1
|
Mullen KR, Felippe MJB. The Horse with Recurrent Fevers and Infections: Approach to Common Variable Immunodeficiency. Vet Clin North Am Equine Pract 2024; 40:179-188. [PMID: 38789347 PMCID: PMC11223947 DOI: 10.1016/j.cveq.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024] Open
Abstract
Equine common variable immunodeficiency (CVID) is a rare, late-onset, nonfamilial humoral deficiency characterized by B-cell depletion and/or dysfunction resulting in inadequate antibody production and predisposition to recurrent infections. Serum immunoglobulin concentration and peripheral blood lymphocyte immunophenotyping are required to diagnose and characterize CVID in horses. Early recognition of the disease by the equine practitioner is paramount to managing the quality of life for these patients, for whom specific treatment is not yet available and long-term prognosis remains poor. An approach to the diagnosis, identification of complicating factors, and management of horses with CVID are discussed.
Collapse
Affiliation(s)
- Kathleen Rory Mullen
- Department of Biomedical Informatics, University of Colorado Anschutz Medical Campus, Anschutz Health Sciences Building, 1890 North Revere Court, Mailstop F600, Aurora, CO 80045, USA
| | - Maria Julia Bevilaqua Felippe
- Department of Clinical Sciences, Cornell University College of Veterinary Medicine, 930 Campus Road, Box 34, Ithaca, NY 14853, USA.
| |
Collapse
|
2
|
Horner A, Bamford NJ, Stear MJ, Piedrafita D, Jabbar A, Hughes KJ, El-Hage CM, Preston S. Strongyle egg shedding and egg reappearance periods in horses with pituitary pars intermedia dysfunction. Vet Parasitol 2024; 328:110176. [PMID: 38603926 DOI: 10.1016/j.vetpar.2024.110176] [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: 12/11/2023] [Revised: 03/26/2024] [Accepted: 03/26/2024] [Indexed: 04/13/2024]
Abstract
Pituitary pars intermedia dysfunction (PPID) is the most common endocrine disorder of older horses. Immune dysfunction in horses with PPID could increase susceptibility to infectious diseases, including strongyle infections; however, few data are available. The aim of this study was to determine if horses with PPID had increased strongyle faecal egg counts (FEC) compared with control horses, over a fourteen-week period in Victoria, Australia. Clinical signs and plasma adrenocorticotropic hormone (ACTH) concentrations were used to categorise horses into PPID (n=14) or control (n=31) groups. Faecal samples were collected for FEC determination prior to anthelmintic treatment, and fortnightly post-treatment for each horse. Generalised linear mixed modelling, using a gamma distribution, was used to compare differences between groups in the repeated measures study. The confounding variable of age was controlled for as a fixed effect. Following anthelmintic treatment, mean FEC was greater for the PPID group compared to the control group on day 56 (405 ± 756 eggs per gram [EPG] vs 40 ± 85 EPG, p=0.05) and day 70 (753 ±1598 EPG vs 82 ±141 EPG, p=0.04). There were no differences in mean FEC between groups on days 84 and 98. Cumulative FEC (day 14 to day 98) was significantly greater for the PPID horses than control horses (2118 ± 4016 EPG vs 798 ± 768 EPG, p<0.0001). Group egg reappearance period was shorter for PPID horses (day 56 post-anthelmintic treatment) compared to control horses (day 70) and 30% of the PPID horses reached a FEC threshold of >200 EPG on day 42, compared to 0% of control horses (p=0.02). These results suggest that the rate of a re-established patent infection between groups could be different due to a comprised immune response in PPID horses or differences in the host-parasite relationship regarding encysted stage larvae. However, despite differences between groups, some horses with PPID consistently had no detectable or low FEC (<200 EPG) during the study period. These findings highlight the importance of individual FEC monitoring to determine if anthelmintic treatment is required, in line with sustainable parasite management practices.
Collapse
Affiliation(s)
- Adelaina Horner
- Institute of Innovation, Science and Sustainability, Federation University, Victoria 3350, Australia
| | - Nicholas J Bamford
- Melbourne Veterinary School, The University of Melbourne, Parkville, Victoria 3010, Australia
| | - Michael J Stear
- School of Life Sciences, La Trobe University, Melbourne, Victoria 3086, Australia
| | - David Piedrafita
- Institute of Innovation, Science and Sustainability, Federation University, Victoria 3350, Australia
| | - Abdul Jabbar
- Melbourne Veterinary School, The University of Melbourne, Parkville, Victoria 3010, Australia
| | - Kristopher J Hughes
- School of Agricultural, Environmental and Veterinary Sciences, Charles Sturt University, Wagga Wagga, NSW 2678, Australia
| | - Charles M El-Hage
- Melbourne Veterinary School, The University of Melbourne, Parkville, Victoria 3010, Australia.
| | - Sarah Preston
- Institute of Innovation, Science and Sustainability, Federation University, Victoria 3350, Australia.
