Use of pentosan polysulphate in cats with idiopathic, non-obstructive lower urinary tract disease: A double-blind, randomised, placebo-controlled trial

Pentosan Polysulfate Affords Pleotropic Protection to Multiple Cells and Tissues

Pentosan polysulfate (PPS), a small semi-synthetic highly sulfated heparan sulfate (HS)-like molecule, shares many of the interactive properties of HS. The aim of this review was to outline the potential of PPS as an interventional therapeutic protective agent in physiological processes affecting pathological tissues. PPS is a multifunctional molecule with diverse therapeutic actions against many disease processes. PPS has been used for decades in the treatment of interstitial cystitis and painful bowel disease, it has tissue-protective properties as a protease inhibitor in cartilage, tendon and IVD, and it has been used as a cell-directive component in bioscaffolds in tissue engineering applications. PPS regulates complement activation, coagulation, fibrinolysis and thrombocytopenia, and it promotes the synthesis of hyaluronan. Nerve growth factor production in osteocytes is inhibited by PPS, reducing bone pain in osteoarthritis and rheumatoid arthritis (OA/RA). PPS also removes fatty compounds from lipid-engorged subchondral blood vessels in OA/RA cartilage, reducing joint pain. PPS regulates cytokine and inflammatory mediator production and is also an anti-tumor agent that promotes the proliferation and differentiation of mesenchymal stem cells and the development of progenitor cell lineages that have proven to be useful in strategies designed to effect repair of the degenerate intervertebral disc (IVD) and OA cartilage. PPS stimulates proteoglycan synthesis by chondrocytes in the presence or absence of interleukin (IL)-1, and stimulates hyaluronan production by synoviocytes. PPS is thus a multifunctional tissue-protective molecule of potential therapeutic application for a diverse range of disease processes.

Prevalence, Risk Factors, Pathophysiology, Potential Biomarkers and Management of Feline Idiopathic Cystitis: An Update Review

Feline idiopathic cystitis is a widespread disease in small animal clinics, which mainly presents with urinary signs like dysuria, stranguria, hematuria, pollakiuria, and periuria. The etiopathogenesis of the disease may involve interactions between the environmental stressors, neuroendocrine system and bladder of affected cats. Diagnostic biomarkers have not been tested in clinical studies though they are theoretically feasible, and since the clinical signs of the disease assemble those of other feline lower urinary diseases, its diagnosis is a procedure of exclusion. The primary treatment of the disease is long-term multimodal environmental modification (or enrichment) while anti-anxiety drugs and nutritional supplements are recommended for chronic recurrent cases. Still, many medicines need to be evaluated for their efficacy and safety. This review aims to provide readers with a comprehensive understanding of feline idiopathic cystitis by summarizing and updating studies concerning the prevalence, risk factors, etiological hypotheses, diagnostic procedures, possible treatments, and prognosis of the disease.

Acute and severe haemorrhage following pentosan polysulfate injection in a Cornish Rex

Case summary

A 14-year-old male castrated Cornish Rex cat was referred for lethargy progressing rapidly to collapse in the hours following a subcutaneous injection of a product containing 100 mg/ml pentosan polysulfate sodium and 168 mg/ml glucosamine. Physical examination revealed the cat to be in hypotensive shock with swelling and interstitial oedema around the cranial thorax and caudal cervical regions without cutaneous haemorrhage. Initial diagnostics revealed a severe anaemia (packed cell volume 11%) which later deteriorated further, necessitating a blood transfusion and aggressive fluid therapy. Post-transfusion, the patient remained dyspnoeic and subsequent diagnostics found evidence of pre-existing cardiomyopathy and congestive heart failure. The cat was euthanased 24 h following presentation due to increasing dyspnoea. Post-mortem findings were of severe subcutaneous and intermuscular haemorrhage over the neck and thorax, among other changes. There were no detectable levels of coumarin anticoagulants in the liver.

Relevance and novel information

This is the first reported case of acute subcutaneous and intermuscular haemorrhage of this severity suspected to be related to the off-label use of an injectable product containing pentosan polysulfate in a cat. Given the popularity of its use for feline arthritis, there is a need for large-scale clinical trials to evaluate the safety and efficacy of products containing pentosan polysulfate for cats, and any side effects to be reported.

Feline musculoskeletal ageing: How are we diagnosing and treating musculoskeletal impairment?

PRACTICAL RELEVANCE

An understanding of the process of musculoskeletal ageing - which all senior and geriatric cats will experience - is vital to maintaining the health and welfare of our ageing cat population.

CLINICAL CHALLENGES

Assessment of the feline musculoskeletal system is not always straightforward. Diagnosis of impairment relies on input from owners and veterinarians in terms of visual observation, and clinical and orthopaedic examination, in addition to diagnostic imaging.

