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Werner S, Wallukat G, Becker NP, Wenzel K, Müller J, Schimke I, Wess G. The aptamer BC 007 for treatment of dilated cardiomyopathy: evaluation in Doberman Pinschers of efficacy and outcomes. ESC Heart Fail 2020; 7:844-855. [PMID: 32212256 PMCID: PMC7261533 DOI: 10.1002/ehf2.12628] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 12/14/2019] [Accepted: 01/06/2020] [Indexed: 12/17/2022] Open
Abstract
Aims Aptamer BC 007, a 15‐mer single‐strand DNA oligonucleotide (5'‐GGTTGGTGTGGTTGG‐3'), was developed to neutralize functional autoantibodies that bind to the extracellular domains of G protein‐coupled receptors (GPCR‐AAB), leading to the modulation of receptor‐mediated signalling cascades that induce pathophysiological states. Among the GPCR‐AAB, there are those directed against the β1‐adrenergic receptor (β1‐AAB) that are highly present in patients with dilated cardiomyopathy (DCM) and are increasingly accepted as disease drivers. Using Doberman Pinschers (DP) with DCM, which possess similarities with human DCM among these β1‐AAB positivity for that the disease‐driving role in DP DCM was demonstrated, the safety of BC 007, efficacy for neutralizing β1‐AAB, and the DP's outcome were investigated. Methods and results Fourteen client‐owned β1‐AAB‐positive DP with electrocardiographically and echocardiographically indicated DCM were treated with BC 007. For controlling, two groups were created: 14 β1‐AAB‐positive DP with DCM not treated with BC 007 (Control 1) and 14 DP with DCM closely matched to the BC 007‐treated DP (Control 2), retrospectively selected from the institutional database of DP. After treatment, DP were monitored both echocardiographically, and for β1‐AAB, and survival curves were calculated. Based on clinical and laboratory examination, no adverse effects associated with BC 007 treatment were observed during the study. Forty‐eight hours after treatment, the DP's blood was free of β1‐AAB, which led to a reduction or stabilization of left ventricular end‐systolic volume (ESVI) during β1‐AAB free time in 10 of the treated DP. In one DP, where β1‐AAB returned after 3 months and ESVI worsened again, a second BC 007 treatment after 9 months again cleared the blood from β1‐AAB and improved the ESVI. Compared with the controls, DP treated with BC 007 showed a significantly longer survival time [572 days, interquartile range (IQR) 442–840 days] vs. Control group 1 (266 days, IQR 97–438 days; logrank: P = 0.009) and Control group 2 (229 days, IQR 174–319 days; logrank: P = 0.012). Conclusions Treatment with BC 007 for β1‐AAB neutralization was safe, resulted in a long‐lasting reduction of β1‐AAB combined with improved cardiac function and prolonged the survival of DP with DCM. Using a natural large animal model of DCM considered superior to small animal models of immunization‐induced cardiomyopathy, combined with a study design comparable with clinical trials, we believe that our results provide the basis for optimism that treatment with BC 007 might also be effective in human patients with DCM.
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Affiliation(s)
- Sabine Werner
- Department of Cardiology, Clinic of Small Animal Medicine, Ludwig-Maximilians-University, Munich, Germany
| | - Gerd Wallukat
- Department of Research & Development, Berlin Cures GmbH, Berlin, Germany
| | - Niels-Peter Becker
- Department of Research & Development, Berlin Cures GmbH, Berlin, Germany
| | - Katrin Wenzel
- Department of Research & Development, Berlin Cures GmbH, Berlin, Germany
| | - Johannes Müller
- Department of Research & Development, Berlin Cures GmbH, Berlin, Germany
| | - Ingolf Schimke
- Department of Research & Development, Berlin Cures GmbH, Berlin, Germany
| | - Gerhard Wess
- Department of Cardiology, Clinic of Small Animal Medicine, Ludwig-Maximilians-University, Munich, Germany
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Gunasekaran T, Olivier NB, Sanders RA. Comparison of single- versus seven-day Holter analysis for the identification of dilated cardiomyopathy predictive criteria in apparently healthy Doberman Pinscher dogs. J Vet Cardiol 2020; 27:78-87. [PMID: 32086162 DOI: 10.1016/j.jvc.2020.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 01/13/2020] [Accepted: 01/22/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The primary objective of this study was to test whether seven-day Holter recording improves the sensitivity of detecting dilated cardiomyopathy (DCM) predictive criteria (DCMp) compared with 24-h Holter recording in asymptomatic Doberman Pinscher (DP) dogs. ANIMALS Twenty-eight asymptomatic DP dogs with normal echocardiographic examinations. METHODS Dogs with normal echocardiographic examinations underwent seven-day Holter monitoring. The presence of ≥50 ventricular premature complexes and or ≥ one couplet/one triplet/one episode of ventricular tachycardia per 24-h period was considered positive for DCMp. RESULTS Five dogs were positive on the first day, and an additional six dogs tested positive from day two to seven of the Holter recording. The number of dogs positive for DCMp detected by four days was significantly different (p = 0.031) compared with the first-day Holter recording. CONCLUSIONS Seven-day Holter recording detected significantly more dogs with DCMp compared with the first-day Holter recording. Follow-up studies are warranted to evaluate the long-term accuracy of multiple-day Holter analysis in predicting the development of DCM in DP dogs.
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Affiliation(s)
- T Gunasekaran
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Veterinary Medical Center, 736 Wilson Rd, East Lansing, MI, 48824, USA
| | - N B Olivier
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Veterinary Medical Center, 736 Wilson Rd, East Lansing, MI, 48824, USA
| | - R A Sanders
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Veterinary Medical Center, 736 Wilson Rd, East Lansing, MI, 48824, USA.