| |
Collapse
|
3
|
Hobbs KJ, Le Sueur ANV, Burke MJ, Cooper BL, Sheats MK, Ueda Y. Feasibility of hemoperfusion using extracorporeal therapy in the horse. Front Vet Sci 2024; 11:1414426. [PMID: 38803798 PMCID: PMC11128652 DOI: 10.3389/fvets.2024.1414426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 04/30/2024] [Indexed: 05/29/2024] Open
Abstract
Objective Develop, implement, and monitor for adverse effects of, a novel hemoperfusion therapy in adult horses. Methods A prospective, observational feasibility study using three healthy adult horses from the North Carolina State University teaching herd. Health status was determined by physical exam, complete blood count, coagulation panel, and serum biochemistry. Each horse was instrumented with a 14 Fr × 25 cm double-lumen temporary hemodialysis catheter and underwent a 240 min polymer-based hemoperfusion session. Horses were administered unfractionated heparin to maintain anti-coagulation during the session. Given the novelty of this therapy in horses, each horse was treated as a learning opportunity that informed an iterative process of protocol development and modification. Measurements and main results Our long-term goal is to investigate potential clinical applications of hemoperfusion in horses, including cytokine reduction in horses with severe SIRS/sepsis. Horses were monitored for changes in clinical exam, biochemistry and hematology parameters. Additionally, cytokines were quantified to determine whether extracorporeal hemadsorption therapy alone caused an inflammatory response. Our results show that hemoperfusion therapy was associated with decreased platelet counts and serum albumin concentration. There was no significant change in plasma cytokine concentrations with hemoperfusion therapy. In one horse, the cytokine concentrations decreased, as previously reported with hemoperfusion therapy in humans. Hypothesis We hypothesized that hemoperfusion therapy could be performed in healthy adult horses without significant adverse effects. Conclusion Polymer-based hemoperfusion is a feasible extracorporeal therapy (ECT) modality for adult horses. Additional studies are needed to further establish clinical protocols, as well as establish efficacy of polymer-based hemoperfusion for treatment of various conditions in horses, including intoxications, immune-mediated conditions, and sepsis.
Collapse
|
4
|
Menzies-Gow NJ, Banse HE, Duff A, Hart N, Ireland JL, Knowles EJ, McFarlane D, Rendle D. BEVA primary care clinical guidelines: Diagnosis and management of equine pituitary pars intermedia dysfunction. Equine Vet J 2024; 56:220-242. [PMID: 37795557 DOI: 10.1111/evj.14009] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 08/19/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND Pituitary pars intermedia dysfunction (PPID) is a prevalent, age-related chronic disorder in equids. Diagnosis of PPID can be challenging because of its broad spectrum of clinical presentations and disparate published diagnostic criteria, and there are limited available treatment options. OBJECTIVES To develop evidence-based primary care guidelines for the diagnosis and treatment of equine PPID based on the available literature. STUDY DESIGN Evidence-based clinical guideline using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework. METHODS Research questions were proposed by a panel of veterinarians and developed into PICO or another structured format. VetSRev and Veterinary Evidence were searched for evidence summaries, and systematic searches of the NCBI PubMed and CAB Direct databases were conducted using keyword searches in July 2022 and updated in January 2023. The evidence was evaluated using the GRADE framework. RESULTS AND RECOMMENDATIONS The research questions were categorised into four areas: (A) Case selection for diagnostic testing, pre-test probability and diagnostic test accuracy, (B) interpretation of test results, (C) pharmacological treatments and other treatment/management options and (D) monitoring treated cases. Relevant veterinary publications were identified and assessed using the GRADE criteria. The results were developed into recommendations: (A) Case selection for diagnostic testing and diagnostic test accuracy: (i) The prevalence of PPID in equids aged ≥15 years is between 21% and 27%; (ii) hypertrichosis or delayed/incomplete hair coat shedding provides a high index of clinical suspicion for PPID; (iii) the combination of clinical signs and age informs the index of clinical suspicion prior to diagnostic testing; (iv) estimated pre-test probability of PPID should be considered in interpretation of diagnostic test results; (v) pre-test probability of PPID is low in equids aged <10 years; (vi) both pre-test probability of disease and season of testing have strong influence on the ability to diagnose PPID using basal adrenocorticotropic hormone (ACTH) or ACTH after thyrotropin-releasing hormone (TRH) stimulation. The overall diagnostic accuracy of basal ACTH concentrations for diagnosing PPID ranged between 88% and 92% in the autumn and 70% and 86% in the non-autumn, depending on the pre-test probability. Based on a single study, the overall diagnostic accuracy of ACTH concentrations in response to TRH after 30 minutes for diagnosing PPID ranged between 92% and 98% in the autumn and 90% and 94% in the non-autumn, depending on the pre-test probability. Thus, it should be remembered that the risk of a false positive result increases in situations where there is a low pre-test probability, which could mean that treatment is initiated for PPID without checking for a more likely alternative diagnosis. This could compromise horse welfare due to the commencement of lifelong therapy and/or failing to identify and treat an alternative potentially life-threatening condition. (B) Interpretation of diagnostic tests: (i) There is a significant effect of breed on plasma ACTH