Serum erythropoietin changes in cats with feline leukemia virus-induced erythroid aplasia

Feline non-regenerative anemia: Diagnostic and treatment recommendations

PRACTICAL RELEVANCE

Non-regenerative anemia, or anemia with reticulocytopenia, is a daily diagnosis in feline practice.

CLINICAL CHALLENGES

The disease processes underlying non-regenerative anemia are many and diverse. A major diagnostic evaluation may be required to correctly diagnose and treat the underlying cause.

AUDIENCE

All veterinarians caring for cats will face the diagnostic and therapeutic challenge of non-regenerative anemia. Readers will benefit from the review of diagnostic testing and therapeutic options for non-regenerative anemia.

EVIDENCE BASE

This review summarizes the currently available literature informing diagnostic and treatment recommendations related to non-regenerative anemia. The evidence available to support the recommendations in this review is graded as low and includes predominantly expert opinion, case reports and cases series, on which the authors' interpretation/consensus is based.

The use of erythropoietin

EPO is a hematopoietic growth factor produced in the kidney that stimulates erythropoiesis. It effectively treats hypoproliferative anemia associated with CRF, improving quality of life in these patients. Other uses that are poorly characterized in veterinary medicine include treatment of cancer patients on chemotherapy, hematologic disorders, and anemic FeLV-infected cats as well as preoperative conditioning for elective surgeries that may involve significant blood loss. Careful monitoring of therapy is necessary for optimal results. Several complications are associated with rHuEPO therapy. The production of anti-rHuEPO antibodies is the most significant and can be a life-threatening event. Alternatives to human EPO are being sought to provide beneficial effects while avoiding antibody formation.

Cytopathic feline leukemia viruses cause apoptosis in hemolymphatic cells

Certain isolates of the oncoretrovirus feline leukemia virus (FeLV) are strongly cytopathic for hemolymphatic cells. A major cytopathicity determinant is encoded by the SU envelope glucoprotein gp70. Isolates with subgroup C SU gp70 genes specifically induce apoptosis in hemolymphatic cells but not fibroblasts. In vitro exposure of feline T-cells to FeLV-C leads first to productive viral replication, next to virus-induced cell agglutination, and lastly to apogenesis. This in vitro phenomenon may explain the severe progressive thymic atrophy and erythroid aplasia which follow viremic FeLV-C infection in vivo. Inappropriate apoptosis induction has also been hypothesized to explain the severe thymico-lymphoid atrophy and progressive immune deterioration associated with isolates of FeLV containing variant envelope genes. The influence of envelope hypervariability (variable regions 1 [Vr1] and 5 [Vr5] on virus tropism, viremia induction, neutralizing antibody development and cytopathicity is discussed. Certain potentially cytopathic elements in FeLV SU gp70 Vr5 may derive from replication-defective, poorly expressed, endogenous FeLVs. Other more highly conserved regions in FeLV TM envelope p15E may also influence apoptosis induction.

Haematological disorders associated with feline retrovirus infections

Feline oncornavirus and lentivirus infections have provided useful models to characterize the virus and host cell factors involved in a variety of marrow suppressive disorders and haematological malignancies. Exciting recent progress has been made in the characterization of the viral genotypic features involved in FeLV-associated diseases. Molecular studies have clearly defined the causal role of variant FeLV env gene determinants in two disorders: the T-lymphocyte cytopathicity and the clinical acute immunosuppression induced by the FeLV-FAIDS variant and the pure red cell aplasia induced by FeLV-C/Sarma. Variant or enFeLV env sequences also appear to play a role in FeLV-associated lymphomas. Additional studies are required to determine the host cell processes that are perturbed by these variant env gene products. In the case of the FeLV-FAIDS variant, the aberrant env gene products appear to impair superinfection interference, resulting in accumulation of unintegrated viral DNA and cell death. In other cases it is likely that the viral env proteins interact with host products that are important in cell viability and/or proliferation. Understanding of these mechanisms will therefore provide insights to factors involved in normal lymphohaematopoiesis. Similarly, studies of FeLV-induced haematological neoplasms should reveal recombination or rearrangement events involving as yet unidentified host gene sequences that encode products involved in normal cell growth regulation. These sequences may include novel protoncogenes or sequences homologous to genes implicated in human haematological malignancies. The haematological consequences of FIV are quite similar to those associated with HIV. As with HIV, FIV does not appear to directly infect myeloid or erythroid precursors, and the mechanisms of marrow suppression likely involve virus, viral antigen, and/or infected accessory cells in the marrow microenvironment. Studies using in vitro experimental models are required to define the effects of each of these microenvironmental elements on haematopoietic progenitors. As little is known about the molecular mechanisms of FIV pathogenesis, additional studies of disease-inducing FIV strains are needed to identify the genotypic features that correlate with virulent phenotypic features. Finally, experimental FIV infection in cats provides the opportunity to correlate in vivo virological and haematological changes with in vitro observations in a large animal model that closely mimics HIV infection in man.

