1
|
Nakamura T, Oya S, Ozawa H, Maehiro Y, Muta S, Umeda M, Takaki Y, Fukuyama T, Yamasaki Y, Yamaguchi M, Aoyama K, Mouri F, Naito Y, Nagafuji K. Correlation of ex vivo and in vivo ammonia production with L-asparaginase biological activity in adults with lymphoid malignancies. Int J Hematol 2024; 119:426-431. [PMID: 38363480 DOI: 10.1007/s12185-024-03718-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/18/2024] [Accepted: 01/18/2024] [Indexed: 02/17/2024]
Abstract
Silent inactivation of L-asparaginase (L-Asp) represents rapid clearance of L-Asp by anti-L-Asp IgG antibodies without clinical symptoms. Measurement of L-Asp activity is the gold standard for diagnosis of silent inactivation, but this test is not commercially available in Japan as of 2023. We evaluated ex vivo and in vivo ammonia production in relation to L-Asp activity. Blood samples from ten adult patients treated with L-Asp were collected to measure ammonia levels and L-Asp activity before the first dose and 24 h after the last dose of L-Asp, during each cycle of treatment. Plasma ammonia levels were analyzed immediately and 1 h after incubation at room temperature, and ex vivo ammonia production was defined as the increase in ammonia concentration. Ex vivo ammonia production correlated with L-Asp activity (R2 = 0.741), and ammonia levels measured immediately after blood collection were moderately correlated with L-Asp activity (R2 = 0.709). One patient with extranodal NK/T-cell lymphoma showed an increase in ammonia levels during the first cycle, but no increase in ammonia levels or L-Asp activity after L-Asp administration during the second cycle. Both ex vivo and in vivo ammonia production and surrogate markers are used for L-Asp biological activity.
Collapse
Affiliation(s)
- Takayuki Nakamura
- Division of Hematology and Oncology, Department of Medicine, Kurume University School of Medicine, 67 Asahi-Machi, Kurume, 830-0011, Japan.
| | - Shuki Oya
- Division of Hematology and Oncology, Department of Medicine, Kurume University School of Medicine, 67 Asahi-Machi, Kurume, 830-0011, Japan
| | - Hidetoshi Ozawa
- Division of Hematology and Oncology, Department of Medicine, Kurume University School of Medicine, 67 Asahi-Machi, Kurume, 830-0011, Japan
| | - Yoshimi Maehiro
- Division of Hematology and Oncology, Department of Medicine, Kurume University School of Medicine, 67 Asahi-Machi, Kurume, 830-0011, Japan
| | - Seiya Muta
- Department of Clinical Laboratory Medicine, Kurume University Hospital, 67 Asahi-Machi, Kurume, 830-0011, Japan
| | - Masahiro Umeda
- Division of Hematology and Oncology, Department of Medicine, Kurume University School of Medicine, 67 Asahi-Machi, Kurume, 830-0011, Japan
| | - Yusuke Takaki
- Division of Hematology and Oncology, Department of Medicine, Kurume University School of Medicine, 67 Asahi-Machi, Kurume, 830-0011, Japan
| | - Toshinobu Fukuyama
- Division of Hematology and Oncology, Department of Medicine, Kurume University School of Medicine, 67 Asahi-Machi, Kurume, 830-0011, Japan
| | - Yoshitaka Yamasaki
- Division of Hematology and Oncology, Department of Medicine, Kurume University School of Medicine, 67 Asahi-Machi, Kurume, 830-0011, Japan
| | - Maki Yamaguchi
- Division of Hematology and Oncology, Department of Medicine, Kurume University School of Medicine, 67 Asahi-Machi, Kurume, 830-0011, Japan
| | - Kazutoshi Aoyama
- Division of Hematology and Oncology, Department of Medicine, Kurume University School of Medicine, 67 Asahi-Machi, Kurume, 830-0011, Japan
| | - Fumihiko Mouri
- Division of Hematology and Oncology, Department of Medicine, Kurume University School of Medicine, 67 Asahi-Machi, Kurume, 830-0011, Japan
| | - Yoshiki Naito
- Department of Clinical Laboratory Medicine, Kurume University Hospital, 67 Asahi-Machi, Kurume, 830-0011, Japan
| | - Koji Nagafuji
- Division of Hematology and Oncology, Department of Medicine, Kurume University School of Medicine, 67 Asahi-Machi, Kurume, 830-0011, Japan
| |
Collapse
|
2
|
