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Keulen JNP, van Nimwegen SA. Laparoscopic partial pancreatectomy through an advanced lateral approach as treatment for insulinoma in dogs: a case series. Front Vet Sci 2024; 10:1278218. [PMID: 38260191 PMCID: PMC10800787 DOI: 10.3389/fvets.2023.1278218] [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: 08/30/2023] [Accepted: 12/11/2023] [Indexed: 01/24/2024] Open
Abstract
A minimally invasive partial pancreatectomy was performed through a novel laparoscopic lateral flank approach in sternal-oblique recumbency in four clinical cases presented with an insulinoma. All four cases were female castrated dogs of older age (range 7-9 years) and different breeds (Wire haired dachshund, German shepherd, Jack Russel terrier, and Boxer), and all presented with episodic weakness, tremors, and/or seizures. The diagnosis was based on plasma glucose level below reference range with concomitant increased or normal insulin level. A laparoscopic approach was considered based on triple-phase contrast-enhanced computed tomography findings of the abdomen, revealing a pancreatic mass situated in the right pancreatic limb or left pancreatic limb without suspicion of metastasis. Laparoscopic procedures were performed without any major complications, and peri-operative glycemia increased to (supra-)normal levels in all cases. Histopathologic reports qualified the masses as neuroendocrine carcinomas, and in conjunction with the clinical picture, this neoplasia was further defined as insulinoma. Post-operative care in an intensive care unit was of short duration, and all animals were discharged being clinically normal and normoglycemic in between 1.5 and 2.5-day post-surgery. At short-term follow-up, no dogs showed clinical abnormalities, all recovered well from the surgical procedure, and blood glucose levels remained in the normal range. During long-term follow-up, 2 cases remained clinically normal at the time of writing, 564 and 1,211 days after surgery, 1 dog had recurrence of hypoglycemic episodes after 246 days and was euthanized after 673 days of surgery due to progressing disease, and 1 dog was euthanized after 1,028 days of surgery due to reasons unrelated to the insulinoma. Survival times ranged from 599 to 1,232 days after diagnosis. Considering the highly metastatic nature and difficulty of full laparoscopic staging of insulinoma patients, thorough pre-operative disease staging is warranted when considering a laparoscopic approach. This case series shows the feasibility of a novel laparoscopic flank approach for right and left partial pancreatectomy in dogs. Furthermore, proper case selection resulted in favorable outcome in these insulinoma patients.
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Affiliation(s)
- Justin N. P. Keulen
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, Netherlands
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Sheppard‐Olivares S, Bello NM, Johannes CM, Hocker SE, Biller B, Husbands B, Snyder E, McMillan M, McKee T, Wouda RM. Toceranib phosphate in the management of canine insulinoma: A retrospective multicentre study of 30 cases (2009-2019). Vet Rec Open 2022; 9:e27. [PMID: 35079406 PMCID: PMC8776903 DOI: 10.1002/vro2.27] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 09/28/2021] [Accepted: 11/22/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Insulinomas are the most common tumour of the endocrine pancreas in dogs. These malignant tumours have a high metastatic rate and limited chemotherapeutic options. The multi-receptor tyrosine kinase inhibitor sunitinib malate has benefit in the treatment of metastatic insulinoma in people. Toceranib phosphate, an analogous veterinary agent, may provide benefit for dogs. METHODS A retrospective study describing the extent and duration of clinical outcomes and adverse events (AEs) in dogs diagnosed with insulinoma and receiving toceranib. RESULTS Records for 30 dogs diagnosed with insulinoma and having received toceranib were identified from a medical record search of five university and eight referral hospitals. The median progression-free interval and overall survival time were 561 days (95% confidence interval (CI): [246, 727 days]) and 656 days (95% CI: [310, 1045 days]), respectively. Of the dogs for which the canine Response evaluation criteria for solid tumours tool could be applied, the majority (66.7%) showed either a complete response, partial response or stable disease. Time to clinical progression was associated with prior intervention and type of veterinary practice. Larger dogs were at increased risk for disease progression and death. No novel AEs were reported. CONCLUSIONS Most dogs diagnosed with insulinoma and receiving toceranib appeared to have a clinical benefit. Randomised, prospective studies are needed to better elucidate and objectively quantify the potential effect and survival benefit of toceranib therapy for management of insulinoma in dogs.
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Affiliation(s)
- Sabina Sheppard‐Olivares
- Department of Clinical SciencesCollege of Veterinary MedicineKansas State UniversityManhattanKansasUSA
- Present address:
3901 Guadalupe Street, Austin, TX 78751, USA.
| | - Nora M. Bello
- Department of StatisticsCollege of Arts and SciencesKansas State UniversityManhattanKansasUSA
| | - Chad M. Johannes
- Department of Clinical SciencesCollege of Veterinary MedicineIowa State UniversityAmesIowaUSA
| | - Samuel E. Hocker
- Ontario Veterinary CollegeUniversity of GuelphGuelphOntarioCanada
- Present address:
Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University, 1800 Denison Avenue, Manhattan, KS 66506, USA.
| | - Barbara Biller
- Flint Animal Cancer CenterCollege of Veterinary Medicine and Biomedical SciencesColorado State UniversityFort CollinsColoradoUSA
- Present address:
4120 Clydesdale Pkwy, Loveland, CO 80538, USA.
| | - Brian Husbands
- Veterinary Clinical Sciences DepartmentCollege of Veterinary MedicineUniversity of MinnesotaSt. PaulMinnesotaUSA
- Present address:
Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, 1900 Coffey Road, Columbus, OH 43210, USA.
