at 5 μg/mL to mebendazole at 0.03 µM led to increased cell death compared to what would be expected for each drug separately. The cytotoxicity of mistletoe in vitro and its additive effect with mebendazole support future expanded in vitro and in vivo studies in dogs and supply early evidence that this may be a useful adjunct therapeutic agent for use in glioma-bearing dogs. To the authors’ knowledge, this is the first published report of Viscum album extract in canine glioma.
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Treggiari E, Pellin MA, Valenti P, Curran KM, Borrego JF, Romanelli G, Mason SL, Taylor A. Tolerability and outcome of palliative treatment for metastatic pulmonary carcinoma in cats. J Small Anim Pract 2021; 62:992-1000. [PMID: 34608648 DOI: 10.1111/jsap.13421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 06/06/2021] [Accepted: 08/17/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Pulmonary carcinoma is uncommon in cats and reporting of outcomes following medical treatment is limited, especially in presence of metastases. The aim of this study was to describe the outcome of cats affected by metastatic primary pulmonary carcinoma and to evaluate the tolerability of palliative treatment in this patient population. MATERIALS AND METHODS Medical records were searched for cats with a cytological or histopathological diagnosis of primary pulmonary carcinoma and evidence of metastatic disease. Cats were treated with antineoplastic agents, corticosteroids, non-steroidal anti-inflammatory drugs (NSAIDs) or received no systemic treatment. Cases in which thoracic CT was not performed, and those lacking definitive diagnosis by cytology or histopathology or receiving curative-intent surgery were excluded. RESULTS Thirty-four cats were identified: 18 were treated with antineoplastic agents and 16 received corticosteroids, NSAIDs or no treatment. Presenting clinical signs included coughing (53%), tachypnoea (26%), gastrointestinal signs (35%) and lethargy (18%). CT scan identified metastases to the lung parenchyma in all cases and additional metastatic lesions in 10 of 34 (59%) cases; pleural effusion was detected in 11 cases (32%). The overall median survival time for all cats was 64 days [range 1-1352 days; 95% confidence interval (CI) 48-164]. Presence of respiratory signs at presentation was the only factor influencing survival in the multivariable analysis. CLINICAL SIGNIFICANCE Medical treatment was well tolerated and appeared to palliate clinical signs in cats with metastatic pulmonary carcinoma, albeit with a modest duration and short overall survival. The role and benefit of chemotherapy/antineoplastic agents versus conventional palliative drugs in this setting remains unclear.
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Affiliation(s)
- E Treggiari
- Oncology Service, Centro Specialistico Veterinario, 20141, Milan, Italy
| | - M A Pellin
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin, Madison, WI, 53706, USA
| | - P Valenti
- Oncology Service, Clinica Veterinaria Malpensa, 21017, Samarate, Italy
| | - K M Curran
- Carlson College of Veterinary Medicine, Department of Clinical Sciences, Oregon State University, Oregon, 97331, USA
| | - J F Borrego
- Oncology Service, Hospital Auna Especialidades Veterinarias, Valencia, 46980, Spain
| | - G Romanelli
- Oncology Service, Centro Specialistico Veterinario, 20141, Milan, Italy
| | - S L Mason
- Department of Oncology, The Queen's Veterinary School Hospital, University of Cambridge, Cambridge, CB3 0ES, Cambridgeshire, UK.,S.L. Mason's current address is Southfield's Veterinary Specialists, Oncology Service, Basildon, UK
| | - A Taylor
- Oncology Service, Queen Mother Hospital for Animals, Royal Veterinary College, Hatfield, AL9 7TA, Hertfordshire, UK
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Alonso-Miguel D, Valdivia G, García-San José P, Alonso-Diez Á, Clares I, Portero M, Peña L, Pérez-Alenza MD. Clinical outcome of dogs diagnosed with canine inflammatory mammary cancer treated with metronomic cyclophosphamide, a cyclooxygenase-2 inhibitor and toceranib phosphate. Vet Comp Oncol 2021; 20:179-188. [PMID: 34390295 DOI: 10.1111/vco.12760] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 08/12/2021] [Indexed: 12/14/2022]
Abstract
Canine inflammatory mammary cancer (IMC) is highly malignant, invasive and a therapeutic challenge, because effective medical treatment is still unavailable. This retrospective study compares the efficacy of an oral cyclooxygenase-2 (COX-2) inhibitor combined with toceranib phosphate and oral cyclophosphamide (multi-drug therapy [MT]) with COX-2 inhibitor therapy alone (single-drug therapy [ST]) in dogs diagnosed with secondary IMC. Clinical response, adverse events, overall survival time (OST), disease-free survival (DFS) and time to progression (TTP) were evaluated. Sixteen patients were included, eight received MT and eight receiving ST. Median OST was significantly higher in patients receiving MT (96.0 vs. 37.5 days; p = .046) and in patients with post-surgical rather than non-surgical IMC (86.5 vs. 41.5 days; p = .038). Additionally, median TTP was significantly higher in patients treated with MT (p = .010). In patients with non-surgical IMC, the clinical benefit (CB) was reached in 100% (n = 3) of patients receiving MT and in 33% (n = 1) of those receiving ST; the response duration was significantly longer in MT cases (p = .026). The absence of disease progression at day 30 of treatment was significantly associated with longer OST, DFS and TTP (p = .018, p = .002 and p < .001, respectively). Adverse events occurred more frequently in patients treated with MT compared with ST (p = .026). The MT protocol produced primarily mild to moderate toxicities, which were resolved with supportive care; therefore, the combination of drugs was adequately tolerated by most of the patients. The combination of toceranib, a COX-2 inhibitor and oral cyclophosphamide may be a protocol with potential therapeutic efficacy for dogs with IMC.
