1
|
Satué K, Fazio E, Medica P, Miguel L, Gardón JC. Biochemical and Hematological Indexes of Liver Dysfunction in Horses. J Equine Vet Sci 2023; 126:104294. [PMID: 36958409 DOI: 10.1016/j.jevs.2023.104294] [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: 02/27/2023] [Revised: 03/17/2023] [Accepted: 03/17/2023] [Indexed: 03/25/2023]
Abstract
In the present review, the authors, based on the multiple functions performed by the liver, analyze the multiple biochemical and hematological changes as an expression of altered liver function in the horse. The liver performs important metabolic functions related to the synthesis, degradation, and excretion of various substances. Modification of these functions can be evaluated and diagnosed by determining serum concentrations of several serum analytes, including enzymes and other endogenous substances. Hepatocellular enzymes, such as sorbitol dehydrogenase-SDH and glutamate dehydrogenase-GLDH, are released following hepatocellular necrosis. Hepatobiliary enzymes, such as γ-glutamyl transferase-GGT, increase in response to necrosis, cholestasis, and other alterations in bile conducts. Serum concentrations of mainly endogenous and exogenous substances that the liver should synthesize or eliminate, such as proteins (albumin and globulins), bile acids, urea, glucose, total and direct bilirubin, and coagulation factors, and fibrinogen should be included in the liver function test profile. The interpretation of laboratory tests of liver function will allow the diagnosis of functional loss of the organ. Some of the analytes considered provide information on the prognosis of liver disease. This review will provide an accurate and objective interpretation of the common biochemical and hematological tests in use in the diagnosis of equine hepatic disease patients, aiding still further the veterinary activity on the applied equine clinical cases.
Collapse
Affiliation(s)
- Katiuska Satué
- Department of Animal Medicine and Surgery, Faculty of Veterinary Medicine, CEU-Cardenal Herrera University, Valencia, Spain.
| | - Esterina Fazio
- Department of Veterinary Sciences, Veterinary Physiology Unit, Polo Universitario Annunziata, Messina, Italy
| | - Pietro Medica
- Department of Veterinary Sciences, Veterinary Physiology Unit, Polo Universitario Annunziata, Messina, Italy
| | - Laura Miguel
- Department of Animal Medicine and Surgery, Faculty of Veterinary Medicine, CEU-Cardenal Herrera University, Valencia, Spain
| | - Juan Carlos Gardón
- Department of Animal Medicine and Surgery, Faculty of Veterinary and Experimental Sciences, Catholic University of Valencia-San Vicente Mártir, Valencia, Spain
| |
Collapse
|
2
|
Hepatic Enzyme Profile in Horses. Animals (Basel) 2022; 12:ani12070861. [PMID: 35405850 PMCID: PMC8996839 DOI: 10.3390/ani12070861] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 03/23/2022] [Accepted: 03/28/2022] [Indexed: 12/29/2022] Open
Abstract
For diagnostic purposes, liver enzymes are usually classified into hepatocellular and cholestatic. These two groups of equine liver-specific enzymes include sorbitol dehydrogenase (SDH), glutamate dehydrogenase (GLDH), γ-glutamyl transferase (GGT), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), and alkaline phosphatase (ALP). SDH and GLDH mostly reflect hepatocellular injury and cholestasis, while GGT expresses high values in biliary necrosis or hyperplasia. Likewise, AST, LDH, and ALP also reflect hepatocellular and biliary disease, but these enzymes are not liver specific. From the clinical point of view of the course of liver or biliary disease, AST and ALP are indicative of chronic disease, whereas SDH, GGT, and GLDH indicate an acute course. The patterns of enzymatic changes at the blood level are associated with different types of liver pathologies (infectious, inflammatory, metabolic, toxic, etc.). Increases in hepatocellular versus biliary enzyme activities are indicative of a particular process. There are different ways to diagnose alterations at the hepatic level. These include the evaluation of abnormalities in the predominant pattern of hepatocellular versus cholestatic enzyme abnormalities, the mild, moderate, or marked (5−10-fold or >10-fold) increase in enzyme abnormality concerning the upper limit of the reference range, the evolution over time (increase or decrease) and the course of the abnormality (acute or chronic).