| | - Elizabeth Snyder
- Department of Medical SciencesSchool of Veterinary MedicineUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
- Present address:
BluePearl Specialty and Emergency Pet Hospital, 1646 Spring Cypress Rd Ste 100, Spring, TX 77388, USA.
| | - Mattison McMillan
- Las Vegas Veterinary Specialty CenterLas VegasNevadaUSA
- Present address:
College of Veterinary Medicine, Washington State University, Pullman, WA 99164, USA.
| | - Talon McKee
- Clinical Studies DepartmentVCA Inc.Los AngelesCaliforniaUSA
| | - Raelene M. Wouda
- Department of Clinical SciencesCollege of Veterinary MedicineKansas State UniversityManhattanKansasUSA
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3
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Ramos‑Cardona X, Luo W, Mohammed S. Advances and challenges of CAR T therapy and suitability of animal models (Review). Mol Clin Oncol 2022; 17:134. [PMID: 35949897 PMCID: PMC9353808 DOI: 10.3892/mco.2022.2567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 06/06/2022] [Indexed: 11/06/2022] Open
Abstract
Chimeric antigen receptors (CARs) recently gained momentum in cancer treatment due to their ability to promote T-cell mediated responses to a specific tumor-associated antigen. CARs are part of the adoptive cell transfer (ACT) strategies that utilize patients' T lymphocytes, genetically engineered to kill cancer cells. However, despite the therapy's success against blood-related malignancies, treating solid tumors has not reached its fullest potential yet. The reasons include the complex suppressive tumor microenvironment, mutations on cancer cells' target receptors, lethal side-effects, restricted trafficking into the tumor, suboptimal persistence in vivo and the lack of animal models that faithfully resemble human tumor's immunological responses. Currently, rodent models are used to investigate the safety and efficacy of CAR therapies. However, these models are limited in representing the human disease faithfully, fail to predict the adverse treatment events and overestimate the efficacy of the therapy. On the other hand, spontaneously developed tumors in dogs are more suited in CAR research and their efficacy has been demonstrated in a number of diseases, including lymphoma, osteosarcoma and mammary tumors. The present review discusses the design and evolution of CARs, challenges of CAR in solid tumors, human and canine clinical trials and advantages of the canine model.
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Affiliation(s)
- Xavier Ramos‑Cardona
- Department of Comparative Pathobiology, Purdue University Center for Cancer Research, West Lafayette, IN 47907, USA
| | - Weichuan Luo
- Department of Chemistry, Purdue University, West Lafayette, IN 47907, USA
| | - Sulma Mohammed
- Department of Comparative Pathobiology, Purdue University Center for Cancer Research, West Lafayette, IN 47907, USA
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4
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Walczak R, Kawalilak L, Griffin L. Fluorine-18 fluorodeoxyglucose positron emission tomography-computed tomography for staging of canine insulinoma: 3 cases (2019-2020). J Small Anim Pract 2021; 63:227-233. [PMID: 34811734 DOI: 10.1111/jsap.13446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 09/14/2021] [Accepted: 10/07/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Canine insulinomas are uncommon malignant functional pancreatic neuroendocrine tumours with a high metastatic rate. Diagnostic imaging aids with staging and surgical planning of these tumours; however, identification is unpredictable across modalities. High-grade human pancreatic neuroendocrine tumours display increased avidity on 18 F-fluorodeoxyglucose positron emission tomography-CT. MATERIALS AND METHODS Dogs with clinicopathologic findings consistent with pancreatic insulinoma were prospectively enrolled. Patients underwent 18 F-fluorodeoxyglucose positron emission tomography-CT and CT angiography, followed by exploratory laparotomy. RESULTS Three patients met the inclusion criteria and had histologically confirmed insulinomas. Both metastatic lesions in patient 1 were mildly avid (SUVmax 2.79 and 3.01). In patient 2, the primary pancreatic insulinoma was minimally avid (SUVmax 2.16). The primary pancreatic lesion in patient 3 had similar avidity to normal pancreatic parenchyma (SUVmax 1.54) and was undetected on 18 F-fluorodeoxyglucose positron emission tomography-CT. Insulinomas demonstrated variable attenuation and contrast enhancement patterns on CT angiography and certain lesions were more conspicuous than on 18 F-fluorodeoxyglucose positron emission tomography-CT. Two metastatic lesions not visible on either imaging modality were discovered in patient 2 at surgery. CLINICAL SIGNIFICANCE Canine insulinomas were inconsistently avid on 18 F-fluorodeoxyglucose positron emission tomography-CT. This finding is likely attributable to the confounding clinicopathological features and multifaceted transformation of these tumours, in addition to the influence of variable tumour size, composition and vascularity. Unpredictable tumoural avidity limits the value of 18 F-fluorodeoxyglucose positron emission tomography-CT for staging canine insulinomas.