concentration, particularly in the autumn with markedly higher ACTH concentrations in some but not all 'thrifty' breeds; (ii) basal and/or post-TRH ACTH concentrations may also be affected by latitude/location, diet/feeding, coat colour, critical illness and trailer transport; (iii) mild pain is unlikely to have a large effect on basal ACTH, but caution may be required for more severe pain; (iv) determining diagnostic thresholds that allow for all possible contributory factors is not practical; therefore, the use of equivocal ranges is supported; (v) dynamic insulin testing and TRH stimulation testing may be combined, but TRH stimulation testing should not immediately follow an oral sugar test; (vi) equids with PPID and hyperinsulinaemia appear to be at higher risk of laminitis, but ACTH is not an independent predictor of laminitis risk. (C) Pharmacologic treatments and other treatment/management options: (i) Pergolide improves most clinical signs associated with PPID in the majority of affected animals; (ii) Pergolide treatment lowers basal ACTH concentrations and improves the ACTH response to TRH in many animals, but measures of insulin dysregulation (ID) are not altered in most cases; (iii) chasteberry has no effect on ACTH concentrations and there is no benefit to adding chasteberry to pergolide therapy; (iv) combination of cyproheptadine with pergolide is not superior to pergolide alone; (v) there is no evidence that pergolide has adverse cardiac effects in horses; (vi) Pergolide does not affect insulin sensitivity. (D) Monitoring pergolide-treated cases: (i) Hormone assays provide a crude indication of pituitary control in response to pergolide therapy, however it is unknown whether monitoring of ACTH concentrations and titrating of pergolide doses accordingly is associated with improved endocrinological or clinical outcome; (ii) it is unknown whether monitoring the ACTH response to TRH or clinical signs is associated with an improved outcome; (iii) there is very weak evidence to suggest that increasing pergolide dose in autumn months may be beneficial; (iv) there is little advantage in waiting for more than a month to perform follow-up endocrine testing following initiation of pergolide therapy; there may be merit in performing repeat tests sooner; (v) timing of sampling in relation to pergolide dosing does not confound measurement of ACTH concentration; (vi) there is no evidence that making changes after interpretation of ACTH concentrations measured at certain times of the year is associated with improved outcomes; (vii) evidence is very limited, however, compliance with PPID treatment appears to be poor and it is unclear whether this influences clinical outcome; (viii) evidence is very limited, but horses with clinical signs of PPID are likely to shed more nematode eggs than horses without clinical signs of PPID; it is unclear whether this results in an increased risk of parasitic disease or whether there is a need for more frequent assessment of faecal worm egg counts. MAIN LIMITATIONS Limited relevant publications in the veterinary scientific literature. CONCLUSIONS These findings should be used to inform decision-making in equine primary care practice.
Collapse
Affiliation(s)
| | - Heidi E Banse
- School of Veterinary Medicine, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Aimi Duff
- Rainbow Equine Hospital, North Yorkshire, UK
| | | | - Joanne L Ireland
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Wirral, UK
| | | | - Dianne McFarlane
- College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
| | | |
Collapse
|
5
|
Drozdzewska K, Winter J, Barton AK, Merle R, Gehlen H. Influence of feeding and other factors on adrenocorticotropin concentration and thyrotropin-releasing hormone stimulation test in horses and ponies. Equine Vet J 2024; 56:342-351. [PMID: 38010866 DOI: 10.1111/evj.14030] [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: 05/31/2023] [Accepted: 10/31/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND The basal (bACTH) and post-thyrotropin-releasing hormone stimulation concentration of adrenocorticotropin (pACTH) are recommended for diagnosis of pituitary pars intermedia dysfunction (PPID). Many factors influence bACTH (e.g., disease, age, month) and some affect the results only in autumn (e.g., breed, colour, sex). There are discrepancies about the impact of feeding on b/pACTH. OBJECTIVES To determine whether feeding, month, age, breed, colour, sex and body condition score affect b/pACTH. STUDY DESIGN Prospective crossover. METHODS Sixty-one animals were divided into groups: healthy, PPID, treated-PPID. The b/pACTH was measured three times (1 mg protirelin; blood collection after 10 min; mid-November to mid-July) after different feedings: fasting, hay, hay + grain. Friedman's test was applied to evaluate the influence of feeding on b/pACTH and linear mixed model to evaluate impact of further factors. RESULTS The b/pACTH was not significantly affected by feeding (p = 0.7/0.5). The bACTH was lowest in healthy (29.3 pg/mL, CI 9-49.5 pg/mL) and highest in PPID-group (58.9 pg/mL, CI 39.7-78.1 pg/mL). The pACTH was significantly lower in healthy (396.7 pg/mL, CI 283.2-510.1 pg/mL) compared to PPID (588.4 pg/mL, CI 480.7-696.2 pg/mL) and treated-PPID group (683.1 pg/mL, CI 585.9-780.4 pg/mL), highest in July (881.2 pg/mL, CI 626.3-1136.3 pg/mL) and higher in grey (723.5 pg/mL, CI 577.5-869.4 pg/mL) than other colours (338.7 pg/mL, CI 324.8-452.5 pg/mL). The size of effect for those variables was >0.5. MAIN LIMITATIONS Small number of animals, subsequent bACTH measurements were significantly lower in each horse. CONCLUSIONS There was no evidence that feeding influences the b/pACTH. There was evidence that pergolide affects the bACTH but it had little effect on pACTH. Further investigation of the impact of month and coat colour on b/pACTH is warranted to better interpret the results.
