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Cain CL, White E, Citron LE, Zheng Q, Morris DO, Grice EA, Bradley CW. Longitudinal evaluation of the cutaneous and rectal microbiota of German shepherd dogs with perianal fistulas undergoing therapy with ciclosporin and ketoconazole. Vet Dermatol 2024; 35:375-385. [PMID: 38616572 DOI: 10.1111/vde.13249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/18/2024] [Accepted: 03/27/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND Perianal fistulas are painful ulcers or sinus tracts that disproportionately affect German shepherd dogs and are proposed as a spontaneous animal model of fistulising Crohn's disease. OBJECTIVES To characterise the rectal and cutaneous microbiota in German shepherd dogs with perianal fistulas and to investigate longitudinal shifts with lesion resolution during immunomodulatory therapy. ANIMALS Eleven German shepherd dogs with perianal fistulas and 15 healthy German shepherd dogs. MATERIALS AND METHODS Affected dogs were evaluated and swabbed at three visits, 30 days apart, while undergoing treatment with ciclosporin and ketoconazole. Healthy German shepherd dogs were contemporaneously sampled. Sites included the rectum, perianal skin and axilla. The microbiome was evaluated following sequencing of the V4 hypervariable region of the 16S ribosomal RNA (rRNA) gene. RESULTS Alpha diversity was not significantly different between healthy and affected dogs at each of the three body sites (p > 0.5), yet rectal and perianal beta diversities from affected dogs differed significantly from those of healthy dogs at Day 0 (p = 0.004). Rectal and perianal relative abundance of Prevotella spp. increased and perianal Staphylococcus spp. relative abundance decreased in affected dogs over time, coincident with lesion resolution. CONCLUSIONS AND CLINICAL RELEVANCE Changes in lesional cutaneous and rectal microbiota occur in German shepherd dogs with perianal fistulas and shift over time with lesion resolution during immunomodulatory therapy. Further investigations of the role of cutaneous and enteric microbiota in the pathogenesis of perianal fistulas, and whether manipulation of microbial populations may ameliorate disease, are needed.
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Affiliation(s)
- Christine L Cain
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ellen White
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lindsey E Citron
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Qi Zheng
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Daniel O Morris
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Elizabeth A Grice
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Charles W Bradley
- Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Ford KR, Anderson JG, Stapleton BL, Murphy BG, Kumar TKS, Archer T, Mackin AJ, Wills RW. Medical Management of Canine Chronic Ulcerative Stomatitis Using Cyclosporine and Metronidazole. J Vet Dent 2023; 40:109-124. [PMID: 36650996 DOI: 10.1177/08987564221148755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Canine chronic ulcerative stomatitis (CCUS) is a spontaneously occurring, painful, and often debilitating condition of the oral cavity, with a suspected immune-mediated component. The response to pharmacological treatment is generally poor, thus the need to identify more effective medical therapies for this condition. This article describes a prospective clinical trial that was designed to evaluate the efficiency of a combination of cyclosporine and metronidazole in managing CCUS. The hypothesis was that a combination of cyclosporine and metronidazole would effectively minimize clinical signs associated with CCUS. Ten client-owned dogs with a biopsy-confirmed diagnosis consistent with CCUS were prescribed cyclosporine (5 mg/kg) for 1 week, followed by the addition of metronidazole (15-20 mg/kg), both administered orally once daily. The cyclosporine dosage interval was lengthened over time. Dogs were observed for a 6-month period and evaluated using a 32-point Canine Ulcerative Stomatitis Disease Activity Index (CUSDAI). Regular cyclosporine therapeutic drug monitoring was also conducted by the measurement of whole blood cyclosporine levels and the pharmacodynamic assessment of the T-cell expression of IL-2. The results demonstrated that a combination of cyclosporine and metronidazole was effective in minimizing the clinical signs of CCUS and in reducing CUSDAI scores. Neither blood cyclosporine levels nor the T-cell expression of IL-2 predicted improvement in clinical signs and CUSDAI scores, although there was a correlation between blood drug concentrations and the suppression of T-cell IL-2 expression. The evaluation of clinical signs and CUSDAI scores appears to be the most effective means of assessing response to therapy, and therapeutic drug level monitoring does not appear to be routinely indicated.
