Effects of dietary lysine supplementation in cats with enzootic upper respiratory disease

A review of evidence-based management of infectious ocular surface disease in shelter-housed domestic cats

Infectious ocular surface disease (IOSD) is a common problem in shelter-housed domestic cats and has a widespread negative impact on animal welfare. While the common etiological agents are well-described, addressing IOSD in large groups of animals presents a management challenge to the clinician and logistical challenges to shelter employees. Treatments, diagnostics, and prevention strategies that are effective in privately owned or experimental animals may be impractical or ineffective in the shelter environment. This review article focuses on the relative prevalence of etiological agents in feline IOSD, practical diagnostic testing protocols, prevention strategies, and treatment of IOSD in shelter-housed cats. Discrepancies between experimental laboratory-based studies and clinical trials assessing therapeutics for treatment of feline herpes virus are highlighted. Further high-quality clinical trials are necessary to determine optimal preventative and therapeutic protocols for IOSD in shelter-housed cats.

Effects of famciclovir in cats with spontaneous acute upper respiratory tract disease

OBJECTIVES

The aim of this study was to assess the effects of famciclovir administration in cats with spontaneously acquired acute upper respiratory tract disease.

METHODS

Twenty-four kittens with clinical signs of acute upper respiratory tract disease were randomly allocated to receive doxycycline (5 mg/kg PO q12h) alone (group D; n = 12) or with famciclovir (90 mg/kg PO q12h; group DF; n = 12) for up to 3 weeks. Clinical disease severity was scored at study entry and daily thereafter. Oculo-oropharyngeal swabs collected at study entry and exit were assessed using quantitative PCR for nucleic acids of feline herpesvirus type 1 (FHV-1), feline calicivirus (FCV), Chlamydia felis, Bordetella bronchiseptica and Mycoplasma felis.

RESULTS

The median (range) age of cats was 1.5 (1-6) months in group D vs 1.6 (1-5) months in group DF (P = 0.54). Pathogens detected in oculo-oropharyngeal swabs at study entry included FCV (n = 13/24; 54%), M felis (n = 8/24; 33%), FHV-1 (n = 7/24; 29%), C felis (n = 7/24; 29%) and B bronchiseptica (n = 3/24; 12%). Median (range) duration of clinical signs was 11.5 (3-21) days in group DF and 11 (3-21) days in group D (P = 0.75). Median (range) total disease score at the end of the study did not differ between groups (group D 1 [1-1] vs group DF 1 [1-3]; P = 0.08).

CONCLUSIONS AND RELEVANCE

This study revealed no significant difference in response to therapy between cats treated with doxycycline alone or with famciclovir; cats improved rapidly in both groups. However, identification of FHV-1 DNA was relatively uncommon in this study and clinical trials focused on FHV-1-infected cats are warranted to better evaluate famciclovir efficacy.

Chronic Rhinitis in the Cat: An Update

The etiology of feline chronic rhinitis is incompletely understood and often is a diagnosis of exclusion. History, clinical signs, and investigations performed to reach this diagnosis are discussed. Several treatment options are provided, although cure of this frustrating disease is rarely achieved.

Effects of free amino acids on cytokine secretion and proliferative activity of feline T cells in an in vitro study using the cell line MYA-1

In vitro studies might be an interesting screening method for targeted in vivo studies in the field of immunonutrition and help to reduce and refine animal studies. As the role of amino acids for immune function of cats has not been evaluated in detail so far, the present study aimed at investigating the effects of eight different amino acids (arginine, leucine, isoleucine, valine, glutamine, lysine, threonine and tryptophan) in six concentrations each (0, 0.25, 0.5, 1, 2 and 8x the cat blood level) on cytokine secretion and proliferative activity of feline T cells (MYA-1) in vitro. The results demonstrated that high doses of arginine increased IL-4, IL-10 and TNF-α secretion of T cells, while increasing concentrations of lysine increased IL-10 secretion and proliferative activity of the T cells. High doses of leucine enhanced GM-CSF and IL-10 secretion, while concentrations of threonine in the cell culture media greater than blood concentration also increased GM-CSF and additionally TNF-α secretion of the cells. The effects of glutamine and isoleucine on T cell function were only small. In conclusion, the present in vitro study could evaluate the immunomodulating potential of specific amino acids for feline T cell function. High doses of arginine, lysine, leucine and threonine had a significant impact on cytokine secretion and proliferative activity of the T cells. Targeted in vivo studies should investigate the clinical relevance of dietary supplementation of those amino acids in healthy and diseased cats as a next step.