Collapse
|
3
|
Panza E, Martinelli D, Magini P, Dionisi Vici C, Seri M. Hereditary Spastic Paraplegia Is a Common Phenotypic Finding in ARG1 Deficiency, P5CS Deficiency and HHH Syndrome: Three Inborn Errors of Metabolism Caused by Alteration of an Interconnected Pathway of Glutamate and Urea Cycle Metabolism. Front Neurol 2019; 10:131. [PMID: 30853934 PMCID: PMC6395431 DOI: 10.3389/fneur.2019.00131] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 01/31/2019] [Indexed: 12/11/2022] Open
Abstract
Hereditary Spastic Paraplegias (HSPs) are a clinically and genetically heterogeneous group of neurodegenerative disorders characterized by a progressive rigidity and weakness of the lower limbs, caused by pyramidal tract lesions. As of today, 80 different forms of HSP have been mapped, 64 genes have been cloned, and new forms are constantly being described. HSPs represent an intensively studied field, and the functional understanding of the biochemical and molecular pathogenetic pathways are starting to be elucidated. Recently, dominant and recessive mutations in the ALDH18A1 gene resulting in the deficiency of the encoded enzyme (delta-1-pyrroline-5-carboxylate synthase, P5CS) have been pathogenetically linked to HSP. P5CS is a critical enzyme in the conversion of glutamate to pyrroline-5-carboxylate, an intermediate that enters in the proline biosynthesis and that is connected with the urea cycle. Interestingly, two urea cycle disorders, Argininemia and Hyperornithinemia-Hyperammonemia-Homocitrullinuria syndrome, are clinically characterized by highly penetrant spastic paraplegia. These three diseases represent a peculiar group of HSPs caused by Inborn Errors of Metabolism. Here we comment on these forms, on the common features among them and on the hypotheses for possible shared pathogenetic mechanisms causing the HSP phenotype.
Collapse
Affiliation(s)
- Emanuele Panza
- Medical Genetics Unit, S. Orsola-Malpighi Hospital, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Diego Martinelli
- Division of Metabolism, Bambino Gesù Children's Research Hospital, Rome, Italy
| | - Pamela Magini
- Medical Genetics Unit, Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - Carlo Dionisi Vici
- Division of Metabolism, Bambino Gesù Children's Research Hospital, Rome, Italy
| | - Marco Seri
- Medical Genetics Unit, S. Orsola-Malpighi Hospital, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| |
Collapse
|
4
|
|
5
|
Affiliation(s)
- J. R. Gold
- Department of Clinical Sciences; Washington State University; Pullman USA
| |
Collapse
|
6
|
Martinelli D, Diodato D, Ponzi E, Monné M, Boenzi S, Bertini E, Fiermonte G, Dionisi-Vici C. The hyperornithinemia-hyperammonemia-homocitrullinuria syndrome. Orphanet J Rare Dis 2015; 10:29. [PMID: 25874378 PMCID: PMC4358699 DOI: 10.1186/s13023-015-0242-9] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 02/13/2015] [Indexed: 02/07/2023] Open
Abstract
Background Hyperornithinemia-hyperammonemia-homocitrullinuria (HHH) syndrome is a rare autosomal recessive disorder of the urea cycle. HHH has a panethnic distribution, with a major prevalence in Canada, Italy and Japan. Acute clinical signs include intermittent episodes of vomiting, confusion or coma and hepatitis-like attacks. Alternatively, patients show a chronic course with aversion for protein rich foods, developmental delay/intellectual disability, myoclonic seizures, ataxia and pyramidal dysfunction. HHH syndrome is caused by impaired ornithine transport across the inner mitochondrial membrane due to mutations in SLC25A15 gene, which encodes for the mitochondrial ornithine carrier ORC1. The diagnosis relies on clinical signs and the peculiar metabolic triad of hyperammonemia, hyperornithinemia, and urinary excretion of homocitrulline. HHH syndrome enters in the differential diagnosis with other inherited or acquired conditions presenting with hyperammonemia. Methods A systematic review of publications reporting patients with HHH syndrome was performed. Results We retrospectively evaluated the clinical, biochemical and genetic profile of 111 HHH syndrome patients, 109 reported in 61 published articles, and two unpublished cases. Lethargy and coma are frequent at disease onset, whereas pyramidal dysfunction and cognitive/behavioural abnormalities represent the most common clinical features in late-onset cases or during the disease course. Two common mutations, F188del and R179* account respectively for about 30% and 15% of patients with the HHH syndrome. Interestingly, the majority of mutations are located in residues that have side chains protruding into the internal pore of ORC1, suggesting their possible interference with substrate translocation. Acute and chronic management consists in the control of hyperammonemia with protein-restricted diet supplemented with citrulline/arginine and ammonia scavengers. Prognosis of HHH syndrome is variable, ranging from a severe course with disabling manifestations to milder variants compatible with an almost normal life. Conclusions This paper provides detailed information on the clinical, metabolic and genetic profiles of all HHH syndrome patients published to date. The clinical phenotype is extremely variable and its severity does not correlate with the genotype or with recorded ammonium/ornithine plasma levels. Early intervention allows almost normal life span but the prognosis is variable, suggesting the need for a better understanding of the still unsolved pathophysiology of the disease. Electronic supplementary material The online version of this article (doi:10.1186/s13023-015-0242-9) contains supplementary material, which is available to authorized users.