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Affiliation(s)
- R Walczak
- Department of Environmental and Radiological Health Sciences, Colorado State University, College of Veterinary Medicine and Biomedical Sciences, 300 West Drake Road, Fort Collins, CO, 80523, USA
| | - L Kawalilak
- Pulse Veterinary Specialists and Emergency, #320, 450 Ordze Road, Sherwood Park, Alberta, T8A5K6, Canada
| | - L Griffin
- Department of Environmental and Radiological Health Sciences, Colorado State University, College of Veterinary Medicine and Biomedical Sciences, 300 West Drake Road, Fort Collins, CO, 80523, USA
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5
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Capodanno Y, Altieri B, Elders R, Colao A, Faggiano A, Schrader J. Canine insulinoma as a model for human malignant insulinoma research: Novel perspectives for translational clinical studies. Transl Oncol 2021; 15:101269. [PMID: 34794032 PMCID: PMC8605301 DOI: 10.1016/j.tranon.2021.101269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 10/29/2021] [Accepted: 11/11/2021] [Indexed: 02/07/2023] Open
Abstract
Insulinomas are considered rare indolent neuroendocrine neoplasms in human medicine, however when metastases occur no curative treatment is available thus, novel therapies are needed. Recently advances have been made in unraveling the pathophysiology of malignant insulinoma still major challenges hinder the development of a functional model to study them. Canine malignant insulinoma have similar recurrence and a poor prognosis as human malignant insulinoma. Additionally, both human and canine patients share extensively the same environment, tend to develop insulinoma seemingly spontaneously with an etiological role for hormones, at a similar incidence and stage of lifespan, with metastasis commonly to liver and regional lymph nodes, which are unresponsive to current therapies. However, the occurrence of metastases in dogs is as high as 95% compared with only 5-16% in human studies. From a comparative oncology perspective, the shared features with human insulinoma but higher incidence of metastasis in canine insulinoma suggests the latter as a model for human malignant insulinomas. With the common purpose of increasing survival rates of human and veterinary patients, in this review we are going to compare and analyze clinical, pathological and molecular aspects of canine and human insulinomas to evaluate the suitability of the canine model for future translational clinical studies.
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Affiliation(s)
- Ylenia Capodanno
- Laboratory of Fundamental Oncology, National Cancer Center Research Institute, Chuo-ku, Tokyo 103-0045, Japan
| | - Barbara Altieri
- Division of Endocrinology and Diabetes, Department of Internal Medicine, University Hospital of Wuerzburg, Oberduerrbacher Strasse 6, Wuerzburg 97080, Germany
| | - Richard Elders
- London Vet Specialists, 56 Belsize Lane, London NW3 5AR, United Kingdom
| | - Annamaria Colao
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Antongiulio Faggiano
- Endocrinology Unit, Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Via di Grottarossa, 1035/1039, Rome 00189, Italy
| | - Joerg Schrader
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Martinstrasse 52, Hamburg 20246, Germany
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Alonso-Miguel D, García-San José P, González Sanz S, Clarés Moral I, Pérez-Alenza MD. Evaluation of palliative therapy, alone or in combination with toceranib phosphate, in dogs diagnosed with metastatic or recurrent beta-cell neoplasia. N Z Vet J 2021; 69:234-239. [PMID: 33944682 DOI: 10.1080/00480169.2021.1905569] [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] [Indexed: 10/21/2022]
Abstract
AIMS To compare survival in dogs with recurrent or metastatic insulinomas that were treated with palliative therapy, alone or in combination with toceranib phosphate and to assess tolerability of the combined therapy in dogs. MATERIALS AND METHODS Dogs diagnosed with insulinoma were retrospectively identified in the records of the Veterinary Teaching Hospital Complutense (Madrid, Spain). Diagnosis of insulinoma was based on clinical signs of hypoglycaemia, concentrations in serum of glucose <3.3 mmol/L and insulin >10 μIU/mL and presence of a pancreatic mass on diagnostic imaging. Dogs were treated surgically or medically, according to clinical stage established by imaging techniques, and monitored with blood and urine analyses monthly and abdominal ultrasonography every 3 months until death. Dogs that presented with metastatic disease at diagnosis or with recurrent hypoglycaemia after surgery were treated, according to the owner's decision, with one of two treatment protocols: palliative therapy alone (control group, n=7: diet, prednisone, famotidine or omeprazole, ±octreotide) or palliative therapy in combination with toceranib (treatment group, n=5; median dose of toceranib 2.52 mg/kg). Overall survival time (OST) and adverse events were compared between the two treatment groups. RESULTS The OST was longer in the treatment group (median 399, min 125, max 476 days) compared to the control group (median 67, min 23, max 387 days; p=0.042). Dogs in the treatment group had a higher incidence of grade 1-2 gastrointestinal toxicity (diarrhoea) than dogs in the control group (p=0.010). In all cases, gastrointestinal toxicity was solved by temporarily discontinuing toceranib. CONCLUSIONS AND CLINICAL RELEVANCE The use of toceranib combined with palliative treatment in dogs with suspect metastatic or recurrent insulinomas increased survival time and was adequate tolerated.
