1
|
Habacher G, Malik R, Lait PJP, Coghill LM, Middleton RP, Warren WC, Lyons LA. Feline precision medicine using whole-exome sequencing identifies a novel frameshift mutation for vitamin D-dependent rickets type 2. J Feline Med Surg 2023; 25:1098612X231165630. [PMID: 37387221 PMCID: PMC10811982 DOI: 10.1177/1098612x231165630] [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] [Indexed: 07/01/2023]
Abstract
OBJECTIVES A 14-week-old female domestic longhair kitten presented with shifting lameness and disproportionately smaller size compared with a co-housed littermate. METHODS Hematology and serum biochemical testing were conducted to investigate causes for delayed growth, and radiographs of the appendicular skeleton were obtained. RESULTS The afflicted kitten had marked hypocalcemia, mild hypophosphatemia and substantial elevations in alkaline phosphatase activity, as well as pathognomonic radiographic findings consistent with rickets. Skeletal changes and hypocalcemia prompted testing of concentrations of parathyroid hormone (PTH) and vitamin D metabolites. Endocrine testing demonstrated significant increases in serum concentrations of PTH and 1,25-dihydroxycholecalciferol (calcitriol), supporting a diagnosis of vitamin D-dependent rickets type 2. Provision of analgesia, supraphysiologic doses of calcitriol and calcium carbonate supplementation achieved normalization of the serum calcium concentration and restoration of normal growth, although some skeletal abnormalities persisted. Once skeletally mature, ongoing calcitriol supplementation was not required. Whole-exome sequencing (WES) was conducted to identify the underlying DNA variant. A cytosine deletion at cat chromosome position B4:76777621 in VDR (ENSFCAT00000029466:c.106delC) was identified and predicted to cause a stop codon in exon 2 (p.Arg36Glufs*18), disrupting >90% of the receptor. The variant was unique and homozygous in this patient and absent in the sibling and approximately 400 other cats for which whole-genome and whole-exome data were available. CONCLUSIONS AND RELEVANCE A unique, heritable form of rickets was diagnosed in a domestic longhair cat. WES identified a novel frameshift mutation affecting the gene coding for the vitamin D3 receptor, determining the likely causal genetic variant. Precision medicine techniques, including whole-exome and whole-genome sequencing, can be a standard of care in cats to identify disease etiologies, and to target therapeutics and personalize treatment.
Collapse
Affiliation(s)
| | - Richard Malik
- Centre for Veterinary Education, The University of Sydney, Sydney, NSW, Australia
| | | | - Lyndon M Coghill
- Department of Veterinary Pathobiology, College of Veterinary Medicine, University of Missouri, Columbia, MO, USA
| | | | - Wesley C Warren
- Division of Animal Sciences, College of Agriculture, Department of Surgery, School of Medicine, Institute for Data Science and Informatics, University of Missouri, Columbia, MO, USA
| | - Leslie A Lyons
- Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri, Columbia, MO, USA
| |
Collapse
|
2
|
Clarke KE, Hurst EA, Mellanby RJ. Vitamin D metabolism and disorders in dogs and cats. J Small Anim Pract 2021; 62:935-947. [PMID: 34323302 DOI: 10.1111/jsap.13401] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 06/05/2021] [Accepted: 06/19/2021] [Indexed: 12/20/2022]
Abstract
Vitamin D plays an important role in regulating calcium metabolism and in the development and maintenance of skeletal health of companion animals. There is also a growing interest in understanding the role vitamin D plays in non-skeletal health in both human and veterinary patients. This review provides an update of our current understanding of vitamin D biology in dogs and cats and gives an overview of how vitamin D metabolism can be assessed in companion animals. Congenital and acquired vitamin D disorders are then summarised before the review concludes with a summary of recent studies which have explored the role of vitamin D in the development and outcomes of non-skeletal diseases of dogs and cats.