Serum erythropoietin concentrations measured by radioimmunoassay in normal, polycythemic, and anemic dogs and cats

Serum erythropoietin (Epo) concentrations were measured by radioimmunoassay (RIA) in normal, polycythemic, and anemic dogs and cats. The serum Epo concentration in normal dogs (n = 25) ranged from 7 to 37 mU/mL (median, 20 mU/mL); and in normal cats (n = 11) ranged from 9 to 38 mU/mL (median, 18 mU/mL). Polycythemic animals (PCV > 55% in dogs, > 45% in cats) were classified as those with primary (polycythemia vera), secondary, or polycythemia of uncertain etiology. Dogs with polycythemia vera (PV, n = 8) had a median serum Epo concentration in the normal range (17 mU/mL); cats with PV (n = 7) also had a median serum Epo concentration that was within the normal range (10 mU/mL). In the category of secondary polycythemias, dogs (n = 7) (median, 30.7 mU/mL) and cats (n = 2) had normal Epo concentrations. The median serum Epo concentration was significantly decreased (P < .05) in dogs with PV compared with dogs with secondary polycythemias. The median serum Epo concentrations in dogs (n = 13) and cats (n = 5) with anemias not due to chronic renal disease were significantly increased (P < .05) compared with normal dogs and cats. In cats with anemias due to chronic renal disease (n = 5) the median serum Epo concentration was not significantly different from normal cats. The measurement of the serum EPO concentration may be useful in assessment of anemia or polycythemia but the overlap of values with the normal range in all groups evaluated limit its diagnostic use.

Antithymocyte globulin treatment of retrovirus-induced feline erythroid aplasia: in vivo and in vitro studies

The Kawakami-Theilen strain of feline leukemia virus (FeLV-KT) was used experimentally to produce erythroid aplasia in cats. The in vivo effects of goat anti-feline-thymocyte globulin (ATG) on hematopoiesis were investigated in FeLV-negative normal and FeLV-positive anemic cats. Treatment was initiated in anemic cats between 4 and 6 weeks postinoculation (PI) when erythroid progenitors were reduced to 10% of normal levels. During the first 2 weeks of treatment, ATG significantly increased the numbers of erythroid precursors in bone marrow from 15 to 35% in anemic cats and from 28 to 43% in normal cats. ATG stimulated a twofold increase of CFU-E and a threefold increase of CFU-GM in normal cats between 2 and 4 weeks after initiation of treatment but had no effect on CFU-E or CFU-GM in anemic cats. The in vivo effects of ATG were transient despite weekly treatment. Cats treated with normal globulin were not significantly different from untreated anemic control cats. In vitro treatment of low density bone marrow mononuclear cells with ATG plus complement increased CFU-E and BFU-E of bone marrow from cats prior to inoculation but not from viremic cats. These results indicate that, although ATG stimulates erythropoiesis and granulopoiesis in normal cats, it does not reverse retrovirus-induced erythroid aplasia.

Feline leukemia/sarcoma viruses and immunodeficiency

This chapter discusses the structure feline leukemia virus (FeLV) and pathogenesis of lymphomas and leukemias BY FeLV. FeLV is quite similar to the better-studied murine leukemia viruses in structure and genetic map. The virus particles bud from cytoplasmic membranes into either extracellular spaces or into vacuoles. FeLV has long been considered a typical noncytopathogenic, longlatency leukemia virus based on its behavior in fibroblasts in vitro . Recent evidence suggests that its in vivo behavior in critical target hemolymphatic tissues is as likely to be cytopathic as transforming. The type of FeLV-related disease that occurs and the disease-free interval probably are influenced by viral envelope proteins and glycoproteins and the consequences of proviral integration. FeLV subgroup specificity apparently determines when and what type of disease will occur. The ecotropic FeLV-A is the most frequent subgroup found in pet cats and is transmitted contagiously. Immunosuppression is the most frequent and the most devastating manifestation of FeLV viremia in clinical and experimental studies. It seems that multiple cell types and multiple processes are involved in the development of feline retrovirus-induced immunosuppression. Although no solid evidence is available for the malfunctioning of cat T helper cells because of the paucity of T-cell specific markers, the circumstantial evidence provided thus far indicates an impaired T helper function in FeLV-infected cats similar to that observed in humans infected with HIV. Studies on the pathogenesis of FeLV-induced immunosuppression might provide a valuable mode for a better understanding and means of control of human AIDS.