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Affiliation(s)
- D Alonso-Miguel
- Department of Animal Medicine and Surgery, School of Veterinary Medicine, Complutense University of Madrid, Madrid, Spain
| | - P García-San José
- Department of Animal Medicine and Surgery, School of Veterinary Medicine, Complutense University of Madrid, Madrid, Spain
| | - S González Sanz
- Department of Animal Medicine and Surgery, School of Veterinary Medicine, Complutense University of Madrid, Madrid, Spain
| | - I Clarés Moral
- Department of Animal Medicine and Surgery, School of Veterinary Medicine, Complutense University of Madrid, Madrid, Spain
| | - M D Pérez-Alenza
- Department of Animal Medicine and Surgery, School of Veterinary Medicine, Complutense University of Madrid, Madrid, Spain
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Suwitheechon OU, Schermerhorn T. Evaluation of the expression of hexokinase 1, glucokinase, and insulin by canine insulinoma cells maintained in short-term culture. Am J Vet Res 2021; 82:110-117. [PMID: 33480281 DOI: 10.2460/ajvr.82.2.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To develop a technique for isolation and culture of canine insulinoma cells and assess expression of cellular hexokinases (glucokinase and hexokinase I) and expression and secretion of insulin from these cells in vitro. SAMPLE Pancreatic insulinomas and normal pancreatic tissue from 4 and 3 dogs, respectively. PROCEDURES Tissues were collected by surgical excision or at necropsy. Insulinoma cells from 2 dogs were cultured for up to 10 weeks with standard techniques; insulin synthesis in vitro was confirmed by immunohistochemical analysis of freshly prepared slides of cultured cells, and insulin secretion was assessed by measurement of insulin concentrations in culture medium with an ultrasensitive mouse insulin ELISA. Expression of cellular hexokinases in insulinomas and adjacent normal (nontumor) pancreatic tissue from the same dog (n = 3) was examined by quantitative reverse transcriptase PCR assay. RESULTS Insulinoma cells survived for up to 10 weeks but did not proliferate in culture. Insulin was detected in isolated cells and secreted into culture medium for up to 10 weeks. Both cellular hexokinases were expressed; glucokinase appeared to be overexpressed in insulinomas, compared with normal pancreatic tissue from the same dogs. CONCLUSIONS AND CLINICAL RELEVANCE Canine insulinomas expressed hexokinases responsible for glucose responsiveness. Insulinoma cells were successfully maintained in short-term culture; cultured cells remained functional for 10 weeks as evidenced by cellular insulin content and had detectable secretion of insulin into the culture medium for ≥ 5 weeks. Apparent glucokinase overexpression by insulinomas suggested a possible mechanism underlying excessive insulin release by these tumors.
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Do Canine Pancreatic Neuroendocrine Neoplasms Resemble Human Pancreatic Neuroendocrine Tumours? A Comparative Morphological and Immunohistochemical Investigation. J Comp Pathol 2020; 181:73-85. [PMID: 33288156 DOI: 10.1016/j.jcpa.2020.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/22/2020] [Accepted: 10/12/2020] [Indexed: 11/20/2022]
Abstract
Although canine pancreatic neuroendocrine neoplasms (PanNENs) have been proposed as a model for the counterpart human neoplasms, the type or grade of human PanNEN that they resemble is unclear. PanNENs in animals are classified as adenoma or carcinoma, whereas in humans they are classified as pancreatic neuroendocrine tumour (PanNET) if well-differentiated, or as pancreatic neuroendocrine carcinoma (PanNEC) if poorly differentiated. We evaluated 16 canine primary PanNENs and two metastases histologically and immunohistochemically, and graded them using the animal and human grading systems. All neoplasms had local or vascular invasion and were classified as pancreatic islet cell carcinomas according to the current WHO classification. The Ki-67 index was low in all cases (0.01-1.50%). All had cytoplasmic expression of synaptophysin and insulin but were immunonegative for glucagon, confirming a functional diagnosis of canine insulinoma. Membranous expression of SSTR2A and nuclear expression of ATRX, but no p53 expression, was found in all neoplasms. One primary tumour was diagnosed as a mixed neuroendocrine-non-neuroendocrine neoplasm, which is the first report of this neoplasm in dogs. The other 15 primary tumours and both metastatic tumours were graded as PanNET G1, according to the human WHO classification. We conclude that canine PanNENs share well-differentiated histomorphology, SSTR2A expression and absence of nuclear p53 immunolabelling with human PanNETs G1. However, they differ in ATRX gene expression and functionality, and seem to have a worse prognosis than human PanNETs G1, although their generally low Ki-67 index precludes more precise assessment of prognosis. Membranous SSTR2A expression renders canine PanNENs potentially amenable to treatment with somatostatin analogues or SSTR targeted in-vivo imaging methods.
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Cleland NT, Morton J, Delisser PJ. Outcome after surgical management of canine insulinoma in 49 cases. Vet Comp Oncol 2020; 19:428-441. [PMID: 32558184 DOI: 10.1111/vco.12628] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 06/15/2020] [Accepted: 06/15/2020] [Indexed: 11/29/2022]
Abstract
Canine insulinoma has historically been associated with a poor prognosis; however, prolonged survival times have recently been reported. Prognostic indicators that are available preoperatively are of limited predictive accuracy, and consensus on post-operative treatment recommendations is lacking. The objectives of this study were to describe outcomes in dogs with insulinoma treated surgically, and to assess whether selected potential risk factors are strongly associated with outcomes after surgery. Medical records of two institutions were searched for dogs with insulinoma that were treated surgically. Forty-nine dogs were included. Thirty-nine dogs (80%) had immediate resolution of hypoglycaemia and 10 (20%) remained persistently hypoglycaemic postoperatively. The median survival time (MST) for all dogs was 561 days. The MST for dogs that had resolution of hypoglycaemia was 746 days. The median of the overall euglycaemic time (times from surgery to first detection of hypoglycaemia at any time point after surgery) for all dogs was 424 days. Forty-four percent of those that had resolution of hypoglycaemia experienced recurrence of hypoglycaemia by 2 years postoperatively. Pathological stage was a predictor of persistent post-operative hypoglycaemia which, in turn, was a predictor of survival time. These results show that dogs with insulinoma can have prolonged survival, and that pathological stage is a predictor of outcome.