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Affiliation(s)
| | | | | | - Brian G Murphy
- Department of Pathology, Microbiology and Immunology, School of Veterinary Medicine, 8789University of California Davis, Davis, CA, USA
| | - T K Santosh Kumar
- Department of Clinical Sciences, College of Veterinary Medicine, 5547Mississippi State University, Mississippi, USA
| | - Todd Archer
- Department of Clinical Sciences, College of Veterinary Medicine, 5547Mississippi State University, Mississippi, USA
| | - Andrew J Mackin
- Department of Clinical Sciences, College of Veterinary Medicine, 5547Mississippi State University, Mississippi, USA
| | - Robert W Wills
- Department of Basic Sciences, College of Veterinary Medicine, 5547Mississippi State University, Mississippi, USA
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The Intersection of Human and Veterinary Medicine-A Possible Direction towards the Improvement of Cell Therapy Protocols in the Treatment of Perianal Fistulas. Int J Mol Sci 2022; 23:ijms232213917. [PMID: 36430390 PMCID: PMC9696944 DOI: 10.3390/ijms232213917] [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: 09/16/2022] [Revised: 10/31/2022] [Accepted: 11/08/2022] [Indexed: 11/16/2022] Open
Abstract
The effective treatment of perianal fistulizing Crohn's disease is still a challenge. Local administration of mesenchymal stromal cells (MSCs) is becoming a part of accepted treatment options. However, as a fledgling technique, it still can be optimized. A new trend in translational research, which is in line with "One Health" approach, bases on exploiting parallels between naturally occurring diseases affecting humans and companion animals. Canine anal furunculosis (AF) has been indicated as condition analogous to human perianal Crohn's disease (pCD). This narrative review provides the first comprehensive comparative analysis of these two diseases based on the published data. The paper also outlines the molecular mechanisms of action of MSCs which are likely to have a role in modulating the perianal fistula niche in humans, and refers them to the current knowledge on the immunomodulatory properties of canine MSCs. Generally, the pathogenesis of both diseases shares main determinants such as the presence of genetic predispositions, dysregulation of immune response and the relation to intestine microbiota. However, we also identified many aspects which should be further specified, such as determining the frequency of true fistulas formation in AF patients, elucidating the role of TNF and Th17 pathway in the pathogenesis of AF, or clarifying the role of epithelial-to-mesenchymal transition phenomenon in the formation of canine fistulae. Nevertheless, the available data support the hypothesis that the results from testing cell therapies in dogs with anal furunculosis have a significant translational value in optimizing MSC transplants procedures in pCD patients.
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Glucocorticoids, Cyclosporine, Azathioprine, Chlorambucil, and Mycophenolate in Dogs and Cats. Vet Clin North Am Small Anim Pract 2022; 52:797-817. [DOI: 10.1016/j.cvsm.2022.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Maldonado-Contreras A, Ferrer L, Cawley C, Crain S, Bhattarai S, Toscano J, Ward DV, Hoffman A. Dysbiosis in a canine model of human fistulizing Crohn's disease. Gut Microbes 2020; 12:1785246. [PMID: 32730134 PMCID: PMC7524328 DOI: 10.1080/19490976.2020.1785246] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Crohn's disease (CD) is a chronic immune-mediated inflammatory condition caused by the loss of mucosal tolerance toward the commensal microbiota. On average, 29.5% and 42.7% CD patients experience perianal complications at 10 and 20 y after diagnosis, respectively. Perianal CD (pCD) result in high disease burden, diminished quality of life, and elevated health-care costs. Overall pCD are predictors of poor long-term outcomes. Animal models of gut inflammation have failed to fully recapitulate the human manifestations of fistulizing CD. Here, we evaluated dogs with spontaneous canine anal furunculosis (CAF), a disease with clinical similarities to pCD, as a surrogate model for understanding the microbial contribution of human pCD pathophysiology. By comparing the gut microbiomes between dogs suffering from CAF (CAF dogs) and healthy dogs, we show CAF-dog microbiomes are either very dissimilar (dysbiotic) or similar (healthy-like), yet unique, to healthy dog's microbiomes. Compared to healthy or healthy-like CAF microbiomes, dysbiotic CAF microbiomes showed an increased abundance of Bacteroides vulgatus and Escherichia coli and a decreased abundance of Megamonas species and Prevotella copri. Our results mirror what have been reported in previous microbiome studies of patients with CD; particularly, CAF dogs exhibited two distinct microbiome composition: dysbiotic and healthy-like, with determinant bacterial taxa such as E. coli and P. copri that overlap what it has been found on their human counterpart. Thus, our results support the use of CAF dogs as a surrogate model to advance our understanding of microbial dynamics in pCD.