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Sarcinella F, Neves J, Maddox TW, Hodgkiss-Geere HM, Bode EF, Dukes-McEwan J. Effect of pimobendan on left atrial function in dogs with preclinical myxomatous mitral valve disease. Open Vet J 2020; 9:375-383. [PMID: 32042661 PMCID: PMC6971367 DOI: 10.4314/ovj.v9i4.16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 12/20/2019] [Indexed: 12/15/2022] Open
Abstract
Background Left atrial (LA) function is an important determinant of the left ventricular (LV) filling, playing a key role in maintaining optimal cardiac performance. Pimobendan is a phosphodiesterase III inhibitor with positive inotropic and vasodilator effects. The present study aims to investigate the effects of pimobendan on LA function in dogs with stage B2 myxomatous mitral valve disease (MMVD). Aim The aim of this investigation was to study the effects of pimobendan on LA function in dogs with preclinical MMVD. Methods Twenty-seven dogs with stage B2 MMVD were retrospectively included. LA function was assessed before and 1-6 months following pimobendan initiation. For each dog, two-dimensional (2D) echocardiography was performed to assess LA diameter and volume for each phase of the LA cycle and to assess complete, passive, and active LA function. Pulsed-wave tissue Doppler imaging (TDI) of the left ventricular longitudinal myocardial velocity associated with atrial contraction (A'), both at the level of the interventricular septum and the LV free wall, was also used as an indicator of LA function. Results There were no significant differences in any of the left atrial variables pre- and posttreatment. Conclusion Echocardiographic estimates of LA function by 2D diameters and volumes and TDI A' in dogs with MMVD do not change after treatment with pimobendan.
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Affiliation(s)
- Fabio Sarcinella
- Department of Small Animal Clinical Science, Small Animal Teaching Hospital, Institute of Veterinary Science, University of Liverpool, Neston, Chester CH64 7TE, UK
| | - Joao Neves
- Department of Small Animal Clinical Science, Small Animal Teaching Hospital, Institute of Veterinary Science, University of Liverpool, Neston, Chester CH64 7TE, UK
| | - Thomas W. Maddox
- Department of Small Animal Clinical Science, Small Animal Teaching Hospital, Institute of Veterinary Science, University of Liverpool, Neston, Chester CH64 7TE, UK
| | - Hannah M. Hodgkiss-Geere
- Department of Small Animal Clinical Science, Small Animal Teaching Hospital, Institute of Veterinary Science, University of Liverpool, Neston, Chester CH64 7TE, UK
| | - Elizabeth F. Bode
- Department of Small Animal Clinical Science, Small Animal Teaching Hospital, Institute of Veterinary Science, University of Liverpool, Neston, Chester CH64 7TE, UK
| | - Joanna Dukes-McEwan
- Department of Small Animal Clinical Science, Small Animal Teaching Hospital, Institute of Veterinary Science, University of Liverpool, Neston, Chester CH64 7TE, UK
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54
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Adin D, Kurtz K, Atkins C, Papich MG, Vaden S. Role of electrolyte concentrations and renin-angiotensin-aldosterone activation in the staging of canine heart disease. J Vet Intern Med 2019; 34:53-64. [PMID: 31769114 PMCID: PMC6979094 DOI: 10.1111/jvim.15662] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 10/29/2019] [Indexed: 11/28/2022] Open
Abstract
Background Refractory congestive heart failure (CHF) and associated diuretic resistance are not well defined. Objectives To characterize renal function, electrolyte concentrations, indices of diuretic efficacy, and renin‐angiotensin‐aldosterone system (RAAS) activation in dogs with naturally occurring heart disease (HD) in American College of Veterinary Internal Medicine stages B1, B2, C, and D and to determine their usefulness in defining HD stages. Animals Group 1:149 dogs with HD stages B1, B2, C, and D. Group 2:22 dogs with HD stages C and D. Methods Group 1: Renal parameters, serum and urine electrolyte and diuretic concentrations, and urine aldosterone concentrations were measured. Medication dosages and measured variables were compared among stages. Correlation of furosemide dosages to serum concentrations was explored. Group 2: Angiotensin‐converting enzyme activity and RAAS components were measured and compared among CHF stages. Results Serum chloride concentration was the best differentiator of HD stage. Furosemide PO dosages (≤6 mg/kg/day) were weakly correlated with serum furosemide concentrations, whereas higher dosages were not significantly correlated. Angiotensin‐converting enzyme inhibitor dosage and RAAS inhibition were greater in stage D, compared to stage C dogs. Conclusions and Clinical Importance Hypochloremia is a useful marker for stage D HD in dogs. Poor furosemide dosage correlation to serum concentration may indicate variable and poor absorption, especially at higher dosages, advanced disease, or both. A small number of stage D dogs met proposed criteria for diuretic resistance. Greater RAAS inhibition in stage D versus stage C indicates effectiveness of RAAS‐suppressive treatments in this group of dogs with refractory CHF.