Collapse
Affiliation(s)
- K E Clarke
- Davies Veterinary Specialists, Manor Farm Business Park, Higham Gobion, Hertfordshire, UK
| | - E A Hurst
- Royal (Dick) School of Veterinary Studies and the Roslin Institute, The University of Edinburgh, Easter Bush Campus, Roslin, Midlothian, UK
| | - R J Mellanby
- Royal (Dick) School of Veterinary Studies and the Roslin Institute, The University of Edinburgh, Easter Bush Campus, Roslin, Midlothian, UK
| |
Collapse
|
3
|
Zafalon RVA, Ruberti B, Rentas MF, Amaral AR, Vendramini THA, Chacar FC, Kogika MM, Brunetto MA. The Role of Vitamin D in Small Animal Bone Metabolism. Metabolites 2020; 10:E496. [PMID: 33287408 PMCID: PMC7761812 DOI: 10.3390/metabo10120496] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/09/2020] [Accepted: 11/10/2020] [Indexed: 12/14/2022] Open
Abstract
Dogs and cats have differences in vitamin D metabolism compared to other mammalian species, as they are unable to perform vitamin D cutaneous synthesis through sun exposure. Therefore, they are dependent on the dietary intake of this nutrient. The classic functions of vitamin D are to stimulate intestinal calcium and phosphate absorption, renal calcium and phosphate reabsorption and regulate bone mineral metabolism. Thus, it is an important nutrient for calcium and phosphorus homeostasis. This review highlights the evidence of the direct and indirect actions of vitamin D on bone mineral metabolism, the consequences of nutritional imbalances of this nutrient in small animals, as well as differences in vitamin D metabolism between different size dogs.
Collapse
Affiliation(s)
- Rafael Vessecchi Amorim Zafalon
- Pet Nutrology Research Center, Nutrition and Production Department, School of Veterinary Medicine and Animal Science, University of São Paulo, Jardim Elite, Pirassununga 13635-900, Brazil; (R.V.A.Z.); (M.F.R.); (T.H.A.V.)
| | - Bruna Ruberti
- Small Animal Internal Medicine Service, Veterinary Teaching Hospital, School of Veterinary Medicine and Animal Science, University of São Paulo, Cidade Universitária, São Paulo 05508-270, Brazil; (B.R.); (M.M.K.)
| | - Mariana Fragoso Rentas
- Pet Nutrology Research Center, Nutrition and Production Department, School of Veterinary Medicine and Animal Science, University of São Paulo, Jardim Elite, Pirassununga 13635-900, Brazil; (R.V.A.Z.); (M.F.R.); (T.H.A.V.)
| | - Andressa Rodrigues Amaral
- Veterinary Nutrology Service, Veterinary Teaching Hospital, School of Veterinary Medicine and Animal Science, University of São Paulo, Cidade Universitária, São Paulo 05508-270, Brazil;
| | - Thiago Henrique Annibale Vendramini
- Pet Nutrology Research Center, Nutrition and Production Department, School of Veterinary Medicine and Animal Science, University of São Paulo, Jardim Elite, Pirassununga 13635-900, Brazil; (R.V.A.Z.); (M.F.R.); (T.H.A.V.)
| | - Fernanda Chicharo Chacar
- Department of Internal Medicine, Federal Institute of Education, Science and Technology of South of Minas Gerais, IFSULDEMINAS, Muzambinho 37890-000, Brazil;
| | - Marcia Mery Kogika
- Small Animal Internal Medicine Service, Veterinary Teaching Hospital, School of Veterinary Medicine and Animal Science, University of São Paulo, Cidade Universitária, São Paulo 05508-270, Brazil; (B.R.); (M.M.K.)
| | - Marcio Antonio Brunetto
- Pet Nutrology Research Center, Nutrition and Production Department, School of Veterinary Medicine and Animal Science, University of São Paulo, Jardim Elite, Pirassununga 13635-900, Brazil; (R.V.A.Z.); (M.F.R.); (T.H.A.V.)
