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Leduc L, Leclère M, Lavoie JP. Towards personalized medicine for the treatment of equine asthma. Vet J 2024; 305:106125. [PMID: 38704018 DOI: 10.1016/j.tvjl.2024.106125] [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: 02/20/2024] [Revised: 04/22/2024] [Accepted: 04/26/2024] [Indexed: 05/06/2024]
Abstract
Although horses with asthma share similar clinical signs, the heterogeneity of the disease in terms of severity, triggering factors, inflammatory profile, and pathological features has hindered our ability to define biologically distinct subgroups. The recognition of phenotypes and endotypes could enable the development of precision medicine, including personalized, targeted therapy, to benefit affected horses. While in its infancy in horses, this review outlines the phenotypes of equine asthma and discusses how knowledge gained from targeted therapy in human medicine can be applied to evaluate the potential opportunities for personalized medicine in equine asthma and to suggest avenues for research to advance this emerging field.
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Affiliation(s)
- Laurence Leduc
- Department of Clinical Sciences, Faculté de Médecine Vétérinaire, Université de Montréal, St-Hyacinthe, QC J2S 2M2, Canada
| | - Mathilde Leclère
- Department of Clinical Sciences, Faculté de Médecine Vétérinaire, Université de Montréal, St-Hyacinthe, QC J2S 2M2, Canada
| | - Jean-Pierre Lavoie
- Department of Clinical Sciences, Faculté de Médecine Vétérinaire, Université de Montréal, St-Hyacinthe, QC J2S 2M2, Canada.
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2
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Johns I. Not lame? What next? 'Other' causes of a poor performance in sports horses. Equine Vet J 2024; 56:383-385. [PMID: 38578101 DOI: 10.1111/evj.14068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 01/11/2024] [Indexed: 04/06/2024]
Affiliation(s)
- Imogen Johns
- B&W Equine Hospital, Berkeley, Gloucestershire, UK
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3
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Simões J, Tilley P. Decision Making in Severe Equine Asthma-Diagnosis and Monitoring. Animals (Basel) 2023; 13:3872. [PMID: 38136909 PMCID: PMC10740644 DOI: 10.3390/ani13243872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 11/22/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023] Open
Abstract
Decision making consists of gathering quality data in order to correctly assess a situation and determine the best course of action. This process is a fundamental part of medicine and is what enables practitioners to accurately diagnose diseases and select appropriate treatment protocols. Despite severe equine asthma (SEA) being a highly prevalent lower respiratory disease amongst equids, clinicians still struggle with the optimization of routine diagnostic procedures. The use of several ancillary diagnostic tests has been reported for disease identification and monitoring, but many are only suitable for research purposes or lack practicality for everyday use. The aim of this paper is to assist the equine veterinarian in the process of decision making associated with managing SEA-affected patients. This review will focus on disease diagnosis and monitoring, while also presenting a flow-chart which includes the basic data that the clinician must obtain in order to accurately identify severely asthmatic horses in their everyday routine practice. It is important to note that European and American board-certified specialists on equine internal medicine can provide assistance in the diagnosis and treatment plan of SEA-affected horses.