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Affiliation(s)
- Darcy Adin
- College of Veterinary Medicine, University of Florida, Gainesville, Florida
| | - Kari Kurtz
- College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina
| | - Clarke Atkins
- College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina
| | - Mark G Papich
- College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina
| | - Shelly Vaden
- College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina
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Carvalho EB, Ramos IPR, Nascimento AFS, Brasil GV, Mello DB, Oti M, Sammeth M, Bahia MT, Campos de Carvalho AC, Carvalho AB. Echocardiographic Measurements in a Preclinical Model of Chronic Chagasic Cardiomyopathy in Dogs: Validation and Reproducibility. Front Cell Infect Microbiol 2019; 9:332. [PMID: 31616643 PMCID: PMC6768978 DOI: 10.3389/fcimb.2019.00332] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 09/10/2019] [Indexed: 02/05/2023] Open
Abstract
Background: The failure to translate preclinical results to the clinical setting is the rule, not the exception. One reason that is frequently overlooked is whether the animal model reproduces distinctive features of human disease. Another is the reproducibility of the method used to measure treatment effects in preclinical studies. Left ventricular (LV) function improvement is the most common endpoint in preclinical cardiovascular disease studies, while echocardiography is the most frequently used method to evaluate LV function. In this work, we conducted a robust echocardiographic evaluation of LV size and function in dogs chronically infected by Trypanosoma cruzi. Methods and Results: Echocardiography was performed blindly by two distinct observers in mongrel dogs before and between 6 and 9 months post infection. Parameters analyzed included end-systolic volume (ESV), end-diastolic volume (EDV), ejection fraction (EF), and fractional shortening (FS). We observed a significant LVEF and FS reduction in infected animals compared to controls, with no significant variation in volumes. However, the effect of chronic infection in systolic function was quite variable, with EF ranging from 17 to 66%. Using the cut-off value of EF ≤ 40%, established for dilated cardiomyopathy (DCM) in dogs, only 28% of the infected dogs were affected by the chronic infection. Conclusions: The canine model of CCC mimics human disease, reproducing the percentage of individuals that develop heart failure during the chronic infection. It is thus mandatory to establish inclusion criteria in the experimental design of canine preclinical studies to account for the variable effect that chronic infection has on systolic function.
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Affiliation(s)
- Eduardo B. Carvalho
- Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Isalira P. R. Ramos
- National Center for Structural Biology and Bioimaging, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Guilherme V. Brasil
- Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Debora B. Mello
- National Center for Structural Biology and Bioimaging, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Martin Oti
- Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Michael Sammeth
- Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Maria T. Bahia
- School of Medicine, Federal University of Ouro Preto, Ouro Preto, Brazil
| | - Antonio C. Campos de Carvalho
- Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- National Center for Structural Biology and Bioimaging, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- National Institute for Science and Technology in Regenerative Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Adriana B. Carvalho
- Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- National Center for Structural Biology and Bioimaging, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- National Institute for Science and Technology in Regenerative Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Pugliese M, Voslarova E, Biondi V, Passantino A. Clinical Practice Guidelines: An Opinion of the Legal Implication to Veterinary Medicine. Animals (Basel) 2019; 9:E577. [PMID: 31430919 PMCID: PMC6720978 DOI: 10.3390/ani9080577] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 08/12/2019] [Accepted: 08/14/2019] [Indexed: 12/13/2022] Open
Abstract
The strengthening of the bond between humans and animals has changed the landscape of the veterinary profession. This has, in turn, led the legal system to assess damages in veterinary malpractice and liability cases more carefully, paying attention to the possibility of using clinical practice guidelines (CPGs) to prove whether the defendant veterinarian contravened or not the standard of care. In this era of evidence-based veterinary medicine, CPGs are becoming an integral part of many aspects of veterinary practice, even if CPGs do not have the force of law and are situated halfway between ethical rules and legal requirements. Although guidelines have been used for several years, there seems to be a general lack of recognition of the medical and legal ramifications of CPGs for veterinarians. This creates ambiguity and inconsistency in the care that veterinary practitioners provide, compromises the care animals receive, and prevents the courts from assessing veterinarian competence in a systematic and rational way. On the basis of these considerations, this article discusses the legal implications of CPGs in veterinary medicine for dogs and cats and explores how the law may treat CPGs in the future. Redefining the CPGs should be a priority for veterinary profession. NOTE: The authors chose to use the terms "companion animal," "pet," and "small animal" interchangeably throughout this article, as all three are commonly in use and refer to the same animals (dogs and cats).
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Affiliation(s)
- Michela Pugliese
- Department of Veterinary Sciences, University of Messina, Polo Universitario Annunziata, 98168 Messina, Italy
| | - Eva Voslarova
- Department of Animal Protection, Welfare and Behaviour, Faculty of Veterinary Hygiene and Ecology, University of Veterinary and Pharmaceutical Sciences Brno, 612 42 Brno, Czech Republic
| | - Vito Biondi
- Department of Veterinary Sciences, University of Messina, Polo Universitario Annunziata, 98168 Messina, Italy
| | - Annamaria Passantino
- Department of Veterinary Sciences, University of Messina, Polo Universitario Annunziata, 98168 Messina, Italy.