A review of antiviral drugs and other compounds with activity against feline herpesvirus type 1

Feline herpesvirus type 1 (FHV-1) is a common and important cause of ocular surface disease, dermatitis, respiratory disease, and potentially intraocular disease in cats. Many antiviral drugs developed for the treatment of humans infected with herpesviruses have been used to treat cats infected with FHV-1. Translational use of drugs in this manner ideally requires methodical investigation of their in vitro efficacy against FHV-1 followed by pharmacokinetic and safety trials in normal cats. Subsequently, placebo-controlled efficacy studies in experimentally inoculated animals should be performed followed, finally, by carefully designed and monitored clinical trials in client-owned animals. This review is intended to provide a concise overview of the available literature regarding the efficacy of antiviral drugs and other compounds with proven or putative activity against FHV-1, as well as a discussion of their safety in cats.

Something old, something new: Update of the 2009 and 2013 ABCD guidelines on prevention and management of feline infectious diseases

OVERVIEW

The ABCD has published 34 guidelines in two Special Issues of the Journal of Feline Medicine and Surgery (JFMS): the first in July 2009 (Volume 11, Issue 7, pages 527-620) and the second in July 2013 (Volume 15, Issue 7, pages 528-652). The present article contains updates and new information on 18 of these (17 disease guidelines and one special article 'Prevention of infectious diseases in cat shelters'). For detailed information, readers are referred to the guidelines published in the above-mentioned JFMS Special Issues.

Lysine supplementation is not effective for the prevention or treatment of feline herpesvirus 1 infection in cats: a systematic review

BACKGROUND

Feline herpesvirus 1 is a highly contagious virus that affects many cats. Virus infection presents with flu-like signs and irritation of ocular and nasal regions. While cats can recover from active infections without medical treatment, examination by a veterinarian is recommended. Lysine supplementation appears to be a popular intervention (recommended by > 90 % of veterinarians in cat hospitals). We investigated the scientific merit of lysine supplementation by systematically reviewing all relevant literature.

METHODS

NCBI's PubMed database was used to search for published work on lysine and feline herpesvirus 1, as well as lysine and human herpesvirus 1. Seven studies on lysine and feline herpesvirus 1 (two in vitro studies and 5 studies with cats), and 10 publications on lysine and human herpesvirus 1 (three in vitro studies and 7 clinical trials) were included for qualitative analysis.

RESULTS

There is evidence at multiple levels that lysine supplementation is not effective for the prevention or treatment of feline herpesvirus 1 infection in cats. Lysine does not have any antiviral properties, but is believed to act by lowering arginine levels. However, lysine does not antagonize arginine in cats, and evidence that low intracellular arginine concentrations would inhibit viral replication is lacking. Furthermore, lowering arginine levels is highly undesirable since cats cannot synthesize this amino acid themselves. Arginine deficiency will result in hyperammonemia, which may be fatal. In vitro studies with feline herpesvirus 1 showed that lysine has no effect on the replication kinetics of the virus. Finally, and most importantly, several clinical studies with cats have shown that lysine is not effective for the prevention or the treatment of feline herpesvirus 1 infection, and some even reported increased infection frequency and disease severity in cats receiving lysine supplementation.

CONCLUSION

We recommend an immediate stop of lysine supplementation because of the complete lack of any scientific evidence for its efficacy.

Effects of physiologic concentrations of l-lysine on in vitro replication of feline herpesvirus 1

OBJECTIVE

To evaluate the effects of various concentrations of l-lysine on in vitro replication of feline herpesvirus 1 (FHV-1).

SAMPLE

Cultures of Crandell-Rees feline kidney (CRFK) cells.

PROCEDURES

CRFK cells were inoculated with FHV-1 and maintained in media with 20 combinations of l-arginine and l-lysine concentrations. Changes in cell viability were monitored by continuous measurement of electrical impedance of cultured cells and by observation of viral cytopathic effects. Viral load was determined by use of quantitative PCR assay in supernatants obtained from infected cultures at specified time points.