- Veterinary Nutrology Service, Veterinary Teaching Hospital, School of Veterinary Medicine and Animal Science, University of São Paulo, Cidade Universitária, São Paulo 05508-270, Brazil;
| |
Collapse
|
4
|
Hurst EA, Homer NZ, Mellanby RJ. Vitamin D Metabolism and Profiling in Veterinary Species. Metabolites 2020; 10:E371. [PMID: 32942601 PMCID: PMC7569877 DOI: 10.3390/metabo10090371] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/11/2020] [Accepted: 09/13/2020] [Indexed: 12/17/2022] Open
Abstract
The demand for vitamin D analysis in veterinary species is increasing with the growing knowledge of the extra-skeletal role vitamin D plays in health and disease. The circulating 25-hydroxyvitamin-D (25(OH)D) metabolite is used to assess vitamin D status, and the benefits of analysing other metabolites in the complex vitamin D pathway are being discovered in humans. Profiling of the vitamin D pathway by liquid chromatography tandem mass spectrometry (LC-MS/MS) facilitates simultaneous analysis of multiple metabolites in a single sample and over wide dynamic ranges, and this method is now considered the gold-standard for quantifying vitamin D metabolites. However, very few studies report using LC-MS/MS for the analysis of vitamin D metabolites in veterinary species. Given the complexity of the vitamin D pathway and the similarities in the roles of vitamin D in health and disease between humans and companion animals, there is a clear need to establish a comprehensive, reliable method for veterinary analysis that is comparable to that used in human clinical practice. In this review, we highlight the differences in vitamin D metabolism between veterinary species and the benefits of measuring vitamin D metabolites beyond 25(OH)D. Finally, we discuss the analytical challenges in profiling vitamin D in veterinary species with a focus on LC-MS/MS methods.
Collapse
Affiliation(s)
- Emma A. Hurst
- The Roslin Institute and Royal (Dick) School of Veterinary Studies, The University of Edinburgh, Easter Bush, Midlothian, Edinburgh, Scotland EH25 9RG, UK;
- Mass Spectrometry Core, Edinburgh Clinical Research Facility, Queen’s Medical Research Institute, The University of Edinburgh, Little France Crescent, Edinburgh, Scotland EH16 4TJ, UK;
| | - Natalie Z. Homer
- Mass Spectrometry Core, Edinburgh Clinical Research Facility, Queen’s Medical Research Institute, The University of Edinburgh, Little France Crescent, Edinburgh, Scotland EH16 4TJ, UK;
| | - Richard J. Mellanby
- The Roslin Institute and Royal (Dick) School of Veterinary Studies, The University of Edinburgh, Easter Bush, Midlothian, Edinburgh, Scotland EH25 9RG, UK;
| |
Collapse
|
5
|
Duplan F, Maunder C. Unusual presentation of vitamin D 3-dependent rickets type II in a kitten. JFMS Open Rep 2020; 6:2055116920910278. [PMID: 32231788 PMCID: PMC7082872 DOI: 10.1177/2055116920910278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Case summary A 15-week-old kitten presented with a 1-month history of intermittent generalised tremors and abdominal distension. Hypocalcaemia associated with increased 1,25-vitamin D3 was consistent with vitamin D3-dependent rickets type II. The bone appearance on CT scan was most consistent with the changes typically seen with nutritional secondary hyperparathyroidism and less typical of the changes seen with rickets. Our patient had a positive response to high vitamin D3 therapy as it remained normocalcaemic 16 months after diagnosis, supporting the diagnosis of rickets. Relevance and novel information This case report is an unusual and interesting presentation of rickets in a kitten. Despite the characteristic vitamin D3 disturbance for rickets type II, the atypical radiographic changes have not been previously reported. In the literature, a positive response to treatment is not commonly seen or follow-up is short. Our case responded well to treatment and was followed for 16 months from the time of diagnosis. This emphasises that the pathophysiology of the condition is not well understood, and that different types of vitamin D3-dependent rickets type II may exist. Although the genetic defects responsible for some cases of rickets type I have been identified, this has still not been determined for rickets type II.
