Prognostic potential of copper, zinc, copper/zinc ratio, cobalamin, and serum amyloid A in cats with panleukopenia

BACKGROUND

Copper (Cu), zinc (Zn), and the copper/zinc ratio (Cu/Zn), which have been studied in gastrointestinal disorders of humans, may facilitate disease prognosis.

OBJECTIVE

Evaluate the predictive potential of Cu, Zn, cobalamin, and serum amyloid A (SAA) as prognostic indicators in cats with feline panleukopenia (FPV) on admission.

ANIMALS

Client-owned cats diagnosed with FPV and controls.

METHODS

Serum Cu and Zn concentrations were assessed using the spectrophotometric method and serum concentrations of SAA and cobalamin were measured by chemiluminescent immunoassay.

RESULTS

On admission, survivor cats with FPV had significantly higher serum Cu and SAA concentrations and Cu/Zn ratios and significantly lower serum Zn and cobalamin concentrations than controls. Furthermore, non-survivor cats with FPV had significantly higher serum Cu and SAA concentrations and Cu/Zn ratios and significantly lower cobalamin concentrations than survivors and controls. Prognostic thresholds were calculated, with positive predictive value (PPV) for survival of 90% for Cu (≥120.3 μg/dL), 90% for Cu/Zn (≥1.34), 90% for cobalamin (≤430.4 pg/mL), and 90% for SAA (≥0.85 mg/L).

CONCLUSIONS AND CLINICAL IMPORTANCE

Cu (0.93 area under curve [AUC]), Cu/Zn (0.95 AUC), cobalamin (0.98 AUC), and SAA (0.98 AUC) were excellent biomarkers for predicting prognosis in cats with FPV. Their effectiveness, as assessed by sensitivity (100%), specificity (80%), AUC (0.98), and PPV (90%) from receiver operating characteristic analysis, emphasizes the performance of cobalamin and SAA.

Insulin-like growth factor-1 expression levels in pro-inflammatory response in calves with neonatal systemic inflammatory response syndrome

The objective of this study was to investigate the mRNA expression of insulin-like growth factor-1 (IGF-1), pro-inflammatory cytokines (IL-1β, IL-6, IL-18, and TNF-α), serum immunoglobulin profiles (IgG and IgM), and lipid peroxidation status (MDA) in relation to pro-inflammatory cytokines. A case-controlled, prospective, and observational investigation was completed on 85 calves. Total RNA was isolated from whole blood samples of both the SIRS and healthy calves, followed by reverse transcription into cDNA. The resulting cDNAs were mixed with iTaq Universal SYBR Green Supermix and primers specific to the relevant genes using the Rotor-Gene Q instrument. After the reaction was completed, gene expressions were normalised against β-actin using the 2-ΔΔCT method. The mRNA levels of pro-inflammatory cytokines namely (IL-1β [SIRS: 2.15 ± 0.55, Control: 1.13 ± 0.62; P = 0.001], IL-6 [SIRS: 2.82 ± 0.52, Control: 0.91 ± 0.11; P < 0.001], IL-18 [SIRS: 1.92 ± 0.41, Control: 0.99 ± 0.13; P < 0.001], and TNF-α [SIRS: 2.59 ± 0.28, Control: 0.93 ± 0.09; P < 0.001]) and IGF-1 (SIRS: 3.55 ± 0.55, Control: 0.91 ± 0.15; P < 0.001) were up-regulated in calves with SIRS, while serum IgG (SIRS: 4.16 ± 0.26, Control: 1.73 ± 0.17; P < 0.001), IgM (SIRS: 1.55 ± 0.11, Control: 1.09 ± 0.13; P < 0.001), and MDA levels (SIRS: 41.12 ± 3.48, Control: 3.76 ± 0.81; P < 0.001) increased significantly in these calves. Furthermore, significant (P < 0.01) positive correlations were found in calves with SIRS in relation to the expression levels of IL-1β, IL-6, IL-18, TNF-α, IGF-1, serum immunoglobulins, and MDA levels. These results suggest that IGF-1 could be a valuable pro-inflammatory marker, considering its high positive correlation with the expression levels of pro-inflammatory cytokines (IL-1β, IL-6, IL-18, and TNF-α) and markers (MDA, IgG, and IgM) in calves with SIRS.