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Affiliation(s)
- Joana Simões
- Equine Health and Welfare Academic Division, Faculty of Veterinary Medicine, Lusófona University, Campo Grande 376, 1749-024 Lisbon, Portugal
- CIISA-Centre for Interdisciplinary Research in Animal Health, Faculty of Veterinary Medicine, University of Lisbon, 1300-477 Lisbon, Portugal;
- Associate Laboratory for Animal and Veterinary Sciences (AL4Animals), Faculty of Veterinary Medicine, University of Lisbon, 1300-477 Lisbon, Portugal
| | - Paula Tilley
- CIISA-Centre for Interdisciplinary Research in Animal Health, Faculty of Veterinary Medicine, University of Lisbon, 1300-477 Lisbon, Portugal;
- Associate Laboratory for Animal and Veterinary Sciences (AL4Animals), Faculty of Veterinary Medicine, University of Lisbon, 1300-477 Lisbon, Portugal
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Page AE, Johnson M, Parker JL, Jacob O, Swan M, Adam E. The Effect of Inhaled Ciclesonide Treatment on Systemic Markers of Immune Function in Horses. J Equine Vet Sci 2023; 130:104925. [PMID: 37717678 DOI: 10.1016/j.jevs.2023.104925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 09/06/2023] [Accepted: 09/10/2023] [Indexed: 09/19/2023]
Abstract
The use of dexamethasone to control equine asthma is a common and effective treatment. Although short-term systemic dexamethasone treatment has not been shown to induce systemic immunosuppression in the horse, the goal of this study was to determine whether inhaled ciclesonide, an FDA-approved drug for the treatment of equine asthma, exerts any systemic immunosuppressive effects when compared to dexamethasone-treated and untreated horses. Eighteen light, mixed breed horses, ranging in age from 3 to 8 years of age, were used for this study and randomly assigned to one of three treatment groups: (1) nontreated controls, (2) ciclesonide treatment, or (3) dexamethasone treatment. Blood was collected daily for steady-state messenger RNA (mRNA) analysis, as well as at Days 0, 5, 10, and 15 of treatment for in vitro stimulation with Concanavalin A (ConA). Messenger RNA relative quantities were determined using RT-qPCR for select genes. Two-way, repeated measures analysis of variance was used to analyze qPCR data and results considered significant at P < .05. There were significant decreases in the steady-state, whole-blood expression of granzyme B and interferon-γ due to dexamethasone treatment, when compared to the nontreated control group. Within ConA-stimulated samples, there remained a suppressive effect of dexamethasone treatment on granzyme B expression compared to nontreated control horses. Similar effects were not noted in the ciclesonide-treated horses. Significant effects of ciclesonide treatment on markers of immune function were not noted in this study, suggesting a low risk for immunosuppression with inhaled ciclesonide treatment.
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Affiliation(s)
- Allen E Page
- University of Kentucky Maxwell H. Gluck Equine Research Center, Lexington, KY.
| | - Mackenzie Johnson
- University of Kentucky Maxwell H. Gluck Equine Research Center, Lexington, KY
| | - Jordan L Parker
- University of Kentucky Maxwell H. Gluck Equine Research Center, Lexington, KY
| | - Olivia Jacob
- University of Kentucky Maxwell H. Gluck Equine Research Center, Lexington, KY
| | - Melissa Swan
- University of Kentucky Veterinary Diagnostic Laboratory, Lexington, KY
| | - Emma Adam
- University of Kentucky Maxwell H. Gluck Equine Research Center, Lexington, KY
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Frippiat T, Art T, Tosi I. Airway Hyperresponsiveness, but Not Bronchoalveolar Inflammatory Cytokines Profiles, Is Modified at the Subclinical Onset of Severe Equine Asthma. Animals (Basel) 2023; 13:2485. [PMID: 37570294 PMCID: PMC10417247 DOI: 10.3390/ani13152485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 07/25/2023] [Accepted: 07/30/2023] [Indexed: 08/13/2023] Open
Abstract
Airway hyperresponsiveness (AHR) and inflammation are both observed in human and equine asthma. The aim of this study was to assess the timeline and relationship of both features at the subclinical onset of severe equine asthma (SEA). First, the repeatability of the pulmonary function test (PFT) using impulse oscillometry system, and the methacholine bronchoprovocation test (BPT) were assessed at a 1-day interval on six SEA horses in clinical remission and six control horses. Then, clinical and ancillary tests were performed before and after a 1-week low-dust environmental challenge, including weighted clinical score, respiratory endoscopy, bronchoalveolar fluid cytology, PFT, and BPT. Both PFT and BPT showed acceptable repeatability. No test allowed SEA horses in clinical remission to be distinguished from control, unlike in human patients. Because of the low-dust environment, no significant difference was observed in the results of clinical and conventional ancillary examinations after the challenge. However, SEA horses showed increased AHR after the environmental challenge. At that stage, no signs of inflammation or changes in pro-inflammatory cytokines profiles (quantification and gene expression) were observed, suggesting AHR is present at an earlier stage of equine asthma than airway inflammation. This feature indicates SEA could present in a different disease pathway than neutrophilic human asthma.