Rincón Reyes DF, Padilla Agudelo JL, Pinilla da Silva AI, Ortega Quintero DM, Valencia Libreros DL, Contreras Acosta AD, Gutiérrez Triana JA. An acute lymphoblastic leukemia cell-based preclinical assay revealed functional differences between commercial brands of L-asparaginase administered in Colombia. Pediatr Blood Cancer 2023; 70:e30199. [PMID: 36633223 DOI: 10.1002/pbc.30199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/29/2022] [Accepted: 12/19/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND L-asparaginase (L-ASNase) is an essential component of chemotherapy strategies due to its differential action between normal and leukemic cells. Recently, concerns about the efficiency of commercial formulations administered in developing countries have been reported, and available methods have limitations for directly determining the quality of the formulation of the medications. PROCEDURE We developed a cell-based protocol to analyze the activity of different L-ASNase formulations used in Colombia to induce apoptosis of the NALM-6 cell line after 24, 48, and 72 hours, using flow cytometry. Then we compared results and determined the statistically significant differences. RESULTS Three statistically different groups, ranging from full to no activity against leukemic cells, using 0.05, 0.5, and 5.0 IU/ml concentrations, were identified. Group 1 (asparaginase codified [ASA]2-4) exhibited very low to no activity against B-cell acute lymphoblastic leukemia (B-ALL) cells. Group 2 (ASA6) exhibited intermediate-level activity, and group 3 (ASA1 and ASA5) exhibited high activity. CONCLUSIONS Differences found between the therapeutic formulations of L-ASNase distributed in Colombia raise concerns about the quality of the treatment administered to patients in low- and middle-income countries. Therefore, we recommend a preclinical evaluation of formulations of L-ASNase in order to prevent therapeutical impacts on the outcome of ALL patients.
Collapse
Affiliation(s)
- Diego Fernando Rincón Reyes
- Immunology and Molecular Epidemiology Research Group (GIEM), Escuela de Microbiología, Facultad de Salud, Universidad Industrial de Santander, Bucaramanga, Colombia
| | - José Luis Padilla Agudelo
- Immunology and Molecular Epidemiology Research Group (GIEM), Escuela de Microbiología, Facultad de Salud, Universidad Industrial de Santander, Bucaramanga, Colombia
| | - Andrea Isabel Pinilla da Silva
- Immunology and Molecular Epidemiology Research Group (GIEM), Escuela de Microbiología, Facultad de Salud, Universidad Industrial de Santander, Bucaramanga, Colombia
| | - Diana Marcela Ortega Quintero
- Immunology and Molecular Epidemiology Research Group (GIEM), Escuela de Microbiología, Facultad de Salud, Universidad Industrial de Santander, Bucaramanga, Colombia.,Clinical Laboratory, Universidad Industrial de Santander, Bucaramanga, Colombia
| | | | | | - José Arturo Gutiérrez Triana
- Immunology and Molecular Epidemiology Research Group (GIEM), Escuela de Microbiología, Facultad de Salud, Universidad Industrial de Santander, Bucaramanga, Colombia
| |
Collapse
|
3
|
Sandley M, Angus J. Asparaginase therapy in patients with acute lymphoblastic leukemia: expert opinion on use and toxicity management. Leuk Lymphoma 2023; 64:776-787. [PMID: 36781296 DOI: 10.1080/10428194.2023.2171267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
The addition of asparaginase to acute lymphoblastic leukemia (ALL) and lymphoblastic lymphoma (LBL) treatment regimens provides significant patient benefits. Asparaginase therapies vary in origin (Escherichia coli- or Erwinia-derived) and preparation (native or pegylated), conferring distinct pharmacokinetic and immunogenic profiles. Clinical hypersensitivity reactions (HSRs) are commonly reported in patients and range from localized erythema to systemic anaphylaxis. Due to its favorable pharmacokinetic profile and reduced immunogenicity compared to native E. coli preparations, pegaspargase is the first-line asparaginase therapeutic option. Switching to an Erwinia-derived asparaginase is recommended for patients who experience HSRs or antibody-mediated inactivation to achieve the significant clinical benefit observed in patients who complete asparaginase treatment. Previous global shortages of asparaginase Erwinia chrysanthemi necessitated conversion mitigation strategies such as premedication protocols, desensitization, and asparaginase activity level monitoring. Here, we discuss the efficacy, safety, pharmacokinetics, current use, and administration of asparaginase therapies for pediatric and adolescent patients with ALL/LBL.