RESULTS

Increases in l-lysine concentration had no effect on the kinetics of cell death in FHV-1-infected cultures. There was also no significant effect (r(2) < 0.1) on viral DNA load for l-arginine concentrations ≥ 12 μg/mL There was a significant effect of increases in l-lysine concentration on viral DNA load in media supplemented with 6 μg of l-arginine/mL (mean ± SD slope, -4,641 ± 1,626 units; adjusted r(2) = 0.45). However, the difference between the lowest (1 × 10(6.28) copies/μL) and highest (1 × 10(6.86) copies/μL) FHV-1 DNA load in these media was < 1 logarithm.

CONCLUSIONS AND CLINICAL RELEVANCE

The difference in FHV-1 DNA load was unlikely to be biologically important. Various l-lysine concentrations did not inhibit in vitro replication of FHV-1 at l-arginine concentrations sufficient to maintain cell growth. This conclusion was consistent with results of other studies in which investigators have not detected a consistently beneficial effect when l-lysine is administered to FHV-1-infected cats.

ABCD: Update of the 2009 guidelines on prevention and management of feline infectious diseases

OVERVIEW

In this article, the ABCD guidelines published in the JFMS Special Issue of July 2009 (Volume 11, Issue 7, pages 527-620) are updated by including previously unavailable and novel information. For a better picture, the reader is advised to consult that issue before focusing on the novel features.

Feline respiratory disease complex

Feline respiratory disease complex (FRDC) refers to the characteristic acute presentation of a contagious respiratory or ocular disease caused by one or multiple pathogens. Environmental and host factors impact the transmission, clinical presentation, preventive strategy, and treatment of affected cats. The FRDC is especially problematic in settings where large numbers of cats cohabit, including animal shelters, catteries, and semi-feral colonies. Although elimination of FRDC is an unrealistic goal, improved understanding can lead to strategies to minimize disease impact.

Results of molecular diagnostic assays targeting feline herpesvirus-1 and feline calicivirus in adult cats administered modified live vaccines

In this pilot study, 12 adult, gang-housed cats that were known to be previously exposed (n=12) to feline herpesvirus-1 (FHV-1) and/or vaccinated against (n=2) feline calicivirus (FCV) and FHV-1 were randomly assigned to one of two groups of six cats each. Nasal and pharyngeal samples were collected from each cat on days -7, -3, and 0 prior to vaccination and on days 3, 7, 10, 14, 17, 21, and 28 after vaccination with an FHV-1, FCV, and panleukopenia (FVRCP) vaccine developed for intranasal (six cats) or parenteral (six cats) use. FHV-1 DNA was amplified from 1/12 cats (1/69 samples; 1.4%) prior to vaccination and 2/12 cats after vaccination (2/154 samples; 1.3%). FCV RNA was amplified from 2/12 cats (2/69 samples; 2.9%) prior to vaccination and 7/12 cats (12/154 samples; 7.8%) after vaccination. Positive molecular diagnostic assay results for FHV-1 and FCV were uncommon prior to or after vaccination in these cats.

Snots and Snuffles: Rational Approach to Chronic Feline Upper Respiratory Syndromes

Practical relevance While the most common cause of chronic upper respiratory disease signs in cats is viral disease, with subsequent, self-perpetuating inflammation, other, more discrete causes need to be ruled out. These include foreign bodies, bacterial or fungal infections, oral-dental diseases and neoplasia. Any factors contributing to alterations in the structure or function of the upper airways, including inflammation of any cause, will compromise normal function and predispose to chronic damage if the cat is unable to resolve the underlying factors.

Clinical challenges The chronic feline snuffler is a frustrating patient to treat. The longer the course of disease, the more severe the consequences to affected tissues, and the more debilitated the patient becomes. A logical diagnostic plan to differentiate probable etiologies and to rule out non-viral causes results in appropriate therapeutic choices. Even with a viral etiology, therapies to reduce the pathological consequences of infection may modulate and help control the clinical signs. Some novel choices and drug combinations are discussed in this review.

Patient group Cats of all ages may be affected. Cats with conformational (breed or malformation) characteristics, such as short or convoluted nasal passages or very small nostrils, are predisposed to unresolving inflammation. Fungal disease is more relevant in specific geographic regions, making inclusion of a travel history important in history collection. Older cats are more likely to have neoplasia-induced signs.

Audience This review is directed at all veterinarians who see cats with chronic, recurrent upper respiratory disease.

Treatment of Corneal Ulcers: What are the Medical Options?