Collapse
Affiliation(s)
- Florent Duplan
- Internal Medicine Department, Langford Veterinary Services, University of Bristol, Langford, Bristol, UK
| | - Christina Maunder
- Internal Medicine Department, Langford Veterinary Services, University of Bristol, Langford, Bristol, UK
| |
Collapse
|
6
|
Zafalon RVA, Risolia LW, Pedrinelli V, Vendramini THA, Rodrigues RBA, Amaral AR, Kogika MM, Brunetto MA. Vitamin D metabolism in dogs and cats and its relation to diseases not associated with bone metabolism. J Anim Physiol Anim Nutr (Berl) 2019; 104:322-342. [PMID: 31803981 DOI: 10.1111/jpn.13259] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 09/27/2019] [Accepted: 11/02/2019] [Indexed: 12/11/2022]
Abstract
Due to the presence of receptors in the cells of numerous body tissues, vitamin D is associated with several physiological functions that go beyond calcium and phosphorus homoeostasis and control of bone metabolism in the body. In humans, several studies have associated lower vitamin D concentrations with numerous diseases, such as cancer, heart disease, autoimmune diseases and infectious diseases, and also with an increase in the total mortality rate of the population. Recently, this nutrient started to gain importance in veterinary medicine, and several articles have shown a correlation between low vitamin D status and diseases unrelated to bone metabolism. The present review aims to highlight the recent publications that investigated this relationship, bringing the evidence that exists so far in dogs and cats.
Collapse
Affiliation(s)
- Rafael V A Zafalon
- School of Veterinary Medicine and Animal Science, University of São Paulo, São Paulo, Brazil
| | - Larissa W Risolia
- School of Veterinary Medicine and Animal Science, University of São Paulo, São Paulo, Brazil
| | - Vivian Pedrinelli
- School of Veterinary Medicine and Animal Science, University of São Paulo, São Paulo, Brazil
| | - Thiago H A Vendramini
- School of Veterinary Medicine and Animal Science, University of São Paulo, São Paulo, Brazil
| | - Roberta B A Rodrigues
- School of Veterinary Medicine and Animal Science, University of São Paulo, São Paulo, Brazil
| | - Andressa R Amaral
- School of Veterinary Medicine and Animal Science, University of São Paulo, São Paulo, Brazil
| | - Marcia M Kogika
- School of Veterinary Medicine and Animal Science, University of São Paulo, São Paulo, Brazil
| | - Marcio A Brunetto
- School of Veterinary Medicine and Animal Science, University of São Paulo, São Paulo, Brazil
| |
Collapse
|
7
|
Teshima T, Kurita S, Sasaki T, Matsumoto H, Niina A, Abe D, Kanno N, Koyama H. A genetic variant of CYP2R1 identified in a cat with type 1B vitamin D-dependent rickets: a case report. BMC Vet Res 2019; 15:62. [PMID: 30777056 PMCID: PMC6378717 DOI: 10.1186/s12917-019-1784-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 01/16/2019] [Indexed: 11/24/2022] Open
Abstract
Background Vitamin D-dependent rickets is rare in animals and humans. Several types of this condition are associated with genetic variants related to vitamin D metabolism. This is the first report of type 1B vitamin D-dependent rickets in a cat. Case presentation Here, we describe the case of a 3-month-old female domestic short-haired cat previously fed on commercial kitten food that presented at our clinic with seizures, lethargy, and generalized pain. Serum and ionized calcium concentrations and 1,25-dihydroxycholecalciferol in this cat were low, and radiographs showed skeletal demineralization and abnormally wide growth plates on the long bones. Initially, simple vitamin D deficiency was suspected; however, the cat’s profile, which included fed a well-balanced commercial diet, together with the findings of additional laboratory tests and the cat’s unresponsiveness to various treatments, raised the suspicion of vitamin D-dependent rickets. Examination of the DNA sequences of CYP2R1 and CYP27B1 genes, which are genes linked with vitamin D metabolism, showed a CYP2R1 frameshift mutation in exon 5 (where T is deleted at position c.1386). This mutation alters the amino acid sequence from position 462, while the stop codon introduced at position 481 prematurely truncates the 501 amino acid full-length protein. With this knowledge, a new treatment regime based on a standard dose of calcitriol was started and this markedly improved the cat’s condition. Conclusions To the best of our knowledge, the present case is the first description of type 1B vitamin D-dependent rickets linked with a genetic variant of CYP2R1 in a cat. Electronic supplementary material The online version of this article (10.1186/s12917-019-1784-1) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Takahiro Teshima
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Medicine, School of Veterinary Medicine, Faculty of Veterinary Science, Nippon Veterinary and Life Science University, 1-7-1 Kyonan-cho, Musashino, Tokyo, 180-8602, Japan.