Collapse
Affiliation(s)
- Melissa Sandley
- Department of Pharmacy, Oregon Health and Science University, Portland, OR, USA
| | - Jonathan Angus
- Department of Pharmacy, Cancer and Blood Disorders Center, Seattle Children's Hospital, Seattle, WA, USA
| |
Collapse
|
4
|
Multiple Asparaginase Infusions Cause Increasingly Severe Acute Hyperammonemia. Med Sci (Basel) 2022; 10:medsci10030043. [PMID: 35997335 PMCID: PMC9397007 DOI: 10.3390/medsci10030043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 08/05/2022] [Accepted: 08/09/2022] [Indexed: 12/05/2022] Open
Abstract
Adverse reactions during and shortly after infusing asparaginase for the treatment of acute lymphoblastic leukemia can increase in severity with later doses, limiting further use and increasing relapse risk. Although asparaginase is associated with hyperammonemia, the magnitude of the increase in serum ammonia immediately after the infusion and in response to multiple infusions has not been examined. The concurrence of hyperammonemia and infusion reactions was studied using weaned juvenile pigs that received 12 infusions of Erwinia asparaginase (Erwinase; 1250 U/kg) over 28 days, with two 5-day recovery periods without asparaginase after the eighth and eleventh doses. Infusion reactions and prolonged hyperammonemia (>50 µM ammonia 48 h after the infusion) began after the fourth dose and increased with later doses. Dense sampling for 60 min revealed an acute phase of hyperammonemia that peaked within 20 min after starting the first infusion (298 + 62 µM) and lasted less than 1 h, without apparent symptoms. A pronounced acute hyperammonemia after the final infusion (1260 + 250 µM) coincided with severe symptoms and one mortality during the infusion. The previously unrecognized acute phase of hyperammonemia associated with asparaginase infusion coincides with infusion reactions. The juvenile pig is a translational animal model for understanding the causes of acute and chronic hyperammonemia, differentiating from hypersensitivity reactions, and for improving infusion protocols to reduce acute hyperammonemia and to allow the continued use of asparaginase.
Collapse
|
5
|
Santos AC, Land MGP, Lima EC. Ammonia level as a proxy of asparaginase inactivation in children: A strategy for classification of infusion reactions. J Oncol Pharm Pract 2021; 28:551-559. [PMID: 33645327 DOI: 10.1177/1078155221998738] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Allergic hypersensitivity reactions related to enzyme asparaginase may occur during intravenous infusion of drugs and other adverse reactions (non-allergic hypersensitivity and hyperammonemia), which do not require discontinuation of therapy as the first case. It makes differential diagnoses between infusion reactions essential to assure the team regarding the right decision to make after the adverse event. This study evaluated a pharmacovigilance strategy of differentiating infusion reactions to asparaginase in pediatric patients, based on the measurement of serum ammonia and the classification of the reactions by clinical symptoms and severity. METHODOLOGY We included children, diagnosed with ALL, and treated with native Escherichia coli asparaginase in a university hospital. The professional team monitored and evaluated all asparaginase infusions for continuity of treatment (rechallenge), seeing the measurement of serum ammonia and classification of reactions for type and severity grade. Data from this monitoring was collected retrospectively. Chi-square and Mann-Whitney tests were used to compare the ratios between serum ammonia concentration posterior and before asparaginase infusion. RESULTS 245 infusions in 32 patients were monitored, and 19 reactions were observed in 17 children (53%). Three children have hyperammonemia and continue their treatment. The variation of the serum ammonia levels before and after the infusion was statistically significant, comparing the groups with no reaction or hyperammonemia versus the group with the hypersensitivity reaction. CONCLUSION The pharmacovigilance strategy applied in the hospital investigated was a useful and inexpensive tool that supported clinical decision-making and enabled the maintenance of asparaginase therapy for three (9,4%) patients followed up.