Practical relevance Corneal ulcers in cats (ulcerative keratitis) are a common presenting complaint, and are a frequent sequela to feline herpesvirus (FHV-1) infection. In fact, it is fair to assume an FHV-1 aetiology until proven otherwise. In practice, therefore, many cases of corneal ulceration can be treated medically, but treatment can frequently be challenging, with the need to tailor therapy carefully to the type of ulcer, the individual cat and its temperament.

Patient group All age groups and breeds can suffer with ulcerative keratitis although some breeds are over-represented for some types of corneal ulceration.

Evidence base The scientific literature on feline ulcerative keratitis is extensive, particularly that related to FHV-1 infection. This article reviews the medical treatment options for corneal ulceration in cats with reference to the current evidence base.

Effects of dietary lysine supplementation on upper respiratory and ocular disease and detection of infectious organisms in cats within an animal shelter

OBJECTIVE

To determine within a cat shelter effects of dietary lysine supplementation on nasal and ocular disease and detection of nucleic acids of Chlamydophila felis, feline calicivirus (FCV), and feline herpesvirus (FHV-1).

ANIMALS

261 adult cats.

PROCEDURES

Cats were fed a diet containing 1.7% (basal diet; control cats) or 5.7% (supplemented diet; treated cats) lysine for 4 weeks. Plasma concentrations of lysine and arginine were assessed at the beginning (baseline) and end of the study. Three times a week, cats were assigned a clinical score based on evidence of nasal and ocular disease. Conjunctival and oropharyngeal swab specimens were tested for FHV-1, FCV, and C felis nucleic acids once a week.

RESULTS

Data were collected from 123, 74, 59, and 47 cats during study weeks 1, 2, 3, and 4, respectively. By study end, plasma lysine concentration in treated cats was greater than that in control cats and had increased from baseline. There was no difference between dietary groups in the proportion of cats developing mild disease. However, more treated cats than control cats developed moderate to severe disease during week 4. During week 2, FHV-1 DNA was detected more commonly in swab specimens from treated versus control cats.

CONCLUSIONS AND CLINICAL RELEVANCE

Dietary lysine supplementation in the amount used in our study was not a successful means of controlling infectious upper respiratory disease within a cat shelter. Rather, it led to increases in disease severity and the incidence of detection of FHV-1 DNA in oropharyngeal or conjunctival mucosal swab specimens at certain time points.

Pilot study to evaluate the effect of oral supplementation of Enterococcus faecium SF68 on cats with latent feline herpesvirus 1

Feline herpesvirus 1 (FHV-1) infection is extremely common in cats and is frequently associated with morbidity because of recurrent ocular and respiratory clinical signs of disease. Enterococcus faecium strain SF68 is an immune-enhancing probiotic used as a dietary supplement. In this pilot study, 12 cats with chronic FHV-1 infection were administered either SF68 or a placebo, monitored for clinical signs of disease, monitored for FHV-1 shedding, and evaluated for FHV-1 specific humoral and cell-mediated immune responses and fecal microbiome stability. Fecal microbial diversity was maintained throughout the study in cats supplemented with SF68, but decreased in cats fed the placebo, indicating a more stable microbiome in cats fed SF68. While clinical results varied among individual cats, the overall findings suggest that administration of the probiotic lessened morbidity associated with chronic FHV-1 infection in some cats. Additional study is warranted to determine efficacy in a clinical setting.

Oral supplementation with L-lysine did not prevent upper respiratory infection in a shelter population of cats

Cats in animal shelters are highly susceptible to infection by feline herpesvirus (FHV) by virtue of their stress and close proximity to other cats. Animal shelters take several different approaches to prevent FHV-related upper respiratory infections (URIs), including empirically treating all cats with L-lysine, a supplement believed to prevent the replication of FHV and, therefore, manifestations of herpesvirus infections. In this study we tested oral supplementation of L-lysine as a means to prevent URIs. One hundred and forty-four cats were treated with L-lysine in a small amount of canned food once daily. A 'no treatment' group of 147 cats received no lysine during the course of the study. The development of conjunctivitis or URI was tracked between the two groups. In all measures, there was no effect between the two groups, suggesting that lysine was not able to prevent URI or conjunctivitis in our shelter situation. Cats entering shelters encounter stressors that may make them more susceptible to FHV reactivation or infection. Infection control and control of fomite transmission are also key to keeping cats healthy in a group housing situation. The finding that lysine did not prevent URI in this animal shelter suggests that shelters may better use their resources by finding ways to decrease stress among their feline population, focusing on proper infection control measures, and limiting fomite transmission of disease.