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Treseder JR, LeBlanc NL, Scollan KF. Inotropic and chronotropic effects of sotalol in healthy dogs. J Vet Cardiol 2019; 25:14-24. [PMID: 31442634 DOI: 10.1016/j.jvc.2019.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 07/09/2019] [Accepted: 07/16/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Sotalol is an anti-arrhythmic drug commonly used for the treatment of pathologic tachyarrhythmias in dogs. The β-adrenergic blockade associated with sotalol administration may result in reduced myocardial contractility, which is clinically relevant for treating dogs with arrhythmias and concurrent myocardial dysfunction. The inotropic properties of sotalol are not well characterized in dogs. ANIMALS, MATERIALS, AND METHODS Ten healthy, adult, large breed dogs were prospectively enrolled. All dogs underwent physical examination, blood pressure measurement, electrocardiography, 24-h Holter monitoring, and echocardiography including three-dimensional left ventricular volume measurements. Dogs were subsequently administered sotalol (1-2 mg/kg) orally twice daily for 12-16 days, and the same diagnostic tests were performed. Paired statistical analysis was used to compare parameters at baseline and after treatment with sotalol. RESULTS Standard echocardiographic parameters of systolic function were reduced on sotalol compared to baseline, including ejection fraction via Simpson's method of disks which was 5.8% (95% confidence interval [CI]: 2.77-8.83%, p = 0.002) lower post-treatment. Maximum heart rate on Holter monitor was 17 bpm (95% CI: 9-37 bpm, p = 0.002) lower post-treatment than at baseline. CONCLUSIONS Sotalol has a mild negative inotropic effect in healthy dogs based on standard echocardiographic measurements. There is also a negative chronotropic effect at higher heart rates based on 24-h Holter monitoring.
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Affiliation(s)
- J R Treseder
- Oregon State University, Carlson College of Veterinary Medicine, Department of Clinical Sciences, 105 Magruder Hall, 700 SW 30th Street, Corvallis, Oregon, 97331, USA
| | - N L LeBlanc
- Oregon State University, Carlson College of Veterinary Medicine, Department of Clinical Sciences, 105 Magruder Hall, 700 SW 30th Street, Corvallis, Oregon, 97331, USA.
| | - K F Scollan
- Oregon State University, Carlson College of Veterinary Medicine, Department of Clinical Sciences, 105 Magruder Hall, 700 SW 30th Street, Corvallis, Oregon, 97331, USA
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58
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Visser LC, Ciccozzi MM, Sintov DJ, Sharpe AN. Echocardiographic quantitation of left heart size and function in 122 healthy dogs: A prospective study proposing reference intervals and assessing repeatability. J Vet Intern Med 2019; 33:1909-1920. [PMID: 31313382 PMCID: PMC6766555 DOI: 10.1111/jvim.15562] [Citation(s) in RCA: 109] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 07/01/2019] [Indexed: 12/21/2022] Open
Abstract
Background Broadly applicable reference intervals (RIs) for measurements of left atrial (LA) and left ventricular (LV) size and function generated prospectively using statistically appropriate methods are limited. Objectives To generate body size‐independent RIs for linear, area, and volume measurements of LA size and LV size and function. Animals Healthy adult dogs (n = 122) of variable size and somatotype. Methods Prospective study. All dogs underwent an echocardiogram performed by the same examiner. Effects of body weight, sex, age, and heart rate were evaluated by regression and correlation analyses. Scaling exponents and prediction intervals were generated for linear measurements using the allometric equation. After normalization to body weight, 95% RIs were determined using nonparametric methods with 2.5 and 97.5 percentiles serving as the lower and upper limits (each with 90% confidence intervals), respectively. Results Linear LA and LV measurements were strongly correlated (R2 ≥ 0.79) with body weight. Scaling exponents were close to the expected 1/3 (0.299‐0.392). Prediction intervals for linear measurements of LV chamber size were considerably narrower than previously reported. Weak correlations (r = −0.42 to −0.50) among LV fractional shortening, fractional area change, and ejection fraction and body weight were identified. No other meaningful relationships were identified between the measurements and sex, age, and heart rate. Conclusions and Clinical Importance Body size‐independent RIs for several linear, area, and volume measurements of LA and LV size and function were generated prospectively from a large and diverse reference population and are available for clinical use.
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Affiliation(s)
- Lance C Visser
- Department of Medicine & Epidemiology, School of Veterinary Medicine, University of California, Davis, California
| | - Marisa M Ciccozzi
- Department of Medicine & Epidemiology, School of Veterinary Medicine, University of California, Davis, California
| | - Daniel J Sintov
- Department of Medicine & Epidemiology, School of Veterinary Medicine, University of California, Davis, California
| | - Ashley N Sharpe
- Department of Medicine & Epidemiology, School of Veterinary Medicine, University of California, Davis, California
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Wess G, Wallukat G, Fritscher A, Becker NP, Wenzel K, Müller J, Schimke I. Doberman pinschers present autoimmunity associated with functional autoantibodies: A model to study the autoimmune background of human dilated cardiomyopathy. PLoS One 2019; 14:e0214263. [PMID: 31276517 PMCID: PMC6611557 DOI: 10.1371/journal.pone.0214263] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 06/14/2019] [Indexed: 12/11/2022] Open
Abstract
Background Autoimmunity associated with autoantibodies against the β1-adrenergic receptor (β1-AAB) is increasingly accepted as the driver of human dilated cardiomyopathy (DCM). Unfortunately, there is a lack of animal models to extend the knowledge about β1-AAB autoimmunity in DCM and to develop appropriate treatment strategies. Objectives To introduce an animal model, we investigated the β1-AAB associated autoimmunity in Doberman Pinscher (DP) with dilated cardiomyopathy, which has similarities to human DCM. Materials and methods Eighty-seven DP with cardiomyopathy in terms of pathological ECG and echocardiography (DoCM) and 31 dogs (at enrollment) without DoCM (controls) were analyzed for serum activity of β1-AAB with a bioassay that records the chronotropic response of spontaneously beating cultured neonatal rat cardiomyocytes to the DP’s IgG. To locate the receptor binding site of β1-AAB and the autoantibody’s sensitivity to inhibition, competing experiments with related blockers were performed with the bioassay. In controls that developed DoCM during follow-up, β1-AAB were analyzed during progress. Results Fifty-nine (67.8%) DoCM dogs and 19 (61.3%) controls were β1-AAB positive. Of the controls that developed DoCM, 8 were β1-AAB positive (p = 0.044 vs. dogs remaining in the control group); their β1-AAB activity increased with the cardiomyopathy progress (p<0.02). To supplement DoCM group with the 9 animals which developed cardiomyopathy in the follow up, a more pronounced β1-AAB positivity became visible in the DoCM group (p = 0.066). Total and cardiac mortality were higher in β1-AAB positive DP (p = 0.002; p = 0037). The dogs’ β1-AAB recognized a specific epitope on the second extracellular receptor and were sensitive to inhibition by drugs already successfully tested to inhibit the corresponding human autoantibody. Conclusions Doberman Pinschers presented β1-AAB associated autoimmunity, similar as in the pathogenesis of human DCM. Consequently, DP could compensate the lack of animal models for the investigation of β1-AAB autoimmunity in human DCM.