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Affiliation(s)
| | - John Morton
- Jemora Pty Ltd, Geelong, Victoria, Australia
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10
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Capodanno Y, Buishand FO, Pang LY, Kirpensteijn J, Mol JA, Elders R, Argyle DJ. Transcriptomic analysis by RNA sequencing characterises malignant progression of canine insulinoma from normal tissue to metastatic disease. Sci Rep 2020; 10:11581. [PMID: 32665562 PMCID: PMC7360586 DOI: 10.1038/s41598-020-68507-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 06/22/2020] [Indexed: 11/30/2022] Open
Abstract
Insulinomas (INS) are the most common human and canine functioning pancreatic neuroendocrine tumours. The long-term prognosis for malignant INS is poor, because micrometastases are frequently missed during surgery. As human and canine malignant INS share clinical and histopathological features, dogs have been proposed as models for INS research. Using RNA-sequencing, we conducted a pilot study to better understand the underlying molecular mechanisms of canine INS. Normal canine pancreas and lymph node control tissues were compared with primary INS and INS-metastatic lymph nodes, revealing more than 3,000 genes differentially expressed in normal pancreas compared to primary INS. Only 164 genes were differentially expressed between primary INS and INS-metastatic lymph nodes. Hierarchical clustering analysis demonstrated similar genetic profiles in normal pancreas and early clinical stage primary INS, whereas late clinical stage primary INS resembled the genetic profile of INS-metastatic lymph nodes. These findings suggest that markers of malignant behaviour could be identified at the primary site of the disease. Finally, using the REACTOME pathways database, we revealed that an active collagen metabolism, extracellular matrix remodelling, beta-cell differentiation and non-beta-cell trans-differentiation might cause disease progression and hyperinsulinism in INS, identifying major pathways worthy of future research in this currently poorly controlled disease.
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Affiliation(s)
- Y Capodanno
- Laboratory of Fundamental Oncology, National Cancer Research Institute, Tokyo, 103-0045, Japan. .,Royal (Dick) School of Veterinary Studies and The Roslin Institute, University of Edinburgh, Edinburgh, EH25 9RG, UK.
| | - F O Buishand
- Royal (Dick) School of Veterinary Studies and The Roslin Institute, University of Edinburgh, Edinburgh, EH25 9RG, UK.,Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - L Y Pang
- Royal (Dick) School of Veterinary Studies and The Roslin Institute, University of Edinburgh, Edinburgh, EH25 9RG, UK
| | - J Kirpensteijn
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands.,Hill's Pet Nutrition, Topeka, KS, USA
| | - J A Mol
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - R Elders
- Royal (Dick) School of Veterinary Studies and The Roslin Institute, University of Edinburgh, Edinburgh, EH25 9RG, UK.,London Vet Specialists, 56 Belsize Lane, London, NW35AR, UK
| | - D J Argyle
- Royal (Dick) School of Veterinary Studies and The Roslin Institute, University of Edinburgh, Edinburgh, EH25 9RG, UK
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11
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Walczak R, Paek M, Uzzle M, Taylor J, Specchi S. Canine insulinomas appear hyperintense on MRI T2-weighted images and isointense on T1-weighted images. Vet Radiol Ultrasound 2019; 60:330-337. [PMID: 30654407 DOI: 10.1111/vru.12715] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 11/06/2018] [Accepted: 11/06/2018] [Indexed: 11/27/2022] Open
Abstract
Clinical and imaging diagnosis of canine insulinomas has proven difficult due to nonspecific clinical signs and the small size of these tumors. The aim of this retrospective case series study was to describe MRI findings in a group of dogs with pancreatic insulinomas. Included dogs were presented for suspected pancreatic insulinoma, MRI was used to assist with localization of the primary lesion, and the diagnosis was confirmed with surgical exploratory laparotomy and histopathology. The MRI studies for each dog were retrieved and the following data were recorded: T1-weighted and T2-weighted signal intensities, type of contrast enhancement, size and location of the primary lesion, and characteristics of metastatic lesions (if present). A total of four dogs were sampled. In all patients, the insulinoma displayed high-intensity signal on T2-weighted fat saturation images, similar to human studies. On postcontrast T1-weighted fat saturation images, the tumors were primarily isointense to normal pancreatic tissue, in contrast to human studies where a low-intensity signal is typically identified. Abnormal islet tissue was detected with MRI in all four dogs and metastases were identified in three dogs. Variations in the MRI appearance of primary and metastatic lesions were identified and could have been related to the variation of tissue composition, including the presence of neoplastic cells, hemorrhage, and fibrovascular stroma, and to the transformation of this tissue throughout the disease process.