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Affiliation(s)
- Thibault Frippiat
- Equine Sports Medicine Centre, FARAH Research Centre, Faculty of Veterinary Medicine, University of Liège, 4000 Liege, Belgium
- Sportpaardenarts–Equine Sports Medicine, 1250AD Laren, The Netherlands
| | - Tatiana Art
- Equine Sports Medicine Centre, FARAH Research Centre, Faculty of Veterinary Medicine, University of Liège, 4000 Liege, Belgium
| | - Irene Tosi
- Equine Sports Medicine Centre, FARAH Research Centre, Faculty of Veterinary Medicine, University of Liège, 4000 Liege, Belgium
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Song Y, Day CM, Afinjuomo F, Tan JQE, Page SW, Garg S. Advanced Strategies of Drug Delivery via Oral, Topical, and Parenteral Administration Routes: Where Do Equine Medications Stand? Pharmaceutics 2023; 15:pharmaceutics15010186. [PMID: 36678815 PMCID: PMC9861747 DOI: 10.3390/pharmaceutics15010186] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 12/23/2022] [Accepted: 12/29/2022] [Indexed: 01/06/2023] Open
Abstract
While the global market for veterinary products has been expanding rapidly, there is still a lack of specialist knowledge of equine pharmaceutics. In many cases, the basic structure of the gastrointestinal tract (GIT) and integumentary system of the horse shares similarities with those of humans. Generally, the dosage form developed for humans can be repurposed to deliver equine medications; however, due to physiological variation, the therapeutic outcomes can be unpredictable. This is an area that requires more research, as there is a clear deficiency in literature precedence on drug delivery specifically for horses. Through a careful evaluation of equine anatomy and physiology, novel drug delivery systems (NDDSs) can be developed to adequately address many of the medical ailments of the horse. In addition to this, there are key considerations when delivering oral, topical, and parenteral drugs to horses, deriving from age and species variation. More importantly, NDDSs can enhance the duration of action of active drugs in animals, significantly improving owner compliance; and ultimately, enhancing the convenience of product administration. To address the knowledge gap in equine pharmaceutical formulations, this paper begins with a summary of the anatomy and physiology of the equine gastrointestinal, integumentary, and circulatory systems. A detailed discussion of potential dosage-form related issues affecting horses, and how they can be overcome by employing NDDSs is presented.
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Affiliation(s)
- Yunmei Song
- Centre for Pharmaceutical Innovation (CPI), Clinical and Health Sciences, University of South Australia, Adelaide, SA 5000, Australia
| | - Candace M. Day
- Centre for Pharmaceutical Innovation (CPI), Clinical and Health Sciences, University of South Australia, Adelaide, SA 5000, Australia
| | - Franklin Afinjuomo
- Centre for Pharmaceutical Innovation (CPI), Clinical and Health Sciences, University of South Australia, Adelaide, SA 5000, Australia
| | - Jin-Quan E. Tan
- SA Pharmacy, Flinders Medical Centre, Southern Adelaide Local Health Network, Adelaide, SA 5042, Australia
| | - Stephen W. Page
- Advanced Veterinary Therapeutics, Newtown, NSW 2042, Australia
| | - Sanjay Garg
- Centre for Pharmaceutical Innovation (CPI), Clinical and Health Sciences, University of South Australia, Adelaide, SA 5000, Australia
- Correspondence: ; Tel.: +61-8-8302-1575
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Wyler M, Sage SE, Marti E, White S, Gerber V. Protein microarray allergen profiling in bronchoalveolar lavage fluid and serum of horses with asthma. J Vet Intern Med 2022; 37:328-337. [PMID: 36479920 PMCID: PMC9889601 DOI: 10.1111/jvim.16600] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 11/16/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The diagnostic value of allergen-specific immunoglobulin E (IgE) in horses with asthma is uncertain. A recently developed protein microarray detected abnormally high latex-specific IgE concentrations in the serum of horses with severe asthma. OBJECTIVES The main objective was to characterize the IgE profiles of asthmatic horses in Switzerland using a protein microarray platform in serum and bronchoalveolar lavage fluid (BALF). The secondary objective was to determine whether serological and BALF allergen-specific IgE concentrations correlated. ANIMALS Forty-four asthmatic and 39 control horses ≥5 years of age. METHODS This prospective cross-sectional study investigated the sensitization profiles of horses with asthma compared with environmentally matched healthy controls. Both serum and BALF were analyzed using the protein microarray. Partial least square-discriminant analysis (PLS-DA) was used to identify and rank the importance of the allergens for class detection (ie, asthma vs control), with a variable influence on the projection (VIP) >1 considered significant. RESULTS The allergens that best discriminated (VIP >1) asthmatic horses from controls were proteins derived from fungi (Aspergillus fumigatus), insects (Culicoides spp.), and latex (Hevea brasiliensis). The serological model predictive ability was markedly inferior (area under the curve [AUC] 0.585, 95% confidence interval [CI]: 0.454-0.747) to that of the BALF (AUC 0.751, 95% CI: 0.582-0.866). The two models shared nine allergens, of which eight showed significant weak to moderate correlations. CONCLUSION AND CLINICAL IMPORTANCE The concentrations of several allergen-specific IgE were higher in asthmatic horses. The protein microarray performed better on BALF than serum for detection of asthma. Serological IgE concentrations do not closely correlate with BALF concentrations and should be interpreted with caution.