Collapse
Affiliation(s)
| | | | | | - Roswitha Merle
- Institute of Veterinary Epidemiology and Biostatistics, Freie Universität Berlin, Berlin, Germany
| | - Heidrun Gehlen
- Equine Clinic, Freie Universität Berlin, Berlin, Germany
| |
Collapse
|
6
|
Zapf AM, Fey K, Büttner K, Gröf M, Staszyk C. Periodontal structures in horses with pituitary pars intermedia dysfunction: A histological evaluation. Front Vet Sci 2023; 10:1114445. [PMID: 36733635 PMCID: PMC9887139 DOI: 10.3389/fvets.2023.1114445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 01/02/2023] [Indexed: 01/18/2023] Open
Abstract
Introduction Pituitary pars intermedia dysfunction (PPID) and dental disorders are of major concern in horses older than 15 years. Although PPID in geriatric horses and dental disorders in all age groups are well described, a connection between this endocrine disease and pathological changes in equine dental structures has not yet been investigated. In humans, periodontitis is considered to be a complication of systemic diseases like diabetes mellitus type 2, obesity and various conditions leading to an impaired immune response. In PPID, cross links to insulin and immune dysregulations are proven. The aim of this study was to compare histological findings of the gingiva and the sub gingival periodontal ligament of PPID affected horses with control horses. Methods In a case-control morphometric descriptive study, 145 dental locations of 10 PPID affected horses (27.3 ± 2.06 years) were compared with 147 dental locations of 10 controls (21.4 ± 4.12 years). Histological parameters were leukocyte infiltration, keratinization of gingival epithelium, blood vessel supply of the periodontium and structure of cementum. Results The distribution and localization of gingival leukocyte infiltrations (LI) in PPID affected horses was more often multifocal to coalescing (p = 0.002) and reached into deeper parts of the periodontium, sometimes down to the sub gingival periodontal ligament (PDL). Aged animals of both groups showed higher prevalence (PPID: OR 1.66; controls: OR 1.15) for severe leukocyte infiltration in the PDL. PPID was not significantly associated with increased LI. The cementum bordering the soft tissue in interdental locations showed four times more irregularities in PPID affected horses than in controls which predisposes for interdental food impaction and periodontal diseases. Discussion In summary, multifocal to coalescing leukocytes and irregular cementum are seen more often in PPID than in controls - however our findings mainly reflect an association of older age with periodontal disease.
Collapse
Affiliation(s)
- Anne Maria Zapf
- Equine Clinic, Internal Medicine, Faculty of Veterinary Medicine, Justus-Liebig-University, Giessen, Germany,*Correspondence: Anne Maria Zapf ✉
| | - Kerstin Fey
- Equine Clinic, Internal Medicine, Faculty of Veterinary Medicine, Justus-Liebig-University, Giessen, Germany
| | - Kathrin Büttner
- Unit for Biomathematics and Data Processing, Faculty of Veterinary Medicine, Justus-Liebig-University, Giessen, Germany
| | - Manuela Gröf
- Faculty of Veterinary Medicine, Institute of Veterinary Pathology, Justus-Liebig-University, Giessen, Germany
| | - Carsten Staszyk
- Faculty of Veterinary Medicine, Institute of Veterinary-Anatomy, Histology, and Embryology, Justus-Liebig-University, Giessen, Germany
| |
Collapse
|
7
|
Kirkwood NC, Hughes KJ, Stewart AJ. Prospective Case Series of Clinical Signs and Adrenocorticotrophin (ACTH) Concentrations in Seven Horses Transitioning to Pituitary Pars Intermedia Dysfunction (PPID). Vet Sci 2022; 9:vetsci9100572. [PMID: 36288186 PMCID: PMC9607114 DOI: 10.3390/vetsci9100572] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/29/2022] [Accepted: 10/11/2022] [Indexed: 12/31/2022] Open
Abstract
Simple Summary Pituitary pars intermedia dysfunction (PPID) is a common disease of the geriatric horse population. The most common clinical sign of PPID is hypertrichosis, or a long hair-coat with delayed shedding. Hypertrichosis is the most easily recognized clinical sign of PPID. However, the presence of hypertrichosis is often associated with severe end-stage disease. There is little research investigating sub-clinical or early PPID and the clinical signs associated with these stages of disease. The benefit of being able to recognize early PPID, is that we are able to begin treatment earlier on in disease process, potentially reducing the deleterious consequences of PPID and improving survival. Laboratory tests are available to more accurately diagnose PPID, and these tests include the basal ACTH and TRH-stimulated ACTH tests. Basal ACTH is easy to perform and is recommended in cases where clinical disease is suspected. The TRH-stimulation test improves diagnostic accuracy in early PPID cases. This study documents both test results and clinical signs associated with the transition from subclinical to clinical PPID, so that we are better able to recognize potential early PPID, as well as interpret results in these horses. Abstract Poor recognition of subtle clinical abnormalities and equivocal ACTH concentrations make early diagnosis of PPID difficult. Progressive clinical findings and corresponding ACTH concentrations in horses transitioning to PPID over time have not been documented. Seven horses with ACTH concentrations equivocal for PPID (utilizing locally derived, seasonally adjusted diagnostic-cut off values (DCOV)) and no clinical signs of PPID were selected. Sequential measurement of basal and thyrotropin-releasing hormone (TRH)-stimulated ACTH concentrations and recording of clinical findings occurred from October 2017 to November 2021 in a prospective case series. In two horses, marked hypertrichosis developed. Although 1/11 basal ACTH concentrations were below DCOV in 2018, subsequently all basal ACTH concentrations in these two horses without treatment were greater than DCOV. One horse was treated with pergolide which normalized basal ACTH concentrations. Four horses developed intermittent, mild hypertrichosis, and one horse never developed hypertrichosis. Basal ACTH concentrations in these five horses were greater than DCOV in 63/133 (47.4%) of testing points. TRH-stimulated ACTH concentrations in these five horses were greater than DCOV in 77/133 (57.9%) of testing points, sometimes markedly increased and greater than the assay upper limit of detection (LoD) of 1250pg/mL. TRH-stimulated ACTH concentrations were most frequently positive in late summer and early autumn, with 24/37 (64.9%) of TRH-stimulated ACTH concentrations greater than the DCOV in February and March. Horses transitioning to PPID can have subtle clinical signs and equivocal ACTH concentrations. However, TRH-stimulated ACTH concentrations can be markedly greater than DCOV, especially in late summer and early autumn (February and March) allowing for identification of subclinical and transitional cases.