Assessment of serum calprotectin as a marker of inflammation in cattle with traumatic reticuloperitonitis

Calprotectin (CP) is an inflammatory marker. The aim of the current study was to investigate oxidative stress and changes in CP in cattle with traumatic reticuloperitonitis (TRP). The study was divided into two groups, experimental (TRP) and healthy control group, with 10 animals in each group. Total leucocyte count, neutrophil and lymphocyte counts were higher in the TRP group compared to the control group and this increase was statistically significant (P < 0.001). The level of malondialdehyde (MDA) in TRP group was statistically significantly higher than the control group (P < 0.001). The level of glutathione (GSH) in the TRP group was statistically significantly lower than in the control group (P < 0.001). Serum Amyloid A (SAA) and CP values were higher in the TRP group and this difference was statistically significant (P < 0.001). It was concluded as a result of ROC analysis that CP, which has similar values with SAA, can be used diagnostically to confirm the inflammatory status in cattle with TRP.

Investigation of hemogram, oxidative stress, and some inflammatory marker levels in neonatal calves with escherichia coli and coronavirus diarrhea

Calf diarrhea is the most common disease affecting calves in the neonatal period resulting in economic losses. Although predisposing factors play a role in the etiology of the disease, in most cases, different pathogens are involved in the development of the infection. In this study, hemogram data, glutathione and malondialdehyde levels were examined to determine lipid peroxidation and glutathione levels in E. coli- and coronavirus-infected calves. Serum amyloid A and calprotectin levels were also analyzed to determine inflammatory status. The study included a total of 45 female Montofon calves aged 0-1 week, including the E. coli group (15 calves), the coronavirus group (15 calves), and the control group (15 calves). Analysis revealed that total leukocyte, neutrophil, lymphocyte, malondialdehyde, serum amyloid A, and calprotectin levels increased in the coronavirus-infected calves compared with the E. coli group and the control group. In contrast, the levels of glutathione, one of the antioxidant markers, decreased. In conclusion, the main findings related to the determination of inflammation and oxidative status were characterized by the presence of E. coli and coronavirus diarrhea, and it is suggested that future studies may be guided by the fact that inflammatory conditions are higher in viral disease than in bacterial infection.

POS0597 EFFECTS OF RITUXIMAB IN PATIENTS WITH RHEUMATOID ARTHRITIS-RELATED INTERSTITIAL LUNG DISEASE: A SINGLE-CENTRE EXPERIENCE FROM TURKEY

Background:

Rheumatoid arthritis-related interstitial lung disease (RA-ILD) is the most common type of lung involvement in rheumatoid arthritis (RA). The existence of RA-ILD is associated with worse survival. There is no mainstay treatment for RA-ILD. However, in recent studies, rituximab (RTX) seems to be effective in RA-ILD.

Objectives:

To determine the effects of RTX in patients with RA-ILD from a single-centre.

Methods:

In our biological treatment outpatient clinic, a retrospective study was conducted in patients with RA who were treated with RTX. Among them, patients with RA-ILD were analysed. For lung response to RTX, progression was defined as a decline of 10% ≥ in forced vital capacity (FVC) and/or a decline of 15% ≥ in diffusion capacity of carbon monoxide (DLCO). Computed tomography of the chest (chest-CT) were integrated to lung response so as to constitute missing data of pulmonary function tests (PFTs).

Results:

A total of 165 patients who are followed-up in our biological treatment outpatient clinic have been using RTX for their RA diagnosis. Among 165 patients, 26 (15.8%) patients with RA-ILD were initiated RTX. Five patients were diagnosed with RA-ILD while using RTX (incidence rate 3%). Patients‘ characteristics were demonstrated in table 1. Of 26 patients, the most commonly used concomitant disease-modifying antirheumatic drugs was leflunomide (46.2%) followed by mycophenolate mofetil (11.5), methotrexate (11.5%) and azathioprine (3.8%). Twenty-four (92.3%) patients used steroids. For the evaluation of lung response, 20 patients who had follow-up PFTs and/or chest-CT were compared. Median DLCO values for pre- and post RTX were 71.0% (60.0-77.0) and 63.0% (47.0-74.0), respectively (p= 0.061). Median pre and post-RTX FVC were 74.0% (61.0-99.0) and 84.0% (63.0-100.0), respectively (p= 0.28). After a median of 2.7 years, 11 (55.0%) patients had stable disease, 2 (10.0%) patients had regression of RA-ILD and 7 (35.0%) patients had progressive disease. Sex, age, seropositivity and radiographic patterns were not associated with progression. In total, 23 adverse events were detected in 11 (42.3%) patients. Five of them were serious infections requiring hospitalization, mostly pneumonia. Other adverse events were simple infections and surgeries such as arthroplasty. RTX was stopped in 4 (15.4%) patients due to infections secondary to hypogammaglobulinemia in 2, malignancy in 1 and allergic reaction in 1.