Collapse
Affiliation(s)
- Amanda C Santos
- Instituto de Puericultura e Pediatria Martagão Gesteira, PPGCM - FM (Graduate program in medical clinic - medical school), Federal University of Rio de Janeiro, University City, Rio de Janeiro, Brasil
| | - Marcelo G P Land
- Instituto de Puericultura e Pediatria Martagão Gesteira, PPGCM - FM (Graduate program in medical clinic - medical school), Federal University of Rio de Janeiro, University City, Rio de Janeiro, Brasil
| | - Elisangela C Lima
- School of Pharmacy, Federal University of Rio de Janeiro, University City, Rio de Janeiro, Brasil
| |
Collapse
|
6
|
Pokrovsky VS, Chepikova OE, Davydov DZ, Zamyatnin AA, Lukashev AN, Lukasheva EV. Amino Acid Degrading Enzymes and their Application in Cancer Therapy. Curr Med Chem 2019; 26:446-464. [PMID: 28990519 DOI: 10.2174/0929867324666171006132729] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 09/12/2017] [Accepted: 09/28/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND Amino acids are essential components in various biochemical pathways. The deprivation of certain amino acids is an antimetabolite strategy for the treatment of amino acid-dependent cancers which exploits the compromised metabolism of malignant cells. Several studies have focused on the development and preclinical and clinical evaluation of amino acid degrading enzymes, namely L-asparaginase, L-methionine γ-lyase, L-arginine deiminase, L-lysine α-oxidase. Further research into cancer cell metabolism may therefore define possible targets for controlling tumor growth. OBJECTIVE The purpose of this review was to summarize recent progress in the relationship between amino acids metabolism and cancer therapy, with a particular focus on Lasparagine, L-methionine, L-arginine and L-lysine degrading enzymes and their formulations, which have been successfully used in the treatment of several types of cancer. METHODS We carried out a structured search among literature regarding to amino acid degrading enzymes. The main aspects of search were in vitro and in vivo studies, clinical trials concerning application of these enzymes in oncology. RESULTS Most published research are on the subject of L-asparaginase properties and it's use for cancer treatment. L-arginine deiminase has shown promising results in a phase II trial in advanced melanoma and hepatocellular carcinoma. Other enzymes, in particular Lmethionine γ-lyase and L-lysine α-oxidase, were effective in vitro and in vivo. CONCLUSION The findings of this review revealed that therapy based on amino acid depletion may have the potential application for cancer treatment but further clinical investigations are required to provide the efficacy and safety of these agents.