| | - Sena Kurita
- Laboratory of Veterinary Clinical Pathology, Department of Veterinary Clinical Medicine, School of Veterinary Medicine, Faculty of Veterinary Science, Nippon Veterinary and Life Science University, 1-7-1 Kyonan-cho, Musashino, Tokyo, 180-8602, Japan
| | - Takashi Sasaki
- Animal Research Center, Sapporo Medical University School Medicine, S-1 W-17, Chuo-ku, Sapporo, Hokkaido, 060-8556, Japan
| | - Hirotaka Matsumoto
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Medicine, School of Veterinary Medicine, Faculty of Veterinary Science, Nippon Veterinary and Life Science University, 1-7-1 Kyonan-cho, Musashino, Tokyo, 180-8602, Japan
| | - Ayaka Niina
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Medicine, School of Veterinary Medicine, Faculty of Veterinary Science, Nippon Veterinary and Life Science University, 1-7-1 Kyonan-cho, Musashino, Tokyo, 180-8602, Japan
| | - Daijiro Abe
- Veterinary Medical Teaching Hospital, Nippon Veterinary and Life Science University, 1-7-1 Kyonan-cho, Musashino, Tokyo, 180-8602, Japan
| | - Nobuo Kanno
- Laboratory of Veterinary Surgery, Department of Veterinary Clinical Medicine, School of Veterinary Medicine, Faculty of Veterinary Science, Nippon Veterinary and Life Science University, 1-7-1 Kyonan-cho, Musashino, Tokyo, 180-8602, Japan
| | - Hidekazu Koyama
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Medicine, School of Veterinary Medicine, Faculty of Veterinary Science, Nippon Veterinary and Life Science University, 1-7-1 Kyonan-cho, Musashino, Tokyo, 180-8602, Japan
| |
Collapse
|
8
|
Parker VJ, Rudinsky AJ, Chew DJ. Vitamin D metabolism in canine and feline medicine. J Am Vet Med Assoc 2017; 250:1259-1269. [DOI: 10.2460/javma.250.11.1259] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
9
|
Pineda C, Aguilera-Tejero E, Guerrero F, Raya AI, Rodriguez M, Lopez I. Mineral metabolism in growing cats: changes in the values of blood parameters with age. J Feline Med Surg 2013; 15:866-71. [DOI: 10.1177/1098612x13478264] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The purpose of this study was to describe changes in calcium, phosphorus, magnesium, parathyroid hormone, calcitriol and calcidiol in cats from 3 to 15 months of age. Fourteen European shorthair healthy cats of both sexes (seven males, seven females) belonging to a research colony were studied from 3 to 15 months of age. Plasma concentrations of total calcium, ionised calcium, albumin, phosphorus, magnesium, intact parathyroid hormone (I-PTH), whole parathyroid hormone (W-PTH), calcidiol and calcitriol were measured at 3, 6, 9, 12 and 15 months of age. From 3 months of age to adulthood cats showed a decrease in calcium (both total and ionised), phosphorus and magnesium. No major changes in PTH were evident, although the ratio of W-PTH:I-PTH decreased significantly with age. A reciprocal change in vitamin D metabolites (decrease in calcitriol and increase in calcidiol) was identified during the growing process. Our results, showing changes in most parameters of mineral metabolism during growth, reinforce the need to use adequate age-related reference values for diagnostic purposes.