Collapse
Affiliation(s)
- Naomi C. Kirkwood
- School of Agricultural, Environmental and Veterinary Sciences, Charles Sturt University, Wagga Wagga, NSW 2678, Australia
| | - Kristopher J. Hughes
- School of Agricultural, Environmental and Veterinary Sciences, Charles Sturt University, Wagga Wagga, NSW 2678, Australia
| | - Allison J. Stewart
- School of Veterinary Science, Gatton Campus, The University of Queensland, Gatton, QLD 4343, Australia
- Correspondence: ; Tel.: +61-754-601-799
| |
Collapse
|
8
|
Pituitary Pars Intermedia Dysfunction (PPID) in Horses. Vet Sci 2022; 9:vetsci9100556. [PMID: 36288169 PMCID: PMC9611634 DOI: 10.3390/vetsci9100556] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/25/2022] [Accepted: 10/04/2022] [Indexed: 12/12/2022] Open
Abstract
Substantial morbidity results from pituitary pars intermedia dysfunction (PPID) which is often underestimated by owners and veterinarians. Clinical signs, pathophysiology, diagnostic tests, and treatment protocols of this condition are reviewed. The importance of improved recognition of early clinical signs and diagnosis are highlighted, as initiation of treatment will result in improved quality of life. Future research should be targeted at improving the accuracy of the diagnosis of PPID, as basal adrenocorticotropic hormone (ACTH) concentration can lack sensitivity and thyrotropin releasing hormone (TRH) used to assess ACTH response to TRH stimulation is not commercially available as a sterile registered product in many countries. The relationship between PPID and insulin dysregulation and its association with laminitis, as well as additional management practices and long-term responses to treatment with pergolide also require further investigation.
Collapse
|
9
|
Durham AE. The effect of pergolide mesylate on adrenocorticotrophic hormone responses to exogenous thyrotropin releasing hormone in horses. Vet J 2022; 285:105831. [PMID: 35477010 DOI: 10.1016/j.tvjl.2022.105831] [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: 01/19/2022] [Revised: 03/08/2022] [Accepted: 04/21/2022] [Indexed: 10/18/2022]
Abstract
Thyrotropin releasing hormone (TRH) stimulation testing is often used to support a diagnosis of pituitary pars intermedia dysfunction (PPID) in horses although it is unclear whether or not repeat TRH stimulation testing post-treatment is a valid means of assessing response to medical therapy. Laboratory submissions from 64 suspected equine PPID cases were examined including the initial pre-treatment TRH stimulation test and a follow up test within 100 days of starting medical therapy with pergolide. In a subset of cases, further follow-up tests were examined beyond 100 days of starting treatment. Results from tests conducted between 1 July and 30 November 30 were excluded. Significant improvements were seen in both the baseline and TRH-stimulated adrenocorticotrophic hormone (ACTH) concentrations within 100 days with no further improvements seen in the subset of cases examined thereafter. Although 88% (n=56/64) of all cases showed a decreased response to TRH post-treatment, only 24% (n=9/38) of horses with positive pre-treatment TRH stimulation tests normalised following treatment, with a further 34% (n=13/38) improving into an equivocal test outcome category. Most commonly (42%; n=16/38), horses with positive pre-treatment TRH stimulation tests remained positive following treatment, although 75% (n=12/16) of these showed a numerically lower post-treatment response to TRH. These results will help inform practitioners of expected changes in TRH stimulation test results when assessing response of horses with PPID to medical therapy with pergolide.
