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Abstract
OBJECTIVES While thromboelastography (TEG) has helped define a complex state of hemostasis in dogs and humans with hepatobiliary disease, it has not been explored in cats with cholestatic liver disease (CLD). The objective of this study was to describe TEG parameters in cats with CLD and to compare these parameters with conventional plasma-based coagulation tests, white blood cell (WBC) count and biochemical indicators of liver disease grade and severity. METHODS Eighteen cats with CLD, defined by a serum bilirubin ⩾3 mg/dl and a greater than two-fold increase in serum alanine aminotransferase (ALT) and/or alkaline phosphatase (ALP) activity, were prospectively enrolled. All cats received vitamin K1 subcutaneously for 24-36 h prior to acquisition of blood for kaolin-activated TEG analysis, prothrombin time (PT) and activated partial thromboplastin time (aPTT). Patient total solids, packed cell volume, platelet count, WBC count, and serum liver enzymes and bilirubin were extracted from the medical record and correlated with coagulation test results. RESULTS TEG global clot strength (TEG G) values defined 9/18 (50%), 5/18 (28%) and 4/18 (22%) cats as hypercoagulable, normocoagulable or hypocoagulable, respectively. TEG G was significantly negatively correlated with PT, aPTT and serum ALP activity and positively correlated with total solids. Five cats (5/18, 28%) were hyperfibrinolytic with clot lysis at 60 mins (LY 60) >15.3%. LY 60 was significantly positively correlated with PT. CONCLUSIONS AND RELEVANCE By TEG analysis, cholestatic cats replete with vitamin K1 display a variety of coagulation profiles. Indications of synthetic failure (prolonged PT and aPTT) were associated with hypocoagulable and hyperfibrinolytic TEG parameters. High disease activity (serum ALP) was associated with a hypocoagulable state.
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Affiliation(s)
- Neketa Kakar
- Small Animal Internal Medicine, Cummings School of Veterinary Medicine at Tufts University, Grafton, MA, USA
| | - Gideon Daniel
- Friendship Hospital for Small Animals, Washington, DC, USA
| | - Claire Fellman
- Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, Grafton, MA, USA
| | - Armelle de Laforcade
- Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, Grafton, MA, USA
| | - Cynthia Rl Webster
- Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, Grafton, MA, USA
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Kummari E, Gibbs A, Riggs C, Fellman C, Stokes J, Thomason J, Wills R, Mackin A, Archer T. Effects of pentoxifylline on whole blood IL-2 and IFN-gamma gene expression in normal dogs. Vet Med Sci 2020; 6:19-24. [PMID: 31621209 PMCID: PMC7036308 DOI: 10.1002/vms3.204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 07/31/2019] [Accepted: 08/30/2019] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Pentoxifylline (PTX) is a methylxanthine phosphodiesterase inhibitor that is used as a hemorrheologic and anti-inflammatory agent in veterinary and human medicine. In human studies, PTX has been shown to decrease T-cell production of cytokines such as IL-2 and IFN-γ. A RT-qPCR assay to measure activated T-cell gene expression of IL-2 and IFN-γ has been validated in dogs. OBJECTIVES The goal of this study was to utilize this assay to investigate the effects of PTX on in vitro cytokine gene expression in canine whole blood. METHODS Whole blood from seven healthy dogs was collected and incubated with various concentrations of PTX for 1 hr before activation. PTX concentrations spanned and exceeded blood concentrations achieved when administered at clinically relevant dosages (1, 2, 10, 50 and 200 μg/ml). Cyclosporine was used at a concentration of 500 ng/ml as a positive control. All blood samples, including untreated activated baseline samples, were then activated with phorbol myristate acetate and ionomycin for 5 hrs. RESULTS Analysis of activated whole blood by RT-qPCR revealed that there was not a significant suppression of IL-2 or IFN-γ gene expression at any concentration of PTX when evaluating ΔCt values. All samples exposed to cyclosporine showed significant changes from untreated activated baseline samples, demonstrating marked suppression as the positive control. Cytokine expression, presented as a percentage of untreated activated baseline samples, was also evaluated. After exposure to the highest concentration of PTX (200 μg/ml), median percentage cytokine expression was suppressed to just below 50% of baseline values. This concentration, however, is much higher than blood concentrations reported to be achieved at standardly used pentoxifylline doses. CONCLUSIONS PTX does not appear to significantly suppress T-cell cytokine production in samples from most dogs at clinically relevant drug concentrations. Further testing is needed to establish the full effects of PTX on the immune system in dogs.