Collapse
Affiliation(s)
- Carmen Pineda
- Department of Animal Medicine and Surgery, University of Cordoba, Cordoba, Spain
| | | | - Fatima Guerrero
- Department of Animal Medicine and Surgery, University of Cordoba, Cordoba, Spain
| | - Ana I Raya
- Department of Animal Medicine and Surgery, University of Cordoba, Cordoba, Spain
| | - Mariano Rodriguez
- Department of Nephrology and Research Unit, University Hospital Reina Sofia, Cordoba, Spain
| | - Ignacio Lopez
- Department of Animal Medicine and Surgery, University of Cordoba, Cordoba, Spain
| |
Collapse
|
10
|
Langley-Hobbs S. Musculoskeletal oddities in the cat: an overview of some curious causes of lameness. J Feline Med Surg 2012; 14:31-42. [PMID: 22247323 PMCID: PMC11148911 DOI: 10.1177/1098612x11432825] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PRACTICAL RELEVANCE Cats, both young and old, can suffer a variety of weird and wonderful musculoskeletal conditions that are a cause of lameness. These include developmental, metabolic and nutritional bone diseases, ectopic mineralisation disorders, conditions that cause lameness or exercise intolerance and primarily or secondarily affect muscle, and lastly pad conditions. CLINICAL CHALLENGES These conditions are mostly rare and can be challenging to diagnose. The aim of this review is to bring these conditions to the attention of practitioners so that, if they are encountered, further research around the topic can be undertaken. Radiographic changes and diagnostic tests that can be used to try to confirm diagnoses are described. EVIDENCE BASE These unusual causes of lameness are the subject of multiple single case reports or small case series, many of which are relatively old. The evidence presented here is drawn from these articles. However, it is not possible within the scope of this review to discuss all the conditions in as much detail as they may warrant, or to make reference to every article relating to them.
Collapse
Affiliation(s)
- Sorrel Langley-Hobbs
- Department of Veterinary Medicine, University of Cambridge, Cambridge CB3 OES, UK.
| |
Collapse
|
11
|
Phillips AM, Fawcett AC, Allan GS, Wilkinson M, Fraser DR, Malik R. Vitamin D-Dependent Non-Type 1, Non-Type 2 Rickets in a 3-Month-Old Cornish Rex Kitten. J Feline Med Surg 2011; 13:526-31. [PMID: 21704902 DOI: 10.1016/j.jfms.2011.05.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2011] [Indexed: 10/18/2022]
Abstract
Case presentation and assessment A 3-month-old female Cornish Rex kitten was found to have non-painful swelling of the carpal and tarsal regions when presented for routine neutering. The kitten was smaller in stature and less active than its siblings and, according to the owner, had a bunny-hopping gait, was reluctant to climb stairs and strained during defecation. Radiography of the affected limbs and a subsequent radiographic survey of the entire skeleton demonstrated features consistent with rickets. The three littermates were clinically and radiographically normal. As a nutritionally complete diet was being fed, it seemed most likely that the kitten had an inborn error related to vitamin D metabolism. Serum biochemistry demonstrated reduced total alkaline phosphatase activity and increased concentrations of parathyroid hormone. Concentrations of 1,25- and 25-hydroxycholecalciferol were markedly reduced, confirming the diagnosis of rickets. Treatment The kitten was treated with calcitriol, administered orally once daily, and improved rapidly both clinically and radiologically. Serial laboratory studies suggested that the error in vitamin D metabolism was transient, and, at the time of writing, as an adult, the cat appears to require no ongoing replacement calcitriol therapy. Clinical relevance This case emphasises the value of examining a full ‘calcium profile’ via a human or veterinary reference laboratory, and a favourable prognosis in some kittens with rickets makes such investigations worthwhile. Even when finances preclude detailed investigation, trial therapy using a nutritionally complete diet and physiological doses of calcitriol or cholecalciferol is inexpensive and can produce a good response.