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Affiliation(s)
- Raelyn Walczak
- Diagnostic Imaging, Gulf Coast Veterinary Specialists, Houston, TX, 77027
| | - Matthew Paek
- Department of Radiology, Synergy Veterinary Imaging Partners, Columbia, MD, 20129
| | - Matthew Uzzle
- Bush Advanced Veterinary Imaging, The Life Centre, Leesburg, VA, 20176
| | - Jim Taylor
- Veterinary Surgical Centers, The Life Centre, Leesburg, VA, 20176
| | - Swan Specchi
- Department of Clinical Sciences, Istituto Veterinario di Novara, Novara, 28060, Italy
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Buishand FO, Vilaplana Grosso FR, Kirpensteijn J, van Nimwegen SA. Utility of contrast-enhanced computed tomography in the evaluation of canine insulinoma location. Vet Q 2018; 38:53-62. [PMID: 29806550 PMCID: PMC6830984 DOI: 10.1080/01652176.2018.1481545] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Objectives: To determine 1) the sensitivity of contrast-enhanced CT (CECT) for detection of primary canine insulinomas and metastases 2) the sensitivity of CECT to locate canine insulinomas within the pancreas and 3) the CECT attenuation pattern of canine insulinomas and post-contrast phase in which insulinomas have the best visibility. Methods: A retrospective review was performed of the medical records of 27 canine insulinoma patients. Simultaneous occurrence of blood glucose < 3.5 mmol/L (reference interval: 4.2–5.8 mmol/L) and plasma insulin > 10 mIU/L (reference interval: 1.4–24.5 mIU/L) were considered diagnostic for insulinoma. The dogs had a mean age of 9.0 ± 1.7 (SD) years and comprised 11 males and 17 females. Results: Using CECT-scans, 26/27 insulinomas were successfully detected. However, CECT-scans predicted the correct location of insulinomas within the pancreas in only 14/27 dogs. In 9/13 inaccurately located insulinoma cases, the location error was major. There was no significant difference between triple, double and single-phase CECT-scans with location accuracies of 54%, 50% and 50%, respectively. Also, there was no specific post-contrast phase in which insulinomas could be visualised best. Detection of lymph node metastases with CECT-scans had a sensitivity of 67% (10/15 lymph node metastases). Detection of liver metastases had a sensitivity of 75% (6/8 liver metastases). This study highlights that major location errors mainly occurred if single- or double-phase CECT-scans were used (6/9 cases). Conclusion: It is suggested that triple-phase CECT-scans have superior outcome over single- or double-phase CECT-scans in pre-operative imaging of canine insulinomas.
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Affiliation(s)
- Floryne O Buishand
- a Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine , Utrecht University , Utrecht , The Netherlands
| | - Federico R Vilaplana Grosso
- a Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine , Utrecht University , Utrecht , The Netherlands.,b Department of Diagnostic Imaging, College of Veterinary Medicine , University of Florida , Gainesville , FL , USA
| | - Jolle Kirpensteijn
- a Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine , Utrecht University , Utrecht , The Netherlands.,c Global Veterinary and Professional Affairs, Hills Pet Nutrition , Topeka , KS , USA
| | - Sebastiaan A van Nimwegen
- a Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine , Utrecht University , Utrecht , The Netherlands
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13
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Capodanno Y, Buishand FO, Pang LY, Kirpensteijn J, Mol JA, Argyle DJ. Notch pathway inhibition targets chemoresistant insulinoma cancer stem cells. Endocr Relat Cancer 2018; 25:131-144. [PMID: 29175872 DOI: 10.1530/erc-17-0415] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 11/24/2017] [Indexed: 12/12/2022]
Abstract
Insulinomas (INS) are the most common neuroendocrine pancreatic tumours in humans and dogs. The long-term prognosis for malignant INS is still poor due to a low success rate of the current treatment modalities, particularly chemotherapy. A better understanding of the molecular processes underlying the development and progression of INS is required to develop novel targeted therapies. Cancer stem cells (CSCs) are thought to be critical for the engraftment and chemoresistance of many tumours, including INS. This study was aimed to characterise and target INS CSCs in order to develop novel targeted therapies. Highly invasive and tumourigenic human and canine INS CSC-like cells were successfully isolated. These cells expressed stem cell markers (OCT4, SOX9, SOX2, CD133 and CD34), exhibited greater resistance to 5-fluorouracil (5-FU) and demonstrated a more invasive and tumourigenic phenotype in vivo compared to bulk INS cells. Here, we demonstrated that Notch-signalling-related genes (NOTCH2 and HES1) were overexpressed in INS CSC-like cells. Protein analysis showed an active NOTCH2-HES1 signalling in INS cell lines, especially in cells resistant to 5-FU. Inhibition of the Notch pathway, using a gamma secretase inhibitor (GSI), enhanced the sensitivity of INS CSC-like cells to 5-FU. When used in combination GSI and 5-FU, the clonogenicity in vitro and the tumourigenicity in vivo of INS CSC-like cells were significantly reduced. These findings suggested that the combined strategy of Notch signalling inhibition and 5-FU synergistically attenuated enriched INS CSC populations, providing a rationale for future therapeutic exploitation.
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Affiliation(s)
- Y Capodanno
- Royal (Dick) School of Veterinary Studies and The Roslin InstituteUniversity of Edinburgh, Midlothian, UK
| | - F O Buishand
- Department of Clinical Sciences of Companion AnimalsFaculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - L Y Pang
- Royal (Dick) School of Veterinary Studies and The Roslin InstituteUniversity of Edinburgh, Midlothian, UK
| | | | - J A Mol
- Department of Clinical Sciences of Companion AnimalsFaculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - D J Argyle
- Royal (Dick) School of Veterinary Studies and The Roslin InstituteUniversity of Edinburgh, Midlothian, UK
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14
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Carvalho MI, Pires I, Prada J, Lobo L, Queiroga FL. Ki-67 and PCNA Expression in Canine Mammary Tumors and Adjacent Nonneoplastic Mammary Glands: Prognostic Impact by a Multivariate Survival Analysis. Vet Pathol 2016; 53:1138-1146. [PMID: 27162119 DOI: 10.1177/0300985816646429] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The assessment of tumor proliferation has been considered a determining prognostic factor in canine mammary tumors (CMTs). However, no studies have assessed the prognostic importance of proliferation in adjacent nonneoplastic mammary glands. We included 64 CMTs (21 benign and 43 malignant) and studied the proliferation index (PI) of Ki-67 and proliferating cell nuclear antigen (PCNA) together with several clinicopathological characteristics. A positive and statistically significant correlation between the PI of Ki-67 and PCNA in tumors and adjacent nonneoplastic mammary glands was observed in benign and malignant tumors. Tumor size, skin ulceration, histological type, mitotic index, nuclear grade, differentiation grade, histological grade of malignancy, lymph node metastasis, Ki-67, and PCNA expression in tumors and adjacent nonneoplastic mammary glands were statistically associated with overall survival by univariate analysis in malignant cases (n = 43). Histological grade of malignancy and high intratumoral PCNA retained their significance by multivariate analysis arising as independent predictors of overall survival. Interestingly, the PI of Ki-67 and PCNA of adjacent nontumoral mammary glands were associated with clinicopathological features of tumor aggressiveness and shorter overall survival, demonstrating the need to better explore this adjacent non-neoplastic tissue.