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Affiliation(s)
- Evangel Kummari
- Department of Basic SciencesMississippi State University College of Veterinary MedicineMississippi StateMSUSA
| | - Andres Gibbs
- Department of Clinical SciencesMississippi State University College of Veterinary MedicineMississippi StateMSUSA
- Present address:
Randall Veterinary HospitalByramMSUSA
| | - Caitlin Riggs
- Department of Clinical SciencesMississippi State University College of Veterinary MedicineMississippi StateMSUSA
| | - Claire Fellman
- Department of Clinical SciencesMississippi State University College of Veterinary MedicineMississippi StateMSUSA
- Present address:
Department of Clinical SciencesTufts University200 Westboro RoadNorth GraftonMA01536USA
| | - John Stokes
- Department of Basic SciencesMississippi State University College of Veterinary MedicineMississippi StateMSUSA
| | - John Thomason
- Department of Clinical SciencesMississippi State University College of Veterinary MedicineMississippi StateMSUSA
| | - Robert Wills
- Department of Pathobiology and Population MedicineMississippi State University College of Veterinary MedicineMississippi StateMSUSA
| | - Andrew Mackin
- Department of Clinical SciencesMississippi State University College of Veterinary MedicineMississippi StateMSUSA
| | - Todd Archer
- Department of Clinical SciencesMississippi State University College of Veterinary MedicineMississippi StateMSUSA
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Beaulac KR, Doron S, Fellman C, Wayne A, McDermott LA, Snydman D. 672. The Impact on Humans of Treating Dogs with Amoxicillin/Clavulanate. Open Forum Infect Dis 2018. [PMCID: PMC6255017 DOI: 10.1093/ofid/ofy210.679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background It has been shown that the use of antibiotics promotes resistance to that antibiotic, and that colonization with resistant pathogens can be transmitted from companion animals to their human owners. There is an evolving concern that use of medically important antibiotics in pets can confer colonization by resistant organisms in their human owners. Methods In dogs receiving amoxicillin/clavulanate for 14 days for a diagnosed infection, we screened stool both at the time of antibiotic initiation and at the end of the course for the dog taking antibiotics and their human owner. Owners had to meet a closeness score of 3 or 4, meaning living in same household with frequent contact, with or without oral contact, and have no recent antibiotic exposure. Stool samples were quantitatively cultured for enteric flora and incubated on selective media for ampicillin/sulbactam resistance (A/S-r), ciprofloxacin resistance (CIP-r), ESBL, MRSA, and VRE. Results We enrolled eight dog–human pairs. All had enteric flora present at the time of antibiotic initiation (Day 1), whereas two of the seven dog samples that could be analyzed had no detectable enteric flora by the end of antibiotics (Day 14). No humans or dogs acquired MRSA or VRE. One human lost colonization with CIP-r flora, whereas two dogs acquired CIP-r during antibiotic treatment that did not transmit to their owners. One dog and one unrelated human acquired ESBL colonization by day 14 that was not present at Day 1. There were three humans colonized with A/S-r on Day 1 which persisted through the treatment period. Of their three dogs, one had no A/S-r at either time point, one newly acquired high counts of A/S-r flora, and one did not provide enough stool at Day 14 for A/S-r testing. There was one other dog that acquired A/S-r flora and one dog that had increasing counts of A/S-r, both of which had human owners with no A/S-r on Day 1 or 14. Conclusion In this pilot study, we identified that use of amoxicillin-clavulanate, a common antibiotic prescribed to both humans and dogs, can lead to resistant colonization in the dog taking antibiotics, and may have some impact on their close human owners who may share or transmit colonization. Further study is under way to better understand this relationship. Disclosures L. A. McDermott, CutisPharma Inc.: Research Contractor, Contractual agreement with Tufts Medical Center.
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Affiliation(s)
| | - Shira Doron
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts
| | - Claire Fellman
- Cummings School of Veterinary Medicine at Tufts University, North Grafton, Massachusetts
| | - Annie Wayne
- Emergency Medicine and Critical Care, Cummings School of Veterinary Medicine at Tufts University, North Grafton, Massachusetts
| | - Laura A McDermott
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts
| | - David Snydman
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts
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Mackin A, Archer T, Lunsford K, Fellman C, Thomason J. Treatment of immune-mediated polyarthritis in dogs. J Am Vet Med Assoc 2016; 248:876-877. [PMID: 27483552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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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] [What about the content of this article? (0)] [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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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] [What about the content of this article? (0)] [Affiliation(s)] [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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