Collapse
Affiliation(s)
- Angela M Phillips
- Sydney Animal Hospitals Inner West, 1A Northumberland Avenue, Stanmore, NSW 2048, Australia
| | - Anne C Fawcett
- Sydney Animal Hospitals Inner West, 1A Northumberland Avenue, Stanmore, NSW 2048, Australia
- Faculty of Veterinary Science, University of Sydney, B14, NSW 2006, Australia
| | - Graeme S Allan
- Faculty of Veterinary Science, University of Sydney, B14, NSW 2006, Australia
- Veterinary Imaging Associates, PO Box 300, St Leonards, NSW 1590, Australia
| | - Margaret Wilkinson
- Pacific Laboratory Medicine Services, The Endocrine Unit, Block 1a, Royal North Shore Hospital, St Leonards, NSW 2065, Australia
| | - David R Fraser
- Faculty of Veterinary Science, University of Sydney, B14, NSW 2006, Australia
| | - Richard Malik
- Centre for Veterinary Education, The University of Sydney, B22, NSW 2006, Australia
| |
Collapse
|
12
|
MacKenzie JM, Crawford J, Ghantous S. Successful Therapy of Vitamin D-Dependant Rickets in a Kitten. J Am Anim Hosp Assoc 2011; 47:290-3. [DOI: 10.5326/jaaha-ms-5610] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A 7 mo old, 2.4 kg, intact female kitten was evaluated for an inability to walk after falling out of the owner's arms. Diagnostic testing abnormalities included hypocalcemia, low ionized calcium, and elevated intact parathyroid hormone concentration. The 25-hydroxyvitamin D level was normal. Radiographic abnormalities included generalized osteopenia, a nondisplaced, folding fracture of the proximal right fibula, and sclerosis with a compression fracture of the proximal right tibia. Based on these findings and response to calcium carbonate and calcitriol therapy, a diagnosis of vitamin D-dependent rickets was made. Reports of similar cases in veterinary medicine are sparse and no other reports to date document radiographic abnormalities with a successful therapeutic outcome.
Collapse
Affiliation(s)
- John M. MacKenzie
- Department of Small Animal Internal Medicine (J.M., S.G.) and Department of Radiology (J.C.), Animal Emergency and Referral Center, Northbrook, IL
| | - Jason Crawford
- Department of Small Animal Internal Medicine (J.M., S.G.) and Department of Radiology (J.C.), Animal Emergency and Referral Center, Northbrook, IL
| | - Seth Ghantous
- Department of Small Animal Internal Medicine (J.M., S.G.) and Department of Radiology (J.C.), Animal Emergency and Referral Center, Northbrook, IL
| |
Collapse
|
13
|
Thompson KG, Dittmer KE, Blair HT, Fairley RA, Sim DFW. An outbreak of rickets in Corriedale sheep: Evidence for a genetic aetiology. N Z Vet J 2011; 55:137-42. [PMID: 17534417 DOI: 10.1080/00480169.2007.36757] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
CASE HISTORY A skeletal disease characterised by lameness, limb deformities and reduced growth rate occurred over two successive years in lambs born on a commercial sheep farm in Marlborough. A genetic aetiology was considered likely following exclusion of other known causes of rickets and because of the progressive nature of the disease, even after affected animals were transferred to another property. CLINICAL FINDINGS Affected lambs appeared normal at birth but developed clinical signs during the first 2 months of life. The most severely affected animals either died or were euthanised within the first year of life, but some survived to breeding age. Serum biochemistry revealed hypocalcaemia, hypophosphataemia and increased concentrations of 1,25 dihydroxyvitamin D. The mean serum 25 hydroxyvitamin D concentration was similar to that of control lambs. PATHOLOGICAL FINDINGS Gross lesions included enlarged costochondral junctions, bilateral irregularity of articular surfaces on humeral heads due to collapse of subchondral bone, thickened cortices in long bones and irregular thickening of physeal cartilages. Microscopically, tongues of hypertrophic chondrocytes extended from physes into metaphyseal regions; metaphyseal trabeculae were thick, disorganised and often lined by wide osteoid seams. Osteoclastic activity was excessive both in cortical and trabecular bone. DIAGNOSIS Inherited rickets in Corriedale sheep. CLINICAL RELEVANCE AND CONCLUSIONS: This disease is likely to be present in several Corriedale sheep flocks in New Zealand and may have been misdiagnosed as arthritis or other diseases causing lameness and/or poor growth. A defect in end-organ responsiveness to 1,25 dihydroxyvitamin D is the likely mechanism. This disease of sheep may be a useful model for studying vitamin D metabolism and the treatment of inherited forms of rickets in human beings.