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Affiliation(s)
- Gerhard Wess
- Clinic of Small Animal Medicine, Ludwig-Maximilians-Universität München, München, Germany
| | | | - Anna Fritscher
- Clinic of Small Animal Medicine, Ludwig-Maximilians-Universität München, München, Germany
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Carnabuci C, Tognetti R, Vezzosi T, Marchesotti F, Patata V, Domenech O. Left shift of the ventricular mean electrical axis in healthy Doberman Pinschers. J Vet Med Sci 2019; 81:620-625. [PMID: 30853668 PMCID: PMC6483916 DOI: 10.1292/jvms.18-0699] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
In canine electrocardiography, the reference interval of the ventricular mean electrical
axis (MEA) is between +40° and +100°. MEA values in dogs can be influenced by the patient
position as well as by the shape of the thorax. The aim of this study was to evaluate the
MEA in healthy Doberman Pinschers, hypothesizing that some present a left shift of the
MEA. In this retrospective study, 41 healthy, client-owned Doberman Pinschers were
included. Echocardiography and standard six-lead ECG examination were performed in all
dogs. The MEA was calculated using the isoelectric method. The morphology of the QRS
complex and the Q/R ratio in lead II were also evaluated. The median MEA was +45° and
ranged from −45° to +90°. MEA was deviated in 16/41 dogs (39%), all presenting a left axis
deviation (range, −45° to + 30°). Age was significantly associated with the MEA
(P=0.008), showing a negative linear correlation. A deep Q wave in lead
II was present in 26/41 (63%) dogs. The Q/R ratio was higher in dogs presenting left shift
of the MEA (0.66; range, 0.28–1.35) in comparison to dogs with a MEA within reference
range (0.44; range, 0.04–0.73; P<0.001). In conclusion, a significant
number of healthy Doberman Pinschers present a left shift of the MEA compare to the
reference range, and dogs with MEA deviation show a higher Q/R ratio in lead II. This data
should be considered when electrocardiographic evaluation is performed in Doberman
Pinschers.
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Affiliation(s)
- Cristina Carnabuci
- Istituto Veterinario di Novara, Strada Provinciale 9, 28060 Granozzo con Monticello, Novara, Italy.,Polivet, Via Salaria 1317, 00138, Rome, Italy
| | - Rosalba Tognetti
- Department of Veterinary Sciences, University of Pisa, Via Livornese, 56122 San Piero a Grado, Pisa, Italy
| | - Tommaso Vezzosi
- Istituto Veterinario di Novara, Strada Provinciale 9, 28060 Granozzo con Monticello, Novara, Italy.,Department of Veterinary Sciences, University of Pisa, Via Livornese, 56122 San Piero a Grado, Pisa, Italy
| | - Federica Marchesotti
- Istituto Veterinario di Novara, Strada Provinciale 9, 28060 Granozzo con Monticello, Novara, Italy
| | - Valentina Patata
- Istituto Veterinario di Novara, Strada Provinciale 9, 28060 Granozzo con Monticello, Novara, Italy
| | - Oriol Domenech
- Istituto Veterinario di Novara, Strada Provinciale 9, 28060 Granozzo con Monticello, Novara, Italy
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Paradies P, Carlucci L, Woitek F, Staffieri F, Lacitignola L, Ceci L, Romano D, Sasanelli M, Zentilin L, Giacca M, Salvadori S, Crovace A, Recchia FA. Intracoronary Gene Delivery of the Cytoprotective Factor Vascular Endothelial Growth Factor-B 167 in Canine Patients with Dilated Cardiomyopathy: A Short-Term Feasibility Study. Vet Sci 2019; 6:vetsci6010023. [PMID: 30845635 PMCID: PMC6466215 DOI: 10.3390/vetsci6010023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 02/17/2019] [Accepted: 02/28/2019] [Indexed: 12/12/2022] Open
Abstract
Dilated cardiomyopathy (DCM) is a myocardial disease of dogs and humans characterized by progressive ventricular dilation and depressed contractility and it is a frequent cause of heart failure. Conventional pharmacological therapy cannot reverse the progression of the disease and, in humans, cardiac transplantation remains the only option during the final stages of heart failure. Cytoprotective gene therapy with vascular endothelial growth factor-B167 (VEGF-B167) has proved an effective alternative therapy, halting the progression of the disease in experimental studies on dogs. The aim of this work was to test the tolerability and feasibility of intracoronary administration, under fluoroscopic guidance, of VEGF-B167 carried by adeno-associated viral vectors in canine DCM patients. Ten patients underwent the gene delivery procedure. The intraoperative phase was well tolerated by all dogs. Clinical and echocardiographic assessments at 7- and 30-days post-procedure showed stable conditions compared to the pre-procedure phase. The results of this work indicate that intracoronary VEGF-B167 gene delivery is feasible and tolerated in dogs with DCM. Further monitoring/investigations are ongoing to evaluate the effects of this therapy on disease progression.