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Affiliation(s)
- Michelle Wyler
- Swiss Institute of Equine Medicine (ISME), Department of Clinical Veterinary Medicine, Vetsuisse FacultyUniversity of BernBernSwitzerland
| | - Sophie Elena Sage
- Swiss Institute of Equine Medicine (ISME), Department of Clinical Veterinary Medicine, Vetsuisse FacultyUniversity of BernBernSwitzerland
| | - Eliane Marti
- Department of Clinical Research and Veterinary Public HealthUniversity of BernBernSwitzerland
| | - Samuel White
- Department of Animal, Equine and Veterinary SciencesNottingham Trent UniversityNottinghamshireUK
| | - Vinzenz Gerber
- Swiss Institute of Equine Medicine (ISME), Department of Clinical Veterinary Medicine, Vetsuisse FacultyUniversity of BernBernSwitzerland
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Klier J, Fuchs S, Winter G, Gehlen H. Inhalative Nanoparticulate CpG Immunotherapy in Severe Equine Asthma: An Innovative Therapeutic Concept and Potential Animal Model for Human Asthma Treatment. Animals (Basel) 2022; 12:ani12162087. [PMID: 36009677 PMCID: PMC9405334 DOI: 10.3390/ani12162087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/26/2022] [Accepted: 08/09/2022] [Indexed: 11/24/2022] Open
Abstract
Simple Summary Severe equine asthma is the most common globally widespread non-infectious equine respiratory disease (together with its mild and moderate form), which is associated with exposure to hay dust and mold spores, has certain similarities to human asthma, and continues to represent a therapeutic problem. Immunomodulatory DNA sequences (CpG) bound to nanoparticles were successfully administered by inhalation to severe asthmatic horses in several studies. It was possible to demonstrate a significant, sustained, one-to-eight-week improvement in important clinical parameters: partial oxygen pressure in the blood, quantity and viscosity of tracheal mucus secretion in the airways, and the amount of inflammatory cells in the respiratory tracts of severe asthmatic horses. The immunotherapy with CpG is performed independent of specific allergens. At an immunological level, the treatment leads to decreases in allergic and inflammatory parameters. This innovative therapeutic concept thus opens new perspectives in severe equine asthma treatment and possibly also in human asthma treatment. Abstract Severe equine asthma is the most common globally widespread non-infectious equine respiratory disease (together with its mild and moderate form), which is associated with exposure to hay dust and mold spores, has certain similarities to human asthma, and continues to represent a therapeutic problem. Immunomodulatory CpG-ODN, bound to gelatin nanoparticles as a drug delivery system, were successfully administered by inhalation to severe equine asthmatic patients in several studies. It was possible to demonstrate a significant, sustained, and allergen-independent one-to-eight-week improvement in key clinical parameters: the arterial partial pressure of oxygen, the quantity and viscosity of tracheal mucus, and neutrophilic inflammatory cells in the respiratory tracts of the severe equine asthmatic subjects. At the immunological level, an upregulation of the regulatory antiallergic and anti-inflammatory cytokine IL-10 as well as a downregulation of the proallergic IL-4 and proinflammatory IFN-γ in the respiratory tracts of the severe equine asthmatic patients were identified in the treatment groups. CD4+ T lymphocytes in the respiratory tracts of the asthmatic horses were demonstrated to downregulate the mRNA expression of Tbet and IL-8. Concentrations of matrix metalloproteinase-2 and -9 and tissue inhibitors of metalloproteinase-2 were significantly decreased directly after the treatment as well as six weeks post-treatment. This innovative therapeutic concept thus opens new perspectives in the treatment of severe equine asthma and possibly also that of human asthma.