Collapse
Affiliation(s)
- K G Thompson
- Institute of Veterinary, Animal and Biomedical Sciences, Massey University, Palmerston North, New Zealand.
| | | | | | | | | |
Collapse
|
14
|
Dittmer KE, Thompson KG. Vitamin D metabolism and rickets in domestic animals: a review. Vet Pathol 2010; 48:389-407. [PMID: 20634407 DOI: 10.1177/0300985810375240] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Rickets and osteomalacia are increasing in prevalence in people because of cultural practices, breast-feeding, decreased sun exposure, and increased sunscreen usage. Several hereditary forms of rickets owing to either renal phosphate wasting or defects in vitamin D metabolism are also reported in people. Rickets is well recognized in domestic animals, but published reports are not always supported by microscopic findings, and diagnoses based on clinical signs and radiology are unreliable. Most cases in domestic animals are caused by dietary deficiency of either vitamin D or phosphorus, but occasional inherited forms are reported in pigs, sheep, cats, and dogs. There is variation between species in susceptibility to dietary vitamin D and phosphorus deficiency and in the ability to manufacture vitamin D in their skin. A number of mouse models have been discovered or created to study human skeletal diseases and skeletal homeostasis. With the discovery that vitamin D is involved in not only calcium and phosphorus homeostasis but also in the immune system and cancer, there is great potential for new and existing animal models to generate valuable information about vitamin D and its many functions. This review presents an overview of vitamin D metabolism and rickets in domestic and laboratory animals and makes comparisons where appropriate with the disease in humans.
Collapse
Affiliation(s)
- K E Dittmer
- Institute of Veterinary, Animal and Biomedical Sciences, Massey University, Palmerston North, New Zealand.
| | | |
Collapse
|
15
|
LeVine DN, Zhou Y, Ghiloni RJ, Fields EL, Birkenheuer AJ, Gookin JL, Roberston ID, Malloy PJ, Feldman D. Hereditary 1,25-dihydroxyvitamin D-resistant rickets in a Pomeranian dog caused by a novel mutation in the vitamin D receptor gene. J Vet Intern Med 2010; 23:1278-83. [PMID: 19909429 DOI: 10.1111/j.1939-1676.2009.0405.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- D N LeVine
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27606, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Geisen V, Weber K, Hartmann K. Vitamin D-dependent hereditary rickets type I in a cat. J Vet Intern Med 2009; 23:196-9. [PMID: 19138382 DOI: 10.1111/j.1939-1676.2008.00220.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- V Geisen
- Institute of Animal Physiology, Ludwig Maximilians University, Munich, Germany.
| | | | | |
Collapse
|
17
|
Allan G, Portas T, Bryant B, Howlett R, Blyde D. Ulnar metaphyseal osteochondrosis in seven captive bred cheetahs (Acinonyx jubatus). Vet Radiol Ultrasound 2009; 49:551-6. [PMID: 19051644 DOI: 10.1111/j.1740-8261.2008.00430.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Distal ulna metaphyseal osteochondrosis was identified in seven captive bred cheetahs raised in Australia between 1984 and 2005. The disorder was characterized by bilateral carpal valgus conformation. In the metaphyseal region of the distal ulnae, an osteolucent defect that appeared as a proximal extension of the lucent physis was identified radiographically between 6 and 10 months of age. Ulna ostectomy was done to correct the angular limb deformity. Histologically, changes were identified in the osteolucent lesion that resembled osteochondrosis. We propose that the condition is probably familial and/or dietary in origin.
Collapse
Affiliation(s)
- Graeme Allan
- Veterinary Imaging Associates, PO Box 300, St.Leonards, NSW 2065, Australia.
| | | | | | | | | |
Collapse
|
18
|
|