Collapse
Affiliation(s)
- Vadim S Pokrovsky
- Blokhin Cancer Research Center, Moscow, Russian Federation.,Orekhovich Institute of Biomedical Chemistry, Moscow, Russian Federation.,People's Friendship University, Russia (RUDN University), Moscow, Russian Federation
| | - Olga E Chepikova
- Institute of Molecular Medicine, Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | | | - Andrey A Zamyatnin
- Institute of Molecular Medicine, Sechenov First Moscow State Medical University, Moscow, Russian Federation.,Belozersky Institute of Physico- Chemical Biology, Lomonosov Moscow State University, Moscow, Russian Federation
| | - Alexander N Lukashev
- People's Friendship University, Russia (RUDN University), Moscow, Russian Federation.,Institute of Molecular Medicine, Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Elena V Lukasheva
- People's Friendship University, Russia (RUDN University), Moscow, Russian Federation
| |
Collapse
|
7
|
Speas AL, Lyles SE, Wirth KA, Fahey CE, Kow K, Lejeune AT, Milner RJ. Plasma ammonia concentration after L-asparaginase therapy in 27 dogs with high-grade lymphoma or leukemia. J Vet Emerg Crit Care (San Antonio) 2018; 28:130-139. [DOI: 10.1111/vec.12695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 04/13/2016] [Accepted: 06/14/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Abbie L. Speas
- Small Animal Department of Clinical Sciences; College of Veterinary Medicine, University of Florida; Gainesville FL 32610
| | - Sarah E. Lyles
- Small Animal Department of Clinical Sciences; College of Veterinary Medicine, University of Florida; Gainesville FL 32610
| | - Kimberly A. Wirth
- Small Animal Department of Clinical Sciences; College of Veterinary Medicine, University of Florida; Gainesville FL 32610
| | - Christine E. Fahey
- Small Animal Department of Clinical Sciences; College of Veterinary Medicine, University of Florida; Gainesville FL 32610
| | - Kelvin Kow
- Small Animal Department of Clinical Sciences; College of Veterinary Medicine, University of Florida; Gainesville FL 32610
| | - Amandine T. Lejeune
- Small Animal Department of Clinical Sciences; College of Veterinary Medicine, University of Florida; Gainesville FL 32610
| | - Rowan J. Milner
- Small Animal Department of Clinical Sciences; College of Veterinary Medicine, University of Florida; Gainesville FL 32610
| |
Collapse
|
8
|
Clinical utility of ammonia concentration as a diagnostic test in monitoring of the treatment with L-asparaginase in children with acute lymphoblastic leukemia. BIOMED RESEARCH INTERNATIONAL 2014; 2014:945860. [PMID: 25157375 PMCID: PMC4135141 DOI: 10.1155/2014/945860] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 07/07/2014] [Accepted: 07/11/2014] [Indexed: 12/30/2022]
Abstract
L-asparaginase (ASP) is an enzyme used as one of the basic regimens in the acute lymphoblastic leukemia (ALL) therapy. Because of the possibility of the enzyme inactivation by antibodies, monitoring of ASP activity is essential. The aim of the study was to examine if plasma concentration of ammonia, a direct product of the reaction catalyzed by ASP, can be used in the assessment of ASP activity. A group of 87 patients with acute lymphoblastic leukemia treated in the Department of Pediatric Oncology and Hematology in Krakow was enrolled to the study. ASP activity and ammonia concentration were measured after ASP administrations during induction. A positive correlation was found between the ammonia concentration and ASP activity (R = 0.44; P < 0.0001) and between the medium values of ammonia concentration and ASP activity (R = 0.56; P < 0.0001). The analysis of ROC curves revealed the moderate accuracy of the ammonia concentration values in the ASP activity assessment. It was also found that the medium value of ammonia concentrations can be useful in identification of the patients with low (<100 IU/L) and undetectable (<30 IU/L) ASP activity. The plasma ammonia concentration may reflect ASP activity and can be useful when a direct measurement of the activity is unavailable.