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Affiliation(s)
- Ana Maldonado-Contreras
- Department of Microbiology and Physiological Systems, University of Massachusetts Medical School, Worcester, MA, USA,CONTACT Ana Maldonado-Contreras Department of Microbiology and Physiological Systems, University of Massachusetts Medical School, Worcester, MA, 01655, USA
| | - Lluís Ferrer
- Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA, USA
| | - Caitlin Cawley
- Department of Microbiology and Physiological Systems, University of Massachusetts Medical School, Worcester, MA, USA
| | - Sarah Crain
- Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA, USA
| | - Shakti Bhattarai
- Department of Microbiology and Physiological Systems, University of Massachusetts Medical School, Worcester, MA, USA
| | - Juan Toscano
- Department of Microbiology and Physiological Systems, University of Massachusetts Medical School, Worcester, MA, USA
| | - Doyle V. Ward
- Department of Microbiology and Physiological Systems, University of Massachusetts Medical School, Worcester, MA, USA
| | - Andrew Hoffman
- Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA, USA
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Kang MH, Park HM. Challenges of stem cell therapies in companion animal practice. J Vet Sci 2020; 21:e42. [PMID: 32476316 PMCID: PMC7263915 DOI: 10.4142/jvs.2020.21.e42] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 03/15/2020] [Accepted: 03/17/2020] [Indexed: 12/13/2022] Open
Abstract
Regenerative medicine using stem cells from various sources are emerging treatment modality in several refractory diseases in veterinary medicine. It is well-known that stem cells can differentiate into specific cell types, self-renew, and regenerate. In addition, the unique immunomodulatory effects of stem cells have made stem cell transplantation a promising option for treating a wide range of disease and injuries. Recently, the medical demands for companion animals have been rapidly increasing, and certain disease conditions require alternative treatment options. In this review, we focused on stem cell application research in companion animals including experimental models, case reports and clinical trials in dogs and cats. The clinical studies and therapeutic protocols were categorized, evaluated and summarized according to the organ systems involved. The results indicate that evidence for the effectiveness of cell-based treatment in specific diseases or organ systems is not yet conclusive. Nonetheless, stem cell therapy may be a realistic treatment option in the near future, therefore, considerable efforts are needed to find optimized cell sources, cell numbers and delivery methods in order to standardize treatment methods and evaluation processes.
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Affiliation(s)
- Min Hee Kang
- Department of Veterinary Internal Medicine, College of Veterinary Medicine, Konkuk University, Seoul 05029, Korea
| | - Hee Myung Park
- Department of Veterinary Internal Medicine, College of Veterinary Medicine, Konkuk University, Seoul 05029, Korea.
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Marchegiani A, Tambella AM, Fruganti A, Spaterna A, Cerquetella M, Paterson S. Management of canine perianal fistula with fluorescence light energy: preliminary findings. Vet Dermatol 2020; 31:460-e122. [PMID: 32914496 DOI: 10.1111/vde.12890] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 06/24/2020] [Accepted: 06/27/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Canine perianal fistula (CPF) is a severe, painful, debilitating skin condition affecting the perianal skin. It often interferes with the quality of life of both dog and owner. Conventional medical treatment involves the use of immunosuppressive therapy; however, the successful resolution of lesions can be limited by poor owner compliance, adverse drug effects and dependence on costly therapies. HYPOTHESIS/OBJECTIVES The present study aimed to assess the potential benefits of fluorescent light energy (FLE) on cases of CPF. ANIMALS Four dogs with active perianal fistulas METHODS AND MATERIALS: FLE was applied as sole management therapy once a week with two consecutive applications in the same session for each dog until clinical signs had significantly improved, with weekly assessments for a six week period. Dogs were assessed by measuring the size of lesions at the start of the study and then weekly for six weeks, using planimetry software. Owners recorded vocalization and straining frequency scores during their pet's defaecation, and perianal licking frequency on a 0-5 point scale to assess the response to therapy. RESULTS All dogs improved with FLE, achieving a significant reduction in vocalization, straining and licking after two weeks (P = 0.002). After five weeks of FLE therapy, lesional areas had significantly decreased (P = 0.04). Only one dog required more than seven applications. No adverse events were reported. CONCLUSION AND CLINICAL IMPORTANCE FLE may be a promising alternative therapy for CPF.