AUDIENCE

This review is written for the primary care veterinary team.

AIMS

The goals are to raise awareness and improve clinical diagnosis of musculoskeletal impairment as a result of ageing. The article also reviews therapeutic options and considers the evidence available for the prevention/deceleration of musculoskeletal ageing and impairment.

EVIDENCE BASE

There is good evidence of a high prevalence of osteoarthritis (OA) and degenerative joint disease (DJD) in older cats. There is also good evidence to indicate that functional impairment and chronic pain are sequelae of musculoskeletal disease. However, there is a paucity of information for what is best practice for the management and treatment of musculoskeletal impairment in a clinical situation. There is also a lack of evidence on how prevention of central stimulation of the nervous system caused by musculoskeletal impairment and, in turn the development of chronic pain, can be avoided.

A prospective randomized study of efficacy of 2 treatment protocols in preventing recurrence of clinical signs in 51 male cats with obstructive idiopathic cystitis

Background

Urethral obstruction (UO) is a common complication of feline idiopathic cystitis (FIC). Robust treatment recommendations to prevent its recurrence are scarce.

Objectives

To evaluate meloxicam treatment for prevention of clinical recrudescence in male cats with obstructive FIC.

Animals

Fifty‐one client‐owned cats.

Methods

Prospective, randomized clinical trial. Every male cat with FIC‐associated UO was deemed eligible for the study and was recruited during hospitalization. After discharge, cats were treated with phenoxybenzamine and alprazolam for 2 weeks, with (24 cats) or without (27 cats) low‐dose meloxicam (0.025 mg/kg/day PO) and monitored for 6 months.

Results

Cumulative number (%) of cats with recurrent UO at 10 days, 1‐, 2‐, and 6‐months after discharge was 1 (2%), 2 (4%), 4 (8%), and 8 (16%), respectively. Overall, 12 (24%) cats experienced signs of recurrent FIC within 6 months, with (8 cats) or without (4 cats) concurrent UO. No difference in the cumulative incidence of UO within 6 months was detected with addition of meloxicam (odds ratio [95% confidence interval], 0.63 [0.13‐2.97]; P = .70). All cats were alive at 6 months.

Conclusions and Clinical Importance

No clinical benefit was detected with the addition of low‐dose meloxicam to phenoxybenzamine and alprazolam treatment for 2 weeks after discharge. Nevertheless, this study was underpowered to identify potential differences, and its findings must be corroborated in larger studies.

Evaluation of meloxicam for the treatment of obstructive feline idiopathic cystitis

Objectives The aim of the study was to investigate the effect of the non-steroidal anti-inflammatory drug meloxicam on the clinical course of obstructive idiopathic cystitis in cats in a placebo-controlled clinical study. Methods Thirty-seven cats with obstructive idiopathic cystitis were enrolled. Cats received supportive treatment and an indwelling transurethral catheter for 48 h. On days 0 and 1, all cats received buprenorphine 0.01 mg/kg subcutaneously every 8 h. On day 1, cats were randomly assigned to the meloxicam (n = 18) or placebo group (n = 19) and received meloxicam (0.1 mg/kg on day 1, 0.05 mg/kg on days 2-5) or placebo orally for five consecutive days. Cats were monitored by repeated physical examinations and urinalysis, and with a 5 day questionnaire filled in by the owners after discharge and a telephone interview 3 months after presentation. Parameters for evaluation of treatment success were the occurrence of recurrent urethral obstruction, results of physical examinations and questionnaires. Results Recurrent urethral obstruction occurred in 4/18 cats (22%) in the meloxicam group and 5/19 cats (26%) in the placebo group ( P = 1.000). General demeanour and pain on abdominal palpation during hospitalisation improved significantly in both groups ( P <0.001). After discharge, with regard to general demeanour, food intake and voiding behaviour, there were no significant differences within or between groups at different time points. Conclusions and relevance Orally administered meloxicam for 5 days did not influence the incidence of recurrent urethral obstruction and the recovery from clinical signs in cats with obstructive feline idiopathic cystitis. The persistence of clinical signs in most of the cats 1 week after initial presentation indicates that symptomatic treatment for a longer period of time is warranted.

Comparison of foods with differing nutritional profiles for long-term management of acute nonobstructive idiopathic cystitis in cats

OBJECTIVE

To evaluate the effect of nutrition on recurrent clinical signs of lower urinary tract (LUT) disease in cats with idiopathic cystitis.

DESIGN

Randomized, controlled, masked clinical trial.

ANIMALS

31 cats with acute nonobstructive idiopathic cystitis.