Collapse
|
7
|
Affiliation(s)
- K T T Corley
- Anglesey Lodge Equine Hospital, The Curragh, Co. Kildare, Ireland
| |
Collapse
|
8
|
|
9
|
Hug S, Guerrero T, Makara M, Kummer M, Grest P, Bettschart R, Schwarzwald C. Diagnosis and Surgical Cellophane Banding of an Intrahepatic Congenital Portosystemic Shunt in a Foal. J Vet Intern Med 2011; 26:171-7. [DOI: 10.1111/j.1939-1676.2011.00837.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2011] [Revised: 09/13/2011] [Accepted: 10/10/2011] [Indexed: 11/26/2022] Open
Affiliation(s)
| | | | | | | | - P. Grest
- Institute of Veterinary Pathology; Vetsuisse Faculty; University of Zurich; Zurich; Switzerland
| | | | | |
Collapse
|
10
|
Unt VE, McSloy A, Kerbyson N, Ivens PAS, Johns I. Gastrointestinal hyperammonaemia in a 35-day-old Warmblood-cross filly. EQUINE VET EDUC 2011. [DOI: 10.1111/j.2042-3292.2011.00285.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
11
|
Dunkel B, Chaney KP, Dallap-Schaer BL, Pellegrini-Masini A, Mair TS, Boston R. Putative intestinal hyperammonaemia in horses: 36 cases. Equine Vet J 2011; 43:133-40. [PMID: 21592205 DOI: 10.1111/j.2042-3306.2010.00128.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
REASONS FOR PERFORMING THE STUDY Intestinal hyperammonaemia (HA) has been infrequently reported in individual horses; however, there have been no studies describing clinical and laboratory data as well as short- and long-term outcome in a larger number of cases. OBJECTIVES To describe clinical and laboratory data and short- and long-term outcome in a large group of horses with intestinal HA. METHODS Multi-centred, retrospective study; case records of horses with HA were reviewed and any horse with a clinical or post mortem diagnosis of intestinal HA was included. Hyperammonaemia was defined as a blood ammonium (NH(4) (+)) concentration ≥60 µmol/l and horses with a diagnosis of primary hepatic disease were excluded. Relevant data were recorded and, if appropriate, data from survivors were compared to nonsurvivors to identify potential prognostic indicators. RESULTS Thirty-six cases, 26 mature horses and 10 foals with intestinal HA were identified. Case histories included diarrhoea, colic and neurological signs and the most common clinical diagnosis was colitis and/or enteritis. The most common clinical and laboratory abnormalities included tachycardia, increased packed cell volume, hyperlactataemia and hyperglycaemia. Fourteen horses (39%) survived to discharge; NH(4) (+) concentration on admission was the only parameter significantly associated with survival. All surviving horses and foals for which follow-up information was available recovered completely and returned to their intended use without further complications. CONCLUSIONS AND POTENTIAL RELEVANCE Intestinal HA occurs in mature horses and foals and can be associated with severe clinical and laboratory abnormalities; further studies are required to investigate predisposing factors and delineate possible differences in aetiologies.
Collapse
Affiliation(s)
- B Dunkel
- Department of Veterinary Clinical Sciences, The Royal Veterinary College, Hertfordshire, UK.