Conclusion:

RTX seems to achieve stabilization/improvement of RA-ILD with fewer adverse events. However, given that RA-ILD develops post-RTX, it is not a panacea; therefore, we need more effective treatment modalities in the case of RA-ILD.

Table 1.

Characteristics of 26 patients with RA-ILD treated with rituximab

Age at first RTX infusion, median (IQR), years61.2 (57.1-65.1)RA disease duration at first RTX, median (IQR), years10.1 (4.3-29.7)ILD disease duration at first RTX, median (IQR), years1.9 (0.1-4.5)Age at RA diagnosis, median (IQR), years51.1 (40.0-60.6)Age at ILD diagnosis, median (IQR), years58.3 (53.9-63.3)Male patient, n (%)16 (61.5)RF positivity, n (%)25 (96.2)ACPA positivity, n (%)20 (90.9)CRP levels,mg/L, mean (SD)40.3 (58.9)ESR levels, mean (SD)37.7 (18.2)Smoking status, n (%)16 (64.0)Prior TNF inhibitor treatment, n (%)5 (19.2)DAS28 at first RTX infusion, mean (SD)5.3 (1.5)Radiographic pattern, n (%)UIP7 (26.9)NSIP8 (30.8)OP2 (7.7)Indeterminate8 (30.8)Others1 (3.8)Follow-up duration, median (IQR), years2.5 (1.2-3.7)

RA-ILD= Rheumatoid arthritis-related interstitial lung disease, RTX= rituximab, RA= rheumatoid arthritis, RF= rheumatoid factor, ACPA= anti-citrullinated protein antibody, TNF= tumor necrosis factor, CRP= C-reactive protein, ESR= erythrocyte sedimentation rate, UIP= usual interstitial pneumonia, NSIP= non-specific interstitial pneumonia, OP= organizing pneumonia

Disclosure of Interests:

None declared

POS1335 CLINICAL CHARACTERISTICS OF THE PULMONARY ARTERY INVOLVEMENT IN PATIENTS WITH BEHÇET’S SYNDROME: A SINGLE-CENTRE EXPERIENCE OF 61 PATIENTS

Background:

Behçet’s Syndrome (BS) is a vasculitis of unknown origin. Vascular involvement, so-called vascular Behçet’s syndrome (VBS), may involve blood vessels of all sizes belonging to both venous and arterial system, with pulmonary artery involvement (PAI) being the most frequent form of arterial involvement. PAI in BS occurs in the form of aneurysms or thrombosis, and results in significant mortality.

Objectives:

To report the clinical characteristics of PAI in patients with BS and to define the predictors of relapses.

Methods:

We performed a retrospective analysis of BS patients with PAI who fulfilled international study group criteria. Among 460 patients with VBS, 66 were diagnosed with PAI. For final analyses, 61 patients with PAI, who had at least 2 follow-up visits (72.1% male, mean age at BS diagnosis 29.34 (SD 10.1) years), were included. The data of the patients were recorded. Relapse was defined as the reoccurrence of vascular event at any vascular structure. Factors associated with relapse were assessed by logistic regression analysis.

Results:

There were not any differences considering demographic and clinical features of the patients with and without PAI in VBS group except for that intracardiac thrombosis was more common in the patients with PAI than the patients without (19.7% vs 0.3%, respectively) (Figure 1). Among 61 patients with PAI, 50 (82.0%) had isolated pulmonary artery thrombosis (PAT), whereas 11 (18.0%) had pulmonary artery aneurysm (PAA) with or without PAT. The characteristics of 61 patients with PAI were shown in Table 1. A total of 37 relapses occurred in 24 (39.3%) patients during follow-up a median of 65.9 (IQR 20.1-109.0) months. To define the factors associated with relapses, the patients with isolated PAT were analysed. In multivariable logistic regression analysis, older age at BS diagnosis and anticoagulation usage seemed to be protective, even though they could not reach statistical significance (OR: 0.92 95% CI 0.86-1.02, OR: 0.34 95% CI 0.09-1.33, respectively).