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Affiliation(s)
- Paola Paradies
- Department of Emergency and Organ Transplantation, Section of Veterinary Clinics and Animal Production; University of Bari, 70010 Bari; Italy.
| | - Lucia Carlucci
- Institute of Life Sciences, Scuola Superiore Sant'Anna, 56100 Pisa, Italy.
| | - Felix Woitek
- Heart Center, Dresden at the Technical University of Dresden, 01067 Dresden, Germany.
| | - Francesco Staffieri
- Department of Emergency and Organ Transplantation, Section of Veterinary Clinics and Animal Production; University of Bari, 70010 Bari; Italy.
| | - Luca Lacitignola
- Department of Emergency and Organ Transplantation, Section of Veterinary Clinics and Animal Production; University of Bari, 70010 Bari; Italy.
| | - Luigi Ceci
- Department of Emergency and Organ Transplantation, Section of Veterinary Clinics and Animal Production; University of Bari, 70010 Bari; Italy.
| | - Daniela Romano
- Department of Emergency and Organ Transplantation, Section of Veterinary Clinics and Animal Production; University of Bari, 70010 Bari; Italy.
| | - Mariateresa Sasanelli
- Department of Emergency and Organ Transplantation, Section of Veterinary Clinics and Animal Production; University of Bari, 70010 Bari; Italy.
| | - Lorena Zentilin
- Molecular Medicine Laboratory, International Centre for Genetic Engineering and Biotechnology (ICGEB), 34149 Trieste, Italy.
| | - Mauro Giacca
- Molecular Medicine Laboratory, International Centre for Genetic Engineering and Biotechnology (ICGEB), 34149 Trieste, Italy.
| | - Stefano Salvadori
- CNR, Institute of Clinical Physiology, Area della Ricerca, 56121 Pisa, Italy.
| | - Antonio Crovace
- Department of Emergency and Organ Transplantation, Section of Veterinary Clinics and Animal Production; University of Bari, 70010 Bari; Italy.
| | - Fabio A Recchia
- Institute of Life Sciences, Scuola Superiore Sant'Anna, 56100 Pisa, Italy.
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62
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Lam C, Casamian-Sorrosal D, Monteith G, Fonfara S. Heart-fatty acid binding protein in dogs with degenerative valvular disease and dilated cardiomyopathy. Vet J 2019; 244:16-22. [PMID: 30825889 DOI: 10.1016/j.tvjl.2018.11.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 11/15/2018] [Accepted: 11/27/2018] [Indexed: 10/27/2022]
Abstract
The study objective was to investigate heart-fatty acid binding protein (HFABP) concentrations in dogs with degenerative valvular disease (MVD) and dilated cardiomyopathy (DCM), and its potential as a prognostic factor. Plasma HFABP, N-terminal pro brain natriuretic peptide (NTproBNP) and serum cardiac troponin I (cTnI) levels were measured in 21 control dogs, 23 dogs with MVD and 13 dogs with DCM, with repeated sampling at 1 and 3 months after initial presentation. All dogs were followed up after 6 and 12 months to verify survival. Heart-fatty acid binding protein concentrations were significantly higher in dogs with MVD and DCM than controls at initial presentation, and after 1 month in dogs with MVD. For dogs with DCM, a significant reduction in HFABP levels over time was observed. Comparing ACVIM stages, highest HFABP concentrations were detected in ACVIM stage C dogs compared to stage B, with the lowest levels seen in controls, and a reduction over time in stage C dogs was present. Similarly, cTnI concentrations were higher in DCM and stage C in comparison to control dogs and reduced over time, while NTproBNP concentrations were only higher in diseased dogs at 1 month. Heart-fatty acid binding protein and cTnI levels at initial presentation and ACVIM disease stage were independent predictors of survival in a univariate analysis. The elevation of HFABP in dogs with MVD and DCM in comparison to controls, its association with disease severity, and its potential in predicting reduced survival, suggest that HFABP might be useful as marker for canine MVD and DCM.
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Affiliation(s)
- C Lam
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, 50 Stone Road E., ON N1G 2W1, Canada.