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Affiliation(s)
- Andrea Marchegiani
- School of Biosciences and Veterinary Medicine, University of Camerino, via Circonvallazione 93/95, Matelica, Marche, I-62024, Italy
| | - Adolfo M Tambella
- School of Biosciences and Veterinary Medicine, University of Camerino, via Circonvallazione 93/95, Matelica, Marche, I-62024, Italy
| | - Alessandro Fruganti
- School of Biosciences and Veterinary Medicine, University of Camerino, via Circonvallazione 93/95, Matelica, Marche, I-62024, Italy
| | - Andrea Spaterna
- School of Biosciences and Veterinary Medicine, University of Camerino, via Circonvallazione 93/95, Matelica, Marche, I-62024, Italy
| | - Matteo Cerquetella
- School of Biosciences and Veterinary Medicine, University of Camerino, via Circonvallazione 93/95, Matelica, Marche, I-62024, Italy
| | - Susan Paterson
- Virtual Vet Derms Ltd., Lakeview, 3 High Birkrigg Park, Stainton, Kendal, LA8 0DY, UK
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8
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9
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Ackermann AL, May ER, Frank LA. Use of mycophenolate mofetil to treat immune-mediated skin disease in 14 dogs - a retrospective evaluation. Vet Dermatol 2016; 28:195-e44. [DOI: 10.1111/vde.12400] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2016] [Indexed: 02/01/2023]
Affiliation(s)
- Amanda L. Ackermann
- Department of Small Animal Clinical Sciences; University of Tennessee; 2407 River Drive Knoxville TN 37996 USA
| | - Elizabeth R. May
- Department of Small Animal Clinical Sciences; University of Tennessee; 2407 River Drive Knoxville TN 37996 USA
| | - Linda A. Frank
- Department of Small Animal Clinical Sciences; University of Tennessee; 2407 River Drive Knoxville TN 37996 USA
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10
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Abstract
Ciclosporin is a lipophilic cyclic polypeptide with powerful immunosuppressive and immunomodulatory properties that has been used in veterinary medicine for two decades. It is a calcineurin inhibitor whose principal mode of action is to inhibit T cell activation. The drug is principally absorbed from the small intestine and is metabolised in the intestine and liver by the cytochrome P450 enzyme system. Ciclosporin is known to interact with a wide range of pharmacological agents. Numerous studies have demonstrated good efficacy for the management of canine atopic dermatitis and this has been a licensed indication since 2003. In addition to the treatment of atopic dermatitis, it has been used as an aid in the management of numerous other dermatological conditions in animals including perianal fistulation, sebaceous adenitis, pododermatitis, chronic otitis externa and pemphigus foliaceus. This article reviews the mode of action, pharmacokinetics, indications for use and efficacy of ciclosporin in veterinary dermatology.
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Affiliation(s)
- Peter Forsythe
- The Dermatology Referral Service, 528 Paisley Road West, Glasgow G51 1RN, UK
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Archer TM, Boothe DM, Langston VC, Fellman CL, Lunsford KV, Mackin AJ. Oral cyclosporine treatment in dogs: a review of the literature. J Vet Intern Med 2013; 28:1-20. [PMID: 24341787 PMCID: PMC4895546 DOI: 10.1111/jvim.12265] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 09/02/2013] [Accepted: 10/28/2013] [Indexed: 11/30/2022] Open
Abstract
Cyclosporine is an immunomodulatory drug used to treat an increasing spectrum of diseases in dogs. Cyclosporine is a calcineurin inhibitor, ultimately exerting its inhibitory effects on T-lymphocytes by decreasing production of cytokines, such as interleukin-2. Although, in the United States, oral cyclosporine is approved in dogs only for treatment of atopic dermatitis, there are many other indications for its use. Cyclosporine is available in 2 oral formulations: the original oil-based formulation and the more commonly used ultramicronized emulsion that facilitates oral absorption. Ultramicronized cyclosporine is available as an approved animal product, and human proprietary and generic preparations are also available. Bioavailability of the different formulations in dogs is likely to vary among the preparations. Cyclosporine is associated with a large number of drug interactions that can also influence blood cyclosporine concentrations. Therapeutic drug monitoring (TDM) can be used to assist in attaining consistent plasma cyclosporine concentrations despite the effects of varying bioavailability and drug interactions. TDM can facilitate therapeutic success by guiding dose adjustments on an individualized basis, and is recommended in cases that do not respond to initial oral dosing, or during treatment of severe, life-threatening diseases for which a trial-and-error approach to dose adjustment is too risky. Pharmacodynamic assays that evaluate individual patient immune responses to cyclosporine can be used to augment information provided by TDM.
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Affiliation(s)
- T M Archer
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, MS
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12
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Abstract
Treatment of immune-mediated disease in dogs and cats continues to evolve as new therapies are introduced or adapted from human medicine. Glucocorticoids remain the first-line therapy for many of the immune-mediated or inflammatory diseases of cats and dogs. The focus of this article is to provide an update on some of the common immunosuppressive therapies used in small animal veterinary medicine. The goals of therapy are to induce disease remission through the inhibition of inflammation and the modulation of lymphocyte function.
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Affiliation(s)
- Katrina R Viviano
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin, Madison, WI, USA.