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Affiliation(s)
- Daniel Alonso-Miguel
- Department of Animal Medicine and Surgery, School of Veterinary Medicine, Complutense University of Madrid, Madrid, Spain
| | - Guillermo Valdivia
- Department of Animal Medicine and Surgery, School of Veterinary Medicine, Complutense University of Madrid, Madrid, Spain
| | - Paula García-San José
- Department of Animal Medicine and Surgery, School of Veterinary Medicine, Complutense University of Madrid, Madrid, Spain
| | - Ángela Alonso-Diez
- Department of Animal Medicine and Surgery, School of Veterinary Medicine, Complutense University of Madrid, Madrid, Spain
| | - Irene Clares
- Department of Animal Medicine and Surgery, School of Veterinary Medicine, Complutense University of Madrid, Madrid, Spain
| | - Miriam Portero
- Department of Animal Medicine and Surgery, School of Veterinary Medicine, Complutense University of Madrid, Madrid, Spain
| | - Laura Peña
- Department of Animal Medicine and Surgery, School of Veterinary Medicine, Complutense University of Madrid, Madrid, Spain
| | - Maria Dolores Pérez-Alenza
- Department of Animal Medicine and Surgery, School of Veterinary Medicine, Complutense University of Madrid, Madrid, Spain
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Cai XJ, Fei WD, Xu YY, Xu H, Yang GY, Cao JW, Ni JJ, Wang Z. Combination of metronomic administration and target delivery strategies to improve the anti-angiogenic and anti-tumor effects of triptolide. Drug Deliv Transl Res 2020; 10:93-107. [PMID: 31418132 DOI: 10.1007/s13346-019-00665-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The metronomic administration of a low-dose cytotoxic agent with no prolonged drug-free breaks is an anti-angiogenic cancer treatment method. The use of nano-formulations in this manner enhances anti-tumor efficacy and reduces toxicity by inhibiting angiogenic activity, reduces adverse effects, and changes the biodistribution of TP in the body, steering TP away from potentially endangering healthy tissues. The present study uses liposomes and Asn-Gly-Arg (NGR) peptide conjugated aminopeptidase N(APN)-targeted liposomes for triptolide (TP), as a model for the investigation of targeted metronomic administration and subsequent effects on the toxicity profile and efficacy of the chemotherapeutic agent. Metronomic NGR-PEG-TP-LPs have been found to have enhanced anti-tumor activity, a phenomenon that is attributed to an increase in angiogenic inhibition properties. In vitro experiments demonstrate that the viability, migration, and tube formation of human umbilical vein endothelial cells (HUVECs) are obviously suppressed in comparison with that of other treatment groups. In vivo experiments also demonstrate that the anti-tumor efficacy of targeted metronomic administration is superior to that of liposome-administered treatments given at maximum tolerated dose (MTD) schemes, as is evidenced by markedly decreased tumor volume, vessel density, and the volume of circulating endothelial progenitor cells (CEPCs) in serum. Moreover, we observed that the metronomic administration of NGR-PEG-TP-LPs could elevate thrombospondin-1 (TSP-1) expression in tumors, a finding that is consistent with the promotion of TSP-1 secretion specifically from HUVECs. Additionally, metronomic NGR-PEG-TP-LPs have minimal drug-associated toxicity (weight loss, hepatotoxicity and nephrotoxicity in mice). Our research demonstrates the significance of targeted metronomic administration using liposomes for anti-angiogenic cancer therapy.