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Affiliation(s)
- John Klier
- Equine Clinic, Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-University, 85764 Oberschleißheim, Germany
| | - Sebastian Fuchs
- Pharmaceutical Technology and Biopharmaceutics, Faculty of Chemistry and Pharmacy, Ludwig-Maximilians-University, 81377 Munich, Germany
| | - Gerhard Winter
- Pharmaceutical Technology and Biopharmaceutics, Faculty of Chemistry and Pharmacy, Ludwig-Maximilians-University, 81377 Munich, Germany
| | - Heidrun Gehlen
- Equine Clinic, Surgery and Radiology, Department of Veterinary Medicine, Free University of Berlin, 14163 Berlin, Germany
- Correspondence: ; Tel.: +49-30-838-62299; Fax: +49-30-838-4-62529
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Trevisiol S, Moulard Y, Kaabia Z, Delcourt V, Loup B, Garcia P, Boyer S, Dauriac K, Groseille G, Rouger S, Narbe R, Popot MA, Bailly-Chouriberry L. LC-HRMS/MS study of the prodrug ciclesonide and its active metabolite desisobutyryl-ciclesonide in plasma after an inhalative administration to horses for doping control purposes. Drug Test Anal 2021; 14:252-261. [PMID: 34634175 DOI: 10.1002/dta.3174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 09/14/2021] [Accepted: 09/28/2021] [Indexed: 11/11/2022]
Abstract
Ciclesonide (CIC) is the first inhaled highly potent corticosteroid that does not cause any cortisol suppression. It has been developed for the treatment of asthma in human and more recently in equine. CIC is the active compound of Aservo® EquiHaler® (Boehringer Ingelheim Vetmedica GmbH), the pre-filled inhaler generating a medicated mist based on Soft Mist™ technology. This prodrug is rapidly converted to desisobutyryl-ciclesonide (des-CIC), the main pharmacologically active compound. Due to its anti-inflammatory properties, CIC is prohibited for use in horse competitions. To set up an appropriate control, the determination of detection times and screening limits are required. Therefore, a highly sensitive analytical method based on supported liquid extraction (SLE) combined with liquid chromatography-high resolution tandem mass spectrometry (LC-HRMS/MS) was developed to detect CIC and its active metabolite des-CIC in plasma. The lower limit of detection of CIC and des-CIC was approximately 1 pg/ml in plasma. After a pilot study conducted on a single horse at the recommended dose (eight actuations twice daily corresponding to 5.5 mg/day for the first 5 days, followed by 12 actuations once daily corresponding to 4.1 mg/day in the last 5 days), the same protocol was applied in the main study using six horses. In all horses, CIC and des-CIC levels were less than 5 and 10 pg/ml, respectively, at 36 h after the end of the administration. The outcome of this risk assessment study should be useful to draw any recommendations for horse competitions.
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Affiliation(s)
- Stéphane Trevisiol
- GIE-LCH, Laboratoire des Courses Hippiques, Verrières-le-Buisson, France
| | - Yves Moulard
- GIE-LCH, Laboratoire des Courses Hippiques, Verrières-le-Buisson, France
| | - Zied Kaabia
- GIE-LCH, Laboratoire des Courses Hippiques, Verrières-le-Buisson, France
| | - Vivian Delcourt
- GIE-LCH, Laboratoire des Courses Hippiques, Verrières-le-Buisson, France
| | - Benoit Loup
- GIE-LCH, Laboratoire des Courses Hippiques, Verrières-le-Buisson, France
| | - Patrice Garcia
- GIE-LCH, Laboratoire des Courses Hippiques, Verrières-le-Buisson, France
| | - Sophie Boyer
- GIE-LCH, Laboratoire des Courses Hippiques, Verrières-le-Buisson, France
| | - Karine Dauriac
- GIE-LCH, Laboratoire des Courses Hippiques, Verrières-le-Buisson, France
| | | | - Sébastien Rouger
- GIE-LCH, Laboratoire des Courses Hippiques, Verrières-le-Buisson, France
| | - Ruediger Narbe
- Boehringer Ingelheim Vetmedica GmbH, Ingelheim am Rhein, Germany
| | - Marie-Agnès Popot
- GIE-LCH, Laboratoire des Courses Hippiques, Verrières-le-Buisson, France
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Wright S. Highlights of recent clinically relevant papers. EQUINE VET EDUC 2021. [DOI: 10.1111/eve.13497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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