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Dandrieux JRS, Noble PJM, Scase TJ, Cripps PJ, German AJ. Comparison of a chlorambucil-prednisolone combination with an azathioprine-prednisolone combination for treatment of chronic enteropathy with concurrent protein-losing enteropathy in dogs: 27 cases (2007–2010). J Am Vet Med Assoc 2013; 242:1705-14. [DOI: 10.2460/javma.242.12.1705] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Thomason J, Lunsford K, Stokes J, Pinchuk L, Wills R, Langston C, Pruett S, Mackin A. The Effects of Cyclosporine on Platelet Function and Cyclooxygenase Expression in Normal Dogs. J Vet Intern Med 2012; 26:1389-401. [DOI: 10.1111/j.1939-1676.2012.01025.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Revised: 08/10/2012] [Accepted: 09/10/2012] [Indexed: 11/29/2022] Open
Affiliation(s)
- J. Thomason
- Department of Clinical Sciences, College of Veterinary Medicine; Mississippi State University; Mississippi State; MS
| | - K. Lunsford
- Department of Clinical Sciences, College of Veterinary Medicine; Mississippi State University; Mississippi State; MS
| | - J. Stokes
- Department of Basic Sciences, College of Veterinary Medicine; Mississippi State University; Mississippi State; MS
| | - L. Pinchuk
- Department of Basic Sciences, College of Veterinary Medicine; Mississippi State University; Mississippi State; MS
| | - R. Wills
- Department of Pathobiology and Population Medicine; College of Veterinary Medicine, Mississippi State University; Mississippi State; MS
| | - C. Langston
- Department of Clinical Sciences, College of Veterinary Medicine; Mississippi State University; Mississippi State; MS
| | - S. Pruett
- Department of Basic Sciences, College of Veterinary Medicine; Mississippi State University; Mississippi State; MS
| | - A. Mackin
- Department of Clinical Sciences, College of Veterinary Medicine; Mississippi State University; Mississippi State; MS
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Kovalik M, Thoday KL, van den Broek AHM. The use of ciclosporin A in veterinary dermatology. Vet J 2012; 193:317-25. [PMID: 22609151 DOI: 10.1016/j.tvjl.2012.03.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2010] [Revised: 03/14/2012] [Accepted: 03/29/2012] [Indexed: 11/18/2022]
Abstract
Ciclosporin A (CsA) has potent immunosuppressive and immunomodulatory activity that has been exploited in human medicine to prevent the rejection of transplanted organs and to manage atopic dermatitis and psoriasis. Over the past decade, CsA has been employed more frequently in veterinary dermatology and its value in the management of several canine and feline dermatoses is now well established. CsA inhibits calcineurin phosphatase, suppressing T cell activation and the synthesis of T cell cytokines consequently impairing the activity of B cells, antigen-presenting cells, mast cells, basophils and eosinophils. The pharmacokinetics of CsA are similar in humans, dogs and cats and the drug has a wide safety margin in dogs, cats and rabbits. Adverse effects, principally transient vomiting and soft faeces/diarrhoea, may be seen shortly after instituting treatment but often resolve despite continuing treatment. Gingival hyperplasia and cutaneous effects such as hirsutism may occur after prolonged treatment.
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Affiliation(s)
- Marcel Kovalik
- The University of Edinburgh, Division of Veterinary Clinical Sciences, Dermatology Unit, The Royal (Dick) School of Veterinary Studies, The Hospital for Small Animals, Easter Bush Veterinary Centre, Roslin, Midlothian EH25 9RG, Scotland, UK.
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Whitley NT, Day MJ. Immunomodulatory drugs and their application to the management of canine immune-mediated disease. J Small Anim Pract 2011; 52:70-85. [DOI: 10.1111/j.1748-5827.2011.01024.x] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Fellman CL, Stokes JV, Archer TM, Pinchuk LM, Lunsford KV, Mackin AJ. Cyclosporine A affects the in vitro expression of T cell activation-related molecules and cytokines in dogs. Vet Immunol Immunopathol 2010; 140:175-80. [PMID: 21227512 DOI: 10.1016/j.vetimm.2010.11.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2009] [Revised: 11/02/2010] [Accepted: 11/10/2010] [Indexed: 10/18/2022]
Abstract
Cyclosporine is a powerful immunosuppressive drug that is being used with increasing frequency to treat a wide range of immune-mediated diseases in the dog. To date, ideal dosing protocols that will achieve immunosuppression with cyclosporine in dogs remain unclear, and standard methods that can measure effectiveness of immunosuppression have not been established. The aim of our study was to evaluate the effects of in vitro cyclosporine exposure on a panel of molecules expressed by activated T cells to ascertain their potential as biomarkers of immunosuppression in dogs. Blood was drawn from six healthy dogs, and peripheral blood mononuclear cells (PBMC) were isolated and activated. Half of the cells were incubated with 200 ng/mL cyclosporine prior to activation, and the other half were not exposed to cyclosporine. Samples were analyzed using flow cytometry, and the expression of intracellular cytokines IL-2, IL-4, and IFN-γ was evaluated after 6, 12, and 24h of drug exposure. Each cytokine exhibited a time-dependent suppression profile, and all but two samples activated in the presence of cyclosporine showed lower cytokine expression than untreated controls. We also evaluated the expression of the surface T cell activation molecules CD25 and CD95 by flow cytometry after 36 h of drug exposure. Expression of these surface molecules decreased significantly when activated in the presence of cyclosporine. Our results suggest that suppressed expression of the markers related to T cell activation could potentially be utilized as an indicator of the efficacy of cyclosporine therapy in dogs.