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Affiliation(s)
- Xin-Jun Cai
- Department of Pharmacy, Zhejiang Chinese Medicine and Western Medicine Integrated Hospital, Hangzhou, 310003, Zhejiang, People's Republic of China
| | - Wei-Dong Fei
- Department of Pharmacy, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, China
| | - Ying-Ying Xu
- Department of Pharmacy, Zhejiang Chinese Medicine and Western Medicine Integrated Hospital, Hangzhou, 310003, Zhejiang, People's Republic of China
| | - Hong Xu
- Department of Gastroenterology and Hepatology, Zhejiang Chinese Medicine and Western Medicine Integrated Hospital, Hangzhou, 310003, Zhejiang, People's Republic of China
| | - Gao-Yi Yang
- Department of Ultrasoud, Zhejiang Chinese Medicine and Western Medicine Integrated Hospital, Hangzhou, 310003, Zhejiang, People's Republic of China
| | - Jia-Wei Cao
- Department of Pharmacy, Zhejiang Chinese Medicine and Western Medicine Integrated Hospital, Hangzhou, 310003, Zhejiang, People's Republic of China
| | - Jian-Jun Ni
- Department of Pharmacy, Zhejiang Chinese Medicine and Western Medicine Integrated Hospital, Hangzhou, 310003, Zhejiang, People's Republic of China
| | - Zeng Wang
- Department of Pharmacy, Institute of Cancer Research and Basic Medical Sciences of Chinese Academy of Sciences, Cancer Hospital of University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, 310022, People's Republic of China.
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Treggiari E, Borrego JF, Gramer I, Valenti P, Harper A, Finotello R, Toni C, Laomedonte P, Romanelli G. Retrospective comparison of first-line adjuvant anthracycline vs metronomic-based chemotherapy protocols in the treatment of stage I and II canine splenic haemangiosarcoma. Vet Comp Oncol 2019; 18:43-51. [PMID: 31648405 DOI: 10.1111/vco.12548] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 09/15/2019] [Accepted: 10/02/2019] [Indexed: 12/14/2022]
Abstract
Splenectomy followed by adjuvant chemotherapy is commonly used to treat canine splenic haemangiosarcoma (HSA), although it is unclear if different treatment protocols may have a similar efficacy. The objective of this retrospective study was to assess outcome in dogs with stage I and II splenic HSA treated with either first-line adjuvant anthracycline (AC) or metronomic (MC)-based chemotherapy protocols, by comparing median time to progression (TTP) and median survival time (MST). Medical records of nine institutions were searched for dogs diagnosed with stage I and II splenic HSA that underwent adjuvant treatment with AC- or MC-based protocols following splenectomy. Patients treated with MC following AC were included in an additional group (AMC). Ninety-three dogs were included: 50 in the AC group, 23 in the AMC group and 20 in the MC group. The overall MST was 200 days (range 47-3352) and the overall median TTP was 185 days (range 37-1236). The median TTP of stage I dogs was significantly longer compared to stage II dogs (338 vs 151 days, respectively, P = .028). When adjusting for treatment type, the MST was 154 days for the AC group (range 47-3352 days), 338 days for the AMC group (range 79-1623 days) and 225 days for the MC group (range 57-911 days). The difference in MST and median TTP was not found to be statistically significant between treatment groups. This study suggests that adjuvant MC in canine splenic HSA may result in a similar outcome when compared to other treatment protocols. Further studies are warranted to confirm these findings.