| | - D Casamian-Sorrosal
- Companion Animal Studies, University of Bristol, Langford House, Langford, Bristol BS40 5DU, United Kingdom
| | - G Monteith
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, 50 Stone Road E., ON N1G 2W1, Canada
| | - S Fonfara
- Companion Animal Studies, University of Bristol, Langford House, Langford, Bristol BS40 5DU, United Kingdom
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63
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Giraut S, Häggström J, Koskinen LLE, Lohi H, Wiberg M. Breed‐specific reference ranges for standard echocardiographic measurements in salukis. J Small Anim Pract 2019; 60:374-378. [DOI: 10.1111/jsap.12975] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 10/12/2018] [Accepted: 11/16/2018] [Indexed: 12/28/2022]
Affiliation(s)
- S. Giraut
- Department of Equine and Small Animal Medicine, Faculty of Veterinary MedicineUniversity of Helsinki Helsinki 00014 Finland
| | - J. Häggström
- Faculty of Veterinary Medicine and Animal ScienceSwedish University of Agricultural Sciences Uppsala 75007 Sweden
| | - L. L. E. Koskinen
- Department of Veterinary Biosciences and Research Programs Unit, Molecular NeurologyUniversity of Helsinki Helsinki Finland
- Folkhälsan Institute of Genetics Helsinki Finland
| | - H. Lohi
- Department of Veterinary Biosciences and Research Programs Unit, Molecular NeurologyUniversity of Helsinki Helsinki Finland
- Folkhälsan Institute of Genetics Helsinki Finland
| | - M. Wiberg
- Department of Equine and Small Animal Medicine, Faculty of Veterinary MedicineUniversity of Helsinki Helsinki 00014 Finland
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64
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Vollmar C, Vollmar A, Keene BW, Fox PR, Reese S, Kohn B. Dilated cardiomyopathy in 151 Irish Wolfhounds: Characteristic clinical findings, life expectancy and causes of death. Vet J 2018; 245:15-21. [PMID: 30819421 DOI: 10.1016/j.tvjl.2018.12.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 12/08/2018] [Accepted: 12/14/2018] [Indexed: 12/15/2022]
Abstract
Dilated cardiomyopathy (DCM) is an important cause of morbidity in Irish Wolfhounds (IW), a breed also predisposed to neoplastic and orthopedic diseases that shorten life expectancy. The objective of this study was to investigate survival and causes of death in IW with DCM and to characterise the clinical findings of DCM over time. Data from cardiovascular examinations performed in 1591 IW, including echocardiography and electrocardiography, were retrospectively evaluated. IW with DCM on medical therapy with long term longitudinal follow-up were included in this study (n=151; 95 males, 56 females). Based on their clinical status at initial diagnosis, IW were classified into one of three groups: preclinical DCM with sinus rhythm (PC-DCM-SR, n=35), preclinical DCM with atrial fibrillation (PC-DCM-AF, n=87), and congestive heart failure with DCM and AF (CHF-DCM-AF, n=29). Survival data were analyzed using cumulative incidence functions, Kaplan-Meier and Cox regression. CHF was predominantly characterized by chylous pleural and mild pericardial effusions. Causes of death were cardiac (CD) in 73/151 and non-cardiac (non-CD) in 62/151; 16 dogs remained alive at study end. The majority of deaths in both preclinical DCM groups were non-CD (PC-DCM-AF=51.9% non-CD, 48.1% CD; PC-DCM-SR, 65.5% non-CD, 34.5% CD). In the CHF-DCM-AF group most dogs (89.6%) experienced a CD. Median survival of the CHF-DCM-AF group (7.3 months) was significantly shorter than in the PC-DCM-AF group (21.9 months) or PC-DCM-SR group (29.1 months, P=0.001). CHF-DCM-AF in IW was associated with reduced life expectancy and CD, while most IW with preclinical DCM died from non-cardiac causes.
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Affiliation(s)
- C Vollmar
- Clinic for Small Animals, Freie Universität Berlin, Oerztenweg 19b, 14163 Berlin, Germany; Small Animal Veterinary Clinics, Sankt Augustiner Str. 74, 53225 Bonn, and Heisterstr. 5, 57537 Wissen, Germany
| | - A Vollmar
- Small Animal Veterinary Clinics, Sankt Augustiner Str. 74, 53225 Bonn, and Heisterstr. 5, 57537 Wissen, Germany.
| | - B W Keene
- College of Veterinary Medicine, North Carolina State University, 1052 William Moore Drive, Raleigh, NC 27607, USA
| | - P R Fox
- The Animal Medical Center, New York, NY 10065, USA
| | - S Reese
- Department of Veterinary Sciences, Chair of Anatomy, Histology and Embryology, Faculty of Veterinary Medicine, LMU Munich, Veterinaerstraße 13, 80539 Munich, Germany
| | - B Kohn
- Clinic for Small Animals, Freie Universität Berlin, Oerztenweg 19b, 14163 Berlin, Germany
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65
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Klüser L, Maier ET, Wess G. Evaluation of a high-sensitivity cardiac troponin I assay compared to a first-generation cardiac troponin I assay in Doberman Pinschers with and without dilated cardiomyopathy. J Vet Intern Med 2018; 33:54-63. [PMID: 30536428 PMCID: PMC6335507 DOI: 10.1111/jvim.15384] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 11/14/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Echocardiography and 24-hour ECG are the gold standard tests to diagnose dilated cardiomyopathy (DCM) in Doberman Pinschers (DP), but myocardial damage might be detected earlier using a high-sensitivity cardiac troponin I (hs-cTnI) assay. OBJECTIVE To evaluate and compare an hs-cTnI assay (Advia Centaur TnI-Ultra assay) with a conventional cTnI assay in DP with different stages of DCM and in healthy DP. ANIMALS Three hundred forty-five examinations from 162 DP with and 179 DP without DCM. METHODS Prospective longitudinal study. Dogs were allocated into 6 groups based on echocardiographic and 24-hour ECG criteria: (1) healthy group (179 dogs), (2) last-normal group (29 dogs), which included dogs that were considered to be healthy at the time of their examination but were assigned to the last-normal group retrospectively when DCM was diagnosed at their next examination within 1.5 years, (3) only arrhythmias (45 dogs, 119 examinations), (4) only echocardiographic changes (24 dogs, 61 examinations), (5) echocardiographic changes with ventricular premature complexes (41 dogs, 100 examinations), and (6) decompensated (23 dogs, 36 examinations). Hs-cTnI and conventional cTnI concentration measurements were performed and compared. RESULTS A cutoff value of hs-cTnI concentration >0.113 ng/mL had a sensitivity of 81.2% and a specificity of 73.2% to identify the presence of DCM. The conventional cTnI assay showed a similar test performance, but the hs-cTnI assay identified more dogs (21/29 dogs, 72%) in the last-normal group compared to the conventional cTnI test (18/29 dogs, 62%). CONCLUSIONS AND CLINICAL IMPORTANCE The hs-cTnI is an additional test with good potential to identify early DCM.