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Affiliation(s)
- C L Fellman
- College of Veterinary Medicine, Mississippi State University, P.O. Box 6100, Mississippi State, MS 39762, USA.
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Hanley MJ, Cerundolo R, Radwanski N, Court MH. Grapefruit juice, lyophilized grapefruit juice, and powdered whole grapefruit inhibit cytochrome P450-mediated triazolam hydroxylation by beagle dog liver microsomes. J Vet Pharmacol Ther 2010; 33:189-95. [PMID: 20444044 DOI: 10.1111/j.1365-2885.2009.01124.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Coadministration of grapefruit juice (GFJ) has been proposed to enhance the systemic availability and decrease the required dose of drugs such as cyclosporine that are extensively metabolized in the intestine and liver. Although GFJ inhibits human cytochrome P450 (CYP) 3A, effects on dog CYP have not yet been reported. Consequently, we determined whether GFJ inhibits triazolam hydroxylation by Beagle dog liver microsomes (DLM) using human liver microsomes (HLM) as positive control. Results were compared with the effects of lyophilized GFJ and commercially-available powdered grapefruit capsules, which may be more convenient dosage forms. GFJ inhibited alpha-hydroxytriazolam formation in both DLM and HLM with similar IC(50) (inhibitor concentration producing a 50% decrease in reaction velocity) values of 0.56% and 0.52% (v/v), respectively. Lyophilized GFJ and powdered grapefruit also inhibited DLM alpha-hydroxytriazolam formation with IC(50) values of 0.76 and 1.2 mg/mL, respectively. Consistent with mechanism-based enzyme inhibition, preincubation of DLM with any of the grapefruit products for 20 min resulted in significant enhancement of inhibition of triazolam alpha-hydroxylation by 8-20%. The results indicate that 16 g of lyophilized GFJ or 23 g of powdered grapefruit would be equivalent to dosing 100 mL of GFJ. In vivo pharmacokinetic interaction studies are needed to confirm these in vitro findings.
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Affiliation(s)
- M J Hanley
- Department of Pharmacology and Experimental Therapeutics, Tufts University School of Medicine, Boston, MA 02111, USA
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Stanley BJ, Hauptman JG. Long-term prospective evaluation of topically applied 0.1% tacrolimus ointment for treatment of perianal sinuses in dogs. J Am Vet Med Assoc 2009; 235:397-404. [DOI: 10.2460/javma.235.4.397] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Barnes A, O’Neill T, Kennedy LJ, Short AD, Catchpole B, House A, Binns M, Fretwell N, Day MJ, Ollier WER. Association of canine anal furunculosis with TNFA is secondary to linkage disequilibrium with DLA-DRB1*. ACTA ACUST UNITED AC 2009; 73:218-24. [DOI: 10.1111/j.1399-0039.2008.01188.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Tivers MS, Catchpole B, Gregory SP, House AK. Interleukin-2 and interferon-gamma mRNA expression in canine anal furunculosis lesions and the effect of ciclosporin therapy. Vet Immunol Immunopathol 2008; 125:31-6. [DOI: 10.1016/j.vetimm.2008.04.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2007] [Revised: 04/09/2008] [Accepted: 04/22/2008] [Indexed: 01/16/2023]
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Abstract
Keratoconjunctivitis sicca (KCS), more commonly known as dry eye, is an inflammatory condition of the ocular surface caused by a pathologic reduction in the aqueous component of the tear film. It is seen commonly in the dog and defined as a Schirmer tear test with a reading of less than 10 mm in one minute. While KCS may be caused by neurological disease or drug toxicity, most cases are immune-mediated. Whereas the immunological basis of autoimmune KCS has been extensively investigated in humans and experimental rodent models, little research has been undertaken in the dog. It is hoped that this review spurs further research into the etiopathogenic factors in canine KCS.