Collapse
|
9
|
A broader view: microbial enzymes and their relevance in industries, medicine, and beyond. BIOMED RESEARCH INTERNATIONAL 2013; 2013:329121. [PMID: 24106701 PMCID: PMC3784079 DOI: 10.1155/2013/329121] [Citation(s) in RCA: 245] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Revised: 07/07/2013] [Accepted: 07/09/2013] [Indexed: 12/13/2022]
Abstract
Enzymes are the large biomolecules that are required for the numerous chemical interconversions that sustain life. They accelerate all the metabolic processes in the body and carry out a specific task. Enzymes are highly efficient, which can increase reaction rates by 100 million to 10 billion times faster than any normal chemical reaction. Due to development in recombinant technology and protein engineering, enzymes have evolved as an important molecule that has been widely used in different industrial and therapeutical purposes. Microbial enzymes are currently acquiring much attention with rapid development of enzyme technology. Microbial enzymes are preferred due to their economic feasibility, high yields, consistency, ease of product modification and optimization, regular supply due to absence of seasonal fluctuations, rapid growth of microbes on inexpensive media, stability, and greater catalytic activity. Microbial enzymes play a major role in the diagnosis, treatment, biochemical investigation, and monitoring of various dreaded diseases. Amylase and lipase are two very important enzymes that have been vastly studied and have great importance in different industries and therapeutic industry. In this review, an approach has been made to highlight the importance of different enzymes with special emphasis on amylase and lipase in the different industrial and medical fields.
Collapse
|
10
|
Tanaka R, Osumi T, Miharu M, Ishii T, Hasegawa T, Takahashi T, Shimada H. Hypoglycemia associated with L-asparaginase in acute lymphoblastic leukemia treatment: a case report. Exp Hematol Oncol 2012; 1:8. [PMID: 23211036 PMCID: PMC3514085 DOI: 10.1186/2162-3619-1-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2012] [Accepted: 03/19/2012] [Indexed: 12/01/2022] Open
Abstract
A patient with acute lymphoblastic leukemia repeatedly developed hypoglycemia during chemotherapy. Comparison of serum glucose trends between chemotherapy with and without L-asparaginase (L-Asp) demonstrated a strong association between L-Asp and hypoglycemia. Critical blood sampling during hypoglycemia indicated hyperinsulinism, suggesting that L-Asp induced hypoglycemia in the patient through inappropriate insulin secretion. Identification of hypoglycemia as an adverse effect will enable clinicians to understand and develop appropriate strategies for L-Asp use in chemotherapy regimens.
Collapse
Affiliation(s)
- Ryuma Tanaka
- Department of Pediatrics, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
| | | | | | | | | | | | | |
Collapse
|
11
|
Lyles SE, Kow K, Milner RJ, Buckley GJ, Bandt C, Baxter KJ. Acute hyperammonemia after L-asparaginase administration in a dog. J Vet Emerg Crit Care (San Antonio) 2012; 21:673-8. [PMID: 22316261 DOI: 10.1111/j.1476-4431.2011.00695.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Accepted: 09/27/2011] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To describe a previously unreported and potentially fatal complication of L-asparaginase (L-asp) administration in a dog. CASE SUMMARY A 7-year-old, 6.6 kg, female spayed Beagle presented with a 1-week history of progressive inappetance and lethargy. Diagnostic tests identified the presence of stage Vb lymphoma and liver dysfunction. The dog was treated with L-asp at 400 IU/kg, corticosteroids, and IV fluids. Within 12 hours the dog became depressed, vomited, and developed abdominal pain. Within 24 hours, the dog's mentation progressed from obtunded to comatose; subsequently the dog developed a "decerebrate posture." Blood ammonia concentrations exceeded 1,000 μmol/L (1,700 μg/dL). Treatment with broad-spectrum antimicrobials, lactulose enemas, and continuous renal replacement therapy were initiated without response and the dog suffered cardiopulmonary arrest. NEW OR UNIQUE INFORMATION PROVIDED The purpose of this report is to describe the development of severe hyperammonemia after L-asp therapy in a dog, which has not been previously reported in the literature. Given the rapid progression and fatal outcome observed in this case, early recognition may be crucial for management and treatment of this complication.
Collapse
Affiliation(s)
- Sarah E Lyles
- Department of Small Animal Clinical Sciences, University of Florida, Gainesville, FL 32610, USA
| | | | | | | | | | | |
Collapse
|
12
|
Current World Literature. Curr Opin Allergy Clin Immunol 2010; 10:400-6. [DOI: 10.1097/aci.0b013e32833d232e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|