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Affiliation(s)
- Lena Klüser
- Clinic of Small Animal Medicine, LMU University, Munich, Germany
| | | | - Gerhard Wess
- Clinic of Small Animal Medicine, LMU University, Munich, Germany
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66
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Stern JA, Ueda Y. Inherited cardiomyopathies in veterinary medicine. Pflugers Arch 2018; 471:745-753. [PMID: 30284024 DOI: 10.1007/s00424-018-2209-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 09/25/2018] [Indexed: 12/31/2022]
Abstract
Comparative and translation medicine is of particular value within the field of inherited cardiomyopathies. Despite massive advances in understanding the functional role of mutations in human cardiomyopathies, these advances have frequently failed to translate into medical discoveries that alter patient care. One potential explanation for this failure lies in the lack of suitable translational models that adequately recapitulate human cardiovascular physiology and disease expression. The vast genetic heterogeneity that complicates human cardiomyopathy research is potentially alleviated through the study of naturally occurring large animal models of disease, where incredibly homogenous populations, like those seen in a single breed of dog or cat, may exist (Kol et al., Sci Transl Med 7:308-321, 2015; Ueda and Stern, Yale J Biol Med 90:433-448, 2017). Veterinary medicine is in a unique position to provide research resources and information that may be readily applied to human disease (Kol et al., Sci Transl Med 7:308-321, 2015). Many inherited cardiomyopathies of humans are phenotypically and genotypically similar in veterinary species and ongoing research holds promise for aiding veterinary and human patients alike (Basso et al., Circulation 109:1180-1185, 2004; Fox et al., Cardiovasc Pathol 23:28-34, 2014; Fox et al., Circulation 102:1863-1870, 2000; Kittleson et al., J Vet Cardiol 17 Suppl 1:S53-73, 2015; Ueda and Stern, Yale J Biol Med 90:433-448, 2017). This article presents the current knowledge of inherited cardiomyopathies in dogs, cats, and non-human primates, with a goal of identifying areas of translational research and future directions.
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Affiliation(s)
- Joshua A Stern
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California Davis, One Shields Avenue, Davis, CA, USA.
| | - Yu Ueda
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California Davis, One Shields Avenue, Davis, CA, USA
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67
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Cardiosphere-derived cells suppress allogeneic lymphocytes by production of PGE2 acting via the EP4 receptor. Sci Rep 2018; 8:13351. [PMID: 30190508 PMCID: PMC6127326 DOI: 10.1038/s41598-018-31569-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 08/07/2018] [Indexed: 12/17/2022] Open
Abstract
Cardiosphere-derived cells (CDCs) are a cardiac progenitor cell population, which have been shown to possess cardiac regenerative properties and can improve heart function in a variety of cardiac diseases. Studies in large animal models have predominantly focussed on using autologous cells for safety, however allogeneic cell banks would allow for a practical, cost-effective and efficient use in a clinical setting. The aim of this work was to determine the immunomodulatory status of these cells using CDCs and lymphocytes from 5 dogs. CDCs expressed MHC I but not MHC II molecules and in mixed lymphocyte reactions demonstrated a lack of lymphocyte proliferation in response to MHC-mismatched CDCs. Furthermore, MHC-mismatched CDCs suppressed lymphocyte proliferation and activation in response to Concanavalin A. Transwell experiments demonstrated that this was predominantly due to direct cell-cell contact in addition to soluble mediators whereby CDCs produced high levels of PGE2 under inflammatory conditions. This led to down-regulation of CD25 expression on lymphocytes via the EP4 receptor. Blocking prostaglandin synthesis restored both, proliferation and activation (measured via CD25 expression) of stimulated lymphocytes. We demonstrated for the first time in a large animal model that CDCs inhibit proliferation in allo-reactive lymphocytes and have potent immunosuppressive activity mediated via PGE2.
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68
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Dutton E, López-Alvarez J. An update on canine cardiomyopathies - is it all in the genes? J Small Anim Pract 2018; 59:455-464. [PMID: 29665072 DOI: 10.1111/jsap.12841] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 01/22/2018] [Accepted: 03/14/2018] [Indexed: 12/17/2022]
Abstract
Dilated cardiomyopathy is the second most common cardiac disease in dogs and causes considerable morbidity and mortality. Primary dilated cardiomyopathy is suspected to be familial, and genetic loci have been associated with the disease in a number of breeds. Because it is an adult-onset disease, usually with late onset, testing breeding dogs and bitches before breeding for a genetic mutation that could lead to dilated cardiomyopathy would be helpful to prevent disease. There is growing evidence that the genetic basis may be multigenic rather than monogenic in the majority of studied breeds. This review article describes the known genetic aspects of canine dilated cardiomyopathy and the implications of genetic tests on heart testing and the future of veterinary cardiology.
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Affiliation(s)
- E Dutton
- Cheshire Cardiology, Cheshire, WA16 8NE, UK
| | - J López-Alvarez
- Fundació Hospital Clínic Veterinari, Universitat Autònoma de Barcelona, Bellaterra 08193, Spain
- Hospital Veterinari Canis Mallorca, Palma 07010, Illes Balears, Spain
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