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Oliveira AM, Obwolo MJ, van den Broek AHM, Thoday KL. Focal metatarsal sinus tracts in a Weimaraner successfully managed with ciclosporin. J Small Anim Pract 2007; 48:161-4. [PMID: 17355608 DOI: 10.1111/j.1748-5827.2006.00147.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Focal metatarsal sinus tracts ('fistulation') are, to the authors knowledge, reported for the first time in a Weimaraner. The six-year-old, entire male had a five-month history of two symmetrical, well-demarcated sinuses on the plantar aspect of each metatarsus. The area surrounding each pair of sinuses was slightly fluctuant and a serosanguineous discharge could be expressed. Cytological examination of the discharge was characteristic of pyogranulomatous inflammation. Bacterial culture showed the material to be sterile. Examination of a skin biopsy revealed a severe inflammatory reaction involving the dermal collagen, with an infiltrate of neutrophils, macrophages, lymphocytes, plasma cells and multi-nucleated giant cells, with some micro-pustule formation. Treatment with ciclosporin induced total remission. Reduction of the dose of ciclosporin resulted in recurrence of the physical signs with further remission on re-introduction of the original dosage. This is the first report of the use of ciclosporin to control this condition.
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Affiliation(s)
- A M Oliveira
- University of Edinburgh, Dermatology Unit, Division of Veterinary Clinical Sciences, The Royal (Dick) School of Veterinary Studies, The Hospital for Small Animals, Easter Bush Veterinary Centre, Roslin, Midlothian EH25 9RG, UK
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Harkin KR, Phillips D, Wilkerson M. Evaluation of Azathioprine on Lesion Severity and Lymphocyte Blastogenesis in Dogs With Perianal Fistulas. J Am Anim Hosp Assoc 2007; 43:21-6. [PMID: 17209081 DOI: 10.5326/0430021] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Fourteen dogs with perianal fistulas were entered into a prospective clinical study to investigate the effects of long-term azathioprine on clinical outcome and to determine if the clinical results correlated with lymphocyte blastogenesis tests. Complete remission of perianal fistulas was seen in eight (57%) of 14 dogs; partial remission occurred in one (7%) dog; and no response was detected in five (36%) dogs. The results of lymphocyte blastogenesis assays did not correlate with therapeutic response.
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Affiliation(s)
- Kenneth R Harkin
- Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan, Kansas 66506, USA
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Klein A, Deneuche A, Fayolle P, Hidalgo A, Scotti S, Zylberstein L, Desbois C, Tessier D, Moissonnier P, Viateau V. Preoperative Immunosuppressive Therapy and Surgery as a Treatment for Anal Furunculosis. Vet Surg 2006; 35:759-68. [PMID: 17187638 DOI: 10.1111/j.1532-950x.2006.00220.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVES To evaluate the efficacy of combining preoperative immunosuppressive therapy with surgical excision for treatment of anal furunculosis (AF) in dogs. STUDY DESIGN Retrospective study. ANIMALS Dogs (n=25) with stages 1-4 AF. METHODS Preoperative immunosuppressive therapy was either cyclosporine A (CyA) alone or in combination with ketoconazole (Group 1; n=18), or azathioprine combined with prednisolone (Group 2; n=7). Surgical excision of residual draining tracts, cryptectomy, and anal sacculectomy were performed. Only dogs with postoperative clinical follow-up exceeding 9 months were retained for the study. RESULTS Both immunosuppressive protocols were effective in reducing progression of AF. Subsequent draining tracts excision, cryptectomy, and anal sacculectomy were bilateral (12 dogs) or unilateral (13 dogs of which 4 had bilateral anal sacculectomy). Postoperative recovery was uneventful, except for 2 dogs that had wound breakdown. Recurrence was not observed in any of the dogs that had bilateral surgical excision and or in 9 dogs that had unilateral excision. CONCLUSION Preoperative immunosuppressive therapy, combined with bilateral surgical resection of affected tissue consistently, resulted in resolution of AF. Four dogs that had recurrence had unilateral excision despite initial bilateral involvement, suggesting that all diseased tissue should be excised. CLINICAL RELEVANCE These preliminary results suggest that immunosuppressive therapy before surgical excision for AF yields minimizes recurrence in dogs.
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Affiliation(s)
- Arnaud Klein
- Unité Pédagogique de Pathologie Chirurgicale, Ecole Nationale Vétérinaire d'Alfort, Maisons-Alfort, France
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House AK, Catchpole B, Gregory SP. Matrix metalloproteinase mRNA expression in canine anal furunculosis lesions. Vet Immunol Immunopathol 2006; 115:68-75. [PMID: 17125846 DOI: 10.1016/j.vetimm.2006.10.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2006] [Revised: 10/05/2006] [Accepted: 10/17/2006] [Indexed: 11/22/2022]
Abstract
Although the aetiology of anal furunculosis (AF) in dogs is poorly understood, there is evidence for an underlying immune dysfunction. This is illustrated by the presence of a T helper type 1 cytokine mRNA profile in AF lesions and the clinical response to ciclosporin therapy. Expression of MMPs 2, 9 and 13 were evaluated in AF lesional biopsies by real-time quantitative RT-PCR. There was significantly increased expression of both MMP-9 and MMP-13 mRNA in AF biopsies compared to controls (p<0.001) but no significant difference in MMP-2 mRNA expression. Since MMP-9 and MMP-13 are primarily produced by macrophages, these data suggest that ulceration could be the result of aberrant activation of this cell type in the tissues. It is feasible that such pathological macrophage activity occurs in response to interferon-gamma secreted by T helper type 1 cells. This could explain why the lesions resolve following treatment with the immunosuppressive drug ciclosporin.