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Affiliation(s)
- Elisabetta Treggiari
- Centro Specialistico Veterinario, Milan, Italy.,Willows Veterinary Centre and Referral Service, Solihull, West Midlands, UK
| | - Juan F Borrego
- Hospital Auna Especialidades Veterinarias, Paterna, Valencia, Spain
| | - Irina Gramer
- Davies Veterinary Specialists, Higham Gobion, Herts, UK
| | - Paola Valenti
- Clinica Veterinaria Malpensa, Samarate, Varese, Italy
| | - Aaron Harper
- Department of Small Animal Clinical Science, Institute of Veterinary Science, University of Liverpool, Neston, UK
| | - Riccardo Finotello
- Department of Small Animal Clinical Science, Institute of Veterinary Science, University of Liverpool, Neston, UK
| | - Cristina Toni
- Willows Veterinary Centre and Referral Service, Solihull, West Midlands, UK
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Polton G, Finotello R, Sabattini S, Rossi F, Laganga P, Vasconi ME, Barbanera A, Stiborova K, Rohrer Bley C, Marconato L. Survival analysis of dogs with advanced primary lung carcinoma treated by metronomic cyclophosphamide, piroxicam and thalidomide. Vet Comp Oncol 2018; 16:399-408. [PMID: 29508493 DOI: 10.1111/vco.12393] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 02/02/2018] [Accepted: 02/02/2018] [Indexed: 12/26/2022]
Abstract
Unresectable or metastatic (advanced) primary pulmonary carcinoma (PPC) represents a therapeutic challenge where surgery may be contraindicated and the therapeutic role of maximum-tolerated dose (MTD) chemotherapy remains uncertain. This study was undertaken to explore the impact of metronomic chemotherapy (MC) in dogs with advanced PPC. Previously untreated dogs with advanced (T3 or N1 or M1) PPC, with complete staging work-up and follow-up data, receiving MC (comprising low-dose cyclophosphamide, piroxicam and thalidomide), surgery, MTD chemotherapy or no oncologic treatment were eligible for inclusion. For all patients, time to progression (TTP) and survival time (ST) were evaluated. Quality-of-life (QoL) was only evaluated in patients receiving MC. To assess QoL, owners of dogs receiving MC were asked to complete a questionnaire before and during treatment. Ninety-one dogs were included: 25 received MC, 36 were treated with surgery, 11 with MTD chemotherapy and 19 received no treatment. QoL was improved in dogs receiving MC. Median TTP was significantly longer in patients receiving MC (172 days) than patients undergoing surgery (87 days), receiving MTD chemotherapy (22 days), or no oncologic treatment (20 days). Median ST was similarly longer in patients receiving MC (139 days) than those undergoing surgery (92 days), MTD chemotherapy (61 days) and no oncologic treatment (60 days). In dogs with advanced PPC, MC achieved a measurable clinical benefit without significant risk or toxicity. This makes MC a potential alternative to other recognized management approaches.
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Affiliation(s)
- G Polton
- North Downs Specialist Referrals, Brewerstreet Dairy Business Park, Surrey, UK
| | - R Finotello
- Department of Small Animal Clinical Science, Institute of Veterinary Science, Faculty of Health and Life Science, University of Liverpool, Neston, UK
| | - S Sabattini
- Department of Veterinary Medical Sciences, University of Bologna, Bologna, Italy
| | - F Rossi
- Centro Oncologico Veterinario, Sasso Marconi, Italy
| | - P Laganga
- Centro Oncologico Veterinario, Sasso Marconi, Italy
| | | | - A Barbanera
- Centro Oncologico Veterinario, Sasso Marconi, Italy
| | - K Stiborova
- Department of Small Animal Clinical Science, Institute of Veterinary Science, Faculty of Health and Life Science, University of Liverpool, Neston, UK
| | - C Rohrer Bley
- Division of Radiation Oncology, Vetsuisse-Faculty, University of Zurich, Zürich, Switzerland
| | - L Marconato
- Centro Oncologico Veterinario, Sasso Marconi, Italy
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Treggiari E, Elliott JW, Baines SJ, Blackwood L. Temozolomide alone or in combination with doxorubicin as a rescue agent in 37 cases of canine multicentric lymphoma. Vet Comp Oncol 2017; 16:194-201. [PMID: 28766920 DOI: 10.1111/vco.12335] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 05/28/2017] [Accepted: 06/26/2017] [Indexed: 12/22/2022]
Affiliation(s)
- E. Treggiari
- Small Animal Teaching Hospital; University of Liverpool, School of Veterinary Science; Neston Cheshire UK
- Willows Veterinary Centre and Referral Service; Solihull West Midlands UK
| | - J. W. Elliott
- Small Animal Teaching Hospital; University of Liverpool, School of Veterinary Science; Neston Cheshire UK
- Willows Veterinary Centre and Referral Service; Solihull West Midlands UK
| | - S. J. Baines
- Willows Veterinary Centre and Referral Service; Solihull West Midlands UK
| | - L. Blackwood
- Small Animal Teaching Hospital; University of Liverpool, School of Veterinary Science; Neston Cheshire UK
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