Collapse
Affiliation(s)
- A E Durham
- Liphook Equine Hospital, Liphook, Hampshire GU30 7JG, UK.
| |
Collapse
|
10
|
Nuclear Transporting Factor 2 as a Novel Biomarker of Head and Neck Squamous Cell Carcinoma and Associated with T/B Cell Receptor Signaling Pathway. BIOMED RESEARCH INTERNATIONAL 2022; 2022:2885323. [PMID: 35155672 PMCID: PMC8837431 DOI: 10.1155/2022/2885323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 01/06/2022] [Indexed: 12/27/2022]
Abstract
Objective This study is aimed at exploring the role of nuclear transporting factor 2 (NUTF2) in head and neck squamous cell carcinoma (HNSCC) based on The Cancer Genome Atlas (TCGA) database. Methods We obtained 528 HNSCC patients' clinical data from TCGA and performed expression level analysis of NUTF2. Gene Sets Enrichment Analysis (GSEA) was conducted to identify NUTF2-associated regulatory mechanisms in HNSCC. In addition, several other tools were used to enrich the regulatory network. Results We found that NUTF2 was significantly upregulated (P < 0.001) in HNSCC. We then observed that higher NUTF2 is associated with poorer overall survival and disease-free survival. Further, by using Cox analyses, we determined high NUTF2 as an independent risk factor of predicting poorer overall survival. Tumor immune infiltration analysis revealed a significantly negative correlation between NUTF2 expression and the level of tumor infiltrated CD8+ T cell and B cell, suggesting that NUTF2 may be involved in the immune regulation of HNSCC. Gene sets related to T/B cell receptor signaling pathways were differentially enriched based on the NUTF2 expression phenotype. KEGG pathways were used to show that NUTF2 may affect proliferation, differentiation, and immune response of T/B cell through regulating PI3K/AKT, NFκB, MAPK, and Calcium signaling pathways. Conclusion NUTF2 might be a valuable biomarker for HNSCC and correlated with T/B cell receptor signaling pathway.
Collapse
|
11
|
Miller AB, Murphy BA, Adams AA. Impact of blue light therapy on plasma adrenocorticotropic hormone (ACTH) and hypertrichosis in horses with pituitary pars intermedia dysfunction. Domest Anim Endocrinol 2022; 78:106651. [PMID: 34656964 DOI: 10.1016/j.domaniend.2021.106651] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 06/30/2021] [Accepted: 07/21/2021] [Indexed: 11/19/2022]
Abstract
Blue light therapy can be used in horses to alter the natural photoperiod and inhibit winter hair coat growth. Seasonal increases in ACTH occur in the fall season but are exaggerated in horses with pituitary pars intermedia dysfunction (PPID). Additionally, PPID horses frequently present with hypertrichosis. Thus, blue light therapy was proposed as a potential management tool for hypertrichosis and for investigating the impact of photoperiod manipulation on ACTH. Eighteen PPID horses, aged 18 to 31 yr, from a university-owned research herd were selected and assigned to either the control group (n = 10) or the treatment (blue light therapy) group (n = 8) based on age and clinical history, which included the results of multiple endocrine tests. Consistent daylength of approximately 14.5 h was maintained for the treated horses from July 15 through approximately late October via the extension of natural daylength using wearable masks that provided short wavelength blue light (465 nm) to 1 eye. The control group was exposed to only the natural photoperiod during this time. All horses were housed on the same farm and remained on pasture for the duration of the study. On Day 0, thyrotropin-releasing hormone (TRH) stimulation tests were performed to confirm PPID status; there were no differences between the 2 groups in resting plasma ACTH or plasma ACTH at 10 min after TRH administration. To determine an effect of treatment on ACTH, blood was collected via jugular venipuncture for measurement of ACTH at sequential timepoints over a 16-h period in mid-October. Hair weights were also assessed throughout the study. No differences in resting plasma ACTH were observed between the 2 groups across the seasonal analysis (July and October) or during the 16-h testing. The PPID horses receiving blue light therapy had lighter hair weights compared to the PPID control horses. These results suggest that blue light therapy does not alter ACTH concentrations but could potentially be used as an additional management tool for hypertrichosis in PPID horses. Manipulation of the photoperiod using blue light therapy did not affect seasonal changes in ACTH in this study.
Collapse
Affiliation(s)
- A B Miller
- M.H. Gluck Equine Research Center, Department of Veterinary Science, University of Kentucky, Lexington, KY, USA.
| | - B A Murphy
- School of Agriculture and Food Science, University College Dublin, Belfield, Dublin 4, Ireland
| | - A A Adams
- M.H. Gluck Equine Research Center, Department of Veterinary Science, University of Kentucky, Lexington, KY, USA
| |
Collapse
|
12
|
Kam YN, McKenzie K, Coyle M, Bertin FR. Repeatability of a thyrotropin-releasing hormone stimulation test for diagnosis of pituitary pars intermedia dysfunction in mature horses. J Vet Intern Med 2021; 35:2885-2890. [PMID: 34642962 PMCID: PMC8692209 DOI: 10.1111/jvim.16281] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 09/27/2021] [Accepted: 10/01/2021] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Pituitary pars intermedia dysfunction (PPID) is a common endocrinopathy of horses diagnosed with a thyrotropin-releasing hormone (TRH) stimulation test. HYPOTHESIS/OBJECTIVES Describe the repeatability of TRH stimulation in horses with and without PPID in winter and autumn. ANIMALS Twenty adult horses; 6 controls and 6 with PPID tested in autumn, 8 controls and 6 with PPID tested in winter with 3 controls and 3 with PPID tested in both seasons. METHODS Thyrotropin-releasing hormone stimulation was performed on 2 consecutive occasions, 1 week before and 1 week after the winter solstice and the autumn equinox. Blood was collected before and 30 minutes after IV injection of 1 mg of TRH. ACTH concentration was determined by a chemiluminescent assay. Repeatability and test-retest reliability were assessed by repeated measures analysis of variance, intraclass correlation coefficient and within-horse coefficients of variation (CV). Bland-Altman plots were generated to visualize agreement between repetitions. RESULTS In winter, no week effect was detected on the results of the TRH simulation and the test had an excellent test-retest reliability. In autumn, after-TRH ACTH concentrations were significantly lower on week 2 (P = .02) and the test only had a good test-retest reliability. There were significantly larger within-horse CV during autumn (P = .04) and after TRH stimulation (P = .04). There were 2 misclassifications in winter and 4 in autumn. CONCLUSIONS AND CLINICAL IMPORTANCE The TRH stimulation test was repeatable when performed 2 weeks apart in winter; however, in autumn, more variability in after-TRH ACTH concentrations resulted in decreased repeatability.