Table 1.

Characteristics of the patients with pulmonary artery involvement

Alln= 61Isolated PATn= 50PAAn= 11Sex (male), n (%)44 (72.1)35 (70.0)9 (81.8)Age at diagnosis of BS, years (SD)29.3 (10.1)28.8 (10.4)31.9 (8.0)Age at diagnosis of PAI, years (SD)36.3 (12.83)36.7 (13.8)34.7 (6.7)Symptoms, n (%)Dyspnea28 (45.9)23 (46.0)5 (45.5)Hemoptysis26 (42.6)19 (38.0)7 (63.6)Vascular event before PAI, n (%)21 (34.4)20 (40.0)1 (9.1)Other vascular events at PAI, n (%)33 (54.1)28 (56.0)5 (45.5)Thrombophlebitis, n (%)7 (21.2)6 (21.4)1 (20.0)Upper and/or lower extremity DVT, n (%)20 (60.6)16 (57.1)4 (80.0)SVCS, n (%)1 (3.0)1 (3.6)0 (0)IVCS, n (%)3 (9.1)1 (3.6)2 (40.0)Intracranial thrombosis, n (%)4 (12.1)4 (14.3)0 (0)Intracardiac thrombosis, n (%)8 (24.2)7 (25.0)1 (20.0)Arterial event other than PAI, n (%)4 (12.1)3 (10.7)1 (20.0)Relapse, n (%)24 (39.3)20 (40.0)4 (36.4)Time to the first relapse, median (IQR), month49.8 (13.2-102.6)54.1 (24.4-117.9)3.9 (1.7-67.9)Death, n (%)2 (3.3)0 (0)2 (18.2)

BS= Behçet Syndrome, PAI= pulmonary artery involvement, PAT= pulmonary artery thrombosis, PAA= pulmonary artery aneurysm, DVT= deep vein thrombosis, SVCS= superior vena cava syndrome, IVCS= inferior vena cava syndrome

Figure 1.

A) Axial CT image shows thrombus formation in the left upper lobe pulmonary artery branch. B) Giant thrombus is seen in the right ventricle (black arrow). Note the thrombus formation in the left lower lobe pulmonary artery branches (white arrows).

Conclusion:

Our results indicate that there is a higher frequency of intracardiac thrombosis in BS patients with PAI and an increasing current trend of PAT in patients with PAI. In addition, there might be a possible efficacy of anticoagulation usage in preventing relapses, which needs confirmation with further studies.

Disclosure of Interests:

None declared

Vitamin K deficiency--late onset intracranial haemorrhage

A retrospective study is presented of the clinical features and outcome of late onset haemorrhagic disease due to vitamin K deficiency in 11 babies who were admitted to the emergency or child neurology unit during a 4-year period (January 1994-December 1997). The disease occurred in infants between 30 and 119 days of age (mean: 56+/-24 days). None of them received vitamin K after birth and all were breastfed. The presenting complaints were seizures (91%), drowsiness (82%), poor sucking (64%), vomiting (46%), fever (46%), pallor (46%), acute diarrhoea (27%), irritability and high-pitched cry (18%). On examination, tense or bulging fontanelle (73%), anisocoria (36%), weak neonatal reflexes (18%), cyanoses (18%) were the most frequent findings. The localizations of the intracranial haemorrhage were as follows: intracerebral (91%), subarachnoid (46%), subdural (27%), and intraventricular (27%). No fatality was observed. However, after a follow-up period ranging from 6 to 48 months (mean: 21+/-13 months), only three (27%) infants remained neurologically normal. Seizure disorders (73%), severe psychomotor retardation (46%), cerebral palsy (46%) and microcephaly (46%) were observed in the remainder. Hydrocephalus developed in three (27%) babies but none of them required shunt replacement. The value is emphasized of vitamin K prophylaxis in the newborn to reduce the incidence of late onset intracranial haemorrhage and handicap in children.