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Affiliation(s)
- M I Carvalho
- CECAV, University of Trás-os-Montes and Alto Douro, Vila Real, Portugal Department of Veterinary Sciences, University of Trás-os-Montes and Alto Douro, Vila Real, Portugal
| | - I Pires
- CECAV, University of Trás-os-Montes and Alto Douro, Vila Real, Portugal Department of Veterinary Sciences, University of Trás-os-Montes and Alto Douro, Vila Real, Portugal
| | - J Prada
- CECAV, University of Trás-os-Montes and Alto Douro, Vila Real, Portugal Department of Veterinary Sciences, University of Trás-os-Montes and Alto Douro, Vila Real, Portugal
| | - L Lobo
- Hospital Veterinário do Porto, Porto, Portugal Faculdade de Medicina Veterinária, Universidade Lusófona de Humanidades e Tecnologias, Lisboa, Portugal Center for the Study of Animal Sciences, CECA-ICETA, University of Porto, Porto, Portugal
| | - F L Queiroga
- Department of Veterinary Sciences, University of Trás-os-Montes and Alto Douro, Vila Real, Portugal Center for the Study of Animal Sciences, CECA-ICETA, University of Porto, Porto, Portugal Center for Research and Technology of Agro-Environment and Biological Sciences (CITAB), University of Trás-os-Montes and Alto Douro, Vila Real, Portugal
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15
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Immunohistochemical quantification of the cobalamin transport protein, cell surface receptor and Ki-67 in naturally occurring canine and feline malignant tumors and in adjacent normal tissues. Oncotarget 2016; 6:2331-48. [PMID: 25633912 PMCID: PMC4385855 DOI: 10.18632/oncotarget.3206] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 12/10/2015] [Indexed: 12/13/2022] Open
Abstract
Cancer cells have an obligate need for cobalamin (vitamin B12) to enable DNA synthesis necessary for cellular replication. This study quantified the immunohistochemical expression of the cobalamin transport protein (transcobalamin II; TCII), cell surface receptor (transcobalamin II-R; TCII-R) and proliferation protein (Ki-67) in naturally occurring canine and feline malignant tumors, and compared these results to expression in corresponding adjacent normal tissues. All malignant tumor tissues stained positively for TCII, TCII-R and Ki-67 proteins; expression varied both within and between tumor types. Expression of TCII, TCII-R and Ki-67 was significantly higher in malignant tumor tissues than in corresponding adjacent normal tissues in both species. There was a strong correlation between TCII and TCII-R expression, and a modest correlation between TCII-R and Ki-67 expression in both species; a modest association between TCII and Ki-67 expression was present in canine tissues only. These results demonstrate a quantifiable, synchronous up-regulation of TCII and TCII-R expression by proliferating canine and feline malignant tumors. The potential to utilize these proteins as biomarkers to identify neoplastic tissues, streamline therapeutic options, evaluate response to anti-tumor therapy and monitor for recurrent disease has important implications in the advancement of cancer management for both human and companion animal patients.
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16
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Fukushima K, Fujiwara R, Yamamoto K, Kanemoto H, Ohno K, Tsuboi M, Uchida K, Matsuki N, Nishimura R, Tsujimoto H. Characterization of triple-phase computed tomography in dogs with pancreatic insulinoma. J Vet Med Sci 2015; 77:1549-53. [PMID: 26118410 PMCID: PMC4710709 DOI: 10.1292/jvms.15-0077] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Little information is available regarding triple-phase computed tomography (CT) of canine
pancreatic insulinoma. A few case reports with small numbers of cases have indicated that
hyper-attenuation in the arterial phase was a common finding on multi-phasic CT in dogs
with insulinoma. Our purpose was to clarify the characteristic findings of dogs with
insulinoma on triple-phase CT. Nine dogs with insulinoma that underwent triple-phase CT
were included in the present study. Attenuation patterns in the arterial phase indicated
hypo-attenuation in 4 cases and hyper-attenuation in 2 cases. In the remaining 3 cases, 1
case showed hypo-attenuation and 1 case showed hyper-attenuation in the pancreatic phase,
and 1 case presented hyper-attenuation in the later phase. Altogether, 5 cases showed hypo
and 4 cases showed hyper-attenuation in at least one phase. The enhancement pattern was
homogenous in 7 cases and heterogeneous in 2 cases. Tumor margins were well-defined in 5
cases and ill-defined in 4 cases. Capsule formation was present in 5 cases and absent in 4
cases. In conclusion, it is important to note that hypo-attenuation was as common as
hyper-attenuation in dogs with insulinoma in triple-phase CT in at least one phase.