| | | | | | | | | | | |
Collapse
|
12
|
Underwood C, Southwood LL, Walton RM, Johnson AL. Hepatic and metabolic changes in surgical colic patients: a pilot study. J Vet Emerg Crit Care (San Antonio) 2010; 20:578-86. [DOI: 10.1111/j.1476-4431.2010.00597.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
13
|
Vanschandevijl K, Van Loon G, Lefère L, Deprez P. Black locust (Robinia pseudoacacia) intoxication as a suspected cause of transient hyperammonaemia and enteral encephalopathy in a pony. EQUINE VET EDUC 2010. [DOI: 10.1111/j.2042-3292.2010.00090.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
14
|
|
15
|
Hughes KJ, McGorum BC, Love S, Dixon PM. Bilateral laryngeal paralysis associated with hepatic dysfunction and hepatic encephalopathy in six ponies and four horses. Vet Rec 2009; 164:142-7. [DOI: 10.1136/vr.164.5.142] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- K. J. Hughes
- Division of Companion Animal Sciences; University of Glasgow; Faculty of Veterinary Medicine; Bearsden Road Glasgow G61 1QH
| | - B. C. McGorum
- Department of Veterinary Clinical Sciences; Royal (Dick) School of Veterinary Studies; University of Edinburgh; Easter Bush Veterinary Centre; Easter Bush Roslin Midlothian EH25 9RG
| | - S. Love
- Division of Companion Animal Sciences; University of Glasgow; Faculty of Veterinary Medicine; Bearsden Road Glasgow G61 1QH
| | - P. M. Dixon
- Department of Veterinary Clinical Sciences; Royal (Dick) School of Veterinary Studies; University of Edinburgh; Easter Bush Veterinary Centre; Easter Bush Roslin Midlothian EH25 9RG
| |
Collapse
|
16
|
Abstract
This chapter describes the normal biochemical processes of intestinal secretion, digestion, and absorption. The digestive system is composed of the gastrointestinal (GI) tract, or the alimentary canal, salivary glands, the liver, and the exocrine pancreas. The principal functions of the gastrointestinal tract are to digest and absorb ingested nutrients, and to excrete waste products of digestion. Most nutrients are ingested in a form that is either too complex for absorption or insoluble, and therefore, indigestible or incapable of being digested. Within the GI tract, much of these substances are solubilized and further degraded enzymatically to simple molecules, sufficiently small in size, and in a form that permits absorption across the mucosal epithelium. This chapter explains in detail the mechanisms of salivary secretions, compositions of saliva, and the functions of saliva. The chapter also elaborates properties of bile as well as the synthesis of bile acids. The chapter explores the pathogenesis of the important gastrointestinal diseases of domestic animals, and the biochemical basis for their diagnosis and treatment. The chapter concludes with a discussion on disturbances of gastrointestinal function such as vomition, acute diarrheas, malabsorption, bacterial overgrowth, and ulcerative colitis.
Collapse
|
17
|
|
18
|
Gastrointestinal Disease. EQUINE NEONATAL MEDICINE 2006. [PMCID: PMC7156017 DOI: 10.1016/b978-1-4160-2353-1.50016-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
19
|
Koch T, Loretti AI, Lahunta AI, Kendall A, Russell D, Bienzle D. Semilobar Holoprosencephaly in a Morgan Horse. J Vet Intern Med 2005. [DOI: 10.1111/j.1939-1676.2005.tb02711.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
20
|
Magdesian KG. Nutrition for critical gastrointestinal illness: feeding horses with diarrhea or colic. Vet Clin North Am Equine Pract 2003; 19:617-44. [PMID: 14740760 DOI: 10.1016/j.cveq.2003.08.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Horses with GI diseases such as colic and diarrhea are often intolerant of adequate enteral nutrition. Nutritional intervention should be an early part of therapeutic management in such cases. Protein and energy malnutrition in critically ill horses can have deleterious effects, including poor wound or incisional healing, reduced immunity, and weight loss. Early enteral or parenteral support should be provided to supply resting DE requirements in the equine ICU.
Collapse
Affiliation(s)
- K Gary Magdesian
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California at Davis, 95616, USA.
| |
Collapse
|
21
|
Desrochers AM, Dallap BL, Wilkins PA. Clostridium sordelli Infection as a Suspected Cause of Transient Hyperammonemia in an Adult Horse. J Vet Intern Med 2003. [DOI: 10.1111/j.1939-1676.2003.tb02441.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
22
|
|
23
|
Hasel KM, Summers BA, De Lahunta A. Encephalopathy with idiopathic hyperammonaemia and Alzheimer type II astrocytes in equidae. Equine Vet J 1999; 31:478-82. [PMID: 10596928 DOI: 10.1111/j.2042-3306.1999.tb03854.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In 3 mature female horses of varying breeds, episodes of colic and depression for 14 days preceded an encephalopathic disorder with maniacal behaviour, anxiety, profuse sweating and, in one case, terminal opisthotonus. Blood ammonia levels were elevated approximately 10-fold. At necropsy, there were gastrointestinal serosal and mesenteric haemorrhages. Histologically, all 3 cases revealed diffuse Alzheimer type II astrocytes in the cerebral grey matter. Alzheimer type II astrocytes were glial fibrillary acidic protein (GFAP) negative or only weakly positive, weakly S-100 positive, and vimentin negative. In the absence of primary hepatic and/or renal lesions, an increase in intestinal ammonia absorption due to ileus or increased ammonia production by colonic bacteria is hypothesised.
Collapse
Affiliation(s)
- K M Hasel
- Department of Pathology, New York State College of Veterinary Medicine, Cornell University, Ithaca 14850, USA
| | | | | |
Collapse
|