PROCEDURES

Cats were assigned to receive 1 of 2 foods (a cystitis prevention or control food) that differed in mineral (calcium, phosphorous, and magnesium), antioxidant, and fatty acid profiles. Owners documented LUT signs daily for up to 1 year. The primary endpoint was the number of recurrent episodes in which a cat had multiple (≥ 2 concurrent) LUT signs within a day (defined as multiple-sign day). Consecutive days in which a cat had multiple LUT signs were considered as a single episode.

RESULTS

4 cats fed prevention food and 2 cats fed control food were excluded from analysis because of noncompliance, gastrointestinal signs, food refusal, or owner voluntary withdrawal. The proportion of cats fed prevention food that had ≥ 1 recurrent episode of multiple-sign days (4/11) was not significantly lower than that of cats fed control food (9/14). However, cats fed prevention food had significantly lower mean incidence rates for recurrent episodes of multiple-sign days (0.7 episodes/1,000 cat-days) and episodes of hematuria (0.3 episodes/1,000 cat-days), dysuria (0.2 episodes/1,000 cat-days), and stranguria (0.2 episodes/1,000 cat-days) as single LUT signs, compared with cats fed control food (5.4, 3.4, 3.1, and 3.8 episodes/1,000 cat-days, respectively). Significantly fewer cats fed prevention food required analgesics (4/11), compared with cats fed control food (12/14).

CONCLUSIONS AND CLINICAL RELEVANCE

Foods with differing nutritional profiles appeared to impact mean incidence rates of recurrent feline idiopathic cystitis-associated signs.

Efficacy of intravesical pentosan polysulfate sodium in cats with obstructive feline idiopathic cystitis

OBJECTIVES

Obstructive feline idiopathic cystitis is a common emergency in small animal practice. There is evidence for a defective glycosaminoglycan layer in the urinary bladder of affected cats. The aim of this study was to investigate the effect of intravesical pentosan polysulfate sodium (PPS) in cats with obstructive feline idiopathic cystitis in a randomised, placebo-controlled, blinded clinical study.

METHODS

Thirty-five cats with obstructive feline idiopathic cystitis were enrolled into the study. On day 0, cats were randomised to receive either 30 mg PPS in saline (18 cats) or saline alone as placebo (17 cats) at the time of indwelling urinary catheter placement and then after 24 and 48 h. The catheter was clamped for 30 mins after administration before connecting it to a sterile urine collection system. The procedure was repeated after 24 and 48 h, and then the indwelling catheter was removed. Treatment success was assessed via the incidence of recurrent urethral obstruction, results of a scoring system for physical examination and daily urinalysis from day 0 to 5.

RESULTS

Recurrent urethral obstruction occurred in 3/18 cats of the verum group and 3/17 of the placebo group (P = 1.000). The verum group showed a significantly lower degree of microscopic haematuria between day 5 and day 0 (P ⩽0.05). The placebo group showed a significantly lower degree of dipstick haematuria between day 5 and day 0 (P ⩽0.05). There was no difference in the clinical score between the groups in the investigated time period.

CONCLUSIONS AND RELEVANCE

Intravesical instillation of PPS three times within 48 h in the chosen dose had no influence on the incidence of recurrent urethral obstruction and clinical signs in cats with obstructive feline idiopathic cystitis.

Causes of lower urinary tract disease in Norwegian cats

A study was made on causes of lower urinary tract disease in cats, and to investigate whether demographic data and factors related to husbandry might influence the occurrence of a particular diagnosis. The study was a prospective, descriptive, and analytical study of primary cases of feline lower urinary tract disease (FLUTD) in Norway. Only cats sampled by cystocentesis were included in the present study. Of the 119 cats included, 28.6% were diagnosed with obstructive FLUTD. The majority of cats were diagnosed with feline idiopathic cystitis (FIC) (55.5%). Urethral plugs were the second most common diagnosis (21.0%), whereas bacterial cystitis and urolithiasis each were diagnosed in 11.8%. Nearly one-third (28.6%) of the cats diagnosed with urolithiasis had significant bacteriuria. Thus, significant bacteriuria was diagnosed in a total of 15.1% of the cats. There were no significant differences in the urine specific gravity, pH and amount of epithelial cells in the urine sediment in the different aetiological categories of FLUTD. There was a higher amount of red blood cells in the urine sediment in cats diagnosed with urethral plugs and urolithiasis, whereas cats with bacterial cystitis and urolithiasis had a higher amount of white blood cells in their sediment. Regarding demographic data and factors related to husbandry, cats diagnosed with FLUTD were more often males and kept strictly indoors, when compared with a 'reference population'.