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Affiliation(s)
- A K House
- Department of Veterinary Clinical Sciences, Royal Veterinary College, University of London, Hawkshead Lane, North Mymms, Hertfordshire AL9 7TA, United Kingdom.
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House AK, Guitian J, Gregory SP, Hardie RJ. Evaluation of the Effect of Two Dose Rates of Cyclosporine on the Severity of Perianal Fistulae Lesions and Associated Clinical Signs in Dogs. Vet Surg 2006; 35:543-9. [PMID: 16911154 DOI: 10.1111/j.1532-950x.2006.00187.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To investigate the effect of cyclosporine (2 or 5 mg/kg every 24 hours) on perianal fistulae (PAF) lesions. STUDY DESIGN Blinded randomized, prospective trial. ANIMALS Dogs (n = 20) with perianal fistulae. METHODS Dogs were randomly assigned to administration of either 2 mg/kg (n = 10) or 5 mg/kg (n=10) of cyclosporine orally every 24 hours for 8 weeks. Lesion surface area was measured, lesion severity was graded using a visual analog scale, and the presence and severity of clinical signs recorded every 2 weeks. RESULTS Lesion variables were significantly reduced in both groups after 8 weeks and owners also reported a reduction in clinical sign severity. The 5 mg/kg dose rate significantly accelerated lesion resolution compared with 2 mg/kg. In the 2 mg/kg group, 20% of dogs had complete resolution of clinical signs and 10% had resolution of lesions. In the 5 mg/kg group, 40% of dogs had complete resolution of clinical signs and 60% had resolution of lesions. CONCLUSIONS A dose rate of 5 mg/kg every 24 hours was more effective at reducing the surface area and severity of PAF lesions than 2 mg/kg every 24 hours but less effective at resolving PAF lesions than previous studies using dose rates > or =5 mg/kg every 12 hours. CLINICAL RELEVANCE Cyclosporine at 5 mg/kg every 24 hours may be useful for the palliation of PAF lesions.
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Affiliation(s)
- Arthur K House
- The Royal Veterinary College, North Mymms, Hatfield, Hertfordshire, UK.
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Allenspach K, Rüfenacht S, Sauter S, Gröne A, Steffan J, Strehlau G, Gaschen F. Pharmacokinetics and Clinical Efficacy of Cyclosporine Treatment of Dogs with Steroid-Refractory Inflammatory Bowel Disease. J Vet Intern Med 2006. [DOI: 10.1111/j.1939-1676.2006.tb02852.x] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Milner HR. The role of surgery in the management of canine anal furunculosis. A review of the literature and a retrospective evaluation of treatment by surgical resection in 51 dogs. N Z Vet J 2006; 54:1-9. [PMID: 16528387 DOI: 10.1080/00480169.2006.36596] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AIMS To retrospectively evaluate the outcome of surgical management of anal furunculosis (AF) in 51 dogs. To compare the outcome of surgery with those of current medical protocols by way of a review of the literature. METHODS Dogs referred for treatment of AF (n=51) were treated by en bloc surgical resection of diseased tissue and primary wound closure. This technique was combined with bilateral anal sacculectomy in all cases in which the anal sacs had not been previously removed. Immunomodulatory therapies were not used, with the exception of post-operative metronidazole antibiosis for 7-10 days. Follow-up was performed by the author using a telephone questionnaire. RESULTS Forty-eight dogs were eligible for post-operative follow-up 1.5 to 36 (mean 17.4, median 18) months after surgery. Lesion recurrence, faecal incontinence and stricture formation occurred in 2%, 4% and 13% of dogs, respectively. The percentage of dogs considered by their owners to have an acceptable level of faecal continence and an improved quality of life was 94%. CONCLUSIONS AND CLINICAL RELEVANCE The aetiopathogenesis of canine AF remains unclear. Whilst recent advances in medical management by the use of various immunomodulatory medications (such as cyclosporine) hold promise, this approach has yet to be refined with respect to affordability, long-term efficacy and morbidity. With meticulous surgical dissection and reconstruction techniques (anoplasty), excellent success rates can be achieved following a single surgical procedure with minimal complications. Surgery remains a viable treatment option, alone or in combination with immunomodulatory medications, until a more thorough understanding of this debilitating disease is achieved.
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Affiliation(s)
- H R Milner
- Veterinary Surgical Specialties, PO Box 8169, Riccarton, Christchurch, New Zealand.
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