Additionally, mass lesions were most conspicuous not only in the arterial phase but in the
pancreatic and later phases in some cases. Therefore, it is important to perform
triple-phase CT and notice about variable findings for the detection of canine pancreatic
insulinoma.
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Affiliation(s)
- Kenjiro Fukushima
- Department of Veterinary Internal Medicine, Graduate School of Agricultural and Life Sciences, The University of Tokyo, 1-1-1 Yayoi, Bunkyo-ku, Tokyo 113-8657, Japan
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17
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Sabattini S, Bassi P, Bettini G. Histopathological findings and proliferative activity of canine sebaceous gland tumours with a predominant reserve cell population. J Comp Pathol 2015; 152:145-52. [PMID: 25678426 DOI: 10.1016/j.jcpa.2014.12.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Revised: 10/29/2014] [Accepted: 12/18/2014] [Indexed: 11/16/2022]
Abstract
Sebaceous gland tumours represent the third most common skin tumours in dogs, but diagnostic criteria for tumours with basal differentiation (i.e. sebaceous epithelioma) are poorly defined and there is lack of correlation with biological behaviour. The aim of this study was to identify the main histological criteria associated with malignancy in 30 canine sebaceous gland tumours with a predominant reserve cell population. For each case, tumour proliferative activity was assessed by determining mitotic index and the Ki67/MIB-1 index. Additional histological features included endophytic or exophytic growth, proportion of reserve/intermediate/mature cells, connection to the epidermis, nuclear characteristics, peripheral invasion, neoplastic emboli and necrosis. Mitotic and Ki67 indexes were variable, but correlated (R = 0.66; P < 0.001), and both were significantly higher in infiltrative tumours (P = 0.018 and P < 0.001, respectively). No significant difference in histological features was observed between tumours comprised of more or less than 90% reserve cells, nor among tumours showing proliferative activity in sebocytes. This study suggests that high proliferative activity and peripheral invasion should be considered the most significant parameters for the differentiation between benign and malignant sebaceous gland tumours. Furthermore, the incidence of circumanal gland and testicular tumours in these dogs was significantly higher compared with an age-matched control population, suggesting a potential androgen-related pathway for the tumourigenesis of canine sebaceous gland neoplasms.
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Affiliation(s)
- S Sabattini
- Department of Veterinary Medical Sciences, University of Bologna, Bologna, Italy
| | - P Bassi
- Department of Veterinary Medical Sciences, University of Bologna, Bologna, Italy
| | - G Bettini
- Department of Veterinary Medical Sciences, University of Bologna, Bologna, Italy.
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18
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Buishand FO, Visser J, Kik M, Gröne A, Keesler RI, Briaire-de Bruijn IH, Kirpensteijn J. Evaluation of prognostic indicators using validated canine insulinoma tissue microarrays. Vet J 2014; 201:57-63. [DOI: 10.1016/j.tvjl.2014.05.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 04/15/2014] [Accepted: 05/01/2014] [Indexed: 01/28/2023]
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Buishand FO, Kirpensteijn J, Jaarsma AA, Speel EJM, Kik M, Mol JA. Gene expression profiling of primary canine insulinomas and their metastases. Vet J 2013; 197:192-7. [DOI: 10.1016/j.tvjl.2013.01.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Revised: 01/18/2013] [Accepted: 01/20/2013] [Indexed: 10/27/2022]
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Northrup N, Rassnick K, Gieger T, Kosarek C, McFadden C, Rosenberg M. Prospective Evaluation of Biweekly Streptozotocin in 19 Dogs with Insulinoma. J Vet Intern Med 2013; 27:483-90. [DOI: 10.1111/jvim.12086] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Revised: 12/27/2012] [Accepted: 03/07/2013] [Indexed: 12/21/2022] Open
Affiliation(s)
- N.C. Northrup
- Department of Small Animal Medicine and Surgery; University of Georgia; College of Veterinary Medicine; Athens GA
| | - K.M. Rassnick
- Department of Clinical Sciences; Cornell University; College of Veterinary Medicine; Ithaca NY
| | - T.L. Gieger
- Department of Small Animal Medicine and Surgery; University of Georgia; College of Veterinary Medicine; Athens GA
| | - C.E. Kosarek
- Department of Small Animal Medicine and Surgery; University of Georgia; College of Veterinary Medicine; Athens GA
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Buishand FO, van Erp MG, Groenveld HA, Mol JA, Kik M, Robben JH, Kooistra HS, Kirpensteijn J. Expression of insulin-like growth factor-1 by canine insulinomas and their metastases. Vet J 2012; 191:334-40. [DOI: 10.1016/j.tvjl.2011.03.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2010] [Revised: 12/17/2010] [Accepted: 03/16/2011] [Indexed: 12/22/2022]
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Wouters EGH, Buishand FO, Kik M, Kirpensteijn J. Use of a bipolar vessel-sealing device in resection of canine insulinoma. J Small Anim Pract 2011; 52:139-45. [DOI: 10.1111/j.1748-5827.2011.01040.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Mobasheri A, Cassidy JP. Biomarkers in veterinary medicine: Towards targeted, individualised therapies for companion animals. Vet J 2010; 185:1-3. [PMID: 20541693 DOI: 10.1016/j.tvjl.2010.04.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Ali Mobasheri
- School of Veterinary Medicine and Science, Faculty of Medicine and Health Sciences, University of Nottingham, Sutton Bonington Campus, Leicestershire, UK.
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