Collapse
Affiliation(s)
- Yan Ning Kam
- School of Veterinary Science, The University of Queensland, Gatton, Queensland, Australia
| | - Kelly McKenzie
- School of Veterinary Science, The University of Queensland, Gatton, Queensland, Australia
| | - Mitchell Coyle
- Office of the Director of Gatton Campus, The University of Queensland, Gatton, Queensland, Australia
| | - François-René Bertin
- School of Veterinary Science, The University of Queensland, Gatton, Queensland, Australia
| |
Collapse
|
13
|
Guarino C, Pinn-Woodcock T, Levine DG, Miller J, Johnson AL. Case Report: Nuchal Bursitis Associated With Borrelia burgdorferi Infection in a Horse. Front Vet Sci 2021; 8:743067. [PMID: 34631864 PMCID: PMC8495068 DOI: 10.3389/fvets.2021.743067] [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: 07/17/2021] [Accepted: 08/18/2021] [Indexed: 11/17/2022] Open
Abstract
Cases of cranial nuchal bursitis associated with Borrelia burgdorferi infection have not been thoroughly described. Here, we describe the case of a 17-year-old mare that was presented for low head carriage, dull demeanor, and resistance to haltering. Imaging supported a diagnosis of nuchal bursitis, and bursoscopy with surgical debridement of the nuchal bursa was performed. B. burgdorferi was identified by molecular diagnostics in serial samples of the bursal fluid, with no other organisms identified. Serology revealed significant elevation in antibodies directed against OspA of B. burgdorferi, but not the typical infection markers, OspC and OspF. Intravenous ceftiofur was administered for 80 days, and the nuchal bursa was directly injected with ceftiofur. The mare recovered and was able to return to work with no recrudescence of clinical signs over the following year to date. Infection with B. burgdorferi should be considered as a differential in cases of septic nuchal bursitis.
Collapse
Affiliation(s)
- Cassandra Guarino
- Population Medicine and Diagnostic Sciences, Cornell University, Ithaca, NY, United States
| | - Toby Pinn-Woodcock
- Population Medicine and Diagnostic Sciences, Cornell University, Ithaca, NY, United States
| | - David G Levine
- New Bolton Center, University of Pennsylvania School of Veterinary Medicine, Kennett Square, PA, United States
| | - Julia Miller
- General Medicine, Alliance Equine Health Care, Glenmoore, PA, United States
| | - Amy L Johnson
- New Bolton Center, University of Pennsylvania School of Veterinary Medicine, Kennett Square, PA, United States
| |
Collapse
|
14
|
Miller AB, Harris PA, Barker VD, Adams AA. Short-term transport stress and supplementation alter immune function in aged horses. PLoS One 2021; 16:e0254139. [PMID: 34411137 PMCID: PMC8376036 DOI: 10.1371/journal.pone.0254139] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 06/18/2021] [Indexed: 11/18/2022] Open
Abstract
Long-distance transport is associated with stress-related changes in equine immune function, and shipping-associated illnesses are often reported. Horses are frequently transported short distances, yet the effects of short-term transport on immune function remain largely unknown. Twelve horses, aged 15-30 yr, were assigned to either the control (n = 6) or treatment (n = 6) groups; treatment horses received a daily antioxidant supplement 3 weeks before and after transport. All horses were transported for approximately 1.5-2 hr on Day 0. Blood was collected via jugular venipuncture at 15-min pre- and post-transport and on Days -21, 1, 3, 7, 14, and 21. Body temperature, heart rate, body weight, total cortisol, and gene expression of IFNγ, IL-1β, IL-2, IL-4, IL-6, IL-8, IL-10, IL-12α, IL-17α, SAA1, and TNFα in whole blood were measured. Peripheral blood mononuclear cells were isolated, stimulated with PMA/ionomycin, and stained for IFNγ and TNFα before analysis via flow cytometry. Statistical analyses were performed with significance set at P < 0.05 (SAS 9.4). Transport and supplementation did not appear to affect body weight, heart rate, IL-4, IL-8, IL-12α, IL-17α, change (Δ) in the % and mean fluorescence intensity (MFI) of IFNγ+ lymphocytes after stimulation, or Δ in the % and MFI of TNFα+ lymphocytes after stimulation. Supplementation decreased IL-1β and SAA1 expression. Transport increased total cortisol concentration, body temperature, and IL-2, IL-6, and IL-10 expression but decreased IL-1β, TNFα, and IFNγ expression. Short-term transportation affected physiological, endocrine, and immune responses; supplementation may ameliorate inflammation in aged horses. Immune responses were most altered at 15-min post-transport and typically recovered by Day 1, suggesting that horses may be vulnerable to disease during and almost immediately after short-term transport.
Collapse
Affiliation(s)
- Ashton B. Miller
- Department of Veterinary Science, M.H. Gluck Equine Research Center, University of Kentucky, Lexington, Kentucky, United States of America
- * E-mail:
| | - Patricia A. Harris
- Waltham Petcare Science Institute, Waltham-on-the-Wolds, Leicestershire, England, United Kingdom
| | - Virginia D. Barker
- Department of Veterinary Science, M.H. Gluck Equine Research Center, University of Kentucky, Lexington, Kentucky, United States of America
| | - Amanda A. Adams
- Department of Veterinary Science, M.H. Gluck Equine Research Center, University of Kentucky, Lexington, Kentucky, United States of America
| |
Collapse
|
15
|
Wei X, Yang B, Chen X, Wen L, Kan J. Zanthoxylum alkylamides ameliorate protein metabolism in type 2 diabetes mellitus rats by regulating multiple signaling pathways. Food Funct 2021; 12:3740-3753. [PMID: 33900301 DOI: 10.1039/d0fo02695f] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Type 2 diabetes mellitus (T2DM) can easily induce insulin resistance (IR) in skeletal muscle, causing protein metabolism disorder and inflammation. The present study aimed to investigate whether Zanthoxylum alkylamides (ZA) could ameliorate T2DM through regulating protein metabolism disorder by using a rat model of T2DM. The predominant bioactive constituents found in ZA were hydroxyl-α-sanshool, hydroxyl-β-sanshool and hydroxyl-γ-sanshool. The results showed that ZA improved a series of biochemical indices associated with protein metabolism and inflammation in T2DM rats. Our mechanistic finding indicated that ZA promoted protein anabolism in T2DM rats by up-regulating the phosphoinositide 3-kinase (PI3K)/protein kinase B (Akt)/mammalian target of rapamycin (mTOR) signaling pathway. ZA also promoted glucose transportation in skeletal muscle to ameliorate skeletal muscle IR and energy metabolism through regulating the AMP-activated protein kinase (AMPK) signaling pathway. Moreover, ZA inhibited protein degradation and improved protein catabolism disorder in T2DM rats by down-regulating the PI3K/Akt/forkhead box O (FoxO) signaling pathway, and ZA further ameliorated inflammation to inhibit protein catabolism via regulating the tumor necrosis factor α (TNF-α)/nuclear factor κB (NF-κB) pathway in the skeletal muscle of T2DM rats. Collectively, the ameliorating effect of ZA on protein metabolism disorder in T2DM rats was the common result of regulating multiple signaling pathways. ZA decreased skeletal muscle IR to promote protein anabolism and inhibit protein catabolism for improving protein metabolism disorder, thus ultimately ameliorating T2DM. In sum, our findings demonstrated that ZA treatment could effectively ameliorate T2DM through improving protein metabolism, providing a new treatment target for T2DM.
Collapse
Affiliation(s)
- Xunyu Wei
- College of Food Science, Southwest University, 2 Tiansheng Road, Beibei, Chongqing 400715, PR China.
| | | | | | | | | |
Collapse
|
16
|
Investigation of innate immune function in adult and geriatric horses. Vet Immunol Immunopathol 2021; 235:110207. [PMID: 33735821 DOI: 10.1016/j.vetimm.2021.110207] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 01/25/2021] [Accepted: 02/07/2021] [Indexed: 11/23/2022]
Abstract
In order to better understand the influence of age on innate immune function in horses, blood was collected from twelve adult horses (aged 10-16 years; mean: 13 years) and ten geriatric horses (aged 18-26 years; mean: 21.7 years) for analysis of plasma myeloperoxidase, complete blood counts, and cytokine and receptor expression in response to in vitro stimulation with heat-inactivated Rhodococcus equi, heat-inactivated Escherichia coli, and PMA/ionomycin. Gene expression was measured using RT-PCR for IFNγ, IL-1β, IL-6, IL-8, IL-10, IL-12α, IL-13, IL-17α, TLR2, TLR4, and TNFα. Endocrine function and body weight were measured to assess any potential impacts of ACTH, insulin, or body weight on immune function; none of the horses had pituitary pars intermedia dysfunction. The geriatric horse group had lower concentrations of plasma myeloperoxidase (P = 0.0459) and lower absolute monocyte counts (P = 0.0477); however, the difference in monocyte counts was no longer significant after outliers were removed. Additionally, only two significant differences in cytokine/receptor expression in whole blood were observed. Compared with adult horses, the geriatric horses had increased TNFα expression after in vitro stimulation with heat-inactivated R. equi (P = 0.0224) and had decreased IL-17α expression after PMA/ionomycin stimulation when one outlier was excluded (P = 0.0334). These changes may represent a compensatory mechanism by which geriatric horses could ensure adequate immune responses despite potentially dysfunctional neutrophil activity and/or decreased monocyte counts. Aging may influence equine innate immune function, and additional research is warranted to confirm and further explore these findings.
Collapse
|